Patient Education Regarding Analgesic Options for Labor and Delivery Handout to Accompany Poster Presentation for Scholarly Event Erin E. Martin NURS 770: Clinical Scholarship IV Winona State University
Search Strategy Description The following databases were searched for the years 2000 - present: Ovid Medline, CINAHL, Academic Search, Google Scholar, The Cochrane Collaboration, National Guideline Clearinghouse (NGC), and the National Institute for Health and Clinical Excellence (NICE). Keywords used in the database searches included: anesthesia, analgesia (and the variation analgesic), obstetrics (and the variation obstetrical), labor, childbirth, epidural, education, teach (and the variation teaching), train, class (and the variation classes), know (and the variation knowledge), prenatal, patient, anxiety, attitude, development and needs assessment. Various combinations of the terms were used utilizing the Boolean function of the databases. The search was limited to articles in English, from peer-reviewed journals. The search identified studies using qualitative and quantitative methods and articles that were not considered studies, and resulted in review of 439 articles. Additional sources were found in the reference lists of various articles obtained from the initial literature search. Sources were included if they related to: (1) patient education effects on anxiety level, knowledge, pain experience, or satisfaction with labor, (2) the provision of information and informed consent regarding analgesic options for labor and delivery, (3) development of educational needs assessments. Although an effort was made to include only publications since 2000, nine sources published prior to 2000 deemed relevant were included. This filtering combined with the pertinent articles identified from the reference lists of other articles resulted in full review of 79 articles, 47 included, 32 excluded. Level of evidence of research articles was assessed using the tool developed by Ackley, Swan, Ladwig & Tucker (2008) and guidelines were appraised using the AGREE II evaluation instrument.
Literature Review Table Related Concept Supportive Evidence Level of Level of Effectiveness** Evidence* Decision Making/Patient Centeredness Caton et al., 2002 VII Possibly Effective Declercq et al., 2006 VII Possibly Effective Expert Maternity Group, 1993 VII Possibly Effective Institute for Family Centered Care, 2004 VII Effective IOM, 2001 VII Effective Lavender et al. 1999 VI Possibly Effective Leeman et al., 2010 VII Possibly Effective Raynes-Greenow et al., 2007 I Effective RoCA, 2006 II Effective Patient and Prenatal Education D Haese et al., 2000 I Effective Gagnon & Sandall, 2011 II Possibly effective Hanson et al., 2009 II Possibly effective Johansson et al., 2005 II Effective Keel et al.,, 1997 VI Possibly Effective Kutluturkan et al., 2010 I Effective Lothian, 2007 VII Possibly Effective Middle & Wee, 2006 VI Possibly Effective Morton & Hsu, 2007 VI Possibly Effective National Guideline Clearinghouse (2012a) II Effective National Guideline Clearinghouse (2012b) II Effective National Guideline Clearinghouse (2012c) II Effective NICE 2008 II Effective Poroch, 1995 III Possibly Effective Ruffinengo et al., 2009 I Effective Walker et al., 2009 VII Possibly Effective White et al., 2003 III Possibly Effective Wong et al., 2010 III Possibly Effective Anxiety Beilin et al., 1996 IV Possibly Effective Hodnett, 2002 II Possibly Effective Lally et al., 2008 II Possibly Effective Lang et al., 2006 VI Possibly Effective Sources of Information Henry & Nand, 2004 VI Possibly Effective Paech & Gurrin, 1999 VI Possibly Effective Saunders et al., 2006 VI Possibly Effective Stewart et al., 2003 I Effective Toledo et al., 2012 VI Possibly Effective Informed Consent Bethune et al., 2004 VI Possibly Effective Fortescue et al., 2007 VI Possibly Effective Hoehner, 2003 VII Possibly Effective Jackson et al., 2000 VI Possibly Effective Middle & Wee, 2009 VI Possibly Effective Raynes-Greenow et al., 2010 VI Possibly Effective Saunders et al., 2005 VI Possibly Effective Williams et al., 2005 NA Effective Satisfaction Hobson et al., 2006 III Possibly Effective Hodnett, 2002 II Effective Sheard & Garrud, 2006 I Effective Needs Assessment McCawley, 2009 Miscellaneous (guideline development) NICE, 2009 VII Effective
Rating System *Level of Evidence Level I: Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guideliens based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results. Level II: Evidence obtained from at least one large (multi-site) well designed RCT. Level III: Evidence obtained from well desinged controlled trials without randomization (i.e., quasi-experimental). Level IV: Evidence from well designed case control or cohort studies. Level V: Evidence from systematic reviews of descriptive and qualitative studies. Level VI: Evidence from a single descriptive or qualitative study. Level VII: Evidence from the opinion of authorities and/or reposrts of expert committees. Citation: Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. St. Louis, MO: Mosby Elsevier. ** Level of Effectiveness Effective: Research validates the effectiveness of the nursing activity or intervention, preferably with Level 1 or with Level 2 evidence. Possibly Effective: There are some research studies that validate the effectiveness of the nursing activity or intervention, but with insufficient strength to recommend that nurses institute the activity or intervention at this time. Generally, more research is needed. Not Effective: Research has shown that the nursing activity or intervention is not effective and generally should not be used. Possibly Harmful: There are some studies that show harm to clients when using the nursing activity or intervention, and the nurse should evaluate carefully whether the activity is ever appropriate. Citation: Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. St. Louis, MO: Mosby Elsevier.
Readiness for Change Various aspects of the innovation (needs assessment and potential change to patient education materials) and the institution indicate the potential for successful adoption, including: (1) compatibility with the organization s values, (2) the relative simplicity and trialability of the innovation, (3) the urban setting and prestige of the institution, (4) the extensive available institutional resources, including patient education support and technology, (5) available advanced communication systems and (6) leadership support (DiCenso, Guyatt & Ciliska, 2005; Grol, Wensing & Eccles, 2005). Facilitators Value compatibility with the institution Simplicity, trialability of the innovation Urban setting of the institution Institutional resources Leadership support Organizational culture of the institution Recent departmental changes and initiatives: patient centered care Budget Table Needs Assessment Patient Education Module Resource Anticipated Cost Questionnaire: question $1,100.00 development, layout and printing, including pre-posted envelopes (assistance from Survey Research Center) Data Processing $650.00 Statistical Analysis (assistance from $750.00 - $1500.00 department of biostatistics) Pamphlet: based on development of a print piece in black & white with illustrations that will be used for at least 5 years) Cost per piece: $1.43 Total cost: $8,584 Computer teaching tool $5,000.00 Computer workstation $750.00 1.0 FTE RN Educator (salary and benefits) $100,904.33 (annual salary: $73,652.80; estimated cost of benefits: 37%)
References Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (Eds.). (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. St. Louis, MO: Mosby Elsevier. The AGREE Research Trust. (2009). Appraisal of Guidelines for Research & Evaluation II (AGREE II). Canada: Author. Retrieved from http://www.agreetrust.org/ Bethune, L., Harper, N., Lucas, D. N., Robinson, N. P., Cox, M., Lilley, A., & Yentis, S. M. (2004). Complications of obstetric regional analgesia: how much information is enough? International Journal of Obstetric Anesthesia, 13(1), 30-34. doi: 10.1016/s0959-289x(03)00102-x Declercq, E.R., Sakala, C., Corry, M.P., & Applebaum, S. (2002). Listening to mothers II: Report of the second national U.S. survey of women s childbearing experiences. Retrieved from Childbirth Connection website: http://www.childbirthconnection.org/pdf.asp?pdfdownload=ltmii_report DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St. Louis: Elsevier Mosby. Fortescue, C., Wee, M.Y.K., Malhotra, S., Yentis, S.M., & Holdcroft, A. (2007). Is preparation for emergency obstetric anaesthesia adequate? A maternal questionnaire survey. International Journal of Obstetric Anesthesia, 16, 336-340. doi: 10.1016/j.ijoa.2007.05.013 Grol, R., Wensing, M., & Eccles, M. (2005). Improving patient care: The implementation of change in clinical practice. St. Louis: Elsevier Mosby. Henry, A., & Nand, S. (2004). Women s antenatal knowledge and plans regarding intrapartum pain management at the Royal Hospital for Women. Australian and New Zealand Journal of Obstetrics and Gynecology, 44, 314-317.
Keel, M., Jackson, I., Madej, T., & Wheatley, R. (1997). Adequacy of information and acceptability of pain relief as assessed by a postpartum questionnaire. International Journal of Obstetric Anesthesia, 6(4), 247-249. doi: 10.1016/s0959-289x(97)80032-5 Kutlutürkan, S., Görgülü, Fesci, H., & Karavelioglu, A. (2010). The effects of providing pregastrointestinal endoscopy written educational material on patients anxiety: A randomised controlled trial. International Journal of Nursing Studies, 47(9), 1066-1073. doi: 10.1016/j.ijnurstu.2010.01.007 Lenz, E.R., Pugh, L.C., Milligan, R.A., Gift, A.G., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27. McCawley, P. F. (2009). Methods for conducting an educational needs assessment. Retrieved from http://www.cals.uidaho.edu/edcomm/pdf/bul/bul0870.pdf National Institute for Health and Clinical Excellence. (2008). Antenatal care: Routine care for the healthy pregnant woman. (NICE clinical guideline 62). Retrieved from http://www.nice.org.uk/nicemedia/live/11947/40115/40115.pdf Raynes-Greenow, C.H., Roberts, C.L., McCaffery, K., & Clarke, J. (2007). Knowledge and decisionmaking for labour analgesia of Australian primiparous women. Midwifery, 23, 139-145. doi: 10.1016/j.midw.2006.06.004 Raynes-Greenow, C.H., Nassar, N., Torvaldsen, S., Trevena, L., & Roberts, C.L. (2010). Assisting informed decision making for labour analgesia: A randomized controlled trial of a decision aid for labour analgesia versus a pamphlet. BMC Pregnancy and Childbirth, 10(15), 1-13. Royal College of Anaesthetists. (2006). Raising the standard: A compendium of audit recipes for continuous quality improvement in anaesthesia (Second ed). Retrieved from http://www.rcoa.ac.uk/index.asp?pageid=125
Sheard, C., & Garrud, P. (2006). Evaluation of generic patient information: Effects on health outcomes, knowledge and satisfaction. Patient Education and Counseling, 61(1), 43-47. doi: 10.1016/j.pec.2005.02.004 Stewart, A., Sodhi, V., Harper, N., & Yentis, S.M. (2003). Assessment of the effect upon maternal knowledge of an information leaflet about pain relief in labour. Anaesthesia, 58, 1015-1019. White, K., & Dudley-Brown, S. (2012). Translation of evidence into nursing and health care practice. New York: Springer. White, L. A., Gorton, P., Wee, M. Y. K., & Mandal, N. (2003). Written information about epidural analgesia for women in labour: Did it improve knowledge? International Journal of Obstetric Anesthesia, 12(2), 93-97. doi: 10.1016/s0959-289x(02)00157-7
Educational Needs Assessment Regarding Analgesic Options for Labor and Delivery Survey Research Center
1-7 MC# 8-15 1. Today s Date: / / Month Day Year 2. Did you receive any information, (books, pamphlets, talking with family or friends, used the internet, etc.) about pain relief options for labor and delivery? 16 1 No 2 Yes If no, skip to question 17 7. 18 If yes, when did you receive the information about pain relief options for labor and delivery? 1 Before going to the hospital to have your baby. 2 While in the hospital to have your baby. 3 Both before going to the hospital and when in the hospital to have your baby. If both, where did you receive most of the information about pain options for labor and delivery? 1 Before going to the hospital to have your baby. 2 While in the hospital to have your baby. 3. How would you rate the amount of information you were given about pain relief for labor and delivery? 19 1 Too much 2 Just the right amount 3 Too little information of information information 4. How informed did you feel you were about your pain relief options for labor and delivery, with 0 being not at all informed and 10 being extremely well informed? 20-21 0 1 2 3 4 5 6 7 8 9 10 Not at all informed Extremely well informed Page 1
5. From which of the following sources did you receive information about pain relief options for labor and delivery, and were they? DID YOU LEARN FROM... No Yes Very Somewhat Not at all HealtHcare Providers tt helpful helpful helpful t t t 22 : 34 Your anesthesia team............0 1 if yes, 23 : 35 Your certified nurse midwife.....0 1 if yes, Your physician (obstetrician or 24 : 36 family medicine provider).......0 1 if yes, 25 : 37 Your labor and delivery nurse....0 1 if yes, 26 : 38 Family/Friends...................0 1 if yes, 27 : 39 education classes................0 1 if yes, other resources 28 : 40 Pamphlets.....................0 1 if yes, 29 : 41 Internet.......................0 1 if yes, 30 : 42 Books........................0 1 if yes, 31 : 43 DVD s........................0 1 if yes, 32 : 44 Computer programs.............0 1 if yes, Page 2
6. Please rate the following questions on a scale of 0 to 10, with 0 being not at all anxious or nervous and 10 being extremely. Prior to receiving information about epidurals, how were you about the pain associated with labor and delivery? 45-46 0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely Prior to receiving information about epidurals, how were you about the thought of having an epidural? 47-48 0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely After your received information about epidurals, how were you about the pain associated with labor and delivery? 49-50 0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely After you received information about epidurals, how were you about the thought of having an epidural? 51-52 0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely If you were to have another baby, how would you be about the pain associated with labor and delivery? 53-54 0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely If you were to have another baby, how would you be about the thought of having an epidural? 55-56 0 1 2 3 4 5 6 7 8 9 10 Not at all Extremely Page 3
7. When would you have preferred to receive the information about pain relief options for labor and delivery? 57 1 Before going to the hospital 2 While you were in the hospital to have your baby before your labor or surgery began 3 While you were in the hospital to have your baby after your labor or surgery began 4 Both before and while in the hospital to have your baby before your labor or surgery began 5 Both before and while in the hospital to have your baby after your labor or surgery began 6 I did not want information about pain relief options 8. Please rate each of the following on you would find these in providing information about pain relief options for labor and delivery. Very Somewhat Not at all helpful helpful helpful t t t 58 Written pamphlet..................................... 1 2 3 59 Video slide presentation............................... 1 2 3 60 Interactive web-based module.......................... 1 2 3 61 Individual visit with expert healthcare provider on unmedicated childbirth................................ 1 2 3 62 Individual visit with expert healthcare provider on epidural, spinal, general anesthesia..................... 1 2 3 63 Opportunity to discuss pain relief options with obstetric provider..................................... 1 2 3 64 Hands-on exposure (example: epidural catheter, birthing ball, etc.)..................................... 1 2 3 65 9. Of the information you received about pain relief options for labor and delivery in the prenatal clinic or hospital, what did you find most beneficial? Page 4
10. Of the information you received about pain relief options for labor and delivery in the prenatal clinic or hospital, what did you find least beneficial? 66 11. What suggestions do you have for changes that could be made to the current education provided regarding pain relief options for labor and delivery? 67 12. What type of delivery did you have with this baby? 68 1 Normal, spontaneous, vaginal birth 3 Elective (planned) cesarean section 2 Assisted vaginal birth 4 Emergency (unplanned) (forceps/vacuum) cesarean section 69, 70, 71 72 What type of assistance did you receive for pain relief? (Mark all that apply.) 1 Non-medication forms of pain relief (birthing ball, tub, shower, water papules, massage, etc.) 1 Morphine, or fentanyl type medications through your IV or in a shot form (IM). 1 An epidural and/or a spinal for a vaginal delivery. What type of anesthesia did you receive? (Mark only one.) 1 An epidural and/or spinal for cesarean section 2 A general anesthetic (you went to sleep from the beginning) 3 You had both an epidural or a spinal and a general anesthetic 4 Other, please specify: Page 5
13. Why did you make the choice to have either an un-medicated or medicated delivery? 73 14. If you used medication, why did you choose the pain relief option that you did? 74 15. How much was your choice for pain relief influenced by your healthcare providers, with 0 being not at all influenced and 10 being extremely influenced? 75-76 0 1 2 3 4 5 6 7 8 9 10 Not at all influenced Extremely influenced 16. How much was your choice for pain relief influenced by your friends and family, with 0 being not at all influenced and 10 being extremely influenced? 77-78 0 1 2 3 4 5 6 7 8 9 10 Not at all influenced Extremely influenced 17. Which healthcare provider had the most influence on your pain relief choice? 79 1 obstetric provider (OB consultant, resident, family medicine provider) 2 nurse midwife 3 nurse 4 anesthesia provider Page 6
18. Which of the following best describes you? 80 1 White or Caucasian 2 Hispanic or Latino 3 Black or African American 4 American Indian or Alaskan Native 5 Asian Pacific Islander 6 Other, please specify: 19. What is the highest grade or level of school you have completed? 81 1 8th grade or less 2 Some high school 3 High school graduate or GED 4 Vocational, technical, or business school 5 Some college or associate s degree (including community college) 6 Four year college graduate (bachelor s degree) 7 Graduate or professional school 8 Other, please specify: 20. What is your age? 82-83 1 Less than 25 2 26 to 30 3 31 to 35 4 36 to 40 5 41 to 45 6 46 to 50 7 51 to 55 8 56 to 60 9 61 to 65 10 66 or more Page 7
21. What is your average yearly income before taxes? 84-85 1 Less than $20,000 2 $20,001 to $29,999 3 $30,000 to $39,999 4 $40,000 to $59,999 5 $60,000 to $79,999 6 $80,000 to $99,999 7 $100,000 to $124,999 8 $125,000 to $149,999 9 $150,000 to $199,999 10 $200,000 to $249,999 11 $250,000 to $299,999 12 $300,000 or more 22. May we contact you to ask for additional input/feedback regarding your experience? 86 1 No 2 Yes If yes, please provide your contact information: 87 Name: Address: City: State: Zip: Telephone: E-mail: Thank you for completing the survey. Your feedback will provide valuable information that will be used in the development of future patient education materials. Page 8