Payant, L., Davies, B., Graham, I. D., Peterson, W. E., & Clinch, J. (2008). Journal of Obstetric, Gynecologic & Neonatal Nursing, 37, 405-414.
This study used a framework suggested by the Theory of Planned Behavior to assess the predictors of nurses' intentions to provide continuous labor support to women. The study also explored organizational factors that influence nurses' ability to provide this support. Continuous labor support was defined as being present with the laboring woman except for coffee breaks and meal breaks. The content of the support included providing information, advocacy, emotional support, and comfort measures. The survey included questions designed to measure nurses' intentions, attitudes, subjective norms, and perceived behavioral control. The survey included two case scenarios with identical questions; the scenarios were identical except for the use of epidural analgesia in one scenario. The study was conducted at a large teaching hospital with two campuses that had identical corporate policies and expectations. Ninety-seven of 129 eligible nurses completed the survey for a return rate of 75%. Organizational barriers, including unit acuity, method of patient assignment, need to cover other nurses for breaks, and nurse-patient ratios, affected the provision of continuous labor support. Nurses reported lower intentions to provide continuous labor support to women with epidural analgesia. The strongest predictor of nurses' intentions to provide continuous labor support was the expectation of others. Nurses are influenced by the expectations of their peers and the organizational culture and expectations. It would be helpful to replicate this study in another setting with a different organizational climate.
Judith A. Lewis