Intermittent Auscultation versus Continuous Fetal Monitoring

Nursing theory is defined as a rigorous and creative constructing of ideas that project a cautious, systemic, and purposeful view of a phenomenon. Through systemic examinations, both in nursing practice and research, nurses can develop knowledge significant to improving patient care. Nursing theories offers a foundational knowledge allowing nurses to offer quality care for their patients and guide their actions. Practice-level nursing theories are situation-specific, focusing on a particular situation and population, and provide frameworks for practice nursing interventions and suggest effects or outcomes of a nursing practice (Im, 2015). Patey, Curran, Sprague, Francis, Driedger, Légaré, and Grimshaw (2017), in their article, compare two practice-level nursing theoretical frameworks, intermittent auscultation (IA), a most recommended approach to fetal surveillance in the labor ward for healthy women, against continuous electrical fetal monitoring (EFM). IA uses an instrument to listen to fetal heart rates (FHR) through the mother’s abdomen for short periods. In many cases, the caregiver may use a portable or external handheld transducer to listen instantly following a contraction for 1 minute, every 15-30 minutes in active labor, and at a frequency of 5 minutes in the active part of the second stage. As defined in the article, electronic fetal monitoring refers to the concurrent application of ultrasound transducers and toco-transducers to measure the duration and frequency of contractions for intermittent periods or continuously throughout the labor.

In nursing, research provide evidence to support an evidence-based nursing practice. Research in nursing helps to develop knowledge concerning health and health promotion over full lifetime, care for individuals with health problems, and nursing actions people’s actions to respond to potential problems (Boswell & Cannon, 2018). In the article, Patey et al. adopted a semi-structured interview method for birthing unit nurses in Ontario, Canada, to collect and analyze their views concerning AI and EFM for fetal surveillance during labor and birth.

Evidence-based practice in nursing refers to the process of collecting, analyzing, and applying research findings to improve patient outcomes and clinical practice. Evidence-based practice in nursing practices helps caregivers to offer the highest quality patient care (Indra, 2019).  In the peer reviewed article, Patey et al. collect evidence on the application and effects AI and EFM for fetal surveillance during labor and birth, by interviewing nurses in the birthing unit and through systematic review of literature. In the Patey et al.’s interview of 12 birthing nurses, the participants reported time constraints, competing tasks, and the need to multitask as the primary factors limiting the nurses’ ability to conduct IA; hence the preference for EFM. Some nurses reported that the decision to apply IA is something they often consciously think about their patients, while others argued it is their default choice provided there are no potential risk factors. The nurses cited positive outcomes of IA, including mother-centered care, avoidance of unnecessary interventions, and some negative consequences, including legal concerns. Some nurses argued that varying support from the caregiving teams and hospital policies introverted their application of IA. They believed that support from the hospital management and care teams could increase the nurses’ preferences for AI. In a systematic review, Patey et al. further noted that continuous EFM is characterized by higher rates of operation virginal and cesarean sections deliveries, and many women report lower satisfaction with their birthing experience. EFM is also linked to 70% of all legal cases and claims relating to intrapartum care, particularly concerning children who suffered a brain injury because of inconsistent interpretation of recordings by physicians and nurses. However, despite the adverse outcomes, EFM is more applied by medical professionals than IA.

Nursing theory is integral to nursing research as it helps to research questions for nursing study. For instance, the research can develop a study question around practice-level nursing theoretical frameworks, IA and EFM concerning their impact in fetal surveillance, child mortality and mother’s safety in the labor period. Research helps to come up with more theories or improve the application of the existing theories. Research derive evidence-based practice, developing knowledge through the advancement of the nursing theories. Nursing theory guides nursing research, and improve evidence-based practice. For instance, the finding that EFM is not safe and nurses’ fear of adopting IA as a primary approach to fetal surveillance is primarily behavioral issues emanating from domains beliefs concerning capabilities, resources, and environmental context, and belief about the consequences and social influences can help healthcare stakeholders to promote nurses’ positive perception of IA by providing the resources and support systems.

Reference

Boswell, C., & Cannon, S. (2018). Introduction to nursing research. Jones & Bartlett Learning.

Im, E. O. (2015). The current status of theory evaluation in nursing. Journal of Advanced Nursing, 71(10), 2268-2278.

Indra, V. (2019). Evidence-based Practice in Nursing. International Journal of Nursing Education and Research, 7(2), 293-296.

Patey, A. M., Curran, J. A., Sprague, A. E., Francis, J. J., Driedger, S. M., Légaré, F., … & Grimshaw, J. M. (2017). Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses’ fetal surveillance practice using theoretical domains framework. BMC pregnancy and childbirth, 17(1), 1-18.