NCM 22107L Care of Mother, Child, and Adolescent (Well Clients)

RELATED LEARNING EXPERIENCES

ACTIVITY 2
Diversity and Maternal Child Nursing

I. Written Assignment:
1. A thorough assessment of a patient is the key to planning care based on the preferences of
the patient and family. Devise a list of interview questions that would be appropriate for the
following patients to assess their cultural values:
a. A 32-year-old woman visits the clinic to arrange for prenatal care after receiving a
positive pregnancy test. This is her first pregnancy. She asks you what type of birth plan
most women follow.
b. A 22-year-old woman who is pregnant visits an OB/GYN office to set up a birth plan with
her 34-year-old partner. She states that she wants a typical hospital birth experience,
but her partner prefers a home birth.

QUESTIONS RISK/PURPOSE BOLD = Targeted Risk Factors

I am going to ask some questions to better help us support you during Rapport building
this pregnancy. This information will be kept confidential. Please let me
know if you have any concerns or questions as we go along.
1. How is your pregnancy going? How are you feeling? Rapport building Check for any warning signs
 How are you feeling about being pregnant? Adjustment to pregnancy
 Is this good timing for your pregnancy? Y or N Tell me more. □ If client is showing any signs of depression she
 Have you had any changes in your appetite or sleep habits? Y or will need further screening
N (If yes) What? ____________________
2. Have you seen a medical provider for this pregnancy? Y or N Referral/link to medical care
(If yes) When did you first see your medical provider? Prenatal medical care:
__________________  Greater than or equal to (≥) 14 and less
When is your next appointment?__________________ than (<)24 weeks and no prenatal care
(If no) Why don’t you have a medical provider? _________________ started at time of screening
(If no medical provider skip to Q #4)  Greater than or equal to (≥) 24 weeks
gestation and no prenatal care started at
time of screening
 Started prenatal care during third trimester
(greater than or equal to (≥) 24 weeks
gestation)
3. (If seen by a medical provider) Has your medical provider told you  Gestational Diabetes
about any health or medical concerns with your current pregnancy, such  Hypertension during pregnancy

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as high blood pressure, gestational diabetes, preterm labor, or pregnant (PIH/Gestational Hypertension)
with two or more babies?  Preterm labor
 Prescribed bed rest due to conditions that
could lead to preterm birth, i.e. placenta
previa or placenta abruption
 Multiple Gestation
4. How much did you weigh before this pregnancy? ________________ Pre-pregnancy BMI:
lb Have you had your weight checked recently? _______ lb Date :  Less than (<)18.5 BMI
__________Height: ___________ (feet and inches)  25 to 29.9 BMI
 Greater than or equal to (≥) 30 BMI
 Please document how you obtained the client’s weight (agency scale,
client reported, another source-medical provider, or WIC).
 MSS providers will need to determine the client pre-pregnancy BMI
and pregnancy weight gain.
5. Is this your first pregnancy? Y or N (If yes) skip to Q #8 (If no) 35 years of age or older and this is the first
pregnancy
 How many times have you been pregnant? ______________  Inter-pregnancy interval less than 9
 Have any of them been miscarriages, stillbirth or early infant death? Y months from end of last pregnancy
or N (If yes) How many and when? ______________ (including miscarriages or terminations)
 When did your last pregnancy end? _____________  Fetal death history (greater than (>) 20
 Did you have fertility treatment with this pregnancy? Y or N weeks gestation)
 35 years of age or older at the time of
conception and used ART
6. (If any live births) Did your baby (babies) have any health or medical  Prior LBW (less than (<)5# 8 oz) and/or
problems at birth? If yes, what were they? ________________ Premature Infant ( less than (<) 37 weeks
 Prior preterm birth due to spontaneous
 How much did your last baby (babies) weigh at birth? _____________ preterm labor*
 How many weeks pregnant were you at delivery? ____________weeks  Prior rupture of the membranes*
 Did you deliver any of your babies before 37 weeks gestation or did any
of the babies weigh less than 5 pounds 8 ounces? Y or N (If yes) How *If marked and singleton gestation, refer to
many? _______________ provider for 17P treatment.

7. Did you have gestational diabetes, high blood pressure, depression, or  History Gestational Diabetes with last
postpartum depression with your last pregnancy? pregnancy
 History of Gestational Hypertension
(If yes) Tell me more. ________________________  History Perinatal Mood Disorder or
postpartum depression with last pregnancy
8. Do you have any health problems or medical conditions not related to  Chronic Hypertension
pregnancy? (If yes) Tell me more. Examples- Hypertension, diabetes,  Diabetes- type 1 or 2
treatment of mental health issues, etc.? ____________________  Perinatal Mood Disorders/ Depression

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  Severe Mental Illness
9. Are you currently taking any prescribed medications, over the counter  Medications related to psychiatric issues,
medications, supplements, vitamins, and/or home remedies? Y or N (If diabetes, and hypertension.
yes) What are they and how much/often do you take them?  Non-prescriptive use of prescription drugs
________________________________________
Supplements, prescription drugs
(If yes and has prenatal care provider) Have you discussed taking these Prenatal vitamins/folic acid/iron
during pregnancy with your prenatal care provider? Y or N (If no) Why
not?
________________________________________
10. When was the last time you saw a dentist? ____________________ Referral to dental care

 Do you have any problems with your teeth or gums that affect how
you eat? Y or N (If yes) What? ________________________
11 Do you ever run out of food before the end of the month or cut down  Food Insecurity
on the amount you eat to feed others? Y or N (If yes) Tell me more.
________________________________________________ Referral to WIC/Basic Food Program (food stamps)
and/or food banks
Depending on feedback follow up with:
 Are you currently on WIC? Y or N
 Basic Food Program (food stamps)? Y or N
 Are you aware of other food programs in the area? Y or N
The following questions we ask everyone, because they have to do with Transition
health and safety.
12. Have you ever smoked or used tobacco or nicotine products? Y or N  Current Maternal Tobacco/Nicotine Use
( If no) skip to Q #13 (If yes) Did you use during the three months before  Quit tobacco/nicotine 3months prior to
you became pregnant? Y or N pregnancy or at time of pregnancy
diagnosis
 Are you currently using tobacco/nicotine? Y or N ( If no) skip to Q #13
(If yes) Are you trying to quit? Y or N Tell me more.
___________________________________________
 Are you interested in getting help to quit? Y or N
13. Does anyone smoke inside your home and/or car? Y or N Basic health message- Second hand smoke

14 When was the last time you drank alcohol? ____________________  Alcohol use/Abuse- See definitions

 Are you currently drinking alcohol? Y or N ( If no) skip to Q #15

 Are you trying to stop? Y or N Tell me more. _____________________
 Are you interested in getting help to stop? Y or N
15 When was the last time you used illicit drugs? (If never) skip to Q #16  Substance Use/Abuse- See definitions

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__________________________________________
 Are you currently using drugs? Y or N ( If no) skip to Q #16
 Are you trying to stop? Y or N Tell me more. ______________________
 Are you interested in getting help to stop? Y or N
16. In the last year, has your partner or FOB physically threatened or  Intimate partner violence within last year
tried to hurt you? Y or N (If yes) Tell me more.
_______________________________________________

17. In the last month, have you felt down, depressed, or hopeless? Y or  Mental Health
N (If yes) Client needs standardized depression screening tool completed.

18 Have you ever received mental health services or counseling? Y or N  Mental Health
( If yes) Client needs clinical assessment.

19. Who can you count on for help/support during this pregnancy? Social Support
Who can you talk to about stressful things in your life?

20. Is there any information or resources you would like us to help you Basic referrals- housing,
with during this pregnancy? Y or N (If yes) Client wants help with transportation, CBE
____________________________________________________________ Health messages
Are you having any problems with transportation? Y or N Client’s needs
Screener, document whether the client discloses or shows signs that she  Developmental Disability-
is severely developmentally disabled in a way that may impact her ability women with severe developmental
to take care of herself during the pregnancy or take care of a child. disability which impacts the woman’s
ability to take care of herself during the
pregnancy or her infant postpartum

II. Web Assignment:

1. Research the Internet for 2020 National Health Goals related to diversity considerations.
Then, write a brief report that includes interventions nurses can perform to help achieve
these goals.
https://www.cdc.gov/oralhealth/healthy_people/index.htm

2. Choose an ethnic group to study (e.g., Jewish, Muslim, Asian) and research the Internet for
information related to their healthcare practices. Be sure to include any cultural or religious
rituals they might perform to cure or prevent diseases. Based on this information, write a
nursing care plan for a patient of this ethnicity that addresses the patient’s cultural needs.
Explore the following aspects of ethnicity and how they are related to health care:
• Typical family structure (e.g., male or female dominated, single or extended family)

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 • Religious or spiritual practices
• Nutrition and dietary preferences
• Rituals and/or taboos
• Healthcare preferences
• Health promotion activities
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924616/

2020 National Health Goals

Overarching Goals

 Attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death;
 Achieve health equity, eliminate disparities, and improve the health of all groups;
 Create social and physical environments that promote good health for all; and
 Promote quality of life, healthy development, and healthy behaviors across all life
stages.

Overarching Goals of Healthy People 2020 Foundation Measures Measures of Progress

Category
Attain high quality, longer lives free of General Health Status  Life expectancy
preventable disease, disability, injury, and  Healthy life expectancy
premature death  Physical and mental unhealthy
days
 Self-assessed health status
 Limitation of activity
 Chronic disease prevalence
 International comparisons
(where available)
Achieve health equity, eliminate disparities, and Disparities and Inequity Disparities/inequity to be assessed by:
improve the health of all groups  Race/ethnicity
 Gender
 Socioeconomic status
 Disability status
 Lesbian, gay, bisexual, and
transgender status
 Geography
Create social and physical environments that Social Determinants of Determinants can include:
promote good health for all Health  Social and economic factors

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  Natural and built environments
 Policies and programs
Promote quality of life, healthy development, and Health-Related Quality of  Well-being/satisfaction
healthy behaviors across all life stages Life and Well-Being  Physical, mental, and social
health-related quality of life
 Participation in common
activities

Results of the current study indicated that there are many gaps in meeting the HP 2020
objectives at both the population level and for low-income, racially/ethnically diverse,
and immigrant children and adults. Additionally, African American and immigrant
households may be the most at risk of not meeting the HP 2020 objectives. Concerted
public health efforts are needed to address the disparities in reaching the HP 2020
objectives and informing the HP 2030 objectives within low-income, racially/ethnically
diverse, and immigrant/refugee children and parents.

Muslim Cultural or Religious Rituals they might perform to cure or prevent

diseases

Muslim
• Dietary issues are important for Muslim elders, because traditionally they do not drink alcohol, eat
pork, or eat blood products. Lard is another avoided ingredient; baked goods and crackers are therefore
examined for their content before consumption.
• Hospitalized Muslims may prefer to eat food prepared by their families in order to maintain dietary
standards.
• Muslims may also resist eating or taking medications during the daytime hours of Ramadan, a holy
month whose timing varies from year to year.
• Sick and elderly believers may be exempt from fasting during Ramadan, as some exceptions are made
for frail individuals.
• Elderly persons of Arab origin may subscribe to folk remedies and beliefs.
• Beliefs may include concern about the evil eye - those who are envious may have the power to inflict
injury on the family.
• Folk prevention measures, which include religious measures, are taken to divert the evil spirit to
prevent harm.

• Mental illness is one of the most feared medical conditions among Arab Muslims.

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 • Psychiatric issues are thought to arise from a loss of faith in God or possession by evil.
• Those suffering from “madness” are likely to seek the help of a religious intermediary or a fold healer
and may neglect formal medical care.
• Among elderly persons of Arab origin and their families, mental illness may be considered a secret to
be minimized, covered up, or denied.
• Traditionally, the young adult offspring’s chances of marriage are believed to be affected if family
medical secrets are disclosed.
• Preventive medical treatment may be seen less important than treatment of acute symptoms of illness
and injury.
• Older patients may expect prescription drugs to address their symptoms, but once the symptoms
subside, they may discontinue their prescribed regimen.
• There is a belief in individual responsibility to obtain medical care but ultimately most believe that
recovery from illness is in the hands of God.

• In Arab tradition, family members are obligated to visit and bring gifts to hospitalized elderly persons,
and therefore may not wish to adhere to visitation restrictions in the hospital.
• Muslims practice and expect high standards of modesty and may also be embarrassed by personal
questions.
• Cleanliness is another important aspect of Islamic tradition.
• After death, family members may have specific wishes regarding what is to be done with the patient’s
body such as the ceremonial washing of the body by the family, wrapping the loved one’s body in sheets
and immediate burial.
• “Good families” traditionally are considered capable of handling any health crisis – older family
members may be hesitant to accept help from “outsiders”.
• Males in the family may be considered to have more authority with regard to medical decisions than
females.
• In Arab countries, patients are typically told only the good news about their diagnosis.

Typical family Religious or spiritual Nutrition and dietary Rituals and/or Healthcare Health promotion
structure practices preferences taboos preferences activities
Extended family The Five Pillars are Islam has rules about Muslims are not a Muslims prioritize Believing that health is a
the core beliefs and the types of food that homogeneous gender-concordant state of complete
practices of Islam: are permissible (halal) group and care providers, physical. mental and
or prohibited (haram).
 Profession different groups providing food social wellbeing
The main prohibited
of Faith foods are: from different consistent with considering that Islam
(shahada). parts of the world religious deems this to be a
The belief will have varying requirements and necessary component of
that "There  Pork and its cultures even space for prayer. ... faith and of Islamic law.
is no god by-products; though they share Healthcare In view of the impact of
but God,
the same religious providers need Lifestyles on the health of
and

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 Muhammad  Alcohol; values and knowledge and individuals and groups.
is the practices. understanding of The Regional Office for
Messenger  Animal fats; However, their these patients' the Eastern
of God" is
 Meat that has behavior is often backgrounds and Mediterranean, convened
central to
Islam. ... not been shaped by cultural beliefs to provide a consultation on Islamic
slaughtered practices that may culturally sensitive lifestyles and their impact
 Prayer according to not be in healthcare on health development.
(salat). ... Islamic rites concordance with The aim was to contribute
 Alms
If hospital mealtimes basic religious to the presentation of this
(zakat). ...
clash with prayer times, practices. Some valuable cultural legacy,
 Fasting
alternative of the cultural or for the benefit of all
(sawm). ...
arrangements may be pre-Islamic humanity. The Regional
 Pilgrimage
required. Many practices Office for the Eastern
(hajj)
Muslims may refuse to observed by Mediterranean decided to
eat hospital food if it is Muslims are publish this booklet which
non-halal and may given an Islamic contains the most
prefer to have meals dimension even important decisions
brought from home. If though they are reached of how health-
this is not possible and not Islamic related Islamic teachings
halal food is not practices. might be used to persuade
available, they should Generally, individuals and
be given the option of religious or communities, in Islamic
having seafood, eggs, Islamic practices countries, to follow
fruits and vegetables. have roots in the healthy lifestyles. The
Qur’an and meeting, which brought
traditions - or together leading
Sunnah, the life physicians, scientists,
and teachings of experts in jurisprudence,
the Prophet and religious scholars,
Muhammad aimed to issue clear health
(Peace and guidance based on an
Blessings be authoritative
Upon Him) interpretation of whole-
some lifestyles as
embodied in Islamic law.
The resulting Amman
Declaration is reproduced
in full. The Declaration
identifies some 60
components of lifestyle
where Islamic teachings
offer guidance on healthy
and harmful behaviors.
These concern the areas
of nutrition, food safety,
personal and community

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 hygiene. waste disposal,
sexual relationships.
breast-feeding and child
care, mental health,
alcohol consumption,
substance abuse, and
violence

REFERENCE: https://www.nursingtimes.net/roles/nurse-educators/cultural-
competence-in-nursing-muslim-patients-30-03-2015/
https://www.healthypeople.gov/sites/default/files/HP2020_brochure_with_LHI_508_FNL
.pdf
https://www.virtualhospice.ca/Assets/cultural%20traditions%20and%20healthcare
%20beliefs%20of%20older%20adults_20090429151038.pdf

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