# Situation: A nurse works in the delivery room of a provincial hospital that is a comprehensive emergency obstetric and newborn care (CEmONC) referral facility. The nurse supervisor wants to make sure that a partograph is started for every woman in labor who meets the protocol criteria for partograph use. In what order should she carry out the steps of the controlling process? 1. Audit a sample of labor records for partograph use 2. Retrain staff and correct the causes of any shortfall 3. Set the standard that a partograph is started for every woman in labor who meets the protocol criteria for partograph use 4. Compare the audit findings with the standard and analyze gaps

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the delivery room of a provincial hospital that is a comprehensive emergency obstetric and newborn care (CEmONC) referral facility.

The nurse supervisor wants to make sure that a partograph is started for every woman in labor who meets the protocol criteria for partograph use. In what order should she carry out the steps of the controlling process?
1. Audit a sample of labor records for partograph use
2. Retrain staff and correct the causes of any shortfall
3. Set the standard that a partograph is started for every woman in labor who meets the protocol criteria for partograph use
4. Compare the audit findings with the standard and analyze gaps

## 보기

1. 3, 4, 1, 2
2. 1, 3, 4, 2
3. 3, 1, 2, 4
4. 3, 1, 4, 2 **✔ 정답**

**정답: 4**

## 해설

The controlling process begins by establishing standards and then measuring actual performance against them. Performance is then compared with the standards and any deviation is analyzed, and finally corrective action is taken and performance is measured again.

## 심화 해설

The controlling process in nursing management follows a logical sequence that moves from defining expectations to evaluating outcomes and then acting on the findings. When the nurse supervisor wants to ensure partograph use meets protocol criteria, the correct order is 3, 1, 4, 2.

Step 1: Establish the standard

The first step is to define what should happen. The supervisor sets the standard that a partograph is started for every woman in labor who meets the protocol criteria. A standard is a predetermined level of performance or a criterion against which actual practice will be measured. Without a clear standard, there is no benchmark for judging whether care is adequate. In this CEmONC referral facility, the standard reflects both clinical necessity and institutional policy, because the partograph is a tool designed to help providers recognize and act on early signs of fetal–maternal distress during labor [1][2].

Step 2: Measure actual performance

Once the standard is set, the supervisor must collect data on what is actually happening in practice. This is done by auditing a sample of labor records for partograph use. Measurement is the data-gathering phase of the controlling process. The audit provides objective evidence of whether the standard is being met. In the context of partograph utilization, studies have shown that despite training, actual use and correct plotting remain suboptimal in many settings, which is why direct measurement of records is essential [2]. Auditing records rather than relying on staff self-report reduces bias and gives a truer picture of routine practice.

Step 3: Compare performance with the standard and analyze gaps

After collecting audit data, the supervisor compares the findings with the established standard. This comparison reveals whether a gap exists between expected and actual performance. If the audit shows that some eligible women did not have a partograph started, the supervisor analyzes why that gap occurred. Possible causes might include staff workload, lack of familiarity with the tool, unclear protocol triggers, or insufficient supplies of partograph forms. The comparison and gap analysis step is what transforms raw data into meaningful information for decision-making [2].

Step 4: Take corrective action

The final step is to correct the causes of any shortfall. In this scenario, the supervisor retrains staff and addresses the identified causes of the gap. Corrective action is not simply repeating the original instruction; it is targeted to the specific reasons the standard was not met. For example, if the audit showed that staff were unsure when to initiate the partograph, retraining would focus on the protocol criteria for initiation. If the gap was due to missing forms, the corrective action would involve ensuring supply availability. After corrective action is implemented, the cycle begins again with re-measurement to determine whether the intervention worked [2].

Watch out! A common error is to place the audit (step 1 in the options) before setting the standard. You cannot meaningfully audit performance if you have not first defined what acceptable performance looks like. The standard must come first.

Key point! The controlling process is cyclical, not linear. After corrective action, performance is measured again to see if the gap has closed. This is why the sequence is standard → measure → compare → correct, and then the cycle repeats.

The partograph context reinforces why this process matters. The WHO Labour Care Guide, a next-generation partograph introduced in 2020, was developed because traditional partograph assumptions were challenged and a more individualized approach was needed . Implementing such a tool requires not only training but also ongoing monitoring and correction of practice gaps [1]. The controlling process provides the management framework for ensuring that a clinical tool like the partograph is actually used as intended in a busy delivery room.References (research sources)

- [1]Developing a Co-Designed Strategy to Improve Labor Monitoring and Management in India Using the World Health Organization Labour Care Guide: A Mixed-Methods Formative Study.Research articleArmari E, Vernekar SS, Pujar Y, Pingray V, Althabe F, Gibbons L, Berrueta M, Ciganda A, Rodriguez R, Kumar JA, Patil SB, Karinagannanavar A, Anteen RR, M R P, Bendigeri S, Shetty S, Latha B, H M M, Gaddi SS, Chikkagowdra S, Raghavendra B, Homer CSE, Somannavar M, Goudar SS, Vogel JP. (2026) · DOI: 10.1111/birt.70004

- [2]Opportunities, Challenges, and Lessons Learned From Partograph Utilization for Labor Monitoring in Sub-Saharan Africa: A Systematic Review.Meta-analysis/systematic reviewMugyenyi GR, Tumuhimbise W, Ntayi JM, Byamugisha JK, Musimenta A, Kayondo M, Ngonzi J, Tornes Y, Atukunda EC. (2025) · DOI: 10.7759/cureus.82295

## 임상 시나리오

Controlling Process in Clinical SupervisionApplying the 4-Step Cycle to Partograph Use
The controlling process begins with establishing a clear standard. The supervisor must first define the expectation that a partograph is started for every eligible woman in labor.

The next step is to measure actual performance by auditing a sample of labor records. This provides objective data on current practice.

After data collection, compare the audit findings with the established standard and analyze any gaps or deviations.

Finally, take corrective action such as retraining staff and addressing root causes of the shortfall, then re-measure to evaluate improvement.

CautionDo not skip the measurement step. Corrective action without first auditing and comparing performance to the standard is ineffective because the specific gap and its causes remain unidentified.

## 핵심 개념

- **Controlling Process** — A management function that involves establishing standards, measuring performance, comparing performance to standards, and taking corrective action.
- **Standard** — A predetermined level of performance or a criterion against which actual practice is measured.
- **Partograph** — A graphical tool used to monitor the progress of labor and identify early signs of fetal or maternal distress.
- **CEmONC** — Comprehensive Emergency Obstetric and Newborn Care; a set of services for managing major obstetric and neonatal complications.
- **Audit** — A systematic review of records or practices to measure actual performance against established standards.

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