Purpose for the Program
At the 2007 Association of Women's Health, Obstetrics, and Neonatal Nurses Convention, Brenda Gulliver, RN, Labor and Delivery, University Hospital University of Utah and Leissa Roberts, MS, CNM, Associate Professor, College of Nursing, University of Utah delivered a presentation entitled “Assessing Pain in Labor.” The presentation was an algorithm they developed for the evaluation of labor pain using the Coping/Not Coping clues and actions to help the patient cope with labor. Permission was obtained to bring this Coping/Not Coping algorithm (with the copyright information of the University of Utah Hospital and Clinics printed at the bottom of the algorithm) to Baylor Health Care System. A project was designed to implement this algorithm in the labor and delivery units of Baylor Health Care System.
The need for an improved method to evaluate and chart labor pain was a driving force for bringing the Coping/Not Coping algorithm to the bedside at Baylor Health Care System. The proposed change was to enable nurses to evaluate labor pain in the Baylor Health Care System through evaluation rather than assigning labor pain a number 0 to 10.
Implementation, Outcomes, and Evaluation
After obtaining permission to bring the tool to the Baylor Health Care System, the process of modifying the algorithm to Baylor Health Care System was started, including how the algorithm fits the Joint Commission standards for pain. It was agreed by all who reviewed the algorithm that a pilot needed to be designed in order for the nurses to evaluate the tool prior to the implementation. At the end of the pilot, many positive responses were obtained with no recommendations for change in the algorithm. The only suggested change was to place the charting information on the pain and contraction tabs of the computer charting system. A booklet for patients also was written, which explained the terminology of the Coping/Not Coping algorithm to labor patients. Education of nurses in Baylor's labor and delivery units was developed and the algorithm was implemented. The nurses have positively stated that the algorithm is an effective tool in the evaluation of labor pain through observation of behaviors.
Implications for Nursing Practice
The use of the Coping/Not Coping algorithm gives the nurses of the labor and delivery units the tools to evaluate a patient's labor pain through the evaluation of labor clues. It also gives the patient control over the perception of her labor pain by not assigning a number of 0 to 10.