Health promotion within the midwifery profession

Health promotion within the midwifery profession This essay will focus on smoking and diet in relation to health promotion within the midwifery profession. Smoking and diet are two main areas of health promotion, which are addressed within the role of the midwife. Smoking and types of diet are both choices which women choose to make, both of which can affect their own health and the health of their child. Smoking is known to have negative effects on pregnancy. There have been many recent public health campaigns which encourage smoking cessation; the reasons for this will be discussed in relation to maternal and fetal heatlh. Diet is an extensive topic and an unhealthy diet can affect pregnancy in various ways. The subtopics of vitamin deficiencies and obesity will be discussed as they are both relevant to todays population of women within the UK. It is a midwives role to promote a healthy diet and lifestyle; as set out by The Royal College of Midwives, and the Nursing and Midwifery council, whom provide rules, regulations and standards which midwives must adhere to when practicing. Evidence based guidelines are also set out by the National Institute for Clinical Excellence, Centre for Maternal and Child Enquiries and the Royal College of Obstetricians and Gynaecologists to improve the way in which midwives practice. Both rules and guidelines aim to provide training which enable midwives to promote a healthy diet and lifestyle to optimise the health of the woman and her developing fetus prior to and during pregnancy. Being healthy means different things to different people. There are many different definitions of health. The medical model, now common in the 20th century, defines health as being the absence of illness and presence of a good bodily function. However, this definition does not take into account social or mental factors and focuses on treatment rather than prevention which may be considered as reductionist and negative (Scriven 2010). Whereas a holistic definition, by The World Health Organisation (1948), states that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Even though the holistic model may be praised for acknowledging that mental and social factors effect health, WHOs definition has been heavily criticised for being too idealistic and would consider many people unhealthy (Scriven 2010). In relation to midwifery it is important to promote health, as a healthy diet and lifestyle prior to and during pregnan cy improves the chances of a successful pregnancy. It is a midwives role to promote health and wellbeing of women and their babies (NMC, 2008). Health promotion, as described by Scriven (2010), is said to be improving, advancing, supporting, encouraging and placing health higher on personal and public agendas. Midwives use health promotion models and approaches to enable a common value to be made clear; allowing all team members to work towards the same goal. As a result, effective communication between midwives is more likely, and therefore the quality of health promotion given to women is improved (Bowden 2006). Commonly, Tannahills model of health promotion, developed by Downie et al (1996), lends itself well to midwifery practice. The model mainly focuses on health education, health protection and preventing ill-health. These three main topics overlap; in which health promoting activities may fall. Child vaccination programmes implemented by the NHS is an example of health protection overlapping with ill-health prevention that oc curs in practice (Bowden 2006).This example emphasises the positive feature of the model; being able to carry out both objectives of improving health and preventing disease (Sykes 2007). The educational approach is often used within this model whereby the midwife gives facts and information to the women who may then choose to act on the information given, or not (Bowden 2006). Similarly, the behaviour change approach is commonly used in midwifery when encouraging women to change her attitudes or beliefs to adopt a healthier lifestyle (Bowden 2006). There are many health promotions approaches and models. However, no specific model is relevant to every woman. Each woman will have individual needs and therefore requires an individual assessment in relation to health promotion. Recently smoking has been the centre of health promotion. It is generally accepted that smoking in pregnancy has detrimental effects on fetal growth. Conter et al (1995) found that women who smoked cigarettes during pregnancy were more likely to have a baby with a lower birth weight than babies born to women who did not smoke during pregnancy. Carbon monoxide, inhaled in cigarette smoke, combines more readily with haemoglobin than oxygen (Sherwood, 2006). As a result, the maternal blood supplies less oxygen to the fetus for growth and development; often resulting in low-birth-weight babies. Lumley et al (2009) undertook a systematic review and concluded that methods which encourage women to quit smoking while pregnant reduce the amount of women who continue to smoke in late pregnancy, as well as reducing low birth weights and pre-term birth. However, some women may argue that it is desirable to have a smaller baby as they assume labour will be shorter and less painful, and therefore will not stop smoking. The midwife must explain that this is untrue and there are serious health implications to herself and her child. It is well-known that babies born with a low-birth weight are more likely to die in their first year of life, or require special educational needs during childhood (RCM 2003). Maternal smoking is thought to increase the risk of miscarriage. Abnormal placentation is a cause of spontaneous abortion of which is linked to increased blood pressure; an adverse effect of smoking (Stables and Rankin, 2010). However, research findings are inconclusive. Similarly, maternal smoking is known to increase the likelihood of sudden infant death syndrome (SIDS). Blair et al (1996) found that the risk of sudden infant death rose with maternal smoking. Postnatal infant exposure to tobacco smoke was also seen to increase the likelihood of SIDS. It can therefore be concluded that antenatal care that encourages smoking cessation during pregnancy and reduces exposure to tobacco smoke in the postnatal environment may help to reduce stillbirths and infant deaths. However, the link between smoking and SIDS is not directional as the causes of SIDS are not yet known. Considering the possible consequences of smoking in pregnancy, it is important that midwives offer help and support to women and their families to encourage smoking cessation. NICE (2010) has recommended that midwives should breath test pregnant women for carbon monoxide levels at booking and antenatal appointments. However, this method may be unreliable as carbon monoxide levels fall quickly in expired breath, and therefore is likely to fail to observe carbon monoxide levels associated with low-levels of smoking. Furthermore, such a test may be considered invasive as some women may not want to disclose their smoking status or. Many women may also feel discouraged to attend antenatal appointments in fear of being judged by the midwife if they have not, or do not want to quit smoking. This may prevent midwives from promoting health if they do not get to speak to, support and educate the women during their antenatal visits. Alternatively, all smoking pregnant women should be given guidance and referred to NHS Stop Smoking Services (NICE 2010). Such services are designed to provide evidence-based non-judgemental support to people who want to stop smoking. It is the responsibility of the midwife to refer women to another practitioner if their health or wellbeing would benefit from doing so (NMC 2008). This may include referral to an especially trained midwife to support pregnant women in stopping smoking. This may enable women to see the same midwife regularly, enabling a midwife-woman relationship to be formed. Therefore women may feel a greater level of support provided by the midwife; increasing the likelihood of smoking cessation. Yet a shortage of midwives may prevent this and instead become a barrier to the further improvement of effective health promotion and smoking cessation services. Successful smoking cessation not only involves educating pregnant women, but their families too. Ashford et al (2009) suggested that it is significantly important that a womans partner and family are well educated by health professionals about the effects of second hand smoke to maintain a smoke-free home to prevent postpartum relapse rates. It is the responsibility of the midwife to ensure that the pregnant woman and her family are aware of the psychological and physical effects of passive smoking. In response to this, a midwife may offer information to women and her family regarding nicotine replacement therapy to encourage cessation. Smoking cessation advice given with the provision of nicotine replacement therapy is a typical intervention in relation to the prevention health education domain of the Tannahill model (Sykes 2007). For most smokers motivation to stop smoking is key. Yet for many women and their partners the presence or planning of a pregnancy is sufficient motivation (Heggie 2006). However, in practice, the midwife may not only provide information about the health benefits of smoking cessation, but the social and financial too. Financial savings can be large and seen quickly, a possible appealing factor to stopping smoking. Socially, women may be able re-build relationships with non-smoking friends; a good source of support to prevent smoking relapse (Heggie 2006). Considering time constraints which often cause a barrier to effective health promotion by the midwife, discussions related to smoking may be brief or an information overload. The midwife may use visual aids such as leaflets, pictures and tables may improve the likelihood that the information is understood, hopefully improving the likelihood that the woman would choose to quit smoking. When encouraging women to quit smoking, the midwi fe commonly uses educational and behaviour-change models, to inform and encourage women to improve their lifestyle for the benefit of her own and the health of her baby. It is equally important that midwives provide pregnant women with information on diet and nutrition as well as smoking in relation to promoting health. It is essential that a pregnant woman has a good nutritional intake, prior to conception and during pregnancy as the developing fetus requires basic nutritional substances for the development of vital structures and systems (Stables and Rankin, 2010). It is generally advised that pregnant women should consume a balanced diet, rich in fruit, vegetables, dairy and starchy carbohydrates. A poor nutritional intake can lead to deficiencies which can cause fetal deformities. An example of this is folic acid; a vitamin essential for the development of DNA and the nervous system. A deficiency of folic acid in early pregnancy can lead to neural tube defects such as spina bifida. During the first 4 weeks of pregnancy, the neural tube is developing, which is often before a woman realises she is pregnant. It would then be recommended to take folic acid as soon as possible, up until 12 weeks of pregnancy, as well as eating a range of foods rich in folic acid such as leafy green vegetables, citrus fruits and fortified cereals (Hunter et al, 2003). Similarly, vitamin D is also important during pregnancy. Women who are not regularly exposed to sunlight or do not eat fish nor dairy, may have a deficiency in vitamin D. Vitamin D assists with the absorption of calcium, essential for the formation of the developing bones and teeth of the fetus (Hunter et al, 2003). However, a randomised control trial conducted by Abdel-Aleem et al (2009) concluded that there are no noticeable effects on fetal or infant growth born to women who received calcium supplementation during pregnancy. Yet, it is difficult to generalise these findings to western cultures as participants were from eastern cultures such as India, South Africa and Vietnam. In contrast, women who over-eat are also at risk during pregnancy. Obesity is becoming an increasing problem for women within the UK. The NHS UK obesity statistics (2010) state that in 2008 25% of women aged 16 and aver were classed as obese. Pregnant women with a Body Mass Index of à ¢Ã¢â‚¬ °Ã‚ ¤30 kg/m2 at the first antenatal consultation are considered obese (CMACE RCOG, 2010). In obesity, fatty deposits to build up within the arteries, causing blockages. This can cause hypertension, of which can increase the chances of preeclampsia; a hypertensive disorder of pregnancy. OBrien et al (2003) found that the risk of preeclampsia doubled in women with a greater pre-pregnancy body mass index. In response to many findings suggesting that obesity has adverse effects on pregnancy, it may be concluded that pre-pregnancy healthy eating advice and weight loss programmes may be beneficial. Due to the extensive effects that diet can have on pregnancy, it is important that the midwife addresses the importance of a healthy diet to women in her care. It is essential that midwives consider a womans lifestyle in relation to her diet. Many women may have a busy lifestyle where they are unable to regularly exercise and prepare meals with fresh ingredients; possibly a contributing factor of obesity. The Centre for Maternal and Child Enquiries and The Royal College of Obstetricians and Gynaecologists (2010) released guidelines in relation to the management of women with obesity in pregnancy. This allows specific guidelines for midwives to follow to provide extra support for women with obesity. Even though the guidelines focus on pregnant women with a body mass index greater than 30 kg/m2, the recommendations can be adapted for women whose body mass index is just below this obesity threshold if considered beneficial. The midwife should spend time during the booking interview to explaining the importance of specific nutrients in relation to her own and her babys health. NICE (2008) suggests that all pregnant women should be advised of the importance of folic acid supplementation prior to and during the first 12 weeks of pregnancy. All women should also be informed about where to get folic acid, which foods contain folic acid, and the recommended daily dose of 400 micrograms per day to prevent less-educated women from not accessing the supplement. Supplementation of pre-pregnancy folic acid is an example of the prevention of ill-health and disease domain of the Tannahils model that occurs in practice (Bowden 2006). Also, it is important a midwife explains which foods should be avoided and why. However, women may choose not to eat nutrient-rich foods because they do not like them. In response, a midwife should provide information on practice alternatives and changes to encourage a healthier diet. Again, this is an example of the behaviour-change and educational models in practice. However, some suggestions may be costly, for example, increasing fruit and vegetable intake or extra nutritional supplements. Hence the midwife should have an up-to-date knowledge of financial benefits that pregnant women can claim, to prevent less economically advantaged women in from being disadvantaged. Again, time restraints may be a barrier to providing health related information to enable women to make informed choices about their diet. Therefore the midwives communication must be effective to ensure that women understand the information. It is part of a midwives role to communicate effectively (NMC 2008). More than one form of communication is more effective in increasing understanding, than only using one (Kerr et al, 2005). In practice, the midwife may therefore discuss a nutritional need then provide leaflets and web addresses with references so women can access further information to enable their informed choice. In addition, during booking, the midwife provides a free copy of the pregnancy book to every woman. The book aims to provide extra information and support for expectant mums and partners, Different aspects of pregnancy are explained to optimise the health and wellbeing of the mother and baby. NICE (2008) states that all pregnant women should receive information regarding the importance of their own and their babys health during the booking interview and antenatal appointments. Often this includes discussing the womans smoking status, diet and the environment which effects this. This includes assessing a women and her baby, providing up to date and accurate information in relation to their health, and if necessary referral to other health related services. The midwife is responsible for updating her own knowledge and skills to ensure that women receive the most up to date care and information. When delivering effective care, the midwife must ensure that she treats each woman as an individual, with respect, dignity, and kindness to enable women to trust her midwife with her health and wellbeing (NMC 2008). In conclusion, the midwife has a vital role in promoting health in relation to smoking and diet. Smoking and a poor diet during pregnancy can have serious adverse effects on the mother and baby. Often the main point of contact during pregnancy, the midwife provides essential information and support to women and her family with the health of the mother and baby at heart. By adhering to rules, standards and guidelines the midwife can ensure that the care provided is of the highest standard. Midwives understand that each woman is an individual and her needs are assessed on an individual basis, with a non-judgemental, caring nature. It is essential that a midwife fulfils her role in promoting a balanced, healthy diet and lifestyle prior to and during pregnancy to improve the chances of a successful pregnancy outcome. Word count: 2839

Les Miserables :: essays research papers

Can we really say we know what a hard life is? The character Fantine in Les Miserables definitely had a hard life, with no breaks. She had a daughter who she adored and never got to see. She worked most of her life and always lived in poverty. Death came upon Fantine while she was in the hospital wishing only to see her child. First, working, for anyone is no easy task. It's especially hard when you have a child. Fantine felt very bad that she couldn't give her baby daughter, Cosette, everything she deserved. One day when Fantine was passing by an Inn she met a woman who had children of her own. Fantine asked if she could leave her child with them and would pay. With that done, Fantine moved on, leaving Cosette with people she believed would take care of her. This was so hard for her, for any mother, and she knew she wouldn't see her again for a very long time. Secongly, although Fantine didn't get to be with Cosette and raise her, she still had to pay for her staying with the better family (So she thought they were). They would make her pay more and more everytime saying Cosette needed more clothes or other excuses. Fantine of course would do anything for her daughter and sent more money, leaving herself dead broke and in poverty. She had nothing for herself, but she didn't care because she was giving her child "the best." She even turned to prostitution to make money. Finally Fantine, after working and doing anything to make money and still living in poverty, fell ill. She was hospitalized and Valjean would take care of her from time to time. Her only wish was to see her child she loved so much. She was only living to see her. Sadly, though, she died without ever getting to see her beloved Cosette. Fantine not only died miserable, sick and poor, but heart broken too. Les Miserables :: essays research papers Can we really say we know what a hard life is? The character Fantine in Les Miserables definitely had a hard life, with no breaks. She had a daughter who she adored and never got to see. She worked most of her life and always lived in poverty. Death came upon Fantine while she was in the hospital wishing only to see her child. First, working, for anyone is no easy task. It's especially hard when you have a child. Fantine felt very bad that she couldn't give her baby daughter, Cosette, everything she deserved. One day when Fantine was passing by an Inn she met a woman who had children of her own. Fantine asked if she could leave her child with them and would pay. With that done, Fantine moved on, leaving Cosette with people she believed would take care of her. This was so hard for her, for any mother, and she knew she wouldn't see her again for a very long time. Secongly, although Fantine didn't get to be with Cosette and raise her, she still had to pay for her staying with the better family (So she thought they were). They would make her pay more and more everytime saying Cosette needed more clothes or other excuses. Fantine of course would do anything for her daughter and sent more money, leaving herself dead broke and in poverty. She had nothing for herself, but she didn't care because she was giving her child "the best." She even turned to prostitution to make money. Finally Fantine, after working and doing anything to make money and still living in poverty, fell ill. She was hospitalized and Valjean would take care of her from time to time. Her only wish was to see her child she loved so much. She was only living to see her. Sadly, though, she died without ever getting to see her beloved Cosette. Fantine not only died miserable, sick and poor, but heart broken too.

Lean System Essay

Lean is a philosophy of manufacturing that emphasizes the minimization of the amount of all resources (including time) used in operations of the company. Operations processes are considered to be Lean when they are very efficient and have few wasted resources. The elimination of WASTE is actually the defining principle of Lean. By eliminating waste of all sorts in the system, the lean approach lowers labour, materials, and energy costs of production. Lean also emphasizes building exactly the products customers want, exactly when they need them. When lean capabilities are introduced in a firm, it can produce smaller quantities, and it can change outputs more quickly in response to changes in customer demand. The primary objectives of Lean systems are to: 1. Produce only the products that customers want. 2. Produce products only as quickly as customers want them. 3. Produce products with perfect quality. 4. Produce in the minimum possible lead-times. 5. Produce products with features that customers want, and no others. 6. Produce with no waste of labour, materials or equipment. 7. Produce with methods that reinforce the occupational development of works. Eliminate Waste Waste is anything that does not add value from the customer point of view. Storage, inspection, delay, waiting in queues, and defective products do not add value and are 100% waste. Seven Wastes: Overproduction, Queues, Transportation, Inventory, Motion, Over-processing and Defective products. Other resources such as energy, water, and air are often wasted. Efficient, sustainable production minimizes inputs, reduces waste. Traditional â€Å"housekeeping† has been expanded to the 7 Ss. Sort – when in doubt, throw it out. Simplify– methods analysis tools. Shine/sweep – clean daily. Standardize – remove variations from processes. Sustain – review work and recognize progress. Safety – build in good practices. Support/maintenance – reduce variability and unplanned downtime. There are four building blocks that contribute to the building of a lean system. When these elements are focused in the areas of cost, quality and  delivery, this forms the basis for a lean production system. They are: 1. Product design 2. Process design 3. Personnel/organizational elements 4. Manufacturing planning and control Product design : Each process is crucial and contributes to an effective lean system. Product design consists of standard parts (workers have fewer parts to deal with), modular design (an extension of standard parts, they are separate parts clustered together and treated as one unit), highly capable production systems with quality built in ( JIT requires highly capable production systems), and concurrent engineering (keeping engineering practices shouldn’t change to avoid disruptions).The fact that customers have unique needs makes it necessary for the producer in the manufacturing sector or the service sector to create products and services that contributes uniquely to the final customer’s requirements. All design activities have performance objectives that are important to all designs. These objectives are: A design should be of high quality; it should be produced quickly, on a dependent basis, flexibility and at a low cost. The three broad design categories, 1) the feasibility of the design, 2) the acceptability of the design, and 3) the vulnerability of each design option. Concurrent engineering-describes the process of collective product design by all affected functions in the organisation. Quality function deployment – is a planning tool used to fulfil customer expectations through a disciplined approach to product design engineering and production. Process Design: consists of small lot sizes (optimal one unit), setup time reductions, and manufacturing cells (specialized and efficient production centres, quality improvement, production flexibility, a balanced system (distributing workload evenly among the workstations), little inventory storage, and fail safe methods (incorporate ways to reduce or eliminate the potential for errors during the process). Lean systems have an extremely effective production method. Schedules must be communicated inside and outside the organization and Better sched uling improves performance and also Increases flexibility. Personnel/organizational: elements includes workers  as assets ( A JIT philosophy), Cross-trained workers (perform several parts of the process and operate several machines), cost accounting, and leadership/project management( a two-way communication process between managers and workers). Manufacturing planning and control: The last building block is manufacturing planning and control. It includes level loading,(achieving stable, level daily mix schedules) pull systems (work moves on in response to demand from the next stage in the process), visual systems (A kanban card used as authorization to move or work on parts), limited work-in-process, close vendor relationships, reduced transaction processing(logistical, balancing, quality, or change transactions), preventive maintenance and housekeeping(keeping the workplace clean and free of unneeded material. Improve employee communication. Identifying problems and driving out waste reduces costs and variability and improves throughput. Lean systems require managers to reduce variability caused by both internal and external factors. By pulling material in small lots, inventory cushions are removed; exposing problems and emphasizing continual improvement. Example Lean operations began as lean manufacturing which was developed by the automobile manufacturer, Toyota. Toyota was sensitive to waste and inefficiency issues. The goal was to eliminate all waste from the process. Waste was identified by them as anything that interfered with the process or simply did not add value. Companies began adopting the lean approach and to do so realized that they had to do major changes in their organization and with their culture in the organization. Lean methods have demand-based operations, flexible operations with rapid changeover capability, effective worker behaviors, and continuous improvement efforts. JIT system stands for a Just-In-Time system. It represents the philosophy that includes every aspect of the process from the design to after the sale. JIT is a highly coordinated processing system in which goods move through the system, and services are performed just as they are needed. First, management should decide if JIT is a compatible method for the company. JIT is best used with companies that have repetitive operations and a stable demand. The first step is planning the conversion to JIT. Managers need to  be involved in the process and understand the commitment needed. The next step is to begin working only with suppliers who support the JIT system. The biggest obstacles faced are management, worker or supplier disapproval, and also changing the culture of the company. Inventory is at the minimum level necessary to keep operations running. JIT Inventory Tactics: Use a pull system to move inventory; Reduce lot sizes; Develop just-in-time delivery systems with suppliers; Deliver directly to point of use; Perform to schedule; Reduce setup time; Use group technology. Different from JIT in that it is externally focused on the customer: Starts with understanding what the customer wants: Optimize the entire process from the customer’s perspective. The main benefits of lean operations systems are: 1. Reduced cost through reduced inventory levels 2. Higher quality 3. Reduced lead time 4. Increased productivity 5. Reduced amounts of waste Inventories should never be used as the solution to fix machine malfunctions. One method that JIT systems uses to minimize inventory is to have suppliers deliver goods directly to the production floor. Overall, carrying low inventories offers many benefits such as less carrying cost, less space needed, and less rework to complete in case of a product recall. Lean systems can also be referred to as â€Å"just-in-time† (JIT) systems. The object of a lean system is to create a system that is demand driven, and provides supply based on demand at any given point. Lean systems tend to concentrate on waste reduction and have continuous improvement.

Essay On Christing - 762 Words

He struggled to remain engaged in conversation with his men, and his gaze kept shifting to Guinevere. Something about her seemed†¦off. She smiled and responded to questions, but something about her facial expression hinted she was in discomfort. Smiles did not quite reach her eyes, and she rolled her neck like she was suffering from a mild headache. Alis took Guinevere by the arm away from the group and whispered something in her ear. Her hands sliding to her belly, the queen nodded and winced. Arthur was just about to approach when Guinevere giggled and Alis rubbed her back. Perhaps Guinevere’s back ached, as it had of late, or she had indigestion from the rich meal. â€Å"Sire, did you hear what I said?† Gawain gestured with his tankard†¦show more content†¦Ã¢â‚¬Å"Fetch Mary, someone start boiling water, warm blankets before the fire, and†¦whatever else needs to happen, make it happen,† he told no one in particular. â€Å"Please, Arthur, don’t go into a frenzy,† said Guinevere. â€Å"It’ll be fine.† â€Å"Sire, come with us.† Perceval gestured to the door. â€Å"Well pass the time in the meeting chamber down the corridor for your rooms. That way, you’ll be close by when your child arrives.† Arthur hated it when he could not control a situation, but since he was not a midwife, what was there left for him to do? It was not as if he could offer his expertise. However, he could offer his wife support during this painful time, but Mary had expressed to him (repeatedly) that his presence in the birthing chamber was not â€Å"desirable.† Perceval had been in the room for his son’s birth and passed out, which caused quite the disturbance. Ulrich had barged his way into his child’s birth, too, and had been decidedly more stalwart, but Mary had grown fed up with men in her way while she worked, and Arthur did not want to irritate one of the two women who would be responsible for seeing his child into the world safely. â€Å"Come along, sire,† Gawain urged. â€Å"No need to be so tense.† â€Å"Really, Gawain?† Drea rolled her eyes. â€Å"If my time comes, you’ll be docile?† â€Å"Wallace and I will be in the tavern, where we belong.† â€Å"Rubbish,† said Ulrich. â€Å"You’ll be pacing the corridors, sweating and having to be propped up by me, Perceval, and Lionel.†