Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily chores and quality of life (Alaloul, Williams, Myers, Jones, & Logdson, 2015). While health care expenses have increased significantly over the years, there have been great improvements in increasing both family and patient involvement in medical care. Hourly care is one of the strategies that have worked well in various healthcare settings. Hourly care has been a success in various areas but using it in urgent pediatric settings hasn't been well documented (Emerson, Chumra, & Walker, 2013). Opportunities still exist to look into pediatric family preferences and perspectives as pertains to the use of whiteboards (Cholli, et al., 2016). Several studies have been done in different setups and this paper references many of them. The research projects include in-patient surveys, quasi-experimental design analyses, installation of whiteboards or incorporation of hourly rounding methods and techniques and one-on-one interviews. The study highlights the role of communication in patient satisfaction and pain management. The discussion covers various areas of concern that were aided by: i. Large quantitative data and sample size that yielded concrete data.

ii. Implementation of whiteboard use was highly specific and this increased knowledge of the level of its effectiveness in postpartum units.

iii. Tracking of hourly rounding metrics which showed that they reduced fall rates, among others.

Ensuring that communication between the interdisciplinary team and the patient together with their family members is one of the key components of Patient Centered Care (PCC). For patients to arrive at informed decisions about the care they want administered, they must have an open line of communication with health care providers serving them. Often times, physicians will meet with a patient to discuss their treatment plan but it is not always the case that the patient understands what's going on and the options that are available to them. Nurses attend to many patients and it is not easy to keep track of a patient's information even with the help of a patient chart. Whiteboards besides patients can be used to bridge the information gap as physicians can update them with any necessary information about the treatment plan and the nurses will update the patient chart as necessary. This can help improve patient safety, better communication needs and significantly improve patient outcomes (Karn, 2016).

PICOT Question

Patient/Problem:

Women going through either caesarean or vaginal delivery

Intervention/ Phenomena of Interest/ Issue:

Making use of white boards and hourly rounding

Comparison/Context:

Compared to no usage of white board and no usage of rounding

Outcome/ Evaluation:

Raise pain management and patient satisfaction

Time: (if applicable otherwise end with PICO)

A trial period of three months

2. Significance of the Problem to Nursing Practice

Most of the metrics used to measure success of post-partum hospital experiences depend on patients' interactions with nurses. The broad goal ought to be managing expectations of post-partum patients and their families as pertains to their stay in the hospital right from the moment they are admitted to the moment they are discharged by using a whiteboard and a postpartum roadmap. Feedback from patients indicate that new families weren't sure of what really to expect of their caregivers and what their responsibilities were as pertains to learning all the new born and postpartum skills required for a discharge to be a success. The whiteboard and postpartum roadmap are very valuable as they allow patients and nurses to communicate effectively during the entire stay of the patient in the facility and manage postpartum care expectations (Horgan, Roe, Yocom-Piatt, & Cohn, 2014).

3. Literature Search Strategy

PICOT Question search terms

i. Emotional, mental, environmental, physical and associated factors linked to labor pain,

ii. Level of relaxation and events are a representation of the delivery experience being perceived positively, iii. Being dissatisfied with equipment, hospital staff, facilities and expenses; and iv. Being aware of one's baby and preparation of the family as pertains to taking the new baby born home, as well as knowing postpartum medical examinations and being ready to be discharged.

Inclusion Criteria

Post-delivery women, no matter their income level, geographies and languages are included in the study.

Exclusion Criteria

Post-delivery women who don't accept the invitation to participate in the study will be excluded.

Search Locations

Google scholar, reputable medical

References of superior quality, as per this research, refer to pieces that are less than 5 years old. Another factor, besides the age, was whether the research articles and citations were written by the same author or not.
The journals or database locations that were searched include:

i. Journal of Nursing Administration,

ii. Various universities' thesis projects, iii. The Journal of Emergency Medicine

iv. Hospital Pediatrics,

v. Pain Management Nursing,

vi. LVHN Scholarly Works -- Research & Neonatal Nursing, vii. Journal of Obstetric, Gynecologic & Neonatal Nursing viii. Journal of Nursing Care Quality, and ix. AWHONN 2013 -- Annual Convention.

Evidence-based Study Types

Qualitative

___Meta-synthesis _X_Generalizable conceptual studies

_X_Descriptive studies __Case Study

Quantitative

_X_Systematic Review _X_Meta-analysis ___Practice Guidelines

_X_Randomized Controlled Trial ___Case-control Study _X_Cohort Study

4. Literature Review

In the paper by (Alaloul, Williams, Myers, Jones, & Lodgson, 2015) the used design was quasi-experimental pretest-posttest, prospective design. The characteristics of the sample were such that all the patients were admitted in two units together with medical-surgical patients and a nurse attended to them between August and December, 2013. The average length of stay for both units was four days and the number of patients in each unit averaged about twenty-two patients at a time. This was done in a health facility based on the grounds of an academic health center in Southern U.S.A. The independent variables that the researchers considered were script-based communication, hourly rounding and whiteboard use. The measurements were patient satisfaction which was evaluated through pain management and effectiveness. There was no quantitative analysis carried out. The researchers' findings were that using whiteboards, and various other communication methods, showed clear and consistent communication with the patients and created a positive effect in realizing better pain management and higher patient satisfaction.

The characteristics and design of the paper done by (Brosey & March, 2015) includes a minimum patient satisfaction score on Hospital Consumer Assessment of Healthcare Providers and Systems (HCANPS) surveys as well as on HAPU and fall rates. These were collected and analyzed before being presented for implementation. There was a seven-day consecutive monitoring rounding compliance that was assessed monthly for the period of the implementation of the project for the eligible 582 students that were discharged. Setting: a 24-bed surgical unit that has both private and semi-private rooms. There was an education session that lasted 20 minutes and nurses provided hourly rounding and this led to an increase in compliance to 69.4% up from 48.6% during the first month of implementation. Nonetheless, this increase wasn't sustained in the months that followed and decreased to 44.3% in the immediate following month and then climbed again to 59.2% the following month.

(Cholli, et al., 2016) look at the pediatric family preferences and perspectives as pertains to the use of whiteboards and also the recommendations made to use whiteboards as tools to ensure patient-centered care and communication. Design: It consisted of semi-structured interviews that involved twenty-nine families. It was set in a pediatric urban academic hospital inpatient surgical service. From the results of the interview, 2/3 of the interviewed respondents reported on using whiteboards while 52% reported having had staff communicate directly with them. Those that had used whiteboards were shown to be 6 times more active using them than those who had been using visual references. A different analysis points to 42% of the group where the parents were the ones who wrote on the whiteboard where 80% of the group had only contact information.

In assessing what impact hourly rounding had on patient satisfaction and communication in pediatric emergency department setting between November and December 2011, (Emerson, Churma, & Walker, 2013) carried out the research with design in observational, prospective study utilizing surveys done between November 2010 and December 2011. The setting was a tertiary care children's hospital. The sample characteristics included 200 discharged families whose opinions were collected and equally divided between post and pre-implementation data. Hourly rounding was the independent variable while call bell activations was the dependent variable. The quantitative analysis that was done wasn't enough. Nevertheless, results show that hourly rounding did not have nor had very small positive effect on call bell activation. The results indicated that accidental call bell activation rose as hourly rounding was introduced.

The goal of (Horgan, Roe, Yocom-Piatt, & Cohn, 2014) was managing expectations of both post-partum patients and their family members regarding their stay in the hospital from the point of their admission to the time they leave after being discharged by using a whiteboard and postpartum roadmap. Design: the design consisted of two interactive tools (whiteboard and written roadmap) that outline every postpartum phase during the hospital stay. Sample characteristics involved all patients and staff in four baby-mother units. Setting: the setting was in four baby-mother units. The use of whiteboards…