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

Nurses may often evaluate their identities by asking questions such as "Who is the perinatal nurse? Accountable professional or institutional employee?" The author analyzes this effort in terms of the metaphors reflected by these questions as they may or may not accurately describe nurses' circumstances of powerlessness and powerfulness. The author suggests ways nurses may improve their ethical reflection by changing metaphors and assuring continuing sedation in individual, professional, and institutional contexts.

An intimate partner's initiation of forced sex may signal the escalation of tyranny in physically abusive relationships and failed plans to obtain mutual consent for sexual intercourse in dating relationships. Providers of obstetric and gynecologic care are in strategic positions for primary detection of and intervention in physical and sexual abuse. To assist nurses with the understanding of women's responses to abuse and to enhance implementation of interventions, this article describes the dynamics of and a process for intervening in such abuses. The dynamics include brief explanations of its insidious development, why women stay, and women's empowerment for coping with physical, emotional, and sexual abuse. Beginning with asking about the abuse, the process progresses through short-term goals, safety issues, and intervention techniques.

Childbirth and parenting education programs are coming to the forefront of public health initiatives aimed at the reduction of infant mortality and low birth-weight in high-risk groups in the United States. Childbirth education programs have proven effective in helping parents make positive life style changes and can play an important role in the reduction of risks associated with poor pregnancy outcomes. Childbirth education gives parents the knowledge, desire, and confidence they need to change their health behaviors. The Florida Outreach Childbirth Education Project offers an example of a statewide program designed to serve a high risk population: low-income, low-literacy families.

Advances in neonatal care have improved survival rates among premature and low-birth-weight (LBW) infants, but highly technical care for these infants costs more than $2 billion a year in the United States. The incidence of premature and LBW infants can be reduced by prenatal education programs that focus on nutrition, obtaining prenatal care, avoiding dangerous substances, and recognizing preterm labor. In an effort to contain health care costs, many companies self-insure employee health benefits and offer health promotion programs designed to improve life style behaviors. This article examines providing a prenatal education program in the work place as a way of reducing the incidence and costs of prematurity and low birth weight.

A review of the recent literature substantiates that sibling preparation classes help to ease the transition into being a sibling. Studies have shown that as a result of this preparation, children who become siblings exhibit fewer anxieties, are better able to express their feelings, and the mother feels better able to cope with the older child when the infant arrives. This article presents a detailed description of one hospital-based sibling preparation class: the setup, arrival of the families, tour of the maternity floor, snack and video presentation, and the separation into a children's class with specific objectives and a parents' class with objectives are presented. A description of other models of sibling preparation classes is included.

Perinatal education has become a common standard of preparation for expectant families anticipating childbirth and support for new families during the transition into parenthood. Twenty-two series and classes are defined and a topical outline is provided for a specific audience of clients, including infants, preschoolers, expectant parents, new parents, and grandparents.

The Sexual Assault Resource Service (SARS), in Minneapolis, Minnesota, has been a leader in developing a new independent role for nurses, the Sexual Assault Nurse Clinician/Examiner. In this role, the nurse works closely with the emergency department staff, the police, and the courts to ensure that proper evidence is collected for use in court to aid in the prosecution of assailants. This program was developed in 1977 when a gap in service delivery to rape victims was identified by obstetric-gynecologic nurses at Hennepin County Medical Center in Minneapolis. An initial 3.5-year demonstration treatment grant allowed development of the model program. The SARS nurse is on call to five community hospitals. When a rape survivor comes to one of the participating hospitals, the SARS nurse on call is paged. In the emergency department, the nurse completes the full evidentiary examination, evaluates the survivor's risk of pregnancy and offers preventive care; treats prophylactically for sexually transmitted diseases; provides crisis intervention; and ensures that injuries are treated by the emergency department staff. The SARS model was developed at the county hospital, but it was expanded to include four local private hospitals. In all hospitals, all services are free of charge to the survivor. There are approximately 12 similar programs throughout the United States.

Women are subject to multiple stressors and often get little recognition or support for their diverse roles. Although stress is a natural part of life, research indicates that prolonged or extreme stress can have a negative effect on a woman's health. Nurses, because of their holistic approach, are ideally suited to use interventions that empower women to deal effectively with stress. This article outlines the mind/body connection and describes the relaxation response as a counterbalance to the deleterious effects of stress. Instructions for several methods of using the relaxation response in a clinical setting are given.

Good communication between clinician and pregnant patients should avert most decision-making conflicts. Pregnant women may legitimately refuse prenatal screening procedures in view of the limited follow-up options. They also may choose alternatives to most standard obstetric interventions; clinical studies raise questions about the necessity of these interventions. A well-informed woman may refuse cesarean delivery in most situations: predictions of harm are highly uncertain, and she would be asked to accept risk and harm for the sake of another. However, in exceptional situations in which harm to the fetus is nearly certain and vaginal delivery also endangers the woman, the harm-to-others principle limits autonomy, and coercion may be ethically justifiable.

The process of assessing learning needs and designing and implementing educational offerings for perinatal families is discussed. Common areas of evaluation are examined, and sample questions are presented. Through careful application of teaching principles in conjunction with the nursing process, nurses can effectively develop comprehensive perinatal education programs.