Assessing Learning Needs Regarding Barriers to and the Use of N2O for the Management of Labor Pain

This project was designed to assess the learning needs and barriers of various obstetric (OB) staff prior to implementing the use of nitrous oxide (N2O) on a labor and delivery unit at a tertiary care center in Salt Lake City, Utah. The purpose of the project was to provide information for the nurse manager in planning a smooth transition for instituting N2O use as a new practice. Nearly 50% of women who have used nitrous oxide report it to be effective in terms of adequately managing their labor pain. Advantages to its use include the ability of the patient to self-administer N2O via face mask, its rapid onset, minimal side effects for the mother, low cost, and antianxiolytic effects. Although N2O crosses the placenta in minimal amounts, it does not alter the course of labor or pose harmful side effects to the fetus when used at 50% concentration. There are some limitations associated with the use of N2O in labor. It is an analgesic rather than an anesthetic, and therefore does not provide complete pain relief. In addition, there is a potential for maternal side effects, such as dizziness, nausea, and vomiting. Environmental concerns are related to excess gas that may be present in the room; however, equipment that utilizes a scavenging system minimizes others' exposure to the eliminated gas. As a precaution, dosimeter badges may be worn to measure one's exposure to environmental N2O. The use of N2O as a labor analgesic is increasing in the United States. Nearly 50 hospitals (including Vanderbilt University, the University of California-San Francisco, the University of San Diego, the University of Colorado, and the University of Washington) now offer it to laboring patients. Offering laboring women this option for pain relief would allow the project hospital to be the first in Utah with this service. For the identified institution to implement its use, however, an assessment of barriers and learning needs was prudent and necessary. Learning needs and barriers to use were assessed through a 21-question survey that included questions about N2O use and its effects in labor. The survey was informed by the current literature and in consultation with the project chair and content experts. The labor and delivery unit's nurse manager assisted in identifying stakeholders. A sample of 67 participants completed the survey over a 2-week period. Survey results were analyzed statistically according to correct answers and unknowns for each group of stakeholders. Results indicated that knowledge about N2O use was the main barrier to its use, and 80% of participants desired more education about it. Survey results were disseminated via written report and verbal interaction with the nurse manager and nurse education specialist on the labor and delivery unit. Educational brochures were created based on the learning needs identified from the survey, and were distributed to stakeholders. The information gained from this project will serve as a foundation for future implementation of N2O use as a labor analgesic at the participating institution