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Operational Definition of “Support”
During the first home visit both Joan and the nurse decide that another visit following the departure of Bill’s mother might be helpful. After this visit the hospital nurse sends a report to the physician’s office with suggestions for discussion a t the first postpartum office visit. The office nurse follows through with these recommendations and considers with Joan the need for further home visits by the office nurse. When the baby is 3 months ald, the Woods are sent a form that asks them to evaluate the nursing care they received during all four trimesters of the childbearing year. The results of this evaluation, completed in duplicate, are sent to the office nurse and to the hospital nursing staff. This kind of individualized and flexible care is adaptable to any situation. It does not negate physiologic or hygienic needs of new mothers and babies, but it does place them in proper perspective. Beyond routine care, emphasis is placed on a family’s ability to determine their own needs and make intelligent decisions for their own welfare when acquainted with alternatives. The concepts discussed here can be used with primiparas and grand multiparas, with unwed mothers, and with parents of retarded, sick, or malformed babies. It allows for the inclusion of other family members and permits older children and grandparents t o come to the hospital to learn baby care under the watchful eye of mother and nurse. While the example given involved a married couple, the same care and opportunities can and should be offered to people in all kinds of family relationships. Not all families, of course, will want
or need the kind of involvement described here. The essential point is that nurses direct their attention and concern t o families. Responsible nurses will respond t o patient needs by providing their patients with many alternatives and by making sure these alternatives are well known. Only then will families be able to make the kinds of decisions best for themselves. The consumers and providers of maternity care will soon be confronted with other approaches to health care during childbirth. Both lay- and nursemidwives are likely to increase in number and availability. More people will probably choose to have their babies at home, and maternity centers that provide a home-like atmosphere may well be the model for the 1980s. Before accepting or rejecting these alternatives, nurses must be knowledgeable and responsive-knowledgeable about the advantages, disadvantages, safety, and potential consequences of each choice presented, and responsive to the needs of those they serve. Linda Wheeler is Assistant Professor, Department of Obstetrics and Gynecology, University of Mississippi Medical Center. She graduated from Queen of Angels School of Nursing in Los Angeles, took her BSN and M N degrees at the University of Washington, and received her certificate in nurse-midwifery from the University of Mississippi Medical Center. Her doctorate is from Highland University. Ms. Wheeler has taught both nursing and nurse-midwifery and served as Director of the Family Planning Nurse Practitioner Program at the University of Mississippi Medical Center.
Operational Definition of “Support” CLAUDlA ANDERSON, RN, BS, M N Terms are often used without much precision. To enhance communication, job satisfaction, and delivery of care, nurses might do well to agree on an operational definition of “support.” The context of this discussion is the process of labor, but the more general applications should be obvious.
“Support” is a term familiar to all nurses. In shift reports it is not uncommon to hear the nurse reporting off say “Mrs. Brown needs a lot of support.” Under nursing care plans, Kardex forms often say “Needs emotional support.” In communicating back and forth, nurses of all levels use this term often. Using the word is easier than defining it. January/February 1976 JOCN Nursing
Webster’s suggests that to support couragement.‘ Support may be implemented by the presence of a symdescribes support as guidance and pathetic nurse.s Still another writer strength;’ another describes the goal notes that the greatest need in a laof support as providing relief from bor room is for nurses to function in mental anguish and making the emotionally supportive roles.6 These descriptions are of little patient less fearful.’ Support provides an attitude of understanding value except as glittering generaland reass~rance.~ To give support ities, and a search of the literature is the nurse must offer praise and en- not much more fruitful. Neither the is to encourage, or help. One writer
17
Index Medicus nor the Cumulative Guide to Nursing Literature list support as a subject heading. One must either go to psychology, emotions, or the specific area in which support is being spoken of to find a reference. However, two definitions with concrete value to nursing were found. Wiedenbach defines support as anything which strengthens the individual’s ability to function capably and to function to his or her sati~faction.~ Noack states that support during labor has a fivefold purpose: 1) to sdstain the woman, 2) to relieve the pain, 3) to assure the couple of a safe outcome for the mother and baby, 4) to accept the couple’s attitudes and behaviors during labor, and 5) to deliver physical care.’ Taking into consideration what support is and what support does according to the previodsly quoted authors, I have attempted to create an operational definition of the term limited to the setting of a patient in labor. Many resources are available to the nurse in providing support for the patient in labor, including the husband, parent, sibling, or friend. The nurse must not feel that she is exonerated from the responsibility of providing support if someone is with the laboring patient; all participants in the labor process require the support of the nurse.
The goal of support by the nurse is to enhance the patient’s participation in the labor process and to foster activity which enables the participants to maintain control. Using this framework, it is obvious that psychologic, emotional, and physical forms of support cannot be separated. Nurses who provide support to the patient in labor, and whomever else is present with the patient, must assess the patient’s needs at that time. On the basis, of this assessment, the nurse then allows the patient to rely on her strength until she is able to function in an independent manner. The nurse’s responsibilities include acting to promote the patient’s dignity by providing for privacy, hygiene, comfort in terms of bodily position, etc. Actions that allow the patient to control her environment include assisting the patient to feel safe, providing encouragement, and reassuring the patient to enable her to control her bodily functions and to actively participate in the labor process. Specific responses must change with the particular situation. I n providing support to t h e patient, the nurse must focus on the behavior of the patient to keep her an active participant in the labor process. The ability of the nurse to assess the patient and to provide appropriate intervention, thereby al-
lowing the patient to maintain dignity, to maintain control, and to be an active participant is of primary importance dui-ing the labor and delivery. Perhaps the term support could be used interchangeably with the nursing process. References 1. Bender, B.: “ A Test of the Effect of Nursing Support on Mothers in Labor.” ANA Regional Clinical Conferences 171179, 1967 2. Goodman, R.: “Psychological Support in Labor: A Supervisor‘s View.” H o s p Top 99-100, Aug 1964 3. Howard, R., and Sr. Jan Marie: “Initial Experience with a Prepared Childbirth Program.” JOGN Nurs 1(3):30-34, 1972 4. Sasmor, J., C. Cantor, and P. Hassid: “The Childbirth Team During Labor.” Am J Nurs 444-447, March 1973 5. Tyron, P.: “Use of Comfort Measures as Support in Labor.” Nurs Res 109-118, Spring 1966 6. Lerch, E.: Maternity Nursing. St. Louis, C. V. Mosby, 1970 7. Wiedenbach, E.: Clinical Nursing: A Helping Art. New York, Springer, 1964, p. 118 8. Noack, 1.:“Psychological Support i n h b o r : A Nursing Educator’s View.” H o s p T o p 97-98, August 1964
Claudia Anderson is an Instructor in Maternal Nursing at the University of Kansas. Her BS and M N degrees are from that university, and she has an MA in Education from the University of Missouri. She is a mcmber of ANA, NAACOG, and Sigma Theta Tau.
CHILDBIRTH EDUCATION The Council of Childbirth Education Specialists announces its 1976 schedule of introductory programs. March 11-18 August 16- 19 October 18-21 October 19-22
New York, New York Fairfield, Connecticut Philadelphia, Pennsylvania Kansas City, Missouri
For particulars please write Patricia Hassis, RN, Registrar, C/CES, 186 West 86th S t r w t . Ncwa York, NY 10024, or call (212) 799-8330.
18
JanuaryIFebruary 1976 JOGN Nursing
or need the kind of involvement described here. The essential point is that nurses direct their attention and concern t o families. Responsible nurses will respond t o patient needs by providing their patients with many alternatives and by making sure these alternatives are well known. Only then will families be able to make the kinds of decisions best for themselves. The consumers and providers of maternity care will soon be confronted with other approaches to health care during childbirth. Both lay- and nursemidwives are likely to increase in number and availability. More people will probably choose to have their babies at home, and maternity centers that provide a home-like atmosphere may well be the model for the 1980s. Before accepting or rejecting these alternatives, nurses must be knowledgeable and responsive-knowledgeable about the advantages, disadvantages, safety, and potential consequences of each choice presented, and responsive to the needs of those they serve. Linda Wheeler is Assistant Professor, Department of Obstetrics and Gynecology, University of Mississippi Medical Center. She graduated from Queen of Angels School of Nursing in Los Angeles, took her BSN and M N degrees at the University of Washington, and received her certificate in nurse-midwifery from the University of Mississippi Medical Center. Her doctorate is from Highland University. Ms. Wheeler has taught both nursing and nurse-midwifery and served as Director of the Family Planning Nurse Practitioner Program at the University of Mississippi Medical Center.
Operational Definition of “Support” CLAUDlA ANDERSON, RN, BS, M N Terms are often used without much precision. To enhance communication, job satisfaction, and delivery of care, nurses might do well to agree on an operational definition of “support.” The context of this discussion is the process of labor, but the more general applications should be obvious.
“Support” is a term familiar to all nurses. In shift reports it is not uncommon to hear the nurse reporting off say “Mrs. Brown needs a lot of support.” Under nursing care plans, Kardex forms often say “Needs emotional support.” In communicating back and forth, nurses of all levels use this term often. Using the word is easier than defining it. January/February 1976 JOCN Nursing
Webster’s suggests that to support couragement.‘ Support may be implemented by the presence of a symdescribes support as guidance and pathetic nurse.s Still another writer strength;’ another describes the goal notes that the greatest need in a laof support as providing relief from bor room is for nurses to function in mental anguish and making the emotionally supportive roles.6 These descriptions are of little patient less fearful.’ Support provides an attitude of understanding value except as glittering generaland reass~rance.~ To give support ities, and a search of the literature is the nurse must offer praise and en- not much more fruitful. Neither the is to encourage, or help. One writer
17
Index Medicus nor the Cumulative Guide to Nursing Literature list support as a subject heading. One must either go to psychology, emotions, or the specific area in which support is being spoken of to find a reference. However, two definitions with concrete value to nursing were found. Wiedenbach defines support as anything which strengthens the individual’s ability to function capably and to function to his or her sati~faction.~ Noack states that support during labor has a fivefold purpose: 1) to sdstain the woman, 2) to relieve the pain, 3) to assure the couple of a safe outcome for the mother and baby, 4) to accept the couple’s attitudes and behaviors during labor, and 5) to deliver physical care.’ Taking into consideration what support is and what support does according to the previodsly quoted authors, I have attempted to create an operational definition of the term limited to the setting of a patient in labor. Many resources are available to the nurse in providing support for the patient in labor, including the husband, parent, sibling, or friend. The nurse must not feel that she is exonerated from the responsibility of providing support if someone is with the laboring patient; all participants in the labor process require the support of the nurse.
The goal of support by the nurse is to enhance the patient’s participation in the labor process and to foster activity which enables the participants to maintain control. Using this framework, it is obvious that psychologic, emotional, and physical forms of support cannot be separated. Nurses who provide support to the patient in labor, and whomever else is present with the patient, must assess the patient’s needs at that time. On the basis, of this assessment, the nurse then allows the patient to rely on her strength until she is able to function in an independent manner. The nurse’s responsibilities include acting to promote the patient’s dignity by providing for privacy, hygiene, comfort in terms of bodily position, etc. Actions that allow the patient to control her environment include assisting the patient to feel safe, providing encouragement, and reassuring the patient to enable her to control her bodily functions and to actively participate in the labor process. Specific responses must change with the particular situation. I n providing support to t h e patient, the nurse must focus on the behavior of the patient to keep her an active participant in the labor process. The ability of the nurse to assess the patient and to provide appropriate intervention, thereby al-
lowing the patient to maintain dignity, to maintain control, and to be an active participant is of primary importance dui-ing the labor and delivery. Perhaps the term support could be used interchangeably with the nursing process. References 1. Bender, B.: “ A Test of the Effect of Nursing Support on Mothers in Labor.” ANA Regional Clinical Conferences 171179, 1967 2. Goodman, R.: “Psychological Support in Labor: A Supervisor‘s View.” H o s p Top 99-100, Aug 1964 3. Howard, R., and Sr. Jan Marie: “Initial Experience with a Prepared Childbirth Program.” JOGN Nurs 1(3):30-34, 1972 4. Sasmor, J., C. Cantor, and P. Hassid: “The Childbirth Team During Labor.” Am J Nurs 444-447, March 1973 5. Tyron, P.: “Use of Comfort Measures as Support in Labor.” Nurs Res 109-118, Spring 1966 6. Lerch, E.: Maternity Nursing. St. Louis, C. V. Mosby, 1970 7. Wiedenbach, E.: Clinical Nursing: A Helping Art. New York, Springer, 1964, p. 118 8. Noack, 1.:“Psychological Support i n h b o r : A Nursing Educator’s View.” H o s p T o p 97-98, August 1964
Claudia Anderson is an Instructor in Maternal Nursing at the University of Kansas. Her BS and M N degrees are from that university, and she has an MA in Education from the University of Missouri. She is a mcmber of ANA, NAACOG, and Sigma Theta Tau.
CHILDBIRTH EDUCATION The Council of Childbirth Education Specialists announces its 1976 schedule of introductory programs. March 11-18 August 16- 19 October 18-21 October 19-22
New York, New York Fairfield, Connecticut Philadelphia, Pennsylvania Kansas City, Missouri
For particulars please write Patricia Hassis, RN, Registrar, C/CES, 186 West 86th S t r w t . Ncwa York, NY 10024, or call (212) 799-8330.
18
JanuaryIFebruary 1976 JOGN Nursing