mosby items and derived items © 2005, 2001 by mosby, inc. family nursing with childbearing families...

Mosby items and derived items © 2005, 2001 by Mosby, Inc.

Family Nursing with Family Nursing with Childbearing Childbearing FamiliesFamilies

By Nataliya Haliyash,

MD,PhD,MSN


Lecture Objectives:Upon completion the lecture students will be able to:• Give definition to ‘childbearing family nursing’

and differentiate it from obstetrical nursing.• Discuss nursing theories that contribute to

nurses’ understanding of families’ growth, development, functioning, and changes during childbearing.

• Understand the developmental tasks for childbearing families.

• Guide health promotion activities in the childbearing families.

• Recognize possible threats to health during childbearing and plan activities for maintaining and preserving family health.


HISTORICAL PERSPECTIVE

• Late 1800s – Industrialization

– Families moved to more urban areas; household size and functions diminished.

– Traditional networks of women were not always available, and mothers needed to replace care previously carried out in the home.

– Childbearing still occurred at home for many middle-class families (Leavitt, 1986; Wertz & Wertz, 1989).



• First Third of the 20th Century

– The hospital became the place for labor, birth, and early postpartum recovery for middle-class families.

– Many immigrant and working-class urban families continued to have babies at home with their traditional care providers.

– An impetus to the development of public health nursing was concern for the health of urban mothers and babies.

– Realizing that the health needs of all the family members were intertwined, early public health nurses considered families, not individuals, as their clients.


HISTORICAL PERSPECTIVE• 1930s through the “Baby Boom” of the 1950s• • With the dramatic shift of births to hospitals, family involvement with

childbearing diminished (Leavitt,• 1986).• • Concerns about infection control contributed to separation of family

members.• • Family members were forbidden to be with women in the hospital.• • Babies were segregated into nurseries and brought out to their mothers

only for brief feeding sessions.• • Nurses focused on the smooth operation of postpartum wards and

nurseries through the use of routine• and orderliness.• • Despite these inflexible conditions, families tolerated them because they

believed that hospital births• were safer for mothers and babies.


Birth in America

• 1900: 95% of all births took place at home

• 1939: 50% of all births at home

• 1955: 95% of all births in the hospital

Wolf, 2009



• 1980s to the Present

– The research of Klaus and Kennell (1976) served as the impetus for the growth of family-centered care (American College of Obstetricians and Gynecologists & Interprofessional Task Force on Health Care of Women and Children, 1978).

– Today promotion of family contact is becoming the hallmark of childbearing care.

– Many hospitals have renamed their obstetrical services, using names such as Family Birth Center to convey the importance of family members in childbearing health care even though obstetrical care is becoming more dependent on technology.

– With the trend for shorter hospital stays after birth, postpartum care is becoming family-based with nursing guidance.


Childbearing Family Nursing

• Childbearing family nursing considers the family as client and/or the family as context for the care of its members.

• Family nursing with childbearing families covers the period before conception, pregnancy, labor, birth, and the postpartum period.

• It focuses on health and wellness rather than on procedures and medical treatment.


Theories applicable to childbearing family nursing

• General Systems Theory– is especially effective for childbearing family

nurses when they consider that a family, while in a state of change and readjustment, has more-permeable boundaries or is more open to the outside environment because the family becomes aware of resources beyond itself.

• Duvall’s Developmental Theory– In this theory, the family childbearing stage is

defined as the period from the beginning of the first pregnancy until the oldest child reaches 18 months of age.


Prenatal Care

Each component can contribute to reductions in perinatal illness, disability and death by identifying and mitigating potential complications

RiskAssessment Treatment for

medical conditions or risk reduction

Education


Frequency of Prenatal Visits

Every 4 weeks until 28 weeks gestation


Weekly until delivery



Weekly until delivery


Antepartal NursingInterventions

• Being knowledgeable in the normal changes of pregnancy

• Instructing in signs & symptoms that indicate a problem may be developing

• Providing appropriate information for self care measures

• Referring when necessary


Nursing in a Home Care Setting

• Can be used for women who have difficulty in accessing the healthcare system

• Most often used for women with prenatal complications that can be managed without hospitalization.


Attitude about pregnancy

Attitude about pregnancy

ExerciseRest

ExerciseRest SmokingSmoking

Danger signsof spontaneous

abortion

Danger signsof spontaneous

abortion

Early pregnancyclasses

Early pregnancyclasses

EmploymentEmployment

TravelingTraveling

Fetal growthdevelopmentFetal growthdevelopment

First TrimesterTopics

First TrimesterTopics


Infants tend to have lower birthweights

Infants have a higher incidenceof preterm birth


The Faces of Fetal Alcohol Syndrome

Growth Retardation

Facial Anomalies

Major Cause of mental retardation


• Increased incidence of lowered birth weight

• Some neurologic effects such as Attention Deficit Disorder

No Safe level of drinking during

pregnancy has been identified

Even moderate alcoholintake is contraindicated


• Live Viruses (like rubella) should not be given to pregnant women

• Vaccines using killed viruses may be used


Exercise during pregnancy

• 30 minutes daily and stop when fatigued

• No balance activities

• No exercising in supine position

• Pulse rates < 140/min


Nursing Pearls of Wisdom

At each prenatal visit, focus your teaching on changes or possible discomforts the woman might encounter during the coming month and the next trimester.


The importance of support during labor---having a doula

http://www.youtube.com/watch?v=16uFf02NYb4

http://www.youtube.com/watch?v=HfOBVPZg94Y


We Are FamilyWe Are Family


Types of FamiliesTypes of Families

Nuclear Cohabiting parent Nuclear Cohabiting parent

Married-parent Single-ParentMarried-parent Single-Parent

Childless Married blendedChildless Married blended

Extended Gay & Lesbian Extended Gay & Lesbian

The primary institution in society that preserves & transmits culture.


What basic information should be included What basic information should be included in a Family Assessment?in a Family Assessment?


Family Family AssessmentAssessment

• Name, age, sex and family relationship Name, age, sex and family relationship of all people residing in the householdof all people residing in the household

• Family type, structure roles and valuesFamily type, structure roles and values

• Cultural associationsCultural associations

• Religious affiliations Religious affiliations

• LanguageLanguage

• Support networkSupport network


Friedman Family Assessment Model

• Identifying data

• History of family

• Environmental data

• Family structure

• Family functions

• Family stress & coping


Culture is not just something the client possesses; it is something that all humans possess.

It is learned….


Are there cultural influences Are there cultural influences on childbearing and rearing? on childbearing and rearing?


Refers to behaviors or things that are avoided

What is avoided inyour family?What is avoided inyour family?


“Ask not what disease the person has, but rather, what person the disease has.”

“Ask not what disease the person has, but rather, what person the disease has.”


Develop cultural competence by Develop cultural competence by becoming knowledgeable about the becoming knowledgeable about the cultural practices of local groups where cultural practices of local groups where you work and live.you work and live.


Cultural HumilityCultural Humility: Lifelong process of self reflection and : Lifelong process of self reflection and awareness with a respectful attitude toward diverse awareness with a respectful attitude toward diverse points of view. points of view.


It’s all about relationships…..


And Respect…which comes full circle


Questions to ask….Questions to ask….

What healing methodshave you tried?

What healing methodshave you tried?

What do you thinkwill help?What do you thinkwill help?

What do you think you should do to remain healthy during pregnancy?

What do you think you should do to remain healthy during pregnancy?


Who do you want with you Who do you want with you during your labor?during your labor?

How will family members How will family members participate in your participate in your pregnancy, childbirth & pregnancy, childbirth & parenting?parenting?

What do you and your What do you and your family expect from the family expect from the nurses caring for you?nurses caring for you?


•L= Listen

•E=Explain

•A=Acknowledge

•R=Recommend

•N=Negotiate


Thanks for attention!

mosby items and derived items © 2005, 2001 by mosby, inc. family nursing with childbearing families...

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