Experienced obstetric nurses' decision-making in fetal risk situations

To determine which clinical factors experienced obstetric nurses consider most important in determining fetal risk during the intrapartum period.

Ten dichotomized variables relevant to participants' clinical decision-making were manipulated in fractional factorial vignettes. Participants were asked to rate the severity of fetal risk on a Likert scale after reading the vignettes.

About 87% of the participants worked in institutions with 4,000 or fewer deliveries per year. More than 25% worked in tertiary level facilities, and the remainder were employed in primary or secondary level facilities.

Participants (N = 573), randomly selected from a list of nurses certified in "inpatient obstetric nursing" by the National Certification Corporation, were mailed the vignettes. The average number of years of intrapartum nursing experience was 13.

Multiple regression analysis was used to determine the weights given to the 10 clinical factors by participants.

Fetal scalp pH, maternal parity, amniotic fluid color, and long-term variability of the fetal heart rate were the most important predictors of nurses' fetal risk assessments.

Long-term variability was the most important cardiotocographic factor in nurses' fetal risk assessments and the only cardiotocographic factor of the best 4 predictors of fetal risk. This indicated that participants were realistic about the limitations of electronic fetal monitoring (EFM).