1. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family Nursing with Childbearing Families By Nataliya Haliyash, MD,PhD,MSN

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

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4. 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).

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6. HISTORICAL PERSPECTIVE 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.

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8. 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.

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10. 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

11. Mosby items and derived items © 2005, 2001 by Mosby, Inc. HISTORICAL PERSPECTIVE 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.

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13. 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.

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

15. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Prenatal Care Each component can contribute to reductions in perinatal illness, disability and death by identifying and mitigating potential complications Risk Assessment Treatment for medical conditions or risk reduction Education

16. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Frequency of Prenatal Visits Every 4 weeks until 28 weeks gestation Every 2 weeks until 36 weeks gestation Weekly until delivery Every 4 weeks until 28 weeks gestation Every 2 weeks until 36 weeks gestation Weekly until delivery

17. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Antepartal Nursing Interventions 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

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

19. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Attitude about pregnancy Attitude about pregnancy Exercise Rest Exercise Rest Smoking Danger signs of spontaneous abortion Danger signs of spontaneous abortion Early pregnancy classes Early pregnancy classes Employment Traveling Fetal growth development Fetal growth development First Trimester Topics

20. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Infants tend to have lower birth weights Infants have a higher incidence of preterm birth

21. Mosby items and derived items © 2005, 2001 by Mosby, Inc. The Faces of Fetal Alcohol Syndrome Growth Retardation Facial Anomalies Major Cause of mental retardation

22. Mosby items and derived items © 2005, 2001 by Mosby, Inc. 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 alcohol intake is contraindicated

23. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Live Viruses (like rubella) should not be given to pregnant women Vaccines using killed viruses may be used

24. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Exercise during pregnancy 30 minutes daily and stop when fatigued No balance activities No exercising in supine position Pulse rates < 140/min

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

26. Mosby items and derived items © 2005, 2001 by Mosby, Inc. The importance of support during labor---having a doula http://www.youtube.com/watch?v=16uFf02 NYb4 http://www.youtube.com/watch?v=HfOBVP Zg94Y

27. Mosby items and derived items © 2005, 2001 by Mosby, Inc. We Are Family We Are Family

28. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Types of Families Types of Families Nuclear Cohabiting parent Married-parent Single-Parent Childless Married blended Extended Gay & Lesbian The primary institution in society that preserves & transmits culture.

29. Mosby items and derived items © 2005, 2001 by Mosby, Inc. What basic information should be included in a Family Assessment? What basic information should be included in a Family Assessment?

30. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Family Assessment Family Assessment Name, age, sex and family relationship of all people residing in the householdName, age, sex and family relationship of all people residing in the household Family type, structure roles and valuesFamily type, structure roles and values Cultural associationsCultural associations Religious affiliationsReligious affiliations LanguageLanguage Support networkSupport network

31. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Friedman Family Assessment Model Identifying data History of family Environmental data Family structure Family functions Family stress & coping

32. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Culture is not just something the client possesses; it is something that all humans possess. It is learned….

33. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Are there cultural influences on childbearing and rearing? Are there cultural influences on childbearing and rearing?

34. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Refers to behaviors or things that are avoided What is avoided in your family? What is avoided in your family?

35. Mosby items and derived items © 2005, 2001 by Mosby, Inc. “Ask not what disease the person has, but rather, what person the disease has.”

36. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Develop cultural competence by becoming knowledgeable about the cultural practices of local groups where you work and live. Develop cultural competence by becoming knowledgeable about the cultural practices of local groups where you work and live.

37. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Cultural Humility: Lifelong process of self reflection and awareness with a respectful attitude toward diverse points of view.

38. Mosby items and derived items © 2005, 2001 by Mosby, Inc. It’s all about relationships…..

39. Mosby items and derived items © 2005, 2001 by Mosby, Inc. And Respect…which comes full circle

40. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Questions to ask…. What healing methods have you tried? What healing methods have you tried? What do you think will help? What do you think will help? What do you think you should do to remain healthy during pregnancy?

41. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Who do you want with you during your labor? Who do you want with you during your labor? How will family members participate in your pregnancy, childbirth & parenting? How will family members participate in your pregnancy, childbirth & parenting? What do you and your family expect from the nurses caring for you? What do you and your family expect from the nurses caring for you?

42. Mosby items and derived items © 2005, 2001 by Mosby, Inc. L = Listen E=Explain A=Acknowledge R=Recommend N=Negotiate

43. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Thanks for attention!