Nurses' Perceptions of Comfort, Competence, and Barriers to Informed Consent in Labor and Delivery.

Abstract

Objective: To identify barriers to patient inclusion in decision-making regarding obstetric care, as witnessed by registered nurses, with a focus on the provision of informed consent in labor and delivery.

Design: Descriptive study.

Setting: Online distribution from September 2023 to March 2024.

Participants: One hundred twenty-five registered nurses with more than 6 months of experience caring for obstetric patients in level I through IV maternal care centers in the United States.

Methods: Data collection was completed using a 20-question online survey. Analysis of quantitative data included descriptive and inferential statistics, and analysis of qualitative data included review of all narrative survey responses, grouping by commonality, and identification of categories of concern related to research aims.

Results: Most participants reported high levels of competence and comfort in providing the patient education necessary to achieve informed consent; however, level of comfort decreased if the education included evidence-based options that go against standard medical advice or provider recommendation. Nearly half of the participants reported experiencing retaliation as a result of providing patient education in efforts to support informed consent, and more than 70% reported witnessing patients be coerced by providers, denied care options, and experience negative care outcomes resulting from insufficient informed consent practices. Eleven categories of concern were identified that represent participants' experiences regarding barriers to patient inclusion in decision-making and insufficient informed consent practices.

Conclusion: Standardized education and protocols for obtaining informed consent in labor and delivery and advocacy for patient inclusion in decision-making may improve informed consent practices, provision of high-quality care, and perceived patient experiences.