Case Study 2: Joanne Duffy’s Quality Caring Model©
Safe labor and delivery is dependent on successful interaction of the four P’s; one of these P’s represents psyche. Psyche refers to “a woman’s emotional structure that can determine her entire response to labor and influence physiological and psychological functioning” (Silvestri, 2011, p. 298). Anxiety and fear are two common emotions experienced by women in labor, especially first time mothers, and can have an unfavorable effect on the labor and delivery process (Silvestri, 2011). In the situation described, Keisha is beginning to experience and express emotions that could be damaging and complicate a safe and successful birthing process. Although Keisha has an outpouring of support from her husband and extended family, it is imperative for the nurse to implement the Quality Caring Model© in this situation. Through implementation of the eight caring factors, the nurse must build and foster caring relationships with Keisha, her husband, their family, and other members of the healthcare team to achieve the best possible outcome for this situation.
The nursing process aids the nurse in assessing the patient and situation; this includes diagnosing the problem, making a plan, implementing the plan, and eventually evaluating the outcome. Keisha is a scared first time mother, who has chosen to forgo pain relief and other interventions during her labor; currently she is becoming uncomfortable and doubting herself. The presence of pain and fear can cause a problem which will affect not only Keisha, but also the labor process. With her husband at the bedside, there is a possibility that he may also start to become fearful for his wife and unborn child and react accordingly. The nurse must acknowledge these feelings and develop a plan quickly to gain and maintain control of the situation; a nurse who has developed a caring relationship with Keisha and her husband will be more successful at intervening at this point. The nurse must actively listen to Keisha, validate her perceptions and concerns, and encourage positive expressions and develop a transpersonal connection so Keisha and her husband feel cared for (Duffy, 2003). The nurse must also be vigilant to not convey any negative feelings about Keisha or her husband at this, this could be damaging to the relationship and delivery process. Basic human needs are also addressed in Duffy’s model; at this time, safety is in question and the nurse is responsible for making sure this does not become an unmet need for Keisha and her husband. The nurse may not be able to meet these needs by herself and may need to consult and establish collaborative relationships with other nurses, physicians, and family members.
Through implementation of the eight caring factors introduced by Duffy, especially attentive reassurance and mutual problem solving, the nurse will be able to foster caring relationships with those involved in this situation. “Patients...