Single Room Maternity Care: The Nursing Response

173BIRTH 28:3 September 2001

Single Room Maternity Care: The Nursing Response

Patricia A. Janssen, BSN, MPH, PhC, Susan J. Harris, MD, CCFP, FCFP, Jetty Soolsma, MA,CNM, Michael C. Klein, MD, CCFP, FCFP, FCPS, and Laurie C. Seymour, BSN

ABSTRACT: Background: The introduction of single room maternity care in the 1990snecessitated a new approach to nursing education and practice. A focus on perinatalnursing requires competence across the spectrum of labor, delivery, postpartum and newborncare. We sought to evaluate the nursing response to this change by comparing satisfactionwith the workplace environment among single room maternity care nurses before and afterthey worked in the setting and among nurses working in traditional birth settings. Methods:Six months before the opening of a pilot seven-bed single room maternity care unit, nurseswho planned to work in the new unit completed a survey about their satisfaction withaspects of their work environment. Three months after the new unit opened the survey wasrepeated with this study group and also by a sample of nurses working in the delivery andpostpartum areas. Results: Responses indicated that single room maternity care nursesbefore and after working in the unit were significantly more satisfied with the physicalsetting, their ability to respond to patients’ needs, their opportunity for teaching families,the nursing practice environment, peer support, and their perceived level of competency.They rated their satisfaction significantly higher than that of their colleagues in the tradi-tional delivery and postpartum settings. Conclusions: The positive transition to singleroom maternity care by obstetrical nurses was demonstrated by their improved overallsatisfaction with the work environment. Evaluation of the nurses’ responses to changes inhealth care delivery has important implications for justifying new clinical approaches andplanning for future changes. (BIRTH 28:3 September 2001)

Single room maternity care supports birth as a natural, In traditional care, however, women are admittedto combined labor and delivery rooms and then trans-family-centered experience. The key element is that

when the parturient woman is in established labor, ferred to postpartum rooms. In some hospitals the laboroccurs in a separate room, necessitating a last-minutefamilies are admitted to one room, where they remain

throughout the intrapartum and postpartum periods. rush to the delivery room. This multitransfer, geo-graphically based model of care assumed that nursesThe newborn stays with the family at all times.required a set of skills unique to their specific clinicalarea. It promoted a ‘‘task’’ approach to nursing carerather than a holistic, client-centered approach. It

Patricia Janssen is at the Department of Family Practice, Universitymeant that nurses involved in each phase of patientof British Columbia, Children’s and Women’s Health Care Centre

of British Columbia, and B.C. Research Institute for Children’s and care needed to receive a report on events to that pointWomen’s Health; Jetty Soolsma and Laurie Seymour are in the in time, and to establish a new relationship with theChildren’s and Women’s Health Care Centre of British Columbia;

family and a new plan of care from that point onward.and Susan Harris and Michael Klein are at the Department ofFamily Practice, University of British Columbia and Children’s The introduction of single room maternity care ne-and Women’s Health Care Centre of British Columbia, Vancouver, cessitates a new approach to nursing education andBritish Columbia, Canada.

practice in obstetrics that in our setting included a6-month preparation period of ‘‘cross training’’ to en-Address correspondence to Patricia A. Janssen, UBC Department

of Family Practice, 5804 Fairview Ave., Vancouver, B.C. V6T-1Z3, sure competency in labor, delivery, postpartum, andCanada.

newborn nursing skills. This paper presents an evalua-tion of nursing satisfaction in the single room maternityq 2001 Blackwell Science, Inc.

174 BIRTH 28:3 September 2001

care environment at BC Women’s Hospital in Vancou- Traditional Settingsver, British Columbia, Canada. It is part of a largerstudy that evaluated client satisfaction and outcomes, In the delivery suite, rooms are much smaller than

those in the single room maternity care unit. They dophysician satisfaction, resource utilization, and nursingeducation. not have windows, have one chair as auxiliary furni-

ture, and have a shower only. The activity level inAlthough promoted as satisfying to clients, market-able, and cost effective, single room maternity care has the delivery suite is extremely high, and mothers and

newborns are transferred to the postpartum unit asnot been adequately studied from nurses’ perspectives.The literature to date has been largely descriptive in soon as their condition allows, usually within 2 hours

after delivery.nature. This study compared satisfaction among singleroom maternity care nurses to a baseline measure and In the postpartum wards, rooms are similarly small

but have showers, bathtubs, windows, and access toto nurses in the traditional delivery and postpartumsettings. patios; approximately 14 percent of the rooms are

shared. Single postpartum rooms have no extra chargeand are allocated on a first-come, first-served basis.MethodsA new care team who has not participated in the birthreceives the family. Thus, a new set of relationships

The Single Room Maternity Care Unit has to be developed by the family and staff, involvingthe reiteration of information about the mother, new-

At BC Women’s Hospital, a pilot program of 7 single born, and the birth itself.room maternity care beds began on October 20, 1997.The pilot unit is staffed by a core group of 20 nurses Satisfaction Questionnairewho chose to undertake perinatal training and movefrom the delivery suite or postpartum unit to the single Nurses’ satisfaction with the single room maternity

care environment was assessed using a survey toolroom maternity care unit. A competency-based perina-tal nursing education program allows nurses to identify designed specifically for this purpose at BC Women’s

Hospital. Items were selected from the literature (1–4),their own learning needs and choose from a varietyof learning methods to prepare for working in the new from feedback given by staff during the planning pro-

cess for single room maternity care, and from toolsenvironment. The nurse-patient ratio is the same as inother areas of the hospital, that is, one-to-one for being developed at other hospitals (unpublished data,

Surrey Memorial Hospital, Surrey, B.C., 1994; Victoriawomen in active labor and one-to-four for mother andnewborn pairs during the postpartum period. Eight General Hospital, Winnipeg, Manitoba, 1992).

The survey was divided into four sections to evalu-nurses with comparable perinatal training on a casual(per diem) basis provide supplementary staffing; they ate nurses’ perception of the physical setting, quality

of care, perceived competence, and nursing practicealso supplement staffing in the delivery suite. A nurs-ing patient care leader oversees the single room mater- environment. The survey tool was pilot tested at BC

Women’s and revised to improve the clarity ofnity care unit and the delivery suite. Nurses and supportstaff communicate by means of an in-house, wireless questions.

Face validity was tested by 10 nurses from thetelephone system.Single room maternity care rooms are large enough obstetrical clinical areas. Content validity was estab-

lished through comparing questions chosen and vali-for staff and family members to move around comfort-ably. Each has a sofa for support persons to sleep on. dated by clinical experts with those deemed to be

relevant in the published literature (1–4). ConstructThey all have windows, and are decorated with modernfabrics and maple furniture. Bathrooms are equipped validity was established through correlation with other

data intended to measure the concept of satisfactionwith showers and bathtubs.On arrival at the hospital, a triage nurse assesses with single room maternity care (5). Predictive or crite-

rion validity refers to the ability of a test to predict aclients. Women are eligible for single room maternitycare if they are in active labor as defined by the pres- relevant criterion (6). Items on the survey rated more

highly by single room maternity care nurses (privacy,ence of regular contractions and with a cervix at least3 cm dilated and less than 0.5 cm in length. They must noise, response to patient needs, teaching opportuni-

ties) were also scored higher by patients when pre-also have a normal pregnancy and are at 37 to 41weeks’ gestation, with a single fetus, cephalic presenta- sented with similar questions in another study (7).

Cronbach’s alpha was used to assess internal consis-tion, and normal fetal health assessment. Families aredischarged according to standards set out in clinical tency reliability. For the domain involving satisfaction

with the physical setting it was 0.88, and for the domainpathways, usually at about 42 to 48 hours postpartum.


measuring the ability to provide quality care (re- their responses after they had worked in the new unitfor 3 months. No dropouts within this group occurredsponding to patient’s needs and teaching, comfort

with making choices, continuity of care) it was 0.97. during the 9-month interval.Cronbach’s alpha was 0.98 for the nursing practice

Data Analysisenvironment, which included autonomy, accountabil-ity, collaboration and teamwork, and promotion of

Survey results from nurses working in each of thecompetence.three areas were compared using the Kruskal-WallisApproval for the final version of the survey wastest, a nonparametric one-way analysis of variance (8).sought and received from the University of BritishA nonparametric test was chosen because answers toColumbia Behavioral Research Ethics Board and thesurvey questions were not normally distributed. ScoresBC Women’s Research Review Committee.from nurses before and after working in single roommaternity care were analyzed using a WilcoxonSurvey Protocolmatched pairs signed rank sum test (8), which is alsononparametric and assumes that the two groups areThe survey was distributed to all 20 of the single roomrelated. Both tests take into account that the categoriesmaternity care nurses, to 26 delivery suite nurses, andwere ordered. Type I (alpha) error (level of signifi-to 26 postpartum nurses over a 2-day period. Nursescance) was set at 0.05. Comments from open-endedwho worked as casual staff in more than one area werequestions were categorized then summarized.excluded. The research nurse approached delivery suite

and postpartum nurses consecutively as she encoun- Resultstered them in the clinical areas and asked for theirparticipation in the study. There were no refusals. Sur- The single room maternity care nurses were all femaleveys were handed to the participants by the research and had a mean age of 35.8 5 7.8 years; more had anurse, completed anonymously, and returned to the diploma in nursing (66.7%) than a baccalaureate de-research nurse in a sealed envelope. The response rate gree (33.3%). Nineteen nurses had practiced in a deliv-for all groups was 100 percent. Data were entered ery suite before in the single room maternity care unitinto a relational database by a commercial data entry (mean duration of 5.3 5 5.1 yr); 15 had previousfacility. Double entry and an error-checking program postpartum experience (mean of 3.5 5 2.0 yr). No dataassured 99 percent accuracy. for nurses from the comparison groups were available,

Nurses who chose to work in the pilot single room except for age, the mean of which was 40.4 5 9.5maternity unit may have been a particularly motivated years. The first series of comparisons (Tables 1–3) areand enthusiastic group compared with those who among single room maternity care nurses, deliverystayed in the traditional settings. We administered the suite nurses, and postpartum nurses.survey to the nurses who had chosen to work in thepilot unit 6 months before it actually opened so as to Physical Spaceassess changes within this group that were associatedwith working in the new environment. At that point Single room maternity care nurses described their

rooms as significantly more spacious than nurses work-the nurses had not seen the unit since it was still underconstruction. These responses were compared with ing in other areas (Table 1); more nurses scored this

Table 1. Physical Space

SRMC LDR PPAttributes (on a Scale of 1–5) (n 4 20) (n 4 26) (n 4 26) p

Room spacious 4.40 3.38 3.43 SRMC vs LDR, PP, 0.008Setup similar 4.90 4.20 4.08 SRMC vs LDR, PP, 0.001Lights adequate 3.68 4.01 3.56 nsDelivery supplies accessible 4.50 3.68 3.00 SRMC vs LDR, < 0.001Newborn resuscitation equipment available 4.42 4.00 4.21 nsPrivacy easily maintained 4.95 3.00 4.04 SRMC vs LDR, PP and LDR

vs PP, < 0.001Noise acceptable 4.70 2.57 2.86 SRMC vs LDR, PP, < 0.001Water therapy choices easily accommodated 4.90 3.36 3.33 SRMC vs LDR, PP, < 0.001Room accommodates family-centered care 4.85 3.40 3.40 SRMC vs LDR, PP, < 0.001

SRMC 4 single room maternity care, LDR 4 delivery suite, PP 4 postpartum unit.


item at 5 on a scale of 1 to 5. Room setup was also setting accommodated family-centered care, nurses insingle room maternity care rated this item at ‘‘5’’ morefound to be more consistent in the single room mater-

nity care unit. No differences between the units were often than in the other units.noted with respect to adequacy of lighting for deliveryand procedures, or for accessibility of newborn resusci- Quality of Caretation carts. Nurses in single room maternity care foundthat equipment and supplies were more easily accessi- Nurses in single room maternity care thought that they

were better able to respond to the physical, emotional,ble compared with the delivery suite. More single roommaternity care nurses chose ‘‘5’’ when asked if privacy and spiritual needs of their clients than in other units

(Table 2). These differences were statistically signifi-was easily maintained in their setting, and they alsoindicated more often that noise levels were acceptable. cant between single room maternity care nurses and

nurses in both the delivery suite and postpartum unit.Accommodation of water therapy choices was easierin single room maternity care, since both bathtubs and Opportunities to teach families about various aspects

of mother and baby care as well as their options forshower were available. When asked if the room in their

Table 2. Quality of Care


Sufficient opportunity to teach partners 4.45 2.70 4.08 SRMC, PP vs LDR, < 0.001Respond to needs for:

Physical care 4.60 3.56 4.17 SRMC, PP vs LDR, 0.003Emotional care 4.50 3.40 3.95 SRMC, PP vs LDR, 0.002Spiritual care 4.38 3.20 3.77 SRMC, PP vs LDR and

SRMC vs PP, < 0.001Teach family:

Choices in pain management 4.68 3.88 4.08 SRMC vs LDR, PP, < 0.001Physical care of mother 4.63 3.68 4.09 SRMC vs LDR, PP, < 0.001Infant feeding 4.63 3.08 4.13 SRMC, PP vs LDR, < 0.001Infant physical care 4.63 2.72 4.08 SRMC, PP vs LDR, < 0.001Behavioral cues 4.68 2.56 3.96 SRMC, PP vs LDR, < 0.001

Comfortable with families making choices 4.85 3.96 4.45 SRMC, PP vs LDR, < 0.001Overall, quality of care excellent 4.75 4.07 4.08 SRMC vs LDR, PP, 0.005Continuity of care excellent 4.60 3.80 3.75 SRMC vs LDR, PP, 0.002


Table 3. Nursing Practice Environment


Autonomous nursing decisions 4.20 3.84 3.87 nsAccountable for decisions 4.50 3.92 4.13 SRMC vs LDR, 0.03Promotes clinical competence 4.55 3.96 3.75 SRMC vs LDR, PP, 0.005Opportunity for collaboration and teamwork 4.50 3.86 3.95 SRMC vs LDR, PP, 0.003Staffing ratios sufficient for patient care 3.35 2.88 4.00 PP vs LDR, 0.007Support and assistance for nursing decisions from:

Nurse clinicians 4.20 4.12 3.88 nsPeers 4.60 4.16 4.44 SRMC vs LDR, 0.04Physicians 3.94 3.80 3.60 ns

Medical staff readily available 2.95 4.26 3.39 LDR vs SRMC, PP, < 0.001Feel competent caring for family through:

Labor and delivery 4.94 4.70 2.05 SRMC, LDR vs PP, < 0.001Postpartum 4.89 4.13 4.78 SRMC, PP vs LDR, 0.001Cesarean birth 4.68 4.52 3.84 SRMC, LDR vs PP, 0.01Newborn care 4.79 4.20 4.78 SRMC, PP vs LDR, 0.02

Are there areas in which you do not feel competent? 22.2% 58.8% 78.9% 0.002Overall satisfaction with job 8.42 6.83 7.56 SRMC vs LDR, 0.007



Table 4. A Comparison of Single Room Maternity Careinterventions during the labor and postpartum experi-Nurses’ Responses Before and After Working in theences were believed to be greater among single roomUnit—Physical Space

maternity care nurses. Continuity and quality of careAttributes Pre-was rated highly in all areas but significantly higher(on a Scale of 1–5) SRMC SRMC pin single room maternity care.

Room spacious 3.06 4.40 0.002Nursing Practice Environment Setup similar 4.18 4.9 0.03

Lights adequate 3.56 3.68 nsNurses in single room maternity care felt more ac- Delivery supplies accessible 4.12 4.50 ns

Newborn resuscitation 4.56 4.42 nscountable for their decisions (Table 3). They foundequipment availablethat this environment promoted competence as well

Privacy easily maintained 2.75 4.95 0.001as collaboration and teamwork. However, they did in- Noise acceptable 2.44 4.70 0.001dicate that medical staff was less readily available. Water therapy choices easily 2.85 4.90 0.001The single room maternity care unit is on the second accommodated

Room accommodates family- 3.00 4.85 <0.001floor, one floor above the delivery suite and operatingcentered carerooms where physicians may be attending other

patients. SRMC 4 single room maternity care.

Competence

Table 5. A Comparison of Single Room Maternity CareLevels of perceived competence reflected training and Nurses’ Responses Before and After Working in the

Unit—Quality of Careexperience, and in this comparison the single roommaternity care nurses scores were similar to those for

Attributes Pre-delivery suite nurses in the area of labor and delivery/ (on a Scale of 1–5) SRMC SRMC pcesarean section care and similar to postpartum nurses

Sufficient opportunity to teach 2.40 4.45 <0.001in postpartum and newborn care (Table 3). Unlike thepartnersother two groups, single room maternity care nurses

Respond to needs for:felt highly competent in all areas. Nurses in the com- Physical care 3.43 4.60 0.001parison groups had not received the same training pro- Emotional care 3.31 4.50 0.003

Spiritual care 3.12 4.38 0.004gram as the single room maternity care nurses,Teach family:although some may have had a broad-spectrum perina-

Choices in pain 3.87 4.68 0.005tal background because of prior training in postbasicmanagement

obstetrical nursing or midwifery programs. Physical care of mother 3.75 4.63 0.003Infant feeding 2.93 4.63 <0.001

Before and After Infant physical care 3.00 4.63 0.001Behavioral cues 2.93 4.68 0.001

Comfortable with families 4.43 4.85 nsResponses from single room maternity care nursesmaking choicesbefore and after working on the unit showed significant

Overall, quality of care 3.75 4.75 0.004improvement (Tables 4–6). As expected, initial re- excellentsponses were similar to those from the delivery suite Continuity of care excellent 3.31 4.60 0.004nurses. All but one of the nurses had come from the

SRMC 4 single room maternity care.delivery suite. The proportion of nurses who believedthat there were areas in which they did not feel compe-tent decreased from 50 to 22.2 percent. Overall job

environment. A major theme among single room ma-satisfaction increased from 6.5 to 8.4 on a scale of 1ternity care nurses was the reluctance of members ofto 10 (p 4 0.002). Thirty-five percent of these nursesthe medical staff, particularly obstetricians, to comesaid that the way they provided care changed afterto the single room maternity care unit to see patients.moving to single room maternity care. All nurses whoWhat nurses liked least about single room maternityparticipated in the survey before the unit opening werecare was the distance from the operating room and thestill employed in the unit and completed the follow-consequent delay in having access to medical staff orup survey.obtaining help in emergency situations compared withthe delivery suite. The single room maternity care unitGeneral Commentswas located one floor above the delivery suite andoperating rooms.Nurses were asked open-ended questions about what

they liked and did not like about their current working Single room maternity care nurses described nega-


Table 6. A Comparison of Single Room Maternity Care or postpartum settings. They also scored higher in theirNurses’ Responses Before and After Working in the ability to provide quality care and teaching of familiesUnit—Nursing Practice Environment

than comparison groups. A key message from the sin-Attributes Pre- gle room maternity care nurses was that teamwork was(on a Scale of 1-5) SRMC SRMC p essential to working on the unit because of the small

number of nurses, the relative geographic isolationAutonomous nursing decisions 3.66 4.20 0.02of the unit, and the lack of hierarchy. Although theAccountable for decisions 3.47 4.50 0.01

Promotes clinical competence 4.06 4.55 ns separation from other units reduced accessibility toOpportunity for collaboration 4.00 4.50 ns medical staff (the only factor on which they scored

and teamwork lower than other nurses), single room maternity careStaffing ratios sufficient for 3.66 3.35 ns

nurses still felt empowered in decision-making, whichpatient caremay be due in part to their increased sense ofSupport and assistance for

nursing decisions from: responsibility.Nurse clinicians 4.06 4.20 ns Our findings of increased satisfaction for nurse arePeers 3.93 4.60 0.06 supported by other reports. Berkland states that nurse-Physicians 3.46 3.94 ns

reported increased job satisfaction related to increasedMedical staff readily available 4.06 2.95 0.007continuity of care after converting from a traditionalFeel competent caring for

family through: labor/delivery/recovery/postpartum system to a 10-bedLabor and delivery 4.25 4.94 0.02 single room maternity care unit in a general hospitalPostpartum 3.87 4.89 0.01 in Omaha, Nebraska (9). The Birthplace at St. Mary’sCesarean birth 4.06 4.68 ns

Hospital in Minnesota with 18 single room maternityNewborn care 3.56 4.79 0.02care rooms also reported that staff members had devel-Overall satisfaction with job 6.48 8.42 0.002oped greater feelings of self worth (10). In contrast,

SRMC 4 single room maternity care. Hanold described areas of concern among nursing staff2 years after initiation of single room maternity careunits in a 24-bed unit in Michigan (11). Nurses reported

tive attitudes directed toward them by a small group being anxious about the adequacy of their skill level.of staff members in traditional settings. Some delivery They believed that their workload had increased andsuite nurses commented that staffing single room ma- that they were performing more non-nursing tasks,ternity care left the delivery suite understaffed. Some such as moving equipment. At BC Women’s Hospital,postpartum nurses complained that when postpartum non-nursing tasks are performed by patient servicesbeds were closed some nurses were transferred from aides.one postpartum module to another. Bailey and Howe described the evaluation of a sin-

A few respondents criticized the expenditure of gle room maternity care system in a Level II birthingmoney on a service that provided care to a relatively unit that has 4500 births per year (12). An extensivesmall number of patients. One postpartum nurse com- staff satisfaction survey 6 months after implementationmented that she liked the opportunity to ‘‘specialize’’ indicated an increase in satisfaction related to ex-within perinatal nursing and that an expectation of panded competencies. In a study examining changescomprehensive perinatal training was not reasonable in maternity care and their impact on nurses, Stolte etfor everyone. al reported that single room maternity care was de-

When asked what they liked about single room scribed as exciting and challenging, including positivematernity care, all nursing groups mentioned continu- aspects of change such as enhanced involvement ofity of care and the ability to practice family-centered families in the birth process (13). Nursing staff satisfac-care. Spaciousness, consistency of room setup, bright- tion was measured at the Victoria General Hospitalness, cleanliness, relaxed work environment, team ap- in Winnipeg, Manitoba, Canada, through the use ofproach, and greater self-direction and independence anonymous surveys (unpublished data, Victoria Gen-were all mentioned. Nurses also alluded to the ease of eral Hospital, Winnipeg, Manitoba, 1992.) This singleworking together on the unit, facilitated by encourage- room maternity care unit has 2000 deliveries annually.ment from nursing leaders to work together to solve Sixty-eight percent of respondents expressed satisfac-problems. tion with the single room maternity care concept; 32

percent indicated uncertainty or some dissatisfaction,Discussion which related to the physical setup (lack of supplies,

poor lighting, the call bell system). In our setting,Single room maternity care nurses indicated a higher initial adjustments had to be made with the birthing

lights and lamps.degree of satisfaction with various aspects of theirwork environment than nurses working in the delivery Increased satisfaction resulting from a perception


of higher feelings of autonomy and enhanced continu- perinatal education program contributed to improvedperceptions of competency. Improved competenciesity of care has also been demonstrated in other settings

(14,15). In a study evaluating midwives’ attitudes to- have been identified in some studies of single roommaternity care to contribute to staff satisfactionward their role after moving to a midwifery-run unit,

autonomy and continuity of care were the best pre- (12,16).Our evaluation of the nursing response to singledictors of midwife satisfaction (15).

Our study is limited by a small sample size. The room maternity care has illuminated some of the com-ponents of satisfaction related to this working environ-sample is not subject to response bias, however, since

all single room maternity nurses completed the survey, ment and will inform future planning initiatives. Apositive response overall has supported allocation ofand all nurses in the delivery suite and postpartum

areas were approached consecutively as the research resources for the expansion of single room maternityservices. A careful examination of the nursing responsenurses located them in clinical areas. No nurse refused

to participate. Detailed data on demographics or work to innovation in health care delivery is a importantaspect of planning for the future.history were not obtained because this information

could reveal the identity of individuals for the smallnumbers of participants in the comparison groups. De- Referencestailed data on the single room maternity nurses werecollected as part of the evaluation of the education 1. Grindel C, Peterson K, Kinneman M, Turner T. The Practiceprogram. It is possible that previous education, work Environment Project—a process for outcome evaluation. J

Nurs Adm 1996;26:43–51.experience, or some unmeasured factor differentiates2. Whitley M, Putzier D. Measuring nurses’ satisfaction withnurses who choose to move to single room maternity

the quality of their work and work environment. J Nurs Carecare. In addition, selection of comparison nurses wasQual 194;8:43–51.

consecutive, not random. Nurses working together on 3. Blegen M. Nurses’ job satisfaction: A meta-analysis of relatedthe same shifts may have conferred in their responses, variables. Nurs Res 1992;42:36–41.

4. Mueller C, McCloskey. Nurses’ job satisfaction: A proposedalthough we have no evidence that this was the case.measure. Nurs Res 1990;39:113–117.Improvements in satisfaction of the single room

5. Janssen P, Klein M, Harris S, Soolsma J, Harris S, Keen L,maternity care nurses, shown by comparison with theirFarren M, Seymour L. Single Room Maternity Care Evalua-

responses before introduction to the unit, strengthened tion. Vancouver, B.C.: Children’s and Women’s Health Centreour belief that the differences observed among compar- of British Columbia, 1998.

6. Kline P. The New Psychometrics. London: Routledge, 1998:ison groups were not due solely to volunteer bias.36–37.Nevertheless, a staffing group that self-selects to move

7. Janssen P, Harris S, Soolsma J, Seymour L, Klein M. Clientinto new surroundings would still be expected to besatisfaction with single room maternity care. Birth 2000;17:

positive about their new setting. The positive response 252–260.to a change, called the Hawthorne effect, is well 8. Altman D. Practical Statistics for Medical Research. London:

Chapman and Hall, 1991:203–205, 213.known. In this particular circumstance, however, such9. Berkland C. Small to Medium Birth Hospitals: Bishopan effect may have been modified by some of the

Clarkson Memorial Hospital. Report of the Fifth Ross Plan-negative responses toward single room maternity carening Associates Symposium, Columbus: Ross Laboratories,

by colleagues in the delivery suite. Because women in 1991:60–65.single room maternity care were screened for eligibility 10. Reed G, Schmid M. Nursing implementation of single room

maternity care. J Obstet Gynecol Neonatal Nurs 1986;15:criteria, it is also possible that traditional setting nurse386–389.participants were caring for more complex patients

11. Hanold K. Medium Birth Hospitals: Barnes Hospital, St.whose needs were more time-consuming than thoseLouis. Report of the Fifth Ross Planning Associates Sympo-

of the single room maternity care nurses. This may sium, Columbus: Ross Laboratories, 1991:72-78.have influenced their responses to some questions re- 12. Bailey S, Howe J. High volume obstetrics in combined LDR/

LD program. Nurs Management 1993;24:42–46.lated to their opportunities to respond to patient’s needs13. Stolte K, Myers S, Owen W. Changes in maternity care andand provide teaching.

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managed delivery unit. Midwifery 1995;11;163–173.maternity care environment on satisfaction from the15. Turnbull D, Reid M, McGinley M, Sheilds N. Changes ineducation program that prepared nurses to undertake

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Single Room Maternity Care: The Nursing Response