Assessment parameters and indicators in expert intrapartal nursing decisions

To determine what clinical parameters and indicators expert intrapartal nurses used to assess the severity of fetal stress.

A descriptive, qualitative study using tape-recorded interviews from verbal protocols during clinical problem solving.

Labor and delivery units of two metropolitan hospitals in the northeastern United States.

Eighteen nurses, designated as experts by nurse managers, with an average of 11.3 years of intrapartal experience.

The clinical assessment parameters identified by content analysis included duration of stress, fetal reserve status, reversibility of stress, and specific signs of stress. The clinical assessment parameters included whether the disturbing pattern was brief or prolonged, continuous or intermittent, and how rapidly the mother's labor was progressing. Indicators of fetal reserve status were maternal pregnancy health status, gestational age of fetus, and biophysical indicators of fetal status. Reversibility of stress was assessed based on the precipitating factors involved and responsiveness of the fetus to resuscitation. Specific signs of stress included the characteristics of the fetal monitor strip changes, scalp sample results, and amniotic fluid color.

Contextual features of clinical problems are key links in the decision-making processes of expert intrapartal nurses. Knowledge elicitation techniques can be used to identify these links.