Ethical Knowing in Providing Care for a Teen Mom
Rochelle Leitschuck, Nicole Marble, Bethany Palosaari, Christy Slaughter
Undergraduate Students, University of Arizona College of Nursing
Orem’s Supportive-Educative system theory provided a conceptual foundation to care for a young mother’s critical needs to learn how to care for her infant. Esthetic and ethical patterns of knowing were particularly useful in implementing the needed education. By employing these patterns of knowing, the student nurses could more accurately plan the most effective approach to teaching this new mother, in an approach based upon empathy as well as expertise.
Meredith is a 17-year-old female, gravida 1, para 1 who spontaneously delivered a baby girl vaginally at 1:00 pm. She had an epidural during labor. Her birth was augmented with Pitocin. Her fundus is firm, midline, and at the umbilicus with small amount of lochia rubra. No laceration or episiotomy is present, though her perineum is slightly swollen and bruised. She has no difficulty voiding… She is breastfeeding her baby, although her nipples have some cracking and soreness. She stated that she was having problems with breastfeeding and did not feel confident. Meredith is expecting to go home in two days.
Orem’s Supportive-Educative system theory (Deynes, Orem, & Gerd-Bekel, 2001) was particularly relevant in considering this patient’s needs. She was a young, first-time mother, in need of teaching how to care for her infant, despite the fact that she lived at home with her mother and sister who may assist in the care. Meredith had requested a lactation consult. This consultation included teaching breastfeeding techniques, infant positioning, and correct latch to avoid pain while breastfeeding. By applying Orem’s theory to our patient, we viewed her as having the ability to care for herself but lacking some knowledge to do so. The self-care theory allowed us to better understand the patient's situation. As a new teen mother, there is an abundance of new information to learn, and our responsibility is to teach and guide her toward improving her self-care while supporting her self-care agency. Although the primary responsibility for personal health belongs to the patient, we did not leave all of the responsibility for care on the patient. We also realized that, in addition to our assistance, family support systems and use of community resources are environmental factors that could facilitate her self-care and infant care.
The empirical pattern of knowing informed us about what content would likely be relevant in our teaching. As a result of their research, Mann, Pearl, & Behle (2004), concluded that it is important to teach adolescent parents about child growth and development, discipline strategies, and the significance of play. This teaching was particularly critical for Meredith because prior research had shown that adolescent mothers tend to be emotionally immature and lack the experience in caring for their children (Mann, Pearl, & Behle, 2004).
Effective application of educative principles would not have been possible, however, without reflection on the esthetic and ethical dimensions of this care situation. Esthetic knowing – having empathy and focusing on her as a unique individual -- enabled us to connect with Meredith to better understand her needs. Our use of esthetic knowing also helped Meredith to accept and absorb the teaching we provided her.
Reflection on our ethical pattern of knowing increased our awareness of potential bias in caring for this patient. Acknowledging that we might be judgmental of an adolescent giving birth helped us reveal attitudes that could diminish our ability to provide nursing care. Evaluating personal feelings and beliefs helps the nurse to foresee biases and deal with moral issues that influence perceptions and interactions with patients.
In conclusion, esthetic and ethical knowing (Carper, 1987), combined with knowledge of nursing theories and research in the field, enabled us to proceed with teaching this new adolescent mother. This approach also helped Meredith open up to share concerns about her breastfeeding ability, not easily discussed by an adolescent. Through reflection on our work with this patient, we discovered in a very real way, the importance of ethical as well as empirical patterns of knowing in nursing care that makes a difference in the client’s well-being.
Carper, B. A. (1978). Fundamental patterns of knowing in nursing. Advances in Nursing Science, 1 (1), 13-23.
Deynes, M.J., Orem, D.E., & Gerd-Bekel, S. (2001). Self-care: A foundational science. Nursing Science Quarterly, 14(1), 48-54.
Mann, M.B., Pearl, P.T., & Behle, P.D. (2004). Effects of parent education on knowledge and attitudes. Adolescence (39)154, 355-360.
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