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

Physical examinations can be positive patient experiences, providing reassurance, education, and case finding. However, examinations also can be extremely anxiety provoking because of feelings of shame and embarrassment about visible injuries from an abuser. They also may provoke flashbacks related to incest, child sexual abuse, and rape. Nurses involved in clinical assessment of any kind need to be aware that a patient's history often affects her response to clinical evaluation. Asking a patient about abuse before evaluation is respectful and empowering and often establishes a valuable opportunity for intervention.

This exploratory study was designed to determine the reasons men might beat their female partners during pregnancy from the perspectives of women who had experienced this form of violence. Seventy-nine battered women were recruited by newspaper advertisement and bulletin board postings to take part in a larger study of women's responses to relationship problems. Women battered in their relationships were asked if they had ever been beaten during pregnancy. The 27 (34%) women who had a pregnancy with the abusive partner as the father and had experienced physical abuse during the pregnancy were compared with 24 (30%) women who also had been pregnant by the abuser but had not been abused during pregnancy. The only significant difference between the two groups was that the women battered during pregnancy were more frequently and severely beaten throughout the course of the relationship. Those abused during pregnancy were asked why they thought that had happened. Their answers were thematically analyzed into the categories: (1) jealousy of the unborn child; (2) anger toward the unborn child; (3) pregnancy-specific violence not directed toward the unborn child; and (d) "business as usual." Implications for nursing assessment and interventions for abuse during pregnancy are derived from this analysis.

One of the most perplexing issues for nurses working with abused women is the extent of violence experienced by teen-agers. This article presents research findings from a study of pregnant women and teen-agers in Baltimore and Houston that found 32% of pregnant teen-agers reported having been physically or sexually abused in the prior year. The rate of abuse during pregnancy was 22% for teen-agers. Teen-age violence is discussed in terms of possible reasons for teen-agers to be reluctant to report abuse and nursing considerations in the assessment and intervention of adolescents experiencing abuse.

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.