Increasing Use of the Peanut Ball in Labor

Abstract

The Johns Hopkins Hospital Perinatal Unit set a goal to decrease the number of primary cesareans performed on nulliparous women with singleton, term (>37 weeks) pregnancies in vertex presentation. There are nursing interventions that can decrease length of labor and incidence of cesarean birth. One intervention is the use of the peanut ball. The aims of this project were to increase staff knowledge of the peanut ball and increase its use during labor. We conducted a survey to identify staff familiarity and comfort with use of the peanut ball. We then provided a series of education sessions outlining rationale for using the peanut ball and demonstrated patient-positioning options. Additional peanut balls were purchased. Peanut ball–positioning posters were displayed in every labor room. We repeated the survey to determine changes in staff knowledge and use of the peanut ball. We created a Likert-scale questionnaire, which included a comment section, to assess knowledge and attitudes regarding the peanut ball. Perinatal nursing staff was encouraged to complete the survey. Twenty-eight nurses completed the presurvey. After the described interventions, nurses were again invited to complete the questionnaire. Thirty-four nurses completed the postsurvey. Pre- and postsurvey score averages were calculated and compared. Narrative comments were reviewed. Although there was an increase in scores for all five questions, the most significant change in score was on the staff education question. This score increased from 2.5 to 4. Narrative comments showed that staff valued peanut ball education and would appreciate additional sessions. This initiative showed that nurses valued and wanted more peanut ball education. As peanut ball use increased, staff realized there was no field to document this intervention, so an Epic field was added. One opportunity for additional inquiry is comparison of labor duration for patients before and after this initiative. Lessons learned during this process included the following: to incorporate providers in the survey process because they were included in the education process; to add a question specifically relating to use of peanut ball and outcome of vaginal versus cesarean birth; to add a demographics question to the presurvey; to attempt to match pre- and postsurveys.