Organization of Perinatal Nurses' Work following Epidural Insertion

Date

2014-01-07

Authors

Baribeau, Isabelle

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Abstract

The perinatal nurse’s work is influenced by the particular needs of each labouring women as well as by institutional discourses and textually mediated work processes that guide obstetrical care in hospital. Institutional Ethnography (IE) was used to explore the work performed by perinatal nurses in relation to the pain management of women labouring with mobile labour epidural analgesia. The data collection process involved interviews with five perinatal nurses working in a tertiary care centre in British Columbia and an in-depth review of the institutional texts used by these nurses. The perinatal nurse’s work associated with the initiation and maintenance of the epidural involves a constant re-prioritizing of the nurse’s actions and interventions in order to attend to multiple demands associated with the care of a labouring woman. The nurse’s extensive knowledge work requires an awareness of the effects of the epidural on maternal and fetal wellbeing and the labour progress. The nurse’s work of promoting effective pain relief is managed separately from the process of supporting labour and birth. Once the epidural is inserted and the contraction pain alleviated, all manifestations of pain are perceived as problematic. Within the context of epidural management, the goal becomes taking every measure possible to alleviate the presence and re-occurrence of contraction pain. The nurse’s work of mobilizing a labouring woman with an epidural involves an additional layer of assessment and evaluations which require additional work on the part of the nurse. The nurse must choose and prioritize the care she provides to the labouring woman. Needing to focus more intensely on the safety of the labouring woman and her fetus, alongside ensuring the required epidural work processes are completed, results in mobility falling to the lowest priority level within the nurse’s epidural management work. The textually mediated work processes embedded in the intuitional policies and forms associated with epidural management reinforce this hierarchy of priorities and directly structure the nurse’s work time away from providing care that supports women to cope with labour pain and encouraging mobility to promote labour progress. The various hospital forms, policies and guidelines coordinate and organize the nurse’s epidural work so that promoting mobility is subsumed; potentially increasing the risk of labour dystocia and caesarean birth for women labouring with a mobile labour epidural analgesia.

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Keywords

Mobile epidural, perinatal nurse, nurse's work, labour and delivery nurse, labour support, birth, institutional ethnography

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