The Coping With Labor Algorithm: An Alternate Pain Assessment Tool for the Laboring Woman


  • Leissa Roberts DNP, CNM,

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    • Leissa Roberts, CNM, DNP, is an Associate Professor (Clinical) and the Clinical Director of the Nurse-Midwifery and Woman's Health Nurse Practitioner Program at the University of Utah, Salt Lake City, UT. She is also the Executive Director of the many other Faculty Practices at the College of Nursing.

  • Brenda Gulliver RN, MS,

    1. Clinical Nurse on Labor and delivery at the University of Utah Hospital, Salt Lake City, UT.
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  • Janet Fisher RNC,

    1. Faculty Member and researcher at the University of Utah College of Nursing, Salt Lake City, UT.
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  • Kristin G. Cloyes PhD, RN

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University of Utah, College of Nursing, 10 S. 2000 E., Salt Lake City, UT 84112-5880. E-mail:


The documentation of pain in the labor and delivery setting is one of the essential tasks of all health care providers who care for women in labor. The Joint Commission standards mandate regular pain assessments, but compliance with this mandate in the highly unique patient population of laboring woman is problematic when using the standard 0 to 10 Numeric Rating Scale. Labor pain is always unique given the various contributing physiologic, emotional, social, and cultural components. This article describes the work of a process improvement group to create an alternative pain assessment tool named the Coping With Labor Algorithm. The group, consisting of nurses and nurse-midwives, used the FOCUS format and Deming's “Plan, Do, Check, and Act” cycle to create a formalized assessment tool for use with laboring women. The Coping With Labor Algorithm is currently in use in the labor unit of a large tertiary care facility, which successfully passed a Joint Commission inspection while using the coping algorithm. The value of the coping algorithm is two-fold: it provides a mechanism for pain documentation, and it provides nursing care suggestions for the laboring woman. This article reports nurses' perceptions of the tool.