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African American Teenage Primigravidas

A research approach to adolescent pregnancy and clinical research on prenatal care appointments for the pregnancies 1- Inability of teenagers to keep prenatal appointments, has led to many problems including low birth weight infants, and an increase in infant morbidity and mortality Infant mortality among teenage parent families is on the rise due to their inability to afford, keep and consistently consult with paediatricians about prenatal appointments. Research shows a decline on healthy infant’s amongst teenage parenthood class.

Paediatricians diagnose low weight, and increase infant morbidity in these infants, most of which is associated with teenage ignorance and misinformation about the importance of prenatal and antenatal appointments. Paediatricians report fewer teenage prenatal appointments on a day to day basis. The problem is likely to escalate due to increased population, decline of social welfare and increasing poverty in the low-earning class citizenry (Besharov, 1996). It is difficult to afford good healthcare due to an expanded population and low wages within this society.

A decline on the learned youths is adversely affecting the social balance. More Hispanic youths are dropping out of school, especially males. The effects on the society are more poor families, crime rate increase and joblessness. A steady decline on stable families and the many unlearned and jobless children is affecting the national economic stability. The increased populace is making healthcare and other important amenities to be un-accessible to the increasing poor. Subsequently there will be more children, the poor and the aged in the population that the stable workers (Sandra Yin 2006).

These demographics explain the increased mortality in teenage borne infants. The need for a clinical approach to understand what causes this ignorance has been ongoing. The social perspective of teen parenting is also being investigated so as to give the society a responsibility so as to safeguard the social interests on the young people. However, much pedagogy reflects on irresponsible sexual behaviour and related ailments and physiological factors as the lead causes of the inability to keep appointments.

Though the cost of healthcare is rising and a decline of social welfare and charitable and community based welfare has been unable to meet the rising numbers of needy people, there are more factors that need to be investigated so as to identify and help in arresting the problem. 2. Significance of the problem (its relevance and importance to clinical practice). The question most doctors are asking is why the prevalence of the teenage parents is on a steady increase at a time when information and knowledge is readily available.

A research approach points out related sexual problems that come along the pregnancies lead to the inability to keep prenatal appointments. According to David & Ken, Sexuality has become an integral aspect of life in adolescent youth in urban settings. Increased sexual activity within this age group has increased and the implications are diverse. They include unwanted pregnancies, venereal infections and physiological problems related to intimate relations and their implications.

In context, escalation of moral decadency and the overt-ness of sexuality in adolescent urban youth is causative of social problem with wide spread implications on family. The rate of underage parenthood is substantial and is marginally on the rise. The age bracket of these young sexually active and assertive youths is from within the age bracket of 13year olds and above (David & Ken 2007) An investigation on cause so as to offer a clinical solution is needed.

Clinically, understanding the problem is important and practitioners will be able to address the problem in a precise clinical or physiological manner. It’s not that, clinically, the healthcare and prenatal counselling and medication is in away different from that of the adults, the problem is based on the physiological aspect of the situation. Clinicians and public-health workers argue that the methodologies used to prevent and respond to health problems in adults need to be tailored to meet the special needs of adolescents.

The Department of Child and Adolescent Health and Development (CAH) has initiated a series of literature reviews and discussion papers, in order to identify existing recommendations on clinical management, and to assess how appropriate these are for adolescents across a wide range of health issues. This process has also led to the formulation of new recommendations on clinical management where none existed, or where existing ones are inappropriate. Practitioners and other clinicians seek to identify the aspects of pregnancy in the adolescent so as to show special problems and any type of vulnerability to disease and complications.

This will offer a proper guideline on how to address and give proper recommendation on clinical management of teen pregnancies as well as how to manage special needs in adolescent pregnancies. 3. Brief Introduction/Background about teen pregnancies and prenatal care Adolescent pregnancies have become a very important health issue across social-government institutions. Prenatal care guidelines stipulate that it is important to have regular checks and proper medication during pregnancy so as to have a healthy pregnancy and baby.

However, adolescent girls seem not to take this seriously and a big percentage does not attend the prenatal clinics for these regular checks. Teen pregnancy is classified as pregnancy of a woman who is below the 20yr mark though the most correct classification is below 18yrs, since a multi cultural approach shows that communities have married off their 16-12yr old girls. This is seen in Africa, Asia and Middle East where marriage age has not been an issue. In fact today communities still marry off their underage girls. The number of teen pregnancies in the West has sharply increased due to increased teen sexual intercourse.

Exposure to diverse cultures and trends has made sexual affluence in the teens to become dynamic and has aggravated social values. An examination on socio-economic aspects of the causative factors of teen pregnancies Bongaarts & Cohen,(998) argue that the sharp rise correlates to low-income families. The independence in the young children is a lead factor and the subsequent exposure to sexually explicit issues lead to sexual intercourse and then pregnancies. A lot of time is spent in school amongst adolescent boys and girls (Bongaarts & Cohen, 1998).

Such increased spending of time together has made adolescents less dependent on parents and family. 4. Research Question Clinicians are seeking to identify the cause of inability of teenagers to keep prenatal appointments which has led to many problems including low birth weight infants, and an increase in infant morbidity and mortality. The perspective is hypothetical since there are two approaches to the problem. The question is based on why do teen expectant girls fail to keep prenatal appointment and the subsequent high infant mortality, morbidity and related clinical problems.

5. Purpose According to Cosey and Bechtel, argue that teenage pregnancy is a multifaceted problem that adversely affects the health, social and economic fabric of every community. The purpose of research is to identify the aetiologies that contribute to teenage pregnancy and how well teenage pregnancy can be managed. On a cross cultural context, teen pregnancies are on the increase but clinical respite is still not available and the expectant teen mothers are not participating in propagating healthy pregnancies.

To understand this context and seeking methodologies to address the problem is important, basically so as to help infants and the young mothers participate in socio-economic activities and also continue in their education. The need for support by family, a clinical-physiological help and a welfare policy on the problem is increasing taking centre stage. Cultural and social values inhibit these unwanted pregnancies. Research also seeks to identify if there is a connection between the lack of keeping prenatal appointments and these cultural perspectives.

Could there be isolation, abuse or some kind of stigmatization that could be demoralizing the teen age expectant mother? Cosey and Bechtel investigated the impact of healthcare delivery system on the pregnancies. The conclusion made is that, critical healthcare deficiencies are throughout the community and that more diverse problems are facing the teen mothers These perspectives are the purpose of the research. A broad view on the needs of the teen expectant mother and the family support hence become integral in the research. 6. Neonatal intensive care unit (NICU) and teenage pregnancies

According to Cosey and Bechtel, providing adequate and proper health education and encouraging supportive networks can ultimately lead sexually active teenagers to recognize the benefits of health-promotion and risk reduction behaviour. Spence and Adams point out that adolescent pregnancy is a major issue, that many problems are identified with adolescent pregnancy. These health problems include multiple physical, emotional, financial and social complications experienced by young females. Use of prenatal care services helps arrest some of these complications.

NICU nurses have relevant knowledge on identifying and diagnosing these problems. Geromius explains that, although the use of prenatal services prevents some of these problems, most adolescents tend to under use these services risking infants’ life as well as their lives and health as well. (Geromius 1983) Prenatal clinics help in diagnosis and maintenance of a healthy pregnancy. In most healthcare institutions, assessment of pregnancy condition is done through the participation of the nurse and a clinician who prescribes and refers a case to the proper medical of facility once diagnosed with a condition.

Past research on nursing in prenatal care revolved around the services so as to help in development of proper frameworks and better maternity facilities and healthcare disciplines (Lane& Kelman 1975). This has now encompassed quality of education about nursing and how to properly administer treatment to cases of severe complications during pregnancy and saving the life of the infant. Interventions by community health nurses to involve family members in all aspects of birthing and parenting can be essential in promoting positive health outcomes (Bechtel, 2001).

Pregnant teenagers are scheduled on specific days of the week in an effort to optimize the educational and social support resources available to them as well as their obstetrical/medical care. More than 90% of teens attending the “Teen Pregnancy Clinic” for prenatal care are able to and are encouraged to continue to pursue their education throughout pregnancy. Nurses have since the 60’sbecome confidants of many gynaecological problems, women tend to trust nurses due to their ability to give prescriptions, saving the woman the pains of being examined by a doctor and her case being known.

The same case applies on the teen pregnancy. Nurses have successfully recognized major problems which make the teen expectant mothers to ignore prenatal clinics. There reasons vary with background of the teenager and the circumstances in which she got pregnant (David & Ken 2006). Various reasons include rape, family/friends/parents abuse, stigmatization, fear, intimidation, lack of money to afford travelling to a hospital, worry over the eventual delivery and the repercussions of early motherhood, frustration and self blame, remorse and denial.

(Duxbury& Adams 2003) nursing has made its most important contribution to the improvement of care for mothers and babies. After delivery teen mothers have shown to develop depression, according to neonatal intensive care nurses, these mothers develop postpartum depression in comparison to adult mothers. Nurse’s proficiency in diagnosis and treatment of postpartum depression is not very consistent within a vast percentage. This is based on facts and respondent response to a survey on their ability to understand and diagnose postpartum depression in new mothers.

Research on nurse’s abilities in postpartum depression is varied. Clinical assertions, facts and treatment preferences about postpartum depression define PPD as a problem with diverse levels of effect, and that its symptoms and are varied. The severities of symptoms define the severity of the postpartum depression. The PPD is, within clinical arguments a crippling emotional problem. The nurse’s perception about the disorder is that, though there are major milestones in diagnoses and screening of the disorder, the PPD remains still un-researched and under-diagnosed.

The same approach is used on the teen pregnancy clinics. Emphasis on proper diet, proper medication and any physical well being is given more emphasis so that the foetus and the mother are healthy throughout the pregnancy 7. Hypothesis Research on why teen women who are expectant don’t keep prenatal appointments has become a subject of intense discussion. Secondly, the family and societal help in supporting the teen-to be mothers is sought to be established so as to address the checks and balances within the hypothetical context.

The Clinical assertions all which base their approach to nurse’s knowledge about the problems faced by these teens reflect of various aspects of socio-economics. A survey on this hypothesis shows the relationship between family and social factors causing variations in pattern and correlation of prenatal clinics. The survey investigates the power and basis of the family social support system compared to non-family support systems. The outcome of the research portrays significant difference in social support contribution amongst who were able to get proper prenatal care and counselling and those who did not.

The contribution of family and society in supporting the teen age pregnancy is seen to be high than that availed from non-family welfare support. The overall conclusion is that healthcare and social welfare auspices and nurse when involved with the family support can bring forth a very healthy pregnancy (Cosey & Bechtel, 2001). The society needs to play a more significant role during pregnancy. The significance of social support for the occurrence of health implications during the pregnancy have been investigated also. Outcomes after delivery show that more support during pregnancy helped in a healthy baby (Turner, Grindstaff & Phillips 1990)

Socio-economic factors are seen as integral in sporadic or zero attendance of clinics. Socio-economic background of these teen mothers is seen to influence the relationship between social support and both infant and mother outcomes (Turner, Grindstaff & Phillips 1990). Increased teen pregnancy is described as endemic, yet it represents a social problem of great magnitude. (Grindstaff ,1988) argue that education, social-economic background and diminished family success are causes of discouragements to attend prenatal clinics.

(Lane & Kelman, 1975) argue that, the need for prenatal consultations and clinical appointments is more important since health and health-related services that are required to safeguard the health of the infant and the mother minimize the consequences of pre-existing health hazards and conditions, subsequently improving the health of these women. Geromius (1983) questions the pattern of prenatal clinics. It requires investigation and a comprehensive solution. Ignorance or complete lack of knowledge about the use prenatal services is questionable.

Geromius attributes it to lack of support by family and society and also lack of information. He argues that, although prenatal care prevents major problems in pregnancy, most teens do not use the services. Childbearing by teenagers produces a host of negative outcomes for many children and families, including consequences that may endure for generations and impose heavy costs on society as a whole. Compared to children whose mothers gave birth in their twenties, the children of adolescent mothers are more likely to become adolescent parents themselves, drop out of school, and rely upon public assistance to support their families.

This ideology correlates with (Spence & Adams, 1997) argument that more problems are related to teen pregnancies than seen within the elementary context of the problem. 8. List of Independent and Dependent (outcome) variables as well as any other ambiguous terms in the Research Question which must be defined. a. Independent variable: Adolescent expectant girls don’t keep prenatal appointments b. Dependent or outcome variable: Family and societal systems support to the teen-to be mother’s c. Additional terms that must be defined –

Socio-economic background of the teens. 9. Conceptually and operationally define each term listed in # 8 above. Give the conceptual definition first, followed by the operational definition. Conceptual definition of why adolescent expectant girls don’t keep prenatal appointments Ignoring visiting prenatal clinics and appointments so as to be checked and advised on proper diet, exercise as well as be examined and checked for disease and foetus conditions so as to diagnose a condition or health risk that could be impending or existing.

The clinics are important and should be emphasised so that the pregnancy can be maintained and the health of both the infant and the mother is maintained. The importance of the clinics is integral in the young mothers physiological health and should be encouraged. Operational definition of why adolescent expectant girls don’t keep prenatal appointments Teen expectant girls fail to keep prenatal care appointment due to various factors which clinicians and stakeholders are seeking to address so as to avoid increased infant mortality, under-weight infants and related problems

Various factors including information, stigmatization, family and social problems are connected with the problem. Clinicians and welfare stakeholders seek to identify these factors so as to sensitize the family and the expectant mothers on the importance. Conceptual definition of Family and societal systems support to the teen-to be mothers Support during the pregnancy to the teen to be mothers is seen as very important in context. Family and social support forms the basis of self confidence and ability of these to-be mothers to continue with their normal lives after delivery.

Studies show that teen-to be mothers who get attention and support from their families get healthy kids and are able to continue with their studies and consequently live normal lives, while those who do not, develop complications and give birth to unhealthy kids. Operational definition of Family and societal systems support to the teen-to be mothers Paediatricians claim that family support and social welfare of teen to be mothers has shown considerable contribution to the health of the pregnant girl. Support and care has shown that attitude towards prenatal clinics.

The family and societal support if positive has contributed to the to-be mothers attend and keep prenatal appointments while negative reception and demoralizing and unsupportive family and societal support has shown negative attitude towards clinics and keeping prenatal appointments. The need to identify the varying support and how it influences the teen to be mothers requires to be well established so as to form proper physiological and clinical approaches to the teen-to be mothers and help the keep prenatal clinics for their own health sake. Socio-economic background

Socio-economic background of the teenage girl contributes greatly. She cannot raise money to afford healthcare, transport and medication. Poor teenage girls have been the most affected with the problem. Those from the poor back ground are prone to pregnancies due to factors like sexual intercourse for money and small favours, molestation by boys from rich back grounds, rape and other forms of abuse. The fear and lack of support to report these crimes against these young girls leads to their silence and inability to keep prenatal clinics. 10. Assumptions

A Family Health Program can be a model methodology/plan to proffer and commit to improving health, social, and economic conditions of the pregnant teenagers. This model can comprehensively address family planning; give education so as to make these girls to be sexually responsive after delivery and in their normal lives. The model will facilitate and create encouragement of the society and these teenagers to seek loving and stable relationships. The model traverses counseling these teenagers about abstinence and avoiding any more sexual relationships after delivery.

The system advices on use of proper family planning methods and how to use contraceptives until these young people mature enough and become committed and responsible people so as to take up responsibilities as parents. African-American births show difference in births based on the teenager’s background. Most of these teens need to be offered counselling on the importance of the prenatal care. Counselling should be through community nurses and in the intensive care nursing units during and after delivery.

. 11. (Delimitations) for the subjects/participants in the research Inclusion NICU nurses Family members of expectant teens Mother to be teens Exclusion Community members Healthcare facilities Healthcare providers 12. Proposed Research Design The easiest way to get satisfactory results on the research is through approaching the participants above and involve them in the research through sampling their most profound perspectives and knowledge about the teen pregnancy and prenatal clinics.

Their views and perspectives through sampling them collectively will offer a sufficient large data sample which can have sufficient evidence on cause, diagnosis and treatment procedures methodologies. By referring this sampling as the social explanations, we will be able to account and prove each factor relatively and how it affects or affected a case.. Though social accounts do not sufficiently account for the clinical-physiological problem, we will have a concrete background on our conclusion on socio-economic background of cases and how this affects keeping prenatal appointments.

Such an understanding can significantly strengthen intervention efforts. A questionnaire with relevant questions reflecting on insights about teen pregnancy and prenatal appointments has to relatively encompass what is the view of these delimitations knowledge on poverty and teen age pregnancy, prenatal appointments and clinics,, nutritional supplements for pregnant women and those that can be adapted for the teen pregnancies, physiological perspectives on teen pregnancy.

All these perspectives are the determinants of the sample data accuracy and relevancy of the data. The research design is meant to identify ways to lower the rates of health problems on both the infants and the parent. The general view is that, there are sufficient health facilities which offer satisfactory services before and after birth (Institute of medicine, 1988). 13. Rationale for proposed research design The rationale of the research and its objective is to ensure that all expectant teens have access to regular prenatal care.

Through identifying all problems that result to these expectant teens from making it to prenatal appointments, the research will comprehensively address these problems and highlight solutions or create way to a methodology of resolving these problems. These teens who fail to access these services and also fail to keep appointments give birth to low weight babies. This is attributed to the mother’s body weight during pregnancy. (Casey foundation, 1999) found out that a mother’s medical condition during pregnancy influences greatly, the health of the infant.

The condition during pregnancy influences birth weight, especially if the mother had high blood pressure, diabetes, bacteria infections, and kidney, heart or lung problems. All these problems lead to an abnormal birth, infant death after birth, or malformation of the infant. Regular clinics diagnose abnormal infants, uterus, cervix and uterine problems. (Alexander & Korenbrot, 1995) This research will seek to identify what is the correlation of infant mortality, morbidity, low birth weight and other infant problems to zero prenatal care in expectant teenagers. 14. Limitations of the research

Key elements of societal shift of perspective on teen sexual behaviour in teenagers have seen roles of parents and social welfare auspices become less influential. Adverse implications on urban environment and the youths are diverse. Health, financial ability and future ability and to be responsible parents, and productive and discipline oriented personalities whose children and other members of the society can emulate and reckon upon is now questionable and beyond reasonable doubt not possible. All these problems are related to social cultural and economic transformations.

Socio cultural and economic transformation has been developing through various economic phases which are part of the diverse development. The transformations implication affects the society subsequently drawing conflicts. The social conflicts are profound and based on diverse interest. Morally the intimacy shown and experienced within this age frame and group is carried forward to future relationships and finally to marriage which is a sovereign institution. The intimacy consummates to perverseness and an uncontrollable lust that manifests itself within the lifespan of the human and becomes habitual.

This cannot be within marriage and subsequently divorce and impromptu negative attitudes and repercussions within such an institution. Financially, the responsibility of young parents is doubtful based on the fact that intimacy is an act triggered by sexual instincts which are biologically ideologies and stimuli based on animalism. (Boss, Doherty, LaRossa, Schumm, & Steinmetz, 1993), the position and the manifest within the youth means it is not a responsible sexual and that within the intricate position, continuity of values and proper moral uprightness is not contentious but doubtful in the case.

However the repercussions are grossly worrying with the rise in crime and immoral youngsters reining the social circles. While these are the basis of the prevailing teen pregnancies, we cannot reach their roots to their diversity. They do not fall under our clinical approach of the research and also, because, they fall short of being admitted to our objective which is prenatal care to teen mothers so as to reduce complications and maintain healthy infants while at the same time, incorporating these teen mothers into our education system and make them able and educated members of the society.

While there are quite a number of legislative ideals put in place to address the prevailing teen pregnancies, escalation of youth sexual behaviour, decreased labour and wage opportunities, the socio-economic perspective remains the most poignant part of the research since its broad and involves aspects of family and societal support and ability in the support. 15. Potential significance of the proposal to Nursing practice

Nurses who have relevant knowledge on major factors leading to teenage pregnancy and the teenagers lack of keeping prenatal appointments will be able to significantly contribute in giving proper counselling and a better approach to the problems that come along with lack of attending the clinics. Practicing nurses can help in pre-conception counselling ad care so that birth outcomes, including birth weight and general health condition of the infant are well known to the to-be mothers.

This will help in the young mothers having knowledge on proper sex practice, nutrition and medication and how to cope with motherhood. Nursing research Based on a socio-economic perspective, nurses will have the ability to understand and confide with the teenager about her problem. Efforts to expand healthcare and prenatal services access focuses on areas where socio-economic potential is minimal. Nurses can be able to identify cases of poor backgrounds and diagnose problems and any physiological problem in the young girl.

In the African-American society, people living in poverty, high school dropouts and young adults have most of their sisters, daughters and teenage girls exposed to pregnancy. Nurses with relevant expediency can easily identify these problems. Nursing education Learning about teen pregnancy will promote nurses proficiency in counselling and helping any health or physiological problem the nurse diagnoses. 16. Literature review Teenage pregnancy refers to pregnancy in a woman of 10–19 years. In most statistics the age of the woman is defined as her age at the time the baby is born.

Because a considerable difference exists between a 12- or 13-year-old girl, and a young woman of 18-20 years, often, the difference of adolescent and teenage should be established and understood, adolescents aged 15–19 years, and younger adolescents aged 10–14 years (Konje et-al). This understanding of teen age creates room for research and comprehensive coverage of the area which is relevant to the research. Outcome of teen pregnancies have led to various clinical problems which need to be addressed through an awareness campaign on need to attend prenatal care clinics regularly.

Maternal morbidity has been diagnosed as very high in teen deliveries. This is low in developed countries but commonplace in low economy backgrounds The maternal mortality ratios in adolescents (<20 years) and non-adolescents were approximated from an analysis of mother’s age in all births in the same period. The maternal mortality ratio among adolescents was 387 per 100,000. As such, as described by Kwast & Liff (1988), young maternal age as such need not be a predictor of maternal death if other factors like health and physiological risks are taken into account.

Low weight births have been attributed to low pregnancy weight. Identifying proper clinical attention based on the findings of the research would contribute to minimizing low birth weights. The research detail based on the trial to assess the number of teens who visited clinics to get counselling and check ups show that, there is minimum correlation between the number of visits and the overall outcome of the pregnancy (Villar et al. , 2001). The recommended numbers of visits are four however; the clinical perspective is that, diagnoses during the visits determine the health perspective of the pregnancy.

The argument is that, what is diagnosed n time is what matters, not the number of times the teen visits the clinic. It’s within this context that prenatal care is highly recommended since it’s within it that a problem affecting the teenage pregnancy is arrested and taken care of. Adolescent girls are at increased risk of a low-birth-weight infant compared with older pregnant women. Makinson (1985), Cooper et al. (1995) found more low birth weights infants in very young (10–14 year-old) adolescents, however; Fraser et al.

(1995) found more low birth weight infants in adolescents collectively. As such, prenatal appointments, all which keep track of the woman’s weight gain or loss, blood pressure, infections and any ailments, obviously will arrest any low birth weight case early enough and rectify the problem. Refusing to keep prenatal appointments risks the infant and the mother’s health, and eventually a low birth weight is observed during delivery. 17. Setting Research covers the following Area of socio economic background of teenagers

Teens from rich backgrounds can afford to visit and access proper healthcare during pregnancy. This is based on the perspective of family support. It is observed that, fewer teenage girls from rich back grounds fall pregnant. Teenage girls from poor backgrounds are prone to teen pregnancy. They are easily abused, sexually assaulted, molested and cheated into pre-age sex. Lack of resources to take care of the pregnancy, money to afford prenatal clinics, or bus fare to travel to a obstetrician are not available making the expec

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