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. 2022 Nov 25:9:23333936221137576.
doi: 10.1177/23333936221137576. eCollection 2022 Jan-Dec.

Using Institutional Ethnography to Explicate the Everyday Realities of Nurses' Work in Labor and Delivery

Paula Kelly  1 , Maggie Quance  2 , Nicole Snow  1 , Caroline Porr  1
Affiliations

Using Institutional Ethnography to Explicate the Everyday Realities of Nurses' Work in Labor and Delivery

Paula Kelly et al. Glob Qual Nurs Res. .

Abstract

Fetal health surveillance is a significant everyday work responsibility for labor and delivery nurses. Here, nursing care is increasingly focused on technological interventions, particularly with the use of continuous electronic fetal monitoring. Using Institutional Ethnography, we explored how nurses conduct this work and uncovered the ruling relations coordinating how nurses "do" fetal health surveillance. Analysis revealed how these powerful ruling relations associated with the biomedical and medical-legal discourses coordinated nurses' fetal monitoring work. Forms requiring documentation of biophysical data caused nurses to focus on technological interventions with much less attention given to holistic and supportive care measures. In doing so, nurses inadvertently activated and participated in these powerful ruling discourses. The practice of ensuring the safe birth of the baby through advances in technological surveillance and medical interventions took priority over well-established approaches to holistic nursing care.

Keywords: Canada; fetal health surveillance; institutional ethnography; labor and delivery; nurses’ work.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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