Date of Conferral
Doctor of Nursing Practice (DNP)
Mary T. Verklan
Epidurals used for labor are common regional anesthesia techniques that are easily placed and controlled, while providing the most reliable method of pain relief in obstetrics for parturient women. Local anesthetics, narcotics, and/or combinations of the two are administered through epidurals to treat labor pain. Hence, the choice of medication is important, as it can highly influence outcomes of pain relief. The purpose of this DNP project was to evaluate the effectiveness of a new service line medication, bupivacaine 0.1% with fentanyl 2mcg/ml, to treat labor pain in parturient women at a rural community hospital in southern California guided by the Johns Hopkins Nursing Evidence Based Practice Model. A quantitative, time-series, retrospective, and prospective design was used to analyze data from a convenience sampling of participants who received ropivacaine and bupivacaine with fentanyl. Paired samples t-tests compared differences in verbal pain scores before and after epidural insertion with initial boluses alongside frequencies of top-off boluses required to achieve adequate pain relief. Findings showed that both medications were equally effective in the treatment of labor pain within the first hour after the intervention. However, the ropivacaine group had higher rebolus demands, while the bupivacaine with fentanyl group had only a minimal amount. The complexity of healthcare today demands inter and intraprofessional collaboration to improve and sustain best outcomes for high quality care. The bupivacaine with fentanyl project impacts social change by improving the quality of care for parturient women, addressing the fear and anxiety of childbirth pain, and highlighting the importance of collaboration with other clinical providers to change practice using the evidence.