A Qualitative Study of Systems-Level Factors That Affect Rural Obstetric Nurses' Work During Clinical Emergencies.

Area of Science:

• Nursing
• Healthcare Systems
• Rural Health

Background:

• Maternal morbidity and mortality are increasing in the U.S.
• Existing research often overlooks rural settings and nurse work systems.
• Understanding rural nurses' challenges is crucial for improving patient outcomes.

Purpose of the Study:

• To explore systems-level factors affecting rural obstetric nurses during patient clinical deterioration.
• To identify challenges faced by nurses in low-resource rural hospital environments.

Main Methods:

• Qualitative descriptive study utilizing a modified critical incident technique.
• Interviews conducted with 7 bedside nurses and 4 physicians across 3 rural New England hospitals.
• Focus on understanding clinician experiences during patient clinical deterioration.

Main Results:

• Identified 6 key systems-level factors: resource shortages, teamwork needs, physician role conflicts, team competency, patient transfer issues, and inadequate policies.
• Physicians' competing responsibilities and difficulties in transferring high-acuity patients were significant challenges.
• Lack of context-specific policies, like medication handling protocols, impacts care delivery.

Conclusions:

• Rural nurses require policies and protocols specifically designed for their low-resource contexts.
• Collaboration between rural clinicians and external experts is essential for developing effective policies.
• Co-creation of policies with rural practitioners ensures relevance and applicability.