Abstract
M.Cur.
Midwives are responsible to assess pain before treating it; then they should reassess the pain to evaluate the effectiveness of the interventions and plan future therapy. Accurate and objective measures of labour pain continue to be scarce and the discrepancy in labour pain perceptions between parturients and health-care providers remains challenging. Various pain measurement tools are currently in use measuring chronic and acute pain, but many problems were encountered applying these methods to the woman in labour. The charts were detailed and required too much time to complete.
The aim of the study was to develop a multidimensional labour pain assessment instrument to assist clinicians and midwives with labour pain control. Objectives for developing a valid and reliable instrument to accurately measure labour pain included refinement of the labour pain assessment instrument developed from literature, testing of the refined instrument on patients during labour, compilation of a final instrument and development of guidelines on how to implement the labour pain assessment instrument in nursing practice.
A descriptive and exploratory approach was used to describe, evaluate, observe, explore and assemble new knowledge on assessment and measurement of pain during the first stage of labour. Development of the instrument was addressed in the literature chapter. The research was conducted in three phases, combining qualitative and quantitative research.
During phase one, the instrument was refined in two stages. Focus group interviews were conducted with members regarded as knowledgeable in the field of normal labour who evaluated the face and content validity of the instrument. The most senior people teaching Midwifery at all South African universities evaluated the face and content validity of the instrument with an open-ended questionnaire thereafter, using the Delphi technique. The analysis of the first Delphi round was compared to the focus group analysis. The instrument was altered and submitted to the Delphi experts in a second open-ended questionnaire to confirm the alterations.
During phase two, the altered instrument was tested in private and provincial hospitals. Testing of the altered labour pain assessment instrument on patients in active labour yielded quantitative data. A statistician at the University of Johannesburg was consulted to assist with tabulation, frequencies and statistical tests needed. The midwives from the private and provincial hospitals also completed the second Delphi open-ended questionnaire. A Likert scale was included in the second Delphi instrument as midwives have less time available to complete questionnaires. The qualitative analysis of their responses was compared to those of the second Delphi round experts to avoid an inflated estimate of validity that might have been brought forth by the very small second Delphi round sample. The instrument was finally altered and, during phase three, guidelines were developed on how to implement the labour pain assessment instrument in nursing practice.The experts concluded the instrument as a simple tool that can measure and assist with labour pain control, assess the progress of labour and the patient’s condition, assist with training, guide inexperienced midwives in pain assessment and serve as a research tool. The labour pain assessment instrument can be a valuable tool in assisting clinicians and midwives with labour pain control during the first stage of labour and initiate standards for pain measurement. The challenge remains to convince institutions to improve pain control during labour and protect themselves from potential pain maltreatment litigation by using a valid and reliable pain measurement instrument.