PPN 301 Class 1 PDF

PPN 301 Class 1 Promoting the Health of Childbearing Individuals and Populations  Agenda ▪ Review course syllabus ▪ Overview of the global trends in maternal, infant, and child health ▪ Maternal, infant, child health promotion ▪ Theoretica...

PPN 301 Class 1 Promoting the Health of Childbearing Individuals and Populations  Agenda ▪ Review course syllabus ▪ Overview of the global trends in maternal, infant, and child health ▪ Maternal, infant, child health promotion ▪ Theoretical perspective guiding Maternal and Child Nursing Practice ▪ Principles of Family-Centred Maternity and Newborn Care ▪ Trauma and Violence informed care ▪ Cultural safety and cultural humility Global Trends in Maternal, Infant, and Child Health Maternal Every day approximately 810 women died from preventable causes related to pregnancy and childbirth. 94% of all maternal deaths occur in low and lower middle-income countries Young adolescents (ages 10-14) face a higher risk of complications and death as a result of pregnancy than other women. Infant Globally 2.4 million children died in the first month of life Approximately 6700 newborn deaths occur every day, amounting to 47% of all child deaths under the age of 5-years An estimated 15 million babies are born preterm (before 37 completed weeks of gestation) https://www.who.int/news-room/fact-sheets/detail/maternal-mortality Preterm birth complications are the leading cause of 3 death among children under 5 years of age Maternal and Infant Mortality in Canada 31 maternal death per 100,000 live births 1,750 infants or 4.7 infant deaths per 1,000 live births. 85.2% within first week of life with most occurring within 24 hours of birth. Infant mortality rates are twice as high for each Indigenous group, compared with the non-Indigenous population Risk of preterm birth is 8.9% higher compared to their White counterparts (McKinnon, 2016) Black maternal mortality in US Black women/ African American are 3- 4 times more likely dies from Pregnancy and Childbirth related complication https://www150.statcan.gc.ca/n1/pub/82-003-x/2017011/article/54886-eng.htm https://www150.statcan.gc.ca/n1/daily-quotidien/191126/dq191126c-eng.htm https://www.cdc.gov/healthequity/features/maternal-mortality/index.html 4 Maternal and Infant Health Inequities Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. Health inequities are unfair and could be reduced by the right mix of government Social Justice policies (WHO,2018) social justice focuses on the advantage that some groups or individuals have relative to others; the need to understand root causes of inequities; and the need to take responsible action to eliminate inequities. (CNA, 2010, p. 13) 5  Maternal, Infant, and Child Health Promotion UN Sustainable Development (SDG) Goal Target 3.1 Reduce maternal mortality Target 3.2 End all preventable death under 5 years of age Target 3.7 Universal access to sexual and reproductive care, family planning and education 6  Promotion Maternal Health: Reproductive Rights and Justice Reproductive rights Reproductive Justice “basic rights of all couples and “ is the complete physical, mental, individuals to decide freely and spiritual, political, economic, and responsibly the number, spacing and social well-being of women and girls, timing of their children and to have and will be achieved when women and the information and means to do so, girls have the economic, social and and the right to attain the highest political power and resources to standard of sexual and make healthy decisions about our reproductive health. It also includes bodies, sexuality and reproduction the right to make decisions for ourselves, our families and our concerning reproduction free of communities in all areas of our lives. discrimination, coercion and (Asian Communities of Reproductive violence,▪asDo all women/persons expressed in human have the same reproductive Justice) rights documents.” (ICPD, Para 7.3) rights? International Conference on Population and Development, Programme of Action, Para 7.3 ▪ Do all women have a voice in their reproductive 7  Critical Social Theory Perspective Understand the root causes of inequities are historical and socio-politically situated Examines relationships of power and the underlying structures in society that produce population inequities Understand health inequities from Micro, Meso, and Macro by asking “WHY Challenges social inequities and injustices, and its impact on populations health Betker et al.,2015 8  Critical race theory Rooted in the understanding that race is a social construct, and that racism is a central feature of society embedded within systems and institutions. Challenges race as a biological construct in the understanding of health disparities Analyzes the historical and sociopolitical structures contributing to differential health outcomes between races and for certain groups Reframe health disparities away from pathologizing Champine et al., 2022 marginalized communities. 9  Critical Social Theory Perspective Cont’d Engages with the problem to bring about transformation Work with individuals, family, and multi sector collaboration to influence policy and address structural and systemic determinants of health Explicit commitment to social justice 10  Practice questions Which of following demonstrates the MCN Which of following the demonstrates the understanding of the principle of reproductive MCN understanding of critical social rights (select all that apply) theory perspective? a) Maternal and child health inequities a. Work with women to advocate for safe are similar across populations abortion services b) Maternal and child health disparities b. Attend a training program on promoting are associated with individual reproductive rights lifestyles c. Work with a school principal to provide c) Maternal and child health disparities young girls with contraceptives are shaped by social conditions d. Create supportive environment to support d) Maternal and child health inequities Trans couples can be address through individual e. Advices pregnant teens to terminate their efforts pregnancy 11 ▷ How do SDH affect the reproductive health of women? ▷ How do issues of racism, poverty homelessness, violence, disability, low education levels, etc. impact prenatal, intrapartum and postpartum care?  Intersectionality “Intersectionality considers how systems such as racism, classism, sexism, homophobia and other forms of discrimination overlap and interact with one another to advantage some and disadvantage others at an individual and social-structural level.” Note: this figure provides examples. It is not a comprehensive list of all forms of discrimination, oppression, and social identity. (National Collaborating Centre for Determinants of Health, 2022, p.2-3)  Anti-Indigenous Racism in Perinatal ▪ Colonization and dominance of the Populations biomedical model – lack of culturally appropriate perinatal care ▪ Isolated communities – need to travel to deliver baby (‘forced evacuation’ imposed by federal government) ▪ Before 2017, women delivered alone, without family or community support, because escorts were not deemed medically necessary ▪ In 2017, policy change: federal government now provides funds for travel companion for Indigenous women leaving communities to give birth ▪ Feelings of loneliness when forced to leave home communities and families ▪ Lack of traditional practices or ceremonies incorporated into birth Copyright © 2021 The AuthoCopyright © 2021Terms and Conditions CJC Open 2021 3S149-S164DOI: (10.1016/j.cjco.2021.09.010) experiences / newborn care Racial Disparities in Birth Outcomes in Canada Differences in perinatal Structural racism and weathering hypothesis outcomes shows Black women Repeated exposure to socioeconomic had higher rates of:  Stillbirths adversity, political marginalization, racism,  Preterm births and perpetual discrimination can harm  Caesarean sections health Higher risk of Allostatic load: refers to the physiological  gestational diabetes,  preeclampsia, effect of chronic or repeated exposure to  placental abruption, stress.  low birth weight, Stress induces the secretion of cortisol,  small for gestational age (Miao et al., 2022) norepinephrine, and epinephrine  High amounts over time may lead to physiological effect of higher systolic and diastolic blood pressures, high cholesterol levels, HbA1c, and increased waist-to-hip ratio. Geronimus et al., 2006; Slopen et al., 2018  Leads to greater physiological wear and tear (aging biologically faster) Anti-Black Racism and Maternal and Infant Health Outcomes Populations Obstetric Racism “Obstetric racism highlights the forms of violence and abuse that medical personnel— and potentially any personnel within medical institutions—routinely perpetrate against Black women.” (Scott & Davis, 2021,p. 682) 16 Sexual Orientation, Gender Identity and Pregnancy ▪ Many lesbian, gay, and transgender couples become parents ▪ Intersecting identities of sexual orientation, gender identity, and race expose racialized 2SLGBTQ people to unique forms of discrimination and stigma ▪ They deserve respectful care during the childbearing experience as well as during health screening and wellness care ▪ Have the same range of reproductive interests as cis people, and many are at childbearing age at the time of transition ▪ Masculinizing and feminizing hormone therapy can have temporary and long-term impacts on fertility ▪ HCPs need to discuss both birth control and fertility preservation prior to the initiation of hormone therapy.  Cultural considerations-Female Genital Mutilation (FGM) ▪ Female genital mutilation (FGM) involves the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons ▪ Practiced in more than 45 countries, with most of these countries being in Africa ▪ Assess for potential FGM during initial prenatal visit, before exam ▪ Clear documentation of extent of cutting ▪ Listening to how the client refers to this; using same terms when providing care ▪ Non-stigmatizing, culturally safe care ▪ Providing information throughout pregnancy ▪ Ensuring privacy during exams ▪ Providing rationale for health provider actions ▪ Ensuring that woman and family understand why this request cannot legally be met by HCP (Durnford, 2022) What are your personal values and beliefs about pregnancy? How do you feel about pregnancy and childbirth? Is pregnancy a joyous experience? What are your Is childbirth a frightening experience? personal values Is childbirth a medicalized or natural process? and beliefs Who or what has shaped your beliefs? about How can your personal values, beliefs and pregnancy? assumptions shape the nursing care you provide to your clients? Meaning of pregnancy ▪ What meaning does pregnancy, childbirth and parenthood have for people. ▪ What is relationship between how someone became pregnant & the meaning of the pregnancy for them ▪ What assumptions does society have about pregnancy, childbirth and parenthood ▪ Who do we see as pregnant? ▪ Who do we see as a ‘parent’? ▪ How do we view people who are NOT parents? ▪ The impact of pregnancy and parenthood for individuals, families, communities and society. Practice questions: Avoiding Assumptions A pregnant 28 year old person has just had their pregnancy confirmed. You will be the nurse following the client during the pregnancy. Which of the following would most likely help establish a trusting nurse-client relationship? a. Congratulations! You must be thrilled. b. How exciting! Is this your first baby? c. Tell me how you are feeling about this news. d. Let me tell you about all of your birthing options. Principles of Family-Centred Maternity and Newborn Care (Public Health Agency of Canada, 2017)  Trauma and Violence-Informed Care Trauma and violence-informed approaches are policies and practices that recognize the connections between violence, trauma, negative health outcomes and behaviours. Focus to minimize the potential for harm and re- traumatization, and to enhance safety, control and resilience for all clients To increase attention on the impact of violence on people's lives and well-being To reduce harm To improve system responses for everyone (Hurley, 2022) 23  Four Principles for implementing TVIC approaches Understand trauma and violence Create emotionally and physically and their impacts on people’s safe environments lives and behaviours ▪ Communicate in non-judgmental ways ▪ Acknowledge the root causes of so that people feel deserving, trauma without probing. understood, recognized, and accepted. ▪ Listen, believe, and validate ▪ Foster an authentic sense of victims’ experiences. connection to build trust. ▪ Recognize their strengths. ▪ Provide clear information and ▪ Express concern. consistent expectations about services and programs. ▪ Encourage patients to bring a supportive person with them to meetings or appointments. (Hurley, 2022)  Four Principles for implementing TVIC approaches Foster opportunities for choice, Provide a strengths-based and collaboration, and connection: capacity-building approach to ▪ Provide choices for treatment and support patient coping and services and consider the choices resilience: together. Help patients identify their strengths, ▪ Communicate openly and without through techniques such as judgement. motivational interviewing, a ▪ Provide the space for patients to communication technique that express their feelings freely. improves engagement and ▪ Listen carefully to the patient’s empowerment. words and check in to make sure Acknowledge the effects of historical that you have understood and structural conditions on peoples’ correctly. lives. Help people understand that their responses are normal. Teach and model skills for recognizing triggers, such as calming, centering, 25  Cultural Safety & Cultural Humility Cultural Safety ▷ Highlights power imbalances in health care relationships Cultural Humility ▷ Process of self-reflection to raise awareness of personal and systemic biases How can cultural safety and humility be incorporated into nursing care for childbearing individuals and populations? (MacKinnon, 2022) How can I SPEAK UP Against Racism? (Institute for Perinatal Quality Improvement, 2020; https://www.perina talqi.org/page/SPE AKUP)  Inclusive Language ▪ Consider the impact of using inclusive versus non-inclusive language during pregnancy ▪ Use inclusive terms such as pregnant people (inclusive) versus pregnant women; parent (inclusive) versus mother or father ▪ Ask client which pronouns they prefer and which words they use to describe their body ▪ Use the client’s preferred words in a respectful & professional manner (eg: breastfeeding versus chestfeeding) http://www.phsa.ca/transcarebc/Documents/HealthProf/Gender_Inclusive_Language _Clinical.pdf  The HBHC program is free, voluntary and an OHIP card is not required. HBHC supports individuals & families with: Having a healthy pregnancy Developing a positive relationship with baby and children Promoting child’s growth and development Connecting to resources and programs within the community Working together to give child the best start in life Services provided by HBHC Public Health Nurses include: Frequent and intensive home visiting Support and health teaching during the prenatal period Breastfeeding and infant/child feeding support and teaching Health promotion teaching Healthy Babies Healthy Referrals to community programs and health Children (HBHC) Program services Service coordination (Toronto Public Health, 2022) Image from: https://sickkidscmh.ca/garry-hurvitz-cmh/prevention-and-early-intervention-services/healthy-babies- healthy-children  Perinatal and Pediatric Nursing Work Settings ▪ Hospitals, community, home, & clinics, ▪ Public Health Nurses: Healthy Babies, Healthy Children Program Pediatric Nurses Care for children from birth up to age 18 years Perinatal Nurses Work collaboratively with childbearing individuals and families from the preconception to postpartum period  Perinatal Healthcare Providers ▪ Nurses: ▪ Public Health Nurse: Healthy Babies, Healthy Children, Nurse-Family Partnership ▪ Hospital Postpartum Nurse ▪ Labour & Delivery Nurse ▪ Midwives ▪ Indigenous midwives: Seventh Generation & Toronto Birth Center ▪ Ontario midwives ▪ Non-insured clients: Access Alliance Non-Insured Clinic ▪ Obstetricians: physicians delivering babies in hospital ▪ Doulas/Birth Workers (not covered under OHIP) ▪ Indigenous Biidaaban Doula Collective ▪ Ontario Black Doula Society ▪ Birthmark Doulas (low cost/free services) ▪ Queer Spectrum Birth Doulas  Key Nursing Practice & Reproductive Health Considerations ▪ What is the role of the MCN in providing reproductive and pregnancy health care? ▪ What factors should a nurse consider in providing reproductive and pregnancy care? ▪ What kinds of ethical issues might arise in providing reproductive and pregnancy care? CASN Entry-to-Practice Competencies for Nursing Care of the Childbearing Family for Baccalaureate Programs in Nursing ▪ Core competencies related to the nursing care of childbearing families that all baccalaureate nursing students in Canada should acquire over the course of their undergraduate education. ▪ Set of knowledge, skills, and attitudes that all new nursing graduates should possess related to care of this population, regardless of the specialty area of nursing in which they may elect to practice, while also ensuring that they have the foundation needed to work in perinatal or related areas of nursing. ▪ Do not replace jurisdictional entry-to-practice guidelines, but rather to offer national, consensus-based guidelines regarding the depth and breadth of the coverage for all entry-level registered nurses related to nursing with childbearing families in Canada. (CASN, 2017) Perinatal Nursing Standards and CNA Speciality Certification Canadian Association of Perinatal and Women’s Health Nurses (CAPWHN) https://capwhn.ca/ Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) https://www.awhonn.org Canadian Nurses Association ○ Offer specialty certification ○ https://www.cna-aiic.ca/en/certification/initial-ce rtification/certification-nursing-practice-specialti es  References All images, except as noted, Images: @ CC Unsplash Canadian Association of Schools of Nursing. (2017). Entry-to-Practice Competencies for Nursing Care of the Childbearing Family for Baccalaureate Programs in Nursing (read pages 3-5; 9-13) https://www.casn.ca/wp-content/uploads/2016/09/FINAL-CHILDBEARING-FAMILY-COMPETENCIES-revised.pdf Cidro, J., Bach, R., & Frohlick, S. (2020). Canada's forced birth travel: Towards feminist indigenous reproductive mobilities. Mobilities, 15(2), 173-187. https://doi.org/10.1080/17450101.2020.1730611 Etowa, J., Dosani, A., & Benster, H. (2020). Maternal, newborn and child health. Chapter 16. In L. L. Stamler, L. Yiu, A. Dosani, J. Etowa and C. Van Daalen-Smith (Eds.), Community health nursing: A Canadian perspective (5th ed.). Toronto: Pearson Prentice Hall. (Note: this is a required textbook for PPN 302) Hurley, E. (2022). Contemporary Perinatal and Pediatric Nursing in Canada.. Chapter 1. In L. Keenan-Lindsay, C.A. Sams, C.L. O’Connor, S.E. Perry, M.J. Hockenberry, D.L. Lowdermilk and D. Wilson (Eds). Maternal child nursing care in Canada (5th ed.). Elsevier Canada. Institute for Perinatal Quality Improvement. (2020). https://www.perinatalqi.org/page/SPEAKUP Keenan-Lindsay, L. (2022). Perinatal nursing in Canada. Chapter 4. In L. Keenan-Lindsay, C.A. Sams, C.L. O’Connor, S.E. Perry, M.J. Hockenberry, D.L. Lowdermilk and D. Wilson (Eds). Maternal child nursing care in Canada (5th ed.). Elsevier Canada. MacKinnon, K. (2022). The family and culture. Chapter 2.. In L. Keenan-Lindsay, C.A. Sams, C.L. O’Connor, S.E. Perry, M.J. Hockenberry, D.L. Lowdermilk and D. Wilson (Eds). Maternal child nursing care in Canada (5th ed.). Elsevier Canada. National Collaborating Centre for Determinants of Health. (2022). Let’s Talk: Intersectionality. Antigonish, NS: NCCDH, St. Francis Xavier University https://nccdh.ca/images/uploads/comments/NCCDH_Lets-Talk-Intersectionality_EN.pdf  References All images, except as noted, Images: @ CC Unsplash Miao Q, Guo Y, Erwin E, Sharif F, Berhe M, Wen SW, et al. (2022) Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada. PLoS ONE 17(6): e0269158. https://doi.org/ 10.1371/journal.pone.0269158 Public Health Agency of Canada. (2017). Chapter 1: Family-centred maternity and newborn care in Canada: Underlying philosophy and principles. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/maternity-newborn-ca re/maternity-newborn-care-guidelines-chapter-1-eng.pdf Rainbow Health Ontario. (2021). Guidelines for gender-affirming primary care with trans and non-binary patients. https://www.rainbowhealthontario.ca/wp-content/uploads/2021/06/Guidelines-FINAL-4TH-EDITION-c.pdf Rainbow Health Ontario. (2022). Racialized 2SLGBTQ health: An evidence review and practical guide designed for healthcare providers and researchers. https://www.rainbowhealthontario.ca/wp-content/uploads/2022/03/Health-in-Focus-Racialized-2SLGBTQ-Health-1.pdf Scott, K. A., & Davis, D. (2021). Obstetric racism: Naming and identifying a way out of black women's adverse medical experiences. American Anthropologist, 123(3), 681-684. https://doi.org/10.1111/aman.13559 Smylie, J., O'Brien, K., Beaudoin, E., Daoud, N., Bourgeois, C., George, E. H., Bebee, K., & Ryan, C. (2021). Long- distance travel for birthing among indigenous and non-indigenous pregnant people in canada. Canadian Medical Association Journal (CMAJ), 193(25), E948-E955. https://doi.org/10.1503/cmaj.201903 Toronto Public Health (2022). Health Babies Healthy Children Program. https://www.toronto.ca/community-people/health-wellness-care/information-for-healthcare-professionals/patient-refer rals/healthy-babies-healthy-children-hbhc-program/