Date of Award

2022-05-28

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN Chairperson; Joseph F. Burkard, DNSc, CRNA Committee Member; Jane Georges PhD, RN Committee Member

Keywords

Nursing, Labor, Pain, Anesthesia, Remifentanil, Patient controlled analgesia

Abstract

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the success of RPCA for labor pain.

Method: Mixed methods approach. Quantitative. Data were extracted from electronic health records and provider interviews. Parturients sorted in one of three groups, (1) no opioid (n=83), (2) traditional opioid (n=48), and (3) RPCA 9 (n=13), were compared on pain scores, side effects, and adverse events. Results: Both traditional opioid administration and RPCA showed significant reduction in pain scores when measured against the no opioid group using the Mann-Whitney U (Z = -3.514, p < 0.001; Z = -2.064, p = 0.039). Chi square analysis indicated grouping was associated with increased likelihood of receiving treatment for nausea and vomiting (χ2 = 21.178, p < 0.001, df = 2) and desaturation events (χ2 = 53.394, p < 0.001, df = 2). No significant association was seen with pruritis treatment (χ2 = 5.264, p = 0.072, df = 2) or lower APGAR score (χ2 = 1.329, p = 0.515, df = 2).

Qualitative investigation was based in the phenomenological method via individual semi-structured interviews (n=8) to gain an understanding of providers’ attitudes toward labor pain management, approach to labor pain management, and perceived or actual barriers to the implementation of the novel RPCA technique. Four themes emerged: Respect for Choice, Shielding from Family Influence, Barriers to the Implementation of a New Technique, and Overall Satisfaction with RPCA.

Conclusions and Implications: RPCA was supported by staff members at this clinical site, an indicator effective education and implementation plans are likely to achieve support. Recommendations for practice are discussed.

Document Type

Dissertation: Open Access

Department

Nursing

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