Providing Adequate Support During and After Labor_Narrated

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Providing Adequate Support During and After Labor:

Providing Adequate Support During and After Labor By: Nicole Ashton, Amy Christensen, Lisa Glandt School of Nursing

Significance of Problem :

Significance of Problem Clinical Impact Labor support positively impacts the outcome of labor (1). Emotional role of labor and delivery nurse normalizes the birthing experience (2). Confidence levels and cultural backgrounds of new mothers impacts the family-centered care being provided (3).

Significance of Problem :

Significance of Problem Quality Impact Adequate support decreases the pain and healing time for mothers (1). Patient advocacy reassures the laboring mothers and improves patient satisfaction (2). While providing accurate information regarding breastfeeding to new mothers, recognizing individual variables will increase the quality of care being provided (3).

Significance of Problem :

Significance of Problem Cost Impact Mothers who are able to have a delivery with minimal interventions beyond support will incur less costs (1). Continuity of care provided by the nurse making the doctors presence with the patient unnecessary allowing the doctors to provide for more patients (2).

Significance of Problem :

Significance of Problem Cost Impact, continued Incorporate cultural and language into prenatal forms for adequate translation of teaching materials and decrease cost of postpartum teaching plans (3).

Purpose:

Purpose Delivery of healthy baby with mom in minimal pain and being is a positive health state at completion of delivery.

PICO:

PICO Adequate support of the pregnant woman and partner leading to normal, unassisted births and individualized postpartum care versus inadequate support resulting in decreased medical interventions, anxiety and breastfeeding.

Article Summaries:

Article Summaries

Factors Associated with Labor Support Behaviors of Nurses:

Factors Associated with Labor S upport B ehaviors o f N urses Purpose “The purpose of the present study was to examine factors associated with labor support behaviors of nurses ” (1) Sample 64 registered nurses (1)

Factors Associated with Labor Support Behaviors of Nurses, continued:

Factors Associated with Labor Support Behaviors of Nurses, continued Level Level IV - Single Non-experimental study (1) Quality Fair (1)

Factors Associated with Labor Support Behaviors of Nurses, continued:

Factors Associated with Labor Support Behaviors of Nurses, continued Summary Experienced people who educate fellow nurses on how to provide adequate support. Birthing couples can also be educated on hospitals with decreased rates of epidurals and cesareans. Also, doulas can be suggested for couples to help with support during labor. Full time nursing support is not feasible with all that nurses have going on . (1)

Women and their partner's perceptions of the key roles of the labor and delivery nurse:

Women and their partner's perceptions of the key roles of the labor and delivery nurse Purpose The purpose of the study is to “examine the roles of the labor and delivery nurse from the unique perspective of women and their partners” (p. 325, 2)

Women and their partner's perceptions of the key roles of the labor and delivery nurse:

Women and their partner's perceptions of the key roles of the labor and delivery nurse Sample 10 heterosexual couples (2) Level Level VI - A qualitative study (2) Quality Fair (2)

Women and their partner's perceptions of the key roles of the labor and delivery nurse:

Women and their partner's perceptions of the key roles of the labor and delivery nurse Summary A study in which perspectives about the roles of labor and delivery nurses in the birthing process are examined. The couples felt that their birthing process was “normalized” by the nurses fulfilling these roles (2 ).

Providing responsive nursing care to new mothers with high and low confidence:

Providing responsive nursing care to new mothers with high and low confidence Purpose “To gain an understanding of the pregnancy, birth and postpartum care received by women within hospital and community settings ” (3) Sample 74 women (3)

Providing responsive nursing care to new mothers with high and low confidence cont.:

Providing responsive nursing care to new mothers with high and low confidence cont. Level Level VI - A qualitative study (3) Quality Moderate (3)

Providing responsive nursing care to new mothers with high and low confidence cont. :

Providing responsive nursing care to new mothers with high and low confidence cont. Summary Further research may include the use of “validated scales with repeated consistent measures using a time series design”. Also, possible incorporation of cultural values and beliefs to be incorporated into measuring the level of maternal confidence (3).

Summary of the Synthesis :

Summary of the Synthesis Level of Evidence Qualitative Study: Level 6 – two articles (2, 3) Single Non-experimental study – Level 4 (1)

Summary of the Synthesis :

Summary of the Synthesis Quality of Evidence Moderate. The articles had strengths of using validity and reliability for the survey, variety of subjects and experiences of mothers and nurses and they were credible and trustworthy (1, 2, 3).

Summary of the Synthesis :

Summary of the Synthesis Quality of Evidence, continued The limitations were a relatively small number of subjects that were not randomly selected and not representative of the entire demographic. All studies had a threat of whole group selection because of polling certain populations, a threat of history because they did not screen backgrounds and threat of reactive effects because all subjects knew that they were in a study (1, 2, 3 ).

Summary of the Synthesis :

S ummary of the Synthesis Results The results stated that many factors tie into the support that mothers are given during the labor process and post-partum . Some of those factors were institution used, experience and confidence of the nurse, patient teaching and amount of time with the birthing mother. Confidence of the mother preceding labor was not a factor, but could be tied to breastfeeding (1, 2, 3 ).

Recommendation for Practice:

Recommendation for Practice Experienced nurses hold workshops and mentor new and less experienced nurses in adequate support techniques . There is a positive correlation between experience of the nurse and support given to laboring woman . This is a clinical outcome. Nurses who had more experience were more likely to provide support to laboring mothers.

Recommendation for Practice:

Recommendation for Practice Nurse educators to incorporate better quality of support for delivering mothers into their care plan. Trustworthiness and credibly were established by field notes, recorded and transcribed interviews and reviewed by multiple researchers. This is a clinical outcome . This will improve patient outcomes and patient satisfaction.

Recommendation for Practice:

Recommendation for Practice Incorporate a consistent breastfeeding teaching plan into the standard of post-partum care. The study is very universal and it coincided with other studies that also addressed the need for increased nursing support during post-partum care. This is a quality outcome . More mothers breastfeeding will decrease health disparities in newborns and costs of formula.

Recommendation for Research:

Recommendation for Research Identify the emotional importance of the roles that the labor and delivery nurses play into laboring mother’s lives. Identify through evidence based research the most efficient breastfeeding teaching plan. Identify the level of care provided by labor and delivery nurses that positively influences occurrence of mechanically assisted deliveries.

Implications for Practice Change:

Implications for Practice Change Increased knowledge level of labor and delivery and post-partum nurses fosters an environment of support. This would be a clinical change. Nurse acts as liaison between professionals such as, primary care provider, pharmacy and social work to ensure the mother’s quality of care.

Reference:

Reference Barrett, S. J., & Stark, M. A. (2010). Factors associated with labor support behaviors of nurses. Journal of Perinatal Education, 19 (1), 12-18. doi:10.1624/105812410X481528 Brown, J. B., Beckhoff , C., Bickford, J., Stewart, M., Freeman, T. R., & Kasperski , J. M. (2009, August). Women and their partner's perceptions of the key roles of the labor and delivery nurse. Clinical Nursing Research, 18 (4), 323-335. Mantha , S., Davies, B., Moyer, A., & Crowe, K. (2008) Providing responsive nursing care to new mothers with high and low confidence. The American Journal of Maternal/Child Nursing, 33 (5), 307-314.

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