As part of my HNC course, I am required to produce a written document which will integrate all knowledge from the units studied across the year. The project will be based on an activity of daily living and will be carried out with a patient from my clinical placement in the labour suite. It will include three different stages: planning, development and evaluation. To allow the patient to remain entirely anonymous, I will be using a substitute name throughout this paper just as The Data Protection Act (1998) protects an individual’s right to confidentiality. The patient I have chosen is Stacy, a 19 year old prim, who is in hospital to have her first child.
A caesarean section is an operation to deliver a baby by making a cut in the front wall of the mother’s abdomen and womb. In some cases, it is an emergency procedure, when circumstances before or during labour call for delivery of the baby by unplanned caesarean. There are many reasons as to why an emergency caesarean section may be carried out; some include the labour process not naturally occurring, placenta praevia which is when the placenta is low lying and covers the entrance to the womb, the patient has had two or more caesarean sections previously, the baby is breech meaning that the bottom is coming out first (NHS Choices, 2014) and in Stacy’s case, her baby was becoming too distressed, meaning that he didn’t have a good supply of oxygen reaching him.
Stacy is from a small town in East Ayrshire and after leaving school, she became a housewife. Her partner has a full time job. They met in school as they attended together. Stacy fell pregnant with their first child soon after leaving school and now has dedicated her time to soon being a full time mum.
I feel it important to highlight sociocultural factors that will impact on Stacy’s lifestyle. It is said that teen pregnancies are more likely to create poorer parents as they are less likely to have a higher paying job due to family responsibilities. This in turn creates a population which can be controlled by the rich. However, this may also create teens who want to have a family to rebel against the oppressive nature of older generations (Blog, 2014). This is a conflict theory within socioculture today. This is reflected in Stacy’s role as a fulltime housewife as she doesn’t work, meaning she doesn’t bring in money and relies on her partner to provide; which might suggest that he has more control in the decision making within the relationship. Similarly, feminist theory also states that young mums find it harder to get on the career path, which again means they may be less likely to have a higher paying job (GEA, 2010). This is also reflected in Stacy’s life as she has left school without going onto further education or into a fulltime job due to her pregnancy. Once she has had her baby she may find it difficult to start her career path until once the child is older, and she may find it easier to have a full time or part time job, which is generally paid less than those with a career. It is apparent that society has influenced Stacy to be content with being a fulltime housewife as a result of being pregnant.
When assessing Stacy’s needs and learning about her thoughts and feelings, it has become clear that she is struggling emotionally with going for a section rather than a natural birth. Stacy’s psychological needs can be related to two theories; Kubler-Ross’ Stages of Grief and Bandura’s Self-efficacy. There are five stages of grief according to Kubler-Ross; denial, anger, bargaining, depression and acceptance (Axelrod, 2016). It would be fair to suggest that Stacy is currently experiencing the depression stage. She has recently discussed her anxieties on the possible death of her child if she doesn’t undergo the section. Listening to patients, especially in times of sadness, is essential to building a therapeutic relationship. A therapeutic relationship is considered to be the most important component in the successful resolution of a client presenting problems (Morse, 2010). Self-efficacy is belief in your own abilities (About Health, 2015). Stacy feels her level of self-efficacy is decreasing due to not having the child naturally. She has previously vocalised how she feels she is losing control over the birthing process. Due to heavy involvement of healthcare professionals, a person’s level of self-efficacy can be dramatically lowered in a hospital environment (Delfs, 2011). To help further my therapeutic relationship with Stacy, I can begin to understand her sense of losing control of the birth. Prior to this, I feel that it is important to allow her to have the ability to choose accordingly during the planned activity.
I have decided to assist Stacy in an activity of daily living from the Roper-Logan-Tierney model, by aiding her with an assisted bed bath after her caesarean section. The aim of this activity is to provide a good level of hygiene in accordance with Stacy’s preferences and also to improve her wellbeing. To respect Stacy’s individual and cultural beliefs, it’s important that I, as a student, don’t enforce any of my personal beliefs on hygiene into Stacy’s naturally routine. People want to maintain their own independence (ANI, 2016) thus meaning that before commencing I will ask Stacy if there are any parts of her body she may not be able to reach and if she would like her hair washed so that I am aware of my level of involvement to help promote her self-efficacy. I will also be mindful of Stacy’s dignity and insure that screens are pulled and it is only I who is present. I will advise that we wash the top half first and then the bottom half so that she doesn’t have to be undressed at anytime. This technique allows the patient to remain dignified and also stops them from becoming cold, according to Nolan (2003). I will also ensure doors and windows are closed to limit draught which may also make Stacy cold.
The resources I will require to carry out my activity include a basin of hot water, toiletries, towels, disposable cloths, fresh gowns, clinical waste bag, linen trolley and an appropriate work surface. I will wear gloves and an apron. Stacy will have just come out of surgery; therefore the use of gloves will limit spread of infection. After surgery, it is recommended that you rest for the first few hours after a caesarean section; therefore I will assist Stacy with a bed bath rather than a shower to promote a period of rest (NHS, 2014). This is a risk assessment carried out in accordance with the Management of Health and Safety at Work Regulations (1992/1999) to ensure the safety of both Stacy and I. Under the guidance of my mentor, it is my duty as a student member of the multidisciplinary team to follow the correct guidelines and procedures to maintain the safety of both Stacy and myself. For example, to minimise the risk of slips, I will have to be observant of water spillages and to ensure the water is a suitable temperature to minimise any harm to the patient. My mentor will remain close by for support and guidance in the event that the activity doesn’t go as planned.
I have gained consent from Stacy and my mentor to carry out this activity which I plan to take place on the 8th April 2016. I will set aside 30 minutes to complete this activity.