COMPETENCY ITEMS AND VALIDATION TECHNIQUES

COMPETENCY: PRENATAL NURSING CARE

STANDARD: Prenatal nursing care promotes a positive birth experience and healthy birth outcomes, and is an integral component of maternal and child health home visiting nurse care.

I. The nurse demonstrates ability to assess, plan, intervene, and evaluate (with client & family) their goals and plan of care

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

Section A

1. Demonstrates prenatal assessment, compares data with norms and reports abnormal findings to physician or certified nurse midwife:

Physical

general health (vital signs, sleep/activity level)

medical & mental health history

current medical & mental health condition(s)

flat or inverted nipples

previous c-section

weight gain or loss

nausea & vomiting

dental health

s/s of preterm labor

s/s of UTI

pain

edema

fetal movement

Psychosocial

cultural and ethnic traditions

use of prenatal care

nutrition

knowledge of pregnancy

support systems

parenting preparation

substance use/abuse (tobacco, alcohol, other)

stressors

Environmental

housing

smoke detectors

exposure to 2nd hand smoke

cats in home/litter box

home, neighborhood & work related hazards

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Develops and modifies the plan of care based upon:

· physical,

psychosocial, and

· environmental findings

3. Builds a realistic plan of care considering the following:

family dynamics

family support systems (availability & quality)

community resources

Case Review

Technical skill item #1 & critical thinking skill

#2 & 3

Prenatal assessment includes the following items. The nurse’s ability to compare data with norms and report abnormal findings to physician or certified nurse midwife is evaluated.

Physical

general health (vital signs, sleep/activity level)

medical & mental health history

current medical & mental health condition(s)

flat or inverted nipples

previous c-section

weight gain or loss

nausea & vomiting

dental health

s/s of preterm labor

s/s of UTI

pain

edema

fetal movement

Psychosocial

cultural and ethnic traditions

use of prenatal care

nutrition

knowledge of pregnancy

support systems

parenting preparation

substance use/abuse (tobacco, alcohol, other)

stressors

Environmental

housing

smoke detectors

exposure to 2nd hand smoke

cats in home/litter box

home, neighborhood & work related hazards

Based upon a review of a prenatal client’s chart and discussion with the nurse, the nurse is able to:

Technical skill #1

Identify the physical, psychosocial and environmental health risks (abnormal findings.)

Critical thinking skill #2

Describe how the health risks (abnormal findings) influenced the client’s plan of care.

Critical thinking skill #3

Describe a factor related to family dynamics, family support systems and community resources that influenced the plan of care.

Section B

1. Lists physical and/or psychosocial risks associated with adolescent pregnancy

2. Lists benefits of prenatal care for the mother and/or fetus

3. Lists at least one warning sign for each of the following pregnancy complications:

preterm labor

placenta previa

placenta abruptio

premature rupture of membranes

fetal demise

preeclampsia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Written test

Technical skill item #1

List 3 physical and/or psychosocial risks associated with adolescent pregnancy

Technical skill item #2

List 3 benefits of prenatal care for the mother and/or fetus

Technical skill item #3

List at least 1 warning sign for each of the following pregnancy complications

preterm labor

placenta previa

placenta abruptio

premature rupture of membranes

fetal demise

preeclampsia

 

 

Section C

1. Identifies the purpose and implications for changes in client’s plan of care related to the following laboratory tests:

HIV

glucose tolerance test (GTT)

triple marker screen

2. Describes the purpose of and how to prepare the client for the following procedures:

ultrasound

amniocentesis

nonstress test (NST)

   

Written test

Technical skill item #1

Identify the purpose and one implication for changes in client’s plan of care related to the following laboratory tests:

HIV

glucose tolerance test (GTT)

triple marker screen

 

Technical skill item #2

Describe the purpose of and how to prepare the client for the following procedures:

ultrasound

amniocentesis

nonstress test (NST)

Section D

1. Elicits client and partner’s reaction to and expectation of pregnancy

2. Assists the client in devising a plan of action in the event of pre-term labor or other complications

3. Assists the client in devising a plan of action if there are barriers to accessing or using prenatal care

 

Case review

Based upon a review of a prenatal client’s chart use the following questions to guide a discussion with the nurse.

Interpersonal skill item #1, #2 & #3

Questions for discussion

1. Ask the nurse to describe her plan of care. This should include the client’s strengths and needs, what additional information the nurse would seek and interventions the nurse would plan.

2. How would you characterize/describe the client’s feelings about pregnancy? Describe how these feelings affect the client’s plan of care.

3. What seemed to be most helpful to the client in recognizing when to call her primary care provider?

4. What actions did you take to support the client’s follow through of the plan of action in the event of pre-term labor or other complications?

5. Did you identify any barriers the client has in accessing care? What actions did you take to support the client in overcoming these barriers?

Section E

1. Provides support and resources to the client who experiences fetal loss (miscarriage or stillbirth)

 

Case study

Interpersonal item #1

Case study

You call your client to schedule her first Healthy Babies home visit. After hesitating about agreeing to a time, she tells you she had a miscarriage a few days ago.

Question for discussion

Ask the nurse to describe her plan of care. This would include the client’s strengths and needs, what additional information the nurse would seek and interventions the nurse would plan.

The nurse’s plan of care should include:

opportunity for client to express her feelings related to her loss;

offering emotional support and

offering information/referral for grieving

 

 

 

II. The nurse demonstrates knowledge of and ability to assess client’s nutritional status, provide nutritional education and refer for nutritional counseling as indicated

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

Section A

1. Lists recommended dietary requirements during pregnancy by:

· using the food guide pyramid

· specific nutrients, their food sources and their functioning in supporting a healthy pregnancy during pregnancy

2. Uses a standard weight gain grid (e.g., Health Diary or Vermont Department of Health Weight Gain Chart) to assess weight gain

   

Written test

Technical skill item #1

Lists the recommended dietary requirements during pregnancy by:

servings for each food group of the food guide pyramid

list 3 specific nutrients, their food sources and their function in supporting a healthy pregnancy

Technical skill item #2

Assesses weight gain, using a standard weight gain grid for a 15 year old G1P0 who is 16 weeks pregnant, pre-pregnant weight of 113 pounds and weighs 118 at 16 weeks

 

 

Section B

1. Lists community resources for supplemental foods

 

2. Elicits client and family attitudes about weight gain, eating habits, food preparation, and shopping and involves client and family in developing a nutritional plan

3. Makes dietary recommendations based on weight gain grid, 24 hour real dietary intake, and other assessment information

Case review

Based upon a review of a prenatal client’s chart use the following questions to guide a discussion with the nurse.

Technical skill item #1 , Interpersonal skill item #2 and Critical thinking skill #3

Questions for discussion

1. Ask the nurse to describe her plan of care. This would include the client’s strengths and needs, what additional information the nurse would seek and interventions the nurse would plan.

2. What techniques did you find most helpful in eliciting information from the client?

3. What strategies were most helpful in obtaining a 24 hour recall?

4. What was your rationale for the specific dietary recommendations you made?

5. Name 2 community resources for supplemental foods that might be helpful to the client.

 

III. The nurse demonstrates knowledge of and ability to provide prenatal & parenting education to client and family

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

Section A

1. Identifies self-care measures for the following common discomforts associated with pregnancy:

backache

frequent urination

heart burn

leg cramps

nausea & vomiting

varicose veins

2. Describes the impact of the following smoking, drugs, alcohol and environmental hazards on fetal growth and development:

cigarette smoking

marihuana

cocaine

heroin

alcohol

3. List preventive measures related to:

car safety for pregnant women and infants

sleep safety (positioning, bedding & crib)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Written test

Technical skill item #1

List 1 self-care measure for each of the following discomforts associated with pregnancy

backache

frequent urination

heart burn

leg cramps

nausea & vomiting

varicose veins

Technical skill item #2

Describe the impact of 3 of the following on fetal growth and development:

cigarette smoking

marihuana

cocaine

heroin

alcohol

Technical skill item #3

List at least 1 preventive measure for each of the following:

car safety for pregnant women and infants

sleep safety (positioning, bedding & crib)

Section B

1. Helps client/family identify expectations of labor and childbirth and ways of coping with unexpected developments

2. Assists client in anticipating and planning the impact of baby on parents, and family including:

development of attachment

emotional adjustment

expectations of newborn

sibling adjustment

 

Case review

Based upon a review of a prenatal client’s chart and discussion with the nurse, the nurse is able to answer the following questions:

Interpersonal skill item #1

1. What are the family’s expectations of labor, childbirth?

2. What are the client’s strengths/resources to deal with unexpected developments?

3. What nursing interventions should be included in the client’s plan of care based upon this knowledge?

Interpersonal skill item #2

What adjustments does the client anticipate and how does the nurse help her plan for those?

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