Objective: The intrapartum nursing role has several components including maternal-fetal surveillance, indirect care activities, and providing supportive care to the woman in labor. There is evidence suggesting supportive care positively affects certain childbirth outcomes, including length of labor and type of delivery, yet this is reported to be the aspect of intrapartum nursing care least provided. It has been suggested that nurses do not have time to provide this care due to insufficient staffing or the medical technology needs of the patient. The purpose of this study was to test the model that client characteristics (patient medical acuity) and setting characteristics (unit level acuity) influence the type and quantity of specific nursing interventions provided to individual women in labor. Design: This was a descriptive study using observational techniques and retrospective chart audit for data collection. Sample: Episodes of intrapartum nursing care (N=75), consisting of one RN and one patient in active, term labor, in a Pacific Northwest medical center, were observed for a two-hour period during the first stage of labor. Data collection was limited to one hospital’s intrapartum nursing unit to minimize the effect of organizational variables. Variables: The independent variables were patient acuity, measured by the total number of six obstetric medical interventions provided during the episode of care and fetal status based on the fetal monitor recording, and unit level acuity, measured by the variance in actual versus recommended RN staffing. The dependent variables were the time spent in patient care and the number of interventions in each of three broad categories of intrapartum care; surveillance, indirect care, or supportive care. Methods: After informed consent was obtained from the RN and the study patient, the researcher followed the RN throughout the nursing unit for the two-hour time period. Nursing activity was recorded each minute; the RN was observed for 30 seconds, and all observed interventions were recorded on the Intrapartum Nursing Observation Tool in the subsequent 30 seconds. Patient medical acuity data and a copy of the fetal monitoring record were obtained at the end of the observation period. Unit level acuity was assessed hourly using the Labor and Delivery Classification System. Hierarchical regression was used to examine the relationships between the patient and unit level acuity variables and intrapartum nursing interventions. Findings: During episodes of care, nurses spent an average of 58.9% of their time in care of the study patient and 15.7% of their time in non-patient care activities. The mean number of interventions provided was 169.9. The patient acuity and unit level acuity variables predicted 17.3% of the variance in the time that the RN spent with the patient and 19.1% of the variance in the time that the RN spent in non-patient care activities. Patient and unit acuity explained only 2.9% of the variance in supportive care interventions, 3.5% of the variance in surveillance interventions, and 7.5% of the variance in indirect care interventions. Conclusions: Patient and unit acuity did have a predictive relationship with the overall time spent in patient care and with the number of indirect care interventions provided, but did not significantly predict the number of surveillance or supportive care interventions provided to the patient. Study data suggest that intrapartum nursing care is not individualized to the patient’s medical needs; rather there appears to be a core set of nursing interventions that remain constant throughout most episodes of care. However, supportive care was provided more frequently than previous studies have reported and was often integrated with surveillance and indirect care interventions. Implications: Supportive care may improve childbirth outcomes. This study suggests that the amount of supportive care provided to childbearing women is not related to the amount of time available to provide those interventions. The low amount of variance explained by the variables selected for this study indicates that additional factors need to be evaluated for their relationship with the amount and type of intrapartum nursing interventions provided to women in labor. Further research is needed to find ways to increase the amount and quality of supportive care provided by intrapartum nurses.
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