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Capstone Project Change ProposalMichele AgrestiGrand Canyon UniversityNRS-493: Professional Capstone and PracticumDr. MaineJune 13, 20211
Capstone Project Change ProposalMany women preparing for labor in the hospital setting experience a variety of emotions including excitement, anxiety, and fear. Delivering a baby comes with risks to both the laboring mother and the baby. Labor and delivery has many potential risks and complications, use of epidural anesthesia and induction of labor can affect the risk profile. Inducing labor is becoming increasingly more common. So much that approximately a quarter of all women deliver following an elective or medical induction of labor (Marconi, 2019). Additional risks with induction include prolonged labor and failure to progress. A labor that fails to progress is the most common indication for an unplanned primary cesarean delivery (Tussey et al., 2015). This proposal seeks to identify the impact prolonged labor and cesarean sections have on patients and their families. As well as discuss the site-specific concerns, and the impact this proposal can haveon patients, the unit, and the organization. Additionally, this paper will propose a research question, describe the literature search strategy utilized, and evaluation of the included literature. Finally, this proposal will outline the applied change theory, describe the proposed implementation plan with outcome measures, an intervention plan, and discuss potential barriers and the plan to overcome them. Identifying evidence-based practices that minimize any additional risks through a non-pharmacologic, nurse driven intervention that can support labor progress, improve outcomes with both mother and baby, and provide a positive patient experience are the forefront of this change proposal.BackgroundCesarean sections create a financial burden on families. This financial burden is complicated by increased time off work to heal, longer hospital admissions and increased cost 2
associated with cesarean section, especially when it follows a prolonged labor, and infection. “On average, commercial and Medicaid insurers pay 50% more for C-sections than for vaginal deliveries” (Rodriguez, 2019). In the United States, greater than 90% of women who have a primary cesarean section will require a repeat in subsequent pregnancies (Tussey et al., 2015). With a rising rate of medical induction and the rising primary cesarean rate, it is imperative to place focus on the induction process. In the United States, epidural anesthesia is the most common type of pain relief used during childbirth (ACOG, 2021). While the epidural is effectivefor pain relief, it limits the mother’s mobility. This can negatively influence the length of labor inthe first and second stages, leading to a higher incidence of operative vaginal deliveries (OVD) (forceps or vacuum), and cesarean section rates, further increasing the risks to both mom and baby (Antonakou & Papoutsis, 2016). Literature shows that women who labor without an