Labor Room Comfort for Pregnant Woman

Comfort is associated by nursing responsibilities with a firm and strong concept. This is given traditionally to patient and families with the use of comfort measures. It is intended to provide comforting measures in order to strengthen the patient and their families. Nurses show proper care because of their abilities. There are no certain measures to the effects of caring however, there some measures to take place in the effects of comfort interventions. (http://www.thecomfortline.com/FAQ.html#beginnings).  Date Retrieved May 20,2010.

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Hospital has been the traditional setting for providing care for people. These individuals were admitted to the hospital and were not discharged until they were fully recovered or had used all of the service available within the hospitals (Fundamentals of Nursing Taylor et al. 1993). Hospital specifically in labor room is in which women in labor are monitored prior to delivery (http://www.pregnology.com/AZ/L/1). Date Retrieved, May 23, 2010

Physical comfort include deficit in physiological mechanism that are disrupted or at risk because of an illness or invasive procedure.Social comfort can get through family, friends co-workers, society and relationship with all of the above. Environmental needs include orderliness, quiet, comfortable, furniture, minimal oders and safety as far as is possible in the setting. Psychospiritual comfort needs include the needs of motivation and trust in order for the family to “rise above” or more peacefully through the discomfort of painful procedure or trauma that cannot be immediately relieved. (Kolcaba).

            Today’s findings, based on responses of the ten NHS health trust, the government perceived that the failure of maternity class in delivery worldly. It has been tested and proven by the women in London. Andrew Lasey, the health secretary said that the new mothers must not put into stress in delivering their babies in aappropriate places. On the year of 2008, there were reported of six cases that has been born on the antecital ward in the hospital of Washington. (http:www.thisisLondon.comVIC) Date Retrieved, February 22, 2010.

 

Birth Center is designed to provide a comforting, safe experience for every patient during labor. The intrapartum nurses on our unit are attentive to specific patient requests and are recognized for their competence and expertise as key health care providers. Their goal is a safe and healthy delivery for every woman. A large percentage of our direct care, in national there were certified staff members that also be called as the Masters which is a certified nurse midwives while the nursing staff are expert and certified on their field. In addition to a highly experienced staff, we also have the pleasure of working with Portland Doulas who are available to support our patients (http://www.ohsu.edu/) Date Retrieved, May 20,2010

 

In the hospital of Cebu Puericulture Center and Maternity House all labor-delivery-recovery rooms (LDRs) are designed to accommodate the birthing process from labor through delivery and recovery of mother and baby. Equipment is moved into the room as needed, rather than moving the patient to the equipped room. Each labor room shall contain a hand washing facility and they do have the access to toilet room. In two labor rooms there is one toilet room and each of it must be controlled in accessing the toilet rooms that has been arranged in nursing station. At least one shower (which may be separate from the labor room if under staff control) for use of patients in labor shall be provided. Windows in labor rooms, shall be located, draped, or otherwise arranged, to preserve patient privacy from casual observation from outside the labor room. Labor room size should be determined by analyzing the needs of the resident(s) to move about the room in a wheelchair, gain access to at least one side of her bed, turn and wheel around the bed, equipment, including chair, stretcher, and IV stand (http://mapiles.com/cebu-puericulture-center-and-maternity-house-inc/) Date Retrieved, May 24, 2010.

The Labor Room of Davao Regional Hospital, Apokon Tagum City is described as one of the most over-populated areas inside the hospital because with or without any complications in pregnancy as long as the woman is already on the first stage of labor will be subjected inside the Labor Room. There were 10 beds available, if a woman belongs to OB ward she will share the bed to another woman; however, if a woman belongs to private rooms she needs not to share the bed to another woman. DRH is considered as one of the tertiary hospitals in the Philippines. In which, this usually has a full complement of services. Since, Davao Regional Hospital cannot say “No” to patients because it is a public, government establishment. They cannot control the increasingly number of patients that were being admitted. Because of this, wards and/or special areas got high census and cannot produce right supplies to the patient causing scarcity.

Statement of the Problem

 

            This study aims to determine the relationship between labor room accomodation and comfort of pregnant women in Davao Regional Hospital, Tagum City.

 

Specifically, this study will answer  the following questions:

 

What is the extent of labor room accomodation in terms of:

1.1 Bed assignment

1.2 Nursing assistance

 

2. What is the level of comfort of pregnant women in terms of:

 

2.1 Physical

2.2 Social

2.3 Environmental

2.4 Psychospiritual

 

   3. Is there significant difference on the extent of labor room accomodation when analyzed according to:

            3.1 Parity

            3.2 Hospital room accomodation

  4. Is there a significant difference on the level of comfort of pregnant women when analyzed according to:

            4.1 Parity

            4.2 Hospital room accomodation

 5. Is there a significant relationship between the extent  of  labor room accomodation and the level of comfort of pregnant women in Davao Regional Hospital.

 

Hypothesis

There is no significant relationship between the labor room accomodation and the level of comfort of pregnant women.

 

Review of Related Literature

            Several and varied sources were used and read to gather relevant literature and research. Professional books, journals, periodicals and related research were found valuable sources of articles worthy of being included in the chapter. These article were valuable in the construction of research instruments. Moreover, they helped  enriched the  contents of such.

 

Bed Assignment

            Hospital address capacity issues in a number of ways. A common approach is to seek licensure for more beds – an expensive investment. Expanding bed capacity through licensure may be necessary. But incorporating a bed management system is a less costly solution that makes better use of existing resources. Bed management systems maximize existing capacity by efficiently moving patients through care delivery.

Bed manages systems provides nurses data necessary to assess performance measures based on activity, thus increasing resiurce of effectiveness.(Technology alleviates bed management woes by: Pam Parker, RN, C, BSN, MBA; Nursing Management 2005) Date Retrieved, May 21, 2010.

Federal health planners propsed a series standards for most of the nation’s hospitals that they said would reduce the number of unneeded beds by 100,00 over the next seven years. The standards, which are aimed at further constraining almost runaway hospital charges, would limit acute care hospital beds to four pero 1, 000 persons throught the country and set a minimum level of 80 percent occupancy in genral hospitals in an effort to force the closing of inefficient and expensive facilities. The specifics of the proposals are also intended in the interests of efficiency to concentrate obstetrical and pediatric services in fewer hospitals and reduce the numbers of high cost (http://news.google.com/newspapers) Date Retrieved, May 23, 2010.

Adjustable beds may be lowered or raised according to their comfort during their labor days. Pregnant mothers who does not want to use pain relievers usually uses their praying abilities and breathing techniques and in that way, they will attain their relaxation they ever wanted. In addition, they will find theirselves to attain their comfort by their way of position. Listening to music such as soft and romantic could help them. Reminiscing the old good memories and thinking things that would make the pregnant mothers smile in order to ease the pain during labor. Being optimistic will help them to manage the pain. (http://www.helium.com/items/1809340-what-to-expect-in-the-labor-room) Date Retrieved, May 23, 2010.

In promoting the relaxation, mobility and calm to the pregnant mothers there has been included some of the radical modifications to the labor room or hospital. Somehow, all women in the labor room spend their time in the bed. (http://www.ncbi.nlm.nih.gov/pubmed/19489810) Date Retrieved, May 23, 2010. Studies have shown that the major reason for lack of mobility is the bed. It only persists that the bed and equipment must have an easy access for interventions to have an appropriate placement for the pregnant women for their comfort. (http://rixarixa.blogspot.com/2009/07/beds-and-birth-rooms.html) Date Retrieved, May 23, 2010.

Nursing Assistance

            When a pregnant trauma patient presents, nurses face and unusual situation; there may be two injured patients, one inside the another. As nurses, we must asses and treat one patient whose body has been anatomically and physiologically change by pregnancy and another whom we cannot see, touch, inserted an IV catheter into, or place an oxygen mask on. It’s essential that we understand the changes associated with pregnancy, which can affect both the nature of an injury and  the body respones to it, and their implication i the assessment and treatment of both patients. (Prauma in pregnancy by: Laura M. Criddle, PWD, RN, CEN, CRN, FAEN) Date Retrieved, May 21, 2010

A certified and expert nurse in Labor Room will do the monitoring, blood exams, vaginal exams, charting and some of the things needed for giving birth.they have the connections toward the physician or midwife to inform and update them. A nurse may also be able to give recommendations for the comfort of the pregnant mothers from positioning to medications. (http://www.helium.com/items/1809340-what-to-expect-in-the-labor-room) Date Retrieved, May 23, 2010.

In today’s hospitals and the extension of their care facilities, the nurse assistants have an important part of a health care team that includes many personnel outside of nurses. They are in need to give care in which they will be able to provide care that they could perform as part of the Nurse Practice Acts. Furthermore, they should be skillful, knowledgeable and has the capability to give the needs of the patient’s condition. Because of their duties, the nurse cannot be able to have an ample time in the room with the patient and thus the nurse assistant will be the eyes and ears of the nurses. (http://en.wikipedia.org/wiki/Certified_nursing_assistant) Date Retrieved, May 23, 2010.

Nurses and midwives are registered with their advanced training in care of obstetric patients. They provide care for about 6% of the birth in the United States and Canada (ventura et al. 1998). Nurse-midwives may practice with physicians or independently and with an arrangement for a physician back up. They usually see low risk obstetrics patients .( Wong et al. 2002)

Nursing assistance has a traditional role and a professional role to fulfil: of clinical assessment of the progress of labor and physical status of mother and fetus. In addition, emotional support is provided by expressing caring and dependability as well as being an advocate for the childbearing woman if needed.  They should display a tolerant non-judgmental attitude, ensuring that the woman is accepted whatever her reactions to labour may be. Women who feel in control of their own bodies, who retain control of thir behavior and who feel they have an active part in decision making have a more satisfactory birth experience. (Green et la 1990, Lindow et l 1998, Wallace et al 1995).

Physical

            Bed rest is often prescribed to pregnant women who shows signs of distress of preterm labor, despite of evidenced of its effectiveness in preverting adverse outcomes. However, the bed rest must include many psychologic and metabolic changes related to musculoskeletal reconditioning. The long term effects of bed rest need to be better understood, and woman who have been on bed rest may need close assessment and rehabilitation to facilitate a return to function and prevent injury (http;//www.medscape.com/viewarticle/436416). Date Retrieved, February 25, 2010.

 

            Back pain during late pregnancy is a constant problem clinically. There is only a little knowledge on the impact of this according to their quality of life in pregnant mothers who manifests back pain. The objective of the study is to know the influence of back pain and physical ability on quality of life in late pregnancy. Irrespective of back pain the pregnant women studied featured lower quality of life (QOL) compared with published data on healthy women. Among the women with back problems, who had the most impaired QOL, the factors affecting QOL were mostly related to physical ability (http;//www.ncbi.nlm.nih.gov/pbmed/10789670) Date Retrieved, February 25, 2010.

 

            All women stated they were physically supported by their female companions. Examples of this physical help included position changing, massaging, and help with walking them to the bathroom. The majority ( n=18) of women stated that the presence of their female relative helped facilitate communicating their wishes and needs to the care providers. The remaining seven women stated that the presence of their female support relative created some minor conflict with midwives, who seemed to view the relatives as interfering with the process of care. (Enkin, M., Keriese, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., et al. (2000).

Previous research has shown that intrapartum practices in Jordan are not always based on the best on the best evidenced in the literature (Khresheh; Kresheh et al., 2007; Sweidan et al., 2008). Women in the sample expected poor support from their healthcare professionals, but when allowed to have support in labor from family members, they readjusted their expectations and had a more positive experience (Dahlen et al., 2008) The physical support provided by the female companion encouraged this sample of pregnant woman to relax. This may reduce theri stress response resulting in an improved pattern of labor ( Taylor et al., 2000).

The physiological dimension addresses factors that affect the client’s physical status, such as rest and relaxation, treatment of medical condtions, level of nutrition and hydration, and elimination of wastes (Kolcaba, 1992a, p. 34). The physical comfort is comprised with all the ramifications in physiological which is associated with medical problems that would or would not result in the physical sensations at once. One of the signifcant examples for the physical comfort are the homeostatic mechanisms such as the fluid and electrolyte balance, blood chemistries, oxygen saturation and other indicatiors of health metabolically. In addition insight from Hamilton in physical comfort which is specifically referred to the theme of positioning. The type of comfort which is important is in ergonomics an associated with function and productivity to increase. (http://books.google.com.ph/books). Date Retrieved, May 23, 2010.

 

Social

            The staff members develop theirfriendliness and caring to achieve the social comfort of the pregnant mothers while in the Labor Room. Thereon, it is included that their approach and attitudes will be needed to continue the care and have a meaningful appointments with the their events and activities. In a way that the patient have their own limitations to support the network. The nurses have the most essential source in social comfort and in the therapeutic use of self that would enhance their comfort which the nurse will realize. The health care providers has the ability to facilitate the the social comfort to the family (http://books.google.com.ph/books). Date Retrieved, May 23, 2010.

Many studies have provided evidence about the positive influences that women may be exposed in receiving the support from the companion during at birth. Sauls 2002 published an overview of the randomized controlled trials related to the effectiveness of labor support on birth and maternal outcomes, reporting that all studies found benefits; the most powerful beneficial effects occurred when support was provided by a birth companion rather than by a health professional. Other studies of laboring have also identified the positive effects of help given by a support companion who was present and provided verbal encouragement (Parpinelli & Osis, 2007).

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A supportive companion has been shown to have a possitive influence on the womans satisfaction with the birth process, and does not interfere with other events, interventions, or neonatal outcome, or breastfeeding. The evidence for the effectiveness of support in labor is strong enough for the World Health Organization to have recommended that woman in labor must be accompanied by people with whom she feels comfortable and trusts ( Bruggemann, , Cecatti, & Neto, 2007)

            There is scarcity of evidence on the effects of the presence of companion during the birth process in developing countries. In a larger part of this current study (Kresheh, 2008), a total of 226 nulliparos women who were admitted to Al-karak government hospital for birth were asked if they wanted a female relative to stay with them. Findings showed significant effects on labor and birth outcomes, with less use of pharmacologic pain relief, and improvement in the womens general perception of their birth experience (World Health Organization. 2007).

Detractors form social comfort include isolation form family, disregard for cultural traditions, uncaring or anxious nursing behaviors, fragmented care, lack of nursing care when desired, poor social support, and limited resources for ongoing care at home after discharge (http://ivythesis.typepad.com/term_paper_topics/2008/12/sample-resear-2.html) Date Retrieved, May 23, 2010.

Environmental

            Clearly, appropriate environment for healing and health promotion is always be considered with asignificant source of comfort by the nurses whio does have the interest in holistic care. Today, the environmental comfort is a key to have a specific design in promoting the physical and ccognitive function of patients who have been hospitalized. (http://books.google.com.ph/books? ) Date Retrieved, May 23, 2010.

There was a study that shows that there were more than 4 million of mixtures chemically in respective homes and businesses in a country with a little potential effect during pregnancy. However,there were only few which have been known as harmful to an unborn babies. Mostly, it have been found in the workplace but not so much as the environmental pollutants in the air and water and also with the chemicals that have been continually used at home that will possess a risk during pregnancy. (http://www.marchofdimes.com/aboutus/681_9146.asp) Date Retrieved, December 19, 2010.

            Pregnant women that could inhale, ingest and/or absorb the chemicals would be hazardous and has the possibilty to harm the unborn baby. Most of the workplace have preventive measures to make sure that this incident won’t happen. They may took some steps in protecting themselves and their babies from the wide source of pollutants and potential risky chemicals which is also used at home (http://www.marchofdimes.com/aboutus/681_9146.asp) Date Retrieved, December 19, 2010.

            Since most of the non-pharmacological methods in relieving th pain will require relaxation in some other way to have an environment that could improve the chance of laboring without needing the medications. Although, the pregnant women will choose to use medication during at labor, the environment will have an important role in the mood. (http://www.birthingnaturally.net/birthplan/options/environment.html) Date Retrieved, December 19, 2010.

Factors in the environment that dtract form pregnant womens’ comfort are cold, noise, chaos, endless bright lights, bad odors, lack of privacy and uncomfortable stretchers, chairs, and beds. Unmet safety need can detract form comfrot and include a lack of properly functioning equipment, security problems, security hazards, inaacurate care poor aseptic/sterile techniques resulting in nosocomial infections and medication or treatment errors. Freeing patients form restraints and retrictive devices such as intravenous lines, noninvasive monitors and intermittent, rather than continuous, monitoring when appropriate (http://ivythesis.typepad.com/term_paper_topics/2008/12/sample-resear-2.html) Date Retrieved, May 23, 2010.

The labor room should be such that the woman is not considered is not constrained by lack of privacy or lack of supports such as cushions and beds from adopting her preferred position. In a hospital environment, it may help to move the labor from its traditional place in the middle of the room, and to place other support such as cushions and birth balls I the room so that the mother is free to roam from one to another as the labor dictates. Low lighting and music of her choice may help the woman to see a safe and secure place to give birth. Minimizing unnecessary intrusion by the other  member of staff is essential.(Fraser et al.2003)

Psychospiritual

Anxiety is a major dtractor form psychospiritual comfort and some include in this context are confusing, incomplete or negative information; threatening diagnoses; fear and the prspect of a change in routine or health status (http://ivythesis.typepad.com/term_paper_topics/2008/12/sample-resear-2.html) Date Retrieved, May 23, 2010.

According to Hamilton the theme of second comfort are self-esteem, which includes their faith in God, independency, relaxation, productivity. These contexts of psychological and spiritual comfort are combined in forming the context of psychospiritual. This comfort is comprises of mental, emotional, and spiritual components of self. It has been evolved to give the meaning of life to an individual which is associated with self-esteem, self-concept, sexuality and relationship to a higher order or being of oneself (Kolcaba, K., 1997).

Parity

Traditionally, aged pregnant women have the chances to have an adverse event in the pregnancy outcome compared to the younger pregnant women. In fact, majority shows that in the literature of medicine in concerning with late childbearing that relates to women ages between 30 to 45 years. Anyhow, research studies have showed that the performance of pregnancy and the outcome of neonatal among the group of mothers with an age of less than 35 years are almost similar to the younger age (Kirz et al., 1985; Ho et al., 1986). Findings constitutes a challenging to the recent definition in advanced maternal age that uses 35 years as the cut-off point with reference to the age-related effects on the pregnancy. There is a higher incidence in primiparous mothers that may be associated in antepartum hemorrhage and hypertensive disorders.

The factors influencing birth experience as acceptable were multiparous women (Para 2-3) in 128 (68.08%) cases; primigravidas in 61 (80.26%) cases, study have shown that the pain threshold of pregnant women differs from the number of birth experiences. Furthermore, labour pain is nearly a universal experience for childbearing women but threshold of this pain varies between individuals (http://jpma.org.pk/full_article_text.php?article_id=2106) Date Retrieved, May 24, 2010.

Hospital room Accommodation 

In some countries, having a companion in labor room is not allowed due to some cultural or other reasons that may affect the perception of pregnant women (policy does not allow, place too crowded, no privacy, bad advice from companion etc). It was discussed and agreed that there is a need for midwives to use their knowledge and scientific evidence available to influence policy in ensuring that companions are not allowed, it can also still be considered. In those countries which allows companion but not permitted in labor ward because they ma be able to give wrong advices. In that sense, midwives were challenged in ensuring that the companion will give an adequate and right information before the labor starts to develop the optimism which will help the pregnant women at labor. http://whqlibdoc.who.int/hq/2005/ICM_report_eng.pdf) Date Retrieved, May 23, 2010.

According to the CHCAA’s interpretation, the Ontario Health Insurance Act requires that public hospital must provide overnight accommodation at the standard ward level at no charge to the patient. In addition, The Canada Health Act states that all Canadians are entitled to the level of accommodation required by the patient’s medical condition at no charge. Funding – including Federal Transfer Payments – for these scenarios is provided to the hospitals by the province (http://www.chcaa.org/education/HospitalWP.pdf) Date Retrieved, May 23, 2010.

 Theoretical and Conceptual Framework

  

In the theory of comfort by Katharine Kolcaba it states that the concept of comfort has a firm association in nursing. Traditionally, the nurse will provide comfort to the patients and their families with an observation of comfort measures. Internationally, the actions of comfort in strengthening the patients and families. If the patients and families were strenghtened with actions of nurses, they can be engaged in seeking health beahvior. (http://www.thecomfortline.com/comfort-theory.html)

 

The researcher anchored this theory in their research since the dependent variable in this research is comfort. Basically the main topic here is about the comfort that the mothers in the labor room are experiencing. every patient in the hospital deserves to have comfort.

 

In this research, the researchers are trying to find out the relationship of lack of beds in the comfort of pregnant women in the labor room of Davao Regional Hospital Tagum City.

 

Figure 1 shows the conceptual framework of the study. It consist of three variables. The Independent variable is the labor room accommodation and the dependent variable is the comfort of pregnant women. The moderators are the parity and ward.

 

 INDEPENDENT VARIABLE DEPENDENT VARIABLE

 

Comfort of Pregnant Women

 

Physical Comfort

Social Comfort

Environmental Comfort

Psychospiritual Comfort

 

Labor Room Accommodation

Bed Assignment

Nursing Assistance

 

 

 

 

 

 

 

 

 

 

 

Parity

Hospital Room Accommodation

 

 

MODERATOR VARIABLE

 

 

 

 

 

 Figure 1 Conceptual Paradigm of the Study

 

Significance of the study

 

            This study will give beneficial and useful information to people in the field of nursing particularly:

 

Pregnant women: the outcome of the study will help them obtain their desired comfort when in labor.

Nurses:  The outcome of the study will give them the knowledge the value of comfort of Pregnant women.

Administration:  The outcome of the study will recognize adjustment to cater and to give genuine care for all the pregnant women.

Student Nurses: The outcome fo the study will assist them to provide more extensive comfort of pregnant women appropriately.

 

Definition of terms

            For easy understanding, in the study the following major terms are herein defined conceptually and operationally.

Labor room accomodation. The labor room should be such that the woman is not considered is not constrained by lack of privacy or lack of supports such as cushions and beds from adopting her preferred position. In a hospital environment, it may help to move the labor from its traditional place in the middle of the room, and to place other support such as cushions and birth balls I the room so that the mother is free to roam from one to another as the labor dictates. Low lighting and music of her choice may help the woman to see a safe and secure place to give birth. Minimizing unnecessary intrusion by the other  member of staff is essential.(Fraser et al.2003). In our study, it refers to the intrapartal care received by the pregnant women in Davao Regional Hospital.

Bed assignment. The staff will show the work of how to work with the bed. The hospital bed is adjustable it could be raised or lowered and it has bedside rails for the patient’s protection. The side rails can be raised for the safety and per request by the patient.. http://www.multicare.org/allenmore/hospital-amenities/ . In our study, beds are classified as to what hospital room accommodation is choosen.

 

Nursing assistance. The Nursing Assistant is an important member of the health care team who often holds a high level of experience and ability, but without qualification is unable to often perform some tasks due to issues of liability and legality. http://en.wikipedia.org/wiki/Certified_nursing_assistant. In our study, it focuses on the maternity care given to the pregnant women.

 

Comfort of pregnant women. According to Oxford Dictionary of English (2007) these refers to the state of physical ease and freedom from pain or constraint; things that contribute to physical ease and well-being. In our study , it refers to the physical and emotional feelings of patients admitted in Davao Regional Hospital.

Physical comfort. The need of patient in admission and discharge. They should be provided with the opportunity of privacy. Their comfort, modesty and emotional support were only secondary issues to treat the disease. http://www.infectioncontroltoday.com/articles/patient-warming-clinical-outcomes.html In our study, it refers to their privacy and how the patient is being accomodated during labor in Davao Regional Hospital.

Social comfort. The health system of materna and child is carried out by its social responsibilities in supporting and protecting the the health of mothers, children and families during the period of labor, it also includes both social and psychological aspects and must take a perspective. The need to recognize the support during the period that would create a strong bonding between the maternal and child that contributes to the mental development of smooth mental of the child. http://www.mhlw.go.jp/english/wp/other/councils/sukoyaka21/3.html. In our study, these refers to the interaction of pregnant women during the labor and the companionship during this period.

Environmental comfort. It i