I. Clinical Question Among pregnant mothers experiencing fatigue during labor; thus, providing independent nursing management (e.

g deep/patterned breathing, providing support & comfort and relaxing during contractions)more effective than administering analgesics PRN in alleviating fatigue during labor? II. Citations Independent Nursing Action: JAN Original Research (ebscohost.online .com) (INA) First Stage Labour Management an examination on nursing management and child birth related fatigue trajectories. Ya-Ling Tzeng, Yu-Mei Y. Chao, Shu-Yu Kuo& Yu KueiTeng October 24, 2007 On drug analgesia:The experience of childbirth in pregnant mothers who received narcotics analgesics during the first stage of labour. Curationis Research Article (ebscohost.online.com) L. Jantjes, J. Strumpher and WJ. Kotze June 2007 III. Study Characteristics 1. Patients included ON ²Independent nursing action Population: 56 primiparous mothers with no epidural anesthesia or analgesics given were selected within the age of 17-35 with a media age of 25 yrs. Sample: These 56 primiparous mothers with no epidural anesthesia or analgesics given during the first stage of labor were retained as the population of the study because the investigator has a complete data and information regarding the population of the study. Participants were advised about purpose and procedure involve in the study wherein they have read and signed a consent form approved by the Institutional Review Board. ON- Drugs Analgesia Population: Consisted of first-time mothers who gave birth at one of the local hospitals. Sample: Participants had to be first-time mothers who received analgesics during the first stage of labour and subsequently had a normal vaginal delivery. 2. Interventions compared Independent Nursing Management vs. Administration of Analgesics PRN on alleviating Fatigue during the first stage of labor 3. Outcomes monitored ON- Independent Nursing Action Outcome of the study was monitored using a Visual Analogue Scale;

some of health care providers lack updated information regarding immediate care of a pregnant mother. though it is very effective in diminishing the pain. her ´fear of the unknownµ or what will happen to her after the delivery process will not be of so much worry to her. The same is true with analgesics but which have suspected side effect. the study focuses on a significant problem on a clinical practice among midwives and especially among student nurses exposed on the clinical area in lying. They could also not spend quality time with their newborn babies as they were unable to hold them properly due to drowsiness. Additionally. 4. The Problem is significant especially on situational setting here in our country wherein lying in clinic or government hospitals lack the appropriate instruments or equipment in addressing this current health care system in our country. Both analgesic and Independent Nursing Action have their own weaknesses and strengths in addressing the fatigue of a pregnant mother during labor. They stated that they felt drowsy and could. A Pregnant Mother usually suffer from fatigue due to excruciating pain and discomfort caused by the frequent contraction of the uterus occurring every 2-3 minutes and lasting for 60 seconds which can leave the mother restless. ON-Drugs Administration of Analgesics is usually done by the midwives to alleviate the pain and discomfort experienced by the mother. . Analgesics if administered it has side effects on the mother it became evident that some women who received narcotic analgesics during labour appeared to be unhappy about the manner in which pain was managed during labour.in clinics wherein normal spontaneous delivery are the only possible cases being entertained. providing comfort and relaxation in dealing with every contraction she is experiencing and guiding and educating her towards the labor process can be beneficial in alleviating the pain and fatigue she is currently undergoing and by sharing such knowledge with her throughout the labor process.Independent Nursing Management can alleviate fatigue during the first stage of labor although the use of analgesics can completely minimize pain and discomfort during labor. As a student nurse it is his/her responsibility to initiate immediate independent nursing action such as deep and patterned breathing. frequently irritated. not cooperate well with the nurses. Does the study focus on a significant problem in clinical practice? ON-Independent Nursing Action Yes. wherein independent nursing action is beneficial to alleviate the pain experienced by the mother during first stages of labor. therefore. feeling of anxiety and usually lethargic due to the pain she is experiencing. but studies shows that frequent use of analgesics during labor among pregnant mother has an effect on the mother itself along with the baby. Data wereanalysed using Tesch's method of descriptive analysis Tesch. a possible side effect of the drugs can be expected both on the side of the mother and the baby as studies done prove it.Drugs The audio taped interviews were transcribed verbatim within 24 hours following each interview. The analgesics given minimize pain along with anxiety but cause several effects on the mother. ON.

physiologic and cognitive aspects of the patient. Methods used ON-Independent Nursing Action The researcher used a qualitative study and employed multistage sampling in gathering its respondents since the sample of the study which a subset of a larger study (n=100) of fatigue during the intrapartum period wherein respondents were selected upon admission wherein structured data was collected through a visual analogue scale which is use to measure subjective pain and fatigue. Subject selection a.IV. VAS was also used to measure the subjective. 3. Data sources Both Independent Nursing Action and Drugs Data gathered are all from primary sources since the data are directly observed and stated by the respondents of the study. Design ON-Independent Nursing Action The study is descriptive and a longitudinal design was used and repeated measurement was collected prospectively on each participant wherein the 56 participants were interviewed at four time points. Setting ON-Independent Nursing Action Large Community Hospital in South Central Pennsylvania on October 24. 5. producing themes and subthemes. ON-Drugs (Methods and Design) The study was qualitative. Methodology/ design 1. hemoglobin more than11g/dl and hematocrit more than 34 % and those mothers who were not given analgesics or spinal anesthesia during the onset of labor. These were used to develop guidelines for practice during the second phase. descriptive and contextual in nature and was conducted in two phases. 2. 2007 ON-Drugs Nelson Mandela Metropolitan Hospital North Carolina USA 4. Inclusion criteria ON -Independent Nursing Action A pregnant woman which has no high-risk factors before the onset of labor. Data were collected and analysed during the first phase. . exploratory.

Drugs The original study has been replicated and subjected to different studies and interventions by different researcher with the aim of finding out the effects of analgesics on alleviating pain and fatigue of pregnant mothers most especially primiparas during the first stage of labor. Some studies also aimed to find out what will be the possible effect to the mother if she wasn·t given an analgesic during the first stage of labor and would it be possible if she could tolerate the pain even without any analgesic given. The condition of mother and baby had to be satisfactory. b. Has the original study been replicated? ON-Independent Nursing Action The original study has been replicated and subjected to different studies but with the same goal to further enrich the benefits of providing independent nursing management within the process of labor among pregnant women especially during the first stage of labor. ´early patterned breathingµ before the onset of labor can stimulate early fatigue on the side of the mother. ON-Drugs Mothers who are multipara G5P5 . bonding must have taken place and the mother had to be well rested. 6. 7. Other studies aimed to find out what is the possible side effect of independent nursing action to the wellness of the mother and with the baby. Exclusion criteria ON-Independent Nursing Action Mothers who are at high-risk before onset of labor and those mothers who have receive spinal anesthesia or analgesics right immediately at the onset of labor. What were the risks and benefits of the nursing action or intervention tested in the study? ON-Independent Nursing Action ´RISKSµ Risk in the study is. Other studies aimed to find out what are the immediate effect of analgesics to the mother upon administration and if it will affect the process of labor and its progress. mothers whom received analgesics to relieve pain and fatigue on the first stage of labor and those mother which are at high-risk before onset of labor.ON-Drugs Participants had to be first-time mothers who received analgesics to relieve pain and fatigue during the first stage of labour and subsequently had a normal vaginal delivery. . ON.

thus independent action such as slight physical activities like walking during the first stage of labor is advisable to alleviate fatigue. Pugh found that women who had received medication also reported higher levels of fatigue. V. Mothers administered w/ analgesics could or has the neither possibility to injure their baby as they are unable to hold them properly nor breastfeed them due to drowsiness. and could therefore not cooperate well with the nurses and immediate health provider. Faced breathing or patterned breathing is beneficial among pregnant mother in alleviating the pain and fatigue during the first stage of labor and as labor progresses but is this independent nursing intervention . ´Benefitsµ Analgesics has a direct affect in optimizing pain and fatigue during labor process and as labor progresses which can provide comfort on the patient.´Faced breathing during the latent phase of laborµ can contribute on the fatigue being experienced by the mother. thus independent action such as slight physical activities like walking during the first stage of labor is advisable to alleviate pain and fatigue. secondary arrest of cervical dilatation which causes pain to the mother mostly on primiparas on the active phase of labor (Peaceman and Socol 1999) The study suggest that Independent Nursing Management has its own strength and weaknesses in addressing fatigue due to pain during the progress of labor mostly on primipara women which has greater risk of experiencing fatigue due to pain and among primipara pregnant women since the labor length of primiparas is longer than of multiparas. Pain medication affects the reticuloactivating system. which inhibits wakefulness and thereby may enhance the feeling of fatigue (Pugh 1990). ON Drugs ´Risksµ Analgesics can make the patient drowsy. it would follow that the fatigue level of primiparas are higher than multiparas. On Physiological factors there is greater risk of experiencing fatigue among primipara pregnant women since the labor length of primiparas is longer than of multiparas. it would follow that the fatigue level of primiparas are higher than multiparas. Results of the study ´On Independent Nursing Action:µ Study shows that Fatigue due to Painhas been reported as one of the distressing symptoms that affects women·s well-being and their capacity to undergo labor task (Pugh and Milligan 1999) in obstetrical literature fatigue is suggested as the cause of primary dysfunctional labor. ´BENEFITSµ Providing a non distracting environment and guiding a pregnant women towards the labor process is beneficial towards the client in alleviating her anxiety and fatigue due to pain and discomfort Studies shows that emotional and physical support to the client can help her ease fatigue as labor progresses since the usual belief as labor is tiring.

inability to cooperate and couldn·t think clearly. Pugh found that women who had received medication also reported higher levels of fatigue. allowing time for questions. The study also shows pain medication and prenatal employment were the situational factors considered for our study. Other independent nursing interventions prove effective in the study are moderate physical activity(breathing exercise. Such prepared women would begin labour feeling less fatigue and. VI. Another finding was that the fastest rate of increasing fatigue was in the active phase. The result of the study testifies that upon admission of analgesics on the respondents they had experienced being drowsy. This empirical research contributes to determining the critical time for dealing with childbirth-related fatigue. ´On drug Analgesiaµ Results of the study suggest several good and bad effects of analgesics among the respondents of the study which are pregnant mother who are injected with analgesics during the first stage of labor and as labor progresses. the medication affected their ability to think. negative feelings such as despair. Pugh (1990) showed that women who exercised regularly during the last trimester of pregnancy and on moderately physically active as labor progresses reported statistically significant less fatigue. clarification and even practicing relaxation techniques. This might also result in less fatigue in the postpartum phase. The study also implies that even though analgesics has some good effect on the mother in alleviating pain and fatigue other studies based on the research sees more side effects of analgesics which is not harmful but can cause delay on activities the mother will be doing on the progress of labor and as care for the mother in continuity. could reduce fear and anxiety and fatigue prior to the onset of labour. fear and anxiety. frustration. Analgesia is commonly used to manage pain in labour. inactive participants had a higher risk of fatigue when they were compared with active participants. and Rhoten (1982) equates pain medication to subjective fatigue. in a study by Lee 2001.is done in advance or before the onset of labor is may contribute or ignite fatigue on the part of the client especially if this patterned breathing is done on the latent phase of labor. irritability. extending of legs. ideally. which inhibits wakefulness and thereby may enhance the feeling of fatigue (Pugh 1990). Caregiver actions need to be directed towards helping women conserve energy and alleviate pain as possible and adjusting to the rapid changes occurring physically and psychologically during this phase. walking)and providing information and knowledge to the client about the progress of is considered to be a facilitator thatcan alleviate fatigue. The study signifies that usage of analgesics has its own strength and weaknesses which is beneficial and harmful to the patient. In this period. with the eventual goal of improving intrapartum care. It is therefore likely that prenatal exercise and independent nursing management on the part of the health care provider is relevant to alleviating levels of Childbirth fatigue. . Pain medication affects the reticuloactivating system. Authors conclusion or recommendation ´On independent nursing actionµ The findings of the study suggest that there are critical points at which caregiver actions (independent nursing action)may have an effect on alleviating childbirth-related fatigue. Prenatal education aimed at explaining the process of labour and delivery. might never reach the higher levels of fatigue expected as labour progressed. However the study implies that this independent nursing management is not 100% effective in alleviating fatigue and pain and so analgesics is sometimes given. and may contribute to a theoretical foundation that can be explored in further study. the strength of uterine contractions increases along with aggravating feelings of pain.

Pain medication and prenatal employment were the situational factors considered for our study. 2. Analgesics can optimize pain and fatigue along with other contributing factors such as anxiety but it has also side effects on the mother yet it isn·t harmful but may delay activities of the mother after the immediate delivery of the baby and before the baby has been delivered. ´On drugs analgesiaµ Yes.developed. because at present it is being practiced and observed among hospitals and lying in clinic here in the country thus administration of analgesics is beneficial in optimizing pain and . The study further signifies that the participants reported on the physical experience of labour and described experiencing a lot of pain for which analgesics were given. since this independent nursing management is usually done in addressing the needs of pregnant mothers especially on the process of labor. ´On drug analgesiaµ Yes. VII. Based on the findings. Pugh found that women who had received medication also reported higher levels of fatigue. Pain medication affects the reticuloactivating system. Does the study provide a direct enough answer to your clinical question in terms of type of patients intervention and outcome? ´On independent nursing actionµ Yes.´On Drugsµ In this research study the childbirth experiences of first-time mothers who received the narcotic analgesic during the first stage oflabour were explored and described. anger and despondence. which inhibits wakefulness and thereby may enhance the feeling of fatigue (Pugh 1990). They also described how these drugs dulled the pain but made them sleepy and unable to cooperate with the midwives. This immediate nursing action is found out to alleviate fatigue due to pain and other contributory factors during the progress of labor and promotes wellness on the side of the client and with the baby. which included joy and happiness as well as anxiety. Analgesia is commonly used to manage pain in labour. The study is applicable in our setting here in the country in which student nurses along with immediate health care providers attends to the immediate needs of the client is assuring their safety and well-being during the labor process until the baby is delivered and continuous care will follow afterwards. general guidelines to assist midwives in selecting a method of pain relief for individual patients were . the study provides a direct answer on the clinical question in which independent nursing management can somewhat alleviate fatigue during pregnancy mostly due to pain and other contributing factors such as anxiety and loss of energy. it is feasible to carry out the nursing action in reality. Is it feasible to carry out the nursing action in the real world? ´On independent nursing actionµ Yes. The study further implies that this independent nursing management has its own strengths and weaknesses in addressing to the needs of the client during the progress of labor. the study provides a direct answer on the clinical question in analgesics has its own strength and weakness. Applicability 1. They described their emotional experiences. and Rhoten (1982) equates pain medication to subjective fatigue.

we should ask ourselves first. We must always put in our mind that as health care providers the safety and wellness of the patient is our responsibility. a. b. Competence Prior to knowing the competency. Competency is measured by how appropriate. Outputs gathered must be collaborated on nursing process. it dulls the senses. Reviewers Conclusion (both studies) The study conducted both on Independent Nursing Interventions and Drug Analgesia needs more revision and updated facts and information in order to strengthen the initial findings and support the initial output of the study.fatigue on the mother yet it has side effect which is not harmful but delays immediate activity of the mother after the administration of the drug. VIII. Yet. The study also should be done on a larger group of respondents to obtain and yield more information regarding the studies. how effective and how efficient the primary health care to be delivered or rendered. this two nursing interventions has its own strength and weaknesses. Studies shows that this immediate nursing action can alleviate and optimize pain and fatigue during the progress of labor as compared to the use of analgesics which in fact can also alleviate and optimize pain and fatigue which has its side effect yet not eventually harmful but delays immediate action on the part during the progress of labor. nursing administration and nursing research in which will be more helpful on nursing students and health care practitioners. The role of the HCP is to make sure to give the right dose of the said medicine and to perform the immediate nursing action properly. The said interventions are well accepted in the country since it is being practice on hospitals and lying in clinic with the proper ways and right knowledge on doing it. With these we can conclude that a health care provider is competent enough so long as he/she is equipped with the right knowledge and skill needed to perform nursing action. Immediate Nursing Action and Administrations of analgesics during the first stage of labor and towards the progress of labor is effective in alleviating and optimizing pain and fatigue on the respondents. . nursing practice. Acceptability Based on the studies shown. output and assessment of the initial study. independent nursing action is more appropriate to use and utilize in responding to the immediate needs of the client during the onset and progress of labor. ³What is the role of the primary health care provider (HCP) with regards to independent nursing action and administration of analgesics in alleviating pain and fatigue during the progress of labor. and verify data·s gathered if it·s useful and factual in strengthening the foundation of the initial findings. c. Safety In regards to safety.

Appropriateness& Efficiency Both interventions are appropriate in alleviating and optimizing pain and fatigue during the progress of labor. yet it is much safer using the independent nursing action.5 kilos. In regards to client·s safety. Administration of analgesics also is effective in alleviating and optimizing pain yet it has side effects but not harmful thus. independent nursing action is a lot safer to initiate that the administration of analgesics. e. f. usage of this until knows is still possible. Effectiveness Studies prove that the immediate nursing action can alleviate fatigue and pain during the progress of labor thus making it appropriate to nursing practiced. Deficient fluid volume related to excessive excretion of watery stools as manifested by a decrease in body weight from 10. . Accessibility These interventions can yield immediate responses which are not harmful and readily accessible. Sleep Disturbace r/t cough as manifested by restlessness and presence of dark circle under eyes Ineffective airway clearance related to retained secretions as manifested by crackles and ineffective cough.d.5 kilos to 9. Independent nursing action is usually done and performed by the health provider along side with the client while upon the administration of analgesics drowsiness and un able to participate on the health care action is easily noticed on the client.

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