Supportive Care in Labour part 1

Supportive Care in Labour:

Part 1Maternal Newborn Orientation Learning ModuleSeptember, 2011

1Introduction and ObjectivesPart 1: Background, research, you and your environmentPart 2: Assessing and Assisting Learning Objectives: Explain benefits of supportive care in labourIdentify factors influence supportive care

2Section 1:

What is Supportive Care?Emotional SupportPhysical Comfort MeasuresInformation/AdviceAdvocacySupport people(Hodnett 1996; Simkin, 2002)

Supportive Care: Emotional supportContinuous presencePraiseDistractionReassuranceVisualization and Attention focusing

4Supportive Care: Comfort MeasuresNon-Clinical touchPositioningHydration and NutritionPersonal hygieneCounter Pressure and MassageHydrotherapy

5Supportive Care: Information, AdvocacyInformationWhats happening, what to expect, suggestionsCoaching in breathing, relaxationInterpreting medical jargonAdvocacySupporting the womans decisionsInterpreting the womans wishes to others

6Supportive Care: Support PeopleRole modelingEncouragementPraiseProviding an opportunity for respite

7Section 1:

Why Supportive Care?Birth is not just another day; memories of birth last a lifetime (Simkin, 1991)

8The Research on Supportive Care

Hodnett et al., 2011Women who receive support in labour are more likely to: Give birth spontaneously and vaginallyHave a shorter laborBe satisfied with their birth experience Choose regional analgesia less frequently Have a baby with a higher 5-minute Apgar score

Nurses and Supportive CareNurses influence on the womans experience of childbirth Maternal satisfaction depends on the quality of relationships with caregivers

10Supportive Care:

Influencing FactorsInstitutional policies and organizational barriersUnit cultureValues and attitudesTraining, education, orientation and mentoring(Ballen & Fulcher, 2006; Hodnett et al.,2007; Payant et al., 2008; Simmonds, 2010)

The Research:

SummaryClinical benefits and no known harm http://childbirthconnection.org/pdfs/CochraneDatabaseSystRev.pdf Nurses need:Education and mentoringSupportive work environmentsCommitment

12Section 1:

Supportive Care - QuizTrue or False?Maternal satisfaction in childbirth is most influenced by the type of delivery (i.e. spontaneous vaginal birth versus C/S). TFA nurses values related to birth can influence her/his capacity to provide supportive care in labour. TFSupportive care in labour includes giving information to women and their support people. TF

Section 1:

Supportive Care Answers to QuizMaternal satisfaction in childbirth is most influenced by the type of delivery (i.e. spontaneous vaginal birth versus C/S). TFA nurses values related to birth can influence her/his capacity to provide supportive care in labour. TFSupportive care in labour includes giving information to women and their support people. TF

14Section 1:

Take Home PointsBirth is not just another daySupportive care is beneficialNurses value relationships with labouring women and familiesIndividual as well as external factors can influence provision of supportive care

15Section 2:

You and Your EnvironmentStaffing, policies and technology are possible barriers to providing supportive care(Payant et al., 2009)BUT.Nursing practice varies between nurses in the same environment (Radin, 1993)

16Ourselves and Our Environments

Supportive Care:

Influencing Factors - Woman and FamilyKnowledge: What does she know? What has she read or seen or heard?Expectations:What is important to her and why?History:Work and life experience, previous birth experience, cultural frame of reference, relationships

18Supportive Care:

Influencing Factors - EnvironmentStaffing and managementExpectations of unit managers, unit acuity, and unpredictabilityInstitutionsEfficiency, technology and risk orientationInter Professional CollaborationTeamwork, respect and clear roles

19Supportive Care:

Influencing Factors - NurseProfessional training and experienceTraining and orientation: PreceptorYears of experience as RN; in birth unitPersonal historyExperience of birthExperiences with pain, hospitalizationAge, Family, Cultural background

20Nurses: Seeing and respondingDo we all see birth the same way?

Whats happening?

What nursing actions are required?

21What do you see?Whats happening?

Is this woman coping/not coping? How can you tell? What might you need to do to support this woman?

22Believing is seeing..Nurses saw.A woman who was coping wellA potentially risky situationAn emergency situation that necessitated immediate intervention by the nurse

23What did you see?What experiences may have influenced your first impressions?Did your attitudes or experiences with pain affect your interpretation of coping?How does who you are impact what you see and do?

24The Environment of CareEnvironmental influences:Staffing levelsThe physical lay-out of the unitNursing leadershipCharacteristics of the families/communityRelationships with physician and nursing colleagues(Carlton, Callister, Christiaens & Walker, 2009)

25Environments that WorkAttitudes: Birth as normalStrong leadership and teamsCommitment to evidence-based practiceCommunication - sharing informationManaging change (Ontario Womens Health Council, 2000).

26Personal & Environmental ScanHow does your work environment measure up?Where do you fit in helping to promote or limit supportive care practices?Where are the opportunities for changeWithin the environment?Within yourself?

Section 2:

You & Environment - QuizAccording to research, barriers to providing supportive care include:Availability of anesthesiaInadequate time Caregiver attitudesAll of the above

Question 1 - Answerc) caregiver attitudes

Rationale:Women choose anesthesia less often when provided continuous supportive care, regardless of availability;Nurses tend to provide more supportive care when units are busy

Section 2:

You & Environment - QuizComprehensive education and training ensures that all nurses will provide the same degree of supportive care.TF

Question 2 - AnswerFalse

Rationale:Nurses personal and professional histories and experiences influence approach to providing supportive care, regardless of education and training received.

31Section 2:

Take Home PointsSupportive care is influenced by:Attitudes, values and practicesInstitutional or environment factorsThe interaction between the individual nurses, women and families and the environment of care

32Questions and Comments?We welcome your feedback. Please click on this link to complete a quick evaluation form:http://rcp.nshealth.ca/education/learning-modules/evaluation

You may contact one of the Perinatal Nurse Consultants with RCP at rcp@iwk.nshealth.ca

THANK YOU!