Interviewing an OB nurse

CARCAM75 · Mar 24, 2008

Hello, I'm a nursing student in my second year. I'm writing a paper and for this paper I have to interview an OB nurse about her experience with prenatal substance abusers and their families (I'm just focusing on the mothers and their families in this paper- not the babies). I was hoping someone (or several someones :wink2:) on here could answer a few questions for me in some detail. Thank you in advance, your help is EXTREMELY appraciated.
~Tanya
Interview Questions:
Please tell me about how many years experience you have in OB.
How often do you deal with prenatal substance abusers in your practice?
When pregnant drug users come to your ward, is it common for them to have family members with them?
Does your hospital have pre-set procedures for nurses handling prenatal substance abusers? If yes, what are they and do you find these policies useful in your practice?
Please tell me about concerns that women who use drugs during pregnancy voice while on your unit.
Please tell me about communication strategies you use when talking to such patients and their families when they are present.
Please tell me about the nursing interventions (not so much physiological, more psychosocial) that you implement to help substance abusers prenatally.
What are nursing interventions that you implement to help the substance abuser's family?
Which approach to treatment do you think is more practical; a woman-centered approach where the substance abuser makes all decision (this allows empowerment of the woman), or a family-centered approach where the substance abuser's family participates in education and prenatal care?
Is there anything else you wish to add on the topic of prenatal substance abuse?

Hi Tanya, hope this helps )) I'm a Labor and Delivery travel nurse currently working in Tampa, FL on assignment. This hospital does about 1800 deliveries annually and is considered a Level 2 Labor and Level 3 NICU hospital.

Interview Question Responses:

-2yrs RN and Labor Nurse experience

-In 1 month, we may see 3-4 substance abusers at my current assignment. Their drug use is usually metamphetamines and/or marijuana, some cocaine users, but mostly the first 2.

-Yes, the pts spouse/ sigificant other is usually with them.

- The policy at this and my last hospital regarding ANYONE with a history (current or prior) of drug use, is basically to provide care as you would any other laboring pt, with the addition of placing a Social Services Consultation order for the pt to receive prior to discharge. Before discharge, someone from social services will see the pt and discuss the discharge of the baby. Most times, the Department of Children and Families (DCF here in FL) takes custody of the babies from the patient, or assign custody of the newborn to a family member at discharge if drug use is current, or if there is a past history of drug use, will visit the pts home to check on the care of the child. As far as the usefulness of the policy, it definitely is useful in early screening for discharging the newborn. As for the pt, there is counseling provided to the pt regarding use of drugs during pregnancy but as with anything else, as the old proverb goes, you can lead a horse to water, but you can't make him drink. A drug abuser has to WANT to stop abusing drugs.

-The laboring woman who is a drug abuser, usually doesn't voice any concern about the baby that is different from a non-drug user. Most moms and their family members are excited about laboring and delivering their babies. The difference is that the drug user when informed about the results of the urine test indicating drug use, will deny using drugs recently or at all and will state the test is an error. Surprisingly enough almost all of the patients who abuse drugs will admit to using drugs during the history/assessment phase of admission for labor. They will tell you what kind and how long as boldly and nonchalantly as telling you how many glasses of water they drank for the day. Where the REALITY hits is when I tell them that due to the result of the test, a member of social services will be seeing you before you are discharged and you run the risk of the baby not going home with you due to the drug use. That's when the patient and or family member truly become concerned and wants to know what they can do about the situation. By then it's too late.

-As with any other patient that is being cared for, the privacy/confidentiality of the patient is protected and enforced in accordance with HIPPA laws. I always ask the family members to leave the room for x-amount of minutes when I am admitting a pt (spouse included) and at the start of my shift so I will ask her at this time whom it is ok to discuss her plan of care, results, cervical dilation checks in front of and whom she wants in the labor room with her at delivery. In labor and delivery the plan of care can change rapidly depending on the status of the fetus and so it is important to know what the patient wants to keep private (information as well as body part ) ) way ahead of time. This way I can strategize my plan my care appropriately and in compliance with the patients wishes. Regardless of her lifestyle, she is a woman and a person first.

-As I stated before, things can go badly quickly in labor and delivery. So I do a lot of patient teaching at the start of my shift. I discuss her plan of care and inform the patient of what to expect in the laboring, delivery, recovery and post partum periods of her care as well as what things need to be done with baby (assessments, routine medication administrations, etc.). I explain the good and the bad things (fetal distress and interventions for dealing with that IF it occurs) so that she is aware of what I'm doing and WHY I'm doing it. In terms of the drug abuse, as she is laboring and asks questions about things, I answer her questions honestly in terms of how her drug use is possibly affecting the baby (why her baby's heart rate is so low, why her baby looks so flat on the monitor, why her baby is shaking so much or screaming so badly after delivery, etc.). The communication though relayed in a caring manner always remains REALITY focused so that there is no misconception of what is happening during the laboring process.

-In terms of the patients family members, they usually don't ask questions about the baby that are related to the effects of drug use. They usually ask the "how much does he way/ how long is he" type of questions. Because a lot of what we do on the labor unit is directly related to the patient and baby, information is very protected and not discussed with family members. So the interventions related directly to the patients substance abuse would not come from me but more so from social services at the discharge phase. Otherwise, it's just the usual respect and common courtesy that is applied to family members.

-In maternity, I'm afraid the only thing that is most effective and there for practical is a woman-centered approach where the substance abuser makes all decision (this allows empowerment of the woman). The bottom line is the woman is going to decide and DO what she wants to in terms of her prenatal care. No matter how the family feels about it, if she truly doesnt want to stop abusing drugs during her pregnancy, she will not stop. She will find ways to get around what her family wants. This is why patient teaching is so incredibly important when implementing patient care. If someone doesn't understand in lay-man's terms what the affects of drugs are on her fetus and how that use affects the outcome of her baby, she will not be adequately equipped to make appropriate, beneficial and long-term decisions regarding her pregnancy or care. When the family participates, it may provide some support, however, if dad is taking drugs (which is usually the case), then how can he be of any support to the patient?

tammikins · Mar 24, 2008

Dear CARCAM, Thank you so much! You have no idea how helpful your information is! I was beginning to feel discouraged that no one would reply, but this is over and above what I thought anyone would help me out with. Again, my sincere thanks to you!

~Tanya

CARCAM75 · Mar 25, 2008

Hi Tanya,

You are more than welcome! Glad I could help.

-Carrie:cheers:

trying2makeit · May 21, 2008

This information was helpful for me, with regards to an issue that I am researching for school... so I just want to say Thanks! too!

CARCAM75 · May 22, 2008

You are very,very welcome.