Knowledge of epidural analgesia among labour ward nursing staff at Chris Hani Baragwanath academic hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesia Johannesburg, 2015Epidural analgesia has become the gold-standard for providing labour analgesia. Internationally 40-60% of labouring women receive epidural analgesia. At Chris Hani Baragwanath Academic Hospital (CHBAH) currently less than 10% of parturients receive epidural analgesia. Greater involvement of nursing staff is needed for this service to expand. Nurses should have the necessary knowledge if they are to be involved in the provision of labour epidurals. All 50 nurses working in the CHBAH labour ward at the time of the study were invited to complete a previously validated, self-administered questionnaire. The questionnaire included demographic data and a knowledge test. The demographic section assessed personal and professional details and identified sources of knowledge related to epidural analgesia. The knowledge test was comprised of 22 questions divided into five knowledge subsections relating to epidural analgesia: spinal cord anatomy and physiology, epidural pharmacology, assessment of sensory and motor blockade, complications of epidural analgesia, and the general management of a patient receiving epidural analgesia. The data was collected during working hours. Of the 50 questionnaires handed out, 45 were returned resulting in a 90% response rate. Of these, 43 questionnaires were usable. The majority of the participants were in the 30-39 years age range. The median number of years worked in labour ward was 11 (range 0.5 - 30 years). Forty four percent of the nurses had a three year diploma in nursing and 33% had a four year diploma in nursing. Sixty five percent of nurses cared for less than five patients with epidurals per month. Eighty four percent of nurses had received no specific education regarding labour epidurals. The overall knowledge of nurses working in the CHBAH labour ward, labour ward high care and labour ward admissions was poor with a median score of 4 out of a total score of 22. The results for the subsections were as follows: anatomy and physiology of the spinal cord with a median score of 1 (range 0-4), epidural pharmacology with a median score of 1 (range 0-4), assessment of sensory and motor blockade with a median score of 0 (range 0-5), complications arising from epidural analgesia with a median score of 0 (range 0-3) and general management of epidural analgesia with a median score of 2 (range 0-3). Urgent educational programs and teaching need to be instituted in order to improve the nurses’ knowledge.MT201