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Contemporary Nursing Practice and Holistic Care

Question:

What is a Holistic Care and why it is Important when you working with woman experiencing Infertility.

In the context of contemporary nursing practice, holistic care has garnered considerable attention in terms of providing adequate care to the concerned individuals. Holistic nursing has gained prominence whereby wellbeing of the individual in addition to health promotion and patient centered care is fostered through integration of physiological concepts and therapeutic approaches encompassing emotional, spiritual and psychological healing in case of the patients (Cowling, 2015). In conjunction with traditional nursing approach, the dimension of mind-body-spirit-emotion-environment component is reckoned in holistic nursing to offer optimal care service for the patient population. There is growing volume of evidences regarding the utility of holistic care nursing to address vital issues. One such issue is infertility in women that is considered as the inability to conceive a child and holds serious repercussions that call for prompt and prudent interventions. Women with infertility often experience greater psychological impact (Begum & Hasan, 2014). However, recently infertility counseling has emerged as a specialist discipline where interdisciplinary professionals intervene for answering the queries and lending adequate support for couples encountering infertility and undergoing medical treatment (Van den Broeck, 2010). Prevalence estimates for infertility has been attended to in order to provide a satisfactory definition through proper demographics and health surveys (Mascarenhas et al., 2012). In the following essay, efforts will be taken to provide a succinct overview on the issue of infertility in women alongside the utility of provision for holistic care in tackling their condition. An insight into the emotional and psychological support for them will be provided in course of the discussions of the essay in conjunction with other available services that will mitigate the problem. The devastating effects of infertility in mental health are matter of concern requiring attention to cope up with mental-emotional, social and cultural aspects (Nahrin et al., 2017).  Thus, the essay will also attend to describe and elucidate such situations with proper examples and suitable references alongside the role of holistic care in combating the condition.


Society plays a major role in dictating and governing the lives of women with infertility to large extent. As per the societal norms and standards, in many of the Indigenous societies, the kind of treatment and self-respect experienced by a woman in her own community is often attributed to motherhood. Infertility is considered problematic under such circumstances and leads to differential life experiences among the victim women (Hollos et al., 2009). Pertinent study has highlighted on the issue of low fertility with respect to urban population whereby both primary as well as secondary infertility culminates in causation of serious personal ramifications for women similar to those belonging to rural regions. Both the personal in addition to social ramifications are of significance in bringing forth appropriate changes in the lives of these women (Hollos & Larsen, 2008). Lifetime as well as current primary infertility rate in the context of Iran has been presented in relevant literature. Implications in terms of healthcare and  service delivery emphasizing on factors such as age at marriage alongside couple’s fertility potential must be considered for prudent interventions (Vahidi, Ardalan & Mohammad, 2009). Role of midwives in caring for women in course of their reproductive life is crucial to guide them in the right direction without posing any threat or harm from injury. Cultural safety that encompasses respecting a woman’s privacy as well as bodily dignity has been considered vital on the part of midwives to drive positive outcomes (Bennett, 2017). Other case reports suggestive of primary infertility in women have indicated on the use of in-vitro fertilization as well as other assistive reproductive technology to help in conception (Legro et al., 2016). Other societal factors that contributes majorly in terms of highlighting and determining the issue of infertility has also been presented in relevant study. Findings have revealed that infertility treatment is dependent on the financial resources that in turn determines the choice of treatment type that a woman is likely to access (Farley Ordovensky Staniec & Webb, 2007). Thus, the societal influence on women with infertility is of importance in gauging the role of holistic care meant for improving the overall condition of women particularly emphasizing on their wellbeing.

The Problem of Infertility in Women: An Overview


Unlike any other profession, the midwives share great responsibilities in assisting the women in a befitting manner so that they do not have to encounter with major hindrances in coping up with their conditions. However, in order to perceive their roles in making suitable care approaches, it is necessary to understand the condition of infertile women. It has been cited in literatures that women with infertility face negative experiences because of the ingrained societal beliefs, stigma and discriminating attitude with respect to fertility and reproduction. As a result the quality of life of these women get severely affected thereby necessitating the need of raising public awareness regarding negative consequences of infertility through active engagement of healthcare professionals (Daibes et al., 2017). Recent decades have witnessed unprecedented changes in the development of assisted reproductive technology that have casted rays of hope in the couples having issues with normal conception. Fertility treatment has advanced quite a bit contributing to the lives of the infertile couple who cannot have child through the normal physiological process. Access to care services has become common that in turn has optimized the quality of life for the service recipients (Collura & Stevenson, 2016). Further, study has brought to the forefront that infertile women are more likely to experience emotional problems ranging from depression, anxiety, psychosomatic disorders, obsession, hysteria and phobia. Thus, the urgency to foster suitable supportive educational program for creating awareness regarding infertility has been felt more strongly. Education coupled with adequate awareness might streamline the actions directed towards overall wellbeing and improvement of the affected individuls (Yakout, Talaat & Fayad, 2016). Although, infertility is essentially recognized as a biomedical issue, yet the mental health issue associated with the condition is of relevance and importance as it dictates the overall wellbeing of the individual. Research has focused on multiple aspects whereby effectiveness of various interventions has been investigated and widely explored to provide an insight on the issue of infertility. Study conducted on infertile women has revealed that mindfulness based cognitive group therapy (MBCT) is fruitful in marital satisfaction and mental health in case of infertile women. Consultation services in liaison with proper trainings for the infertile couple have the potential of alleviating their problems to certain extent (Shargh et al., 2016).


Holistic care approach resorts to address the psychological, emotional, spiritual, societal and environmental needs thereby ensuring wholesome recovery of the patient. In this respect, a cross-sectional study conducted on women having diminished ovarian reserve in contrast to those diagnosed with anatomical cause of infertility has been conducted to examine the magnitude and predictors of emotional reactions. Infertility distress was found to be greater in women with diminished ovarian syndrome as opposed to those diagnosed with anatomical cause of fertility (Nicoloro-SantaBarbara et al., 2017). In subsequent study, it has been shown that quality of life and emotional status of infertile women both during and after fertility problems show stark differences in comparison to their partners. Thus, women are predisposed to the risk of encountering emotional problems thereby inviting suitable interventions to mitigate the issues (Huppelschoten et al., 2013). Studies conducted with respect to understanding about the perceptions and experiences of the infertile women in receiving care and other fertility services. A prudent study brought to the forefront that infertile women experience discrepancies in terms of receiving the support they desire in contrast to what they actually receive from their friends, family, spouses, online sources and medical professionals. Thus, support adequacy is advocated through utilization of positioning social support as dynamic resource to combat the effects of infertility in women (High & Steuber, 2014).  Thus, the provision of psychosocial care is of importance to facilitate the support for those experiencing infertility and medically assisted reproduction. Study has shown that psychosocial care is of paramount importance for catering to the diverse needs of the target population. Needs may range from behavioral, relational, emotional and cognitive. Therefore following of suitable guidelines that has the potential of ameliorating stress and concerns about medical procedures that in turn is likely to enhance the lifestyle outcomes, fertility related knowledge, wellbeing of the patient and conformance with the treatment agenda (Gameiro et al., 2015). Therefore, holistic midwifery nursing is of profound importance as it adopts meticulous and pertinent approaches to combat the issues concerning infertile women and account for holistic improvement of their outcomes.

Society's Influence on Women with Infertility

Infertility is commonly attributed with distress that impairs the health condition of the lives of couples. Moreover, physical and marital health of infertile women often is determined by the sexual function of this population. However, appropriate research has shown that in case of infertile women, sexual dysfunction is high. The women experiencing secondary infertility are more likely to suffer from impaired sexual functioning in contrast to ones suffering from primary infertility (Tanha, Mohseni & Ghajarzadeh, 2014).  Across recent researches, empirical evidences have been presented whereby association between stress of fertility treatment and pregnancy rates and patient dropouts are prominent. Nevertheless, psychological interventions constituting coping skills training as well as stress management has harbored positive outcomes in terms of managing infertility patients. Mitigation of distress, loss of control, disruption in developmental trajectory and stigmatization may be attained through therapeutic intervention which stand for holistic healing of patient (Cousineau & Domar, 2007). Further study has provided a sneak peek into the issue of prevalence of psychiatric disorders among the infertile men and women who are undergoing in-vitro fertilization (IVF) treatment. The study outcomes has revealed that mood disorders are common among both men and women who are undergoing IVF treatment. Another alarming outcome revealed that majority of such patients having psychiatric disorder was undiagnosed and untreated (Volgsten et al., 2008). Another relevant study brought to the forefront the relationship between perceived stigma, disclosure patterns, support and distress as experienced by the new attendees in the infertility clinic. Results of the study demonstrated that higher levels of distress might be seen in case of women who have been exposed to greater disclosure. Support for people having fertility problems must be attended to in relation to stigma and wider social context. Distress is quite rampant among these population owing to the negative impacts due to stigma attached to the issue of infertility in women (Slade et al., 2007). Therefore, in order to combat these issues and advocate good practices for the nurses and other healthcare professionals, it is imperative to streamline the healthcare services in a manner where infrastructures are well equipped and the staffs are empowered with proper training and competencies thereby ensuring holistic recovery for the intended audience.


Further studies have laid emphasis on the perception of control, coping and psychological stress as experienced by infertile women undergoing IVF. Results of this insightful study depicted that avoidance coping may be attributed to low perception of controllability. Moreover both this confounding factors added to the experience of stress in the concerned population of infertile women. Therefore, it is pivotal to arrange for suitable remedies and implement interventions that might benefit infertile women undergoing treatment for altering their coping skills and enhancement of sense of control (Gourounti et al., 2012). Empathetic understanding and consideration on the part of the medical advisors and counselors might lessen the burden of infertility experience among the couples or at individual level. Couple counselors have been identified as competent professional who holds the authority and ability to guide these people in leading a better life overcoming the challenges faced due to infertility. Physical, social and emotional responses to the infertility experiences need to be dealt adeptly so that holistic outcomes in relation to the patient may be generated of which mental health status of infertile women is of significance (Peterson, Gold & Feingold,  2007).  Further, the association between anxiety and infertility related stress in men and women has been confirmed in suitable study that revealed the presence of greater degree of anxiety and infertility stress among women than men (Peterson, Newton & Feingold, 2007). Thus, it is evident that the risks for infertile women is higher in contrast to men thereby necessitating the urgency for suitable interventions that will aim to address their issues and arrive at resolutions accordingly.

The Role of Midwives in Combating Infertility

In view of the plethora of findings concerning infertility in women, efforts must be strategized so that optimal wellbeing and holistic care may be directed to this population with the aim of mitigating their psychological and emotional problems. Lack of training and insight on matter related to infertility in women must be dealt adequately by arranging for educational programs and awareness campaigns that will attend to the issues relevant to infertile women more rigorously

References

Begum, B. N., & Hasan, S. (2014). Psychological problems among women with infertility problem: a comparative study. J Pak Med Assoc, 64(11), 1287-91.

Bennett, L. R. (2017). Indigenous healing knowledge and infertility in Indonesia: Learning about cultural safety from Sasak midwives. Medical anthropology, 36(2), 111-124.

Collura, B., & Stevenson, E. L. (2016). CHALLENGES TO INFERTILITY ADVOCACY IN THE UNITED STATES: DEFINING INFERTILITY AND BARRIERS TO ACCESS TO CARE. Fertility and Assisted Reproductive Technology (ART): Theory, Research, Policy and Practice for Health Care Practitioners, 191.

Cousineau, T. M., & Domar, A. D. (2007). Psychological impact of infertility. Best Practice & Research Clinical Obstetrics & Gynaecology, 21(2), 293-308.

Cowling, W. R. (2015). Evolving and enduring topics in holistic nursing.

Daibes, M. A., Safadi, R. R., Athamneh, T., Anees, I. F., & Constantino, R. E. (2017). ‘Half a woman, half a man; that is how they make me feel’: a qualitative study of rural Jordanian women’s experience of infertility. Culture, Health & Sexuality, 1-15.

Farley Ordovensky Staniec, J., & Webb, N. J. (2007). Utilization of infertility services: how much does money matter?. Health services research, 42(3p1), 971-989.

Gameiro, S., Boivin, J., Dancet, E., de Klerk, C., Emery, M., Lewis-Jones, C., ... & Wischmann, T. (2015). ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction—a guide for fertility staff. Human Reproduction, 30(11), 2476-2485.

Gourounti, K., Anagnostopoulos, F., Potamianos, G., Lykeridou, K., Schmidt, L., & Vaslamatzis, G. (2012). Perception of control, coping and psychological stress of infertile women undergoing IVF. Reproductive biomedicine online, 24(6), 670-679.

High, A. C., & Steuber, K. R. (2014). An examination of support (in) adequacy: Types, sources, and consequences of social support among infertile women. Communication Monographs, 81(2), 157-178.

Hollos, M., & Larsen, U. (2008). Motherhood in sub?Saharan Africa: The social consequences of infertility in an urban population in northern Tanzania. Culture, Health & Sexuality, 10(2), 159-173.

Hollos, M., Larsen, U., Obono, O., & Whitehouse, B. (2009). The problem of infertility in high fertility populations: meanings, consequences and coping mechanisms in two Nigerian communities. Social science & medicine, 68(11), 2061-2068.

The Need for Psychosocial and Emotional Support

Huppelschoten, A. G., Van Dongen, A. J. C. M., Verhaak, C. M., Smeenk, J. M. J., Kremer, J. A. M., & Nelen, W. L. D. M. (2013). Differences in quality of life and emotional status between infertile women and their partners. Human Reproduction, 28(8), 2168-2176.

Legro, R. S., Hurtado, R. M., Kilcoyne, A., & Roberts, D. J. (2016). Case 28-2016: A 31-Year-Old Woman with Infertility. New England Journal of Medicine, 375(11), 1069-1077.

Mascarenhas, M. N., Cheung, H., Mathers, C. D., & Stevens, G. A. (2012). Measuring infertility in populations: constructing a standard definition for use with demographic and reproductive health surveys. Population health metrics, 10(1), 17.

Nahrin, N. E., Ashraf, F., Nessa, K., Alfazzaman, M., Anwary, S. A., Abedin, S. A. A., & Rahman, M. M. (2017). The Emotional-Psyc hological Consequences of Infertility and Its Treatment. Medicine Today, 29(1), 42-44.

Nicoloro-SantaBarbara, J. M., Lobel, M., Bocca, S., Stelling, J. R., & Pastore, L. M. (2017). Psychological and emotional concomitants of infertility diagnosis in women with diminished ovarian reserve or anatomical cause of infertility. Fertility and Sterility.

Peterson, B. D., Gold, L., & Feingold, T. (2007). The experience and influence of Infertility: Considerations for Couple Counselors. The family journal, 15(3), 251-257.

Peterson, B. D., Newton, C. R., & Feingold, T. (2007). Anxiety and sexual stress in men and women undergoing infertility treatment. Fertility and sterility, 88(4), 911-914.

Shargh, N. A., Bakhshani, N. M., Mohebbi, M. D., Mahmudian, K., Ahovan, M., Mokhtari, M., & Gangali, A. (2016). The Effectiveness of Mindfulness-Based Cognitive Group Therapy on Marital Satisfaction and General Health in Woman With Infertility. Global journal of health science, 8(3), 230.

Slade, P., O'Neill, C., Simpson, A. J., & Lashen, H. (2007). The relationship between perceived stigma, disclosure patterns, support and distress in new attendees at an infertility clinic. Human Reproduction, 22(8), 2309-2317.

Tanha, F. D., Mohseni, M., & Ghajarzadeh, M. (2014). Sexual function in women with primary and secondary infertility in comparison with controls. International journal of impotence research, 26(4), 132.

Vahidi, S., Ardalan, A., & Mohammad, K. (2009). Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005. Asia Pacific Journal of Public Health, 21(3), 287-293.

Van den Broeck, U., Emery, M., Wischmann, T., & Thorn, P. (2010). Counselling in infertility: individual, couple and group interventions. Patient education and counseling, 81(3), 422-428.

Volgsten, H., Skoog Svanberg, A., Ekselius, L., Lundkvist, Ö., & Sundström Poromaa, I. (2008). Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Human Reproduction, 23(9), 2056-2063.

Yakout, S. M., Talaat, M., & Fayad, E. M. (2016). Emotional problems of Infertile Egyptian women. Journal of Nursing Education and Practice, 7(1), 146.

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