Online Program

Training on labor monitoring tools and partograph use in nursing classrooms: A digital pen study

Wednesday, November 6, 2013

Heather Underwood, PhD Candidate, ATLAS Institute, University of Colorado Boulder, Boulder, CO
Background. The World Health Organization (WHO) estimates that in 2010, 287,000 women died due to pregnancy related complications, with the vast majority (99%) occurring in developing countries. Many maternal and infant deaths can be attributed to obstructed labor. The paper partograph is effective in the early detection and prevention of obstructed labor if used correctly. However, correct partograph use is challenged by limited training, understaffing and form complexity. Objective. The PartoPen project seeks to increase the effectiveness of partograph training using digital pen technology. Digital pens use handwriting recognition and paper-based location awareness to interpret partograph data and provide audio and text alerts in real time. Alerts include decision-support for high-risk labors, reminders to take patient measurements, and WHO instructions on partograph use. Methods. 95 third and fourth year nursing students at the University of Nairobi, Kenya participated in a partograph worksheet completion task. Students were in one of three groups: silent PartoPen, enabled PartoPen without training, or enabled PartoPen with training. Each student was asked to use the pen to plot sample patient data on paper partographs. Students were given two of three possible sample patients: normal labor, prolonged but uncomplicated labor, or prolonged and complicated labor. Results. The average worksheet score in the silent PartoPen group was 58% (SD = 18). The average score in the enabled PartoPen without training group was 63% (SD = 10). The average score in the enabled PartoPen with training group was 66% (SD = 14). Statistical significance between groups increased with the degree of labor complication. Discussion. Students using an enabled PartoPen performed better than those using a silent pen. Results suggest that the PartoPen improves performance even without training. The difference between groups for the most complex labor illustrates the effectiveness of audio being played only when patients need increased care.

Learning Areas:

Communication and informatics
Implementation of health education strategies, interventions and programs

Learning Objectives:
List barriers facing the correct use of maternal labor monitoring tools in developing countries. Explain how digital pen technology works, and how it can be used in health applications. Analyze the benefits and drawbacks of using paper-based health systems as opposed to mobile/electronic systems.

Keyword(s): Maternal and Child Health, Health Education

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator on a Bill & Melinda Gates foundation grant focusing on using digital pen technology to improve maternal labor monitoring in developing countries. My research over the last three years has focused on partograph use and implementation in Kenyan nursing classrooms, hospitals, and labor wards.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.