Elucidating the Ruling Relations of Nurses' Work in Labor and Delivery: An Institutional Ethnography.

Area of Science:

• Obstetrics and Gynecology
• Nursing and Midwifery
• Medical Law and Ethics

Background:

• Obstetrics is a high-risk field for malpractice claims, particularly concerning intrapartum fetal injuries.
• Nurses in labor and delivery play a critical role in monitoring fetal well-being, a recognized legal responsibility.
• Understanding the organizational influences on nursing practice is crucial for patient safety and risk management.

Purpose of the Study:

• To investigate how dominant discourses shape nurses' practices in fetal surveillance during labor.
• To analyze the interplay between biomedical and medical-legal frameworks in organizing nursing work.
• To uncover the social organization of nurses' fetal monitoring responsibilities.

Main Methods:

• Institutional ethnography was employed to study nurses' work in labor and delivery settings.
• Analysis focused on identifying and examining the ruling discourses influencing nursing practice.
• The study explored the use of intertextual hierarchy and ideological circles in organizing surveillance work.

Main Results:

• Two primary discourses, biomedical and medical-legal risk, were identified as powerful organizers of nursing practice.
• These discourses establish an intertextual hierarchy, prioritizing certain information and actions in fetal surveillance.
• An ideological circle was observed, reinforcing the dominance of these discourses and shaping nurses' decision-making processes.

Conclusions:

• Biomedical and medical-legal discourses significantly influence and structure nurses' fetal surveillance work in labor and delivery.
• The findings highlight the need to critically examine these discourses to improve nursing practice and patient outcomes.
• Understanding these organizational dynamics is essential for addressing malpractice risks and ensuring optimal fetal care.