Medical College of Wisconsin
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Maternity Nurses' Responses to Maternal Early Warning Criteria. MCN Am J Matern Child Nurs 2021;46(1):36-42



Pubmed ID




Scopus ID

2-s2.0-85097581622 (requires institutional sign-in at Scopus site)


OBJECTIVE: The purpose of this study was to assess the influence of nursing care on implementing perinatal risk-appropriate care in the context of maternal early warning criteria.

DESIGN: Medical record review and survey of maternity nurses in a three-hospital system in Wisconsin with two level I hospitals and 1 level III hospital.

PARTICIPANTS: Seven maternity nurses from the level III hospital conducted the medical record reviews and all maternity staff nurses from two level I hospitals were invited to complete the survey.

MEASUREMENTS: All medical records in 2017 that met these inclusion criteria: hypertension, sepsis, preeclampsia, hemorrhage, low Apgar scores, and transport were reviewed to assess identification and response time for maternal early warning signs using the Nurses Contribution to Maternal Mortality Worksheet. The survey included questions about influences on the nurses' confidence when interpreting early warning indicators.

RESULTS: Thirty-two medical records met inclusion criteria and were reviewed. The number of maternal early warning signs recorded ranged from one to four, with a mean of 1.75 indicators. Eighty percent of records documented increased evaluation as a nursing response to the maternal early warning signs. Time-lapse between notifying a provider and bedside evaluation was less than 15 minutes in 54% of cases. Of the 31 eligible nurses, 18 completed the survey (58% response rate). Personal knowledge (90%) was reported by nurses as being the greatest influence on nursing confidence. Sixty-nine percent of nurses reported not receiving patient information from team members at the transporting hospital.

CONCLUSION: A systematic record review by frontline nurses can monitor identification and response to maternal early warning signs. Feedback on patient transports can reinforce nurses' decision-making that has the potential to improve responsiveness to clinical warning signs.

Author List

Gillespie KH, Chibuk A, Doering J, Nelson K 3rd


Jennifer Doering PhD Associate Professor in the Nursing department at University of Wisconsin - Milwaukee

MESH terms used to index this publication - Major topics in bold

Clinical Competence
Education, Nursing, Continuing
Obstetric Nursing
Self Efficacy
Surveys and Questionnaires