Transcript Counseling the Pregnant Woman

Counseling the Pregnant Woman
General strategies for providing
effective nutritional care
• Assess nutritional status
– anthropometric
– biochemical
– social
– medical
– dietary
Dietary Assessment: Selection
of Methods
• Avoid collecting information that won’t be
used:
• What is the language skill and literacy level of the
woman?
• How will I use the information? How accurate and
detailed does it need to be?
• What is the standard that will be used for
comparison?
• What resources do I have for collecting, analyzing
and interpreting the data?
Essential Steps for Patient Education
(IOM Implementation Guide)
•
•
•
•
Identify the problem(s)
Develop a tentative clinical objective
Discuss objective with the woman
If woman does not perceive as a problem
offer personalized information
Essential Steps for Patient Education
(IOM Implementation Guide) Cont.
• With the woman:
– Identify behaviors that support or impede
achievement of the clinical objective
– Assess barriers to behavioral change &
strategize about removing barriers
– Plan one or two behavior changes
– Help to reduce barriers with referrals or
information
– Offer feedback and reinforcement for success
Referrals to Food and Nutrition
Programs
• WIC
• Temporary emergency food assistance
program or food banks
• Food stamp program
• Cooperative Extension- Expanded Food
and Nutrition Program
Family Food Hotline
• http://www.familyfoodline.org/
• Order outreach cards
• 1-888-4-food-wa
Cultural factors affecting diet and pregnancy
outcome in Mexican-Americans (Gutierrez, J. J Adolesc
Health. 1999 Sep;25(3):227-37.
• N=48 primigravida adolescents aged 1318 who self identified as MexicanAmerican.
• Questions:
• In some parts of Mexican culture food is classified
into “hot” such as pork or “cold” such as fruit juices
to balance good health. Do you practice or follow
such classification?
• Some people believe that cravings during
pregnancy should be satisfied or the infant may be
marked by whatever food was craved. What do
you think?
Cultural factors affecting diet and pregnancy
outcome in Mexican-Americans
(Gutierrez, J of Adolescent
health, in press)
• Questions (cont.)
• Some people believe that nausea and vomiting
during pregnancy should be treated by drinking
flour and water, cornstarch and lemon juice, or
chamomile tea. What do you think?
• Do you believe that heartburn is caused by eating
chili?
• Some people believe that during pregnancy, if the
woman sleeps too much it causes the baby to stick
to the uterus. What do you think?
Hot & cold
No
Yes
Cravings
No
Yes
Nausea
No
Yes
Chili
No
Yes
Sleep/Uterus
No
Yes
Group I
N=14
3-12 mos.
Group II
n-19
12-48 mos
Group III
N=13
84-216 mo
8
6
14
5
13
0
7
7
9
10
11
2
6
16
6
15
2
1
6
8
9
10
9
4
4
10
2
17
8
5
Seven Domains of Cultural
Competence
Cultural Competence: A Journey
http://www.bphc.hrsa.gov/culturalc
ompetence/Default.htm#1
1. Values and attitudes
Promoting mutual respect . . . awareness
of the varying degrees of acculturation . . .
a client-centered perspective . . .
acceptance that beliefs may influence a
patient’s response to health, illness,
disease and death. . .
2. Communications styles
Sensitivity . . awareness . . . knowledge . .
. alternatives to written communication .
3. Community/consumer participation
Continuous, active involvement of
community leaders and members . . .
involved participants are invested
participants, health outcomes improve. .
4. Physical environment, materials,
resources
Culturally and linguistically friendly interior
design, pictures, posters, and artwork as
well as magazines, brochures, audio,
videos, films. . . literacy sensitive print
information . . . congruent with the culture
and the language . . .
5. Policies and procedures
Written policies, procedures, mission
statements, goals, objectives incorporating
linguistic and cultural principles . . . clinical
protocols, orientation, community
involvement, outreach. . . multicultural and
multilingual staff reflecting the community .
.
6. Population-based clinical practice
Culturally skilled clinicians avoid
misapplication of scientific knowledge . . .
avoid stereotyping while appreciating the
importance of culture . . . know their own
world views . . . learn about populations . .
. understand sociopolitical influences . . .
practice appropriate intervention skills and
strategies . .
7. Training and professional
development
Requiring training . . . nature of cultural
competence training . . duration and
frequency of professional development
opportunities . . .
Ethnomed
http://healthlinks.washington.edu/clinical/eth
nomed/
Southeast Asian
“Traditional practices are heavily based in concepts of
"hot" and "cold" conditions. Younger women may no
longer follow traditional practices but the family (mother
or mother-in-law) may insist on following traditions and it
is important to understand how an individual woman and
the greater family compromise.”
Southeast Asian Pregnancy
Foodways - Ethnomed
• "Cold" foods are needed for the "hot" condition of
pregnancy according to Chinese categories.
• There are a wide range of foods which are felt beneficial
or harmful between cultural groups.
• Bean sprouts/green peas avoided - thought to cause
SAB (Vietnamese)
• Homemade rice wine, herbal medicines, coconut juice
are taken to help give the baby good quality skin. Beer is
thought to make the delivery easier (Cambodian)
• Drinking milk and gaining too much weight will make
baby fat and difficult to deliver (all SE Asian)
Southeast Asian Postpartum
Foodways - Ethnomed
• Maternal diet balanced between "hot" (alcohol,
ginger, black pepper & some high protein) and "cold"
(fruits, vegetables, some seafood). No sour foods
(cause incontinence), no raw foods. Pork felt very
nutritious.
• Cold ice water offered post delivery in the hospital
may be seen as unhealthy.
• Inability to follow traditional post-partum practices is
thought to cause later health problems, especially
abdominal pain in women (which may occur months
or even years later). Once a woman becomes sick
from symptoms thought due to violation of "d'sai
kchey", she is sick for the rest of her life.
(Cambodian)
East Africa Pregnancy FoodwaysEthnomed
“Related women and women within a neighborhood
have very strong ties among each other in East African
communities. In some cultures, such as that of ethnic
groups from Ethiopia, women have a daily coffee ritual
where they gather each day in homes to share coffee
and talk. This daily gathering of women established
support networks for pregnancy, postpartum help, and
child care.”
East Africa Pregnancy
Foodways- Ethnomed
• Women try to have good nutrition and
particularly may increase meat in their
diet.
• Flax seed flour is mixed with warm water
before delivery and drunk by the woman to
help produce an easy delivery.
East African Post-Partum
Foodways - Ethnomed
• Traditionally women rest in bed for 40
days postpartum and are attended by
other women who prepare nutritious food
and do housework.
• Special teas, soups, and porridge are
provided for the mother.
• Flax seed porridge with honey is
commonly given to mothers post-partum.
Adolescent Development (Drake
P. J Obset. Gynacol. Neonatal Nursing, 1996)
Adolescent Development (Drake P.
J Obset. Gynacol. Neonatal Nursing, 1996)
Early (11-14)
Middle (15-17)
Late (18-20)
Concrete, Egocentric,
confused about body
and sexuality, peer
oriented, need to
establish independence
may conflict with need
for support
Begins to be capable of
seeing connection
between behavior and
health, emerging sense
of self, may affirm adult
identity through
pregnancy
Increased ability for
abstract thinking and
planning, greater
comfort with body
image, stronger sense
of self may facilitate role
as mother, may be able
to enlist support of
father of baby
Responding to Developmental Differences of
Adolescence: Goal Setting
Early
Middle
Late
Limited –
may be
unable to
formulate
realistic
goals
Improving –
may
formulate
grandiose,
unrealistic
goals
Often able to
set goals –
may not be
interested in
doing so
Responding to Developmental Differences of
Adolescence: Professional Approaches
Early
Middle
Offer simple, Respect
concrete
need to
choices
make
independent
decisions,
encourage
negotiation
with adults
Late
Offer
opinions as
one adult to
another,
serve as
sounding
board