title: Understanding the moral nature of intrapartum nursing.
abstract: OBJECTIVE
  To explore how intrapartum nurses understand and negotiate their moral responsibilities toward women during childbirth.
  
  
  METHODS
  Qualitative critical narrative.
  
  
  METHODS
  Labor and birth unit in an urban Canadian hospital.
  
  
  METHODS
  Fourteen intrapartum registered nurses.
  
  
  METHODS
  Critical narrative analysis using a feminist ethics perspective.
  
  
  RESULTS
  Nurses understood their moral responsibilities to laboring women in a variety of ways depending on the nurses' personal and professional experiences, the people involved, and the context of care. Four themes were identified: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. A key factor influencing responses to women was the degree to which expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women, and their families. Although nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. Nurses also described limits of their responsibilities for others, which departed from the idealized expectations often reflected in professional guidelines
  
  
  CONCLUSIONS
  These findings suggest a need to challenge assumptions related to the provision of choice and family centered care to create environments that can support and sustain understanding and trust between nurses and women giving birth. In addition, given the lack of shared understandings of what constitutes best care, there is a need to develop collaborative models of care that include the voices of women as a central component.
authors: Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Toronto, ON, Canada. anne.simmonds@utoronto.ca
authors: Anne H
authors: AH
authors: Simmonds
authors: Elizabeth
authors: E
authors: Peter
authors: Ellen D
authors: ED
authors: Hodnett
authors: Linda
authors: L
authors: McGillis Hall
mesh_terms: D002170:Canada; D003657:Decision Making; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D009014:Morals; D033262:Narration; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D009773:Obstetric Nursing / Q000941:ethics*; D019555:Physician-Nurse Relations; D011247:Pregnancy