Community health: concepts, services, and delivery models

Community Health Project for Pregnant Women
Healthcare is the fundamental necessity for every individual living in any state, regardless of religion, race, sex, color, etc. The population chosen for this paper is that of JMJ Pregnancy Center, which is a catholic pro-life crisis pregnancy management base. The reason for selecting this center is that it often resides with low socio-economic status women without health insurance. This paper aims to identify and prioritize community diagnosis for the women of this center so that a plan is developed to address their healthcare needs.
Part 1: Literature Review
Crisis pregnancy centers (CPCs) are pro-life organizations that are non-profit and work for women who experience unplanned pregnancies and are considering abortions (Holtzman, 2017). These centers are more religious to mentor and convince pregnant women to reconsider their abortion and contemplate adoption or parenting. Unwanted pregnancies are most commonly seen among adolescents, and that too belonging to the lower socio-economic class who have less access to the best medical health services and insurance facilities (Yazdkhasti et al., 2015). There is an unwanted increase in population, and the country's healthcare budgets increase despite the allocated yearly budgets from the government. The economic conditions tighten for the state authorities, and the employment is affected as well. Also, the unequal distribution of healthcare is experienced by unintended pregnant women, leading to health inequalities. Teens are more prone to health risks since they have less education and knowledge about the pregnancy, resulting in severe bias n health insurance and medical aid disparities.
Research has also shown that pregnancy centers do not give accurate and ample health knowledge to pregnant women since their ideologies are more religious, and they want these women to stop thinking about it (Rosen, 2012). They think that abortion is against God’s will, and pregnant women should not commit this crime. They spread knowledge like abortion causes future pregnancies, is conducive to breast cancer and harms mental health. The Society for Adolescent Health and Medicine (SAHM) and North American Society for Pediatric and Adolescent Gynecology (NASPAG) stated that crisis pregnancy centers do not provide essential health and sexual information that is critical for maintaining health standards of pregnant women (SAHM & NASPAAG, 2019). The reproduction of health information is misleading, and informed consent is not given due importance in these organizations, causing serious health threats to these women who are already deprived of health insurance facilities. Such tactics are often considered as subtle cases of fraud since the CPCs provide counseling that instills fear into the minds of pregnant women who are already going through a mental trauma of unwanted pregnancy (Brown, 2018). In certain instances, the state government has been collaborating with the CPCs to disclose ‘informed consent’ by convincing the physicians to give the women inaccurate information, which is called TRAP laws. It is understood that physicians can be forced to give misleading information as they are ‘professionals,’ but the crisis pregnancy centers cannot. Such a situation makes women vulnerable to the harms of paradoxical treatment, both mentally and physically.
Assessment
The selected population of pregnant women is the JMJ pregnancy center, a pro-life pregnancy center for women planning to abort their unwanted pregnancies. The women are from adolescence years and have low socio-economic status. They even do not have access to health insurance, which costs a great deal to the government, as mentioned earlier in the previous section.
A similar section of the population was selected as a sample for the study that aimed at studying the effect of low socio-economic status on the unintended pregnancy of women as a risk factor (Iseyemi et al., 2018). The socio-economic factors like age, ethnicity, education, requirements for public health assistance, and self-reporting of healthcare services or struggle for paying its charges were recorded for the St. Louis region in the United States. More than nine thousand participants were included, and among them, unintended pregnancy was faced by mostly Blacks, having little college education, were obese, large numbers of the participants belonged to low socio-economic class, and most of them received no health insurance. These conditions were the same as the selected population for this paper.
When the selected population of the JMJ crisis pregnancy center and the women of the above study data are compared, it is observed that both have similar conditions that are not favorable for a healthy pregnancy. Since pregnancy requires a healthy diet and thorough medical examinations each month, both these populations remain deprived of these facilities due to their low socio-economic status that does not allow them to pay fees for medical check-ups. They even do not have health insurance, and basic health needs are not met. The literature review also suggests that physicians also are forced by the state governments to provide unsuitable pregnancy information to pro-life pregnant women who are fearful of abortion and undergo mental stress. These circumstances are evident in both the population, and the comparisons reveal similar results.
The restrictive state abortion policies, such as enforcing the physicians to misguide the unintended pregnant women and preventing them from aborting the pregnancy, indicate that the government is increasing the chances of unplanned pregnancies. The cost of involving in unprotected sex would compel the women to go for other alternative birth control methods, which is the underlying notion of rational choice theory (Medoff, 2012). The information available to the JMJ crisis pregnancy center women and the alternates for avoiding unplanned sexual activities is the factors that would help women choose between options, which is their rational decisions.
The nursing diagnosis and intervention for crisis pregnancy centers’ women should include training and education the fundamental knowledge of pregnancy such as healthy diet, light exercise, walk, sleep, prevention from smoking and alcohol, etc. Disease prevention and management support for these women could be provided, such as if women are experiencing anemia, extra-bleeding problems, or allergies that they are unaware of coping with (Esquillo, 2017). Nurses can conduct an assessment regarding the internal feelings of the new mom-to-be, mental trauma of unexpected pregnancy and zero family support, monthly check-ups for maintaining a healthy physical and mental status of women, mentorship related to decision-making for the baby and the women themselves, and indications of symptoms of complication in pregnancy or delivery, etc.
Part 2: Planning
The nursing diagnosis can encompass future family planning and taking care of the baby if the women decide to keep the pregnancy, make necessary alterations to the lifestyles and dietary rations, risk factors related to smoking and alcohol consumption, daily exercise, etc. A priority nursing diagnosis can include teaching and mentoring the women about their right to decide they are comfortable with and not being fearful of the statements that crisis pregnancy centers try to implant into them. The nurses should make them aware of their right to unwanted pregnancy and should be able to pursue them with accurate supervision of pregnancy tenure, diet, and healthcare guidance. At such crucial times, when women are unsure of their future of their baby and themselves, the most needed healthcare assistance is proper guidance and direction for taking care of themselves. Women who undergo crisis pregnancy are in dire need of psychological care to cope with full pregnancy term and that too, with healthy diet, crisis counseling, and care management techniques (Taylor & James, 2012). This would be the priority diagnosis for the women residing at crisis pregnancy centers that already belong to the low socio-economic class and might not be in the position of paying abortion or health insurance charges.
Intervention
The care provided by nurses can be demonstrated in the form of implementation of medical planning such as giving adequate emotional support for the unintended pregnant women, coaching the significance of healthy diet and avoiding junk food like pizza, burgers, but encouraging them to take foods they crave for, teaching them the importance of full and proper rest and sleep, monthly ultrasound reports and enabling healthy discussions with other women having similar problems so that they can associate themselves with the surrounding individuals which would give them a morale boost (Esquillo, 2017).
The possible barriers can be the will of the pregnant women who might be adamant in the beginning to abort the pregnancy. The remedy for this barrier could be constant counseling and mentoring for the women by the nurses so that they let go of their resistance towards the unwanted pregnancy. Otherwise, if they still are resilient, they should be mindful of the state laws and the physical condition required for early abortion, especially during the first three months of pregnancy since in later pregnancy months, it is not possible.
Evaluation
The evaluation plan can include weekly, or monthly assessments and discussions for the women who have either changed their abortion plan are still contemplating to go for it. The nurses would take notes on whether they have complied with the nursing guidelines given to them for coping with stress and fear of unwanted pregnancy. Mentorship and guidance programs would be evaluated based on how willful pregnant women continue their uninvited gravidity. If they express satisfaction with their decision, then the mentoring would be assumed successful.
This evaluation method's limitations can be personal subjective judgments regarding their positive or negative reactions toward unwanted pregnancy, which can cause bias in the evaluation results. Recommendations for nurses can include remaining unbiased and objective towards the women and treating them as ordinary patients. Also, the nurses should develop any personal inclination to any of the women to avoid bias.
The implication for community health nursing is to recognize the significance of mental healthcare and physical care for pregnant women, especially in the unintended pregnancy population. Since the crisis pregnancy centers are Catholic and would imply their religious concerns on the pregnant women to stop the abortion of unwanted pregnancy, which would impose more mental pressure with fear and uncertainty of unwished pregnancy. The nurses should mentor and guide proper health care directions so that pregnant women's psychology should be amended towards their satisfaction regarding their decision to either continue or abort the pregnancy.
References
Brown, T.R. (2018). Crisis at the pregnancy center: Regulating pseudo-clinics and reclaiming informed consent. Yale Journal of Law and Feminism, 30(2), 221-274.
Esquillo, J. (2017, January 19). NCLEX: Health promotion and maintenance, nursing care of the childbearing family. Brilliant Nurse. Retrieved from https://brilliantnurse.com/nclex-health-promotion-and-maintenance-nursing-care-of-the-childbearing-family-iv/
Holtzman, B. (2017). Have crisis pregnancy centers finally met their match: California’s Reproductive FACT Act. Northwestern Journal of Law and Social Policy, 12(3), 78-110.
Iseyemi, A., Zhao, Q., McNicholas, C. & Peipert, J.F. (2018). Socio-economic status as a risk factor for unintended pregnancy in the contraceptive CHOICE project. Obstetrics and gynecology, 130(3), 609-615. DOI: 10.1097/AOG.0000000000002189
Medoff, M.H. (2012). Unintended pregnancy and abortion access in the United States. Hindawi: International Journal of Population Research, 2012, 254315. https://doi.org/10.1155/2012/254315
Rosen, J.D. (2012). The public health risks of crisis pregnancy centers. Perspectives on Sexual and Reproductive Health: A Journal of Peer-Reviewed Research, 44(3), 201-205. DOI: https://doi.org/10.1363/4420112
Society for Adolescent Health and Medicine (SAHM) and North American Society for Pediatric and Adolescent Gynecology (NASPAG). (2019). Crisis pregnancy centers in the US: Lack of adherence to medical and ethical practice standards. Journal of Adolescent Health, 65, 821-824. https://doi.org/10.1016/j.jadohealth.2019.08.008
Taylor, D. & James, E.A. (2012). An evidence-based guideline for unintended pregnancy prevention. Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN, 40(6), 782-793. DOI: 10.1111/j.1552-6909.2011.01296.x
Yazdkhasti, M., Pourreza, A., Pirak, A. & Abdi, F. (2015). Unintended pregnancy and its adverse social and economic consequences on health system: A narrative review article. Iranian Journal of Public Health, 44(1), 12-21.