Midwifery Health Care Process

1. ASSESSMENT:

Includes: History and current needs expressed by woman,

physical examination, laboratory findings.
[cognitive, psychomotor, affective functions]

Sources of data: Woman, family, available records, observation.

Criteria for success: Systematic and accurate data collection done in
culturally appropriate, respectful manner.

2. DECISION-MAKING:

Includes: Organizing data collected to clarify actual or

potential midwifery diagnoses based on woman’s
needs/problems and determining if emergency
action required. [Cognitive & affective functions]

Sources of data: See Step 1.

Criteria for success: Correct interpretation of data that results in

accurate midwifery diagnoses.

3. PLANNING:

Includes: Prioritizing need for action in partnership with the

woman, determining which needs/problems will
be resolved by midwifery actions; need for
consultation or referral. [Cognitive & affective
functions]

Sources of data: Steps 1 and 2.

Criteria for success: Comprehensive plan with input from

woman/family, including alternates when
available based on evidence/sound rationale.

4. IMPLEMENTATION:

Includes: Timely, appropriate, safe midwifery care provided

with compassion and cultural sensitivity,
promoting self-care when possible. [Cognitive,
 affective, psychomotor functions]

Sources of data: Steps 1, 2, and 3.

Criteria for success: Timely intervention with safe, evidence-based,

efficient, ethical, compassionate care-giving
along with appropriate recording of data and plan
of care.

5. EVALUATION:

Includes: Feedback from woman/family on needs met,

satisfaction; midwife self assessment and
reflection on outcomes & whether new approach
needed; confirmation/validation from colleagues,
teachers. [Cognitive, affective functions]

Sources of data: Self, woman, family, peers, supervisors.

Criteria for success: Extent to which care given met needs of woman
and midwifery goals. Outcomes of midwifery care
includes improved health/well-being of women
and newborns.

FIRST-LEVEL ASSESSMENT

Presence of Wellness Condition – stated as Potential or Readiness- a

clinical or nursing judgment about a client in transition from a specific
level of wellness or capability to a higher level. Wellness potential is a
nursing judgment on wellness state or condition based on client’s
performance, current competencies or clinical data but no explicit
expression of client desire. Readiness for enhanced wellness state is a
nursing judgment on wellness state or condition based on client’s
current competencies or performance, clinical data explicit expression
of desire to achieve a higher level of state or function in specific area
on health promotion and maintenance.

Potential for Enhanced Capability for:

· Healthy lifestyle – e.g. nutrition/diet, exercise/ activity
· Health Maintenance
· Parenting
· Breastfeeding
· Spiritual Well-being – process of a client’s unfolding of
mystery through harmonious interconnectedness that
comes from inner strength/sacred source/GOD (NANDA)
Readiness for Enhanced Capability for:

· Healthy Lifestyle
· Health Maintenance
· Parenting
· Breastfeeding
· Spiritual Well-being

Presence of Health Threats – conditions that are conducive to disease,

accident or failure to realize one’s health potential.
Family history of hereditary condition, e.g. diabetes
Threat of cross infection from a communicable disease case
Family size beyond what family resources can adequately provide.

Accidental hazards

· Broken stairs
· Sharp objects, poison, and medicines improperly kept
· Fire hazards

Faulty nutritional habits or feeding practices:

· Inadequate food intake both in quality & quantity

· Excessive intake of certain nutrients
· Faulty eating habits
· Ineffective breastfeeding
· Faulty feeding practices

Stress-provoking factors :

· Strained marital relationship

· Strained parent-sibling relationship
· Interpersonal conflicts between family members
· Care-giving burden

Poor home condition:

· Inadequate living space

· Lack of food storage facilities
· Polluted water supply
· Presence of breeding sites of vectors of disease
· Improper garbage
· Unsanitary waste disposal
· Improper drainage system
· Poor ventilation
· Noise pollution
· Air pollution
Unsanitary food handling and preparation and
Unhealthful lifestyles and personal habits:

· Alcohol drinking
· Cigarette smoking
· Inadequate footwear
· Eating raw meat
· Poor personal hygiene
· Self-medication
· Sexual promiscuity
· Engaging in dangerous sports
· Inadequate rest
· Lack of inadequate exercise
· Lack of relaxation activities
· Non-use of self protection measures

Inherent personal characteristics – e.g. poor impulse control

Health history which induce the occurrence of a health deficit,
e.g. previous history of difficult labor

Inappropriate role assumption – e.g. child assuming mother's

role, father not assuming his role
Lack of immunization/ inadequate immunization status specially
of children.

Family disunity:

· Self-oriented behavior of member(s)

· Unresolved conflicts of member(s)
· Intolerable disagreement
· Other

Presence of Health Deficits – instances of failure in health

maintenance.

Illness states, regardless of whether it is diagnosed or by

medical practitioner
Failure to thrive/ develop according to normal rate
Disability – whether congenital or arising from illness

Temporary Presence of stress Points/ Foreseeable Crisis Situations – anticipated

periods of unusual demand of the individual or family in terms of family
resources.

Marriage
Menopause
Pregnancy
Loss of job
Parenthood
Hospitalization of a family member
Additional member
Abortion
Death of a manner
Entrance at school in a new community
Resettlement
Adolescence
Divorce
Illegitimacy

SECOND LEVEL ASSESSEMENT

Inability to recognize the presence of the condition or problem due to:

Lack of or inadequate knowledge

Denial about its existence or severity as a result of fear of
consequences of diagnosis of problem, specifically:

· Social-stigma, loss of respect of peer/significant others

· Economic/cost implications
· Physical consequences
· Emotional/psychological issues/concerns
Attitude/philosophy in life which hinders recognition/acceptance
of a problem
Others, specify: _______________________

Inability to make decisions with respect to taking appropriate health

action due to:

Failure to comprehend the nature/magnitude of the problem/condition

Low salience of the problem/condition
Feeling of confusion, helplessness and/or resignation brought
about by perceived magnitude/severity of the situation or
problem, i.e., failure to break down problems into manageable
units of attack.
Lack of/inadequate knowledge/insight as to alternative courses of action open to them
Inability to decide which action to take from among a list of alternatives
Conflicting opinions among family members/significant others regarding action to take
Lack of/inadequate knowledge of community resources for care

Fear of consequences of action, specifically:

· Social consequences
· Economic consequences
· Physical consequence
· Emotional/psychological consequences
Negative attitude towards the health condition o problem – by
negative attitude is meant one that interferes with rational decision making
Inaccessibility of appropriate resources for care, specifically:
· Physical inaccessibility
· Cost constraints or economic/financial inaccessibility

Lack of trust/confidence in the health personnel/agency

Misconceptions or erroneous information about proposed
course(s) of action
Others, specify ______________________

Inability to provide adequate nursing care to the sick, disabled,

dependent or vulnerable /at-risk member of the family due to:

Lack of/inadequate knowledge about the disease/health

condition (nature, severity, complications, prognosis and management)
Lack of/inadequate knowledge about child development and Care
Lack of/ inadequate knowledge of the nature and extent of nursing care needed
Lack of the necessary facilities, equipment and supplies of care
Lack of or inadequate knowledge and skill in carrying out the
necessary interventions/treatment/procedure/care (e.g. complex therapeutic regimen or
healthy lifestyle program)

Inadequate family resources for care, specifically:

· Absence of responsible member
· Financial constraints
· Limitations/lack of physical resources –e.g. isolation room

Significant person’s unexpressed feelings (e.g., hostility/anger,

guilt, fear/anxiety, despair, rejection) which disable his/her capacities to provide care.
Philosophy in life which negates/hinder caring for the sick, disabled, dependent,
vulnerable/at-risk member
Member’s preoccupation with own concerns/interests
Prolonged disease or disability progression which exhausts supportive capacity of family
members Altered role performance – specify:

· Role denial o ambivalence

· Role strain
· Role dissatisfaction
· Role conflict
· Role confusion
· Role overload
Others, specify _________________________

Inability to provide a home environment conducive to health

maintenance and personal development due to:
Inadequate family resources, specifically:
· Financial constraints/limited financial resources
· Limited physical resources – e.g. lack of space to construct facility

Failure to see benefits (specifically long-term ones of investment in home environment

improvement

Lack of/inadequate knowledge of importance of hygiene and

sanitation
 Lack of/inadequate knowledge of preventive measures
 Lack of skill in carrying out measures to improve home
Environment
 Effective communication patterns within the family
 Lack of supportive relationship among family members
 Negative attitude/philosophy in life which is not conducive to
health maintenance and personal development.
 Lack of/inadequate competencies in relating to each other for
mutual growth and maturation (e.g. reduced ability to meet the
physical and psychological needs of other members as a result
of family’s preoccupation with current problem or condition)
 Others, specify ______________________

Failure to utilize community resources for health care due to:

 Lack of/inadequate knowledge of community resources for
health care
 Failure to perceive the benefits of health care/services
 Lack of trust/confidence in the agency/personnel
 Previous unpleasant experience with health worker
 Fear of consequences of action (preventive, diagnostic,
therapeutic rehabilitative), specifically:
· Physical/psychological consequences
· Financial consequences
· Social consequences – e.g., loss of esteem of
peer/significant others
 Unavailability of required care/service
 Inaccessibility of required care/service due to:
· Cost constraints
· Physical inaccessibility, i.e., location of facility
 Lack of or inadequate family resources, specifically:
· Manpower resources – e.g. baby sitter
· Financial resources – e.g. cost of medicine prescribed
 Feeling of alienation to/lack of support from the community,
e.g., stigma due to mental illness, AIDS, etc.
 Negative attitude/philosophy in life which hinders
effective/maximum utilization of community resources for health care.