Abstract
BackgroundIntermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour.MethodsUsing a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA.ResultsWe interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses’ behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social influences; Behavioural regulation).ConclusionWe identified potential influences on birthing unit nurses’ use of IA as their primary method of fetal surveillance. These beliefs suggest potential targets for behaviour change interventions to promote IA use.
Highlights
Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour
We used the Theoretical Domains Framework (TDF) to identify possible determinants of Birthing Unit (BU) nurses’ use of IA as their predominant method of fetal surveillance with healthy mothers during low risk labour. Design This descriptive study used semi-structured interviews based on the TDF with nurses who work in BUs in Ontario to investigate their views about their fetal surveillance practices
These nurses represented the three levels of care provided at Ontario Hospitals (Level 1, n = 3; Level 2, n = 6; Level 3, n = 3) and their experience as a BU nurse ranged in years from 2 to 25
Summary
Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Monitoring of fetal heart rate, a routine procedure typically carried out by Birthing Unit (BU) nurses [2], aims to assess fetal wellbeing and detect potential hypoxia during labour to prompt an intervention to reduce risk to both the fetus and mother [3]. Electronic fetal monitoring (EFM) is the simultaneous use of an ultrasound transducer and a tocotransducer (to measure frequency and duration of contractions) continuously or for intermittent periods throughout labour [1]. Its use has contributed to an increase in maternal morbidities due to unnecessary medical interventions (e.g. caesarean section, instrumental vaginal births) without decreasing fetal/newborn morbidities [5]
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