NURS 6051 N-25 Transforming Nursing and Healthcare through Technology
Week 4 Assignment
The Laboring Epidural
An epidural is often the most requested form of pain management for laboring patients in the facility where I work. There is often concern from patients, family members, and healthcare providers as to the safety of an epidural for the laboring patient and unborn baby. The purpose of this paper is to present a clinical question regarding epidurals for laboring patients, and explain how I related the research information to advance through the nursing informatics (NI) concepts of data, information, knowledge, and wisdom. The steps taken, databases searched, and keywords searched, to obtain this information, will be explained in the following pages.
To develop the question to be the focus of my research, I considered my patient population which is laboring patients. The most requested intervention for the elimination of pain is the administration of epidural anesthesia. Patient concerns regarding an epidural are the safety of the epidural for themselves and their baby. The desired outcome is the elimination of pain while in labor. After considering all information, the clinical question that I formulated is as follows: Is the administration of epidural anesthesia safer, for all laboring patients and their unborn infants, than other forms of anesthesia to manage pain during labor?
To answer the question that I formulated, I went to the Walden Library. Before any research article search, it is important to determine keywords to use. Keywords are entered into the search engine, to help narrow down the pursuit of the topic, to give maximum results (Stekel, 2011). The Keywords used to identify articles relevant to my research were “epidural anesthesia”, and “labor*” and “safety”. Searching for articles by topic, I chose the nursing subject and nursing and health databases to bring me to a list of options to choose from for the database search. The database search option that is my “go to” is the CINAHL & MEDLINE Simultaneous Search. During my research, I explored in the CINAHL & MEDLINE Simultaneous Search, OVID, and ProQuest Health & Medical Complete. The ProQuest Health & Medical Complete database resulted with the most articles that were relevant to my research. Using the advanced search options I was able to narrow down my results by searching for articles written in English, published between the years 2000-2016, be peer-reviewed and have full text available. By following this process, I found seven articles with information to help answer my question.
The development and expansion of clinical information can be broken down into four concepts; data, information, knowledge, and wisdom (McGonigle & Mastrian, 2015). The data in my research is the basic information that is objective and does not need interpretation (McGonigle & Mastrian, 2015); gender, patient age, and gestational age. The information utilized to interpret and organize the research includes vital signs, past medical history, allergies, fetal heart tones, the patient reported pain scale, cervical dilatation, and patient compliance. By taking the data and the information of the research, I was able to identify how this information related to positive or negative outcomes of epidural placement, resulting in gained knowledge to answer my clinical question. Understanding when and how to use the knowledge gained by researching the question of the safety of epidural anesthesia represents acquired wisdom.
Nursing informatics can be used to gain wisdom. Electronic health records (EHR) are utilized by nurses and other healthcare professionals to obtain information regarding patients to develop a plan of care. The past medical history, allergies and patient vital signs are all essential pieces of information needed before determining if a patient can receive an epidural during labor. Fail-safe pop-ups can be incorporated into the EHR that interprets patient information to identify non-qualifiers that prevent the epidural procedure. Utilizing this knowledge and understanding the adverse outcomes, that can occur when information is disregarded, and the epidural is placed, demonstrates the clinical wisdom of the healthcare provider.
The ACOG Committee on Obstetric Practice recognizes that “labor results in severe pain for many women. There is no other circumstance in which it is acceptable for a person to experience untreated severe pain, amenable to safe intervention, while under a physician’s care” (Chichester, Hoffman, Colmorgen & Shlossman, 2010). Most comparisons to the epidural, for safe management of labor pain, are made with IV opioids. With opioid administration there is an increased risk of low Apgar’s, thought to be a result of the crossing of the opioid through the placental barrier, something that does not occur with an epidural (Sultan, Murphy, Halpern, & Carvalho, 2013). The knowledge that the RN and Anesthesia MD or CRNA use to interpret the patient information, co-morbidities and stages of labor allow them to understand a patient’s particular situation to determine if an epidural can be safely placed. Patient evaluation and education are necessary for any invasive procedure.
While reviewing articles found in the Walden Library, I was able to able to expand my knowledge regarding the question “Is the administration of epidural anesthesia safer, for all laboring patients and their unborn infants, than other forms of anesthesia to manage pain during labor?” I identified the continuum of data, information, knowledge, and wisdom in the clinical setting and how nursing informatics applies to this continuum. I also deduced that even with the education of risk factors, a patient will request to receive the epidural, when given the choice, choosing to endure some negative side effects of the epidural in exchange for pain elimination (Mhyre, 2010).
Chichester, M. L., Hoffman, M. K., Colmorgen, G. H. C., & Shlossman, P. A. (2010). Labor analgesia for patients with preterm premature rupture of membranes.Journal of Perinatology, 30(10), 650-4. doi:http://dx.doi.org/10.1038/jp.2010.18
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.) (pp 131-145). Burlington, MA: Jones and Bartlett Learning.
Mhyre, J. M., M.D. (2010). Assessing quality with qualitative research. Canadian Journal of Anesthesia, 57(5), 402-7. doi:http://dx.doi.org/10.1007/s12630-010-9290-8
Stekel, S. (2011) Academic guides: Keyword searching: Finding articles on your topic: Searching basics. Available at: http://academicguides.waldenu.edu/library/keyword#5628348 (Accessed: 28 March 2016).
Sultan, P., M.B.ChB., Murphy, C., M.B.B.Ch, Halpern, S., M.D., & Carvalho, B., M.B.B.Ch. (2013). The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: A meta-analysis. Canadian Journal of Anesthesia, 60(9), 840-54. doi:http://dx.doi.org/10.1007/s12630-013-9981-z