Evidence-Triggers for Care of Patient with Cleft Lip and Palate at Srinagarind Hospital: Antenatal Care Unit.

Background: The abnormalities of cleft lip and palate (CLP) condition are the serious problems which always found in the northeastern region of Thailand. The treatment must be sustainably and continuously integrated by the interdisciplinary team, including registered nurses who take care of all nine organizations under the corporation among nurses who work at Tawanchai Cleft Center. Starting from the diagnosis of the fetus by the new technology along with medical knowledge which can diagnose the abnormalities since birth. The diagnosis of the fetus with CLP affects mental and health of mother, so the nurse who takes extended care of them needs to have the data in order to plan the integration treatment and prepare them to be ready of confronting to the crisis. Also, this is for the adaption of fetal abnormalities and the encouragement for their new baby. Hence, clinical evidence triggered for care of pregnant women with fetal CLP is really important.

Objective: To trigger the clinical evidence of pregnant women whom found the fetal CLP at antenatal care unit, Srinagarind Hospital.

Material And Method: This descriptive study of clinical evidence-triggers for care of pregnant women with fetal CLP is the part of the study in antenatal care clinic which was applied to use the clinical evidence-triggers of The Center for Advance Nursing Practice Model. After the considerations of human ethics, the four stimulators were examined as the followings: 1) the simulation of practice triggers which was studied by reviewing five patient medical records in order to know the general data and health condition; 2) reviewed related literature, 3) interviewed five pregnant women whom diagnosed with fetal CLP, 4) interviewed one responsible nurse with 15-20 minutes, and using open-ended questions to ask about the health problems of pregnant woman, also giving an advice. The data were collected during January-December 2015. The descriptive data were analyzed using percentage and the qualitative data were analyzed by content analyses.

Results: A total of five pregnant women with fetal CLP were included in the study with the mean age of 32 years, and the second pregnancy was 80%. The clinical problems of pregnancy with fetal CLP included: 1) mental and health of pregnant women and families; 2) discouragement of being pregnant and taking care of their pregnancy; 3) fetal facial image; and 4) nurture of such fetus after birth. The results after the diagnosis of pregnancy with fetal CLP and receiving advice from physicians and nurses were found regarding medical records that they were advised from the physician and nurse towards the abnormalities and chromosome inspection, and given treatment after birth. According to the interviewing of the nurse, it was found that the pregnancy felt regret and denied the diagnostic results, and needed treatment information. Besides, according to the interviewing of the pregnancy, it was found that they wanted to discontinue the pregnancy, needed information, wanted to know about any abnormality. The literature review revealed that nurses were those who providing care, knowledge, and advice.

Conclusion: The clinical problems of pregnant women detected with fetal CLP included feelings of disappointment, sadness, and regret whether or not found other abnormalities and being stress in caring for pregnant and postpartum care. The best handling and treatment was to obtain care from the interdisciplinary team in order to help them and their families to face with the crisis, accept to the abnormality of the fetus and having alternatives, and select such the appropriate alternatives, including antepartum and postpartum care.