(—THIS SIDEBAR DOES NOT PRINT—) DES IGN GUIDE

This PowerPoint 2007 template produces a 44”x44” presentation poster. You can use it to create your research poster and save valuable time placing titles, subtitles, text, and graphics. We provide a series of online tutorials that will guide you through the poster design process and answer your poster production questions. To view our template tutorials, go online to PosterPresentations.com and click on HELP DESK. When you are ready to print your poster, go online to PosterPresentations.com Need assistance? Call us at 1.510.649.3001

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Zoom in and out As you work on your poster zoom in and out to the level that is more comfortable to you. Go to VIEW > ZOOM.

Title, Authors, and Affiliations

Start designing your poster by adding the title, the names of the authors, and the affiliated institutions. You can type or paste text into the provided boxes. The template will automatically adjust the size of your text to fit the title box. You can manually override this feature and change the size of your text. TIP: The font size of your title should be bigger than your name(s) and institution name(s).

Adding Logos / Seals Most often, logos are added on each side of the title. You can insert a logo by dragging and dropping it from your desktop, copy and paste or by going to INSERT > PICTURES. Logos taken from web sites are likely to be low quality when printed. Zoom it at 100% to see what the logo will look like on the final poster and make any necessary adjustments. TIP: See if your school’s logo is available on our free poster templates page.

Photographs / Graphics You can add images by dragging and dropping from your desktop, copy and paste, or by going to INSERT > PICTURES. Resize images proportionally by holding down the SHIFT key and dragging one of the corner handles. For a professional-looking poster, do not distort your images by enlarging them disproportionally.

Image Quality Check Zoom in and look at your images at 100% magnification. If they look good they will print well. If they are blurry or pixelated, you will need to replace it with an image that is at a high-resolution.

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QUICK START (cont. )

How to change the template color theme You can easily change the color theme of your poster by going to the DESIGN menu, click on COLORS, and choose the color theme of your choice. You can also create your own color theme. You can also manually change the color of your background by going to VIEW > SLIDE MASTER. After you finish working on the master be sure to go to VIEW > NORMAL to continue working on your poster.

How to add Text The template comes with a number of pre-formatted placeholders for headers and text blocks. You can add more blocks by copying and pasting the existing ones or by adding a text box from the HOME menu.

Text size

Adjust the size of your text based on how much content you have to present. The default template text offers a good starting point. Follow the conference requirements.

How to add Tables

To add a table from scratch go to the INSERT menu and click on TABLE. A drop-down box will help you select rows and columns. You can also copy and a paste a table from Word or another PowerPoint document. A pasted table may need to be re-formatted by RIGHT-CLICK > FORMAT SHAPE, TEXT BOX, Margins.

Graphs / Charts

You can simply copy and paste charts and graphs from Excel or Word. Some reformatting may be required depending on how the original document has been created.

How to change the column configuration RIGHT-CLICK on the poster background and select LAYOUT to see the column options available for this template. The poster columns can also be customized on the Master. VIEW > MASTER.

How to remove the info bars

If you are working in PowerPoint for Windows and have finished your poster, save as PDF and the bars will not be included. You can also delete them by going to VIEW > MASTER. On the Mac adjust the Page-Setup to match the Page-Setup in PowerPoint before you create a PDF. You can also delete them from the Slide Master.

Save your work Save your template as a PowerPoint document. For printing, save as PowerPoint or “Print-quality” PDF.

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Women undergoing cesarean delivery (C-section) report more pain with activity than those who had a vaginal delivery (p < 0.0002) (Hardy-Fairbanks, Lauria, Mackenzie, & McCarthy, 2013). On postpartum day 2, women after C-section reported significantly more pain when compared with those with a vaginal delivery (p < 0.04), which requires additional analgesia medications that can interfere with involvement in baby care activities (Hardy-Fairbanks et al., 2013). Additionally, the increased pain is not associated with demographic or clinical characteristics (i.e., age, prior birth experiences, prior pregnancies; it is only significantly associated with cesarean delivery (p= .001) (Dunn & O’Herlihy, 2005; Granot, Lowenstein, & Yarnitsky, 2003; Pan, Coghill, & Houle, 2006). While narcotic and non-narcotic analgesia (i.e., Dura morph and Ketorolac) are routinely used and found to reduce pain significantly after C-section, pain associated with activity can be an important problem for a new mother who may need to care for her infant and other children immediately postpartum. Additionally, sleepiness or exacerbation of fatigue caused by increased analgesia use can also be a source of frustration and lead to women choosing to refrain from optimal pain control to minimize medication side effects (Tully & Ball, 2014). Offering non-pharmacologic interventions (i.e., abdominal binders) to decrease pain after C-section would complement the analgesia effects of medications.

Abdominal binders are identified in the non-professional literature as an effective intervention to improve ambulation and decrease pain. Pregnancy websites (i.e., www.webmd.com/baby/features/belly-wraps-post-pregnancy-hit-or-hype) encourage women to bring abdominal binders to the hospital when they are admitted for planned cesarean delivery. Abdominal binders were available for use by patients at Northern Westchester Hospital but were not part of routine care.

While abdominal binders are identified as an effective intervention to decrease pain and increase ambulation for women after C-section, little evidence was found to support the use of the binders. A systematic review of the literature failed to produce primary research studies about the use of abdominal binders for post-caesarian section patients. PubMed, CINHAL, EMBASE, and the Cochrane databases were searched for all published articles from electronic database from 1990 through March 2014. Common to each database were the search limits of English language publications, human studies. Inclusion criteria for articles included primary research in women who have had cesarean sections for childbirth. When the search did not reveal articles, further searches were completed with the key words “abdominal binder” and “abdominal surgery”. The Proquest Dissertation Abstract database was also searched for doctoral dissertations to address publication bias within the results of the other database searches.

Three articles were identified that examined the use of abdominal binders to decrease pain and improve ambulation after abdominal surgery. Abdominal binders were consistently associated with decreased reports of pain, and increased ambulation (Cheifetz, Lucy, Overend, & Crowe, 2010; Larson, Ratzer, Davis-Merritt, & Clark, 2009; Olsen, Josefson, & Wiklund, 2009). Additionally, an improvement in pulmonary function with subsequent decreased atelectasis was identified as a serendipitous benefit of abdominal binder use related to the “splinting ability “ to support deep breathing (Larson et al., 2009)

BACKGROUND

Nurses on the post-partum unit noted that when abdominal binders were offered and used by women after C-section, they ambulate more frequently and for longer duration compared to the women after C-section that do not use abdominal binders. It is also noted that the women after C-section that do not use abdominal binders report more constipation and gas pain, that is attributed to less frequent ambulation. Additionally, decreased ambulation places patients at risk for post-operative ileus, deep vein thrombus and pulmonary embolism.

Some of the women after C-section express concern about taking narcotics while nursing, and suffer pain to prevent medications entering into their breast milk. Also, breastfeeding is often more successful sitting in a chair. Women also express stress about their ability to care for their newborn with post-operative pain given the planned discharge after cesarean section of post-operative day three. The women often state that they “can’t imagine how I will take care of my newborn, while in so much pain”.. It is anticipated that when women after cesarean sections use an abdominal binder, pain will decrease; ambulation will increase enabling women to more effectively engage with baby care activities, and breastfeeding. Therefore the goals of this Evidence-Based Practice project in women after C-section were to:

•  Decrease pain ratings to less than 3 on the 0-10 visual analog pain. •  Increase ambulation •  Enhance feelings of self-efficacy to care for the newborn at home

OBJECTIVES

Our patients' told us…

Number of women wearing a binder at each assessment

RESULTS PROJECT IMPLEMENTATION The Mather-Baby Unit Nursing staff partnered with the OB physicians. Since current

practice at NWH required a written MD order for the nurse to offer an abdominal binder to women post C-section, a standing order was written to allow the nurses to offer the binder starting the project.

The project was approved by the NWH IRB as exempt from informed consent (IRB #14-008) because the project met the Health and Human Services requirements for waiver of informed consent (i.e., the only record linking the subject and the data collection would be the consent document, the project presents no more than minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside the research context).

Procedure All women after C-section were offered an abdominal binder before the first post-operative ambulation (i.e., approximately twelve hours post-operative).

–  The abdominal binder would be placed on the patient while lying down, and proper body mechanics for ambulation will be taught to the patient.

–  Data were collected •  On both women who chose to wear an abdominal binder and those that did not

choose to wear an abdominal binder •  Baseline at abdominal binder placement or when offered and refusal •  Approximately 24 hours post-op (i.e., 12 hours after binder offered) •  Then every 12 hours until discharge. •  Data collection forms were de-identified

REFERENCES Cheifetz, O., Lucy, S. D., Overend, T. J., & Crowe, J. (2010). The effect of abdominal support on

functional outcomes in patients following major abdominal surgery: a randomized controlled trial. Physiotherapy Canada, 62(3), 242-253. doi: 10.3138/physio.62.3.242

Dunn, E. A., & O’Herlihy, C. (2005). Comparison of maternal satisfaction following vaginal delivery after caesarean section and caesarean section after previous vaginal delivery. European Journal Obstetrical Gynecological Reproductive Biology, 12(1), 56-60.

Granot, M., Lowenstein, L., & Yarnitsky, D. (2003). Post cesarean section pain prediction by preoperative experimental pain assessment. Anesthesiology, 98(6), 1422-1426.

Hardy-Fairbanks, A. J., Lauria, M. R., Mackenzie, T., & McCarthy, M. (2013). Intensity and Unpleasantness of Pain Following Vaginal and Cesarean Delivery: A Prospective Evaluation. Birth: Issues in Perinatal Care, 40(2), 125-133. doi: 10.1111/birt.12039

Larson, C. M., Ratzer, E. R., Davis-Merritt, D., & Clark, J. R. (2009). The effect of abdominal binders on postoperative pulmonary function. Am Surg, 75(2), 169-171.

Olsen, M. F., Josefson, K., & Wiklund, M. (2009). Evaluation of abdominal binder after major upper gastrointestinal surgery. Advances in Physiotherapy, 11(2), 104-110.

Pan, P. H., Coghill, R., & Houle, T. T. (2006). Multifactorial preoperative predictors for post cesarean section pain and analgesic requirement. Anesthesiology, 104(3), 417-425. Tully, K. P., & Ball, H. L. (2014). Maternal accounts of their breast-feeding intent and early

challenges after caesarean childbirth. Midwifery, 30(6), 712-719. doi: 10.1016/j.midw.2013.10.014

The Evidence-Based Practice and Research Council The Nursing Staff and Leadership of the Mother Baby Unit Navid Mootabar MD, Chief Department of Obstetrics and Gynecology Lauraine Spano- Szekely DNP, MBA, RN, Chief Nursing Officer, Vice President of Patient Care Services Maria Hale MBA, Vice President, Patient Advocacy & Service Excellence Fay Wright PhD, RN, APRN-BC, Evidence-Based Practice and research Coordinator

Northern  Westchester  Hospital,  Mt.  Kisco,  New  York  

Patricia  Chambers  RNC,    Jessie  Edward  RNC,  BSN,  Lora  Kelly  BSN,  RN,  Mary  Padovani  RN,  Mary  DiShaw  BSN,  RNC-­‐MNN,  CNML    and  the  Nurses  of  the  Mother-­‐Baby  Unit  

Abdominal  Binder  Use  Increases  AmbulaAon  and  Decreases  Pain  in  Women  ADer  Cesarean  SecAon    

Across all assessment times, wearing an abdominal binder was significantly associated with

•  Less pain (χ2=27.42(8), p=.001) •  More ambulation (χ2=19.55(1), p<.000) •  Decreased request for pain medications (t=3.96(299), p=.000)

No significant differences between women wearing or not wearing an abdominal binder in the

•  Length of time out of bed (p=.40), •  Level of activity when out of bed (p=.13).

During the EBP project HCAP scores for key pain and nursing care increased •  “Pain well controlled”: increased from 78.9 to 94.4 •  “Pain staff do all they can to help”: increased from 84.2 to 88.9 •  “Rate hospital 9 or 10” : increased from 71.4 to 89.5 •  “Nurses communicate” increased from 83.9 to 95.0

Wearing an abdominal binder was significantly associated with less pain (t=-4.8(452), p=.0001)

 

N=94

Average age 33.1 years (range 20-46 years, SD=5.0 years)

Age or parity not associated wearing a binder (p=.34)

DISCUSSION Based on the data from this project, the use of an abdominal binder appears to be a

beneficial option to support patient ambulation and pain management. Women wearing abdominal binders experienced significantly improved pain and increased ambulation, especially within the first 12 hours after C-section. The women consistently reported that the binders made them feel more confident and comfortable. There were no changes noted in any incisional assessments from baseline with a binder. When women were offered the binders more than 95% consented to using a binder. Additionally the women who had a repeat C-section told the team that they wished they had a binder at the prior C-section. These positive results suggest improved post C-section mobility and improved post-operative recovery with decreased risk of DVT or ileus due to increased ambulation.

Based on the project results, offering abdominal binders was included as a standing order in the standard of care for women after C-Section and has become the standard of practice for women after C-section as a non-pharmacologic, complimentary intervention to decrease pain.

ACKNOWLEDGEMENTS