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The purpose of this study was to explore the decision making process and nursing needs of pregnant women with positive reaction to maternal serum screening for Down''s syndrome facing amniocentesis. The grounded theory method was used in this study. Seventeen pregnant women who were shown positive reactions to maternal serum screening for Down''s syndrome participated in this study, after they made their decisions. The data were collected through semi-structured interviews and analyzed by using qualitative methods.
The findings revealed that participants showed four decision making patterns through three ways they received the results of maternal serum screening, from their OPD doctors, phone calls from health care providers, or the mailing reports. Afterward, the decisions were made in OPD or home. Substantially, the whole decision making activities can be grouped into three stages: post-acknowledgement transition, decision-making transition, and after-decision transition. Within them, the decision-making transition was short and inapparent in the first pattern.
During the post-acknowledgement transition, most participants had feelings in psychological reactions including shock, being afraid and nervous, worry, sadness and stress. The main reasons resulting in the above phenomena were: 1.personal experiences, 2.existence of risk factors, 3.health status, 4.high risk, 5.measures for health improvement, 6.doctor''s opinions, 7.unavailability of assistance, 8.mismatch of expectation. Strategies used to cope with these feelings included clarification of cognition and spiritual support.
During the decision-making transition, the involved concerns were: 1.the health of fetus, 2.the relevant problems in amniocentesis and maternal serum screen, 3.the trust toward medical professionals, 4.the responsibilities of maternal role, 5.the opinions from family members, 6.being afraid of abortion. The health of fetus was the most important issue for most participants. They developed strategies to deal with their concerns included: individual efforts, confirming the result of maternal serum screen, seeking help from others, and turning to spiritual consolation.
During after-decision transition, The participants who accepted amniocentesis were concerned about: 1.the fetal problems, 2.the related problems in amniocentesis, 3.the psychological impacts, 4.the trust of medical facilities and professionals, 5.social context factors, 6.the responsibilities of maternal role, 7.the preparation before amniocentesis, and 8.limited time for decision making. The related problems in amniocentesis were concerned most. They overcome their worries by individual efforts, confirming the result of maternal serum screen, seeking help from others, and turning to spiritual consolation. The other participants who were refused amniocentesis were only concerned the increasing psychological stress after their decision.
In terms of the decision making process, the nursing needs of participants could be expressed through the nursing actions they perceived. Including two categories: perception of nursing actions (helpful and unhelpful nursing actions, the expectant roles of nurse) and absence of nursing actions. The nursing actions that participants believed to have help were information providing and psychological support. The unhelpful nursing actions were failing to providing information that participants need, giving no psychological support to participant, and couldn''t playing the role as physician assistant. Most participants hope nurse to satisfy their needs during decision-making process by five expectant roles: information provider, advisor, support role, spokesman role, and referral role. The reasons for lacking nursing actions were no contact with nurses, having no idea that nurses could help them, and unavailability of assistance.
The findings can help nurses understand the decision making process and nursing needs of pregnant women with positive reaction to maternal serum screening for Down''s syndrome facing amniocentesis. Nurses are accordingly able to understand social and cultural context of participants'' behaviors when interacting with these pregnant women. This study facilitate nurses to provide consultation in working with Taiwanese women. The quality of nursing will be enhanced in the future.
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