DNP SCHOLARLY

PROJECT: A WORK
IN PROGRESS
Erin Biscone, RN, CNM
Emory University
Nell Hodgson Woodruff School of Nursing

CREATE A
CULTURE OF
RESPECT FOR
PATIENTS,
THEIR
FAMILIES,
AND
HEALTHCARE
WORKERS
IMPROVE
SAFETY,
QUALITY,
AND PATIENT
SATISFACTION

Idea one: Transform

the OB triage area

INITIAL
LITERATURE
REVIEW

Bergs, J., Verelst, S., Gillet, J.-B., Deboutte, P.,

Vandoren, C., & Vandijck, D. (2014). The number
of patients simultaneously present at the
emergency department as an indicator of unsafe
waiting times: A receiver operated curve-based
evaluation. International Emergency Nursing,
22(4), 185-189. doi:
http://dx.doi.org/10.1016/j.ienj.2014.01.002
Hosek, C., Faucher, M. A., Lankford, J., &
Alexander, J. (2014). Perceptions of care in women
sent home in latent labor. MCN Am J Matern Child
Nurs, 39(2), 115-121. doi:
10.1097/NMC.0000000000000015
Paul, J., Jordan, R., Duty, S., & Engstrom, J. L.
(2013). Improving satisfaction with care and
reducing length of stay in an obstetric triage unit
using a nurse-midwife-managed model of care.
Journal of Midwifery & Women's Health, 58(2),
175-181. doi: 10.1111/j.1542-2011.2012.00239.x
Persson, E., & Mtt, S. (2012). To provide care
and be cared for in a multiple-bed hospital room.
Scandinavian Journal of Caring Sciences, 26(4),
663-670. doi: 10.1111/j.1471-6712.2012.00976.x

TRANSFORM
THE OB
TRIAGE AREA

I am choosing this problem because I believe

it is the area in our hospital that is in need of
the most improvement that would have the
largest impact on the most number of women
and their families.
It is important I do this project because
woman-centered care is the very essence of
midwifery. Nothing about OBI is designed for
the convenience, comfort, or of the women
who are cared for there.
Challenges in taking on this problem include
planning for times of high volume, and
resistance from the nursing staff or other
disciplines. In addition, the project might have
limited impact without changes in the space.
Early findings from the literature review
suggest that there is not much written
specifically about multi-bed triage for OB. In
general, women want the ability to move and
eat in early labor, and privacy is a concern for
patients who are in a multi-bed room. In
addition, system-wide change is needed to

HELPS
WOMEN
RELAX
GIVES THEM
A SENSE OF
CONTROL
REDUCES
AND
DISTRACTS
THEIR PAIN
PERCEPTION
(ROOKS,
2012)

Idea Two: Pilot program offering

nitrous oxide for pain control in labor

INITIAL
LITERATURE
REVIEW

Dammer, U., Weiss, C., Raabe, E., Heimrich, J.,

Koch, M. C., Winkler, M., . . . Kehl, S. (2014).
Introduction of inhaled nitrous oxide and
oxygen for pain management during labour
Evaluation of patients and midwives
satisfaction. 74(07), 656-660. doi: 10.1055/s0034-1368606
Likis, F. E., Andrews, J. C., Collins, M. R., Lewis,
R. M., Seroogy, J. J., Starr, S. A., . . .
McPheeters, M. L. (2014). Nitrous oxide for the
management of labor pain: a systematic
review. Anesth Analg, 118(1), 153-167. doi:
10.1213/ANE.0b013e3182a7f73c
Pita, C., Pazmio, S., Vallejo, M., SalazarPousada, D., Hidalgo, L., Prez-Lpez, F., &
Chedraui, P. (2012). Inhaled intrapartum
analgesia using a 5050% mixture of nitrous
oxideoxygen in a low-income hospital setting.
Archives of Gynecology and Obstetrics,
286(3), 627-631. doi: 10.1007/s00404-0122359-6
Rooks, J. P. (2012). Labor Pain Management
Other Than Neuraxial: What do we know and

PILOT
PROGRAM
USING
NITROUS
OXIDE FOR
LABOR PAIN

I am choosing this problem because it would be

a high-profile project that would get attention,
and provide women with a safe, patientcontrolled pain control option.
It is important I do this project because our
hospital is a teaching hospital and many of the
epidurals do not work well. Additionally, Latina
women are very suspicious of epidurals, and all
have friends who blame very problems on the
epidural they received in labor.
Challenges in taking on this problem include
possible expenses and getting approval from the
hospital to have nitrous oxide in the labor rooms.
Early findings from the literature review suggest
that there have not been enough quality studies
done to establish the efficacy of Nitrous Oxide in
labor. Studies have shown that with a valve to
cut off the flow of NO2 when it is not being
actively inhaled, and scavenging equipment to
remove NO2 from the room, it is safe. Most
women who use it would use it again.

WHICH TO CHOOSE?

Nitrous Oxide in
Labor

Transform OBI