Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Jean A. Bachman D.S.N.


Granger, Charles

Anne Folta Fish, PhD, RN

Ruth Jenkins, PhD, RN

Kathleen Rich Simpson, PhD, RNC, FAAN


The purpose of this study was to determine if perinatal team members; nurses (RN) and primary care providers (PCP), were using the NICHD standardized terminology to document Fetal Heart Rate patterns during labor. Agreement in documentation of FHR and agreement in concept between the RN and PCP was also studied. A descriptive, comparative research design was used. Cohen?s Kappa statistics measured agreement in documentation of FHR patterns and Chi square measured agreement in concept, p< 0.05 for each. A retrospective medical records chart review was performed on 400 charts, meeting inclusion criteria, from three community hospitals. There were three data collection points and four criteria reviewed. This study found the use of NICHD terminology to document FHR alarmingly low (RN=51%; PCP=13%). It was used most often for decelerations (81%) RN, (22%) PCP, and least often for variability (19%) RN, (3%) PCP. Incomplete documentation was extremely high for the PCP (69%) and 81 charts (20%) had no FHR documentation. Agreement in documentation varied between the RN and PCP. They agreed most often on accelerations (81.4%) and least often on baseline rate (41.5%). When looking at all there points in time the RN and PCP agreed in documentation 59% but agreed in concept 78%. There were four areas where the RN and PCP agreed in their use of NICHD terminology: Accelerations on admission n=151, Kappa=0.091, p=0.007; variability during labor n=68, Kappa=0.27, p=0.015; variability prior to delivery n=33 Kappa=0.33, p=0.010, and decelerations during labor n=103, Kappa=0.16, p=0.018. Data from this study supports expanding this research, to identifying barriers to documentation. It also appears that education in use of NICHD terminology is needed.

Included in

Nursing Commons