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

Domestic violence is a highly prevalent event in the United States. Health providers frequently treat abused patients; however, many do not routinely assess for family violence or suspect it when the injuries seem fairly obvious. Because abused women feel stigmatized by the violence, they are hesitant to volunteer the abuse. In 1990, the Joint Commission on the Accreditation of Healthcare Organizations added requirements for emergency and ambulatory care services to develop and use protocols for the identification of violence among patients. This article addresses the ethical and legal dilemmas facing nurses that influence their assessment and intervention in family violence.

Women are the fastest growing population with newly diagnosed acquired immune deficiency syndrome (AIDS) in the United States. Although little is known of specific female manifestations, research trends suggest an increase in genital tract infections and neoplasms that may be recurrent and difficult to treat. The initial presentation of early human immunodeficiency virus (HIV) infection in many women is recurrent and chronic vaginal candidiasis. Abnormal cervical cytology is common, and biannual Papanicolaou (Pap) smear screenings are recommended, preferably with a colposcopic examination. Because such human papillomavirus (HPV)-related dysplasias often are multifocal, anal Pap smears also are recommended. This article addresses the gynecologic problems and care of HIV-positive women.

Childbirth education can have an enormous positive effect on the maternal health and birth experience of women in shelters. The childbirth educator can empower economically disadvantaged pregnant women to take personal responsibility for their childbirth outcome. The characteristics of women in shelters pose unique challenges to childbirth educators. Transient populations, different stages of pregnancy, substance abuse, nutrition deficiencies, and difficulties with the skills required for being a good parent present unusual problems and rewarding educational opportunities. With understanding, sensitivity, and commitment, the childbirth educator can prepare women in shelters to participate more actively in a healthy and informed birth experience.

Women's health care providers have few resources to guide them in giving sensitive care to survivors of childhood sexual abuse. This article reviews some commonly seen coping responses, discusses ways in which these coping responses may affect the experience of gynecologic or obstetric care, and provides suggestions on how the care provider can facilitate the patient's process of healing. Also addressed is the need of care providers to process the often intense feelings evoked by issues of sexual violence and abuse.

A commitment to family-centered care demands that perinatal education include the following critical dimensions: presenting information, enhancing coping strategies, fostering support systems, promoting informed decision making, and integrating consumer advocacy. Families must have accurate, current information about pregnancy, birth, infants, early parenting, and the health care system in which these vents occur. This information is the foundation, not the final product, of perinatal education. Families need appropriate and effective coping skills and a strong support network as they move through this stage of the life cycle. The ultimate goal, and perhaps the most critical dimension of perinatal education, is to promote informed decision making. Families need options and the opportunity to understand the implications and feasibility of alternative decisions in their lives. The perinatal educator acts as an advocate by providing information and support for the client, and in advocating for the client in the health care system.

There are three critical issues in perinatal education today: changing clients, changing perinatal educators, and the changing obstetrical climate. Each of these issues is discussed, and difficult philosophical questions that require answers are identified. The answers will require serious deliberation, hard thought, values clarification, collective wisdom, and an element of risk taking by perinatal educators.

Battering is a public health problem that traditionally has been ignored by nurses, which has conveyed acceptance and approval of violence. Using the Betty Neuman Health Care System Model, nurses on obstetrical units can understand the health effects battering has on the mother and infant. Battering puts the woman at serious risk. By systematically addressing this stressor, nurses can improve the health and quality of life of the mother and newborn.

Rural battered women face enormous challenges when they attempt to end the abuse in their lives. Success depends on overcoming difficulties such as geographic isolation from sources of help; lack of accessible services for battered women and their children; limited opportunities for higher education, employment, and affordable housing for women; and strong allegiance to the land, kinship ties, and traditional gender roles. Through community education, routine assessment for abuse, responding in a helpful manner to women who disclose abuse, and forming links with existing programs for battered women and their children, nurses in rural areas can positively influence the health and safety of rural battered women.

Physical violence against women is pervasive; and such abuse may begin during pregnancy. This article chronicles the clinical research on battering during pregnancy and focuses on a prospective study of 691 pregnant women; the study documented that one in six women are abused during pregnancy. Ethnic differences in the patterns of abuse are discussed, as are related findings of entry into prenatal care and characteristics of the abuser. Clinical implications are presented, with an emphasis on the usefulness of straightforward assessment with a three-question abuse assessment screen to identify abused women and intervene to prevent abuse during pregnancy.