Operational Definition of Stable in High-Risk Antepartum Client

Tuesday, 13 July 2010

Susan L. Hall, MSN, RNC
Maternity Child Health Nursing, Winston Salem State.com, Winston-Salem, NC

Learning Objective 1: identify factors that are associated with stable and unstable Antepartum clients

Learning Objective 2: classify Antepartum clients as "stable" or "unstable" congruent with the operational definition, then apply ACOG nurse ratio guidelines.

The use of Fetal Heart Monitoring (FHM) is an important component of caring for high-risk antenatal clients to assess the physiologic status of the fetus (Collins, 2008). However, FHM has caused much debate in the field of obstetrics, particularly because it is often used in low-risk cases (Blincoe, 2005). FHM is a time-consuming nursing task which requires that an ultrasound Doppler be secured on the pregnant client's abdomen with belts to obtain a fetal heart tracing. It is the nurse's responsibility to maintain a fetal heart tracing at all times and frequently interpret the tracing to validate fetal well-being (Simpson, 2004).

Given the complex nature of FHM, it is imperative that appropriate nurse/patient ratios are established for clients on continuous FHM. However, no specific guidelines exist. According to the American College of Obstetricians and Gynecologist (ACOG), the recommended nurse-to-patient ratio for high-risk obstetric client is 1:3 with complications but in "stable" condition, and 1:6 without complications (Perinatal Care, 2007;Schofield, 2003). Clarification is needed regarding an operational definition of "stable" to effectively apply the ACOG ratio guidelines. In addition, the impact of FHM on nursing time must be factored into ratio determination to ensure adequate monitoring, including troubleshooting and interpretation.

The purpose of this study was to determine an operational definition of "stable" as it relates to high-risk Antepartum clients. Using Constructivism as the theroetical framework, a definition of stable was constructed using expert practitioners at FMC, as well as medical literature and professional organizations.

The outcomes of this study will provide the Antepartum UCIC with some guidance when determining staffing policies and use of FHM.