Solved by verified expert:Read Chapter 81. Describe a situation in which the nurse manager would use problem resolution in the workplace. Describe a situation in which the nurse manager would use negotiation to resolve a conflict (or potential conflict) in the workplace.2. Compare and contrast strategies for resolving a conflict, using first the informal negotiation method and then the formal negotiation method.3. Explore the American Nurses Association website for information on collective bargaining for nurses. Which states have nursing unions? Debate the issue of joining a union with another group of students.4. PART 1: Log onto the website of your state nurses association and search for information on collective bargaining. Search for news articles, union websites, and other recent information on collective bargaining for nurses in your state. Is there a great deal of collective bargaining activity in your state? If not, why? If yes, what are the primary issues under discussion?PART 2: Review the pros and cons of becoming part of a collective bargaining unit. If you were a full-time staff nurse, would you want to join a union? Why or why not?
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Learning Objectives, Chapter 6, Nursing Care for the Family in Need of Reproductive Life
1. Describe common methods of reproductive life planning and the advantages, disadvantages,
and risk factors associated with each.
2. Identify 2020 National Health Goals related to reproductive life planning that nurses can
help the nation achieve.
3. Formulate nursing diagnoses related to reproductive life planning concerns.
4. Using the nursing process, plan nursing care that includes the six competencies of Quality &
Safety Education for Nurses (QSEN): Patient-Centered Care, Teamwork & Collaboration,
Evidence-Based Practice (EBP), Quality Improvement (QI), Safety, and Informatics.
5. Implement nursing care related to reproductive life planning, such as educating adolescents
about the use of condoms as a safer sex practice as well as to prevent unintended pregnancy.
6. Evaluate expected outcomes for achievement and effectiveness of care.
7. Integrate knowledge of reproductive life planning with the interplay of nursing process, the
six competencies of QSEN, and Family Nursing to promote quality maternal and child
health nursing care.
KE Y T E RMS
Abstinence: or refraining from sexual relations, has a theoretical 0% failure rate and is also the
most effective way to prevent STIs
barrier methods: Barrier methods of contraception include the diaphragm, cervical cap,
sponges, vaginal spermicides, and condoms (male and female). Such methods are low in cost but
are not as effective as ovulation suppressant methods. Use of diaphragms may be associated with
basal body temperature: Just before the day of ovulation, a woman’s basal body
temperature (BBT), or the temperature of her body at rest, falls about 0.5°F. At the time of
ovulation, her BBT rises a full Fahrenheit degree (0.2°C) because of the rise in progesterone with
ovulation. This pattern serves as the basis for the BBT method of contraception
cervical cap: A cervical cap is made of soft rubber shaped like a thimble, which fits snugly
over the uterine cervix
coitus: sexual relations
coitus interruptus: is one of the oldest known methods of contraception. The couple proceeds
with coitus until the moment of ejaculation. Then, the man withdraws and spermatozoa are
emitted outside the vagina.
Contraceptive: (a measure to halt conception)
Diaphragm: A diaphragm is a circular rubber disk that is placed over the cervix before
intercourse to mechanically halt the passage of sperm
elective termination of pregnancy: An elective termination of pregnancy is a procedure
performed by a knowledgeable healthcare provider to end a pregnancy before fetal viability.
female condom:. Female condoms are sheaths made of latex or polyurethane, prelubricated
with a spermicide so, similarly to male condoms, they offer protection against conception as well
as STIs, including HIV.
fertile days: All the days on which cervical mucus is copious, and for at least 3 to 4 days
afterward, are considered to be fertile days, or days on which the woman should abstain from
coitus to avoid conception
fertility awareness: Also known as natural family planning, periodic abstinence and the rhythm
method, this approach entails not having sexual intercourse on the days of a woman’s menstrual
cycle when she is most likely to become pregnant or using a barrier method.
intrauterine device: An intrauterine device (IUD) is a small plastic device that is inserted into
the uterus through the vagina. IUDs can be either hormonal or nonhormonal.
Laparoscopy: Laparoscopy is a surgical procedure where a small incision is made in the
abdomen for the purpose of viewing or performing surgery on the organs of the pelvis or
male condom: A male condom is a latex rubber or synthetic sheath that is placed over the erect
penis before coitus to trap sperm.
natural family planning: Natural family planning methods, also called periodic abstinence
methods, are, as the name implies, methods that involve no introduction of chemical or foreign
material into the body
reproductive life planning: Reproductive life planning includes all the decisions an individual
or couple make about whether and when to have children, how many children to have, and how
they are spaced.
Spermicide: A spermicide is an agent that causes the death of spermatozoa before they can
enter the cervix
transdermal contraception: Transdermal contraception refers to patches that slowly but
continuously release a combination of estrogen and progesterone. Patches are applied each week
for 3 weeks.
tubal ligation: Sterilization of women could include removal of the uterus or ovaries
(hysterectomy), but it usually refers to a minor surgical procedure, such as tubal ligation, where
the fallopian tubes are occluded by cautery, crushed, clamped, or blocked, thereby preventing
passage of both sperm and ova.
Vasectomy: In a vasectomy, a small puncture wound (referred to as “no-scalpel technique”) is
made on the scrotum. The vas deferens on each side are then pulled forward, cut and tied,
cauterized, or plugged, blocking the passage of spermatozoa.
1Describe common methods of reproductive life planning and the advantages, disadvantages,
and risk factors associated with each.
Reproductive life planning includes all the decisions an individual or couple make about
whether and when to have children, how many children to have, and how they are spaced. Some
couples you will meet want counseling about how to avoid conception. Others want information
on increasing fertility and about their ability to conceive. Others need counseling because
a contraceptive (a measure to halt conception) has failed
As many as 93% of women of childbearing age in the United States use some form of
contraception. Major benefits of this increase in contraception include decreases in unintended
adolescent pregnancies, the need for “morning after” or postcoital medications, and elective
terminations of pregnancy.
For counseling to be successful, it is necessary to understand how various methods of
contraception work and how they compare in terms of benefits and disadvantages (Box 6.2). In
addition to assessing to determine the best contraceptive option, be certain to emphasize safer
sex practices. Although there are many contraceptive options for reliable pregnancy prevention,
only condoms (both male and female) provide protection against sexually transmitted infections
(STIs) or HIV—an important concern if a relationship is not a monogamous one.
Because no method of contraception, except abstinence, offers 100% protection against
pregnancy, it is important to carefully answer a patient’s questions regarding methods of
contraception. It is necessary to be prepared to answer questions about postcoital protection if
there were unprotected sexual relations as well as elective termination of pregnancy if
Abstinence, or refraining from sexual relations, has a theoretical 0% failure rate and is also the
most effective way to prevent STIs. Due to the natural human sexual drive, patients may find it
difficult to adhere to abstinence because they may deny the possibility of sexual activity and fail
to plan for pregnancy and STI prevention. Because it is difficult for many couples to adhere to
abstinence, the method has a high failure rate (Schalet, Santelli, Russell, et al., 2014).
Many sex education classes for adolescents advocate abstinence as the only contraceptive
measure, so teenagers and young adults who take these courses may know little about other
Periodic abstinence is a method to avoid pregnancy by avoiding sex on the days a woman may
conceive. Methods for determining the days when a woman could conceive are under “Fertility
LACTATION AMENORRHEA METHOD
When a woman is breastfeeding, there is a natural suppression of both ovulation and menses.
Lactation amenorrhea method (LAM) is a safe birth control. After 6 months, or if the infant
begins to receive supplemental feedings or isn’t sucking well, the use of LAM as an effective
birth control method becomes questionable and the woman probably should be advised to choose
another method of contraception). A woman should also consider a different method of
contraception once her baby begins sleeping through the night, even if this occurs before the
child reaches 6 months of age.
Coitus interruptus (withdrawal) is one of the oldest known methods of contraception. The couple
proceeds with coitus until the moment of ejaculation. Then, the man withdraws and spermatozoa
are emitted outside the vagina. Unfortunately, ejaculation may occur before withdrawal is
complete and, despite the caution used, some spermatozoa may be deposited in the vagina.
Douching following intercourse, no matter what solution is used, is ineffective as a contraceptive
measure as sperm may be present in cervical mucus as quickly as 90 seconds after ejaculation,
long before douching could be accomplished.
FERTILITY AWARENESS METHODS
Fertility awareness methods rely on detecting when a woman will be capable of impregnation
(fertile) so she can use periods of abstinence during that time. There are a variety of ways to
determine a fertile period, such as using a calendar to calculate the period of time based on a set
formula, using a visual tool such as “CycleBeads,” measuring the woman’s body temperature,
observing the consistency of cervical mucus, or employing a combination of these methods. The
methods consider the typical length of sperm survival (anywhere from 3 to more than 5 days)
and the length of time an ova is ripe for fertilization (about 1 day). Based on this, a fertile period
exists from about 5 days before ovulation to 1 day after.
Calendar (Rhythm) Method
The calendar method requires a couple to abstain from coitus on the days of a menstrual cycle
when the woman is most likely to conceive. To plan for this, the woman keeps a diary of about
six menstrual cycles. To calculate “safe” days, she subtracts 18 from the shortest cycle she
documented. This number predicts her first fertile day. She then subtracts 11 from her longest
cycle. This represents her last fertile day. If she had six menstrual cycles ranging from 25 to 29
days, her fertile period would be from the 7th day (25 [the shortest cycle] − 18) to the 18th day
(29 [the longest cycle] − 11). To avoid pregnancy, she would avoid coitus during those
days).When used conscientiously, the method has a low failure rate; in typical use, however, this
rate rises substantially because of irregular menstrual cycles, miscalculation, or disregard for
predicted fertile days.
Basal Body Temperature Method
Just before the day of ovulation, a woman’s basal body temperature (BBT), or the temperature of
her body at rest, falls about 0.5°F. At the time of ovulation, her BBT rises a full Fahrenheit
degree (0.2°C) because of the rise in progesterone with ovulation. This pattern serves as the basis
for the BBT method of contraception.
To use this method, the woman takes her temperature, either orally or with a tympanic
thermometer, each morning immediately after waking before she rises from bed or undertakes
any activity; this is her BBT. A woman who works nights should take her temperature after
awakening from her longest sleep period, no matter what the time of day. As soon as a woman
notices a slight dip in temperature followed by an increase, she knows she has ovulated. She
refrains from having coitus (sexual relations) for the next 3 days (the possible life of the
Because sperm can survive from 3 to 5 days and rarely as many as 7 days in the female
reproductive tract, it is usually recommended that the couple combine this method with a
calendar method, so they abstain for a few days before ovulation as well. The BBT method has
an ideal failure rate as low as 3% but a failure rate of 25%..
A problem with assessing BBT for fertility awareness is that many factors can affect BBT.
For example, a temperature rise caused by illness could be mistaken as the signal of ovulation. If
this happens, a woman could mistake a fertile day for a safe one. Changes in the woman’s daily
schedule, such as starting an aerobic program or getting up earlier than usual, could also affect
Cervical Mucus Method (Billing’s Method)
Yet another method to predict ovulation is to use the changes in cervical mucus that occur
naturally with ovulation. Before ovulation each month, the cervical mucus is thick and does not
stretch when pulled between the thumb and finger. Just before ovulation, mucus secretion
increases. On the day of ovulation (the peak day), it becomes copious, thin, watery, and
transparent. It feels slippery (like egg white) and stretches at least 1 inch before the strand
breaks, a property known as spinnbarkeit.
A woman using this method must be conscientious about assessing her vaginal secretions
every day, or she will miss the change in texture and amount. The feel of vaginal secretions after
sexual relations is unreliable because seminal fluid (the fluid containing sperm from the male)
has a watery, postovulatory consistency and can be confused with ovulatory mucus.
This method has a potentially high failure rate because of difficulty in interpreting mucus
status. Because sperm have a life span from 3 to more than 5 days, a woman needs to abstain for
at least 4 days prior to the appearance of estrogen-influenced mucus; therefore, this method
should be combined with a calendar method for best results.
To use a 2-day method, a woman assesses for vaginal secretions daily. If she feels secretions for
2 days in a row, she avoids coitus that day and the day following as the presence of secretions
suggests fertility. The method requires conscientious daily assessment and results in about 12
days per month in which she should avoid coitus, the same as a calendar method
The symptothermal method of birth control combines the cervical mucus and BBT methods. The
woman takes her temperature daily, watching for the rise in temperature that marks ovulation.
She also analyzes her cervical mucus every day and observes for other signs of ovulation such
as mittelschmerz (midcycle abdominal pain) or if her cervix feels softer than usual. The couple
then abstains from intercourse until 3 days after the rise in temperature or the fourth day after the
peak of mucus change. The symptothermal method, because it assesses more clues to ovulation,
is more effective than either the BBT or the cervical mucus method alone (ideal failure rate about
Standard Days Method: CycleBeads
This method is designed for women who have menstrual cycles between 26 and 32 days. A
woman purchases a circle of beads that helps her predict fertile days. The first bead on the ring is
red and marks the first day of her menstrual flow; this is followed by six brown beads which
indicate “safe” days. Twelve glow-in-the-dark white beads, which mark fertile days (during
which she needs to abstain from coitus), and 13 additional brown “safe” days follow. The
woman advances one bead per day during the month. If she reaches a dark brown bead (appears
on the 27th day) before she begins her next menses, her cycle is too short for the method to be
reliable. If she reaches the end of the string of beads (32 days) before menses, she knows her
cycle is too long for the method to be reliable. The system is easy to use, and, if a woman wants
a more technology-based system than using a circle of beads, there is an iPhone app available in
place of actual beads (iCycleBeads). The system is easy to understand; most women, however,
need to use a calendar to check off daily that they have moved a bead or they can lose track of
Still another method to predict ovulation is by the use of an over-the-counter ovulation detection
kit. These kits detect the midcycle surge of luteinizing hormone (LH) that can be detected in
urine 12 to 24 hours before ovulation. Such kits are 98% to 100% accurate in predicting
ovulation. Although they are fairly expensive and not intended to be used as a contraceptive aid,
combining a cervical mucus assessment and the ovulation detector to mark the peak fertile day is
becoming the method of choice for many families. An ovulation detector can be used in the
future to help conception when the couple is ready to have children.
This method combines the use of ovulation detection with other signs of ovulation (cervical
mucus, BBT, cervix position and softness) to avoid pregnancy during a woman’s fertile period. It
was developed in the late 1990s by nurses and doctors at Marquette University in Wisconsin.
Side Effects and Contraindications for Natural Family Planning
Natural family planning methods do not have side effects. If there is a contraindication to their
use, it would be for couples who must prevent conception (perhaps because the woman is taking
a drug that would be harmful to a fetus or the couple absolutely does not want the responsibility
of children) because the failure rate of all forms is about 25%.
BARRIER METHODS OF CONTRACEPTION
Barrier methods are forms of birth control that place a chemical or latex barrier between the
cervix and advancing sperm so sperm cannot reach and fertilize an ovum.
A spermicide is an agent that causes the death of spermatozoa before they can enter the cervix.
It is a chemical barrier method and is often used in combination with other physical barrier
methods. Spermicides not only actively kill sperm but also change the vaginal pH to a strong
acid level, a condition not conducive to sperm survival. They do not protect against STIs. In
addition to the general benefits for barrier contraceptives,
The advantages of spermicides include:
• They may be purchased without a prescription or an appointment with a healthcare
provider, so they allow for greater independence and lower costs.
• When used in conjunction with another contraceptive, they increase the other method’s
• Various preparations are available, including gels, creams, sponges, films, foams, and
Side Effects and Contraindications
Vaginally inserted spermicidal products are contraindicated in women with acute cervicitis
because they might further irritate the cervix. Some women find the vaginal leakage after use of
these products bothersome. Vaginal suppositories, because of the cocoa butter or glycerin base,
are the most bothersome in this regard.
Male and Female Condoms
A male condom is a latex rubber or synthetic sheath that is placed over the erect penis before
coitus to trap sperm. Male condoms have an ideal failure rate of 2% and a true failure rate of
about 15% because breakage or spillage occurs in up to 15% of uses.
A big advantage of male condoms is they are one of the few “male-responsibility” birth control
measures available. In addition, no healthcare visit or prescription is needed. They are
recommended for partners who do not maintain a monogamous relationship because although
latex condoms do not necessarily offer protection against diseases spread by skin-to-skin contact
such as human papillomavirus (HPV), syphilis, or genital herpes, they do prevent the spread of
STIs such as gonorrhea and chlamydia; their use has become a major part of the fight to prevent
infection from HIV.
To be effective, a condom must be applied before any penile–vulvar contact as even preejaculation fluid may contain some sperm. The condom should be positioned so it is loose
enough at the penis tip to collect the ejaculate without placing undue pressure on the condom.
The penis (with the condom held carefully in place) must be withdrawn before it begins to
become flaccid after ejaculation to prevent sperm from …
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