AWHONN's clinical issues in perinatal and women's health nursing最新文献

Social stigma impedes the delivery of quality health care to women who identify as lesbians. Nurses who are aware of and sensitive to women who are lesbians in their practice are able to increase the caliber of the health care they provide. This article provides examples in which a lesbian sociosexual orientation has an impact on the medical history, differential diagnosis, physical examination, and treatment.

Women face criticism regarding their bodies from childhood to old age. Overt and covert messages demand that all women seek the ever-changing "ideal" body through a variety of costly, ineffective, and often dangerous means. As these demands are internalized, healthy women may develop a negative body image and a damaged sense of self. Nurses can promote peace between mind and body through the nursing process, role modeling, and community involvement. Body image should be assessed, particularly during vulnerable periods, such as adolescence, pregnancy, postpartum, and menopause. Planning, intervention, and evaluation should focus on self-acceptance and emotional and physical well-being, rather than on changing one's appearance.

Interstitial cystitis (IC) is a form of painful bladder disease, characterized by chronic urinary urgency, frequency, and pain without evidence of bacterial infection. Ninety percent of patients with IC are women. Somatization disorder is a psychiatric diagnosis, given most often to women who report a variety of symptoms, such as dysmenorrhea, burning in sex organs, dyspareunia, irregular menstrual periods, and painful urination. Because diagnosis of interstitial cystitis may take many years, health care providers must be alert to the risks of the overdiagnosis of psychiatric problems and the underdiagnosis of interstitial cystitis.

It is well known that regular, moderate-intensity exercise is beneficial in promoting good health and preventing disease and disability in women; however, high levels of sedentary behavior are observed in women of all races, incomes, and age groups. The determinants of exercise participation in women are poorly understood. Exercise intervention programs should be designed to increase women's general physical activity habits and enhance physical fitness. Exercise programs should include physical activities that are safe and increase gradually in the frequency, intensity, and duration of effort expended over time.

Nurses working with migrant farm worker women face serious challenges. Poverty, language, and cultural differences between farm worker women and health care providers present substantial barriers to women obtaining access to the health care system. These differences are especially important in instances of domestic violence. The transient life style of migrant farm workers, combined with geographic and social isolation, make it especially difficult for health care providers to meet the needs of migrant battered women. Strategies for working with migrant battered women are offered.

This article outlines clinical approaches with women in abusive relationships or those who recently have left such situations. A model, the process of entrapment in and recovering from an abusive relationship, describes the experience of women in abusive relationships with a male partner and the cumulative influence of these experiences on women's views of self. This model has served as the basis for the development of specific interventions designed to assist women at different points in time while they experience abuse in a relationship or are recovering from the experience of being abused.

Women who are leaving abusive relationships rely on social support. However, their descriptions of the process of leaving, their reasons for leaving, and what helped them most in leaving relate to issues about the self as much as the availability of support. Clinicians who consider both of these resources can better support the decision making of women who are living in and leaving abusive male partners.

Interest in developing hospital-based domestic violence programs, protocols, policies, and procedures is growing secondary to efforts by national nursing, medical, and hospital accreditation organizations. Creating specialized health services for domestic violence survivors can be expedited by reviewing existing protocols, policies, and procedures. A reference list of sample domestic violence protocols and a sample domestic violence policy and procedure are provided. The authors share their experiences in developing two of the nation's eight hospital-based domestic violence programs. Domestic violence is a nursing concern, and nurses have been the leaders in providing perinatal and women's health services to battered women. Implementing the suggestions contained in this article will enhance hospitals' successful compliance with the 1992 Joint Commission on Accreditation of Healthcare Organizations guidelines for emergency and ambulatory services departments. The need for preprogram data collection, multidisciplinary support, patient and staff safety, specific program services, and staff supervision is addressed.

Ethical theory about what is right and good in human conduct lies behind the issues practitioners face and the codes they turn to for guidance; it also provides guidance for actions, practices, and policies. Principles of obligation, such as egoism, utilitarianism, and deontology, offer general answers to the question, "Which acts/practices are morally right?" A re-emerging alternative to using such principles to assess individual conduct is to center normative theory on personal virtues. For structuring society's institutions, principles of social justice offer alternative answers to the question, "How should social benefits and burdens be distributed?" But human concerns about right and good call for more than just theoretical responses. Some critics (eg, the postmodernists and the feminists) charge that normative ethical theorizing is a misguided enterprise. However, that charge should be taken as a caution and not as a refutation of normative ethical theorizing.

This article discusses the concept of values and the roles of values in the ethical decision-making process. The acquisition of values and the role of different types of values are explored. A model is presented to illustrate the nature of values as a guide to behavior. Finally, the role and impact of the individual values systems of health care professionals and patients are identified as essential ingredients in the resolution of ethical dilemmas.