Patient Education Regarding Analgesic Options for Labor ... · Handout to Accompany Poster...

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

Evidence*

Level of Effectiveness**

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

Resource Anticipated Cost

Needs Assessment Questionnaire: question

development, layout and printing,

including pre-posted envelopes

(assistance from Survey Research

Center)

$1,100.00

Data Processing $650.00

Statistical Analysis (assistance from

department of biostatistics)

$750.00 - $1500.00

Patient Education

Module

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 pre-

gastrointestinal 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 decision-

making 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 Extremely informed well informed

Page 1

5. From which of the following sources did you receive information about pain relief options for labor and delivery, and how helpful were they?

DID YOU LEARN FROM...

HealtHcare Providers No Yes

tt

Very Somewhat Not at all helpful helpful helpful

t t t 22 : 34 Your anesthesia team. . . . . . . . . . . .0 1 if yes,

how helpful was it 1 2 3

23 : 35 Your certified nurse midwife . . . . .0 1 if yes, how helpful was it 1 2 3

Your physician (obstetrician or 24 : 36 family medicine provider) . . . . . . .0 1 if yes,

how helpful was it 1 2 3

25 : 37 Your labor and delivery nurse . . . .0 1 if yes, how helpful was it 1 2 3

26 : 38 Family/Friends . . . . . . . . . . . . . . . . . . .0 1 if yes, how helpful was it 1 2 3

27 : 39 education classes . . . . . . . . . . . . . . . .0 1 if yes, how helpful was it 1 2 3

otHer resources

28 : 40 Pamphlets. . . . . . . . . . . . . . . . . . . . .0 1 if yes, how helpful was it 1 2 3

29 : 41 Internet . . . . . . . . . . . . . . . . . . . . . . .0 1 if yes, how helpful was it 1 2 3

30 : 42 Books . . . . . . . . . . . . . . . . . . . . . . . .0 1 if yes, how helpful was it 1 2 3

31 : 43 DVD’s . . . . . . . . . . . . . . . . . . . . . . . .0 1 if yes, how helpful was it 1 2 3

32 : 44 Computer programs. . . . . . . . . . . . .0 1 if yes, how helpful was it 1 2 3

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 anxious or nervous.

Prior to receiving information about epidurals, how anxious or nervous 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 anxious or nervous anxious or nervous

Prior to receiving information about epidurals, how anxious or nervous were you about the thought of having an epidural?

47-48 0 1 2 3 4 5 6 7 8 9 10


After your received information about epidurals, how anxious or nervous were you about the pain associated with labor and delivery?

49-50 0 1 2 3 4 5 6 7 8 9 10


After you received information about epidurals, how anxious or nervous were you about the thought of having an epidural?

51-52 0 1 2 3 4 5 6 7 8 9 10


If you were to have another baby, how anxious or nervous would you be about the pain associated with labor and delivery?

53-54 0 1 2 3 4 5 6 7 8 9 10


If you were to have another baby, how anxious or nervous would you be about the thought of having an epidural?

55-56 0 1 2 3 4 5 6 7 8 9 10


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 how helpful 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

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?

65

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 Extremely influenced 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 Extremely

influenced 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

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

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


19. What is the highest grade or level of school you have completed?


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

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