Role of the Nurse in Premarital Care

The nurse plays crucial role in PMC as she is the heart of health care system. These include roles of maternity, pediatric and comunity nurses that go hand in hand to help people prevent hereditary disorders and consequential morbidity and mortality. They play an integral role in providing PMC services that include assess genetic risk, provide information, discuss available testing options and provide appropriate supportive counseling. In addition they ensure that the couples are aware of concerns related to their situation and help them make decisions that fit lifestyle and belief system, (Rahman 2012).

The nurse role require good qualifications as she must be good communicator, skillful interviewer , care giver , good educator and health counselor, and able to assist with adequate decition making or appropriate referral. With those qualifications she can perform her role during PMC which includes helping during assessment, diagnosis, planning and implementation, interpretation, assistance for decition making and evaluation, (Wilson, Audibert et al. 2011).

A scrupulous PMC history identifies couples who are genetically at risk. Prospective couples should always be screened for a genetic history. When women and their spouses are informed of the risks of giving birth to a baby with birth defects or a genetic disorder previous to pregnancy, then they are capable of determining their options concerning a pregnancy including contraception, artificial insemination, adoption, prenatal invasive testing, or chance 27. The nurse should be able to help with referral to an obstetric or genetic service where prenatal diagnosis and amniocentesis are available, (Qari, Balobaid et al. 2013).

The matter of obtaining consent to see family records must be handled in a non-threatening way. The nurse may plan with or help prospective couples organize for a diagnostic test both by discussing the tests, the procedure, the length of time needed for the test and results, the possible outcomes and by helping in procedures in the clinic, the physician‘s office, or the hospital. Later than taking history and preparing the couples for the referral sessions, the nurse should caution them or the family against expecting immediate results. They may tell that it may take time to get the result or respond from the counselor, (Wilson, Audibert et al. 2011).

Interviewing skills are very important in obtaining the relevant preliminary history. The skilled nurse may also drawing the family‘s pedigree in preparation for genetic counseling and she should gather history about family dynamics. In many cases the family medical records will be needed for further research into the incidence of a disorder in the family. Sometime some couples don‘t want others in the family to know that they are having ancestral defects. They want to keep it covert, (Ibrahim, Bashawri et al. 2013).

Diagnosis:

The nurse may assist in preparing family members for blood transmited or infectious disease testing, specific genetic diagnostic testing and counseling. Some nursing or collaborative the problems should be recognized by the nurse. The following are some nursing diagnoses that may be mainly useful in the care of families with genetic problems: knowledge deficit, decisional conflict, disturbance in self-concept or grieving, (Al-Aama 2010)

Planning and implementation:

Planning and implementing follow-up is probably the most important care the nurse can give a couple undergoing PMC especially in case of any discovered problems during the assessment as presence of infectious disease, STDs, suscebtability to have baby with genetic disorders or congenital defects. In these cases there must be continuity of care even after marriage to ensure safe pregnancy and to make the couples aware of possible diagnostic test during pregnancy for early detection and management of any problems. Also the nurse should plan with them for alternatives as contraception, precautions in case of STDs, prenatal diagnosis. (Ibrahim, Bashawri et al. 2013).

Interpretation and reinforcement:

The nurse is required to understand and emphasize information given by the doctor, investigator and geneticist. She should be able to answer further questions, explain the information and discuss management services, community agencies for support. Also she must be aware of the sensitivity of this process and chose the best words and sentences according to the couples level of understanding to meet the plnned goals. (Ibrahim, Bashawri et al. 2013).

Assistance for decision-making:

Support should be given to couples and families both in making decision and following the decision has been made. Decisions will be emotionally painful. They may involve infectios diseases, cancelling marriage and the birth of a defective baby or such things as termination or avoidance of pregnancy, sterilization, adoption or artificial insemination. So the nurse should provide support and make preparations to facilitate decisions and to be able to support them during decition making and be available for support after making decition. She should provide support not only to prospective couple but also she must involve the family during these important and stressful situations (El-Ghany, Gad et al., 2010).

Evaluation:

Once the care is indicated the nurse should evaluate the sufficiency of couples education and supportive care on a continuous basis. Finally when couples or families are faced with hard decisions with respect to PMC outcomes, the nurse is responsible for ongoing follow-up to make sure that adequate information and sufficient anticipatory guidance is offered 29.