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With reference to the theories of communication and health promotion, examine a critical incident in practice that enhances healthcare in a multi-cultural society.
Health promotion is defined as the process of enabling individuals to make decisions to improve and maintain their health, by receiving relevant information (World Health Organisation (WHO), (2018). Health promotion is an important part of the midwife’s role, “the nature of health promotion work in midwifery is geared toward promoting the health of the mother and ensuring an optimum environment for mother and baby” (Price, 2013). Focusing on health not illness, health promotion in midwifery acknowledges there are many factors outside peoples control that influences their decisions and choices and the midwife should seek to understand and highlight the risks associated with drinking alcohol during pregnancy by outlining the guidelines in a practical and clear manner. The role of the midwife within health promotion seeks to encourage women to consider a healthy lifestyle and present relevant national and local public health information and initiatives enabling women to make informed choices about their health (Nursing and Midwifery Council (NMC) (2018).
The purpose of this essay is to examine the aspect of drinking alcohol during pregnancy. The incident took place during an antenatal assessment, within the community and It will follow the structure of the Stages of Change Model, Prochaska & DiClemente’s, (1984), describing a process of change. This model applies a trans- theoretical approach which helps explore the incident further by applying the five stages of change to help make a plan for individual change of lifestyle and choices (Naidoo & Wills, 2016) The stages of change model, provides a conceptual framework for individuals to naturally change their behaviour, from pre-contemplation stage, when individuals have no interest in making necessary changes to habits and lifestyles, through to maintenance stage, when individuals are maintaining a healthier lifestyle (Price, 2013). Confidentiality will be maintained throughout using pseudonyms for individuals, in accordance with the Nursing and Midwifery Council code (NMC) (2015). The woman will be named Lisa, her partner named Jimmy and the local trust will be named Trust A.
Toward the end of the student’s placement within community Lisa attended her 16-week antenatal appointment with her partner Jimmy, who appeared to be very supportive. Lisa, a nulliparous woman, with a low risk pregnancy and she was enjoying her pregnancy and the couple was very excited. Antenatal assessment was completed, all was normal and within range and nothing abnormal detected (NAD). The student asked Lisa if she had any questions or wanted to discuss any issues, Lisa then asked the student how much glasses of red wine could she have per day and the student asked Lisa whether she had been drinking often and she admitted to drinking one to two glasses of red wine each evening. The student informed Lisa that according to current DoH guidelines, (2016) recommended that woman should abstain from drinking alcohol during pregnancy The student recalled attending a recent lecture about alcohol consumption during pregnancy and through further evidence-based research informed Lisa about the risk of baby being born with fetal alcohol Syndrome (FAS) if consuming two or more units of alcohol per day, discussing the affects of alcohol on the developing fetus that, health at birth, ability to learn, and vulnerability to illness during infancy and childhood, even when drinking in small amounts. Jimmy was surprised that two glasses of wine per day can cause harm to his unborn baby, he always assumed it is good to have a glass of wine with evening meals and Lisa had reduced her alcohol consumption since being pregnant. Lisa agreed with Jimmy’s response and implied that it was fine to drink in moderation. The couple had not been informed about the effects of alcohol on herself and developing fetus and required clarification about alcohol units to make an more informed choice about her health. Lisa admitted she had one to two glasses of wine daily with her meal. Jimmy was also consuming alcohol daily and they were both at risk of developing an alcohol addiction. The student informed Lisa that drinking alcohol and sharing bed or sofa with baby is associated with sudden infant Death Syndrome (SIDS) and evidence suggests, regularly drinking more than 2 units of alcohol daily while breastfeeding can significantly reduce breast milk supply (Williams, 2015). Lisa was given leaflets and literature about the dangers of drinking alcohol during pregnancy and discussed online material, such as fact sheets about the stigma associated with drinking alcohol as a normal way to de-stress, celebrate or socialise. Jimmy accessed online material via his mobile phone at alcoholchange.co.uk to gain information about ways fathers can support their partners to stop drinking alcohol and their role in ensuring changes to their own health (Alcohol Change UK, 2019).
The student and couple discussed the options of alcohol free wine as an alternative to alcohol and offered referral options to discuss further with The Alcohol and Drug Misuse Prevention Team within Trust A, for further guidance on reducing and preventing developing an alcohol addiction. Lisa and Jimmy were surprised about the risks of alcohol consumption and were determined to change their drinking habits. At the end of Lisa’s antenatal visit, the midwife and student planned a follow-up appointment to review Lisa’s progress, which offered continuity of care and encouraged Lisa to make informed choices about her health. Plan of care was written in Lisa’s notes and an initial referral was made to alcohol and drug misuse prevention team with consent from Lisa. Lisa and Jimmy were both eager to abstain from drinking alcohol and looked forward to reviewing interactive online material about abstinence and planning a healthier lifestyle.
The World Health Organisation (WHO, 2018) defines health as a complete physical, mental and social wellbeing. A variety of economic, social and environmental factors create difficulties for people to make necessary changes to their health. The term health promotion was used for the first time in 1974 setting the agenda for health promotion. Health promotion arose from the shift of perceptions of the determinants of health, for example people’s lifestyles, social, environmental and economic conditions that impact people’s health. Additionally, the management and role of the healthcare services. The Ottawa Charter 1986 was the first health promotion conference, which outlined important principles for modern day health promotion. The Ottawa charter was instrumental in creating five action areas and three strategies to achieve health, aimed to enable people to take control of their health and thereby improve their health (Naidoo & Wills, 2016). Action areas includes; building healthy public policy, creating supportive environments, strengthening community action, reorienting health services and developing personal skills. The charters strategies included, building health public policies that protect the health of individuals and communities, making it easier to make healthy choices. Creating supportive environments, where people live and work to increase people’s ability to make healthy choices. For example, the promotion of smoke-free messages creates opportunities for individuals to stop smoking, such as health advertisements in different languages to educate people about health. Strengthening communities by empowering community action, funding and develop strategies to achieve better outcomes. Orientating health services by applying a preventative approach rather than curative approach, encouraging health professionals and all sectors to take responsibility for health promotion.
It is the role of the midwife to offer lifestyle advice and inform woman of the implications of alcohol consumption on the fetus. To identify women who require additional support, discuss follow-up appointment and arranging referrals to specialist services when required following the local Trust pathway for women who drink alcohol. (NMC, 2015). The NMC (2015), outlined in the Midwifery practice assessment document, 2018, advice student midwives to participate in advising women of health promotion strategies, maintaining confidentiality and respecting the woman’s autonomy when making decisions about care or treatment (Marshall & Raynor, 2015)
There are various health promotion approaches which include communication and health models, that draw upon one or more theories to guide health promotion, to study the concept of health and empower individuals to make informed decisions about their health (Nidecker, M., DiClemente, C. C., Bennett, M. E., & Bellack, A. S, 2008). Stages of Change Model (1984), aims to encourage individuals to understand the consequences of behaviours that affect health and to take action to adopt a healthy lifestyle. Targeted towards individual change, the approach implements five stages of change to reach people by providing information to educate people.
“ The process of change represents the internal and external experiences and activities that enable a person to move from one stage to the next” (Nidecker et al, 2008). Pre contemplation stage-The first stage of change according to the model focuses on when individuals are not ready for change, and in denial about their lifestyle or addiction . Initially Lisa had no intention of abstaining from drinking alcohol. She lacked knowledge about the risks associated with alcohol consumption during pregnancy. Contemplation stage- Individuals who are at the stage considering changing bad habits and has mixed feelings about changes. Lisa had not initially intended to abstain from drinking alcohol. However, she started to consider the advice given, anticipating making changes as she learned about the effects of alcohol on the developing fetus. The student discussed Jimmy’s role and how that may effect Lisa’s decisions. Preparation stage- An individual who has overcome denial and ready for change, seeking advice and support as they prepare for change. The student presented evidence based information regarding FASD and associated disorders related to drinking alcohol and Lisa decided to stop drinking by obtaining materials about FASD, the effects of alcohol consumption. Action-making a change stage- Individuals who are committed to change with a clear goal and realistic plan, begin to change their behaviour. Lisa and Jimmy began to engage in discussions about The support that is available from the Alcohol and Drug Misuse Prevention Team and identified assistance available to support their choice to abstain from drinking alcohol. The student listened to Lisa’s needs, encouraging her to make informed choices about her health. Maintenance stage- Individuals who have created healthier lifestyles by maintaining the new behaviour. People may relapse at this stage of the model, as they avoid falling back into previous habit. The student and midwife arranged follow- up appointments to assess Lisa’s progress. Lisa made the decision to abstain from drinking alcohol and the student imparted information that was coherent, easily understood and evidence-based. On evaluation the stage of change model seems to oversimplify the transition that individuals face when changing a lifestyle, by depicting one continuous process of change, which is so often unachievable.
Teratogen compounds can cause congenital abnormalities when crossing the placenta, causing interference to the growth factors causing cell damage, which can lead to abnormalities. Examples of teratogens include some medications, certain chemicals, diseases in the mother and alcohol consumption. (Huzink & Mulder, 2006). Abnormalities caused by alcohol include fetal growth restriction deformities of the arms, face, legs, heart conditions and intellectual disability. Abnormalities may include problems with thinking and remembering also behavioural issues, developed during organ development of the fetus. According to WHO (2000), it is estimated that 1 in 100 infants are born with alcohol related defects and 2 in 1000 born with fetal alcohol syndrome. Alcohol consumption is socially acceptable behaviour forming part of daily interaction in western society and excessive alcohol intake has a potentially damaging impact on every organ in the body, including the liver, neurological system and pancreas, affecting the storage of nutrients as it suppresses appetite. Alcohol consumption during pregnancy is associated with fetal alcohol spectrum disorder (FASD), a term used which incorporate a range of adverse effects associated with birth defects caused by drinking alcohol during pregnancy and prenatally (Williams & Smith, 2016). There is no universally acceptable safe measure of alcohol consumption during pregnancy and therefore abstinence from drinking alcohol, is recommended. The National Institute for Health and Care Excellence guidelines (NICE) (2014) recommends that women should avoid drinking alcohol during pregnancy. If women chose to drink alcohol pre-conception, it is advised to minimise the risk of FASD by drinking no more than one or two units per week. Research indicates that heavy prenatal alcohol exposure is associated with neuropsychological defects including memory, learning, motor skills and low IQ which suggesting devastating consequences of prenatal exposer to alcohol on the developing central nervous system (Guerri, C,. Bazinet, A. Riley, EP 2009). In 2007 the Department of Health (DoH) issued guidelines advising women to avoid alcohol during pregnancy or when trying to conceive as the most sensitive periods of development in the brain and CNS is between three to sixteen weeks gestation continuing when major organs start development. In 2016, the DoH guidelines outline the risk of harm to the baby when drinking alcohol. The document states there is likely to be less risk of harm to baby if women drink small amounts of alcohol, before and during pregnancy. However, the main weakness of the new guidelines fails to consider that light prenatal alcohol consumption is associated with preterm delivery and the recent changes to guidelines for alcohol use during pregnancy in the UK should consider applying a precautionary guideline of complete abstinence in light of the current evidence as women such as Lisa assume that there are no risks associated with “light drinking” during pregnancy and prenatally. The new low risk drinking guidelines presents vague and unclear information about what is considered safe amounts of alcohol for pregnant women in light of the risk to fetus (DoH, 2016)
In conclusion, evidence shows that drinking alcohol during pregnancy can cause birth defects and it is difficult to determine the safe limits of alcohol for women who want to continue drinking during pregnancy. Ultimately, it would be a woman’s right to decide whether she would take advantage of light drinking guidance or abstain from drinking alcohol during pregnancy (DoH, 2016). Midwives make a major contribution to the wellbeing of the woman and her family and by increasing women’s knowledge about the facts of drinking alcohol during pregnancy there will be a reduction in the number of babies born with FASD and other defects. Health promotion models provide ways to assess the progress of women who want to change their lifestyle choices. Midwives advising women about what is the safe practice for themselves and their baby always encouraging women to make informed choices about their health. Applying health models continues to provide a structure which encourages a change to unhealthy behaviour. Appropriate and effective communication should be offered to women and their families in a way they can understand, by making information simple and relevant to their needs applying active listening and non-verbal communication, continues to encourage the woman to make the right choices for themselves and baby (Price, 2013). The future challenge is to reduce the rate of FASD during pregnancy by creating clearer guidelines surrounding drinking alcohol during pregnancy.
- Alcohol Change UK, (2019). Alcohol Change UK. Retrieved 03 January 2019, from https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-and-families
- Alcohol Policy Team, Department of Health (2016). How to keep health risks from drinking alcohol to a low level Government response to the public consultation. Department of Health. Retrieved December,28, 2018 from’ https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545911/GovResponse2.pdf
- Department of Health, (2016). UK Chief Medical Officers Low Risk Drinking Guidelines. Retrieved 7 January 2019, from https://assets.publishing.service.gov.uk/gov
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- Huizink, A., & Mulder, E. (2006). Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring. Neuroscience & Biobehavioral Reviews, 30(1), 24-41. https://doi.org/10.1016/j.neubiorev.2005.04.005
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- NICE Pathways . (2019). Alcohol-use disorders – Pathways.nice.org.uk. Retrieved 12 January 2019, from https://pathways.nice.org.uk/pathways/alcohol-use-disorders#path=view%3A/pathways/alcohol-use-disorders/alcohol-use-disorders-overview.xml&content=view-index
- Nidecker, M., DiClemente, C. C., Bennett, M. E., & Bellack, A. S. (2008). Application of the Transtheoretical Model of change: psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness. Addictive behaviors, 33(8), 1021-30.
- Price, C (2013) British Journal of Midwifery,.volume 21 number 6 Effective Communication in Midwifery
- World Health Organisation. (2018) https://www.who.int/topics/health_promotion/en/
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