21 Oct 2014

Nursing Sample Action Plan

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Date 06/08/2014
Chosen topic to examine Management of second stage of labour: approaches for reducing perineal trauma
Rationale for this choice Perineal trauma is a significant cause of morbidity in vaginal births. The morbidity can be severe when it comes to third or fourth degree tears. Hence it is necessary to determine which is the most effective method or intervention for reducing perineal trauma. The PICO based search would be as follows:
Selected Pieces of Evidence Aasheim, V., Nilsen, A., Lukasse, M. and Reinar, L. (2011). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev, 12.Beckmann, M. and Garrett, A. (2006). Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev, 1.East, C., Lau, R. and Biro, M. (2014). Midwives’ and doctors’ perceptions of their preparation for and practice in managing the perineum in the second stage of labour: A cross-sectional survey. Midwifery.Geranmayeh, M., Habibabadi, Z., Fallahkish, B., Farahani, M., Khakbazan, Z. and Mehran, A. (2012). Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Archives of gynecology and obstetrics, 285(1), pp.77–81.Harlev, A., Pariente, G., Kessous, R., Aricha-Tamir, B., Weintraub, A., Eshkoli, T., Dukler, D., Ayun, S. and Sheiner, E. (2013). Can we find the perfect oil to protect the perineum? A randomized-controlled double-blind trial. The Journal of Maternal-Fetal & Neonatal Medicine, 26(13), pp.1328–1331.Mei-dan, E., Walfisch, A., Raz, I., Levy, A. and Hallak, M. (2008). Perineal massage during pregnancy: a prospective controlled trial. The Israel Medical Association journal, 10(7), p.499.

Premkumar, G. (2005). Perineal trauma: reducing associated postnatal maternal morbidity. RCM midwives: the official journal of the Royal College of Midwives, 8(1), pp.30–32.

Smith, L., Price, N., Simonite, V. and Burns, E. (2013). Incidence of and risk factors for perineal trauma: a prospective observational study. BMC pregnancy and childbirth, 13(1), p.59.

Zhou, F., Wang, X., Li, J., Huang, G. and Gao, B. (2014). Hyaluronidase for reducing perineal trauma. status and date: New, published in, (2).
Any other relevant evidence that you might use Other evidence from online databases and journals, books, and websites pertaining to nursing managed by hospitals and research institutions, research papers and abstracts on these topics.
How do you think this will impact upon your own individual practice? It will affect my own practice as I will consider the existing methods I am using in this area, the pros and cons, how advantageous are they, whether they can be improved on, and whether the method I am planning to check through this study will offer greater benefits in interventions. I will also be able to gauge my level of confidence and preparedness in using these techniques and changing to a new one and whether I need to undergo more training and practice in this area. My current practice would be enriched.Nurses are expected to incorporate EBP or evidence based research into their own research and practice. Even though a lot of progress has been achieved, a lot still needs to be done to incorporate more sound research evidence into practice. There is proof that evidence from rigorous research would strengthen nurses’ practice.
Additional Information
The PICO method of determining the research question.
a. Patient problem: Perineal trauma leading to ASI and episiotomy
b. Intervention: Use of perineal warm compresses to reduce the perineal trauma
c. Comparison: hands on hands off the fetal head/perineum approach
d. Outcome: there should be a significant reduction of third and fourth degree tears, reduces perineal trauma

The following keywords would be used for doing the literature search across various databases:
Perineal trauma, warm compresses, hands on/hands off approach, episiotomy, Anal Sphincter injuries
Article was selected by using the CASP tools and NORA library as well as PUBMED.
The above was one example of a Nursing action plan sample.

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