Purpose: To describe the application of the Quality of Health Outcomes Mode
l, introduced by the American Academy of Nursing Expert Panel on Quality of
Health Care, to obstetrical care, particularly second-stage labor.
Organizing Framework: The model is different from the more linear structure
-process-outcome frameworks used in the past to a dynamic conceptualization
of reciprocal relationships among the system, intervention, client, and ou
tcome components. Analysis of these components can provide a comprehensive
picture of the complexity of patient care decision making in hospital labor
and delivery units.
Conclusions: Research findings indicate that interventions such as cesarean
delivery and epidural analgesia may result in several significant quality
of health outcomes for women that should receive increased attention. Uses
of this model for shaping best practices among physicians and nurses and fo
r setting directions for priorities in future interdisciplinary research an
d health policy are discussed.