Supportive Care in Labour: Part 1

Supportive Care in Labour:Part 1 Maternal Newborn Orientation Learning Module September, 2011

Introduction and Objectives • Part 1: • Background, research, you and your environment • Part 2: • Assessing and Assisting • Learning Objectives: • Explain benefits of supportive care in labour • Identify factors influence supportive care

Section 1: What is Supportive Care? • Emotional Support • Physical Comfort Measures • Information/Advice • Advocacy • Support people (Hodnett 1996; Simkin, 2002)

Supportive Care: Emotional support • Continuous presence • Praise • Distraction • Reassurance • Visualization and Attention focusing

Supportive Care: Comfort Measures • Non-Clinical touch • Positioning • Hydration and Nutrition • Personal hygiene • Counter Pressure and Massage • Hydrotherapy

Supportive Care: Information, Advocacy Information • What’s happening, what to expect, suggestions • Coaching in breathing, relaxation • Interpreting medical jargon Advocacy • Supporting the woman’s decisions • Interpreting the woman’s wishes to others

Supportive Care: Support People • Role modeling • Encouragement • Praise • Providing an opportunity for respite

Section 1: Why Supportive Care? Birth is not “just another day”; memories of birth last a lifetime (Simkin, 1991)

The Research on Supportive CareHodnett et al., 2011 Women who receive support in labour are more likely to: Give birth spontaneously and vaginally Have a shorter labor Be satisfied with their birth experience Choose regional analgesia less frequently Have a baby with a higher 5-minute Apgar score

Nurses and Supportive Care • Nurses influence on the woman’s experience of childbirth • Maternal satisfaction depends on the quality of relationships with caregivers

Supportive Care: Influencing Factors • Institutional policies and organizational barriers • Unit ‘culture’ • Values and attitudes • Training, education, orientation and mentoring (Ballen & Fulcher, 2006; Hodnett et al.,2007; Payant et al., 2008; Simmonds, 2010)

The Research: Summary Clinical benefits and no known harm http://childbirthconnection.org/pdfs/CochraneDatabaseSystRev.pdf Nurses need: • Education and mentoring • Supportive work environments • Commitment

Section 1:Supportive Care - Quiz True or False? • Maternal satisfaction in childbirth is most influenced by the type of delivery (i.e. spontaneous vaginal birth versus C/S). T F • A nurse’s values related to birth can influence her/his capacity to provide supportive care in labour. T F • Supportive care in labour includes giving information to women and their support people. T F

Section 1: Supportive Care – Answers to Quiz • Maternal satisfaction in childbirth is most influenced by the type of delivery (i.e. spontaneous vaginal birth versus C/S). T F • A nurse’s values related to birth can influence her/his capacity to provide supportive care in labour. T F • Supportive care in labour includes giving information to women and their support people. T F

Section 1: Take Home Points • Birth is not “just another day” • Supportive care is beneficial • Nurses value relationships with labouring women and families • Individual as well as external factors can influence provision of supportive care

Section 2: You and Your Environment Staffing, 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)

Ourselves and Our Environments

Supportive Care: Influencing Factors - Woman and Family Knowledge: • 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

Supportive Care: Influencing Factors - Environment Staffing and management • Expectations of unit managers, unit acuity, and unpredictability Institutions • Efficiency, technology and risk orientation Inter Professional Collaboration • Teamwork, respect and clear roles

Supportive Care: Influencing Factors - Nurse Professional training and experience • Training and orientation: Preceptor • Years of experience as RN; in birth unit Personal history • Experience of birth • Experiences with pain, hospitalization • Age, Family, Cultural background

Nurses: ‘Seeing’ and responding • Do we all ‘see’ birth the same way? • What’s happening? • What nursing actions are required?

What do you see? What’s happening? • Is this woman coping/not coping? • How can you tell? • What might you need to do to support this woman?

Believing is seeing….. Nurses saw…. • A woman who was coping well • A potentially risky situation • An emergency situation that necessitated immediate intervention by the nurse

What 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?

The Environment of Care Environmental influences: • Staffing levels • The physical lay-out of the unit • Nursing leadership • Characteristics of the families/community • Relationships with physician and nursing colleagues (Carlton, Callister, Christiaens & Walker, 2009)

Environments that Work • Attitudes: Birth as normal • Strong leadership and teams • Commitment to evidence-based practice • Communication - sharing information • Managing change (Ontario Women’s Health Council, 2000).

Personal & Environmental Scan • How does your work environment measure up? • Where do you ‘fit’ in helping to promote or limit supportive care practices? • Where are the opportunities for change • Within the environment? • Within yourself?

Section 2:You & Environment - Quiz According to research, barriers to providing supportive care include: • Availability of anesthesia • Inadequate time • Caregiver attitudes • All of the above

Question 1 - Answer c) 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 - Quiz Comprehensive education and training ensures that all nurses will provide the same degree of supportive care. TF

Question 2 - Answer False Rationale: Nurses’ personal and professional histories and experiences influence approach to providing supportive care, regardless of education and training received.

Section 2:Take Home Points Supportive care is influenced by: • Attitudes, values and practices • Institutional or environment factors • The interaction between the individual nurses, women and families and the environment of care

Questions 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!

Supportive Care in Labour: Part 1