Identifying labor support actions of intrapartum nurses

The relationship between attitude and self-efficacy of labor support with supportive behaviors from the perspective of midwives

BACKGROUND AND AIM

Effective support given by a midwife during labor and childbirth is associated with numerous positive outcomes. Yet the delivery of such support can be hindered by negative workplace cultures. The purpose of the current study was to examine the relationship between attitude and self-efficacy of labor support and labor supportive behaviors from the perspectives of midwives working in Iran.

METHODS

Midwives (n = 213) employed in the labor wards of selected hospitals in an urban area of Iran participated in this cross-sectional study. Participants were recruited via convenience sampling from December 2016 to September 2017. The data were collected using a personal characteristics tool, the Labor Support Questionnaire, the Self-efficacy Labor Support Scale, and attitudes toward the Labor Support Questionnaire. Descriptive statistics along with multiple linear regression was used for data analysis.

RESULTS

Participants had a supportive behavior score of 74.98 for mean (SD ± 13.39). The informational support dimension had the highest reported score of the supportive behaviors, whereas the tangible support dimension had the lowest score. The mean scores of attitude and self-efficacy toward labor support were 24.79 (SD ± 4.14) and 79.83 (SD ± 13.82). There were also statistically significant correlations between attitude and self-efficacy, and labor support behaviors and its dimensions. Multiple linear regression analysis results indicated that interests in occupation, attitude, and self-efficacy were predictors of labor supportive behaviors.

CONCLUSION

Midwives' level of interest in the profession, attitude, and self-efficacy of labor support were significantly associated with labor support behaviors. Thus midwives' interest in their profession, along with their attitudes and self-efficacy could usefully be developed to enhance their supportive behaviors during labor.

Future career pathways in nursing and midwifery. A Delphi survey of nurses and midwives in South West England

There is growing interest, both nationally and internationally and within healthcare research, regarding future career pathways for nurses and midwives and what these pathways should represent. This paper presents the results of a research project that investigated these issues. A Delphi approach was taken to determine consensus, and consisted of three rounds: round 1 — statementgeneration, rounds 2 and 3 — rating and ranking of statements. The study aimed to discover the extent to which participants agreed about what the key features of a future career pathway should represent. Forty-three nurses and midwives representing a wide range of nurses and midwives participated. Consensus was achieved and 14 key features were identified. The paper concludes by suggesting that these statements will aid and inform stakeholders and decision-makers as to the future direction that career pathways in nursing and midwifery could take.

Factors associated with labor support behaviors of nurses

Labor support is known to support progress of normal labor. Nurses are encouraged to provide labor support yet may encounter barriers to the practice of labor support. The purpose of this secondary data analysis was to examine individual and institutional factors associated with labor support behaviors. Age and experience were individual factors related to labor support. Older and more experienced nurses reported providing more labor support. Institutional factors associated with labor support were lower rates of epidural analgesia use and cesarean surgery. These findings indicate birthing families should understand that the birth environment may influence the care that nurses give during labor. Choosing an environment that supports normal birth may be the best place for receiving labor supportive nursing care.

Supporting patients' birth plans: theories, strategies & implications for nurses

Pregnant women often create birth plans to specify their preferences for their labor and delivery. When nurses implement and advocate for women's birth plans, it increases women's autonomy and decision-making in the birth process and can lead to greater patient satisfaction. This article describes strategies for how nurses can help implement patients' birth plans, and discusses two psychological theories as a base for understanding nurses' roles in advocating for birth plans to improve patients' experiences.

Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers

AIM

This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians.

BACKGROUND

Immunization is an important and effective public health intervention. Understanding immunization providers' attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change.

METHOD

A postal survey was conducted with all immunization providers in British Columbia, Canada, in 2005. The survey elicited data on demographics, practice characteristics, attitudes, perceived social norms and perceived behavioural control related to key immunization behaviours.

RESULTS

Responses were received from 344 nurses and 349 physicians. The response rate was 67% for nurses and 22% for physicians. More nurses than physicians thought that administering all recommended vaccines at one visit was important (89.2% vs. 63.2%P < 0.001); nurses felt more pressure from parents to administer all recommended vaccines (82.4% vs. 48.7%P < 0.001), and nurses were also more likely to intend to give all recommended vaccines at one visit (98.8% vs. 73.8%P < 0.001). Both nurses and physicians thought that their own receipt of influenza vaccine each year was important (88.9%, 87.1% respectively P = 0.65).

CONCLUSION

The foundational work done to develop the survey tool can be used to modify it so that survey findings can be validated according to the Theory of Planned Behaviour. The results could inform the development of behavioural change interventions targeting the identified determinants of immunization provider behaviour.

How caregivers manage pain and distress in second-stage labor

Innovative care interactions are needed when helping a woman who exhibits severe pain or distress during the second stage of labor. We describe how caregivers and laboring women interacted during second-stage labor, with particular attention to how caregivers managed pain and distress. We used observational methods to perform a microanalysis of behaviors from video-recorded data. Pain occurred during labor contractions, and distress (an emotional response to pain) manifested primarily between contractions. Four patterns of women's behavior were identified: 1) no pain or distress, 2) low-level pain and/or distress, 3) focused working, and 4) severe pain and/or distress. Successful care was identified as enabling the woman to maintain herself in any state other than severe pain and/or distress. Particular modes of speech used by the caregiver enabled the attainment of successful care when the woman was not in severe pain or distress. When severe pain or distress existed, innovative caregiving transitioned the woman to another state. Successful intervention strategies included 1) giving innovative directions and 2) "talking down." Ordinary modes of "birth talk" can be used when severe pain or distress is not manifested and when the primary care problem is to assist women with bearing down. Innovative care interactions are needed when faced with severe pain or distress. Managing labor pain is an ongoing focus of clinicians who provide care to women in labor. In addition to pain, women might also experience distress, an emotional response to the labor experience. Whether from choice or necessity, caregivers for laboring women need nonpharmacologic interventions and interpersonal skills that can help women endure labor and give birth. Labor is hard work, and even in precipitous labors most women require assistance. Care given to a laboring woman consists of employing comforting strategies that help her cope with the pain of uterine contractions. The purpose of these comfort strategies is to help the woman find needed resilience during labor. Most cultures have mechanisms for providing this kind of support. In this article, we identify patterns of behavior used by laboring women and describe successful and unsuccessful strategies used by caregivers to help these women deal with pain and distress during the second stage of labor.

Women and their partners' perceptions of the key roles of the labor and delivery nurse

This descriptive qualitative study examined the perspectives of women and their partners regarding the key roles of the labor and delivery nurse during labor and birth.Ten couples were interviewed separately.The data analysis, conducted through independent and team analysis, was both iterative and interpretive. Participants identified four key roles of the labor and delivery nurse: support person, educator, patient advocate, and provider of continuity. Nurses provided both physical and emotional support.As an educator, they normalized the birth experience and served as a coach for the couple. Nurses advocated on behalf of the woman in labor, particularly when there was an adverse event. The continuity of care provided by the nurses wove the above roles into a cohesive whole. Findings provide important information for nursing educators, supervisors, and hospital administrators to reinforce the meaningful roles nurses serve in the labor and birth experiences of women and their partners.

Occupational therapists’ reflection on practice within psychiatric care: A Delphi study

AIM

The aim of this study was to describe the reflections on practice in a group of Swedish occupational therapists in psychiatric care in order to illuminate the present practice and ideas about the future using a Delphi survey of three rounds.

MATERIAL AND METHOD

The sample consisted of 14 occupational therapists in psychiatric care. The answers from the first and second rounds illustrate the wide variation in their practice. The third round points out consensus and disagreements in the domains: professional role, theories in practice, domain of concern, occupational therapy assessment, goal setting/treatment, outcome/evaluation and thoughts about the future. A consensus was reached in all domains, but not regarding competence to treat functional reduction and symptoms, or on the importance of theories for documentation, the choice of a theoretical foundation, and the importance of an evidence-based treatment model, although the theories were seen as supporting practice. Disagreements were found as to the effectiveness of repeated assessments as a means of evaluation. The future for OTs within psychiatric care was looked upon as positive.

DISCUSSION

The results developed from providing a relatively unclear and shallow perspective on OT practice to indicating a depth that shows what occupational therapy within psychiatry can be. During the process it became more and more clear how OTs think and act.

Nurses' intentions to provide continuous labor support to women

OBJECTIVE

To examine the determinants of nurses' intentions to practice continuous labor support.

DESIGN

A descriptive survey based on the Theory of Planned Behavior.

SETTING

A large, urban Canadian hospital with 2 sites and 7,000 births per year.

PARTICIPANTS

Ninety-seven registered nurses from 2 birthing units.

RESULTS

Scores measuring nurses' attitudes, subjective norms, and intentions regarding continuous labor support for women with epidural analgesia were significantly lower than those for women without epidural analgesia (p<.0001). Multiple regression analyses revealed that previous labor support courses, subjective norms, and perceived behavioral control explained 55% of the variance in nurses' intentions to provide continuous labor support to women without epidural analgesia while 88% of the variance in intentions to provide continuous labor support to women with epidural analgesia was explained by subjective norms and attitudes. Subjective norms made the most significant contribution to the variance in nurses' intentions to provide continuous labor support. Top perceived organizational barriers to continuous labor support included unit acuity and method of patient assignment.

CONCLUSION

Nurses' intentions to provide continuous labor support are lower for women receiving epidural analgesia and are influenced by the perceived social pressures on their unit. Nurses view organizational barriers as important factors influencing their ability to provide continuous labor support.

A new way to measure nursing: computer timing of nursing time and support of laboring patients

The goal of this observational, descriptive study was to use an innovative computerized program to measure simultaneous nursing time and support activities during the first stage of active labor. No previous studies have looked at nursing time or support from the view of those in the labor room or have measured multitasking in labor care. A computerized timing program (developed using Microsoft Visual C++ version 6.0) was developed to accommodate time recording of up to seven simultaneous activities for nursing events during labor care. The program was highly usable and effective. It was determined that labor nurses spent an average of 69% of their time out of the patient's rooms and 31% of their time in the room of the active laboring patient. On average, patients received nursing supportive care for 13% of their active phase of labor. While in the room, 41% of the nurses' time was spent in supportive care and 63% was spent in other nursing activities. On average, nurses engage in only one observable activity 70% of the time; two activities, 20% of the time; and three activities, 1.5% of the time. This finding falls short of recommendations for provision of labor support.

Dimensions of professional labor support for intrapartum practice

PURPOSE

To define and describe the dimensions of Professional Labor Support (PLS).

DESIGN AND METHODS

A factor-analytic study was conducted with a random sample of 146 intrapartum nurses in Texas. Nurses' responses to the Labor Support Questionnaire (LSQ) were subjected to principal components analysis and descriptive analysis.

FINDINGS

A six-factor solution indicated the dimensions of PLS: Tangible Support, Advocacy, Emotional Support-Reassurance, Emotional Support-Creating Control, Security and Comfort, Emotional Support-Nurse Caring Behavior, and Informational Support.

CONCLUSIONS

Although the presence of four dimensions was theorized, six dimensions were found. The emotional support dimension was identified by nurses as being an important component of labor support as indicated by the identification of three separate emotional support dimensions.

The Meaning of the Nurse’s Presence During Childbirth

OBJECTIVE

The purpose of this exploratory study was to develop new understandings of what it means to women in labor for a nurse to be present during childbirth.

DESIGN

Hermeneutic inquiry was used to explore the phenomenon of nursing presence during childbirth. The purpose of questioning in hermeneutic phenomenology is to stimulate thoughtful reflection and deeper exploration of the subject's experiences. PARTICIPANTS/ SETTING: Six women from an urban center in Canada volunteered to share their experiences of childbirth through conversations with the research team.

DATA ANALYSIS

Audio-taped, transcribed interviews were analyzed along with the reflections of the research team.

RESULTS

Women attribute multiple meanings to the care provided by intrapartum nurses. However, what stood out in these women's accounts was that a nurse's presence was the way in which a nurse was "there" for them and was a very important part of their childbirth experience.

CONCLUSIONS

Women's experiences of a nurse's presence cannot be understood apart from the institutional structures and work processes that shape their experiences. Further research is needed to explicate how hospital procedures, administrative structures, and medical practices enable or constrain the presence of the intrapartum nurse.

More than support: nursing interventions provided to women in labor

OBJECTIVE

To describe the type and quantity of interventions provided to women in the first stage of labor.

DESIGN

Descriptive, observational.

SETTING

An intrapartum nursing unit in a Pacific Northwest medical center.

PARTICIPANTS

Participants were 24 registered nurses employed on the intrapartum nursing unit and 75 women in labor with singleton pregnancies at 36 weeks or more gestation. Seventy-five 2-hour episodes of care that included one registered nurse assigned to a woman in labor were the units of analysis.

MAIN OUTCOME MEASURES

Observed surveillance, indirect care, and supportive care interventions recorded during the episode of care during the first stage of labor.

RESULTS

Nurses spent an average of 58.9% of the observed time in direct or indirect care of the study patient and provided an average of 169.9 interventions. Nurses spent 31.5% of the observed time providing at least one supportive care intervention with or without a simultaneous surveillance and/or indirect care intervention.

CONCLUSION

Nurses provided supportive care more frequently than previous work sampling studies have suggested. This supportive care was frequently done in conjunction with other, more technical nursing care interventions. Integration of supportive care with other direct and indirect care interventions may offer the best model for providing high-quality intrapartum nursing care.

Labor support: nurses' self-efficacy and views about factors influencing implementation

OBJECTIVE

To develop and evaluate a questionnaire assessing nurses' self-efficacy for labor support and to describe nurses' perceptions of factors assisting and preventing the provision of labor support.

DESIGN

Two surveys completed by participants.

SETTING

Five Canadian hospitals.

PARTICIPANTS

For Phase 1, 81% (55/68) of maternity nurses at one hospital participated; for Phase 2, 88% (152/173) of labor and delivery (L&D) nurses at four hospitals participated.

MAIN OUTCOMES

Phase 1, psychometric properties of a new scale; Phase 2, nurses' self-efficacy for labor support and content analysis of nurses' comments.

RESULTS

Phase 1: The Cronbach's alpha coefficient of the self-efficacy scale was .98, with a test-retest correlation of r(s) = .93. Higher (more positive) self-efficacy scores were found for L&D nurses compared with postpartum nurses, p < .0001. Phase 2: Mean self-efficacy scores for L&D nurses were high (range 86.9 to 92.1 out of 98). Written comments (n = 304) about the influencing factors in each work setting were coded into the following categories: staffing, physical environment, teamwork, management support, and negative staff attitudes.

CONCLUSIONS

Phase 1 provided beginning evidence of the reliability and validity of the Self-Efficacy Labor Support Scale. Phase 2 found that L&D nurses' self-efficacy or confidence to provide labor support was high. Therefore, it is recommended that future attention needs to be focused on factors related to the provision of labor support (staffing, physical environment, teamwork, management support, and negative staff attitudes). Attention to organizational factors is vital if nurses are the professional group to provide the evidence-based practice of continuous support for women in labor.