Michelle Marks

9/18/2014
Nurs 320
Prof. Riley
Self-Evaluation Week 2
My patient was a first time mother (gravida 1 para 1). She was admitted at 39
weeks, 6 days gestation because she was feeling intense pain due to frequent
contractions. The patient had an epidural and was in stage 1, active phase of her labor
when I first arrived in her room at seven oclock. Her reactions to labor were age
appropriate and culturally appropriate. At 29 years old, and having her first child, I
observed the patient to be within a normal range of what is expected with women going
into labor for the first time. She was uncomfortable and feeling some pain even thought
she had an epidural. The patient was of Japanese ethnicity. Although older Japanese
generations may have been less likely to show their pain and discomfort during
childbirth, younger Japanese mothers are more likely to show signs of labor pain and
even request an epidural. The patients husband was present and was participating in
her labor by coaching her with breathing and rubbing her back. The husband was
sincere in his communications with his wife. These were also signs appropriate to the
culture of the patient as a young mother.
Once the patient moved into active labor, the number of health care team
members grew. The patients chosen doctor, two medical students, the nurse and
pediatric nurse, plus another nursing student and myself were in the room for the hour
of active labor preceding the babys birth. Each member of the health care team

communicated therapeutically to the patient and her husband, as well as to each

other. The doctor helped the patient focus on where to send her energy during pushes
and directed the husband on how he could hold the patients leg during her contractions
and also where to stand. Having the patient and her spouse communicate supportively
with each other laid a welcome foundation for the health care team to also speak in a
supportive manner and use therapeutic communication. The doctor was encouraging
and responsive to the nurse. He coached the patient during her pushes while
examining her. The nurse asked several times if the doctor wanted the patient
prepped. Each time the doctor said, No, not yet. The doctor was respectful in his
answers and the nurse acknowledged his authority and timeframe. Finally, the doctor
gave the green light to have the patient prepped and the nurse reacted quickly. The
doctor also requested a specific oil that was available in the birth prep kit. The nurse
knew that the doctor preferred this in the last stage labor and she had it ready for him.
The therapeutic communication continued after the baby was born. The
doctor continued with his teachings to the medical students. He coached them on
stitching up the second degree laceration the patient experienced during the birth. The
doctor was very helpful and patient. He guided the medical students in their stitches.
After the doctor and medical students left, I congratulated the new parents, also using
therapeutic communication. I thanked them for allowing me and the other nursing
student to be in the room to observe their birth and also told the mother what a great job
she did with her labor. I took pictures of the new family and congratulated them again
before allowing them private time to enjoy their new daughter.