title: Nurses' perspectives on the intersection of safety and informed decision making in maternity care.
abstract: OBJECTIVE
  To explore maternity nurses' perceptions of women's informed decision making during labor and birth to better understand how interdisciplinary communication challenges might affect patient safety.
  
  
  METHODS
  Constructivist grounded theory.
  
  
  METHODS
  Four hospitals in the western United States.
  
  
  METHODS
  Forty-six (46) nurses and physicians practicing in maternity units.
  
  
  METHODS
  Data collection strategies included individual interviews and participant observation. Data were analyzed using the constant comparative method, dimensional analysis, and situational analysis (Charmaz, 2006; Clarke, 2005; Schatzman, 1991).
  
  
  RESULTS
  The nurses' central action of holding off harm encompassed three communication strategies: persuading agreement, managing information, and coaching of mothers and physicians. These strategies were executed in a complex, hierarchical context characterized by varied practice patterns and relationships. Nurses' priorities and patient safety goals were sometimes misaligned with those of physicians, resulting in potentially unsafe communication.
  
  
  CONCLUSIONS
  The communication strategies nurses employed resulted in intended and unintended consequences with safety implications for mothers and providers and had the potential to trap women in the middle of interprofessional conflicts and differences of opinion.
authors.forename: Carrie H
authors.initials: CH
authors.lastname: Jacobson
authors.forename: Marya G
authors.initials: MG
authors.lastname: Zlatnik
authors.forename: Holly Powell
authors.initials: HP
authors.lastname: Kennedy
authors.forename: Audrey
authors.initials: A
authors.lastname: Lyndon
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003657:Decision Making; D003661:Decision Support Techniques; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D016389:Maternal-Child Nursing / Q000458:organization & administration*; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D010348:Patient Care Team / Q000458:organization & administration*; D057240:Patient Preference; D061214:Patient Safety; D011247:Pregnancy; D011256:Pregnancy Outcome; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: United States; childbirth; communication; grounded theory; maternity nursing; patient safety