Document Type
Final Project
Graduation Date
Spring 5-10-2025
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Elizabeth Mollard
Abstract
Objective: The objective of this project was to implement the Coping with Labor Algorithm in the labor and delivery setting and study its impact on nurse self-efficacy and on birthing persons’ experiences.
Design: A quasi-experimental pre- and post-design was used for this project.
Setting: The project was conducted in a maternity unit with six labor beds located in the Midwest.
Methods: This project was conducted over twelve weeks. Twenty-five registered nurses were provided in-person education, access to educational materials, and training on how to use the Coping with Labor Algorithm. A pre-test was administered before the unit implementation of the project. Each labor room was supplied with a laminated copy of the algorithm for reference. Upon completion of the twelve-week project, registered nurses were given a post-survey to assess improvement in self-efficacy. Additionally, a unit-collected patient-reported experience measure (PREM) distributed by the Nebraska Perinatal Quality Improvement Collaborative (NPQIC) was utilized to evaluate patient perceptions related to respectful care, communication, decision-making, and overall satisfaction.
Results: There were no statistically significant differences in NSEQ and LSSQ scores based on age, years as a registered nurse, or years working in labor and delivery. While effect sizes suggested moderate to large practical differences, high variability and low small sample sizes likely contributed to the lack of statistical significance. Additionally, an overall increase was observed in patient-reported respect for healthcare choices and respectful treatment during their stay after implementing the Coping with Labor Algorithm.
Conclusion: The implementation of the Coping with Labor Algorithm showed promising improvements in nurse confidence and patient perceptions of respectful maternity care. Although statistical significance was not achieved in self-efficacy and labor support scores across demographic groups, moderate to large effect sizes suggest meaningful, practical differences that merit further exploration. Importantly, the PREM survey revealed an increase in patients feeling their healthcare choices were respected throughout their stay, as well as overall respectful treatment during the study period. These findings highlight the potential clinical impact of structured, person-centered labor support interventions and underscore the importance of continued research in this area.
Recommendation: Future research should incorporate larger and more diverse samples to enhance statistical power and generalizability. Studies should also address unequal variances and thoroughly examine the influence of factors such as race, educational background, and overall nursing experience, including labor and delivery experience, on self-efficacy and labor support. Longitudinal designs are recommended to track changes in NSEQ and LSSQ over time. Additionally, integrating qualitative methods with quantitative data can provide deeper insights. Future studies should explore the relationship between labor and delivery experience and labor support skills and how these factors impact NSEQ and LSSQ within the context of the intervention. Emphasis should also be placed on evaluating the clinical significance of observed changes in these outcomes.
Recommended Citation
Johnson, Diane and Murlowski, Amy, "Enhancing Nurse Confidence in Labor Pain Management and Respectful Maternity Care Through Implementation of the Coping with Labor Algorithm" (2025). Doctor of Nursing Practice Projects: College of Nursing. 47.
https://digitalcommons.unmc.edu/con_dnp/47