Frances Payne Bolton School of Nursing
Case Western Reserve University
Dr. Deborah Lindell
The Practice Situation
Complex physiological changes during pregnancy have a significant impact on almost every organ on the body system including the oral cavity -- these changes are due to hormonal changes. Estrogen causes increased blood flow to the oral cavity, making the gums friable and easy to bleed, contributing to gingivitis. Pregnancy-associated gingivitis is highly prevalent. It affects approximately 30%-75% of pregnant women and resolves after delivery. Nausea and vomiting during pregnancy can also increase the risk of extensive erosion (Varney, Kriebs, & Gegor, 2004; Barak, Oettinger, Machetie, Peled, & Ohel, 2003). In addition, changes in diet, such as increased consumption of carbohydrates, increased acid from vomiting, and changes in oral hygiene may increase the risk of tooth decay during pregnancy (Russel & Mayberry, 2008). Current research and evidence shows the importance of maintaining good oral health during pregnancy. Evidence supports that periodontal infections during pregnancy increases the risk of adverse birth outcomes such as premature deliveries, low birth weight, still birth, miscarriage, and pre-eclampsia (Russell & Mayberry, 2008; Jeffcoat, Geurs, Reddy, Cliver, Goldenberg & Hauth, 2001). Preterm birth is a significant public health problem, as the prematurity rate at in the United States was 12.7% in 2007. Preliminary data for 2008 indicates a slight decline to about 12.3% (Martin, Hamilton, Sutton, Ventura, Mathews, Kirmeyer, & Osterman, 2010). Behrman & Butler (2007) reported that annual societal preterm births cost more than $26.2 billion in 2005, or $51,600 per infant born preterm, including maternal delivery, medical care, early intervention services, and loss of household and labor market productivity. As a midwife, one main goal during antenatal care is to improve pregnancy outcomes. Part of this can be accomplished is by promoting oral health care and healthy behaviors. It is important to provide oral health education before and during the current pregnancy, as well as educate our clients about the association between poor maternal oral health and adverse pregnancy outcomes. In addition, we must encourage them to see a dentist during pregnancy. Theory
To choose a theory to apply to the practice problem, relevant theories must be critically evaluated based on a set of criteria. The author used the three questions posed by Fawcett and Associates (1992) as described by Kenny (2006): “(1) Does the theory or model address the client problems and health concerns?; (2) Are the nursing interventions suggested by the model consistent with client’s expectations for nursing care?; and (3) Are the goals of nursing actions, based on the model or theory, congruent with the client’s desired health outcomes?” (Kenny, 2006, p.305). Several middle range theories can be used and applied to maximize oral health during pregnancy, as well as the prevention of adverse outcome related to oral problems. The Theory of Reasoned Action and Theory of Planned Behavior focuses on and explores the relationship between behavior and beliefs, as well as attitudes and intention (Montano & Kasprzyk, 2008). The Diffusion of Innovations Theory has been used to study the adoption of health behaviors and programs (Tiffany & Lutjens, 1998). The Precaution Adoption Process Model has been applied to behaviors which require deliberate action and initiating new behaviors (Weinstein, Sandman, & Blalock, 2002). The Transtheoretical Model and Stages of Change are used to guide the individual through the stages of change to action and maintenance (Prochaska, Redding, & Evers, 2002). The Health Belief Model is used to predict and explain health behaviors...