Lyndon A
University of California, San Francisco, 2 Koret Way, Box 0606, San Francisco, CA 94143 USA.
Qual Saf Health Care. 2010 Oct;19(5):e8. doi: 10.1136/qshc.2007.024547. Epub 2010 Feb 8.
To describe maternity nurses' perspectives on how they contribute to safety during labour and birth at two urban academic medical centres in the United States.
Grounded theory: data were collected using semistructured, open-ended interviews and participant observations with registered nurses (RNs) in two inpatient maternity settings. Data were analysed simultaneously using constant comparison, and dimensional and situational analysis.
Purposive sample of 12 RNs working in the two maternity units.
Safety was broadly conceptualised by RNs as protecting the physical, psychological and emotional wellbeing of a woman and her family. During labour and birth, safety was maintained by RNs through "skillful anticipation" of situational potential. This required integration of medical and technical knowledge and skill with intimate knowledge of the woman and the operational context of care to achieve accurate situation awareness and appropriate future planning. Conditions and processes promoting skillful anticipation included being prepared, knowing, and envisioning the whole picture.
In the two settings, maternity RNs made active contributions to safe birth in the context of constrained resources through preparing the environment, anticipating potential problems and trapping errors before they reached the patient. The contributions of maternity nurses to team situation awareness and to creating safety need to be appreciated and administratively supported. Continued research with RNs may reveal previously unrecognised opportunities for safety improvements.
描述美国两家城市学术医疗中心的产科护士对于她们在分娩过程中如何促进安全的看法。
扎根理论：采用半结构化、开放式访谈以及对两家住院产科机构的注册护士（RN）进行参与观察来收集数据。使用持续比较、维度分析和情境分析对数据进行同步分析。
在两个产科病房工作的12名RN的目的抽样。
RN们将安全广泛地概念化为保护女性及其家庭的身体、心理和情感福祉。在分娩过程中，RN们通过对情境可能性的“巧妙预判”来维持安全。这需要将医学和技术知识与技能，与对女性的深入了解以及护理的操作环境相结合，以实现准确的情境意识和恰当的未来规划。促进巧妙预判的条件和过程包括做好准备、了解情况以及设想全局。
在这两家机构中，产科RN们通过准备环境、预判潜在问题并在错误影响到患者之前加以防范，在资源有限的情况下为安全分娩做出了积极贡献。产科护士对团队情境意识和创造安全的贡献需要得到重视和行政支持。对RN们持续进行研究可能会揭示出此前未被认识到的改善安全的机会。
