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

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.