Book Review High-Touch Nursing Care During Labor - DOC - DOC by qcq15579


									Book Review: High-Touch Nursing Care
During Labor
Volume 34 Issue 3 Page 271-272, September 2007

To cite this article: Barbara A. Hotelling MSN, LCCE, CD(DONA) (2007)
High-Touch Nursing Care During Labor
Birth 34 (3), 271–272.

High-Touch Nursing Care During Labor

      Barbara A. Hotelling, MSN, LCCE, CD(DONA)112112 Bretton Drive
       Rochester Hills, Michigan 48309, USA
       2112 Bretton Drive
       Rochester Hills, Michigan 48309, USA

AWHONN & InJoy Videos, 2006
Volume 1: Admission Assessment, 37 minutes
Volume 2: First Stage Labor Support, 40 minutes
Volume 3: Second Stage Labor Support, 36 minutes
DVD/VHS, $999.95

In today’s economy, hospital spending on continuing education is limited yet the
challenges remain in closing the gap between evidence and practice. The Association of
Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and InJoy Videos have
presented caregivers with a solution. High-Touch Nursing Care During Labor is designed
to provide nurses in the labor and birth setting with the theoretical knowledge to
implement physical comfort measures, emotional support, and patient teaching from a
woman’s admission to the unit until the birth of her baby.

The evidence-based information in these three videos can be used as group or
independent study, offers contact hours, promotes cultural sensitivity, and shares clinical
tips from renowned perinatal nurse specialist Kathleen Rice Simpson. The information
can be presented in small increments using the appropriate modules for the time available
and allowing nurse educators flexibility in updating the nursing staff. Expanded
information on selected topics is presented in the forms of teachable moments, clinical
tips, and research in action. Teachable moments highlight opportunities for teaching the
woman and her supporters and often show role plays. Clinical tips provide additional
information on the high-touch approach to medical procedures or facilitating patient
comfort. Research in action provides the evidence base for practice recommendations.
Graphic illustrations are exemplary, and nurses visualize the information as real nurses
support women in actual labor situations. At the end of each module, case studies provide
nurses with an opportunity to discuss implementation of what they have just learned.

Volume I: Admission Assessment

Nurses are instructed to create an early positive connection with the hospitalized mother.
Fear is to be diminished by giving more control to the mother in pain management,
positions, privacy, and obtaining permission before proceeding with the vaginal
examination. Admission criteria reflect the research that more positive outcomes occur
when the mother is admitted in active rather than latent labor. However, only general
guidelines for admission are given rather than a solid definition of the criteria for
admission. Psychosocial assessments are both discussed and demonstrated in the
teachable moments using mothers in real labor situations. Nurses are given suggested
questions to ask to determine the mother’s cultural preferences, some examples of which
are listed while cautioning the viewer that not all women in an ethnic group will share
these preferences. Respect for birth plans and doulas is encouraged, and the clinical tips
for working with women with hearing or language challenges are invaluable.

Volume II: First Stage Labor Support

The recommendations in this video are evidence-based and suggest using nonmedical
techniques that promote optimal labor. Food and fluids are recommended for the
mother’s caloric needs and hydration. Nurses are instructed to remain with the laboring
woman as much as possible and not to just be in the room but to be present for the
woman. Somatic, behavioral, and physiologic cues to anxiety are listed so nurses can
adequately assess and treat. Evaluation and assessment tools nurses may have never
considered are asking if the comfort measure is helping the mother and asking "What was
going through your mind during that last contraction?" The benefits of limiting the
number of interventions, avoiding unnecessary staff in the room, and providing adequate
adult support for children attending births are described. This research tip focuses on
Ellen Hodnett’s doula studies and emphasizes ways to support doulas with rest, food, and
fluids. Frequent position changes are encouraged and viewers learn the benefits of side-
lying, upright and forward-leaning positions and pelvic rocking, walking, and stair-
climbing movements.

The clinical tip concerns the use, cleaning, and inflation of the birth ball. Fetal
monitoring should not interfere with movement and positions, even with the use of
hydrotherapy, and the American College of Obstetricians and Gynecologists’
recommendations for intermittent auscultation are reviewed. The last module presents the
physiologic basis for how nonpharmacologic pain relief methods work with the positive
effects and timing of initiation for massage, breathing techniques, attention focusing,
distraction, heat, cold, and hydrotherapy. Mentioned briefly are hypnosis, acupressure,
aromatherapy, vocalization and back pain relief measures, such as back pressure, TENS,
and intradermal water blocks.

Volume III: Second Stage Labor Support

The goals of this volume are to follow evidence-based guidelines in promoting positions
for pushing, giving supportive care to the entire family, and facilitating infant attachment.
Upright and side-lying positions are recommended as well as spontaneous pushing when
the woman feels the urge. Nurses are encouraged to promote instinctive bearing down
instead of the age-old and dangerous Valsalva pushing. Counting to 10 and coached
pushing are not recommended.

The clinical tip here is the nurse’s action in the event of a nonreassuring fetal heart rate.
AWHONN and InJoy recommend left side positioning; stopping the oxytocin, oxygen,
and intravenous fluid bolus; and for the mother to stop pushing. For the mother who has
epidural analgesia, delayed pushing until the fetal head presents on the perineum is the
recommendation. The producers recognize that no single best position for labor and birth
exists for all women and discuss and demonstrate upright, productive positions. Factors
inhibiting pushing efforts include a teachable moment of a nurse exploring with a woman
her fears of pushing and birth. The clinical tip includes many comfort measures for
reassuring and physically supporting the woman in second stage.

Birth and breastfeeding activists will be happy to know that this teaching series
recommends no separation of the mother and baby at birth. Better practices for shoulder
dystocia are recommended than the dangerous fundal pressure that is still used in some
institutions today. Nurses demonstrate assessment of the baby while on the mother’s
chest, with an environment of dim lights, minimal investigation, low noise level, and
privacy for the new family. Radiant warmers are to be used only if medically indicated.
The final message is for nurses to plant seeds of accomplishment in the mother’s mind
and that nurses are powerful in their abilities to shape positive birth memories.

Clearly the price and the information exclude nonmedical viewers of these three DVDs.
AWHONN has found a way to promote the message of family-centered nursing care of
the laboring and birthing woman to those who provide the services and who have the
power to practice evidence-based birth methods that lead to healthy families and a
healthy society. Consumers and nonmedical providers of care of birthing families can
rejoice in the messages this set of DVDs promotes.

Barbara A. Hotelling, MSN, LCCE, CD(DONA)

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