The establishment of effective relationships is fundamental to good nursing practice and the fulfillment of nurses’ moral responsibilities. While intrapartum nurses are uniquely placed to establish relationships that can directly influence the woman’s experience of childbirth, there has been limited investigation of the relationships, identities and values that underlie nurses’ varied approaches and responses to labouring women. The purpose of this study was to explore intrapartum nurses’ understanding of their moral responsibilities from a social-moral perspective, using Margaret Urban Walker’s “expressive-collaborative” model of morality. Interviews were conducted with fourteen registered nurses working in a birthing unit of a Canadian teaching hospital. Four themes were identified that captured nurses’ moral responsibilities, including: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. Nurses enacted their moral responsibilities to labouring women in a variety of ways depending on their personal and professional experience, the circumstances, the people involved and the context of care. A key factor influencing responses to women was the degree to which understandings and expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women and their families. Nurses also described limits on their responsibilities to others. Their choice of response to circumstances in which practice was constrained departed from the idealized expectations and ‘expert’ practices often reflected in professional guidelines.
While 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. This suggests a need to challenge normative assumptions related to care of women in childbirth, including the provision of choice and family centred care, in order to create environments that can support and sustain practices that build understanding, mutuality and trust between nurses and birthing woman. In addition, given the contested nature of childbirth and the lack of shared understandings of what constitutes ‘best’ care, there is a need to develop collaborative models of inter-professional maternity care that include the voices of women as a central component.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/26237 |
| Date | 17 February 2011 |
| Creators | Simmonds, Anne Harriet |
| Contributors | Peter, Elizabeth Helen |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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