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Response to Question 1

  1. a) In consonance with the given vignette, Renae is predominantly concerned about undergoing two major forms of stigma, during the course of seeking medical assistance for her pregnancy, which is mentioned in detail as follows:
  • Stigma pertinent with Homelessness: From the given case study, it is obvious that Renae has been couch surfing for the last three months and as of now her landscape has not enhanced significantly. This stigma pertaining to homelessness eventually manifest into societal judgment thereby inculcating stereotyping aside from discrimination against individuals who are not able to seek housing in current economic landscape (Bendall et al., 2021). In general, it is a common preconceived notion that somehow homeless people are experiencing struggle due to their own mistake and due to their lack of responsibility they are to be held accountable and they are less deserving of help and support. As a consequence of these biases, Renae’s mind is preoccupied with being judged for her living circumstances. On a similar note, she also anticipates that healthcare providers would treat her differently because of it (Mehra et al. 2020).
  • Stigma concerning Mental Health and Substance Use: The medical history of Renae revolves around prior evidence which substantiate an accidental heroin overdose as well as a mental health admission for depression attributed with suicidal ideation. Whenever these experiences are present, the feasibility of being judged emanates stigma, associated with substance abuse along with mental disparity (Weber et al. 2021). Especially for pregnant individuals who has such history of substance use, often stumble upon heavy judgment and it is generally taken into consideration that they would not be able to parent, and those with mental health histories encounters impediments in the form of stereotypes that are based on misconceptions regarding their capacity to make informed decisions about their pregnancy and care (Cleary et al., 2020).

The aforementioned stigmas are what Renae is primarily concerned with and she worries that healthcare providers will concentrate upon her past struggles, rather than her current needs.

  1. b) For the sake of extending culturally safe ambiance and quality care that promotes the mental well-being of Renae all while minimizing the notion of stigma, the registered nurse should undertake a series of measures which are mentioned herein under:
  • Fostering a relation based on trust and rapport: The first course of action that a registered nurse should concentrate upon is to establish a meaningful and amicable relationship there is absolutely nonjudgmental in nature with One of the important aspects that should be taken into consideration in this context is that this strategy can only be accomplished provided active listening is taken into consideration, all while validating her experiences, so that empathy is demonstrated under all circumstances (Coupland et al., 2021). Aside from empowering Renae with recovery-oriented language, it is prudent to acknowledge her strength. For instance, incorporating articulation that reflects resilience in terms of overcoming her current challenging landscape, rather than concentrating upon her past, would definitely assist the registered nurse to foster a relationship that is based on trust.
  • Trauma-Informed Care: It is immensely prudent to recognize Renae’s traumatic past, which includes sexual assault as well as traumatic previous hospital admission. Inculcating care that is aligned with trauma informed measures would assist the registered nurse to avert certain events which could trigger re-traumatization. Apart from making any insinuations or reflecting preconceived notions regarding her past experiences, it is imperative to ask permission in order to gain information regarding topics that are sensitive in nature (Ford et al., 2021).
  • Cultural Sensitivity: Besides acknowledging the unique cultural background of Renee it is imperative to gain insights regarding her past experiences, which revolves around accumulating cognizance regarding the ramification of her parent’s separation upon her, which eventually led to extensive exposure to domestic violence and her subsequent homelessness. This is necessary in order to understand the gravity of her current circumstances, which would eventually help the registered nurse to formulate better questionnaires that are open-ended in nature, so that gaining insights into Renae's perspective and cultural needs become seamless in nature (Gerber, 2019).
  • Collaborative Approach: Undertaking a collaborative approach in this instance is the best way forward. In view of the fact that this sort of situation necessitates input and quality contribution from diverse healthcare providers, so that holistic care can be ensured and delivered adequately. In this instance, incorporating input from general medical practitioners as well as relevant healthcare providers would definitely augment the chances of providing non stigmatizing care, since they would be well aware of Renae's history (Andalibi & Garcia, 2021).

All of the aforementioned strategies can be incorporated since these measures not only augment Renae’s mental health but at the same time also advocate her overall well-being during her pregnancy.

Response to Question 2

In accordance with the given scenario, an inference can be drawn that substantiating a therapeutic relationship is of immense priority in the case of delivering quality care Renae, in view of her complex medical and psychosocial history. The reason being that with the help of a strong therapeutic relationship trust can be fostered seamlessly, which promotes engagement and active discourse that eventually leads to amendingthe quality of care, which Renae receives. It is quintessential to grasp the gravity of her current circumstances in order toaddress the unique challenges she faces, inculcating her past history of homelessness, substance use, mental health concerns, and trauma (Calear et al. 2021).

Strategies for Developing a Therapeutic Relationship with Renae:

  • Besides building trust, establishing an amicable rapport is also paramount in the case of treating Renae. This relationship should be attributed with empathy and respect, where her resilience should be appreciated, and her strengths should be acknowledged (Madden, 2019). Besides employing active listening skills, reflecting a non-judgmental attitude is also important in order to demonstrate that the healthcare professionals are oriented to grasp the gravity of her perspective, which is feasible by incorporating recovery oriented languages that concentrates upon her present and future and does not dwell on her past experiences, thereby motivating her to undertake positive changes within a short span of time (Isobel et al., 2021).
  • One of the intriguing aspects is that besides recognizing her history of trauma, inculcating trauma informed care is of the essence in this instance (LoGiudice et al., 2023).Owing to the fact that the ramification of traumatic experiences potentially creates mental disequilibrium in subjects. Hence, augmenting a safe ambiance where the patient can be enquired regarding her preferences of care, potentially avert circumstances that could trigger previous experiences, it also empowers her to undertake decision as per her preference (Hui et al. 2021).
  • On a similar vein, a collaborative approach should be fostered where knowledge pertinent with Renae's medical condition should be disseminated accordingly to her, which inculcates available support resources and challenges during the course of pregnancy, so that healthcare team member can deliver comprehensive care. Aside from maintaining open flow of communication, facilitating the sharing of pertinent information through which a coordinated healthcare plan can be holistically delivered is crucial for Renae. This would also empower her to undertake decisions in an informed manner regarding the health and the well-being of her unborn child (Morton Ninomiya et al., 2023).

Culturally Safe Practice for Nurses:

In order to ensure that this practice is culturally safe, nurses should be well versed in the concepts of cultural competence, which is feasible provided continuous education is extended regarding diverse cultural beliefs, practices and traditions to the registered nurses, so that they can gain cognizance regarding diverse culture respectively (Weller et al. 2023). Aside from that, continually engaging in self-reflection also assists registered nurses to recognize any sort of personal bias as well as prejudice that can affect the patient's care. Hence, the willingness to accept feedback from culturally diverse perspectives, not only assist the registered nurse to gain insight regarding the cultural background of the patient, but at the same time, tailor care plans accordingly, which do not impede the flow of effective communication, but at the same time guarantees that holistic care is delivered adequately and swiftlyas per the patient’s cultural preferences (McCloskey et al. 2021).

Response to Question 3

Two key trauma-informed care (TIC) principles that would significantly benefit Renae's care are "Realization about trauma and how it can affect people and groups" and "Recognizing the signs of trauma." These principles are aligned in augmenting a safe and supportive healthcare ambiancefor Renae, since these principles diligently takes the notion of her past trauma and distrust with the healthcare systeminto consideration (Gerber, 2019).

Realization about trauma and how it can affect people and groups:

This principle revolves around the concept that health care providers should primarily gain cognizance regarding the widespread ramification of traumatic experiences on individuals as well as communities (Ranjbar et al., 2020).In view of the fact that these ramifications potentially emanate mental disequilibrium in individuals. Hence it is imperative to concentrate upon the requirement of acknowledging the trauma and how it has affected the individual or the community at large, since the past traumatic experiences can significantly influence an individual's response to current situations.

Example of how the nurse can practice this principle for Renae:

The nurse should educate themselves about the various forms of trauma, including Renae's experiences such as sexual assault, homelessness, and past interactions with the healthcare system. By being well versed in the manners of determining the potential triggers and sensitivities related to Renae's trauma, the registered nurse (RN) can inherently tailor approach that empathically carry out conversations that avoid re-traumatization. Furthermore, the RN can also engage in ongoing self-reflection to ensure they are providing trauma-informed care (Drexler, Quist-Nelson & Weil, 2022).

Recognizing Indicators of Trauma:

This fundamental tenet underscores the healthcare provider's capacity to discern cues and manifestations of trauma in individuals, even in cases where such experiences are not explicitly divulged(Weber et al., 2021). It necessitates a heightened sensitivity to behavioral and emotional manifestations that necessarily signify a background of trauma, such as heightened vigilance, anxiety, or tendencies towards avoidance.

Illustration of the manner in which the Nurse Can Implement this Principle with Renae:

In the course of their interactions with Renae, the nurse should exercise acute awareness regarding any indications of distress or unease. Renae's demeanour, characterized by manifestations of anxiety like nail-biting, frequent scanning of her surroundings, and her challenges in establishing rapport, potentially allude to a history fraught with traumatic encounters. Instead of ascribing labels of recalcitrance or dismissiveness to her, the nurse should astutely interpret these behaviours as potential indicators of inner turmoil. In response, they should approach Renae with an attitude characterized by non-judgment and empathy, endeavouring to cultivate a secure environment wherein she feels comfortable to divulge her apprehensions and emotions (Lefever‐Rhizal, Collins‐Fulea & Bailey, 2023).

Inculcating the aforementioned trauma informed care principles into the care plan oriented for Renae would assist the registered nurse to develop a safe ambiance where her experiences are validated and understood.By stringently adhering to these principles, the nurse can work towards rebuilding Renae's trust all while promoting her recovery, and extending care that is respectful of her unique needs and experiences (Quist-Nelson & Weil, 2022). This approach aligns with the principles of person-centered and recovery-oriented care, emphasizing Renae's strengths and supporting her on her journey towards improved health and well-being.

References:

Andalibi, N., & Garcia, P. (2021). Sensemaking and coping after pregnancy loss: the seeking and disruption of emotional validation online. Proceedings of the ACM on Human-Computer Interaction5(CSCW1), 1-32.

Bendall, S., Eastwood, O., Cox, G., Farrelly-Rosch, A., Nicoll, H., Peters, W., ... & Scanlan, F. (2021). A systematic review and synthesis of trauma-informed care within outpatient and counseling health settings for young people. Child maltreatment, 26(3), 313-324.

Calear, A. L., Batterham, P. J., Torok, M., & McCallum, S. (2021). Help-seeking attitudes and intentions for generalised anxiety disorder in adolescents: the role of anxiety literacy and stigma. European child & adolescent psychiatry, 30, 243-251.

Cleary, M., West, S., Kornhaber, R., Visentin, D., Neil, A., Haik, J., ... & McLean, L. (2020). Moving the lenses of trauma—Trauma-informed care in the burns care setting. Burns, 46(6), 1365-1372.

Coupland, H., Moensted, M. L., Reid, S., White, B., Eastwood, J., Haber, P., & Day, C. (2021). Developing a model of care for substance use in pregnancy and parenting services, Sydney, Australia: Service provider perspectives. Journal of substance abuse treatment, 131, 108420.

Drexler, K. A., Quist-Nelson, J., & Weil, A. B. (2022). Intimate partner violence and trauma-informed care in pregnancy. American Journal of Obstetrics & Gynecology MFM, 4(2), 100542.

Ford, S., Clarke, L., Walsh, M. C., Kuhnell, P., Macaluso, M., Crowley, M., ... & Kaplan, H. C. (2021). Quality Improvement Initiative to Improve Healthcare Providers’ Attitudes towards Mothers with Opioid Use Disorder. Pediatric Quality & Safety, 6(5).

Gerber, M. R. (2019). Trauma-informed maternity care. Trauma-informed healthcare approaches: A guide for primary care, 145-155.

Hui, A., Philips-Beck, W., Campbell, R., Sinclair, S., Kuzdak, C., Courchene, E., ... & Shen, G. X. (2021). Impact of remote prenatal education on program participation and breastfeeding of women in rural and remote Indigenous communities. EClinicalMedicine, 35.

Isobel, S., Wilson, A., Gill, K., & Howe, D. (2021). ‘What would a trauma‐informed mental health service look like?’Perspectives of people who access services. International Journal of Mental Health Nursing, 30(2), 495-505.

Lefever‐Rhizal, D., Collins‐Fulea, C., & Bailey, J. M. (2023). Trauma‐Informed Psychosocial Screening and Care Planning: A Patient‐Centered Improvement Project in a Midwife Clinic. Journal of Midwifery & Women's Health.

LoGiudice, D., Hughson, J., Douglas, H., Wenitong, M., &Belfrage, M. (2023). Culturally safe, trauma-informed approach to cognitive impairment and dementia in older Aboriginal and Torres Strait Islander people. Australian Journal of General Practice, 52(8), 505-511.

Madden, E. F. (2019). Intervention stigma: How medication-assisted treatment marginalizes patients and providers. Social Science & Medicine, 232, 324-331.

McCloskey, L., Bernstein, J., Amutah-Onukagha, N., Anthony, J., Barger, M., Belanoff, C., ... & Lachance, C. (2021). Bridging the chasm between pregnancy and health over the life course: A national agenda for research and action. Women's Health Issues, 31(3), 204-218.

Mehra, R., Boyd, L. M., Magriples, U., Kershaw, T. S., Ickovics, J. R., & Keene, D. E. (2020). Black pregnant women “get the most judgment”: A qualitative study of the experiences of Black women at the intersection of race, gender, and pregnancy. Women's Health Issues30(6), 484-492.

Morton Ninomiya, M. E., Almomani, Y., Dunbar Winsor, K., Burns, N., Harding, K. D., Ropson, M., ... & Wolfson, L. (2023). Supporting pregnant and parenting women who use alcohol during pregnancy: A scoping review of trauma-informed approaches. Women's Health, 19, 17455057221148304.

Quist-Nelson, J., & Weil, A. (2022). Intimate Partner Violence and Trauma Informed Care in Pregnancy. In Maternal-Fetal Evidence Based Guidelines (pp. 257-261). CRC Press.

Ranjbar, N., Erb, M., Mohammad, O., & Moreno, F. A. (2020). Trauma-informed care and cultural humility in the mental health care of people from minoritized communities. Focus, 18(1), 8-15.

Weber, A., Miskle, B., Lynch, A., Arndt, S., &Acion, L. (2021). Substance use in pregnancy: identifying stigma and improving care. Substance Abuse and Rehabilitation, 105-121.

Weller, M. M., Boyle, F., Ellwood, D., Flenady, V., Loughnan, S., & Cocker, M. N. (2023). Best practice care after perinatal loss and subsequent pregnancy care: A workshop for midwives. Women and Birth, 36, S45-S46.

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