Decreasing Pain Intensity Utilizing Non-Pharmacological Interventions During the Active Phase of Labor

Olivia Meitzner- Upper Division Fall 2018

Background Design Framework Evaluation

• Location: Saint Joseph Women’s Labor and delivery unit
• Many women choose to avoid the harmful adverse • Infrastructure: Nursing staff and nurse managers will implement • Strengths:
effects of medication, deciding to have a natural change – Strong evidence from RCTs to support the
childbirth2,5 • Patient population: Women during the active phase of labor change in practice1−5
• Pain is one of the most frequent concerns regarding • Practice change: Education integrated into the maternity class – Addition of a ‘non-pharmacological pain
schedule a St. Joseph’s, team member training, and obtaining
childbirth. If pain isn’t addressed, satisfaction with the resources for the interventions management’ class at Saint Joseph’s Women’s
birthing process will decrease Hospital reaches a diverse population of patients
• Pain intensity scores and the secondary outcome measurement of
• Monitoring effacement, dilation, station, fetal heart rate satisfaction will be collected – Interventions researched are easily implemented
and vital signs are common standards of care for • Data collection: 6-month pilot study and cost-effective
women in labor1−5 o Pre-intervention: Pain intensity measured before implementation
– Training for nurses will be timely and
of interventions
• Many facilities either don’t offer non-pharmacological o During intervention: Pain intensity measured until cervical straightforward
pain reduction interventions or don’t have the dilation reaches ten centimeters
o Post-intervention: Pain intensity and satisfaction level measured • Limitations of project:
resources available2,4,5 . after implementation of interventions – Only reaching one hospital population
• In pregnant women, how does utilizing non- – Individuals may show resistance to change
pharmacological interventions, compared to the Data Analysis (Melnyk & Fineout-Overholt, 2019)
– Ensuring compliance with the project is
standards of care, impact pain intensity during the 1) Opportunities for improvement include: consistent
• Goal: Pain severity will decrease significantly (<0.05) during
active phase of labor? a) Educating patients about non-pharmacological interventions
and after the interventions. Overall satisfaction will increase
after the interventions.
before labor in form of a birthing class • Future implications:
• Providing multiple non-pharmacological interventions in b) Providing nurses with training for providing non- – Are the findings in this study replicable in other
addition to the standards of care for women during • Visual Analogue Scale (VAS) will be used to collect data pharmacological interventions
relating to pain intensity and satisfaction levels c) Availability of resources for interventions at hospitals. environments including at home births and
labor will increase patient satisfaction5 while
• Nurses will collect pain scores before intervention is Team of stakeholders: birthing centers?
decreasing pain during the childbirth experience1−5
implemented, during the interventions until cervical dilation 1. Patients and family advisory boards – Are there any age, family structure, or cultural
• There is no standardized education in place that reaches ten centimeters and after interventions are 2. Nurses, APRN and clinicians
differences in pain and satisdaction scores after
executed 3. Nurse managers/Administration
informs women about different treatment options
[Background research completed in May 2019] interventions are implemented?
• Availability of resources will increase utilization of non-
Study Intervention Comparison Outcome 2) Evidence was searched for using PubMed and CINHAL. Inclusion – Does the cost associated with the study produce
pharmacological options into patients plan of care criteria: peer-reviewed, published within five years (2014-2019), and a worthwhile benefits?
randomized controlled trial (RCT). Evidence was critically appraised
• Nurses should attend training sessions to learn how to RCT1 The intervention The control group was At the end of the intervention, pain
and organized in a literature review table.
group was exposed exposed to the severity was 52 mm in the
implement different non-pharmacological interventions to massage during standards of care at experimental group and 72 mm in [Completed May-June 2019]
into patients plan of care the active phase of
labor
the hospital as well as
a researcher present
control group, which was significantly
different with a mean difference of 20 3) After research was critically appraised, a synthesis of the literature
References
in the room to answer mm (95% Cl 10 - 31). was completed. Evidence from the literature demonstrates that non-
questions pharmacological interventions during the active phase of labor
1. Silva- Gallo, R. B., Santana, L. S., Jorge- Ferreira, C. H.,
RCT2 The intervention The control group Pain was reduced significantly in the decreased pain significantly better than the standards of care and
Literature Review and Synthesis group was exposed received the standard shower treatment group (p< 0.001) supports the need to integrate these interventions into clinical practice.
Marcolin, A. C., Polineto, O. B., Duarte, G., & Quintana, S. M.
(2013). Massage reduced severity of pain during labor: a
to therapeutic unit care without compared to the control group.
[Completed June-July 2019]
showering during the showering or initiation Discomfort, anxiety, relaxation and randomized trial. Journal of Physiotherapy), 59(2), 109–116.
active phase of labor of an epidural tension all showed significant 4) Proposed practice change: https://doi-org.ezproxy.hsc.usf.edu/10.1016/S1836-
• PubMed and CINAHL were used to acquire improvements (p< 0.001) a. Integrating a ‘Non-pharmacological pain management’ class into the 9553(13)70163-2
randomized controlled trials (RCTs) regarding RCT3 The intervention The control group There was a significant reduction in Saint Joseph Women’s Maternity Class schedule that demonstrates all
group was exposed received the standards pain in the group that received the different pain management options available. 2. Stark, M. A. (2017). Testing the Effectiveness of Therapeutic
the effectiveness of non-pharmacological to acupressure, or a of care acupressure in the SP6 point in Showering in Labor. Journal of Perinatal & Neonatal Nursing,
b. Providing team members with training sessions that show them how to
interventions for women during the active phase light touch that was comparison with the TG and CG
implement non-pharmacological interventions into their patients care 31(2), 109–117. https://doi-
the placebo group, groups (p <0.0001).
of labor plan. org.ezproxy.hsc.usf.edu/10.1097/JPN.0000000000000243
during the active
phase of labor c. Obtaining the resources necessary to provide this new practice. This 3. Roque Mafetoni, R., & Kakuda Shimo, A. K. (2016). The effects
• The key terms used in the search included: RCT^4 The intervention In the control group, • There were significant includes a professional to teach the birthing class, train the staff and of acupressure on labor pains during childbirth: randomized
group was exposed patients were in a differences between the pain obtain equipment for the non-pharmacological interventions.
obstetric labor, nursing care, labor pain, to either birthing ball reclining position scores of the women in the birth
clinical trial. Revista Latino-Americana de Enfermagem (RLAE),
[Completed July 2019] 24, 1–8. https://doi-org.ezproxy.hsc.usf.edu/10.1590/1518-
massage, non-pharmacological interventions, exercises or heat without ambulating or ball group after 30-min (P =
8345.0739.2738
therapy during the any other intervention. 0.001), 60-min (P = 0.001), and 5) Implementation of a six-month pilot study on the labor and delivery
and pain management active phase of labor They received the 90-min interventions (P = 0.001) unit at Saint Joseph Women’s hospital. Next, evaluation of the
standard nursing care when compared with the pain
4. Taavoni, S., Sheikhan, F., Abdolahian, S., & Ghavi, F. (2016).
process, outcomes, and costs will be examined. Finally, conclusions
• Publication years searched were 2013-2019 scores of the women in the
made as to whether the study supports the practice change
Birth ball or heat therapy? A randomized controlled trial to
control group. compare the effectiveness of birth ball usage with sacrum-
• The average pain severity score [Completed by December 2019] perineal heat therapy in labor pain management.
in the heat therapy group was Complementary therapies in clinical practice, 24, 99-102.
lower than the control group, 60 6) Incorporate the new practice into the standards of care and continue
and 90 minutes after the to monitor the process and outcomes. Disseminate findings through 5. Abdolahian, S., Ghavi, F., Abdollahifard, S., & Sheikhan, F.
intervention (p<0.05) presentations at professional conferences, publications and hospital (2014). Effect of dance labor on the management of active
• newsletters.
RCT^5 The intervention In the control group, There were significant phase labor pain & clients’ satisfaction: a randomized controlled
group was exposed the participants differences between the pain [Start integration of new practice by January 2020] trial study. Global journal of health science, 6(3), 219.
to dance labor during received usual care scores of the participants in the
the active phase of during labor without dance labor group 30 min after Strategies to promote staff engagement: 6. Melnyk, B. M., & Fineout-Overholt, E. F. (2019). Evidence-
labor ambulating or any intervention (p=0.012) and 60
- Celebrate successes throughout the EBP implementation with small based practice in nursing & healthcare: A guide to best practice
intervention. minutes after intervention
(p=0.036) when compared with rewards like coffee and donut parties (4th ed.). Philadelphia, PA: Wolters Kluwer
the pain scores of the
- Acknowledge members who were vital to the planning and
participants in the control group.
implementation process by recognizing them in meetings or hospital
• The mean satisfaction score in
the dance labor group was newsletters.
significantly higher than the - Allocate meetings for stakeholders to address thoughts, opinions, and
control group(p=0.021). concerns regarding the project.

University of South Florida College of Nursing Tampa, Florida