PRAXIS PRESENTATION

Spiritual Health & Well-beingSelf-Care Deficit

Clinical Challenge

IntroductionSN and RN on LDR unit at Covenant Healthcare in Saginaw, MI3rd clinical day as a senior II student in leadership rotation

Situation23 y.o. African-American female admitted at 0430States water broke at 0400 while getting out of bed to use restroom.Arrived to LDR in wheelchair from the ED by motherG1P2; 41 weeks gestation

SituationArrival: pt looked like she was in pain. Breathing through ctxStates ctx started ~1300, but started to get “really painful” at approximately 0300Pt visibly shaking in wheelchair and kept asking to be placed in room and to have an epiduralPt states that last labor lasted 2 hrs so she knew that this “was going to happen fast”

SituationPt reassured that care is going to be provided in a fast, but safe manner. Wheeled pt to roomTOCO and EFM monitor applied

SituationTOCO and EFM revealed ctx q 2-3

mins, lasting 60-70 seconds, and a normal FHR (135 bpm) with positive long-term variability

BackgroundPt’s 12-month daughter was born within 4 hrs of admissionPt had epidural with previous delivery

SituationAt this time, pt is agitated. Pt is moaning and doing little breathing during ctxPt reminded by SN to breathe in slowly through the nose and to exhale slowly through the mouth during contractionsEncouraged to rest in between ctx to promote rest

ISBAR: AssessmentPt checked by CNMPt was 9 cm; 100% effaced; +1 station

Pt’s assessment was WNL

Pt requested epidural, but RN told pt that by the time the CRNA arrived with epidural, the baby would be in her armsPatient was in agreement to obtain IV Nubain 10mg for pain managementNubain would promote rest in-between ctx

Conversations

Spiritual and bonding experience for pt and motherMother was unable to attend pt’s first delivery, for unspecified reasons.Pt’s mother stated she was pleased to be part of “this miracle of life”Pt’s mother is battling cancer and stated, “this is what I have always wanted to see. I cannot wait to meet this blessed baby. This is the only grandchild I will ever see [delivered].”

ConversationsDuring ctx, daughter makes statements like, “I am doing this for you mom. I have no other reason for doing this.”At times RN and SN reminded daughter that she was doing this for herself and the baby, too.RN/SN promoted the growing bond between pt and her mother to give the pt strength in childbirth by refraining from reminders after every statement of this kind

ConversationsPt also talked about FOBHe decided to not be part of the child’s life.Pt and FOB discussed this ~4wks agoPt states she has been under “a lot of stress” and uncertainty since this conversation

DeliveryAt 0530, pt delivers a 7lb 15 oz baby boy by vaginal deliveryAPGAR: 9; 1 & 5 minute assessments were WNLAfter delivery pt states she could, “never imagine loving anything more than the miracle of life”

Post-Partum CareFrom 0530-0715, SN took care of pt’s recovery needsThis included, but was not limited to:

BathingToiletingFundal assessments

Postpartum bleeding educationAssessments (pt and baby)Being present for any questions or concerns pt or mother may have

NANDASPIRITUAL WELL-BEING, readiness for enhanced r/t placing meaning and purpose on an event and relationship aeb pt’s statements, “I am doing this for you, mom. I have no reason for this” and pt being through “a lot of stress” since conversation with FOB.NANDA definition“ability to experience and integrate meaningand purpose in life through a person’sconnectedness with self, others…or a powergreater than oneself” (Wilkinson, 2007, p.513)

Spiritual well-being, Readiness for enhanced

Defining characteristics:Connection with others:

Pt requested mother to be in during deliveryFOB not presentNo other discussions of other support systems.

Connection with self:Statements of “no other reason for this” pertaining to birth of baby.Statements like, pt could “never imagine loving anything more than this miracle of life”

Pt demonstrates some connections with self and others, but enhancement is desired

NICs

Hope instillation: “Facilitation of the development of a positive out-look of particular situation”Spiritual Growth Facilitation: “Facilitation of growth in pt’s capacity to identify, connect with, and call upon the source of meaning, purpose, comfort, strength, and hope in her life”

(Wilkinson, 2007, p. 415)

NOCsHope: “Presence of internal state of optimism that is personally satisfying and life-supporting”Quality of life: “An individual’s expressed satisfaction with current life circumstances”Spiritual well-being: “Personal expressions of connectedness with self, others…that transcend and empower self”

(Wilkinson, 2007, p. 415)

NANDA

SELF-CARE DEFICIT, bathing/hygiene r/t severe anxiety as evidenced by statements of not desiring to use shower and toilet

NANDA definition: “Impaired ability to perform bathing and hygiene activities for oneself”

(Wilkinson, 2007, p. 423).

Self-care deficit, Bathing/hygiene

Pt was refused to use restroom because she thought that all patients must wait until they “go downstairs” (post-partum unit)Pt was on epidural last delivery, therefore was unable to use it until she was stable in the post-partum unitSN clarified that pt was only on Nubain 10mg, therefore pt was able to use restroom

NIC/NOCNIC

Self-care assistance; hygiene/bathing: “Assisting the patient to perform personal hygiene”Bathing: “cleaning of the body for the purposes of relaxation, cleanliness, and healing”

NOCSelf-care hygiene: “Ability to maintain own hygiene”Self-care bathing: “Ability to cleanse own body”

(Wilkinson, 2007, p. 425)

Nursing ResearchChose to explore the relationship between prenatal stress, social support, and spiritual well-being in pregnancyLimited studies, but found two peer-reviewed nursing articles within 4 years of publication

Nursing ResearchArticle 1:

Found that prenatal stress was negatively related to spiritual well-being

Reaffirmed that this article enforced the need for the NANDA: Spiritual well-being, readiness for enhanced, NICs: Spiritual growth facilitation & Hope instillation, and NOCs hope, quality of life, and spiritual well-being

(Zacharias, 2009)

Nursing ResearchArticle 2

Found that higher levels of spirituality, whether it is perspective or religious, were “significantly correlated with greater satisfaction with social support, higher levels of self-esteem, and decreased levels of smoking”This is of concern, considering the stress of having a 12 month y.o. at home, a mother with cancer, and the FOB recently choosing not to partake in care of the baby.

(Dunn, 2007)

ConclusionAfter reading these articles, I had a new appreciation for NANDA diagnoses such as Spiritual well-being, Readiness for enhanced,I acknowledge that the pt’s pregnancy experience may share stress, joys, ups, downs, but with spirituality and well-being, I hope that the pt is able to cope with life’s .stressors

ReferencesDunn, L.L., Handley M.C., Shelton, M.M.

(2007). Spiritual well-being, anxiety, and depression in anetpartal women on bedrest. Issues in Mental Health Nursing, 28(11), 1235-1245.

Wilkinson, J.M. (2005). Nursing diagnosis handbook. Upper Saddle River, NJ: Pearson Prentice Hall.

Zachariah, R. (2009). Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Research in Nursing & Health, 32(4), 391-404.