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Counseling the Pregnant Woman

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Title: Counseling the Pregnant Woman


1
Counseling the Pregnant Woman
2
General strategies for providing effective
nutritional care
  • Assess nutritional status
  • anthropometric
  • biochemical
  • social
  • medical
  • dietary

3
Dietary Assessment Selection of Methods
  • Avoid collecting information that wont 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?

4
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

5
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

6
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

7
Family Food Hotline
  • http//www.familyfoodline.org/
  • Order outreach cards
  • 1-888-4-food-wa

8
Cultural factors affecting diet and pregnancy
outcome in Mexican-Americans (Gutierrez, J. J
Adolesc Health. 1999 Sep25(3)227-37.
  • N48 primigravida adolescents aged 13-18 who self
    identified as Mexican-American.
  • 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?

9
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?

10
(No Transcript)
11
Seven Domains of Cultural Competence
  • Cultural Competence A Journey
    http//www.bphc.hrsa.gov/culturalcompetence/Defaul
    t.htm1

12
1. Values and attitudes
  • Promoting mutual respect . . . awareness of
    the varying degrees of acculturation . . . a
    client-centered perspective . . . acceptance that
    beliefs may influence a patients response to
    health, illness, disease and death. . .

13
2. Communications styles
  • Sensitivity . . awareness . . . knowledge . .
    . alternatives to written communication .

14
3. Community/consumer participation
  • Continuous, active involvement of community
    leaders and members . . . involved participants
    are invested participants, health outcomes
    improve. .

15
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 .
    . .

16
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 . .

17
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 . .

18
7. Training and professional development
  • Requiring training . . . nature of cultural
    competence training . . duration and frequency of
    professional development opportunities . . .

19
Ethnomed
  • http//healthlinks.washington.edu/clinical/ethnome
    d/

20
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.
21
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)

22
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)

23
East Africa Pregnancy Foodways- Ethnomed
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.
24
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.

25
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.

26
Adolescent Development (Drake P. J Obset.
Gynacol. Neonatal Nursing, 1996)
27
Adolescent Development (Drake P. J Obset.
Gynacol. Neonatal Nursing, 1996)
28
Responding to Developmental Differences of
Adolescence Goal Setting
29
Responding to Developmental Differences of
Adolescence Professional Approaches
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