The relationship between patient and unit level acuity and intrapartum nursing care

Abstract

The intrapartum nursing role has several components including maternal-fetal surveillance, indirect care activities, and providing supportive care to the woman in labor. Using the Quality Health Outcomes Model as the conceptual framework, this study focused on describing the type and quantity of specific intrapartum nursing interventions provided to individual women in labor and exploring the relationships between the patient's medical acuity, unit level acuity, and the process of intrapartum nursing care. Episodes of intrapartum nursing care (N = 75), consisting of one RN and one patient in active, term labor, in a Northwest medical center, were observed for a two-hour period during the first stage of labor. All nursing interventions observed were recorded and categorized as surveillance, indirect care, or supportive care interventions. Patient acuity was measured by the total medical interventions provided and fetal status based on the fetal monitor recording. Unit level acuity data were measured by the variance in actual versus recommended RN staffing. During episodes of care, nurses spent an average of 58.9% of their time in care of the study patient and 15.7% of their time in non-patient care activities. Nurses provided an average of 169.9 interventions during each episode of care which ranged from 0 to 352 interventions. Supportive care interventions were provided an average of 79.4 times, surveillance interventions were provided an average of 41.3 times, and indirect care interventions were provided an average of 49.3 times.;Results of the multivariate analysis indicated that the patient's acuity and unit level acuity predicted 17.3% of the variance in the time that the RN spends with a patient, and 19.1% of the variance in the time that the RN spends in non-patient care activities. However, these patient and unit acuity variables did not significantly predict the specific categories of nursing interventions that the RN provides to the labor patient, explaining only 2.9% of the variance in supportive care interventions, 3.5% of the variance in surveillance interventions, and 7.5% of the variance in indirect care interventions. These results suggest that variation in intrapartum nursing practice is related to other, as yet unidentified, factors.