Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
Step 3: Identify needs and problems
This is the third step of the problem-solving method. Using the information from steps 1 and 2,
the provider will identify problems the client is experiencing. Identification of needs or problems
is done by thinking about findings, what the client has said (history), and what was found in the
physical examination. The provider will compare the findings with what is known about normal
findings to determine if the condition is normal or if there is a problem.
If the findings are all normal, the provider will proceed to identify the client’s needs. These are
the things the client needs to remain healthy, such as immunizations, birth preparedness in the
antenatal period, or counseling on nutrition and basic care of the woman and her baby.
If the findings indicate there is a problem, the provider will compare the abnormal findings with
what she/he remembers or finds in references about complications. If the findings match those
for a complication, the provider will determine the diagnosis. Sometimes, it is difficult to
determine an exact diagnosis. In this case, either eliminate some diagnoses and use a
differential diagnosis or describe the problem and refer the woman/baby for further evaluation
and care.
It is important that all the client’s problems and needs are treated, not just the problem that
caused her to come to you. A pregnant woman may need information on family planning
methods, good nutrition during pregnancy, how to relieve hemorrhoid pain, and where to go for
immunizations for her small children—all in one visit. She may have come with only one
complaint, problem, or question. Make certain that you write all the problems or needs on her
record/antenatal form.
Step 4: Make a plan of care
This is the fourth step of the problem-solving method. The provider will decide what should be
done to solve each problem or meet each need. Ideally, the provider will develop the care plan
with the client, the client’s mother, or the client’s family members.
The following actions should be considered for each problem or need, and the provider must
decide which to do first, second, and so on. Sometimes medical treatment will be needed first.
For example, when a woman has a retained placenta and is bleeding heavily, you must stop the
bleeding by manually removing the placenta before laboratory tests can be done. You may then
give her more treatment, education or counseling, or refer her. Or, when a woman who is six
months pregnant comes to you and is feeling very tired, you will test her hemoglobin (Hb) before
giving her treatment, education and counseling, or referring her.
A baby brought with a danger sign needs referral to an appropriate center after giving the first
dose of antibiotics, whereas a newborn infant with a minor infection may be managed locally
along with routine basic care, such as giving immunizations.
Here are some appropriate actions a provider might write in the plan of care developed for the
client:
• Medical treatment. Choose the correct medication, procedure, or treatment by following
the clinical protocols.
• Education. Help the woman learn to care for herself well. Always teach women the
danger signs they should be aware of in themselves and their babies and where to go if
any of these signs or symptoms appear.
• Counseling. Help the client understand the problem or needs. Work with her to develop
a way to treat the problem or meet the needs.
Integrated maternal and newborn care
Basic skills course
25