Date of this Version

2024

Document Type

DNP Project

Abstract

Background: Effective pain management during labor is a vital aspect of maternal satisfaction. Pharmacologic and nonpharmacologic interventions are utilized for this purpose. Entonox has been a longstanding labor analgesic, known for its easy use, minimal side effect profile, and preservation of motor and sensory functions, which have shown to enhance satisfaction rates. continuous epidural infusion (CEI) garners high patient satisfaction rates due to its mechanism of action, motor and sensory block, low side effect profile, and little effect on the type of delivery. However, there is no universally accepted standard for providing adequate labor analgesia. Research suggests that Entonox has a positive influence on parturient satisfaction comparable to CEI. This quality improvement project aimed to evaluate whether an educational module focused on Entonox use in labor encouraged a positive change in anesthetists’ knowledge, attitude, and practice regarding nitrous oxide as a labor analgesic, ultimately improving patient satisfaction rates.

Methods: PubMed Central, Cumulative Index to Nursing & Allied Health (CINAHL), and Google Scholar search engines were accessed via Florida International University’s library database to construct a comprehensive search for peer-reviewed literature, published within the last 10 years, that evaluated maternal satisfaction, along with other labor outcomes, related to Entonox and CEI. The relevant evidence was utilized to develop an online educational module composed of a pre-module assessment to evaluate anesthesia providers’ baseline knowledge and attitudes regarding Entonox, a 10-15 slide voiceover PowerPoint presentation (VPP) that highlights labor analgesic options, including Entonox, and patient satisfaction, and a post-module assessment to assess providers’ knowledge and attitudes toward Entonox following the VPP. The module was distributed via an anonymous link and data was collected through Qualtrics, which was also used to generate the study’s results.

Results: A total of 9 anesthesia providers participated in the educational module. Qualtrics pre- and post-test evaluations were utilized to assess the efficacy of the module, as well as its influence on improving participants’ knowledge and attitudes of Entonox as a labor analgesic to enhance maternal satisfaction.

Conclusion: Results indicated that the implementation of this educational module exhibited a degree of improvement in anesthetists’ knowledge and attitudes regarding Entonox as an option for labor analgesia to increase patient satisfaction. Increasing provider familiarity of nitrous oxide and its use, and administration, during labor positively influence anesthetists to include the gaseous mixture as an option for labor pain management. Limitations included a small sample size consisting of 1 anesthesia group and the method of dissemination of the material. Further research across multiple clinical settings with an increased number of participants is necessary to further evaluate the benefit of Entonox use in labor and strategies to optimize patient satisfaction. However, the outcomes of this QI project support enhancing providers’ knowledge of Entonox use in labor to encourage a shift in the anesthetic management of a laboring woman.

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