| ObjectiveThe purpose of this study is to construct a scientific and suitable bundle analgesic nursing program for vaginal delivery based on evidence-based theory.To explore the application effect of the analgesia bundled care program in the normal delivery of primipara.It could provide a reference for midwives to carry out the analgesia bundled care program for primipara.Methods1.This study based on evidence-based nursing Research methods to develop a strict retrieval strategy,using The Appraisal of Guidelines for Research and Evaluation,AGREE Ⅱ(The Appraisal of Guidelines for Research and Evaluation,AGREE)Evaluation criteria to evaluate The included Guidelines,using The Australian evidence-based health care center(Joanna Briggs Institute,JBI)literature Evaluation criteria to evaluate The quality of The literature outside The Guidelines.Summarize the nursing and analgesic intervention measures of normal childbirth,after expert group discussion,preliminarily draw up the bundle analgesic nursing program.Invite 20 experts to evaluate the contents of the proposed bundle analgesia nursing program according to the structure table of JBI evidence FAME(Feasibillity,Appropriateness,Meanfolless,Effectiveness),to check the feasibility of clinical application of various nursing items and measures in this program,and finally construct a bundle analgesia nursing program suitable for vaginal delivery in this region.2.The nature of this study is almost experimental.Convenience sampling method was used.A total of 240 primiparas who delivered in a tertiary hospital in Jiangsu province from April 2020 to November 2020 were selected as the research subjects.The subjects were divided into groups according to the implementation time of the analgesia bundled care program.The primiparas with normal delivery from April 2020 to July 2020 were divided into the control group(N=120),and the primiparas with normal delivery from August 2020 to November 2020 were divided into the intervention group(N=120).All participants completed the entire research.Primiparas in the control group were given routine nursing measures during three stages of labor and 2 hours postpartum observation period,while primiparas in the intervention group were given the analgesia bundled care program on the basis of routine nursing measures.Compared the general information,Childbirth attitude questionnaire,Numerical Pain Rating Scale(the first labor every h/1,the second and third stages of labor,and postpartum 2 hours),delivery end(including three labor time,2 hours is produced when the bleeding,postpartum blood loss,episiotomy and perineal laceration and neonatal Apgar score,newborn asphyxia),postpartum depression scale and nursing service satisfaction index between the control group and intervention group.3.Epi Data3.1 software was used to export data,SPSS25.0 was used to analyze data.With the methods of statistical description,t test,chi-square test and rank sum test.P<0.05 was considered statistically significant.Results1.The analgesia bundled care program for normal delivery in this study was preliminarily formulated based on evidence-based theory,Experts were invited to evaluate the feasibility of each care item and measure according to the JBI evidence FAME structure table,including 6care items,which were divided into 17 care measures.The participants were strictly selected by the method of this research conference.The 20 experts invited were all from the obstetrics department of tertiary and above hospitals,which could provide effective,accurate and practical opinions on the cluster-based analgesic nursing program.In this study,the expert authority coefficient(CR)of the conference was 0.90,and the CR value was greater than 0.80,indicating that the experts participating in the conference were familiar with the content of the conference,had rich theoretical basis and practical experience,had a high degree of authority,and the results were credible.2.There was no statistically significant difference between two groups of primipara in age,height,weight,medical expenses,pregnancy,marital status,educational level,place of residence,occupation,family income per head,choose escorts,pregnancy inspection agencies,number of tests during pregnancy,attend classes at pregnancy school(Ρ>0.05).3.The effect of the implementation of the analgesia bundled care program on the pain scores of primiparas in normal delivery: the comparison between the intervention group and the control group showed that both groups of primiparas had a certain degree of pain during childbirth.The pain scores at the first hour after opening the uterine orifice 2cm and the pain scores at the third stage of labor were not statistically significant between the two groups(all P>0.05).In the control group,the pain scores of the first stage of labor was ranged from(5.38±1.23)to(7.78±0.83),the second stage of labor was(8.10±0.83),the third stage of labor was(3.97±1.74),and postpartum 2 hours was(5.03±1.23).In the intervention group,the pain scores of the first stage of labor was ranged(4.93±1.61)to(5.25±0.96),the second stage of labor was(4.46±1.40),the third stage of labor was(2.93±1.31),and the fourth stage of labor was(2.52±0.62).The differences between the two groups after intervention were statistically significant(all P<0.05).4.The effect of the analgesia bundled care program on the duration of each stage of labor of primiparas: in the control group,half of the primiparas were fully opened 8 hours after their uterine opening was 2cm wide,and in the intervention group,more than half of the primiparas were fully opened 7 hours after their uterine opening was 2cm wide.The intervention group spent less time in the maternity room than the control group,and the difference between the two groups was statistically significant(P<0.05).In the control group,the total labor time was(464.89±102.06)minutes,the first labor time was(421.45±96.13)minutes,and the second labor time was(51.34±26.56)minutes.The total time of labor in the intervention group was(404.88±110.54)points,the first stage of labor was(358.04±103.79)points,and the second stage of labor was(41.68±21.13)points.The difference between the two groups was statistically significant(all P<0.05).The third stage of labor in the control group was(5.01±2.44)points.The time of the third stage of labor in the intervention group was(5.30±1.46)points,and the difference between the two groups was not statistically significant(P>0.05).5.The effect of the analgesia bundled care program on the amount of postpartum blood loss at 2 hours: the average amount of blood loss at birth was(290.63±65.22)ml in the control group and(276.71±66.98)ml in the intervention group,and there was no significant difference between the two groups(P>0.05).The blood loss at 2 hours in the control group was(67.50±22.25)ml,and the blood loss at 2 hours postpartum in the intervention group was(60.08±15.13)ml.The amount of blood loss at 2 hours postpartum in the intervention group was less than that in the control group,and the difference between the two groups was statistically significant(P<0.05).6.Influence of the analgesia bundled care program on neonates:Apgar score of neonates in the control group was(8.97±0.37)in 1 minute,and Apgar score of neonates in 5 minutes was(8.98±0.18)in 5 minutes,1 case of neonatal asphyxia.Apgar score of neonates in the intervention group were(8.98±0.18)for 1 minute,and(9.00±0.00)for 5 minutes,1case of neonatal asphyxia.There was no significant difference between the two groups(P>0.05).7.The effect of the analgesia bundled care program on the attitude of parturient women: the average CAQ score of the control group was(32.36±7.66),and the average CAQ score of the intervention group was(29.39±5.46).The average CAQ score of the intervention group was lower than that of the control group,and the difference between the two groups was statistically significant(P<0.05).8.The effect of cluster analgesia nursing scheme on perineal condition of primiparas: 19 cases of lateral perineal resection,accounting for 15.83%,11 cases of perineal intact,accounting for 9.17%;In the intervention group,there were 12 cases of lateral episiotomy,accounting for 10.00%,and 9,216 cases of complete perineum,accounting for13.33%.The perineal lateral resection rate and perineal integrity rate in the intervention group were better than those in the control group.There was significant difference between the two groups(P<0.05).9.Influence of the analgesia bundled care program on postpartum depression in primiparas: EPDS score of the control group was(10.80±2.48),there were 85 cases(70.83%)with EPDS,and 15 cases(12.50%)with PPD.The postpartum EPDS score of the intervention group was(8.56±2.52).there were 58 case in the high-risk group of postpartum depression,accounting for 48.33%,and 2 case with postpartum depression,accounting for 0.17%.The EPDS score of the intervention group was higher than that of the control group,those at high risk of postpartum depression and postpartum depression of the intervention group were less than those of the control group,and the difference between the two groups was statistically significant(P<0.05).10.Influence of the analgesia bundled care program on postpartum satisfaction of primiparas: the score of postpartum satisfaction of the control group was(84.89±9.86)points,and that of the intervention group was(95.52±3.52)points.The score of postpartum satisfaction of the intervention group was higher than that of the control group,and the difference between the two groups was statistically significant(P<0.05).Conclusion1.The analgesia bundled care program constructed based on evidence-based theory and expert meeting method is feasible and effective for its application in this region.2.The analgesia bundled care program could relieve the pain in all stages of labor of primipara in normal delivery,shorten the labor room after waiting for palace mouth open all the time,shorten the total labor,the first labor,the second labor time,blood loss,reduce postpartum 2hours episiotomy rate and increase the rate of perineal complete,ease childbirth fear,To reduce the high risk group of postpartum depression and the incidence of postpartum depression,improve the satisfaction of primipara to the delivery room nursing service,and provide a reference for the delivery of vaginal delivery women with midwifery-led analgesic nursing program. |
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