Minimizing adverse outcomes at delivery is a crucial issue in obstetric practice studied by many researchers in recent years. Before the research discussed in the paper, there have been multiple suggestions that the timing of baby delivery influences the risks of adverse outcomes; however, no other study tried to correlate the delivery time to the working patterns of the clinical staff. In the article “The influence of hours worked prior to delivery on maternal and neonatal outcomes: A retrospective cohort study,” Aiken, Aiken, Scott, and Brockelsby (2016) aim to prove that time worked by clinicians before delivery correlates with the number of adverse outcomes in the matter.
The problem is that delivery staff, including nurses, work 12-hour shifts, and long continuous work contributes to personnel’s fatigue, which can negatively affect the adverse complications count (Aiken et al., 2016). The significance of the research lies in understanding that even though neonatal deaths are rare in developed countries, adverse outcomes are relatively common, and identifying times of increased risk concerning working patterns may contribute to a decrease in the number of neonatal complications.
The purpose of the study was to determine whether adverse complications for mothers and their newborns are more common during night shifts and examine if risks of adverse outcomes correlate with the number of hours worked before delivery. The research questions are not specified; however, it could be deciphered that Aiken et al. (2016) attempt to discover if modifying working patterns can improve statistics concerning complications in obstetric practice.
The purpose and the research questions are closely related to the problem; therefore, the background of the problem may be considered consistent and coherent. In summary, the problem is crucial for nursing practice, as nurses commonly work in 12-hour shifts, and their fatigue can increase the risk of adverse outcomes, and the authors of the research emphasize the matter openly.
Methods
The authors of the researchers analyzed a cohort of 24,506 women who gave birth in the setting of a UK tertiary obstetrics center between January 2008 and October 2013 while considering the working patterns of midwives and obstetricians. No informed consent was obtained, and the subjects participated involuntarily; however, as individual medical records were not accessed, the matter does not seem to be unethical. Moreover, for the same reason, the approval of the institutional review board was not needed. Due to the study design, the participants could not encounter any risks or acquire benefits. Consequently, the issue was not addressed by the authors. Thus, the data collection does not seem to have any trace of bias.
The major variables are numerous and identified, which stimulates the reader’s appreciation of the research design. The variables included the mother’s age, BMI, ethnicity, and baby’s weight. The authors also considered the mode of delivery, the birth date, and whether a midwife or an obstetrician assisted the delivery. All the possible adverse outcomes are also identified as variables and analyzed in the research.
The data was acquired from an electronic maternal database that was created explicitly for the study purposes and maintained by the hospital staff. While the reason for choosing the data collection method mentioned above is not specified, the authors state that the database is regularly validated by audits. Thus, the rationale for selecting the data collection method may lie in source availability and relevancy.
The authors did not specify the period for data accumulation, nor did they identify the sequence of information collection events for participants. However, the matter does not seem crucial, as all the data was accessed simultaneously, and no actions were required from the participants. Referring to the first part of the article’s purpose, the researchers compared the delivery characteristics during the day and night using binary logistic regression.
After that, they compared adverse outcomes during the day versus night and examined risks of complications applying a generalized additive model. The rigor of the process was assured as all the data was analyzed with the help of the R statistical software package version 2.14.1 (Aiken et al., 2014). The authors used different calculation models to minimize the effect of bias. In brief, the question of data management was addressed with due consideration to acquire relevant results.
Results
The results of the study are valid, coherently presented, and one can have confidence in the findings. The data examination and analysis showed that there was no correlation between the frequencies of adverse outcomes during the day versus night shifts. However, “the number of hours worked since the beginning of the shift by obstetricians and midwives prior to delivery does influence the risk of adverse outcomes” (Aiken, 2016, p. 634.e5). Considering the results, the authors of the article suppose that a decrease in working hours or increased rest periods of medical specialists can decrease the number of negative implications in obstetric practice. The findings of the authors are logical, and the presentation is consistent, making the research reliable and trustworthy.
The limitation of the study are identified and discussed, and suggestions for further studies are made. The authors state that the cohort size is not sufficient, and all the data is taken from one source, which makes the results non-generalizable to other settings. The researchers propose further studies to be focused on the evaluation of potential interventions that can improve working patterns to decrease the frequency of adverse outcomes in delivery. The comments concerning the limitation and further development of the study made by the authors are relevant and add the credibility of the article.
Even though the study does not concentrate on nursing practice, it can be implemented to the matter, as nurses have the same working pattern as the medical specialists discussed in the article. The 12-hour working shifts contribute to fatigue and, consequently, to negative implications count in any profession. Adverse outcomes may become less frequent if the hospitals’ authorities considered the study and decreased working hours or increased rest periods during nurses’ shifts are offered. Thus, the results of the article can be applied to general nursing practice.
Ethical Consideration
As the authors of the article did not access any personal data or conduct research that could be harmful to the subjects’ health, dignity, or confidentiality, ethical considerations are not present in the study. The subjects’ privacy was protected because a rolling program of audits regularly validated the database, and individual medical records were not accessed (Aiken et al., 2016). The study was approved by the obstetrics center; however, as mentioned above, Institutional Review Board approval was not obtained, as it was not required. In short, no ethical considerations seem to be needed for the study, as it was anonymous and unhazardous.
Conclusion
In conclusion, while the study does not directly concern nursing, its results are applicable to the practice. As mentioned above, the problem of minimizing adverse outcomes in nursing practice is central to contemporary health care. The article analyzed in the current paper makes a clear hypothesis, uses appropriate methods concerning confidentiality, and presents consistent results concerning the issue. It proves that interventions concerning working patterns can be made to decrease the number of negative implications. Even though some changes can be made to increase the generalizability of the results, the research provides valuable suggestions for healthcare authorities to improve the quality of service.
Reference
Aiken, C. E., Aiken, A. R., Scott, J. G., & Brockelsby, J. C. (2016). The influence of hours worked prior to delivery on maternal and neonatal outcomes: A retrospective cohort study. American Journal of Obstetrics and Gynecology, 215(5), 634.e1-634.e7. Web.