A 23-year-old African American female presented to the labor and delivery unit at 41 weeks gestation in active labor. She had stated her water broke at home and contractions started intensifying in the early morning. Upon assessment, she was found to be 9 cm dilated. The patient delivered a healthy baby boy shortly after arrival. Nursing diagnoses of readiness for enhanced spiritual well-being and self-care deficit in bathing/hygiene were made based on her statements and situation. Research was explored on the relationships between prenatal stress, social support, and spiritual well-being.

1. Praxis Presentation Spiritual Health & Well-beingSelf-Care Deficit

2. Clinical Challenge Introduction SN and RN on LDR unit at Covenant Healthcare in Saginaw, MI 3rd clinical day as a senior II student in leadership rotation

3. Situation 23 y.o. African-American female admitted at 0430 States water broke at 0400 while getting out of bed to use restroom. Arrived to LDR in wheelchair from the ED by mother G1P2; 41 weeks gestation

4. Situation Arrival: pt looked like she was in pain. Breathing through ctx States ctx started ~1300, but started to get “really painful” at approximately 0300 Pt visibly shaking in wheelchair and kept asking to be placed in room and to have an epidural Pt states that last labor lasted 2 hrs so she knew that this “was going to happen fast”

5. Situation Pt reassured that care is going to be provided in a fast, but safe manner. Wheeled pt to room TOCO and EFM monitor applied

6. Situation TOCO and EFM revealed ctx q 2-3 mins, lasting 60-70 seconds, and a normal FHR (135 bpm) with positive long-term variability

7. Background Pt’s 12-month daughter was born within 4 hrs of admission Pt had epidural with previous delivery

8. Situation At this time, pt is agitated. Pt is moaning and doing little breathing during ctx Pt reminded by SN to breathe in slowly through the nose and to exhale slowly through the mouth during contractions Encouraged to rest in between ctx to promote rest

9. ISBAR: Assessment Pt checked by CNM Pt was 9 cm; 100% effaced; +1 station Pt’s assessment was WNL

10. Pt requested epidural, but RN told pt that by the time the CRNA arrived with epidural, the baby would be in her arms Patient was in agreement to obtain IV Nubain 10mg for pain management Nubain would promote rest in-between ctx

11. Conversations Spiritual and bonding experience for pt and mother Mother was unable to attend pt’s first delivery, for unspecified reasons. Pt’s mother stated she was pleased to be part of “this miracle of life” Pt’s mother is battling cancer and stated, “this is what I have always wanted to see. I cannot wait to meet this blessed baby. This is the only grandchild I will ever see [delivered].”

12. Conversations During ctx, daughter makes statements like, “I am doing this for you mom. I have no other reason for doing this.” At times RN and SN reminded daughter that she was doing this for herself and the baby, too. RN/SN promoted the growing bond between pt and her mother to give the pt strength in childbirth by refraining from reminders after every statement of this kind

13. Conversations Pt also talked about FOB He decided to not be part of the child’s life. Pt and FOB discussed this ~4wks ago Pt states she has been under “a lot of stress” and uncertainty since this conversation

14. Delivery At 0530, pt delivers a 7lb 15 oz baby boy by vaginal delivery APGAR: 9; 1 & 5 minute assessments were WNL After delivery pt states she could, “never imagine loving anything more than the miracle of life”

15. Post-Partum Care From 0530-0715, SN took care of pt’s recovery needs This included, but was not limited to: Bathing Toileting Fundalassessments Postpartum bleeding education Assessments (pt and baby) Being present for any questions or concerns pt or mother may have

16. NANDA SPIRITUAL WELL-BEING, readiness for enhanced r/t placing meaning and purpose on an event and relationship aeb pt’s statements, “I am doing this for you, mom. I have no reason for this” and pt being through “a lot of stress” since conversation with FOB. NANDA definition “ability to experience and integrate meaning and purpose in life through a person’s connectedness with self, others…or a power greater than oneself” (Wilkinson, 2007, p. 513)

17. Spiritual well-being, Readiness for enhanced Defining characteristics: Connection with others: Pt requested mother to be in during delivery FOB not present No other discussions of other support systems. Connection with self: Statements of “no other reason for this” pertaining to birth of baby. Statements like, pt could “never imagine loving anything more than this miracle of life” Pt demonstrates some connections with self and others, but enhancement is desired

18. NICs Hope instillation: “Facilitation of the development of a positive out-look of particular situation” Spiritual Growth Facilitation: “Facilitation of growth in pt’s capacity to identify, connect with, and call upon the source of meaning, purpose, comfort, strength, and hope in her life” (Wilkinson, 2007, p. 415)

19. NOCs Hope: “Presence of internal state of optimism that is personally satisfying and life-supporting” Quality of life: “An individual’s expressed satisfaction with current life circumstances” Spiritual well-being: “Personal expressions of connectedness with self, others…that transcend and empower self” (Wilkinson, 2007, p. 415)

20. NANDA SELF-CARE DEFICIT, bathing/hygiene r/t severe anxiety as evidenced by statements of not desiring to use shower and toilet NANDA definition: “Impaired ability to perform bathing and hygiene activities for oneself” (Wilkinson, 2007, p. 423).

21. Self-care deficit, Bathing/hygiene Pt was refused to use restroom because she thought that all patients must wait until they “go downstairs” (post-partum unit) Pt was on epidural last delivery, therefore was unable to use it until she was stable in the post-partum unit SN clarified that pt was only on Nubain 10mg, therefore pt was able to use restroom

22. NIC/NOC NIC Self-care assistance; hygiene/bathing: “Assisting the patient to perform personal hygiene” Bathing: “cleaning of the body for the purposes of relaxation, cleanliness, and healing” NOC Self-care hygiene: “Ability to maintain own hygiene” Self-care bathing: “Ability to cleanse own body” (Wilkinson, 2007, p. 425)

23. Nursing Research Chose to explore the relationship between prenatal stress, social support, and spiritual well-being in pregnancy Limited studies, but found two peer-reviewed nursing articles within 4 years of publication

24. Nursing Research Article 1: Found that prenatal stress was negatively related to spiritual well-being Reaffirmed that this article enforced the need for the NANDA: Spiritual well-being, readiness for enhanced, NICs: Spiritual growth facilitation & Hope instillation, and NOCs hope, quality of life, and spiritual well-being (Zacharias, 2009)

25. Nursing Research Article 2 Found that higher levels of spirituality, whether it is perspective or religious, were “significantly correlated with greater satisfaction with social support, higher levels of self-esteem, and decreased levels of smoking” This is of concern, considering the stress of having a 12 month y.o. at home, a mother with cancer, and the FOB recently choosing not to partake in care of the baby. (Dunn, 2007)

26. Conclusion After reading these articles, I had a new appreciation for NANDA diagnoses such as Spiritual well-being, Readiness for enhanced, I acknowledge that the pt’s pregnancy experience may share stress, joys, ups, downs, but with spirituality and well-being, I hope that the pt is able to cope with life’s .stressors

27. References Dunn, L.L., Handley M.C., Shelton, M.M. (2007). Spiritual well-being, anxiety, and depression in anetpartal women on bedrest. Issues in Mental Health Nursing, 28(11), 1235-1245. Wilkinson, J.M. (2005). Nursing diagnosis handbook. Upper Saddle River, NJ: Pearson Prentice Hall. Zachariah, R. (2009). Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Research in Nursing & Health, 32(4), 391-404.