Using the SEIPS Framework to Understand Systems-Level Factors Affecting Obstetric Nurse Decision Making: A Convergent Parallel Mixed Methods Study

Abstract

The United States has the worst maternal morbidity and mortality in the developed world, with a maternal death rate of 17.3/100,000 live births. Efforts to improve this have not been fruitful. This dissertation suggests that future research with a patient safety focus and human factors framework may improve our understanding of this multifactorial problem and identify new potential solutions for improving this devastating crisis. The first manuscript is a scoping review discussing the use of trigger tools to identify women in labor in need of care escalation. The second manuscript is a realist review describing current approaches to the problem of obstetric failure to rescue. The third manuscript details a convergent parallel mixed methods study looking at the systems-level factors affecting nurses who are caring for women in labor and makes recommendations for systems changes with the potential to improve outcomes