Working With the Mentally Ill, Homeless Pregnant Mother

Last holiday, I was doing my clinical rounds in a private hospital trying to locum for a friend nurses who had a family emergency in a distant location. While doing rounds, there was this particular case that was rushed to the OR after an accident. In the wee hours of the morning, most nurses are exhausted, and I was among these nurses. The hospital had no blood bank, and the facilities were not comparable to my station back in the city where we enjoyed the convenience of the ultramodern facility. Never the less, in these hospitals, things were different for pregnancy. The homeless mother who was also mentally ill was accidently by a runaway car, and she was fast losing blood and pulse. I realized that there were times that decision was to be made without proper thinking.

We had to start series of test to determine the patient’s health status and other vital information. We realized that she had to be transferred to another hospital with better families due to her health conditions, her mental condition, and the complexities that might arise with the baby. The labor was quick, the urge to push and the urge to have a bowel movement, the rapid contractions, as well as vagina bulges after every contraction. I realized that the patient was about to have emergency birth. We had a private car transport her to the hospital, but before we reach the next hospital, she was already giving birth and bleeding from the injury sustained from the accident. We had to choose between the lives of the kid, the mother to save both.

Despite my one-year experience in the hospital, I have never had an emergency car birth, but this was real as I had to make a faster decision we had not access to the patient’s medical records, so we had to guess everything including medical condition, contraindication, and sensitivity. However, the driver has laptop computer he was carrying from work that I used to retrieve her data froth national database to know the medical status. I also got from records of a nearby obstetrician who walked us through the delivery process including cleaning and sterilizing hand, checking the position of the baby as at the last checkup, has multiple birth history. We placed the mother on the back seat and put a pillow under her head then help her control the urge to push until the baby started crowning. We helped her pant to enable her to push the baby slowly. I supported the baby’s head, held the head in a downward position, and encouraged her to push. The head came out, then the shoulder and finally the whole body. We did not cut the umbilical cord until we reached the hospital with the placenta beside her.

Having worked in the obstetrics and gynecology section as a nurse for one year, I realized that I was not fully prepared for delivery as I still had a lot to learn, but I am happy I helped the mother deliver safety and saved both the life of the mother and the child. I sympathized, but also used holistic care to support the patient. I was especially glad about the evidence-based nursing as the gynecologist took as thigh the car delivery process over the phone. The expert advice, clinical evidence, and systematic research were combined to a fruitful outcome. My discussion with the patient helped me determine her faith, values, medical background. I also realized that the electronic health records could be very useful in saving the life due to quick decision-making. With the computer and smartphones, it is clear that electronic health records (EHR) and technology can help save lives

The difference between caring for a pregnant mother with mental problems and these pregnant women without mental problems is that they mental problem mother can give conflicting information. In this case, the patient was not coherent, we could not understand her mixed messages, but we picked up cues and pieced together to come up with workable information. She was also violent unlike the ordinary women, and we could not sedate her because I needed her to push the baby.

The roles of the nurse in with psychiatric/mental health needs.

Working with this mentally, ill and homeless woman taught me a lot. I realized that unlike in normal circumstances when psychiatrists are given adequate time to study the patient, and the patient had a right to refuse treatment, in this case, the time was too short, and I had to inform her right to reject treatment. There was also no time for meeting with the mother to establish contact and offer treatment, as I had to start to treatment immediately

In conclusion, the psychiatrist is always responsible and will feel responsible for the case. However, when there is not much time to invest in developing a relationship with the patient, I had to ignore many rules in psychiatry because their lives were both in danger. I gathered that the patient was not suffering from any severe psychopathology and I was happy I saved her life and that of the baby.

Journal Entry F.doc