issues of maternal and child health nursing
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ISSUES OF MATERNAL AND CHILD HEALTH NURSING AGE,
GENDER, SEXUALITY AND SOCIO CULTURAL FACTORS
Introduction
Irrespective of the race, culture, Age, Gender the care of the ante
natal mother is to be given equally. In a multicultural, multi ethnic society
valuing diversity is an important aspect. An understanding of some of the
cultural differences between social groups is essential in ensuring that
professional practice is closely matched to meet the needs of individual
clients. Practitioners of health and social cure must understand the role
culture plays in determining health, health behaviours and illness so that
services are planned and delivered to meet the health needs of the
population they serve.
Terminologies
Ethinicity
It refers to the cultural, group into which a person was born, although
the term is sometimes used in a narrow context to mean only a race.
Culture
Culture is a view of the world and a set of traditions that a specific
society groups users and transmits to the next generation.
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Cultural values
These are preferred ways of acting based on those traditions. The way
people react to health care is a cultural value.
Norms : The usually values of a group are termed more of norms.
Expecting women to come for prenatal care and for parents to bring
children for immunizations are examples of norms in the United States, but
these are not beliefs world wide.
Taboos : Action that are not acceptable to a culture are called taboos. (eg)
Murder
The primary goal of maternal and child health nursing care can be
stated simply as the promotion and maintenance of optimal family health to
ensure cycles of optimal child bearing and child rearing.
The range of Practice includes
Preconceptual health care
Care of women during 3 trimesters of pregnancy and the puerperium
Care of children during the perinatal period (6 weeks before
conception to 6 weeks after birth).
Care of children from infancy through adolescens.
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Care in settings as treated as the birthing room, paediatric intensive
care unit, and the home.
Maternal and child health nursing is always family centered, which
means the family is considered the primary unit of care.
The level of family functioning affects the health status of individuals. If
the familys level of functioning is low, the emotional, physical and social
health and potential of individuals in the family can be adversely affected.
A healthy family, on the other hand establishers an environment.
Conducive to growth and health promoting behaviours that sustain family
members during crises.
Similarly, the health of individuals and the ability to strongly
influences the health of the family members, and overall family functioning.
Thus a family centered approach enables the nurse to better understand
an individual and in turn, provide the holistic care standards of maternal and
child health nursing practice.
The importance a society places on caring can best be measured by the
concern it places on its most vulnerable members or its elderly,
disadvantaged, and young citizens. Speciality organizations develop
standards of care to promote consistency and ensure quality nursing care in
their areas of nursing practice.
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Socio cultural aspects
Cultural values influence the manner on which people plan for child
bearing and child rearing and respond to health and illness. In a culture, in
which men are the authority figures, for example, if might be expected that
the father rather than mother ensures questions about an ill child.
If you are from a culture in which women are expected to provide all
childcare, you might find it annoying to hear a man taking over the responses
at a health interview. A nurse who has been culturally influenced to believe
that stoic behaviour is the proper response to pain may be inpatient with a
women who has been influenced to believe that expressing discomfort during
child birth is proper. Nurses need to include all cultural groups in nursing
research samples so more can be learned about cultural preferences in
relation to nursing interventions and care.
Cultural differences occur not only different ethnic backgrounds but
also different life styles. Adolescents, urban, youth, the hearing challenged,
and gays or lesbians have separate cultures from mainstream, for instance. A
patient who has been deaf since birth, for example, expects her deaf culture
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to be respected by having health care professionals attempt to communicate
with her in her language.
A lesbian mother could become hesitating of she is ahead, where is
your husband ? Given the cultural mix, almost any behaviour can be
considered appropriate for some individuals at some time and place. Nursing
care that is guided by cultural aspects and respects individual difference is
termed transcultural nursing.
Stereotyping culture
It means expecting a person to act in a characteristic way without regard
to his or her individual characteristics. It is generally derogatory in nature.
Statements such as, men never diaper babies well or Japanese women are
never assertive are examples of stereo typing. Sterotyping occurs largely
because of lack of understanding of the wide range of differences among
people. In the above examples, the first speaker, having seen one man change
diapers poorly, assumes that this represents the entire male population, using
this sterotype, planning health may be improper and it should be avoided.
On the other hand it is important not to ignore cultural characteristics,
because most people are proud of their cultural heritage. It is possible to
acknowledge and celebrate a clients culture without stereotyping by
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assessing the way in which she express cultural characteristics. Culture
influences health so much that several National Health goals have been
established in reference to socio cultural aspects of care.
Assessment based on socio cultural aspects of care
It is important to be certain that care is planned not on predetermined
assumptions but on the actual preference of the family, to do this, assess each
client as an individual, not merely as one of a group. Learn as much as you
can about different cultures by reading about or talking to members of as
many different ethnic groups as possible.
Assessing the culture of a community is important as assessing
individual families because families are intrinsically joined to their
community. An important area to assess is whether the family matches the
dominant culture in the community. This is important because the type of
foods stocked in the supermarket, the type of entertainment events that are
planned, and the values and history that are stressed in schools and work
settings are all influenced by the dominant culture.
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ASSESSING FOR CULTURAL VALUES
Areas of assessment Questions to ask or observations to make Ethnicity What country or race is the family from ?
Communication What is the main language used in the home ? Touch Does the family typically touch each other ? Do they
use intimate or conversational space Occupation Is work important to the family ?
Do they plan leisure time or leave it instructed > Pain Does the family express pain or remain stoic in the
face of it ?
What do they believe relieves pain best ? Family structure Is the family nuclear ? Extended ? Single parent ?
Are family roles clear ? Can an individual name a
family member he/she would call on for support in a
crisis ? Male and female
roles
Is the family male or female dominant ?
Religion What is the family religion ? Do they actually
practice their religion ? Health beliefs What does the family believe about health ?
What do they believe causes illness ?
Makes illness better ? Do they use alternative
therapies or established practices ? Nutrition Does the family eat in ethnic diet ?
Are the foods they enjoy available in their
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community ?
Nursing diagnosis
Powerlessness related to expectations of care not being respected Powerlessness related to socio cultural isolation
Impaired verbal communication related to English not being primary
language.
Nutrition, less than body requirements, related to cultural preferences.
Anxiety related to a cultural preference for not bathing while ill.
Fear related to inability to buy food due to poor economic status.
Outcome identification and planning
Planning needs to be very specific for the family and circumstance
involved because socio cultural preferences tend to be very personal. Care
may begin with in service education for health care providers who are
unfamiliar with particular cultural practice and its importance to the specific
family involved. It may include arranging for variations in policy, such as the
length of the family visiting. Lower types of food served, or kind of child
care. It can make health care more acceptable.
Implementation
Appreciate that cultural values are ingrained and usually very difficult
to change. An example of implementing care might be making arrangement
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for a new Native American mother to take home the placenta of that is
important to her, or planning home care for a Chinese American child
whose family believer in herbal medicine. It must be establishing a network
of health care agency personnel or personnel from a nearby university or
importing firm to serve as interpreters. It might be educating a child, family
or community about the reason for a hospital practice. A particular situation
may call for both sides to adjust (cultural negotiation).
Outcome
Evaluation by assessing whether outcomes have been met should
reveal that a familys socio cultural preferences were considered and
respected during care.
Examples
Parents lost three ways they are attempting to presence cultural
traditions in their children.
Child states she no longer feels socially isolated because of cultural
differences.
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Family members state they have learned to substitute easily purchased
foods for traditional foods unavailable in local stores in order to
obtain adequate nutrition cultural competence continuum.
Cultural destructiveness
Making every one fit the same cultural pattern and exclusion of those
who dont fit forced assimilation. Emphasis on difference and using
difference as barriers.
Cultural blindness
Dont see or believe there are cultural differences among people.
Everyone is same
Cultural awareness
Being aware that we all live and function within a culture of our own
and that our identity is shaped by it.
Cultural sensitivity
Making every one fit the same cultural pattern, and exclusion of those
who dont fit forced assimilation. Emphasis on differences and using
differences as barriers.
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Cultural blindness
Dont see or believe there are cultural difference among people. Everyone is
same.
Cultural awareness
Being aware that we all live and function with in a culture of our own
and that our identity is shaped by it.
Cultural sensitivity
Understanding and accepting different cultural values, attitudes and
behaviour.
Cultural competence
The capacity to work, effectively and with people integrating elements
of their culture, values, attitudes rule and norms. Translation of knowledge
into action.
Conclusion
To provide maternal and child health nursing effectively the socio
cultural factors to be considered in mind so that the wholistic care can be
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achieved fully, people also seek the health service if it is satisfied as per
their custom, culture etc.
Health education can be given to modify their behaviour if they need
to get change regarding the prevention of health problems. We cant force
the public to follow the methods to attain the goal. Creating the awareness in
such a way and to accept them to follow the healthy aspects to maintain their
health is most important.