Nurses’ Intentions to Provide Continuous Labor Support to Women Laura Payant, Barbara Davies, Ian D. Graham, Wendy E. Peterson, and Jennifer Clinch Correspondence Laura Payant, BScN, MScN, Perinatal Partnership Program of Eastern and Southeastern Ontario (PPPESO), 2305 St Laurent Blvd., Ottawa, ON, Canada K1G 4J8. lpayant@pppeso.on.ca; laurapayant@rogers.com Keywords labor support childbirth obstetric nursing planned behavior epidural evidence-based practice ABSTRACT Objective: To examine the determinants of nurses’ intentions to practice continuous labor support. Design: A descriptive survey based on the Theory of Planned Behavior. Setting: A large, urban Canadian hospital with 2 sites and 7,000 births per year. Participants: Ninety-seven registered nurses from 2 birthing units. Results: Scores measuring nurses’ attitudes, subjective norms, and intentions regarding continuous labor support for women with epidural analgesia were significantly lower than those for women without epidural analgesia ( po.0001). Multiple regression analyses revealed that previous labor support courses, subjective norms, and perceived behav- ioral control explained 55% of the variance in nurses’ intentions to provide continuous labor support to women without epidural analgesia while 88% of the variance in intentions to provide continuous labor support to women with epidural analgesia was explained by subjective norms and attitudes. Subjective norms made the most significant contribution to the variance in nurses’ intentions to provide continuous labor support. Top perceived organizational barriers to continuous labor support included unit acuity and method of patient assignment. Conclusion: Nurses’ intentions to provide continuous labor support are lower for women receiving epidural analgesia and are influenced by the perceived social pressures on their unit. Nurses view organizational barriers as important factors influencing their ability to provide continuous labor support. JOGNN, 37, 405-414; 2008. DOI: 10.1111/j.1552-6909.2008.00257.x Accepted April 2008 L abor support is a term for the caring work or social support that is provided to women during labor and birth (Davies & Hodnett, 2002; Hodnett, Gates, Hofmeyr, & Sakala, 2007; Sauls, 2006). Labor support includes emotional sup- port (continuous presence, reassurance, praise), physical comfort (touch, massage, warm baths/ showers, encouraging £uid intake and output), advocacy (communicating the woman’s wishes), and o¡ering of information (advice/information on coping methods, update on progress of labor) (Enkin et al., 2000; Health Canada, 2000; Hodnett et al., 2007). Although elements of labor support may be pro- vided by all members of the healthcare team, as well as the woman’s personal support system, labor support is an especially important dimension of the care provided by nurses. The birth experience can have a lasting, even lifelong, impact and can a¡ect women’s psychological well-being (Good- man, Mackey, & Tavakoli, 2004; Simkin, 1991). In most North American hospitals, nurses spend more time with women in labor than do other care provid- ers (Bryanton, Fraser-Davey, & Sullivan,1994; Gale, Fothergill-Bourbonnais, & Chamberlain, 2001; MacKinnon, McIntyre, & Quance, 2005). As a result, nurses are in a unique position to have a powerful in£uence on the physiological and psychosocial outcomes of the childbirth experience through their actions and words. In today’s technology-dominated system, many demands have been placed on childbirth nurses, challenging their ability to provide continuous labor support (CLS) (Health Canada, 2000; Hodnett et al., 2007). Although family and friends provide much of the companionship and support for women in childbirth, women report that they value and desire support from nurses including continu- ous, rather than intermittent, presence (MacKinnon et al., 2005; Sleutel, 2000). In a retrospective study where 80 postpartum women were asked for their perceptions of nursing support during labor, partic- ipants reported emotional support as being more helpful than physical support or receiving pain (Continued) Laura Payant, BScN, MScN, is a Perinatal Coordinator, Perinatal Partnership Program of Eastern and Southeastern Ontario (PPPESO), Ottawa, ON Canada. Barbara Davies, RN, PhD, is associate professor, School of Nursing, Faculty of Health Sciences University of Ottawa, Ottawa, ON, Canada. Ian D. Graham, PhD, is Vice President, Canadian Institutes of Health Research and associate professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. JOGNN R ESEARCH http://jognn.awhonn.org & 2008 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses 405