Uncovering the tacit: a qualitative study of obstetric nurses' risk recognition and decision-making in perinatal care

This study explored how obstetric nurses identify and manage clinical risks under high-pressure and uncertain conditions, with emphasis on the tacit cognitive processes shaping their judgment.

A qualitative descriptive study was conducted using a phenomenological approach, based on Tanner's Clinical Judgment Model.

Semi-structured, in-depth interviews were conducted with 25 obstetric nurses from three tertiary hospitals in western China. Data were analyzed using reflexive thematic analysis following Braun and Clarke's six-phase approach. The interview guide was developed and refined according to Tanner's four phases-noticing, interpreting, responding, and reflecting-to capture the multidimensional nature of clinical judgment.

A total of 11 interconnected subthemes were identified across the four dimensions. In the noticing phase, nurses recognized baseline conditions, detected atypical cues, and developed experience-driven vigilance. The interpreting phase involved synthesizing multi-source cues and, critically, managing conflicting signals when subjective impressions and objective indicators diverged-a key finding that reveals how intuitive and analytical reasoning interact in clinical ambiguity. The responding phase encompassed prioritizing action, communicating and seeking peer confirmation, and acting under uncertainty. The reflecting phase entailed recurrent self-review, reflective learning, and the development of heightened risk sensitivity. A cross-cutting theme of sustained risk vigilance permeated all stages, representing nurses' enduring attentiveness to subtle warning signs and potential deterioration.

Obstetric risk recognition is not merely technical but an iterative cognitive process integrating perception, experience, emotion, and reflection. Nurses' risk vigilance functions as a tacit safeguard in managing uncertainty and ensuring maternal safety.

The findings highlight the need to strengthen a simulation-based training program that targets ambiguous cues, promote reflective debriefing and peer learning, and design institutional environments that support collaborative and emotionally sustainable decision-making in obstetric care.