Using Institutional Ethnography to Explicate the Everyday Realities of Nurses' Work in Labor and Delivery

Area of Science:

• Nursing care and technology integration in obstetrics.
• Sociology of healthcare and professional practice.
• Patient safety and childbirth interventions.

Background:

• Fetal health surveillance is a core duty for labor and delivery nurses.
• Increasing reliance on technological interventions like continuous electronic fetal monitoring.
• Need to understand how nurses navigate these technological demands within their practice.

Purpose of the Study:

• To explore how nurses perform fetal health surveillance.
• To uncover the coordinating 'ruling relations' influencing nursing practice in this area.
• To examine the impact of biomedical and medical-legal discourses on nursing care.

Main Methods:

• Employed Institutional Ethnography as the primary research methodology.
• Focused on understanding the social relations and structures shaping nurses' work.
• Analyzed how nurses 'do' fetal health surveillance in practice.

Main Results:

• Identified powerful ruling relations within biomedical and medical-legal discourses.
• Documentation requirements for biophysical data shifted focus to technology over holistic care.
• Nurses inadvertently reinforced these dominant discourses through their actions.

Conclusions:

• Technological surveillance and medical interventions are prioritized for safe birth.
• This prioritization often overshadows established holistic nursing care approaches.
• Nursing practice is significantly shaped by external biomedical and legal frameworks.