Patient-Centered Care and Adherence - Essay Example

? Labor delivery s Birth Story Birth story includes the process of birth together with the delivery of the child. Actually, thechild birth for Esther Davies commenced spontaneously, approximately 280 days after conception. Mainly the length of labor was about 7 hours, and it was actually the woman’s second birth. Inherently, the birth process entails a number of phases. First stage This involved the cervix dilating to about 10cm. specifically; the process has two phases which include the early/latent phase and the active phase. The patient did not show considerable signs of discomfort during the latent phase, although the contractions increased in strength with progress of labor. The process included conducting a pelvic exam in order to determine how the patient was progressing (Stevens, 2004). Notably, the active stage was faster than the latent phase with the patient experiencing contractions in every two minutes. However, the contractions were more painful. The transition to second stage began when the cervix dilated to about 8 – 9 cm. Second stage By the time the second stage started, the baby’s head had appeared at the top of the cervix. It is worth noting that the mother was advised on when to push. Notably, uterine contractions were also getting stronger (Tharp, 2000). With assistance from abdominal muscles contraction together with mother’s pushing, the baby passed through the birth canal. It was noted that active pushing played a significant role during the stage. More importantly, an epidural anesthetic was administered in order to make the mother to manage the abdominal muscles better. Consequently, crowning occurred as the infant filled the lower vagina. After the head was out, then the shoulders followed, and the baby’s mouth and nose was suctioned in order to ease the baby’s first breath. Third stage During the final stage of labor, the continuing uterine contractions push the placenta out of vagina. To reduce chances of heavy bleeding, the all of the placenta was taken away from uterus. Diagnosis The commencement of labor was determine through measuring the cervix dilation, more importantly, fetal monitoring which involved monitoring the baby’s heart rate to check for the indicators of stress during birth (Korte, 1992). This called for use of a stethoscope known as fetoscope. Consequently, after child birth, the patient was given some pain relief. This involved an epidural being placed in the patient while she lay on her side. Then her back was scrubbed with antiseptic, while the local anesthetic was injected in the skin. The anesthesia provided complete pain relief. Natural birth preparation The patient together with the family selected Lemaze method for preparing for childbirth. The method entails practice of breathing exercises together with concentration at a focal point (Tharp, 2000). This was done to assist the patient to control her pain while at the same time being conscious. In addition, the method made the flow of oxygen possible in the baby as well as to the muscles. I coached the mother during the birthing process. Conclusion The birth process was successful as expected. The mother did not experience any complications although the baby was noted to have heart murmurs. All in all, all the procedure that are involved in the birth process were a success. References Korte, D. (1992). A good birth, a safe birth. Harvard: Harvard Common Press.  Stevens, L. R. (2004). "Gimme a C: Is Choosing a Cesarean Section for a Nonmedical Reason Wise?" Fit Pregnancy April-May: 40-42. Tharp, A. J. (2000). This giving birth: pregnancy and childbirth in American women's writing. Bowling Green, OH: Bowling Green State University Popular Press.  Evidence based care Evidence based care refers to an evidence based solution that addresses a clinical dilemma and calls for defining the problem, in addition to conducting an efficient search in order to obtain the best evidence (Walsh, 2007). This is then followed by appraisal of the evidence, which is then considered putting into consideration the implication in the context of the patients’ values and circumstances. The techniques aim at improving the services rendered to the patients. More importantly, evidence based maternity care can be defined as the care that is supported by current and reliable research and it is directly beneficial to mothers together with their babies, and consequently it reduces incidences of complications, death or injury. To improve the condition on the faint murmur evident in the baby, the management adopted the idea of nutritional supplements to be added to the breast milk. This was actually after the research that had earlier been conducted on the neonatal mortality rates. It had been found that about 30 per 1000 newborns die within the first 28 days after birth. Evidently, the study takes advantage of Evidence Based Practice (EBP), taking into consideration the 5 sequential steps of EBP, and is therefore very relevant to the course. First, it asks a clinical question in a PICO format (Patient population, Intervention, Comparison and Outcome). That is “in newborns within 28 days of birth, how do nutritional supplements (I), compared to breast feeding alone (C), affect heart murmurs (O). Secondly, process involved searching for the best evidence that will provide an answer to the PICO question. The level II evidence presented includes the fact that there is a relationship between nutritional supplements and heart murmur. Consequently, the third step is a critical appraisal of the evidence found in the literature search. In the particular research, the results are valid, and are in line with (Roberts, 1999), conclusion that heart murmur can be reduced by breastfeeding, and more importantly when using nutritional supplements, the impact is greatly felt. This signifies that the results from the study are close to the truth. Moreover, they are meaningful, reliable and clinically relevant to the patients if applied. More importantly, forth step in EBP is where the sufficiency of the evidence is addressed. Since the evidence was reliable and applicable, it was integrated with the clinician’s expertise. More importantly, forth step in EBP is where the sufficiency of the evidence is addressed (Malloch, 2010). Since the evidence is reliable and applicable, it needs to be integrated with the clinician’s expertise. Since there is no provision for inclusion of patient preferences, it will be crucial in the process in order to achieve a quality decision regarding the patients care. The final step of EBP will call for evaluation of the clinical outcome in a healthcare provider own setting. This involves considering the most appropriate outcomes that will subsequently translate to the successful evidence implementation. In conclusion, the presentation is excellent and includes most of the EBP sequential steps. The management supported the idea that the child be given nutrition supplement in addition to breast milk. References Malloch, K. (2010). Introduction to evidence-based practice in nursing and health care. Sudbury, Mass: Jones and Bartlett.  Roberts, R. (1999). Information for evidence-based care. Abingdon: Radcliffe Medical Press.  Walsh, D. (2007). Evidence-based care for normal labour and birth : a guide for midwives. London New York: Routledge.  Informed consent According to Berg et al., (2001) informed consent involves communication between the patients together with the physician and normally ends up in patient’s authorization of undergoing a specific medical intervention. Mainly during the informed consent the physician providing treatment should disclose as well as discuss the patient’s diagnosis, nature together with purpose of treatment proposed, risks associated with the treatment, alternatives, risks and benefits of the alternative and risks and benefits of not receiving the treatment. Inherently, the elements of a proposed valid informed consent are mainly the disclosure, capacity and voluntariness. The disclosure should provide adequate information to the patient in order to help the patient make an informed decision. The consent form is then written in a lay language that suits the apprehension skills of the subject and moreover, it assesses the level of understanding in the meeting. Inherently, the capacity will involve the ability of the patient not only to understand the information given, but also to make a reasonable judgment that is based on the possible consequences of the decision the patient will make. In addition, the voluntariness takes into account the patient’s right to freely exercise their decision without any feeling of subjection by any external pressure, such as influence, manipulation or coercion. Evidently, before the patient experienced labor she had been informed by the responsible practitioners well in advance so that she would be in a position to act wisely with any possible new decision that she might be required to make (Levy, 1999). More importantly, she was provided with different choices of giving birth which included natural birth or caesarean section. Inherently, this was also combined with the benefits and the harms of the two methods. She was also offered a chance together with her husband to point out her needs and preferences, and she opted for the natural birth. The process can be said to have been an interactive one. Similarly, after giving birth, there was also an informed consent that involved the administration of various food supplements to the baby. Actually, the considered administration included vitamin K that was aimed at preventing vitamin K deficiency and bleeding in the baby. Consequently, the parents were informed about the role of vitamin K in the child’s blood, and more importantly, the need to administer it immediately after birth (Lowe, 2004). This was to present them with an option of either agreeing or refusing to have their child be given vitamin K. Inherently, the informed consent also included the need for vaccination. They were informed all about the vaccination that the new born child is supposed to receive so as to reduce chances of contracting diseases. They were also given room to either agree or refuse to go ahead with vaccination. Actually, in the two cases, the parents were okay with vitamin K administration and vaccination. In conclusion, the process met the basic elements of an informed consent and was appropriate for the mother. More importantly, the patient was involved in three informed consents while giving birth and after giving birth. This includes the birth method she preferred, administration of supplements and vaccination of the newborn child. References Berg, J. W., Appelbaum, P. S., Lidz, C. W, et al. (2001). Informed Consent: Legal Theory and Clinical Practice (2nd ed.). New York: Oxford University Press.  Levy, V. (1999). Maintaining equilibrium: A grounded theory study of the processes involved when women make informed choices during pregnancy. Midwifery, 15(2), 109-19. Lowe, N. K. (2004). Context and process of informed consent for pharmacologic strategies in labor pain care. Journal of midwifery & women's health, 49(3), 250-9. Patients centered care The patient centered care calls for active involvement of patients together with their families during the design of the care models as well as in decision-making concerning the individual options regarding the treatment. Similarly, Cronin (2004) defines patient centered health care as a health care that can establish a partnership between patients, medical practitioners and the patient families in order to make sure that the decisions made will ensure that the patients’ needs along with preferences will be met. Moreover, the patient centered care makes sure that the patients receive proper education as well as support that they require to make decisions and when participating in their own care. Luxford, Safran and Delbanco (2011) believe that great involvement of patient in the delivery and design of the health care and safe medical systems as depicted by the patient centered care are some of the overreaching goals of health care. Mainly the attributes of the patient centered care includes a whole-person care, ready access, patient empowerment and support, and coordination and communication. It is actually about educating the patients about the diagnosis, the planned treatment and healthy behavior. Evidently, the mother and the child were offered patient-centered care. This involved training the mother on the basic skills through which she is supposed to take care of her new born baby. The training not only involved the mother but also it included the father. The parents were taken through basic steps they are supposed to consider while handling the baby (Robinson et al., 2008). The training entails handling techniques of the new born babies, which included supporting the new baby’s head, bathing the baby, dressing and changing the baby’s diaper, cleaning the umbilical cord, feeding as well as burping the baby, taking the baby’s temperature and also soothing the baby. Moreover, the practitioners also educated the couple on how to assist the new born baby in breathing to reduce the effects of heart murmurs. The parents were also given tips on how to use bulb syringe to clear the baby’s nasal passage. Consequently, it is clear that this was a patient centered care. This is because the training is aimed at encouraging the parents to be actively involved in taking care of their new born child (Hofmann, 2011). Moreover, the information given to the parents will be very influential in making good informed decisions regarding their child so as to ensure that the child will not only get well but also will stay well. The training also respected the patient’s needs together with their wants and preferences. For instance, they are actually the first time parents who needed support in taking care of their child. Moreover, the child was diagnosed with faint heart murmur which is well covered in the patient centered care. In conclusion, the patient centered care was achieved despite the fact the patients were not given options for treatment. The family of the baby was also involved greatly in the care. References Cronin, C. (2004). Patient-centered care: An overview of definitions and concepts. Washington DC: National Health Council. Hofmann, P. B. (2011). Patient-centered care: rhetoric or reality?.Healthcare executive, 26(5), 56-9. Luxford, K., Safran, D. G., & Delbanco, T. (2011). Promoting patient-centered care: A qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. International journal for quality in health care, 23(5), 510-5. Robinson, J. H., Callister, L. C., Berry, J. A., et al. (2008). Patient-centered care and adherence: Definitions and applications to improve outcomes. Journal of the American Academy of Nurse Practitioners, 20(12), 600-7 Read More