Implementation of Robert's Coping with Labor Algorithm© in a large tertiary care facility.

OBJECTIVE: to implement use of Roberts' Coping with Labor Algorithm© (CWLA) with laboring women in a large tertiary care facility. DESIGN: this was a quality improvement project to implement an alternate approach to pain assessment during labor. It included system assessment for change readiness, implementation of the algorithm across a 6-week period, evaluation of usefulness by nursing staff, and determination of sustained change at one month. Stakeholder Theory (Friedman and Miles, 2002) and Deming's (1982) Plan-Do-Check-Act Cycle, as adapted by Roberts et al (2010), provided the framework for project implementation. SETTING: the project was undertaken on a labor and delivery (L&D) unit of a large tertiary care facility in a southwestern state in the USA. The unit had 19 suites with close to 6000 laboring patients each year. PARTICIPANTS: full, part-time, and per diem Registered Nurse (RN) staff (N=80), including a subset (n=18) who served as the pilot group and champions for implementing the change. FINDINGS: a majority of RNs held a positive attitude toward use of the CWLA to assess laboring women's coping with the pain of labor as compared to a Numeric Rating Scale (NRS). RNs reported usefulness in using the CWLA with patients from a wide variety of ethnicities. A pre-existing well-developed team which advocated for evidence-based practice on the unit proved to be a significant strength which promoted rapid change in practice. IMPLICATIONS FOR PRACTICE: this work provides important knowledge supporting use of the CWLA in a large tertiary care facility and an approach for effectively implementing that change. Strengths identified in this project contributed to rapid implementation and could be emulated in other facilities. Participant reports support usefulness of the CWLA with patients of varied ethnicity. Assessment of change sustainability at 1 and 6 months demonstrated widespread use of the algorithm though long-term determination is yet needed.

Adaptive functioning in children with seizures: impact of maternal anxiety about epilepsy.

This study evaluated the impact of maternal anxiety about a child's epilepsy on parental overprotection and the child's adaptive functioning. Specific maternal and family characteristics that contribute to elevated maternal anxiety about epilepsy were also studied over a year's time in a group of 56 mothers with children recently diagnosed with epilepsy. Overall, the primary predictor of maternal anxiety about epilepsy was the mother's level of coping resources, although family stress aggravated anxiety at the initial time point. Maternal anxiety about epilepsy was associated with overprotective and overly directive parenting styles, but it was the anxiety level itself that was most strongly related to the child's adaptive functioning. Maternal anxiety about epilepsy decreased over time, as did the relationship of maternal anxiety to the child's adaptive functioning. Nonetheless, after a year had elapsed, maternal anxiety was still associated with poorer adaptive skills.