Nursing diagnosis – READINESS FOR ENHANCED CHILDBEARING PROCESS

READINESS  FOR  ENHANCED CHILDBEARING  PROCESS

DEFINITION

A pattern of preparing for, maintaining and strengthening a healthy

pregnancy and childbirth process and care of newborn

DEFINING CHARACTERISTICS

During pregnancy

• Reports appropriate prenatal lifestyle, physical preparations; man-

aging unpleasant symptoms in pregnancy

• Demonstrates respect for unborn baby

• Reports a realistic birth plan

• Prepares necessary newborn care items

• Seeks necessary knowledge (e.g., of labor & delivery, newborn

care)

• Reports availability of support systems

• Has regular prenatal health visits

During labor & delivery

• Reports lifestyle that is appropriate for the stage of labor

• Responds appropriately to the onset of labor

• Is proactive in labor & delivery

• Uses relaxation techniques appropriate for the stage of labor

• Demonstrates attachment behavior to the newborn baby

• Utilizes support systems appropriately

After birth

• Demonstrates appropriate baby-feeding techniques; basic baby care

techniques

• Provides safe environment for the baby

• Reports appropriate lifestyle

• Utilizes support system appropriately

RELATED FACTORS

• Prenatal health status

• Obstetrical/medical history (including perinatal risks/complications)

• Cultural beliefs/expectations

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Knowledge

• Roles/relationships

EXPECTED OUTCOMES

The patient/childbearing family will

• Demonstrate a willingness to maintain/modify his or her lifestyle

for optimal prenatal health.

• Convey confidence and knowledge of pregnancy, the labor &

delivery process, and newborn care.

• Express appropriate self-control and readily cooperate with recom-

mendations of the healthcare team during labor & delivery.

• Exhibit parent–newborn attachment after delivery.

• Meet the newborn’s physical, social, and nutritional needs.

SUGGESTED NOC OUTCOMES

Prenatal Health Behavior; Knowledge: Pregnancy; Knowledge: Labor

& Delivery; Knowledge: Newborn Care; Parent Infant Attachment.

INTERVENTIONS AND RATIONALES

Determine: Assess baseline knowledge of prenatal self-care, labor &

delivery process, and newborn care to identify and resolve

knowledge deficits.

Perform: Provide written literature on prenatal wellness, labor &

delivery expectations, and newborn care. Providing written materials

allows adequate time to synthesize and understand new information.

Inform: Teach self-care for common prenatal discomforts to promote

patient autonomy.

Teach childbearing family labor & delivery process and newborn

care. Understanding   expectations improves confidence and reduces

anxiety.

Attend: Assist childbearing family with development of a birth plan.

This allows childbearing family to participate in managing the birth

experience and promotes communication with the healthcare team.

Encourage and support childbearing family throughout the course

of the pregnancy to improve self-confidence and promote patient

compliance with health recommendations.

Manage: Refer to certified childbirth educator for classes on prenatal

care, labor & delivery (to include Cesarean birth), breast-feeding,

and newborn care. Advanced knowledge of the childbearing process

promotes empowerment and positive maternal outcomes.

SUGGESTED NIC INTERVENTIONS

Anticipatory Guidance; Childbirth Preparation; Emotional Support;

Parent Education: Infant, Prenatal Care.

Reference

Ward, S. L., & Hisley, S. M. (2009). Maternal–child nursing care: Optimizing

outcomes for mothers, children, and families. Philadelphia: F.A. Davis Com-
pany.

Nursing diagnosis – risk for parent-child attachment

Risk for Impaired Parent-Child Attachment
DEFINITION
Disruption of the interactive process between parent/significant other
and child/infant that fosters the development of a protective and
nurturing reciprocal relationship
RISK FACTORS
• Anxiety over parental roles
• Illness in infant that doesn’t
allow initiation of interaction
with parents
• Inability of parents to meet
their personal needs
• Lack of privacy, physical barriers,
separation, substance abuse
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Communication
• Coping
• Emotional status
EXPECTED OUTCOMES
The parents will
• Initiate positive interaction with child.
• Hold child and talk to him or her.
• Express confidence in their ability to respond to child’s needs.
• Respond appropriately to child.
• Express positive feelings about child.
• Express confidence in their ability to care for child.
• Recognize when they need assistance.
The child will
• Respond positively to parents.
• Show interest in parents’ faces.
• Become calm when soothed by parents.
SUGGESTED NOC OUTCOMES
Parenting Performance; Role Performance
INTERVENTIONS AND RATIONALES
Determine: Assess composition of family and ages of members;
ability of family to meet physical and emotional needs of its members;
knowledge of growth and development patterns; energy levels
of parents; recent life changes; child’s neurological and sensory
status, including vision and hearing; sleep patterns of parents and
child. This information will assist in establishing appropriate interventions.
Perform: Reduce environmental stressors (including people) where it
is possible to observe whether the parents’ responses to the child are
appropriate.
Provide parents and child with periods of privacy to promote
attachment.
• Role/relationships
• Sleep and rest
• Values and beliefs
• RISK FOR IMPAIRED PARENT–CHILD
ATTACHMENT
Provide physical care to child when appropriate. This may be to
demonstrate to the family the appropriate way to perform ADLs.
Inform: Teach parents to observe and understand behavioral cues
from the child. For example, the child may become fussy when he
or she is ready for a nap or may pull his or her ear if he or she has
an earache. Explain the range of options for responding to these
cues positively. It is important that the parents have a variety of
options made available to them.
Teach parents to give physical care when the needs exist to
increase their self-confidence and self-competence.
Teach relaxation techniques (guided imagery, progressive muscle
relaxation, and meditation) that can be done by the parents to
restore psychological and physical equilibrium by decreasing
autonomic response to anxiety.
Attend: Provide emotional support and encouragement to help
improve parents’ self-concept and self-confidence in parental roles.
Initiate discussions with parents on life changes precipitated by
the birth of the child. Parents are often confused and blame themselves
because the stress of birth causes frustration and anger.
Encourage parents to talk about the kinds of activities that
promote feelings of comfort. Assist parents to create a plan to
engage in at least one of these activities each day. This provides parents
with a sense of control over their own lives.
Make sure parents have clear explanations for everything that is
expected of them. Ask for feedback to ensure parents understand.
Anxiety may impair their cognitive abilities.
Manage: Provide the name of professionals and/or agencies where
parents can receive assistance to continue developing attachment
skills and/or ongoing support. Refer to case manager/social worker
to assess the home environment to enable the parents to make modifications
that will be needed.
SUGGESTED NIC INTERVENTIONS
Abuse Protection Support: Child; Child Coping Enhancement; Developmental
Enhancement; Parenting
Reference
Delaney, K. R. (2006, November). Learning to observe relationships and coping.
Journal of Child and Adolescent Psychiatric Nursing, 19(4), 194–202.