Client from Midwifery Discipline for Whom Provided Care - Case Study Example

MIDWIFE The current investigation is written from the perspective of midwifery and shows attention to drawing connections between real case study examples in the field, and the theory and knowledge behind them in texts. In any case, there are both psychological and social factors that may impact on the client, and in this case, these psychological and social theories can be related by looking at existing studies, as well as a case personally observed. Therefore, the majority of the current report looks at issues brought up by the scenario of a female African client, MR. This client had a history of type 1 diabetes and a large baby for which she was given medication during labour. The mother on this maternity situation had a normal delivery at the end of the situation, which brought up issues of the midwife and how these issues of midwifery can be related to modern practice today. Therefore, the plan involved the provision of a trained midwife as well as diabetes education. When admitted the patient showed a history of diabetes and a necessity to work with a midwife due to MR’s condition. Throughout the process of patient-centered care, the patient was given a full history and support for her condition, and was also counseled about risks which the situation would bring in terms of the necessity of specific midwife interventions. Under the current system nurse midwives continue to work alongside physicians and in hospitals to provide prenatal and natal care, and MR’s case was no exception: she was given a midwife nures professional with a full client history. But although some have hailed the current care system, which makes healthcare work on more of a social model and does not limit the choices of patients, others say that the system has limited nurse midwives. “The overall trend in legislative action and regulation has been to expand opportunities for practice by certified nurse midwives (CNMs). However, efforts in some areas to seek title recognition for CNMs… or obtain prescriptive authority, among other issues, have been met with consitent opposition” (Reed, 1997). The main problems for nurse midwives in cases like those of MR include unfair malpractice targeting, the lack of homecare and care continuity options, restrictions in authority, and limits on the provisional care system as a whole in recognizing the increasing popularity and utility of CNMs. This is a system that many criticize for its slow ability to change, and in fact, MR had to request a nurse midwife, rather than have one supplied. Because MR’s baby was born rather large, there was some concern, but this turned out to not be the main issue. Overall the case proceeded rather smoothly. This topic is very relevant to advanced practice nursing because it is required that most midwives working in registered healthcare facilities are also nurses. This is also relevant to current practice in general because, “Midwives need to be prepared to practice in new environments, consumers need to be educated so they can make informed choices, and organizations need to develop the means to gather and analyze data in order to provide healthcare that meets the patient needs” (Paine, 1999). The health-care patient of today like MR has needs, wants and demands that they need to have fulfilled by the institution of their choice. They are also increasingly well-informed, with the advent of internet technology which allows them to gather a great deal of information before making the choice to go to one facility or another, according to their needs. MR already knew a lot about the process of giving birth from classes she had attended and also, she said, information she saw on the internet. Of course, patients should be cautioned against believing everything they read. Hospitals are increasingly turning to provision of services like midwifery systems or CNMs to find specialized place in the patient consciousness in an effort to increase patient satisfaction by treating patients like MR as individual people with specific sets of needs. They may offer specialized services that cover a wide range of possible targets in an effort to induce patients to find value and be urged to come back again, displaying the loyalty that comes from satisfaction. This is a potentially positive impact, as during the case, MR really seemed to appreciate being treated with the help of a midwife, as it was more in league with the African culture as well, where midwives are more popular than in modern Europe and the UK. The main stakeholders in this issue are nurses who want to be midwives, practicing nurse midwives, patients, and physicians. One ethical problem overall could be the opposition between evidence supporting midwifery and the actual practice of care which is more prohibitive towards it. “Members have been providing safe and cost effective healthcare with a focus on disease prevention and health promotion… Despite increasing evidence that midwifery care is high quality, accessible, and cost effective, however, it has not been universally adopted as a model for the delivery of healthcare in many modern care settings” (Williams, 1999). It becomes clear that the working environment or hospital must also function in the society with the individual, to match the needs of society. Before moving on to compare the protocol and the study, something should be said about diabetes in general. There are many kinds of diabetes, and the protocol and study focus on type I diabetes, or diabetes mellitus. Diabetes mellitus exists when a patient has a deficiency of insulin or the resistance to insulin in their system, and it may result in symptoms such as an inordinate amount of urination and the patient’s being constantly thirsty as well as other problems. These symptoms are common to diabetes mellitus, but in the case of diabetes insipidus, another type of diabetes, there is no insulin deficiency. Diabetes mellitus is the more common of the two types of diabetes, and is what most people think of when they hear of diabetes, and is in fact what people are linking to type 1 diabetes. Diabetes insipidus, while it shares some symptoms with diabetes mellitus, is a different type of ailment, and is not related to diabetes mellitus. The existing literature shows in terms of evidence based practice that, “The goals of diabetes education are to optimize metabolic control, prevent acute and chronic complications, and optimize quality of life while keeping costs acceptable. One of the goals of Healthy People 2010 is to increase to 60% the proportion of individuals with diabetes who receive formal education” (Norris et al., 2001). The New York Presbyterian Hospital also follows this goal because it focuses on educating the diabetes patient. In the protocol, there are modifiable and non-modifiable factors that patients need to take into consideration when assessing their risk level and talking to their healthcare services about cutting down on diabetes risk factors. Many of these factors may be unique, however, especially from the angle of pharmacological intervention, for patients with diabetes. The literature shows that assessment of the neonatal diabetic patient should include testing too, so that outcomes can be optimized within the system that gives care. Psychological and sociological theories One psychological theory that can be applied to this case is behavioralism, because diabetes can often be affected by behavioral interventions. An example of behaviorism at work is if a person has a way of thinking or behaviors that are false or negative, the behaviorist can help them become a better person by countering these assumptions with positive and helpful ones. The societal balance suggested by this influx of positive thinking can also be seen from a sociological perspective as being basically functionalist. Behavioral theory assumes that while the above is useful, it will not succeed unless healthy concepts are socially constructed and the environmental factors are reinforcing. “In the late 30s Skinner was able to show that a broad range of behavior can be acquired, changed, and regulated by manipulating the consequences in the library. But Skinner in the tradition of Watson preferred to avoid mentalistic terms such as pleasure and satisfaction in favor of the direct description of the observable events” (Monte and Sollod, 2003). From a sociological perspective, functionalists state that the mechanisms of society have latent and manifest functions that may be quite different in their explicit and implicit natures. For example, from a functionalist perspective, healthcare delivery in the U.S. could be seen to have the manifest function of preparing clients like MR for diabetes symptom management and the latent function of trying to reverse the diabetes by lifestyle choices. Healthcare facilities could also be seen from this perspective to have the function of helping patients like MR by placing them in a cooperative environment in which they are assessed partly by their ability to perform various functions. REFERENCE Monte, C. and R. Sollod (2003). Beneath the Mask. New York: Wiley. Norris, S. et al. (2001). Effectiveness of self management training in type 1 diabetes. Diabetes Care. Paine, L. (1999). Midwifery in the 21st century. Journal of Nurse Midwifery 44(4). Reed, A. (1997). Trends in laws and regulations affecting nurse-midwives. Journal of Nurse Midwifery 42(5). Read More