Table 3 Summary of belief statements and sample quotes from Birthing Unit Nurses assigned to the theoretical domains identified as not relevant to changing fetal surveillance behaviour

Knowledge

I am aware of guidelines. (Provincial/National)

“…the SOGC guidelines about fetal surveillance which encourages us to be using auscultation with low-risk pregnancies…” (N1)

“We follow the SOGC guidelines.” (N4)

“Well I know the SOGC has Guidelines.” (N5)

“Our hospital tries to follow More OB Guidelines.” (N8)

There is evidence to support the use of IA guidelines.

“I believe they are evidence-based and I think the evidence is good in that like I’ve seen the trend and that it tends to be focusing on the fact that increased continuous fetal monitoring generally it doesn’t improve fetal well being. It simple increases intervention.” (N5)

“Yes [they’re evidence based]. I have read the background information so I understand that there has been a lot of Cochrane reviews and things like that so yes I do trust it.” (N11)

“Oh I do believe they are evidence-based. They have had many studies and proven similar outcomes between fetal monitoring and intermittent auscultation.” (N3)

“Yes I think that they are and I think that the evidence is that outcomes are not necessarily improved by continuing fetal monitoring. I think that the risk of C-section related to increased interventions is an outcome of EFM.” (N6)

Skills

There are skills requires to use IA but they are no different than any other technique to monitor a baby.

“Yes there certainly is a skill set to that [IA] but that’s with any sort of fetal monitoring including continuous monitoring…” (N10)

“I don’t think so. I think you need to know how to interpret things. I don’t think the skill is different it’s the interpretation of what you are listening to…same expertise that you would need for any kind of listening to the baby.” (N1)

“I think it’s just the general experience of understanding the labour process and what to expect in terms of fetal heart rates and patterns during the labour process." (N11)

Professional/Social Role & Identity

Using IA is part of my job as a Birthing unit nurse.

“I think I’m doing more of a job that way because I am more aware of her and I am more present and I am in the room as opposed to being at a desk watching a strip.” (N8)

“Absolutely…[I’m doing my job by using only IA].” (N9)

“I think I am [doing my job]. I think I’m being a little bit extra when I’m using IA because it demands that you are more present with the patient if you do it versus if you just hook them up to the monitor and leave them on the monitor continuously. So I feel like I’m giving a little bit extra effort when I do it.” (N2)

The training and practice we receive Birthing Unit nurses influences my decision to use IA

“My preceptor training was very, very good and she paid a lot of attention to detail and she really made it clear to me that it’s an option and when it’s a safe option so I think it’s just who I was trained by when we initially got hired on the unit that makes the decision so easy for me to make because she made me feel like this is something that we are allowed to do, it doesn’t happen very often, but we are allowed to do it so I think it’s my training.” (N2)

“I think being trained in the More OB is beneficial and I think personally a lot of reading and extracurricular done on my own has been more directed toward the midwifery model of care and the hands off approach and I think that is what makes me push for and make sure I’m more aware of the importance of doing IA.” (N8)

As a nurse we have a standard of practice that guides our care of a labouring woman.

“…our moral bead that we’re involved in…[is special to our training as a Nurse that influences use IA].” (N1)

“…that it is the preferred method and it is within our standards of practice…” (N11)

“I just think if you have like I think as a nurse you all know what a low-risk pregnant woman presents as and when to use IA.” (N2)

Motivation and goals

Using IA is important to me.

“Very important. You’ve got better patient satisfaction. You’ve got equal outcomes. The babies do just as well with IA as they do with fetal monitoring; everybody is happier.” (N6)

“I actually think it’s very important. I think we’ve got to get nurses comfortable in doing it though. I think because the climate has been to put them on EFM and I believe we really need to get away from that.” (N3)

“Yes [it’s important] I think because I believe in it.” (N5)

IA is a top priority for me as long as it done safely

“I think it’s very important to use it because especially if it’s a woman who is trying to go ‘au naturale’. ” (N2)

“For un-medicated births I would say it’s very much the top priority to be able to do IA in the way that you know it is safe.” (N12)

Emotion

I’m not worried when using IA.

“No, [I’m not worried]. If it’s low-risk and there’s nothing and healthy there should be no reason why we have to change our plan of action.” (N7)

“Whether I’m on the monitor or not, so [there’s] no difference for me so using IA does not make me worry more." (N11)

“No [using IA with a healthy woman having a low risk pregnancy ever evoke worry or concern in me]. ” (N9)