Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-8-2021

Graduate Advisor

Dr. Alicia Hutchings, PhD, RN, CNE

Co-Advisor

Dr. Julie Bertram, PhD, RN

Committee

Meredith Meyer, MSN

Abstract

Abstract

Problem

Currently, no national practice guidelines or organizations suggest the use of continuous bladder catheterization during labor for women receiving epidural anesthesia (DeSevo & Semeraro, 2010). Despite there being no national practice guidelines supporting the use of continuous bladder catheterization, many labor and delivery units still utilize this method for bladder drainage following epidural anesthesia in labor. The purpose of this project is to evaluate if the type of bladder management post-epidural anesthesia affects the length of the second stage of labor and the mode of delivery after implementation of new intermittent catheterization pilot.

Methods

This quality improvement project implemented a new bladder catheterization nursing practice that encouraged independent voiding or intermittent catheterization rather than continuous bladder catheterization following epidural anesthesia for laboring women. The primary outcome measure was the length of the second stage of labor for women receiving intermittent catheterization compared to continuous catheterization. The secondary outcome measure was mode of delivery (vaginal or cesarean section).

Results

Data was collected via retrospective and prospective review of electronic medical records. Analysis of the data was completed using differential and inferential statistics, as well as chi-square test for categorical variables and ANOVA for continuous variables within the software Statistical Package for the Social Sciences (SPSS). The pre-implementation group sample size was 83 women, and the post-implementation sample size was 50 women. The Pearson Chi-Square test comparing the post implementation of the new method of bladder management vs. the mode of delivery approached significance at p=.060 but was ultimately found not be statistically significant. The method of delivery in relationship to the length of the second stage of labor was significant at p= .000.

Implications for Practice

As a result of this evidence-based quality improvement project, a new bladder management protocol was successfully implemented. While the findings of this project were unable to fully statistically substantiate current literature supporting the use of intermittent bladder catheterization for women receiving epidural anesthesia in labor, clinically significant findings included a decrease in routine use of indwelling bladder catheterization. Further research and monitoring of this practice change is needed to determine its impact on this labor and delivery unit.

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