Discussion Postings on Reproductive Plan

There are three discussion postings from three separate individuals about Reproductive planning...you are to evaluate their postings and determine whether you agree or disagree with what they have said. If you agree (why) or if you disagree (why)Please label you response to each as one, two and three. 1)Hi Sherlonda, Good post! Giving the legal and ethical definitions was really a good way to sum this up. Wish I had thought of it. This is why I really like the discussion boards, it helps me to see the same information from different perspectives. It is important to keep these implications in the forefront of the plans we make for our patients. The Reproduction Life Plan is a really great pro-active tool for the empowerment of individuals to make informed choices that reflect their personal desires, wants, and needs in relation to their own reproduction. I kept reading materials and websites on this topic and thought to myself that it only was addressing half of the story. I finally took the time to listen to Merry-K Moos's webinar and found the part that I thought was missing. Nearly all of the information on this subject deals with women and their reproductive wishes. Granted most of the health issues associated with unplanned pregnancies are directly related to the females so I could understand the emphasis being placed on women's health with the RLP. I kept thinking though that this played into the age old cultural bias that an unwanted pregnancy was all of the woman's fault and was disappointed that the healthcare community seems to play into this by default thru not addressing or making it a priority to address that males can have just as much control over their reproductive status as women can. Ms. Moos was one of the experts who designed the RLP. She states that this is designed to be used by males as well as females. She acknowledges that there is little emphasis placed on it or research done on it but that males can benefit from having a RLP as much as females. What are your thoughts on this? Lori Hall 2) The role of the nurse in helping the individual to develop a reproductive life plan is to initiate the process with individuals who are not familiar with it. They encourage the use of the process because it is the start of an ongoing plan and educational topic. Nurses need to assess for the current status of the patient's health literacy, implement interventions to meet the patient's health literacy needs with educational materials, and assure that the patient is participating in the plan along with adherence. The best time for the nurse to initiate the development of a reproductive life plan is at the point of care when seeing a health care provider for any reason. Additionally, women can create this plan for themselves without the help of a health care worker. After a sexual partner or spouse enters a woman's life, she needs to make sure to keep the lines of communication open regarding the reproductive life plan from both his and her perspective. Personal goals and considerations affect a person's reproductive life plan because the plan aids people in looking towards the future and in planning out what that individual person needs or wants to accomplish before they have children or not, the financial standpoint of where they want to be before and after childbirth, consider their age and/or health status, the education needed to use proper contraception before and after childbirth, and what roles the individual expects from themselves and their spouse or sexual partner. Having a plan before childbirth aids people in following that plan to their best ability, that way if someone conceives off of their plan, then they already know what their plan of action is and just need to revise it to fit their needs at that time. Some barriers that the nurse might encounter include social, cultural, religion, lack of a support system, language (different one or even signing), the lack of resources available regarding health literacy, lack of health insurance, knowledge deficit, and the decreased amount of time the nurse has to initiate and complete a reproductive life plan in one office visit. Legal and/or ethical implications of a reproductive life plan include that most state funded health care plans do not cover preconception visits which are in need in order to develop a reproductive life plan, and with the combination of increased unemployment rates and increased lack of health care insurance coverage is contributing to the rise of infant mortality rates, unplanned pregnancies and late entry into prenatal care (if any) in individuals who do not have the means necessary to develop a reproductive life plan. 3)A Reproductive Life Plan (RLP) is a tool that is used to represent the individual's personal values, goals, and preferences for pregnancy. Merry-K Moos (2010) identifies the plan as fluid and dynamic and without assumption or bias from the healthcare provider. The RLP represents a change in the way that reproductive planning is to be perceived by health care professionals as well as individuals. Instead of looking at contraceptives as a means for preventing pregnancy the emphasis is for the individual to be empowered to plan for their reproductive goals and to have a means to take control of their reproductive choices (Moos, 2010). Reproductive Life Plans are not intended to be used only by females. They are designed so that both males and females will be able to have control over their personal reproductive wishes. -What is the role of the nurse in helping the individual to develop a reproductive life plan? 1. The role of the nurse in the helping the individual to develop a reproductive life plan is started with the Centers for Disease Control questionnaire provided below that is non-bias, open-ended, and multicultural. It asks the following questions and provides input to the healthcare provider as to the rationale supporting it (CDC, 2012): Do you plan to have any (more) children at any time in your future? IF YES: -How many children would you like to have? (Encourages the person to consider that there is a choice about the number of children one has.) -How long would you like to wait until you or your partner becomes pregnant? (Encourages the person to vision their own future.) -What family planning method do you plan to use until you or your partner are ready to become pregnant? (Gives the patient an opportunity to formulate and communicate a personal strategy.) About half of all pregnancies in the United States are unplanned. Slightly more than half of unintended pregnancies occur among women who were not using any method of contraception in the month they conceived (CDC, 2012). Moos (2010) describes this as 49% and points out that just because a pregnancy was unplanned does not mean it is unwanted – just mistimed. The purpose of the RLP is to help women and men to understand that even pregnancies that are wanted (after being unplanned) can have health problems that could have been avoided if they had been planned with the advice of their healthcare professional). -How sure are you that you will be able to use this method without any problems? (Encourages the patient to recognize that methods can have problems and to consider matching method choice to personal circumstances.) B: IF NO: -What family planning method will you use to avoid pregnancy? (Gives an opportunity to formulate and communicate a personal strategy to achieve plan.) -How sure are you that you will be able to use this method without any problems? (Encourages recognition that methods can have problems and to consider matching method choice to personal circumstances.) -People's plans change. Is it possible you or your partner could ever decide to become pregnant? (Relays the message that plans can change and that it is okay, but deliberate decisions about becoming pregnant are possible and desirable.) 2. The second and equally as important role of the nurse is to help the patient identify ways in which he or she can implement or modify the plan for implementation. It is not enough for the patient to identify his or her RLP they need to be given the tools (education, referral to services, health assessments, counseling, etc) to be able to enact their plan or modify it to be a viable part of their life. -When is the best time to develop a reproductive life plan? The best time to develop a reproductive life plan is anytime the nurse or healthcare provider has the opportunity to assess the patient who is of reproductive age (Moos, 2010). It should be brought up as early as the teen years, but is effective at any stage of life after that. Peoples needs and desires change throughout their lives and the RLP should be re-visited periodically to insure that it is still viable for that individual (Moos, 2010) -How do personal goals and considerations affect a person's reproductive life plan? The RLP should be totally based on the individual's personal goals and considerations. This applies whether the person developing their RLP is male or female. It is designed to empower everyone to have a plan and the tools to insure that their personal reproduction goals are met. It is the healthcare provider/nurse role to help them with achieving realistic and obtainable goals. -What barriers might the nurse encounter? Some of the barriers that have been identified are Cost of services, Limited access to publicly funded services, Limited access to insurance coverage, Family planning clinic locations and hours that are not convenient for clients, Lack of awareness of family planning services among hard-to-reach populations, No or limited transportation, Inadequate services for men, and Lack of youth-friendly services (Healthy People 2020, 2012). Just as important though are the barriers that come from lack of understanding the need for RLP, personal bias, social perception of the role of sex (recreational versus pro-creational),as well as personal acceptance or realization of need for reproduction responsibility. -What are the legal and/or ethical implications of a reproductive life plan? The first ethical and/or legal implication that comes to mind is possible bias on the part of the healthcare provider or perception of bias by the healthcare provider by the patient. It would be very easy for assumptions to be made about personal reproductive wishes by the health care provider. For example a woman has 4 children and is 40 years old and the health care provider assumes she does not want more children or that she is somehow irresponsible if she does want more children. Nurses and other healthcare providers need to be on guard against their own personal opinions and insure that advice they are giving is not based on bias or opinion. Another unfortunate implication is due to the lack of follow thru on a person's RLP. If a person goes to the trouble of thinking thru a RLP and it stops with the questionnaire they may feel their wishes are devalued. Just getting a person to use contraceptives is not the goal of a RLP. They goal is to have people actively involved in making informed decisions about their reproduction status. The last implication that I thought of is that healthcare providers need to be cognizant of is that the RLP is meant to be fluid and changeable as the wishes of the individual changes. We don't want to pigeon hole a person into a one-time plan that they must persevere thru. Instead, make them aware that it is okay to change contraceptive methods if they don't like one type or decide to move up or postpone getting pregnant if they choose. We (nurses) are to be their coach and mentor thru this process not their boss or director (Moos, 2010).