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I am sending an atachment with the information you need for this paper. harvard referencing with lots of intext referencing with page numbers, 2 general texts and 20 references in tolal, Essay Example

  • Category:
    Nursing
  • Document type:
    Case Study
  • Level:
    Undergraduate
  • Page:
    5
  • Words:
    3506

Case study

Introduction

Jane a 28year old woman, in a stable relationship with her partner Harry lives in a rural area four hours from a referral hospital. A year ago she had an abortion due to fears that the foetus may have had a genetic defect. The pathology on the body at the time was inconclusive. Currently, Jane is 22 weeks pregnant. This paper seeks to provide a holistic analysis of the physiological, psychological and social changes that both Jane and his partner Harry will be experiencing during this pregnancy. Foremost, this paper will examine the important aspects of Jane’s physiological state based on the provided history. Subsequently, it will discuss the socio-cultural issues outlined in the history for Jane and for Harry, over the trimesters of her pregnancy. In addition, this paper will analyze how the psycho-social and physical aspects of her pregnancy would vary for Jane and Harry if they lived in a remote area.

Physiological state

Some of the important areas for Jane’s physiological state include; age, mental health, her physical settings, her genetic make-up and the duration of her gestation. From the history presented, it is evident that some of the important areas for Jane’s physiological state may influence the risk factors associated with the abortion conducted on her first pregnancy and the implications that the abortion conducted a year ago would have on her current pregnancy. Statistics on Abortion depict that approximately 10% of women who undergo induced Abortion suffer from short-term and long-term complications, 2% of these complications are life threatening (Shadigian 2005, p.1). The physical complications associated with abortion vary, depending on the type of Abortion conducted and the duration of the pregnancy. Nevertheless, the risks of complication increase with the gestational age of the pregnancy. Some of the short-term physical complications that come as a result of Abortion include; cervical injury and lacerations, uterine perforations, hemorrhage and bleeding and chronic abdominal pain among many other complications (Shadigian 2005, p.1).

In future pregnancies, some of the complications associated with Abortion include; pre-term birth or premature birth, placenta previa, RH sensitization and ectopic pregnancies. With regards to pre-term birth or premature birth, studies show that induced abortion increases the chances of pre-term birth ,that is, prior to 33 weeks of gestation and early pre-term birth, that is, 20 to 30 weeks’ gestation in future pregnancies. Abortion can bring about cervical injuries thus bring about an ineffective cervix which is a risk factor for pre-mature births. Induced Abortion has also been associated with uterine scarring, infections and adhesions which in turn heightens the chances for pre-term birth. Pre mature birth in turn is one of the main risk factor that is commonly associated with cerebral palsy (Rooney & Calhoun 2003, pp 46-47).

Moreover, in future pregnancy, Abortion has been associated with placenta previa. In this case the placenta attaches itself very low to the uterus thus covering the opening of the cervix. Placenta previa increases the chances of bleeding in the course of pregnancy and labor. It can also bring about severe hemorrhage, premature separation of the placenta or even death (Thorpe, Hartmann, & Shadigan 2002, p. 70).Moreover, induced Abortion can contribute to RH sensitization. Usually, when a pregnant woman who is RH positive delivers a child either through abortion or birth, the woman can become sensitized to RH antigens. When the woman becomes pregnant in future, the fetus RH antigens enter the blood stream of the woman causing her to develop anti-RH antigens. Subsequently, the pregnancy with the RH positive fetus may cross over via the placenta thus contributing to the clumping of the red blood cell of the fetus this in turn could contribute to brain or nerve damage .Furthermore, RH sensitization can bring about critical clumping of the blood when the woman is transfused with blood that is RH positive. Nonetheless, the immunization of the mother after delivery can reduce the chances of RH sensitization (Neubardt & Schulman 197, pp. 52-59).

Ectopic pregnancy is one of the common risk factor that is associated with Abortion. Ectopic pregnancy is a complication during pregnancy whereby the embryo implants itself outside the cavity of the uterus. Ectopic pregnancy is life-threatening complication since it contributes to internal hemorrhage. During a normal pregnancy the fertilized enters into the uterus and rests in the lining of the uterus whereby the egg has plenty of space to divide itself and grow. However, in an ectopic pregnancy the implantation of the egg does not take place in the uterus instead it occurs in the fallopian tubes or outside the uterine cavity (WHO 2003, p.25).Various studies conducted over the years show a strong connection between Abortion and ectopic pregnancy (Tharaux-Deneux 1998, pp.401-405). The detection of ectopic pregnancy during the early stages of gestation has been made possible due to the improved diagnostic capabilities. Although there are notable achievements when it comes to the diagnosis of ectopic pregnancy, ectopic pregnancy still remains a major cause mortality and maternal morbidity around the world particularly in areas whereby there is poor prenatal care (WHO 2010).

As depicted by Shadigian (2005, p.1) there are short-term and long-term effects of Abortion. In future pregnancies, some of the complications associated with abortion conducted in the past may be experienced. Nevertheless, these complications may occur depending on the gestation period of a woman. For example, studies show that induced abortion increases the chances of pre-term birth ,that is, prior to 33 weeks of gestation and early pre-term birth, that is, 20 to 30 weeks’ gestation in future pregnancies (Rooney & Calhoun 2003, pp 46-47).Therefore, Jane is more bound to experience pre-term birth due to the duration of her gestation. Additionally, depending on her physical settings and the duration of her gestation, she may experience complications such as ectopic pregnancy, placenta previa and RH sensitization among many other complications (Thorpe, Hartmann, & Shadigan 2002, p.70).

Jane and her partner Harry, live in a rural area which is four hours from a referral hospital. Their physical settings may to a large extent affect the physiological state of Jane since the accessibility health care in cases of emergency may prove to be challenging. Consequently, Jane may succumb to some of the risk factors associated with the abortion conducted on her first pregnancy. Hancock (2006, p.31) observes that the provision of midwifery services in remote and rural Australia is characterized by various challenges. The distance from resources, institutions and regional centers is often excessive thus the accessibility of resources and services is unreliable and challenging. In addition, the unpredictability of what can happen in isolation is also a challenge. This is further heightened by the distress and anxiety of transferring and placing women in larger regional centers so that can get maternal services. As a result these women experience estrangement for their loved ones and loneliness (Hancock 2006, p.31). Therefore, the physical settings of Jane and her partner Harry largely is an important aspects for Jane’s physiological state.

According to statistics of the Health Insurance Commission in Australia that were collected using figures from Medicare services, there has been a decline in the number of abortions conducted on teenagers, that is young women between the ages of 0-19 years. This decline can be attributed to changes on sexual behaviours, improved access and uptake of contraceptives, better education and less diagnosis of fetal abnormalities or genetic defect in fetus during pregnancy. On the other hand, the number of abortions carried out women above the age of 25 years has increased in Australia. Much of this increase can be attributed to advance testing for prenatal abnormalities (Australian Federal Government Health Insurance Commission 2011). With reference to these statistics and the history presented in the case study, it is apparent that the pathology of fetal abnormalities or genetic defect in fetus is more prevalent among pregnant women above the age of 25 years than women less than the age of 25years. Therefore, age is a determinant factor on the pathology of fetal abnormalities or genetic defect in fetus. Similarly, in the case of Jane, her age played a crucial role in the pathology of genetic defect of the foetus during her first pregnancy. This pathology in turn influenced Jane’s current physiological state.

A number of studies suggest that induced Abortion can contribute to mental disorders. For example, Fergusson et al (2008, p.444) argues that induced Abortion can be associated with an increase of risks in mental disorders and thus women who had abortions are 30% more likely to suffer from mental disorders than women who have not had abortions. Similarly, A review of 100 long term research studies established that induced abortion heightens the chances for mood disorders that could provoke self-harm (Thorpe, Hartmann & Shadigan 2002, p.67-79). Some studies have also established that a pattern of psychological issues referred to as Post-Abortion Syndrome which is characterized by anger, flashback, guilt, relationship problems, anxiety, fear and denial (Speckhard & Rue 1992, pp.95-119). Subsequently, the mental health of a person in turn affects their physiological state. Therefore, in the case of Jane, it is evident that she does not suffer from a critical mental disorder hence the stability of her relationship with Harry. This is in turn reflected in her physiological state.

Socio-cultural issues

Jane and her partner Harry, live in a rural area which is four hours from a referral hospital. Given the fact that Jane’s current pregnancy is sensitive due to several risk factors associated with a previous abortion, she requires special and personalised midwifery care. However, her physical settings from the referral hospital may prove to be a challenge when it comes to accessing medical attention. According to Hancock (2006, p.31) hospital in rural Australia may lack the specialized facilities or personnel needed to provide specialized midwifery services. As a result pregnant women in need of special care like Jane may end up being transferred to health institutions in region centers so that they can get the much needed quality health care. Consequently, following the transfer of woman to a different area, the woman may experience isolation, distress, loneliness and estrangement from their family (Hancock 2006, p.31). In the case of Jane and Harry, both of them may experience isolation, distress or loneliness whenever the other partner is out for work or out to get medical attention. The distance between the home and the referral hospital requires a day’s travel thus it may be taxing on the couple’s job or daily routine.

According to Campbell, 2006, 87, women who live in rural areas have reported that accessing medical services, mostly specialist services is a major hindrance in sustaining optimal health as well as well-being within rural areas. Since both Jane and Harry live in rural area, accessing pre-natal care for Jane could be faced with lots of difficulties. Campbell further notes that treatment for the rural society in most cases requires the person to stay away from home in order to get the specialist services in most cases without family support and incurring financial expenses. This is likely to affect both Jane and Harry financially because as it seems, they do not have a stable income since Harry is does plumbing to earn income. A shortage of public transport in addition to affordable private transport has been constantly perceived as a key aspect in regard to accessing health services for people living in rural areas. Transport hardships are a considerable hindrance for all rural communities (Campbell M. 2006, 88). The CSU Research demonstrated that about 66 percent of rural population is required to travel to a regional center in order to access medical care but 84 percent shows that the public transport is not available to medical care centers. Transport is a predominantly serious matter within rural societies. Older, less learned as well as people staying in rural areas are the least likely to access health services, more so if they have low incomes in addition to limited transportation. Both Jane and Harry have low income and restricted transportation and hence this will be a major barrier for Jane in regard to health care access.

Hindin 2009:58-62, argues that while accessing health services within rural areas is a problem across several health concerns, the lack of maternal support is a major concern for the rural women. His research indicated that about 51 percent of rural women complain of difficulties in accessing maternity services and also 58 percent experience difficulties in accessing birthing center services. Latest rise in medical indemnity expenses has made it considerably hard and in numerous cases impossible for rural general practitioners to provide maternity services. Less number of rural general practitioners is delivering babies and less rural general practitioners are performing ante-natal care. Rural health matters considerably affect ante and post-natal care of the mother and the baby as well. These consist of poor access to superficial confidential health care, reduced access to ante-natal care, lower ante-natal screening, social isolation, difficulty in accessing post-natal home visits by midwives and also family services and finally difficulty in accessing post-natal depression services (Hindin 2009, 59).

Maternal nutrition throughout the pregnancy is an important factor for both the mother and the child. The Australian Longitudinal Study on Women’s Health research has shown that, whereas pregnant women change their diets once they get pregnant, most of them do not still obtain the necessary nutrients. Australian studies point out that the folate, fiber, iodine, in addition to iron intake of pregnant women does not meet national recommended levels especially in rural areas. Most pregnant women are supposed to increase their intake in some particular nutrients, before, during and even after the pregnancy. On the contrary, highly educated women and also older women have high likelihood of taking nutritious food while pregnant. In this case, Jane and Harry do not appear to be highly educated judging from Harry’s occupation as a plumber. This implies that Jane might experience nutritious deficiencies during her pregnancy. Once again, in comparison to pregnant women living in metropolitan areas, expectant women in rural and also remote areas are less likely to utilize crisis service or emergency services incase of any complication during the pregnancy. Furthermore, studies have shown that the mental well-being of a pregnant woman is extremely important. According to Hindin 2009:59, the direct and indirect nature of depression as well as mental health on rural women is very wanting. Latest stressors, for instance commodity prices and also drought have resulted into endless stress on rural women and their families, which consequently has an undesirable impact on these women, especially when they are pregnant (Hindin 2009, 60). It is very important to take into consideration the social determinants of health when handling the well-being in the rural context. Socio factors affecting health take account of the level of income, education, employment in addition to the quality of the physical and social atmosphere. Mental well-being is very important especially for pregnant women and also families have identified that the mental health of those close to them is a key concern for them. In this case, Jane’s mental health could be affected because of the stresses that come with pregnancy in addition to socio-economical factors that elevate the level of stress. On the other hand, Harry will be affected since the mental health of Jane is a major concern for him (Hindin 2009, 58-62).

Difference in the psycho-social and physical aspects of Janes pregnancy if they lived in a remote area

A report by Strong et al (1998), on health in rural and remote Australia illustrates that as compared to people who live in the metropolitan areas in Australia, people living in Australia’s remote and rural populations experience poor health outcomes. Their rate of mortality is higher hence they have a lower life expectancy. Hancock 2006:.31 further notes that maternity care in remote and rural settings in Australia continues to be permeate with unsubstantiated medicalisation and institutionalization based on unsound evidence. Nevertheless, the kind of health care services provided in rural areas varies significantly varies with the healthcare services provided in the remote areas (Strong et al 1998, p vi). Therefore, the psycho-social and physical aspects of Jane’s pregnancy would vary for Jane and Harry if they lived in a remote area. One of the ways in which health care services vary between in rural Australia and remote Australia revolves around the accessibility of health services. People living in remote zone have less access to health care services as compared to people living in rural area. In remote areas, one has to travel for a long-distance in order to access medical attention. On the other hand, though not urbanized, accessing health care services in rural areas in Australia is easier as compared to accessing healthcare services in the remote areas (Willis 2008, pp.119-124).Moreover, the number of medical specialist in remote zones in Australia is substantially low as compared to the number of medical specialist found in rural Australia. Consequently, a person visiting a health care center in rural Australia is bound to more receive quality and specialized medical attention than the person visiting a health care centre in a remote zone (Smith 2004, pp.143-147).

Thus if Jane and Harry lived in remote zones their the psycho-social and physical aspects of Jane pregnancy would be more distressing and would contribute to more risk factors since accessing the much needed medical attention would be difficult. It is worth noting that Jane’s physical condition is fragile since she is vulnerable to some of the risk factors associated with pregnancy subsequent to an induced abortion. Therefore, she requires special attention and quick access to health care. If she were living in a remote area, this would prove to be difficult and in turn affect her overall physiological and physical state. On the other hand, Harry would be affected by this state, Jane’s condition may take a toll on their relationship and social life. As a result of her physical condition Jane will be completely dependent on Harry when it comes to the execution of simple tasks. The lack of quick access to quality health care services may also cause fear, anxiety and depression for both Jane and Harry (Hancock 2006, p.31).

Conclusion

Some of the important areas for Jane’s physiological state include; age, mental health, her physical settings, her genetic make-up and the duration of her gestation. Based on the history presented, it is apparent that these factors may considerably influence the risk factors associated with the abortion conducted on her first pregnancy and the implications that the abortion conducted a year ago would have on her current pregnancy (Shadigian 2005, p.1). On the other hand, the socio-cultural issues pertinent to Jane and Harry in the course of Jane’s pregnancy revolve around the accessibility of health care services, maternal support and maternal nutrition. if Jane and Harry lived in remote zones their the psycho-social and physical aspects of Jane pregnancy would be more distressing and would contribute to more risk factors since accessing the much needed medical attention would be difficult. Therefore, in the case of Jane proper prenatal care is essential (Hindin 2009, p.58-62).

Bibliography

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