St. Vincent Health System NCAP Exemplar Tool Name: Melissa L.

Russenberger Date of Experience: April 2011 UNIT: 3 Northwest

Describe the nursing situation you were in: In April of 2011 I arrived at work and was receiving report just like I had done time and time before. On this day however, I was taking over a situation that I had never been faced with in my nursing career. At this time I was told that my patient was a forty-three year old first time mother who after a successful In vitro pregnancy had just delivered by Cesarean section due to failure to progress. Not only was this my first In vitro pregnancy, I was also informed during report that this baby has two mothers. This non-traditional family was my first experience with a lesbian couple. As with all of the couplets I care for, it is my responsibility to initiate motherbaby bonding, this case brought on a new set of challenges in which I would be initiating mother-baby bonding with two mothers. What specific skills were required for your intervention? The nurses code of ethics which under section one states the following: [The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.1] This opening section of this code of conduct really rings home to me when I think of this particular case. This situation was the very definition of a case where there was a non-traditional social element combined with a high degree of uniqueness. It was my responsibility to not only care for the couplet, and establish mother baby bonding in a traditional sense, I had to be sensitive to the fact that this unique situation called for both mothers to establish an equal motherly bond with the child. In order to achieve this I had to use a variety of skill sets, which included an equal mixture of professionalism in caring for the patients while showing compassion and respect for their wishes as parents. These skills combined with my ability to communicate and show patients that I am here to help them in any way I can was very successful in handling this unique situation. How did your intervention affect patient and family outcomes? Once I met the family and understood that their wish was for both to be treated like the mother of the child and form a motherly bond with the child I knew that I would have to be sensitive to the fact that the mother of the child that didn't give birth wanted to have the same bond with the child as the mother that gave birth. My ability to communicate with them about the child equally and referring to them both as Mom seemed to make their childbirth experience and memorable and happy one. Upon discharge from the unit both mothers, had experienced the initial maternal bond with the child. How did you determine the appropriate action? Although I had never been presented with a case like this before, once I was in this situation it came naturally. I just tried to open a line of communication with the family and from there using the basic principles of the standard nursing conduct I was able to handle this situation in a professional manner that not only provided for a standard of healthcare for the family, I also participated in this couple transforming into a family. What thinking led to your decision? I chose this field of nursing because I realize the importance and the impact that a nurse can have on a family when a child born and added to the family structure. I wanted to make this couple feel comfortable and that there case was not strange or odd, and that their baby and their family as special and important as any traditional family. I wanted them to feel as though I wasn't concerned with their unique marriage, but more concerned with the care and treatment of their family.
1

American Nurses Association, Code of Ethics for Nurses With Interpretive Statements, www.nursingworld.org/mainmenucategories/ethicsstandards of care; accessed on 22, July 2011.

What evidence or standard of care was your decision based on? (Documentation must include current published Evidence based on Practice of nationally accepted standards of care) You must site references. As a card carrying member of the AMERICAN NURSES ASSOCIATION, I have read and reviewed the standard code of conduct for a nurses as stated in provision one which states: [The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.2] Based on this standard of care I found that it was my responsibility to show compassion and respect for the social status of this couple. It was the wish of this couple that both parents be given the opportunity to establish a maternal bond with the child. I felt that it was important to make this couple feel as though I was attending to the needs of their initial parenting plan. In the past Lesbian couples have not had their needs identified or met.3 I felt that maintaining an open dialog of communication with the couple I could identify their needs and make their experience in our unit a positive one. In Jeanne Sorrell's journal article entitled Ethics: The Ethics of Diversity: A Call for Intimate Listening in Thin Places, she states the following: [ Unless we listen to these voices of diversity, we are likely to remain oblivious to the harm done in healthcare through unwitting oppression of minorities.4] I learned a great deal through this process as I did not have very much experience with the gay and lesbian community. I learned that by having an open mind and open communication with my patients I can provide them a higher standard of care and meet needs specific to their situation. How has this experience increased your nursing knowledge or affected the way you provide nursing care? This experience has shown me that as my career progresses I will be confronted with a variety of situations. It is my job to provide the best possible care for my patients. This particular case has shown me that on any given day I could be confronted with a new situation. I learned through this process that by opening a line of communication with my patients I am able not only to give them a high standard of healthcare but I can make their experience in our unit special as they welcome a new family member. When acting as a clinical coach or mentoring a new nurse, how would you communicate this situation the interventions you took to enrich the new nurse learning experience? I am of the opinion that this situation is a text book case for being a advocate for patients rights. It is not our place as nurses to form opinions or use our personal beliefs in our standards of care. It is however our responsibility to show our patients respect in their treatment plans and allow them to maintain their dignity. I would show them that it is important to listen to our patients and show them that we are willing as nurses to allow them to play a role in their own healthcare. How did your interventions and action support the Nursing Vision and Nursing Philosophy of St. Vincent Health System? By communicating with and showing compassion for the nontraditional family setting of this patient and their family, I was supporting the philosophy of St Vincent Health System. As a nurse it is my job to learn, understand, acknowledge, and integrate in practice the values, beliefs, and habits of diverse cultural and subcultural orientations.
2

American Nurses Association, Code of Ethics for Nurses With Interpretive Statements, www.nursingworld.org/mainmenucategories/ethicsstandards of care; accessed on 22, July 2011. 3 Blankenship, Vicki Ann. Implementation of a Women's Healthcare program to meet the needs of the Lesibian Population. JOGNN JULY/AUGUST 1987. 4 (Sorrell, J. (August, 2003) Ethics Column: The Ethics of Diversity: A Call for Intimate Listening in Thin Places. Online Journal of Nursing, www.nursingworld.org/MainMenuCatagories/ANAMarketplace/ANAperiodicals/OJIN/Columns/Ethics/Ethicsofdiverity .aspx accessed on 23, July, 2011.