Category Archives: Women’s Health and Neonatal Care

The Benefits of Hiring A Doula

Doulas provide emotional, physical, and educational support to expectant mothers during the labor process and postpartum.  The doula is professionally trained in childbirth with the purpose of helping women have safe, memorable experiences and empowering a birth the way the mother desires. The doula services begin typically a few months before the birth in order to establish a relationship with the expectant mother.  Having the relationship early allows the doula to answer any questions that the mother and father have prior to delivery, ease any anxiety, and assist in developing a birth plan. During labor, the doula will provide the mother with comfort measures, position changes, breathing techniques, and partner involvement in the birthing process.  A doula leads to a better birth outcome and helps to reduce complications for both mother and baby.    Doulas use touch and massage as a means to decrease stress and anxiety during labor.  They use the sound of their voice to have the mother focus during the difficult stages of labor allowing this moment to engage the birth partner on the focal point.

Cultural Sensitivity and In-vitro Fertilization

A nurse once shared a situation from her workplace involving in-vitro fertilization (IVF). In this case, a treating physician did not want to be involved in the patient’s delivery because five embryos had been terminated and three remained. This raised important questions: Could all eight embryos have survived? Could some have been frozen for future use? Beyond the medical decisions, this opened a deeper discussion about cultural sensitivity and religious beliefs in healthcare.

For some, an embryo may not be considered “alive” or “a baby” yet, while for others it represents life from the very beginning. These different perspectives make patient care more complex, particularly when personal and professional values conflict.

Consider another scenario: a nurse working on a GYN floor encounters a woman experiencing complications after an abortion. The nurse is a Christian who does not believe in abortion. The patient is not there for the procedure itself but for treatment of her complications. Should the nurse refuse care based on personal beliefs, or provide care because the patient is in need?

These are difficult but necessary questions. As managers, we also face the challenge of balancing employee requests for religious accommodations with the responsibility to ensure safe, compassionate care for every patient. Partnering with human resources and taking a holistic approach helps to respect both the nurse’s values and the patient’s needs.

Cultural sensitivity is not about everyone holding the same beliefs—it is about acknowledging differences and working through them with respect. When we do this, we strengthen trust, improve collaboration, and move closer to providing excellent care for all.

Reference
DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd ed., pp. 6-17). [Vital Source Bookshelf].

Quality and Safety at Well Baby Clinics

Recently, I was speaking with a health nurse at a clinic about the increase in babies being sick due to a lack of well baby check ups and vaccinations.  In speaking with the health nurse and in review of her concerns about her well-baby clinic, one of the critical dimensions that came to mind was inquisitiveness to determine whether offering immunizations at her clinic was working or not working to get the parents to come to the clinic.  If it is a well baby care clinic, are the parents bringing in the babies for any other check ups? For instance  are they coming in when a shot is not needed?

nurse-practitioner28

After our conversation, the health nurse decided to seek information about the mothers that were not coming and noticed that there was a drop in the amount of people who came because they did not have public transportation available for them, due to the distance that they lived from the clinic (she is in a rural area).  I suggested that there should be some creativity on the clinic’s part to establish a new way for the immunizations to get to the parents.

immunization

Creativity and inquisitiveness were two critical thinking dimensions that I identified in this well baby clinic scenario as I was speaking to the health nurse.  The structure is the routine immunizations that they provide to the parents at the clinic.  The process is based on the age of the infant and that will determine when they come in for their routine immunizations.  The outcomes are the hopes of reducing childhood illness, for instance measles (Rubenfeld & Scheffer, 2005).

In thinking, there are a few alternative ways that I think would help the well baby clinic and also help these families. First of all, finding out where the majority of the families that were affected by the lack of transportation live.  Once that is determined, locate a school, church or shopping center that will allow once per week or once per month depending on the amount of babies that need immunization, to set up an immunization clinic for those families affected by the bus system.  The schools, church and shopping centers are places that parents will need to go to if they have school age children or if they have to buy groceries or attend a church.   Even if they don’t attend the church, if it is in the community they have easy access to bring the baby for the immunizations.

school-clinic-1 school-clinic-2

Another alternative, is working with the resources available in the community.  Perhaps the clinic can find out if the transportation available to take people to doctor’s appointments would be available to bring the parents on a specified appointment day.   If the bus can pick up the parents where they used to take the city bus and bring them in to the clinic to get the shots, then go back to the bus stop once the group was done.

bus

When the clinic presents these alternatives to the stakeholders making the decisions on what they will pay to make the clinic a success, it is important to share the benefits for doing the immunizations.  If presented in a narrative format, explaining first, the subpopulation that uses the clinic, then the treatment and frequency that they come as well as the consequences of the parents not coming.   Presenting the stakeholders with realistic facts if the babies are not immunized and that they can get a childhood illness like the measles, and how an epidemic can spread in the community, is an eye opener.  If there are complications from the illness without having proper care to the child or even an adult who was never immunized as a child, there can be an inpatient hospital stay.  The inpatient hospital stay would cost the tax payers and stake holders more money when simpler solutions could have been implemented.

In conclusion, education and preventative care is the basis of the well-baby clinic, but when the parent does not have the means to get to the one and only clinic, then an alternative to provide the same service has to be sought to keep the community healthy and avoid unnecessary inpatient hospital stays.

 

References

Rubenfeld, M. G., & Scheffer, B. K. (2015). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

Critical Consciousness

My awareness of critical perspective has expanded beyond the arena  of where I work, it has involved my charity The Gift of Life  and my wedding business 27 Miracles.  I started out my nursing career working in a high risk labor and delivery unit.  In labor and delivery you meet all kinds of people from different walks of life, different religions, different ethnicities and socioeconomic status.  During a critical time such as labor when there is pain, this is when you learn about other people’s cultures and how pain is perceived by them.  As a nurse we learn about those different cultures through experience so that when we do encounter them, we can understand what level of privacy and respect they need.

parents-in-labor

My husband and I own a wedding and event planning business called 27 Miracles.  Through the years we have become well known in our town for working with ethnic weddings from different countries as well as interracial.  It has allowed me as an individual to learn many cultures and be able to show respect for other cultures and their ways of communicating.  It is a beautiful thing to see love spoken and expressed in so many different languages and cultures through music, food and traditions.

wedding

I have learned through my nursing experiences and my wedding experiences how to appreciate people more and take interest in who they are as a person.  As nurses we get  busy when we work on the floor or in an office and talk about our patients as just another number because we are  in a hurry.  Even on our busy days, we need to stop along the road and take a moment to say hello to our patients, provide a gentle touch to their hand or shoulder, and a listening ear.  These are all part of critical perspectives or as I like to call it cultural awareness.

Nurse holds elderly patient's hand

Many say that the parents of premature babies experience preterm birth  because the parent did something wrong, they smoked, drank, did drugs or a teen age pregnancy caused the premature birth.  Although some of those reasons may be true, there is another side to prematurity that people do not think about.  The mother that develops maternal illnesses like Diabetes and Hypertension, or the baby that for some reason starts developing intrauterine growth retardation and it is unsafe for him or her to be inside the womb.  It is very easy to judge when you don’t know the situation or have never experienced it, but as nurses we need to develop  ways of thinking that allows us to be aware about ourselves and those around us  (Gotzlaf & Osborne, 2010).

nicu-mom

Working with a population of parents that have premature babies, has shown me that premature birth happens all over the world. Premature birth limits no race, religion or economical status.  Our job as a nurse is to be aware of the different cultures and take the time to learn about their culture and how you can work with that person.

new-moms

References

Gotzlaf, B. A., & Osborne, M. (2010). A Journey of Critical Consciousness: An Educational Strategy for Health Care. International Journal of NursingEducation Scholarship, 7(1), 1-15. http://dx.doi.org/ 10.2202/1548-923X.2094

Working Your Staff Unsafely

This week has been the week of speaking with different professionals on training and how companies place employees in jobs that are not properly trained in their skill set to pay them less and get more out of them.  I used to work for a large insurance company that employed over 80,000 people.  I worked in the long-term care department which had about 400 staff from administrative assistants to presidents. I was the manager of case managers which consisted of RN’s, LPN’s and Social Workers.  They all did the same job and got paid different salaries to do it, however the job description and responsibility was the same.

chw-1 nurses-1

I felt that this policy of having nurses and social workers working on the same cases needed to be changed. Having all the staff doing the same exact work and paying them differently based on their degree and expecting the same level of skill, was inappropriate.   Nurses have a different skill set than social workers.  If a patient has a medical issue, the social worker that is visiting that member in the home completing an assessment may not be able to capture that the member has been retaining water in their ankles and think to ask if they are on a diuretic.  Much like the nurse that goes in the home setting and sees a patient that has issues paying their light bill won’t know where to call to find a resource for them.  The patient may be concerned because they are on oxygen at home; they wonder how they will pay their light bill and what they will do if the power is turned off. This can be a liability to any staff member but also a disservice to the patient.

oxygen

In contrast, I worked for another company that did case management. I loved that job, until federal cutbacks came along for the program during the new Obama administration.   The company employed RN’s, MSW’s, CHW’s, Nutritionists and Behavioral Health Specialists.   The cases were assigned only to nurses and there were two tiers of nurses, regular case managers and those that were more experienced received complex care patients.  The other staff MSW’s, CHW’s , Nutritionists and Behavioral Health Specialists were consulting on the files that the nurses referred to them.  They would work as a team with the nurses. This team work gave the patient a more well-rounded form of care.

illu_home_team01_xxl

There are several leadership styles in companies, autocratic, democratic and laissez-faire.  In the large insurance company that had all the workers regardless of skill set do the same job,  the leadership was autocratic.  The department maintained total control in all decisions and no opinions or suggestions were accepted from others. There was no opportunity to make a change due to the leadership style.   In my prior job, where everyone worked on a tiered team,  there was a democracy; decisions were made after consideration of input from the staff (Mitchell, 2013).

A team of medical professionals  gather for a daily meeting to discuss the elderly patients at the “Acute Care for Elders” unit at the University of Alabama Hospital, Birmingham. (Hal Yeager for KHN)

There are some days that as a professional you want to see changes implemented or at least considered, however the leadership does not support that.  If you are the type of person that works for the better of seeing changes in a situation, get involved in the departments or committees that have a say in policy writing, this will be the only way to see changes that can be discussed for the betterment of the company.

References

Mitchell, G. (2013, April). Selecting the Best Theory to Implement Planned Change. Nursing Management, 20(1), 32-37. Retrieved from http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?sid=4ba42c53-9a6d-4ec5-b6bb-2f078e04b7c7%40sessionmgr4001&vid=1&hid=4204