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

3. 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

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

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

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

7. 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

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

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

10. The Research on Supportive Care Hodnett 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

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

12. 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)

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

14. Section 1: Supportive Care - Quiz True or False? 1.Maternal satisfaction in childbirth is most influenced by the type of delivery (i.e. spontaneous vaginal birth versus C/S). TF 2.A nurse’s values related to birth can influence her/his capacity to provide supportive care in labour. TF 3.Supportive care in labour includes giving information to women and their support people. TF

15. Section 1: Supportive Care – Answers to Quiz 1.Maternal satisfaction in childbirth is most influenced by the type of delivery (i.e. spontaneous vaginal birth versus C/S). TF 2.A nurse’s values related to birth can influence her/his capacity to provide supportive care in labour. TF 3.Supportive care in labour includes giving information to women and their support people. TF

16. 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

17. 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)

18. Ourselves and Our Environments Woman and family: Knowledge, expectations, history Nurse: Personal history and professional experience Environment: Staffing, institutions, interprofessional relationships

19. 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

20. 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

21. 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

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

23. 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?

24. 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

25. 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?

26. 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)

27. 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).

28. Personal & Environmental Scan 1.How does your work environment measure up? 2.Where do you ‘fit’ in helping to promote or limit supportive care practices? 3.Where are the opportunities for change Within the environment? Within yourself?

29. Section 2: You & Environment - Quiz According to research, barriers to providing supportive care include: a)Availability of anesthesia b)Inadequate time c)Caregiver attitudes d)All of the above

30. 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

31. Section 2: You & Environment - Quiz Comprehensive education and training ensures that all nurses will provide the same degree of supportive care. TF

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

33. 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

34. 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.carcp@iwk.nshealth.ca THANK YOU!