Experienced obstetric nurses' decision-making in fetal risk situations

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Nursing Research

Background:

• Accurate assessment of intrapartum fetal risk is crucial for optimizing maternal and neonatal outcomes.
• Understanding the clinical factors prioritized by experienced obstetric nurses informs best practices in fetal monitoring and risk stratification.

Purpose of the Study:

• To identify the key clinical factors that experienced obstetric nurses deem most significant in evaluating fetal risk during labor.
• To analyze the relative importance of various clinical indicators in nurses' real-time decision-making processes.

Main Methods:

• A fractional factorial vignette design was employed, manipulating 10 dichotomized clinical variables.
• Participants rated fetal risk severity using a Likert scale after exposure to vignettes.
• Multiple regression analysis determined the weighting of each clinical factor in nurses' risk assessments (N=573).

Main Results:

• Fetal scalp pH emerged as a critical indicator.
• Maternal parity and amniotic fluid color were significant predictors of perceived fetal risk.
• Long-term variability of the fetal heart rate was identified as the most influential cardiotocographic factor.

Conclusions:

• Long-term fetal heart rate variability was the paramount cardiotocographic predictor and among the top four overall predictors of fetal risk.
• The findings suggest that experienced nurses possess a realistic understanding of the capabilities and limitations of electronic fetal monitoring (EFM).
• These insights can refine clinical guidelines and educational strategies for intrapartum fetal surveillance.