ABSTRACT
AIM: This article reports on a qualitative study of nurse perceptions of caring nurse practice in the complex adaptive system of health care. BACKGROUND: Caring nurse practice encompasses technical skills and caring behaviours. Maternity care in the USA has seen worsening maternal and neonatal outcomes and safety has become a priority. As a result, hospital systems have begun efforts to improve outcomes, initiating safety and quality programmes that standardize care and implementing nursing frameworks that enhance relationships. DESIGN: Qualitative hermeneutic phenomenology. METHODS: A qualitative design analysed 13 nurses' perspectives on caring practice during the second stage of labour. In June and July of 2012, interviews were conducted with 13 labour and delivery nurses located in a hospital that had adopted a perinatal safety initiative and relationship-focused nursing model. The nurses described caring nurse practice and the factors that affected its provision. Transcripts of audio recordings and notes taken during interviews were analysed for themes and fundamental meanings. FINDINGS: Nurses' perspectives about the provision of caring nurse practice was affected by the complexity of the healthcare system, interactions with team members, challenges related to documentation; and respect for natural birth. CONCLUSION: Nurses at all levels of practice can use these perspectives to identify patterns in the complex adaptive healthcare system to improve quality and safety. Best practices include enhancing teamwork, implementing safety initiatives and promoting a Relationship-Based framework. Continued study of caring nurse practice could lead to establishment of additional safety and quality protocols vital to improving patient outcomes.
