Running head: RESOURCE MOTHERS 1

Health Planning Project: Resource Mothers/Loving Steps

Taiquita Ardan, Megan Bess, Kristel Cornejo, Samantha Galloway, Shelby Lowery,

Rica Reuyan, Delenthia Smith, Trishana Wallace, Andrea Whitaker, & Lakesa Williams

Old Dominion University

RESOURCE MOTHERS 2

Health Planning Project: Resource Mothers/Loving Steps

The purpose of this project is to gain entry and assess a population within our

community. By working with the community, we will identify and prioritize a community

diagnosis and develop a plan to address it. For the duration of the academic year, the assigned

aggregate population is Resource Mothers, a community outreach group dedicated to assisting

young, at-risk mothers with prenatal care and child rearing. Mothers can participate in the

program through the second year after their child’s birth. The Resource Mothers Program in

Norfolk, Virginia partners with Loving Steps, which is a federally funded, interdisciplinary

organization that functions to prevent infant mortality and low birth weights by providing

pregnant women assistance with stress reduction, education, transportation to doctor’s

appointments, and home care visits. For the purpose of the Health Planning Project, the group

conducted a health assessment of the Resource Mothers/Loving Steps Program (RM/LS) over the

course of the fall semester. Upon analyzing the assessment results, priority health needs were

identified. In an effort to provide interventions to the identified needs, a literature review was

completed along with a review of available resources. In theory, the chosen nursing diagnosis

together with the proposed interventions should be applicable to similar populations.

Assessment

Identify Aggregate

The aggregate population selected for this project was a program already in place at

RM/LS. This population was selected due to an already established relationship between Old

Dominion University School of Nursing and the RM/LS programs. RM/LS primarily assists

pregnant women from their prenatal period until the infant’s second birthday (Virginia

Department of Health [VDH], 2014). They help the pregnant women deal with the stress of

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pregnancy, learn how to care for themselves and their pregnancy, and assist them in their

transition to parenthood.  The RM/LS staff includes dieticians, registered nurses, and lay

community health workers who work with and mentor the mothers. They provide education

regarding mother and child nutrition, proper infant sleep safety, and infant development. They

also conduct home visits and even provide transportation to and from doctor’s appointments. The

objective of RM/LS staff is to reduce the infant mortality rate, increase the number of babies

born at a healthy weight, decrease the numbers of mothers smoking during pregnancy, encourage

the completion of high school, and assist pregnant women in navigating the many challenges

faced. Their overall goal is to improve the health of both the mothers and their infants.

An additional aggregate group was established at Granby High School in Norfolk

consisting of teen mothers and pregnant teenagers who were attending the school. This

population was selected because they were identified as needing additional support and

education based on becoming parents at such a young age and with limited resources. Both the

RM/LS and the Granby High School aggregates had previously established relationships with the

Old Dominion University School of Nursing; however, since we were a new group of student

nurses, new relationships had to be formed with us specifically. It was determined that it was

best to allow the aggregates to disclose information to student nurses based on their comfort

levels. The student nurses would listen to the aggregates and use prompting questions to gain

insight. The aggregates were also asked to complete a form that prioritized needs that they felt

were most important for student nurses to address regarding their health, pregnancy, children,

and motherhood in general.

A second sub-aggregate group was established through the partnership with RM/LS

called the Stork’s Nest, which consisted of at risk mothers of all ages in the Norfolk area who

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needed information and encouragement on maintaining a healthy pregnancy. This aggregate was

selected because of the overwhelming need in the community for both information,

encouragement, and baby/maternity items. This group was an incentive based program that gave

mothers points to participate in encouraged behaviors like keeping prenatal appointments,

attending informational sessions, and giving referrals. The women could use these points to

“buy” items from the “Stork’s Store” that included diapers, maternity and baby clothing, toys,

etc. The group was run by the Zeta Phi Beta sorority and curriculum for the informational

sessions was provided by the March of Dimes; however, the nursing students were asked to teach

the monthly informational sessions. Previous groups did not teach these sessions, so a new

relationship with the aggregate had to be established. The sessions were run as a discussion

group that allowed participants to discuss feelings and needs associated with pregnancy and

motherhood as it pertained to that month’s topic. The students used this open discussion group

style to get to know the aggregate, assess knowledge levels and learning needs, and provide

needed information as determined by the assessment.  

Aggregate Characteristics

Socio-demographic characteristics. Through community outreach and government

funding, the RM/LS program assists pregnant women and teenagers of lower socioeconomic

status with their prenatal and postnatal care. There are six staff members at RM/LS; one director,

a Registered Nurse, a Registered Dietician, and three outreach workers. An individual, full-time

resource mother serves 40-60 teens per year, with an average active caseload of 20-30 clients

(VDH Loving Steps, 2014).

The RM/LS program of Norfolk qualifies for federal grant funding based on a three-year

average infant mortality rate of at least 10.58 deaths per 1,000 live births. In 2012, the mortality

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rate of African American infants was 20.5 deaths per 1,000 live births in the city of Norfolk.

That same year, the rate for the total Virginia population was only 13 deaths per 1,000 live births

(VDH Division of Health Statistics, 2012). According to the U.S. Census Bureau, in 2013

African Americans accounted for 43.2% of the population of Norfolk. In Norfolk, 18.2% of the

entire population falls below the poverty line. The high school dropout rate for African

Americans in Norfolk for the class of 2012 is 14.2% (U.S. Census Bureau, 2014).  Mothers who

are able to complete high school are better prepared to provide a stable and nurturing home

environment. These factors all play a role in prenatal care and potential neglect.

The aim of RM/LS is to decrease the infant mortality rate by increasing the number of

normal weight babies being born. “Babies born weighing less than 5.5 pounds are 50 times more

likely to die in the first 28 days of life” (VDH Resource Mothers, 2014). The babies that survive

are twice as likely to suffer physical and mental handicaps as compared to normal weight babies.

Low birth weight babies born too small or too early can require increased medical interventions,

costing as much as $1,000 to $2,500 per day. The cost for a complicated birth can range from

$20,000 to $400,000 compared to $6,400 for a normal birth. Lifetime medical costs for one

premature baby can average $500,000 (VDH Resource Mothers, 2012). Another effort of the

education done by RM/LS is to increase the time between children being born because it will

increase positive health outcomes for mother and infant. Smoking is a major contributor to low

birth weights. Smoking cessation, even in the third trimester, can improve infant birth weight.

Direct program cost per family is an average of $1,680.  Participating teens have lower rates of

low weight births than non-participants (VDH Loving Steps, 2014).

Locally, from January 2014 to November 2014, there were 30 new enrollees, 83 mothers

served, and 630 home visits conducted. Of those participants 97% were African American. The

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Virginia Department of Health gives statistics for the year of 2012 that are not much more

comforting than the previous years. In Virginia, there were 8,391 infants born with low birth

weight. In Norfolk, there were 424 low birth weights and over 50% (265) were African

American. There were a total of 471 neonatal deaths in Virginia. In Norfolk, there were 34

neonatal (younger than 28 days old) deaths and 25 of them were African American. In Virginia

there were a total of 617 infant deaths. In Norfolk, there were a total of 114 infant deaths. Of the

114 deaths, 42 were white and 69 were African American. There is a clear and discouraging

correlation between low birth weights, neonatal and infant deaths and the African American

population, which is the primary population provided to by Resource Mothers. The website

statistics for this information have not been updated since 2012 (VDH Division of Health

Statistics, 2014).

Health status. The health status of the Resource Mothers’ aggregate is closely related to

their socioeconomic status and internal and external influencing factors, just as all populations

are affected by these factors. Through assessment, information about actual and perceived needs

of the aggregate was gathered, with characteristics of poor nutrition, anemia, hypertension

(preeclampsia), preterm labor, sexually transmitted disease, genitourinary infections, domestic

violence, and psychosocial disturbances.  

Lower socioeconomic status directly impacts mothers’ ability to make healthy food choices,

thus ultimately contributing to diets consisting of processed and fast foods. Processed and fast foods

are considerably higher in fat, sodium, and carbohydrates (Ball, Crawford, and Thornton, 2010).

Like much of society, RM/LS clients were unaware of the long-term effects of eating unhealthy

diets; the need for education and dietary instruction is an ongoing process that cannot be ignored

because it is a major contributor of good health.  Education and intervention can undoubtedly

improve the health of the aggregate without the use of extensive resources.  

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Complications of poor dietary consumption may lead to health problems such as anemia,

hypertension, diabetes, and heart disease. Many disease processes have negative effects on the

pregnant women.  Hypertension, which is prevalent in the African American culture, can lead to

pregnancy induced hypertension or eclampsia.  Evidence shows that neonates born to these

women are at greater risk for a premature delivery and low birth weights (Jeyabalan, 2013).

Premature birth leads to complications, such as respiratory distress syndrome, causing neonates

to be placed in intensive care units, costing billions of dollars annually (Thomas, 2011). Early

prenatal care is of utmost importance in safeguarding women and children’s health, and an early

start on adequate nutrition promotes more positive outcomes.  

Other common health conditions among this population are sexually transmitted

infections and genitourinary infections. Without proper intervention and education, clients are

not screened and therefore do not receive adequate treatment for the infection. These issues

continue to perpetuate poor health status of both the mother and baby that could be easily

remedied with adequate healthcare services and community resources.

Lastly, psychosocial health is another concern, and, although it is prominent, it is often

times ignored. Domestic violence and mental health disturbances are more prominent in lower

socioeconomic classes. Due to the nature of this health issue, responsibility is laid upon mental

health and social workers, when evidence suggests profound biophysical implications on

physiological functions (Keeling & Mason, 2011). With proper attention and therapeutic

intervention, such conditions may be managed to yield more positive outcomes, in regards to

mental health. There are many variables that contribute to domestic violence, but recognition and

education may stop the cycle and have lasting effects on a community. As discussed, health

status is greatly influenced by a number of factors.  With appropriate interventions and lifestyle

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management, many complications may be avoided, and a better outcome may be realistically

achieved for individuals, families, and communities.

Internal and external influences. Due to the socio economic status of the aggregate,

there lies great challenge in meeting even just the basic needs like food, shelter, clothing,

transportation, etc. (Maurer & Smith, 2009). Like many other people living in poverty, a choice

often has to be made between good healthcare and meeting these basic needs. This leaves the

aggregate feeling hopeless and powerless.  There’s a lack of control that compounds the issue,

making resolution difficult.

Ethnicity and culture are internal factors that have an impact on an aggregate’s health

status. According to the U. S. Census Bureau (2007-2011) the highest national poverty rates

were for American Indians and Alaska Natives (27.0%) and Blacks or African Americans

(25.8%) compared to Caucasians (11.6%). Also, infant mortality rates are higher for African

Americans as compared to Caucasians (U.S. Census Bureau, 2007).   

Support from others is a key external influence for a mother caring for her child and these

roles are typically fulfilled by the spouse/partner. Looking at the statistics for teenage

pregnancies and marital status of the mothers of babies born in 2012, it is evident that there is a

gap that Resource Mothers is aiming to fill. In the state of Virginia, 35.3% of new mothers are

not married. In Norfolk, the average is 50.6% and 74.6% of those are single, African American

mothers. Teenage pregnancy rate is still very high, with a total of 8,651 pregnancies. In Norfolk

alone there were 517 teen pregnancies. Of these pregnancies, 387 were African Americans (75%

of all teenage pregnancies in Norfolk)! In 2011, Norfolk fell among the worst ratings for teenage

pregnancies in comparison to other cities and counties in Virginia. (VDH Division of Health

Statistics, 2013).

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Ethnicity and culture are internal factors that have an impact on an aggregate’s health

status. According to the U. S. Census Bureau (2007), African Americans, Hispanics, and Native

Americans have a three times greater risk for poverty than Caucasians. Discrimination, culture

related behaviors, and beliefs about diet and exercise are all related to health issues observed in

the community.

Literature Review

Nelson (2009) performed a qualitative exploratory study to understand how adolescents

who were pregnant or in the postpartum period viewed breastfeeding. The sample population

included 16 adolescents under 19 years of age in an outreach program who had low incomes and

were minorities. Some common beliefs that were identified included that breastfeeding is

healthy, but it hurts. Attitudes that were identified included that the decision to breastfeed is the

mother’s choice and that the baby should come first. There were concerns regarding privacy and

dependency. This study is applicable to our aggregate since we are working with adolescents at

Granby High school. This research can be used to provide proper education about breastfeeding

and clarify any misconceptions that were identified. Some areas that may need further teaching

include the belief that breastfeeding hurts and concerns about privacy. The teenagers can be

taught ways to prevent pain when initiating breastfeeding such as proper latching and use of

lanolin cream. In regards to modesty, they can be taught how to breastfeed modestly by using a

nursing scarf or any covering that they feel comfortable using.

Tender et al. (2009) performed a study to determine the reasons that low-income

breastfeeding mothers used formula supplementation in the hospital and risk factors for

supplementation. Formula supplementation is associated with negative impacts on the duration

of breastfeeding. The sample consisted of 150 mothers in a Washington D.C. clinic. Of this

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population, 60% started breastfeeding in the hospital and 78% of them were using formula

supplementation. The majority had no identified medical reason for the use of supplementation.

Mothers who did not attend prenatal breastfeeding classes were five times more likely to use

formula supplements. An important implication is to educate low-income mothers during their

pregnancy to enhance their knowledge and minimize formula supplementation. This is applicable

for our aggregate since the women fall into the low-income category. Proper breastfeeding

education can help increase the initiation and duration of breastfeeding.

   Drug use in pregnancy is associated with a lack of or no prenatal care. Research by

Roberts and Pies (2011) was performed to understand how drug use in pregnancy affects prenatal

care. An exploratory qualitative study was performed with a sample of 20 women. Women were

included if they had a current or previous history of alcohol and/or drug use and were pregnant

or had a child younger than the age of two. Drug use alone was considered a barrier to prenatal

care for only a few women; most women reported multiple barriers associated with drug use.

Several of the women reported absence of prenatal care because providers were reluctant to

receive a patient in her third trimester. Many women also reported being fearful of the possible

harmful effects that the drugs or alcohol were having on the fetus, which caused them to delay

prenatal care. Another issue reported was isolation as a result of drug use. Women may not have

a support system to help them with their problem. A major significant barrier was fear of being

reported to Child Protective Services (CPS). Some interventions that can be used to eliminate

these barriers include educating these women about the potential harmful effects that the drugs

and/or alcohol can have on their baby and identify strategies to have a healthy baby. Another

important teaching point is to explain how the CPS reporting policies work. It is also necessary

to make it easier for women to find a provider in their third trimester (Roberts & Pies, 2011).

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This research is pertinent to our aggregate since several mothers reported using drugs during

their pregnancies and may experience the identified barriers as a result.

Groth and Morrison-Beedy (2013) conducted a qualitative, descriptive study to determine

how low-income, pregnant, African-American females perceived physical activity and nutrition

during pregnancy. The study consisted of 26 women recruited from the Women, Infants and

Children (WIC) services. Women were included in the study if they were at least 18 years old,

pregnant, and African-American. The majority of the women claimed they wanted to improve

their diets; however, there was a pervasive belief that a good diet is "listening to what their

bodies or fetuses wanted," and resulted in increased cravings and appetite. The women also

viewed eating out as a lifestyle and chose to eat foods based on what was appetizing. Women

reported wanting to increase physical activity, but were too fatigued and had lack of motivation

to do so. This lack of motivation could be attributed to inadequate education about the benefits of

exercise or poor nutrition. This study suggests that low-income, pregnant, African-American

females may not prioritize healthy eating habits and exercise. Interventions should include

educational programs about the positive effects of exercise, and correcting the aggregate's idea

that eating healthy means listening to every craving (Groth & Morrison-Beedy, 2013). This

research is applicable to our aggregate because the majority are low-income African-Americans.

Research by Stotts, Northup, Hutchinson, Pedroza, & Blackwell (2014) investigated the

rates of home and car smoking bans enacted by low-income, pregnant women living in an urban

area. This quantitative study included 820 pregnant women from a prenatal clinic; 98% of the

women used Medicaid insurance. The sample was 59.8% African-Americans. The researchers

found that nearly one-third of the pregnant women lived with a smoker, and within that

household, 44% of the pregnant women also smoked. Only a quarter of the women enacted a

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total smoking ban in their home and car. Women were more likely to smoke if another smoker

lived with them, and if she was pregnant with her first child. This is applicable to our aggregate

because most of them are low-income, African-Americans carrying their first baby. Several also

admitted to smoking during an informational session. Smoking during pregnancy is associated

with various adverse effects, and interventions should focus on increasing low-income women's

awareness of these negative consequences. Furthermore, the women's household must be

involved in participating in a smoking ban. A smoke ban during pregnancy can lower the risks of

a preterm birth, and a low birth weight infant among other things.

Ramos-Marcuse et al. (2009) conducted a longitudinal study that examined the incidence

of depressive symptoms in low-income, first-time, African American, adolescent mothers. The

study included 181 adolescents. Symptoms were measured using the Beck Depression Inventory

(BDI), with follow-ups at 6 and 24 months after the initial assessment. BDI scores were highest

in the initial visit (1 month post-partum) with 49% of the subjects experiencing depressive

symptoms. This decreased to 37% in the follow-up assessments. Based on this data, the

researchers developed a trajectory model that measured the probability of the rates of depressive

symptoms. They concluded that 41% will experience low depressive symptoms in the long term,

45% medium, and 14% high. This study is applicable to our Granby High School aggregate

because it consists of low-income, African American, pregnant adolescents. Based on the high

percentage of adolescents experiencing depressive symptoms, early and frequent screening

should be conducted. Other interventions include referral to a mental health provider for further

evaluation, and attending a support group to discuss their experiences.

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Comparison of Health Status

The aggregate selected for this assessment is made up of women from Granby High

School and the Resource Mothers/Loving Steps’ Storks Nest program. The former consists of

adolescents, and the latter is a mix of all age groups. The aggregate is primarily low income

African Americans.

A good comparison for the Granby High School aggregate and adolescents in the RM/LS

Storks Nest program would be other pregnant teenagers because they share the same health

status of being pregnant at a young age. Most of the evaluated aggregate comes from low-income

families and cannot afford the proper resources needed for a healthy pregnancy. Most cannot

afford prenatal care, doctor visits, prenatal vitamins and other aids that support and promote a

healthy pregnancy. Pregnancy at a young age creates many additional obstacles for teenage girls,

as many pregnant teens find it hard to balance school and pregnancy. Pregnant teens are more

likely to come from low-income families, rely on welfare for financial support, and drop out of

high school (Weiss, 2012).

Teen pregnancy is an important national issue, as well as in the state of Virginia and in

Norfolk.  In 2010, Norfolk reported a teen pregnancy incidence of 39.2 to 52 per 1,000 females,

ages 10 to 19 years old (Weiss, 2012). The birth rate for teenagers 15 to 19 years old in Virginia

has declined over the last ten years and has remained consistently lower than the national

average. From 2000 to 2009 the Virginia birth rate for teenagers declined by approximately 10

births per 1,000 females for the year 2009. The national rate in 2009 was around 39 births per

1,000 females, while Virginia’s was 31 births per 1,000 females (Figure 1).

The assessed aggregate is in Norfolk, which is in the Hampton Roads region of Virginia.

The Hampton Roads region is consistently above the Virginia rate of teenage births, at

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approximately 59 births per 1,000 females in 2009 (Figure 2). However, the rate of births for

teenagers 15 to 19 years old is on the decline in this area with approximately 53 births per 1,000

females in 2010 (Figure 2). These statistics demonstrate how pregnancy is very common among

teenage girls in the evaluated aggregate community of Norfolk, as well as in the state of Virginia.

This prominence greatly affects the aggregates’ health status of pregnancy at an early age and the

importance of the RM/LS program.

Since both Granby High and RM/LS are primarily made up of African Americans,

another comparison that can be made is the infant mortality rates of African Americans

compared to other races. According to the 2010 National Vital Statistics Report, the national

average for infant deaths is 6.14 infants per 1,000 live births. The rate for African Americans is

almost double at 11.46 infants per 1,000 live births. Other races stayed in the range of 3.79 - 8.28

deaths per 1,000 live births (Mathews & MacDorman, 2013).

Virginia is ranked 18th highest in the nation for infant mortality. Per 1,000 live births, 6.8

infants die in Virginia. In the city of Norfolk where our aggregate lives, the 2012 rate is 20.5

infants per 1,000 live births for African Americans (Virginia Department of Health, 2014). That

is almost double the national average for African Americans, and more than triple the national

average.

Infant mortality rates are higher in infants born prematurely and with low birth weights.

According to the VDH Infant Mortality Strategic Plan (2011), prematurity is the leading cause of

infant death in the United States and Virginia. In Virginia, the number one cause of infant

mortality in the African American community are disorders related to short gestation and low

birth weight. The CDC states that preterm-related infant deaths for African Americans in 2010 is

487.3 per 100,000 births which is three times more than non-Hispanic white women (Mathews &

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MacDorman, 2013).  Prevalence of preterm birth and low birth weight are higher in the African

American population because they are more likely to live in communities with limited access to

health care and other resources.

The health status of our RM/LS aggregate in comparison with other similar aggregates

has not changed in the last year. The most up to date health status information on this aggregate

was published in 2012 (VDH Division of Health Statistics, 2013). More information about our

aggregate will be gathered and analyzed in future meetings and compiled in a follow-up report to

be given at the end of spring, 2015.

Health Problems and Needs of the Population

        Living in a lower socioeconomic society predisposes the aggregate to a higher-risk and

more stressful pregnancy.  Both primiparous and multiparous women can experience increased

maternal stress during pregnancies which can cause poor birth outcomes.  Women should be

identified as having an increased level of stress early in the pregnancy in order for interventions

to be provided.  Identifying those with a higher level of stress, earlier in pregnancy, can lead to

better birthing outcomes (Lynn, Alderdice, Crealey &McElnay, 2011).

        Since the target aggregate is at a higher risk for poor pregnancy outcomes they qualify for

several NANDA International nursing diagnoses.  Deficient knowledge related to a lack of

exposure to prenatal teaching and/or misinterpretation of the information provided is the highest

priority for the mothers in the population.  Enhancing the mother’s knowledge will be a benefit

to the mother, the fetus and any other children in the household.  Increasing knowledge can also

address other diagnoses pertaining to the group (listed in order of priority) such as Risk for

Disturbed Maternal/Fetal Dyad related to substance abuse; Imbalanced Nutrition: Less than

Body Requirement related to poor eating habits; Noncompliance; and Fear related to the

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uncertainty of pregnancy. The diagnoses identified pertain to the patient as a whole (Carpenito,

2013). The diagnoses were identified and prioritized based on assessments of the aggregates

during teaching sessions performed throughout the semester, questions asked during these

sessions, and statements made about eating habits, drug use, etc. We found that knowledge

deficiency was the major problem that fueled all of the others, and therefore, prioritized it as the

most important for intervention. However, we also found that most of the women wanted more

information on how to be healthy and have healthy babies, so Readiness for Enhanced

Knowledge about Pregnancy was the next priority followed by those already listed above.

        The majority of the women demonstrated a Readiness for Enhanced Knowledge about

their pregnancy.  The desire to learn about how to care for themselves and their children was

evident by their participation in the group sessions offered by Stork’s Nest and Granby High

School.  Many of the mother’s in the Stork’s Nest program were able to participate in additional

educational opportunities offered by the RM/LS programs.  The desire to learn about the prenatal

period and how to best care for their babies was an important factor to accomplish interventions

for Deficient Knowledge.

Planning

Nursing Diagnosis

This aggregate lacks knowledge about the complications that can be experienced during

pregnancy.   The priority nursing diagnosis for this aggregate is Deficient Knowledge related to a

lack of information provided on the various complications experienced during pregnancy, as

evidenced by their inability to effectively verbalize specific complications that can occur. The

aggregate needs to receive educational sessions that provide additional information on the

various complications that can be experienced during pregnancy, such as gestational diabetes and

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preeclampsia. The educational sessions will allow the pregnant women of Stork’s Nest to meet

the desired outcome of being able to recall the provided information on the various

complications that can be experienced during pregnancy, and be able to utilize this information

in detecting complications in their own pregnancy.

        In order to meet this desired outcome, a baseline of the aggregate’s knowledge on

pregnancy complications needed to be obtained. Assessing the aggregate’s baseline knowledge

will prevent teaching any unnecessary information, as well as illuminate the specific areas that

require teaching.  After assessing the aggregate’s baseline, a teaching plan needs to be

implemented that allots a certain amount of time to each learning objective.  Allotting specific

time to each learning objective will prevent information overload, as well as help ensure that

only one specific topic is taught during each session (Gulanick & Myers, 2011). At the end of

each individualized teaching sessions, a series of questions will be asked to test the aggregate’s

knowledge. Testing the aggregate’s knowledge will help determine the effectiveness of the

information session as well as help reinforce the information given. Making sure the aggregate

understands the provided information increases the likelihood of applying this information

during their own pregnancies.

        Three teaching sessions were completed during the semester. One at Granby High

School, and the other two at the monthly Stork’s Nest meeting. The first teaching session,

centered on gestational diabetes along with other prenatal information.  The session focused on

providing education about the pathophysiology of gestational diabetes and the associated signs

and symptoms. The learning objective for the specific teaching session was that the aggregate

will be able to verbalize the pathophysiology of gestational diabetes and identify at least five

signs and symptoms associated with diabetes complications at the end of the teaching session.

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The objective would be measured by asking the aggregate a series of questions that includes

pathophysiology and signs and symptoms associated with gestational diabetes.

Before the teaching session was implemented, a baseline knowledge level was assessed.

They were asked if they ever heard of gestational diabetes, or if any of them were diagnosed with

it. Two of the aggregates were diagnosed with the disease and were currently receiving treatment

for it, while the other five participants only knew a minimal amount of information on it. The

teaching session was achieved through a brief lecture and open discussion, where the women

were provided information on the pathophysiology of gestational diabetes, as well as the signs

and symptoms associated with the complication, such as feeling tired, being thirsty, and frequent

urination.  The women also received information on the effects that diabetes can have on

pregnancy, such as having a baby large for gestational age. The presentation lasted for 30

minutes. After giving the provided information, the women’s knowledge was tested. Not all of

the aggregates participated in the question and answer session, so the effectiveness of the

teaching session was not determined among all of the girls. Also, at the end of the informational

session, most of the girls still did not understand the acceptable blood sugar level to be classified

as borderline for gestational diabetes.

The second teaching session was focused on the negative effects of participating in

substance abuse during pregnancy.  The informational session provided teaching on the negative

effects of using drugs while pregnant.  The learning objective for this specific session was by the

end of the session all of the participants would be able to verbalize at least two reasons why

participating in substance abuse is dangerous during pregnancy. Acceptable answers included

giving birth to premature babies, underweight babies, and babies born with birth defects and

neonatal abstinence syndrome.

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Before the teaching session was implemented, the aggregate’s baseline knowledge about

participating in substance abuse during pregnancy was assessed. However during this initial

assessment, it was determined that a large percentage of the women believed participating in

substance abuse during pregnancy was not harmful.  Most of the women that favored substance

abuse during pregnancy did not want to listen to the provided information because they were so

convinced that drugs did not affect the pregnancy.  Unfortunately, the learning objective was not

met. However the failure of this teaching session suggested that additional teaching utilizing a

different approach may be needed.

The last teaching session was focused on preeclampsia.  The informational session

provided information on the pathophysiology of preeclampsia and the various signs and

symptoms, such as rapid weight gain, severe headaches, abdominal pain, and reduced or no urine

output.  The session also included information on the negative effects preeclampsia can have on

the newborn, such as having a baby that is malnourished, premature, or small for gestational age.

The learning objective for the informational session was by the end of the teaching session, all of

the participants would be able to verbalize the pathophysiology of preeclampsia, three signs and

symptoms associated with preeclampsia, and the two main effects on the newborn baby.

        Before the teaching session was implemented, the aggregates baseline knowledge of

preeclampsia was obtained. None of the aggregates were diagnosed, and a few had minimal

knowledge about the complication. The teaching session included a brief lecture where the

aggregates were provided information on the pathophysiology, signs and symptoms associated

with the complication, and the negative effects it can have on the newborn.  The presentation

lasted about 45 minutes.  Throughout the presentation the participants asked questions about the

provided content. At the end of the presentation, a series of questions about preeclampsia were

RESOURCE MOTHERS 20

asked to test the aggregate’s knowledge.  Only about two or three aggregates actively

participated in the question and answer session, so the whole group was not properly assessed for

the effectiveness of the teaching session. However, based upon the amount of questions the

aggregates had at the end of the presentation, it was clear that deficient knowledge still existed.

Alternative Interventions

Participants of the Resource Mothers program can build on the knowledge they have

attained from the Stork’s Nest information sessions through additional nursing interventions.

These interventions would be focused on helping women incorporate knowledge into their lives

in order for them to make necessary changes to promote the health of themselves and their child.

Excessive as well as deficient weight gain during gestation has been shown to increase the risk of

developing gestational diabetes and having poor birth outcomes including small for gestational

age, large for gestational age and macrosomia (Siega-Riz, Viswanathan, Moos, Mumford,

Knaack& Lohr, 2009). Diet counseling can be implemented as a means of helping the women in

our aggregate create individualized goals to counter these risks. This would consist of having

biweekly or monthly scheduled sessions in which a nutritionist would speak with the group of

women about their diet choices and offer verbal as well as written information about healthier

alternatives. The sessions would also incorporate regular weight monitoring and information

regarding appropriate physical activities that would promote healthy weight management.

Between 2009 and 2010 a meta-analysis was conducted to review various studies

regarding interventions to help manage gestational weight gain. The analysis revealed that when

the previously mentioned interventions were used exclusively, they were significantly less

effective as studies that incorporated both nutritional and physical activity interventions

(Streuling, Beyerlein & Kries, 2010). By implementing these interventions, we would be helping

RESOURCE MOTHERS 21

to meet our objective to provide education in areas where there is deficient knowledge as well as

assist the women in our program to apply this education in such a way as to suit their individual

needs.

Recommendations

Since the teaching sessions at Granby High School and the Storks nest meetings were

successful, it is recommended to continue these sessions with more focus on lesson development

and creative engagement.  Due to the nature of the functions of Resource Mothers, it was

difficult to schedule home visits, but this is something that should be enforced and made priority,

as it is very instrumental in meeting healthcare needs.  To serve this population, in depth

assessments must be made, and this begins in the home and community.  Disease may follow a

pathophysiological process, but there are certain environmental conditions that contribute to

disease processes.  These conditions are more commonly related to unsanitary conditions that

may be due to negligence, and this discrepancy is being addressed in the General Academic

Pediatric clinic.

Within the General Academic Pediatric clinic, a program known as Legal Educational

Advocacy in Pediatrics (LEAP) is in its initial stages of development.  This program seeks to

offer legal assistance to its low income population.  This intervention is truly important in

providing holistic care to those of lower socioeconomic status.  For example, a child with

repeated asthma exacerbations was exposed to mold in the walls of the apartment complex.  It is

obvious that the landlords were not meeting government regulations and were not addressing the

issue. Due to limited income, these clients had no resources to fight the problem.  Programs like

LEAP bridge the gap and offer these services, and this ultimately meets the objectives of health

RESOURCE MOTHERS 22

maintenance, the most important aspect of community health.  With further development and

research, this project may prove beneficial to the aggregate of Resource Mothers.   

Summary

Resource Mothers / Loving Steps assists mothers of lower socioeconomic status in

obtaining perinatal care for up to one year after birth to improve the health and well-being of

mothers and their babies. The RM/LS aggregate primarily consists of African American

teenagers of lower socioeconomic status that have an increased risk for developing complications

during pregnancy. It has been found that teenage mothers have an increased risk of developing

STIs, pregnancy induced hypertension, nutritional deficiencies, and depression due to lower

socioeconomic status. Furthermore, low socioeconomic status is associated with the increased

use of alcohol, drugs, non-compliance with birth control, decreased rates of breastfeeding, and

living in neighborhoods with high rates of crime and violence. These lifestyle risk factors result

in lack of access to healthcare and pregnancy complications that affect the health of the mother

and the baby. Thus, it is essential to implement programs like RM/LS that will help facilitate

improved health and wellbeing.

Just as in last year’s group’s decision, the primary nursing diagnosis was determined as

Deficient Knowledge followed in priority by Imbalanced Nutrition: Less than Body

Requirements, Risk for Situational Low Self-Esteem, Altered Mental Status, and

Noncompliance. In regards to Deficient Knowledge, the mothers will be provided with

information about what to expect during pregnancy, prenatal care, and how to care for their

newborns through learning in the cognitive, psychomotor, and affective domains. In addition,

mothers will be provided information about the physical, social, and emotional development of

their babies. The expected outcome of the teaching is use of this information throughout their

RESOURCE MOTHERS 23

pregnancy and in caring for their babies. Therefore, a nursing care plan was developed to provide

perinatal education to teenage mothers of low socioeconomic status who participate in the

RM/LS program to improve health, and prevent low birth weight and infant mortality.

RESOURCE MOTHERS 24

References

Carpenito, L. J. (2013). Handbook of Nursing Diagnosis (14th ed.). Philadelphia, PA: Wolters

Kluwer.

Groth, S. W., & Morrison-Beedy, D. (2013). Low-income, pregnant, African American women's

views on physical activity and diet. Journal of Midwifery & Women's Health, 58(2), 195-

202.

Jeyabalan, A. (2013). Epidemiology of preeclampsia: impact of obesity. Nutrition Reviews,

71S18-S25

Keeling, J, & Mason, T. (2011).  Postnatal disclosure of domestic violence:  Comparison with

disclosure in the first trimester of pregnancy.  Journal of Clinical Nursing, 20(1/2), 103-

110. doi: 10.1111/j.1365-2702.2010.03486.

Lynn, F. A., Alderdice, F. A., Crealey, G. E., & McElnay, J. C. (2011). Associations between

maternal characteristics and pregnancy-related stress among low-risk mothers: An

observational cross-sectional study. International Journal of Nursing Studies, 48, 620-

627.

Mann, J. R., McDermott, S., Griffith, M. I., Hardin, J., & Gregg, A. (2011). Uncovering the

complex relationship between pre-eclampsia, preterm birth and cerebral palsy. Paediatric

& Perinatal Epidemiology, 25(2), 100-110. doi: 10.1111/j.1365-3016.2010.01157.

Mathews, T.J. & MacDorman, M. (2013). Infant mortality statistics from the 2009 period linked

birth/infant death data set.  National Center for Health Statistics. Vital Health Stat 61(8).

Nelson, A. M. (2009). Adolescent attitudes, beliefs, and concerns regarding breastfeeding. MCN,

34(4), 249-255.

RESOURCE MOTHERS 25

Ramos-Marcuse, F., Oberlander, S., Papas, M., McNary, S., Hurley, K., & Black, M. (n.d).

Stability of maternal depressive symptoms among urban, low-income, African American

adolescent mothers. Journal of Affective Disorders, 122(1-2), 68-75.

Roberts, S. C. M., & Pies, C. (2011). Complex calculations: How drug use during pregnancy

becomes a barrier to prenatal care. MCN, 15, 333-341.

Siega-Riz, A. M., Viswanathan, M., Moos, M. K., Deierlein, A., Mumford, S., Knaack, J., &

Lohr, K. N. (2009). A systematic review of outcomes of maternal weight gain according

to the Institute of Medicine recommendations: birth weight, fetal growth, and postpartum

weight retention. American journal of obstetrics and gynecology, 201(4), 339-e1.

Stotts, A. L., Northrup, T. F., Hutchinson, M. S., Pedroza, C., & Blackwell, S. C. (2014).

Families at risk: Home and car smoking among pregnant women attending a low-income,

urban prenatal clinic. Nicotine & Tobacco Research: Official Journal of the Society for

Research on Nicotine and Tobacco, 16(7), 1020-1025.

Streuling, I., Beyerlein, A., & von Kries, R. (2010). Can gestational weight gain be modified by

increasing physical activity and diet counseling? A meta-analysis of interventional trials.

The American journal of clinical nutrition, ajcn-29363.

Thomas, P. E. (2011). Do racial disparities persist in infant mortality from respiratory distress

syndrome? JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(1), 47-

51. doi: 10.1111/j.1552-6909.2010.01205.

Thornton, L., Crawford, D., & Ball, K. (2010). Neighborhood-socioeconomic variation in

women’s diet:  The role of nutrition environments.  European Journal of Clinical

Nutrition, 64(12), 1423-1432. doi: 10.1038/ejcn.2010.174.

RESOURCE MOTHERS 26

Tender, J. A. F., Janakiram, J., Arce, E., Mason, R., Jordan, T., Marsh, J., He, J. (2009). Reasons

for in-hospital formula supplementation of breastfed infants from low-income families.

Journal of Human Lactation, 25(1), 11-17.

Virginia Department of Health. (2012). Division of Health Statistics. Retrieved from

        http://www.vdh.virginia.gov/healthstats/stats.htm#tables.

           Virginia Department of Health (2011). Infant Mortality Strategic Plan. VDH Division of Health

Statistics. Richmond, VA.

Virginia Department of Health. (2014). Loving Steps. Retrieved from

http://www.vdh.virginia.gov/ofhs/childandfamily/ReproductiveHealth/infantMortality/lo

vingSteps/whatislovingsteps.htm.

Virginia Department of Health. (2014). Resource Mothers Program. Retrieved from

http://www.vdh.virginia.gov/ofhs/childandfamily/reproductivehealth/homeVisiting/

ResourceMothers

RESOURCE MOTHERS 27

Table 1

Virginia Resource Mothers Program Outcomes (2005- 2012)

Year

New Enrollees

New Pregnant

Teens Enrolled

Total Teens Served

Low Birth

Weight Comparison

of State Teens to VRMP

Participants (%)

Repeat PregnancyComparison

of State Teens toVRMP

Participants (%)

Virginia LBW

Births to Women Ages 19 & Under

VRMP Participant

LBW Rates

State Repeat

Pregnancy Rate for Teens by Resident1

State Repeat

Pregnancy Rate for Teens by

Occurrence2

VRMP Participant

Repeat Pregnancy within 12 months

2005 1063 2119 10.2 8.3 25.0% 24.8% 5.1%

2006 1057 2136 10.4 7.7 23.9% 23.9% 5.2%

2007 1138 2330 10.7 8.9 22.7% 22.8% 5.1%

2008 1121 2345 10.4 9.0 23.9% 23.9% 5.1%

2009 1077 2248 10.6 9.6 24.3% 24.4% 5.7%

2010 993 2160 9.7 9.3 22.6% 22.5% 4.8%

2011 1017 2096 9.3 9.6 21.3% 21.1% 3.5%

2012 831 1874 Not Available

9.2 20.5% 20.0% 3.1%

Note.  1=Virginia residents only; 2=Includes all teens pregnancies in Virginia among residents and non-residents

RESOURCE MOTHERS 28

Table 2Virginia Resource Mothers Program Service Areas SFY 2012

Virginia Resource Mothers Program Service Areas SFY 2012

Counties (39)

AccomackAlleghanyArlingtonAugustaBlandBuchananCarrollCharles CityCovingtonCumberlandDickensonEssexFloyd

GilesGraysonHanoverKing and QueenKing WilliamLancasterLeeMiddlesexMontgomeryNew KentNorthamptonNorthumberland

PulaskiRichmond CountyRoanoke CityRockbridgeRockinghamRussellScottSmythSouthamptonTazewellWashingtonWestmorelandWiseWythe

Cities (26)

AbingdonAlexandriaArlingtonBedfordBristolCharles CityCovington

FairfaxFranklinGalaxHamptonHarrisonburgHopewellLynchburgNewport NewsNorfolkPetersburg

PortsmouthRadfordRichmond CityRoanokeSalemStauntonSuffolkVirginia BeachWaynesboro

RESOURCE MOTHERS 29

Figure 1. Birth rate for teenagers ages 15-19 years old in the United States. This graph describes the rate of teen pregnancy for the state of Virginia against the National rate as well as rates of related states from 2000 to 2009. Virginia Performs. (2012). Teen pregnancy. Retrieved from http://vaperforms.virginia.gov/indicators/healthfamily/teenpregnancy.php#

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Figure 2. Birth rate for teenagers ages 15-19 years old in the state of Virginia. This graph describes the rate of teen pregnancy for each region of the state from 2001 to 2010. Virginia Performs (2012). Teen Pregnancy. Retrieved from http://vaperforms.virginia.gov/indicators/healthfamily/teenpregnancy.php#

RESOURCE MOTHERS 31

Honor Code Statement"We, the students of Old Dominion University, aspire to be honest and forthright in our academic endeavors. Therefore, we will practice honesty and integrity and be guided by the tenets of the Monarch Creed. We will meet the challenge to be beyond reproach in our actions and our words. We will conduct ourselves in a manner that commands the dignity and respect that we also give to others."

Honor Pledge "I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the Honor Code. I will report to a hearing if summoned."

Signatures: Taiquita Ardan, Megan Bess, Kristel Cornejo, Samantha Galloway, Shelby Lowery, Rica Reuyan, Delenthia Smith, Trishana Wallace, Andrea Whitaker, & Lakesa WilliamsDate: 11/24/14

RESOURCE MOTHERS 32

Health Planning Project: GRADING CRITERIAI.  Assessment                Points: 60

A.  Identify aggregate selected for study.  Provide a general orientation to the aggregate.  Include why this aggregate was selected and the method used for gaining entry.(10 points) 10 Good job.10 points  B.  Describe specific characteristics of the aggregate including:

1. Socio-demographic characteristics (must utilize a minimum of four data collection sources). (10 points)  10 points 10 points2. Health status (actual and perceived). Include (when possible) input from clients regarding their perceptions of needs. (10 points) 10 points 10 points3. Internal and external influences affecting the aggregate. (5 points) 5 points 5 well done.

C.  Provide relevant information gained from literature review, especially in terms of characteristics, problems or needs that one would anticipate finding with this type of population. (10 points)  10 points 10 Well Done!

D.  Include comparison of health status of chosen aggregate with other similar aggregates, the community, the state, and/or the nation. (10 points) Excellent stats! 10 points10 pointsE.  Identify health problems and/or needs of specific population based (Nursing Diagnosis) on comparative analysis and interpretation of data collection and literature review. Give priorities to health problems and/or needs and indicate how these priorities are determined. (5 points)5 points Discussed thoroughly. 5 pointsInstructor’s Comments:   Excellent job of presentation on all of this. 60 points.

II.        Planning                                                                Points: 25                                                 A.  Select one health problem (Nursing Diagnosis) and/or need for intervention and identify the ultimate goal of the intervention.  Identify specific, measurable objectives as (mutually agreed on by student and aggregate, when possible) (15 points)  15 points Well done! Good planning. 15 points.       B.  Describe alternative interventions necessary to accomplish objectives.  Select and validate intervention (s) with highest probability of success.  (Note: Interventions may include using existing resources and/or developing resources.) (10 points)  10  points Excellent job of choosing resources and getting the job done. 10 points

Instructor’s Comments:  C.  Appropriate resources Points: 5 points.5 pointsD.  Format Points: 10 points. (One minor problem with one of the references but very minor and the rest was done well.Grammar, sentence structure, honor code, spelling & APA format10 points

RESOURCE MOTHERS 33

Instructor’s Comments:    Total:   100 points                                                 Group Score: ____100_________

Excellent job of presentation with new and thoughtful insights! You have done and will be doing so much!!.