MacLeod Martha L P, Zimmer Lela V, De Smit Amanda, Jónatansdóttir Steinunn, Dietz Kristi
School of Nursing, University of Northern British Columbia, Prince George, BC, V2N 4Z9, Canada.
School of Nursing, University of Northern British Columbia, Fort St John, BC, V1J 8C3, Canada.
BMC Pregnancy Childbirth. 2025 Mar 31;25(1):378. doi: 10.1186/s12884-025-07458-7.
Sustaining rural perinatal services is increasingly difficult, largely due to ongoing challenges in recruiting and retaining healthcare providers, including registered nurses. In Canada, where most births take place in hospitals, nurses play central roles in rural prenatal, intrapartum, and postpartum care. Through articulating nurses' everyday practices, their considerable contributions to woman-centred care can be made visible, their value clarified, and appropriate supports to retain them identified. The aim is to provide an in-depth understanding of what it means to be a nurse providing perinatal care in a rural hospital.
This hermeneutic study was conducted in partnership between perinatal nurses and university-based researchers. In-depth interviews with 26 nurses, physicians, other professionals, and birthing women along with shadowing nurses as they went about their practice provided data for a multi-stage hermeneutic interpretation.
We identified five facets of nurses' practice: providing individualized prenatal care, orchestrating care in the birthing centre, working with and through the team, maintaining the flow of the unit and the care of birthing women and being a generalist in a specialized area. Nurses were seen to play critical but often overlooked roles in providing woman-centred care to pregnant and birthing women, their newborns, and families. Nurses continuously attended to the social, emotional, and physical health of those in their care. Their practice was attuned to the unexpected in the context of the individual woman, interprofessional team, available resources, isolated geography and weather. They showed often hidden and taken-for-granted perinatal knowledge and skills, including knowledgeable anticipation, problem-solving, and making interprofessional teams and systems work.
Through providing finely tuned individual care and orchestrating care, the nurses facilitate birthing as a good life event for childbearing families, even in times of difficulty and uncertainty. As rural perinatal services continue to be at risk of closure, uncovering and articulating nurses' everyday practice and supportive mechanisms create the potential to highlight nurses' value and garner greater respect for their practice and contributions to care and the sustainability of rural perinatal services.
维持农村围产期服务愈发困难，这主要是由于在招聘和留住包括注册护士在内的医疗保健人员方面持续存在挑战。在加拿大，大多数分娩在医院进行，护士在农村产前、产时和产后护理中发挥着核心作用。通过阐述护士的日常工作，可以彰显她们对以产妇为中心的护理所做出的巨大贡献，明确她们的价值，并确定留住她们所需的适当支持措施。目的是深入了解在农村医院提供围产期护理的护士意味着什么。
这项诠释学研究是围产期护士与大学研究人员合作开展的。对26名护士、医生、其他专业人员和产妇进行了深入访谈，并在护士工作时进行跟踪观察，为多阶段诠释学解释提供了数据。
我们确定了护士工作的五个方面：提供个性化的产前护理、在分娩中心协调护理、与团队合作并通过团队开展工作、维持科室的工作流程以及对产妇的护理，以及在专业领域成为多面手。人们发现护士在为孕妇、产妇、她们的新生儿及其家庭提供以产妇为中心的护理方面发挥着关键但往往被忽视的作用。护士持续关注她们所护理人员的社会、情感和身体健康。她们的工作适应了个体产妇、跨专业团队、可用资源、地理位置偏远和天气等情况下的意外情况。她们展现出了常常被隐藏且被视为理所当然的围产期知识和技能，包括有见识的预判、解决问题以及使跨专业团队和系统有效运作。
通过提供精心调整的个性化护理和协调护理，护士们促进分娩成为生育家庭的美好生活事件，即使在困难和不确定时期也是如此。由于农村围产期服务仍面临关闭的风险，揭示并阐述护士的日常工作及支持机制有可能凸显护士的价值，并使她们的工作以及对护理的贡献和农村围产期服务的可持续性获得更多尊重。
