Decision making by auxiliary nurses to assess postpartum bleeding in a Dominican Republic maternity ward

Abstract

Objective: To understand the process of decision making by auxiliary nurses regarding postpartum bleeding among women in the Dominican Republic.

Design: An ethnographic qualitative design of semistructured interviews and participant observation.

Participants: Twenty four auxiliary nurses on a maternity unit of a referral hospital in the Dominican Republic.

Findings: Auxiliary nurses use specific criteria and logic to decide if postpartum maternal bleeding is excessive. However, systematic postpartum assessments are not routinely conducted on every woman.

Main outcome measures: A decision tree that traces how auxiliary nurses evaluate postpartum bleeding indicates that they have knowledge of contemporary obstetric nursing care, but the organization of care delivery is not structured for them to apply it routinely.

Conclusions: A collaboration of U.S. midwives and Dominican nurses will build on the assets of the auxiliary nurses. Rather than focusing the content of educational conferences on current knowledge of labor and delivery, an important next step is modeling woman- and family-centered care. The U.S. midwives and Dominican nurses are committed to finding empowering and effective ways to improve maternity care.