Development and testing of nurses' perceptions of the use of hydrotherapy in labor questionnaire.

While effective for labor pain, hydrotherapy is not often used. The purpose of this study was to develop and test an instrument of nurses' perceptions of the barriers to the use of hydrotherapy in labor. Following generation of items and review by content experts, the Nurses' Perceptions of the Use of Hydrotherapy in Labor (NPUHL) questionnaire was administered to 65 intrapartum nurses (phase I) and to 401 nurses (phase II). In phase I, the mean score of the NPUHL was significantly and negatively correlated with the Labor Support Scale (r = -.30, p = .016), indicating that nurses who demonstrated more labor-supportive behaviors also perceived fewer barriers to the use of hydrotherapy in labor. In phase II, exploratory factor analysis revealed five factors: Health Care Environment, Knowledge and Beliefs, Personal Concerns, Effort Required for Hydrotherapy, and Technology. There was a significant negative correlation (r = -.61) between use of hydrotherapy and the total NPUHL score and those of its subscales (r = -.12 to -.61); nurses with access to hydrotherapy tubs perceived fewer barriers to hydrotherapy than nurses without (t = 9.71, df= 387, p < .01). For the revised 30-item NPUHL, Cronbach's alpha was .93, and subscale alphas ranged from .58 to .93. The 30-item NPUHL scale demonstrated evidence of good initial reliability and validity.