Nurse-physician communication during labor and birth: implications for patient safety.
OBJECTIVE
To describe communication between nurses and physicians during labor within the context of the nurse-managed labor model in community hospitals and its relationship to teamwork and patient safety.


METHODS
Multicenter qualitative study involving focus groups and in-depth interviews.


METHODS
Labor and birth units in 4 Midwestern community hospitals.


METHODS
54 labor nurses and 38 obstetricians.


METHODS
Focus groups and in-depth interviews were conducted using open-ended questions. Data were analyzed using inductive coding methods to gain understanding from the perspective of those directly involved.


METHODS
Description of interdisciplinary interactions during labor.


RESULTS
Nurses and physicians shared the common goal of a healthy mother and baby but did not always agree on methods to achieve that goal. Two clinical situations critical to patient safety (fetal assessment and oxytocin administration) were frequent areas of disagreement and sources of mutual frustration, often leading to less than optimal teamwork. Minimal communication occurred when the mother and fetus are doing well, and this seemed to be purposeful and considered normal. Physicians and nurses had distinct opinions concerning desirable traits of members of the other discipline.


CONCLUSIONS
Interdisciplinary communication and teamwork could be improved to promote a safer care environment during labor and birth.
Simpson
Kathleen Rice
KR
St. John's Mercy Medical Center, Doisy College of Health Sciences School of Nursing, Saint Louis University, MO 63141, USA. krsimpson@prodigy.net
James
Dotti C
DC
Knox
G Eric
GE
D001291:Attitude of Health Personnel; D003142:Communication; D003299:Cooperative Behavior; D016903:Drug Monitoring / Q000451:nursing; D005260:Female; D005323:Fetal Monitoring / Q000451:nursing; D017144:Focus Groups; D006040:Goals; D006764:Hospitals, Community; D006801:Humans; D007751:Labor, Induced / Q000451:nursing; D007743:Labor, Obstetric / Q000523:psychology*; D019300:Medical Errors / Q000451:nursing / Q000517:prevention & control / Q000523:psychology; D008505:Medical Staff, Hospital / Q000523:psychology; D015146:Midwestern United States; D016294:Models, Nursing; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology; D009773:Obstetric Nursing / Q000458:organization & administration; D010120:Oxytocics / Q000008:administration & dosage; D010819:Physician's Role / Q000523:psychology; D019555:Physician-Nurse Relations; D011247:Pregnancy; D011361:Professional Competence / Q000592:standards; D036301:Qualitative Research; D017751:Safety Management / Q000458:organization & administration*; D011795:Surveys and Questionnaires
D010120:Oxytocics