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Exploring the Nurse’s Role in Perinatal Patient Safety

Phase II: Agency for Safety among Community Providers of Inpatient Maternity Care

This is the second phase of a grounded theory study exploring maternity nurses’ and other health care providers’ individual and collective sense of agency for preventing patient harm in the inpatient setting.  As members of interdisciplinary teams, maternity nurses must engage effectively with others to optimize care.  There may be conflict among team members regarding goals, interventions, the meaning of signs and symptoms, and the roles of team members.  Understanding of nurses’ and other providers’ experiences and challenges in maintaining safe care, and what types of strategies are effective in maintaining clear communication among team members is fundamental to developing realistic improvements in team performance and patient safety.  Specific aims are to: a) Identify individual and system characteristicsthat enable perinatal health care providers to effectively voice their concerns in inpatient community hospital perinatal units. b) Identify interpersonal, structural, cultural, and other process that affect perinatal nurses’ and physicians’ awareness of the nature and urgency of evolving clinical problems and their willingess to intervene to generate a productive response to clinical safety threats.  The research questions include:

  • What do maternity nurses experience in the process of working to prevent patient harm?
  • How do experienced maternity nurses and physicians decide when and how to take action to prevent harm to patients in the labor and delivery setting?
  • What factors facilitate or constrain clinicians working to prevent harm to their patients?
  • What factors make RN-provider communication effective from the physician/CNM perspective?
  • What are the barriers to a collective sense of agency for safety and effective teamwork in the inpatient maternity environment, as experienced by maternity nurses and other providers?.
Additional Members: 

Marya G. Zlatnik, MD

Audrey Lyndon

UCSF CTSI KL2 Career Development Award & Hellman Family Award for Early Career Faculty (phase II); Association of Women's Health, Obstetric, and Neonatal Nurses (phase I)

Published Results: 

Lyndon, A. (2008). Social and environmental conditions creating fluctuating agency for safety in two urban academic birth centers. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 37:12-23. PMID: 18226153

Lyndon, A. (2010). Skilful anticipation: Maternity nurses' perspectives on maintaining safety. Quality and Safety in Health Care. 19:1-5. PMID: 20142407

Lyndon, A., Zlatnik, M.G., & Wachter, R.M. (2011). Effective physician-nurse communication: A patient safety essential for labor & delivery. American Journal of Obstetrics & Gynecology.  205(2):91-6. PMID: 21640970 (Thought piece/review article)