Public Health Home Visit: Antepartum Client

Public Health Home Visit: Antepartum Client

Instructions/Descriptions

Public Health Home Visit: Antepartum Client

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The PHN received a referral to see a 17-year-old African American woman named Ali, who was referred by the county prenatal clinic. Ali was 5 months pregnant with her third pregnancy within the past year. Ali miscarried the previous two pregnancies during the first trimester.

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When the nurse made the home visit, she noted that Ali was 5 feet 9 inches tall and weighed 120 lb. She resided in a two-room apartment with her boyfriend, who was the father of the baby. The nurse began the first visit with social talk, asking Ali general questions about her employment, education, and the duration of her residence in the area. Ali appeared to be pleased that the nurse was interested in her. Once a trusting relationship was initiated, the nurse asked Ali how she felt about the pregnancy. Ali revealed that she was happy about the pregnancy but was worried that there would be problems because she had had two previous miscarriages. She had not planned any of the pregnancies, but she did not use contraceptives to prevent the pregnancies either. Ali’s boyfriend worked and was able to pay the rent and buy food for her. Ali dropped out of high school during her junior year, but she wanted to complete her high school education. She had Medicaid coverage for her health care.

During the initial home visit, the nurse assessed that Ali was underweight and had several knowledge deficits in the areas of prenatal nutrition, infant care, breastfeeding, and contraception. The nurse also identified the need for a referral to the public school for the continuation of Ali’s high school education. The nurse briefly discussed her assessment with Ali in a nonthreatening, nonjudgmental manner. The nurse informed Ali that, if she was interested, she could schedule future home visits to provide Ali with more information and answer her questions. Ali agreed to receive future visits to discuss the topics the nurse identified during the assessment phase. They mutually agreed upon the plan for future visits. As the visits progressed, the nurse and Ali modified the plan on the basis of progress evaluation.

The nurse terminated home visits with Ali when the mutually established goals were achieved. The nurse scheduled a postpartum visit with Ali after the baby was born to assess infant care and answer any questions Ali had concerning infant care.

Assessment

Although it was important to perform an individual assessment of Ali, the PHN assessed Ali as a member of a family and as a member of the community. Community in this case referred to the aggregate of publicly insured adolescent pregnant women. Assessment of Ali revealed an underweight 17-year-old pregnant woman who was unable to demonstrate knowledge of nutrition in pregnancy, infant care, breastfeeding, contraception, or educational options for pregnant teenagers.

An individual assessment of Ali mandated the need for an assessment of the composition and function of Ali’s family. The PHN assessed the following factors with regard to Ali’s family:

Family composition and support network

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Family’s and support network’s attitude toward mental and physical health and use of health care services

Family’s and support network’s attitude toward Ali’s physical, mental, social, spiritual, and economic support

Family’s and support network’s beliefs and attitudes regarding infant care, breastfeeding/bottle feeding, immunizations, and nutrition

Attitude of infant’s father regarding involvement with Ali and their baby, his health beliefs, and his ability to assume the role of parent

The PHN was aware of the need to see the larger, aggregate picture. Identifying the aggregate as the pregnant adolescent community, the PHN used the following techniques in an ongoing assessment (Lewenson and Truglio-Londrigan, 2010)

1. Observations
2. Resource analysis
3. Key informant interviews
4. Environmental indexes

Using these techniques, the PHN gathered information regarding the following:

1. Educational and employment options for pregnant teens and teens with infants
2. Availability of health services targeting low-birth-weight infants
3. Availability of support groups for this aggregate
4. Availability of teen parenting classes

Diagnosis

The PHN formulated nursing diagnoses based on thorough individual, family, and community assessments.

Individual

1. Lack of awareness regarding nutrition in pregnancy, infant care and feeding, contraception, availability of community resources, and educational options for pregnant teenagers
2. Inadequate nutritional support related to low-income status and inadequate knowledge of nutritional requirement for pregnancy

Family

1. Lack of family support related to Ali’s living away from home
2. Altered family communication patterns related to role confusion among family members

Community

1. Minimal availability of health care services, parenting classes, contraception counseling, and educational opportunities for pregnant teenagers
2. Lack of coordination of existing services

Planning

Planning health services and interventions for pregnant teenagers involves formulation of mutually agreed-upon short-term and long-term goals for the individual, family, and community.

Individual

Long-Term Goal

1. Ali will carry her infant to term without evidence of maternal or fetal complications.

Short-Term Goals

1. Ali will gain at least 3 lb per month.
2. Ali will demonstrate knowledge of community resources for pregnant adolescents by the next nursing visit.

Family

Long-Term Goal

1. Ali, her partner, and other family members will be able to perform mutually determined role responsibilities.

Short-Term Goal

1. Ali and her partner will attend teen parenting classes.

Community

Long-Term Goals

1. Establishment of effective, comprehensive prenatal health, contraception, and education services for pregnant teenagers
2. Decline in rate of teen pregnancies and birth of compromised neonates over the next 24 months

Short-Term Goals

1. Increased community awareness of resources for pregnant teenagers
2. Increased awareness of contraception counseling services for adolescents

Intervention

Individual

Implementation of Ali’s individual care plan involved visits by the PHN with a referral to existing prenatal services for pregnant teenagers.

Family

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Family intervention was composed of Ali’s and the father’s referral to a support group for pregnant teenagers and partners.

Community

Implementation of the care plan for the aggregate of adolescent pregnant women included the following:

1. Meeting with community leaders
2. Meeting with local school administrators and faculty to disseminate information for pregnant teenagers
3. Formation of community organizing groups

Evaluation

Individual

Evaluation included measures of the client’s nutritional status and her use of support groups and educational and nutritional services.

Family

Evaluation included measures of the family’s use of support groups and educational and services.

Community

Evaluation of the effectiveness of interventions at the aggregate level focused on measurement of available options for pregnant teenagers, measures of teen awareness and use of services, and determination of changes in incidence rates of teen pregnancy and compromised neonates.

Levels of Prevention

The PHN not only works with the patient and the patient’s support network, but also provides care to the entire community through education and intervention programs. The PHN is actively involved in working with individual teenagers, their friends and families, and the community in reducing the incidence of teenage pregnancy and assisting pregnant teenagers with prenatal care and available resources. Examples of providing care at the three levels of prevention are listed here.

Primary

1. Activities that prevent teen pregnancy from occurring, such as individual and family counseling and school and community education programs

Secondary

1. Interventions for early detection of teen pregnancy and early intervention, such as counseling for prenatal care

Tertiary

Goal: To reduce the effects of adolescent pregnancy

1. Provision of prenatal education in areas such as nutrition, parenting, and infant care
   

   Public Health Home Visit: Antepartum Client

   

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