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Course: Maternity Nursing�Topic: Empathetic and Mother Friendly Care�

The Nurses International Community

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Module Goals

The learner will be able to:

Define Empathetic Care
Identify the significance of Empathetic Care
Define the elements of Empathetic Care
List the principles of mother friendly care related to pregnancy
Describe the mother friendly care in labour, delivery, and postpartum period
List seven ways that mothers can play a role in their own care

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What is Empathy?

Empathy is the ability to share and understand the feelings of others
Empathic communication:

Learning to listen to the whole person and not just their words
This type of communication makes one feel seen, heard, and understood

Types of Empathy
Feeling empathy
Thinking empathy

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Angry?

Happy?

Afraid?

Sad?

Upset?

Confused?

What is your initial feeling seeing this picture?

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Angry?

Happy?

Afraid?

Sad?

Upset?

Confused?

What is your initial feeling seeing this picture?

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Feeling Empathy

It is what we feel when we see someone else suffering
It is different from sympathy. In sympathy, we ‘feel sorry for’, where as in feeling empathy we ‘feel with’
Feeling empathy is innate. Some examples:

One baby starts to cry, other babies start to cry too
Rub your head when you see someone bump their heads

In feeling empathy we share or “feel” the feelings of others

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Feeling Empathy

We may not always notice what we are feeling if we are not aware
Some people have more empathy than others
Feeling empathy is automatic, but everyone gives different meanings to their feelings because of the differences in upbringing

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Thinking Empathy

Thinking empathy is understanding or appreciating what others are experiencing
It let’s one ‘walk in the shoes of others’ without actually doing it

It understands perspectives, intentions, and needs of the other before judging them

Thinking empathy is not automatic, it is an intentionally learned and focused skill
Without thinking empathy, it is easy to misunderstand others’ actions because people do not always behave in a way that we can relate

Example: someone may shout or break things when angry while others may cry, walk away or become silent

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Thinking Empathy

In Nepal, it is culturally accepted disciplinary action for parents to beat their children when they steal or break something. However, in the United Kingdom (UK), this is illegal.

As a result, a UK observer might share the feeling of anger when their child steals. However, in Nepal, the mother would see her action to be normal while UK observer would not consider the beating normal.

If you were to apply thinking empathy, what would you understand about the mother’s feelings/behavior?
How does thinking empathy help in this case?

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(Reminder: Instructor advised to provide examples that they think will appropriately make students understand thinking empathy)

Thinking empathy helps one to understand the other better, it does not necessarily mean agree with the other.

For this example, if the observer were to stand in that mothers' shoes (put oneself in her situation) and think, then the observer would consider following:

Like her, if the observer was brought up in a culture where disciplining a child by beating was acceptable then the observer would probably use the same technique or at least see it as normal if some else did so.
Or, if observer thought fear of pain is a good deflector for child to not steal or break things, or if the observer did not know that beating have ill consequences on child's physical and mental development, then the observer would probably not see harm in disciplining a child through beating. Mother might think the same.

In this case scenario, putting oneself in 'her shoes' (in her situation)and thinking about how she thinks or feels about her actions is thinking empathy.

It was not an automatic response. The observer had to initiate the action of thinking empathy.

Thinking empathy helped the observer explore mothers' perspective and intentions for her actions.

Observer still may not agree with the action of the mother but observer now understands where the actions of the mother come from.

By understanding it, observer is able to be non-judgemental and think about ways they can best address the issue.

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Responding to the Suffering of Others

We cannot control how we feel but we can choose how we respond
We usually respond by:

Detachment or distancing: we feel emotions but instead of being curious we find reasons why we should not help, become disinterested in helping others.
Sympathetic distress: feeling overwhelmed with sympathy; we only want to help so that we can stop feeling bad; we are unable to separate our own feelings from the feelings of others and fail to understand their experiences and needs (thinking empathy) so we really cannot help.

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Responding to the Suffering of Others

Compassion: it is having both feeling and thinking empathy together with a desire to help others

Showing compassion is being uncomfortable yet putting personal feelings/perspectives aside trying to understand others' needs, and not push them away or simply feel sorry for them
The compassionate person does not automatically think they understand the other person and do not attempt to judge the other person
It takes practice and self-awareness to develop compassion

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Significance of Empathetic Care

Care that encompasses empathetic communication through feeling empathy and thinking empathy
It bridges the gap – generational, cultural, religious, and socio-economical, between the care provider and the patient
Helps to connect with client emotionally and relate to them by understanding their experiences, perspectives, intentions, needs
Builds trust that fosters open communications from the clients which in return, helps provider to accurately diagnose/identify clients' needs

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Case Scenario

A pregnant mother had been waiting for an hour for her antenatal checkup. In the next hour she had to pick up her 4-year-old from daycare. The woman appeared restless and voiced her frustration to staff in the waiting area. When the nurse sat with her for the antenatal check up, the woman started to shout at the nurse angrily.

What might the nurse initially feel?
How can the nurse give empathetic care? (use thinking empathy)
What will happen if empathetic care is not practiced?

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What would nurse initially feel seeing angry woman?

- feeling empathy: feel angry or feel afraid or feel confused etc.

How can nurse provide empathetic care?

Showing kindness and compassion starts with willingness to help.

- To help, first nurse must be aware of their own feelings and distinguish it from that of what the pregnant mother is feeling.(Feeling

empathy).

- Take a moment and try to assess the situation from the pregnant mothers perspective, which is thinking empathy.

- Listen to what the mother has to say and understand her situation in its entirety. This is empathetic communication.

- The nurse will be able to see and understand that anger was the expression of frustration from having to wait mixed with fear of being late

to pick up her 4 year old.

- The nurse will then feel and think differently about the situation than how they felt initially. The nurse will be able to empathize.

- The nurse will not be angry/afraid/confused/upset anymore

- The will keep calm and in soft voice greet the angry mother appropriately.

- The nurse will politely say' I understand your anger/frustration.' ,'how can I help you feel more comfortable during this antenatal check up?'

- The nurse will give all the time and distance needed by mother to calm down, not hurry her.

What will happen if empathetic care is not practiced?

Possibilities are:

-The nurse will be angry/afraid/confused/upset at mother for shouting at the nurse and not be able to put it aside and think empathy.

-The nurse will not be able to relate to the mother's frustrations/fear/anger, thus not able to help her

-The mother will feel she is not understood. This may escalate her anger/frustration

-it will take time for mother to calm down,

-It might cause her to leave without antenatal the needed antenatal care.

-Both the nurse and the mother will have an unpleasant experience. The mother may not return for additional antenatal care.

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What is Mother Friendly Care?

It is a method of caring for women during pregnancy, where the best interests of the woman and her fetus are considered above those of the hospital or clinic staff.
It is individualized care.
It is care that makes the mother feel good.

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Principles of Mother Friendly Care

Each woman is welcomed and given individualized care, paying special attention to her wishes and needs.
Always calling a mother by her name.
Women are treated with kindness, compassion, patience and gentleness.
Care is sensitive, responsive and supportive to the needs, values, and customs of each woman's culture and home background.
Women are encouraged and helped to play an important role in their own care and decision making.

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Principles of Mother Friendly Care (...continued)

The woman's physical and emotional needs are considered
Women are informed about their condition and that of the unborn infant in a way that they will understand
Health workers give women opportunities to voice their feelings, needs, and questions
Care is evidence-based

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Individualized Care

When possible, every effort is made to ensure that the same health workers see the same patient at each visit
Specific needs of each woman are considered when planning her care, being mindful that needs of all pregnant women are not same

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Individualized Care

Benefits:

A relationship of trust and respect develops between the patient and health worker
Care is individualized
Care is consistent
Patients feel they are receiving better care
Getting to know patients and engage with them in a meaningful way brings satisfaction to the health care workers

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Kindness, Compassion, Patience and Gentleness

Kindness means being friendly, welcoming and willing to help without wanting anything in return
Compassion, as discussed in previous slides, is feeling empathy and thinking empathy together with a desire to help others
Patience is the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset
Gentleness is showing a calm attitude that exhibits soft emotions

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In previous case scenario:

A pregnant mother had been waiting for an hour for her antenatal checkup. In the next hour she had to pick up her 4 years old child from the daycare. The mother became restless and voiced her frustration out loud in the waiting area. When the nurse finally had the time to sit with her for antenatal check up, she started to shout at the nurse angrily.

How can the nurse show patience and gentleness in previous case scenario?

- Keeping calm and in soft voice greet the angry mother appropriately.

- Politely say' I understand your anger/frustration.' ,'How can I help you feel more comfortable during this antenatal check up?'

- Where appropriate, gently pat mothers hands for reassurance.

- Giving all the time and distance needed by mother to calm down, do not hurry her.

- Keeping a calm demeanor the entire time with the mother.

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Sensitive, Responsive and Supportive to the Needs, Values, and Customs of Each Woman's Culture and Home Background

Cultural values and beliefs have strong influence on one's perception and action
Providers need to be aware of needs, values, and customs of the woman's culture and home background, and customize the care accordingly
If this is not done:

The care is less likely to fulfill the needs of the mother
Mother is less likely to perceive and embrace the care

Needs of the women within same culture may vary

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Case scenario:

While counseling a pregnant mother about danger signs during pregnancy, the nurse suggests some health care centers that the mother should go to in case of emergency. The mother replied," We are poor people, Allah will help us; He will never give us any burden which goes beyond our capacity”.

Is providing information on danger signs and nearest healthcare facility enough to ensure safety of the mother? Why?
How can the nurse be sensitive, responsive, and supportive to the needs, values, and customs of the patient’s culture and home background?

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What cultural values do the mother share?

- She believes in Allah. She lives her life by the rule that allah will not give her any burden and will help her.

What information do we get about customs of her home background?

- mother has weak financial/economic resources

Is providing information on danger signs and nearest healthcare facility enough to ensure safety of the mother? why?

- No it does not. Because of financial constraints and faith in Allah, she is less likely to seek emergency care when needed. So, getting information on identifying danger signs during pregnancy and information on health care centers solely is not enough to ensure her safety.

How can nurse be sensitive, responsive, and supportive to the needs, values, and customs of her culture and home background?

Being aware of her faith in Allah as well as her poor financial background.

Being self-aware about own values, beliefs regarding Allah. The nurse mat share same faith or culture, but it should not be voiced. Example- 'I do not believe in allah', or 'Allah will not help you when you are in emergency.' The mother may feel offended or threatened and stop coming for antenatal care.

Being responsive and supportive of her cultural values by saying " I understand that you have faith in Allah.'

Beng responsive and supportive to her needs by trying to help her find out other options for seeking emergency care. This does not conflict with her belief in Allah’s provision.

Identifying health care centers that are free of costs and accessible to the mother. This does not conflict with her belief in Allah’s provision

Helping her plan to start saving money for such emergencies. This does not conflict with her belief in Allah’s provision

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Encourage and Help Women to Play an Important Role in Their Own Care and Decision Making

Pregnant mothers have better pregnancy experience when they have confidence in themselves
Confidence develops and strengthens through making own decisions and competent self-care
Nurses should provide pregnant mothers with adequate and accurate information to help make informed decisions about their care, and to help them be successful in caring for themselves

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The Woman's Physical and Emotional Needs Are Considered

Women experience both physical changes and emotional changes during pregnancy and the postnatal period
Emotions can be related to physical changes or external factors such as social relationships, economic factors, etc.
Emotional state has a profound effect on pregnancy and its outcome
Emotional support from a friend or family member is essential for a healthy pregnancy
Healthcare providers need to address the emotional needs of the woman in additional to medical management. This fosters a relationship of trust

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Women Are Informed About Their Condition And That Of The Unborn Infant In A Way That They Will Understand

Research has shown that women are concerned about the health of their unborn infant and their own health
Therefore, when examinations or tests are done, the women should be informed of the findings
Avoid using medical jargon and use language familiar to the patient

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Give Women Opportunities To Voice Their Feelings, Needs, And Questions

Women might not voice their feelings, needs or ask questions for various reasons such as fear, shyness, or guilt
Their needs cannot be accurately identified and resolved if they cannot communicate their feelings and needs, or are unable to ask questions
Healthcare providers should create an environment where mothers find it comfortable to openly communicate their concerns and needs
The healthcare provider should never criticize a mother

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Care Should Be Evidence Based

Evidence-based care is the clinical management of a patient where the treatment is based on and connected to the results of research
Non-evidence-based care is based on prejudice, unconfirmed beliefs and traditions
Evidenced-based nursing practice promotes safe and effective patient care

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How Can Pregnant Mothers Play A Role In Their Own Care?

Being allowed and encouraged to speak about their needs and fears
Learning more about the physical and emotional changes that take place during pregnancy
Understanding the care they are being given
Understanding the importance of a good diet during pregnancy
Understanding that self-care will improve the health of their infant
Not smoking or drinking alcohol during pregnancy
Helping to monitor their own pregnancy

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Case Study:

A young woman who was just “thrown out of her home by her family,” attends an antenatal clinic where she sees a midwife that she has not met before. She is not greeted by name, but simply asked to lie on the examination table. Although asked about her health, she is not asked about her other needs. As a result, her anxieties about her home issues are not discussed. The midwife provides no information about the examination and gives her a date for the next appointment. The woman decides not to come back for her next appointment but to look for another clinic where she is not treated as ‘just another patient’.

Did the woman receive patient friendly care?
Why did the young woman decide to try another clinic for her next antenatal care visit?
What can the nurse do to provide mother friendly care in this situation?

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Answers:

She did not get mother friendly care because she was treated as a ‘number’ rather than as individual. (GIving the same care in the same way to all patients, instead of addressing individual needs and differences).

- by not greeting her by name or other appropriate way

- by not giving any details of the examination findings- health status of herself and her unborn baby

- by not giving opportunity to ask questions or concerns, share her emotions

- by not discussing if the date for next appointment given was convenient for the mother

The mother did not feel kindness or compassion from the provider.

In order for nurse to provide ‘mother friendly care,’ all of the above must be addressed. Nurse must make the young woman feel heard and understood by asking her about her needs, both physical and emotional.

Nurse can ask,’ Miss/Mrs. ….., “How are you feeling? do you have any questions or concerns?”.

” is there anything I can help you with?”

“ Do you have any other questions.?”

The mother decided to try another clinic for her next antenatal care visit because:

- she wants a clinic where she feels heard and understood

- she wants to feel that staff are interested in providing her with good care

- she wants mother friendly pregnancy care.

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Mother Friendly Care In Antenatal, Intrapartum And Postpartum

The interests of the woman and her fetus/newborn infant are the main priority
Care is evidence-based
Principles of mother friendly care during pregnancy apply
Right to informed choices and consent regarding care and procedures such as vaginal exams, labor inductions, pain management, etc. is provided
Supportive companion of choice is allowed and considered important to patient care
The mother and baby bonding process is supported

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Mother friendly care in Labor:

Allowed choice regarding use of enema and shaving perineum.
Allowed to shower or bath
Encouraged to take small sips of water
Small frequent snacks are encouraged while large meal is discouraged.
Encouraged to move about and walk around
Allowed choice for wearing her own clothes during labour
Encouraged to have a companion in labour of her choice
Monitor condition of the fetus during every labour
Allowed choice of available pain relief methods
Routine early rupture of the membranes are no longer practiced

Mother friendly care in Delivery

Encouraged and allowed to have a natural childbirth as much as possible, but she can make informed choice about C-section.
Help make informed choice for trained personnel to deliver and place of birth.
Father should be encouraged to attend the labour and delivery (but only if mother wishes)
Children need to be told what to expect, that their mother will have some pain, and that this is normal.
Guide and encourage to find the most comfortable position during delivery
Provide emotional support and reassurance if childbirth did not go as planned
Assist in making informed decision for induction of labour
Protect woman's dignity by allowing her to express her opinion and her wishes, and showing serious considerations to them.
Know that shouting or hitting a woman during delivery is unacceptable.(This is routine in some cultures)

Mother friendly care in Postpartum

Infant should be given to the mother as soon as possible after delivery.
Encourage kangaroo mother care after the mother receives the baby
Encourage breastfeeding as soon as possible.
Routine procedures of the baby can be done after the mother has had chance to meet and hold the infant.
Mother and infant should not be separated after delivery
Emotional and practical support is provided by staff, family and friends during episodes of 'baby blues'
Screen mother for postnatal depression during pregnancy, and identify and address it as soon as possible during postpartum

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Case Study:

During a normal labour at a hospital, a woman is told she should stay in her bed and not walk around. Her clothes are taken away and she is given a hospital gown. She is allowed to have sips of water during early labour and instructed not to eat anything. She is not given any pain relief. She is afraid to ask questions and does not know whether analgesia is available at the clinic. She is worried that the fetal heart rate is not being monitored as she was taught during antenatal classes.

How would a nurse provide mother friendly care in this case?
How would a nurse help the mother take care of herself?

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Essential Factors In Mother Friendly Health Workers

Correct attitude and behaviour- kindness, friendliness, politeness, and respect
Acceptable appearance
Good communication skills
Team work
Providing good care
Ongoing education and training

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Correct Attitude and Behaviour

Healthcare provider shows kindness, friendliness, politeness, and respect
Non-friendly behaviors that should not be practiced by nurses:

Being rude, aggressive, sarcastic and insensitive and ignoring the mothers needs, feelings, and wishes
Emotionally, verbally or physically abusing women
Ignoring what the woman says or requests
Not respecting a woman's privacy
Not giving opportunity to ask questions

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The most important factor in mother friendly care is the correct attitude of the staff

Correct attitude and behaviours from the care provider aides in building good rapport with the mother

Why are staff sometimes not mother friendly?

They have not learned the correct attitudes.
They have personal emotional problems
They are overworked.
Chronic staff shortages and low morale.
Patients and their relatives may be perceived as demanding and difficult.
They are not supported by their management.
They are afraid of changing outdated attitudes and practices.
They may feel that patients are inferior to them
They may feel insecure due to lack of knowledge and skills.

Staff may need to receive professional development about Empathetic care and encouraged, and supported to incorporate these changes into their practice.

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Acceptable Appearance

Good Communications Skills

Professional appearance has following benefits:
Helps identify care providers as professionals
Shows self-respect
Shows respect for colleagues

Good communications skills are those that promote relationship of trust and respect between the care provider and the mother
Healthcare provider should be aware of both verbal and nonverbal communications
Must be empathetic (empathetic communication)

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Team Work

Members of a group share a common spirit of trust and support
Benefits:

Improves self-esteem
Improves staff morale and confidence
Creates a friendly and warm atmosphere in the clinic
Promotes loyalty to the institution and colleagues

Aids in implementation of activities that result in patient friendly services

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Ongoing Education and Training

Part of lifelong learning and professional development
Essential for nurses to maintain and update skills to remain competent in their work
Achieved through:

Self-learning- textbooks, online resources, seminars
Group training provided by health Institutes
Licensed training institutes

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Case study:

A teenage girl who has missed her menstrual period for two months, attends a local clinic to have a pregnancy test Her pregnancy is confirmed and she is told to return for an appointment for antenatal care when she reaches 20 weeks of gestation. However, when she returns to schedule an appointment, there is a long queue. After waiting all morning, she is asked to come back the next day. When she is finally seen, the staff are rude. She notices that their uniforms are dirty and they appear uninterested in the care of their patients.

List the actions that are non-mother friendly care
How can nurse provide mother friendly care to the teenage girl?

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Nurse can provide mother friendly care to the teenage girl by:

- booking for antenatal care for pregnant teenage girl in the same day her pregnancy was confirmed, instead of waiting to 20 weeks of gestation

- providing antenatal are the same day she is booked, instead of delaying and cancelling her appointment for next day.

- Provide special consideration regarding her social and emotional needs related to her age.

- Being friendly, welcoming and considerate.

why were the staff rude?

Inadequate staffing rapidly leads to stress, exhaustion and poor staff morale.

Poor standard of dress and negative attitude of the staff support the conclusion that there was a poor team spirit.

How can the poor team spirit of the staff be improved?

Staff need help and support from management.

They should be given an opportunity to speak about the problems at the clinic.

Team spirit can be rebuilt with good leadership training and encouragement.

Group activities such as audit meetings, self help, and learning opportunities would be helpful.

Staff needs education about mother friendly care.

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Cultural Considerations

Calling woman by name may not always be appropriate in all cultures. The nurse should ask how the woman would liked to be addressed.
Using culture appropriate language promotes mother friendly care.

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Summary

Empathetic care helps health care workers to connect with patients emotions and relate with their situation practically while patients feel seen, heard and understood. This in turn helps build a relationship of trust between health care workers. Only then are they able to provide mother friendly care that is based on kindness, compassion, patience, gentleness and respect, manages woman as an individual, and addresses both physical and emotional needs of the mother. Mother friendly care is given throughout pregnancy and post childbirth.

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Reference:

Bettercare. (n.d.) Empathetic Care: 1. Introduction to kindness, empathy, and compassion. Accessed from: https://bettercare.co.za/learn/empathetic-care-a-guide-for-community-health-workers/text/01-introduction-to-kindness-empathy-compassion.html
Bettercare (n.d.) Mother and baby friendly care: 1. Mother friendly care during pregnancy. Accessed from: https://bettercare.co.za/learn/mother-and-baby-friendly-care/text/01.html#1-mother-friendly-care-during-pregnancy
Bettercare (n.d.) Mother and baby friendly care during labour, delivery, and puerperium. Accessed: https://bettercare.co.za/learn/mother-and-baby-friendly-care/text/02.html

Contact info: info@nursesinternational.org

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Reference:

Choudhury, N., Moran, A.C., Alam, M.A. et al. Beliefs and practices during pregnancy and childbirth in urban slums of Dhaka, Bangladesh. BMC Public Health 12, 791 (2012). Accessed: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-791
Klein, S. Miller, S., & Thomson, F. (2020) A Book for Midwives; Care for pregnancy, birth, and women’s health. Berkeley, California: Hesperian Health Guides. Retrieved from: https://en.hesperian.org/hhg/A_Book_for_Midwives:Respectful_and_compassionate_care

Contact info: info@nursesinternational.org

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Reference:

Oxford University Press (2020). Definition of patience.Lexico.com. Retrieved from: https://www.lexico.com/en/definition/patience
RCN Factsheet: Continuing Professional Development (CPD) for nurses working in the United Kingdom (UK), 2016. Accessed from: https://www.rcn.org.uk/about-us/our-influencing-work/policy-briefings/pol-1614
The Greater Good Science Center (n.d.). Empathy. Berkeley University of California. Accessed from: https://greatergood.berkeley.edu/topic/empathy/definition#why-practice-empathy

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