OB Chapter 2: Family-Centered Community-Based Care

Client education

when nurses share information, knowledge, and skills with clients and families, thus empowering them to take responsibility for their health care.

techniques can facilitate learning

Slow down and repeat information often. Speak in conversational style using plain, nonmedical language. "Chunk" information and teach it in small bits using logical steps. Prioritize information and teach "survival skills" first. Use visuals, such as pictures, videos, and models. Teach using an interactive, "hands-on" approach

Advantages of home birth

-Is the least expensive -Allows the woman to experience labor and birth in the privacy, comfort, and familiarity of home while surrounded by loved ones -Permits the woman to maintain control over every aspect affecting her labor (e.g., positions, attire, and support people) -Minimizes interference and unnecessary interventions, allowing labor to progress normally -Provides continuous one-on-one care by the midwife throughout the childbirth process -Promotes the development of a trusting relationship with the nurse midwife

Postpartum care in the home environment usually includes:

-Monitoring the physical and emotional well-being of the family members -Identifying potential or developing complications for the mother and newborn -Linking the family, as needed, to community social services and housing and governmental programs

Disadvantages of home birth

-limited availability of pain medication -danger to the mother and baby if an emergency arises (e.g., placental abruption, uterine rupture, cord prolapse, or a distressed fetus). -Delay in getting to the hospital could jeopardize the life of the child or the mother.

Birthing centers

-offer a home-like setting but with proximity to a hospital in case of complications. -Midwives often are the sole care providers in free-standing birthing centers, with obstetricians as backups in case of emergencies. -no pedi on staff -discharge in 4-24 hours]

Steps to developing cultural competance

1 . cultural awareness 2. cultural knowledge 3. Cultural skills 4. Cultural encounter

Complementary medicine

used together with conventional medicine ex. such as using aromatherapy to reduce discomfort after surgery or to reduce pain during a procedure or during early labor

Reasons for Documentation

1. the medical record serves as a communication tool that the entire interdisciplinary team can use to keep track of what the client and family have learned already and what learning still needs to occur. 2. serves to testify to the education the family has received if legal matters arise. 3. verifies standards set by the Joint Commission, Centers for Medicare and Medic-aid Services, and other accrediting bodies that hold health care providers accountable for client education activities. 4. informs third-party payers of the goods and ser-vices that were provided for reimbursement purposes

Tips for working with interpreters

1. Help the interpreter prepare and understand what needs to be done ahead of time. A few minutes of preparation may save a lot of time and help communication flow more smoothly in the long run. 2. Introduce yourself to both parties. It is the key to easy communication across the language barrier. 3. Physically place yourselves so that you are facing your client, and your client is facing you. Place the interpreter physically close to both of you, but not in a position that breaks the line of sight between you and your client. 4. Begin with a minute or two of light conversation to establish a rhythm before getting into the business at hand. This establishes the quantity of speech in the conversation. 5. Remember, the interpreter is the "communication bridge" and not the "content expert." The nurse's presence at teaching sessions is vital. 6. Be patient. The interpreter's timing may not match that of others involved. It often takes longer to say in some languages what has already been said in English; therefore, plan for more time than you normally would. 7. Speak slowly and clearly. Avoid jargon. Use short sentences and be concise. Avoid interrupting the interpreter. 8. Pause every few sentences so the interpreter can translate your information. After 30 seconds of speaking, stop and let the interpreter express the information. Talk directly to the family, not the interpreter. 9. Give the family and the interpreter a break. Sessions that last longer than 20 or 30 minutes are too much for anyone's attention span and concentration. 10. Express the information in two or three different ways if needed. Cultural barriers or language and dialect differ-ences can interfere with understanding. Interpreters may often know the correct communication protocols for the family. 11. Use an interpreter to help ensure the family can read and understand translated written materials. The interpreter can also help answer questions and evaluate learning. 12. Avoid side conversations during sessions. These can be uncomfortable for the family and jeopardize client-provider relationships and trust. 13. Remember, just because someone speaks another language doesn't mean that he or she will make a good interpreter. An interpreter who has no medical background may not understand or interpret correctly, no matter how good his or her language skills are. 14. Do not use children as interpreters. Doing so can affect family relationships, proper understanding, and compliance with health care issues.

Chiropractic therapy

Aimed at removing irritants to the nervous system to restore proper function (e.g., spinal manipulation done for musculoskeletal complaints)

Assessment of the family's preparedness for newborn care/ Support systems.

Assess physical and emotional support for the new mother by asking questions about the avail-ability of her immediate family, other relatives, and sig-nicant others to provide help. If lacking, referrals may need to be made to community parenting programs, cooperative daycare, or other community resources needed to assist this family.

Assessment of the family's preparedness for newborn care/Parenting education.

Assess the family's knowledge of positioning and handling of their infant, nutrition, hygiene, elimination, growth and development, immunizations needed, and recognition of illnesses.

Therapeutic touch

Balancing of energy by centering, invoking an intention to heal, and moving the hands from the head to the feet several inches from the skin

Homeopathy

Based on the theory of "like treats like"; helps restore the body's natural balance

Assessment of the family's preparedness for newborn care/ Postpartum care.

Determine the mother's concerns in areas of body image, weight loss, sleep/rest needs, discomfort, fatigue, and adjustment to her new role.

Primary Prevention

Health promotion - preventing the disease or condition before it occurs through health promotion activities, environmental protection, and specific protection against disease or injury.

Examples of secondary Prevention

Health screenings are the mainstay of second-ary prevention. Pregnancy testing, blood pressure evalu-ations, cholesterol monitoring, fecal occult blood testing, breast examinations, mammography screening, hearing and vision examinations, and Papanicolaou (Pap) smears a

Community based nurse provides direct care to the perinatal client, beginning with the woman's first visit to the health care provider and extending through the pregnancy and birth

Includes: Contraception, Abortion, Infertility, Screening for sexually transmitted infections, Preconceptual risk assessment and care

Most commonly used CAM therapy

Prayer

Spiritual healing

Praying, chanting, presence, laying on of hands, rituals, and meditation to assist in healing

Acupressure

Restoration of balance by pressing an appropriate point so self-healing capacities can take ove

Feng shui (pronounced fung shway)

The Chinese art of placement. Objects are positioned in the environment to induce harmony with chi.

Herbal medicine

The therapeutic use of plants for healing and treating diseases and conditions

Cultural concepts

Time ori-entation, personal space, family orientation (patriarchal, matriarchal, or egalitarian), and language

Guided imagery

Use of consciously chosen positive and healing images along with deep relaxation to reduce stress and to help people cope

Reflexology

Use of deep massage on identifed points of the foot or hand to scan and rebalance body parts that correspond with each point

Aromatherapy

Use of essential oils to stimulate the sense of smell for balancing mind, body, and spirit

Community

a specific group of people, often living in a defined geographic area, who share common interests, who interact with each other, and who function collectively within a defined social structure to address common concerns

Examples of Tertiary prevention

cerebrovascular disease or the chronic effects of sexually trans-mitted infections (e.g., herpes, human immunodeciency virus [HIV], and untreated syphilis). Another example would involve working with women who have suffered long-term consequences of violence

Integrative medicine

combines mainstream medical therapies and CAM therapies for which there is some scientifc evidence of safety and effectiveness

Appraisal support, also called esteem support

conceptualized as enhancing, reinforcing, and supporting the family role.

Basic components of prenatal care

early and continuing risk assessment, health promotion, medical and psycho social interventions, and follow-up.

Secondary Prevention

early detection and treatment of adverse health conditions. (halting the disease, thus shortening its duration and severity to get the person back to a normal state of functioning. )

population

group of individuals who share personal or environmental characteristics. Typically the most common characteristic is geographic location.

Informational support

idesigned to provide supportive communication by making available understandable information to the family about their member's condition, treatment, development, and care; about their behavioral and emotional responses and needs; and about what to expect regarding their condition.

Instrumental support

includes assistance of any kind, such as financial, time, labor, or environmental modifications.

2 primary goals of Healthy People 2020

increase the quality of life and the life expectancy of individuals of all ages and to decrease health disparities among different populations.

Emotional support

listening, exhibiting caring behaviors, and being concerned in ways that help the family cope with their member's illness and the other aspects of their lives that are impacted by the illness

most frequently applied CAM methods during pregnancy

massage, acupuncture, vitamins, and herbs

High Risk Newborn Home Care equipment that may be used

mechanical ventilation, electronic apnea monitors, home oxygen equipment, intravenous infusion equipment, respiratory nebulizers, phototherapy, and suction equipment

Examples of primary prevention

nutrition, good hygiene, sanitation, immunizations, protection from ultraviolet rays, genetic counseling, bicycle helmets, handrails on bathtubs, drug education for schoolchildren, adequate shelter, smoking cessation, family planning, and the use of seat belts. Giving anticipatory guidance to parents about poison prevention and safety during play is another example of primary prevention.

Community-based nursing care settings

physicians' offces, clinics, health depart-ments, urgent care centers, hospital outpatient centers, churches, shelters, and clients' homes. N

High Risk Newborn Home Care

preterm infants who continue to need oxygen, low-birth-weight infants who need nutritional or hypercaloric for-mulas or adjunct feeding methods (e.g., tube feedings), or infants with hydrocephalus or cerebral palsy.

core concepts of family-centered care

providing dignity and respect for the client and family choices; sharing health care information that is meaningful and accurate; encouraging clients and their families to participate in decisions about their care; and collaborating with clients, families, and other health care providers in the delivery of care

Tertiary Prevention

reduce or limit the progression of a permanent, irreversible disease or disability.

Purpose of Tertiary Prevention

restore individuals to their maximum potential Tertiary intervention takes place only if the condition results in a permanent disability.

Epidemiology

study of the causes, distribution, and control of disease in populations

Discharge planning

the development and implementation of a comprehensive plan for the safe discharge of a client from a health care facility and for continuing safe and effective care in the community and at home.

Cultural competence

the knowledge, willingness, and ability to adapt health care to enhance its acceptability to and effectiveness with clients from diverse cultures

the steps of client and family education

the nurse must assess, plan, implement, evaluate, and document the education. ( similar to the steps of the nursing process)

Massage therapy

therapeutic stroking or kneading of the body to decrease pain, produce relaxation, and/or to improve circulation to that body part.

Barriers to cultural competence

those related to providers and those related to systems.

Factors needed to create and foster effective therapeutic communication ( 3)

trust, respect, and empathy

Alternative medicine

used instead of conventional medicine