6. Assessment: psychosocial aspects:
1. Pregnancy: planned or not; desired or not.
2. Present plans:
1. Carry pregnancy, keep baby.
2. Carry pregnancy, adoption.
3. Abortion.
3. Cultural, ethnic influences on decisions: will influence range of activities, types of safeguarding actions, diet, and health-promotion behaviors.
4. Parenting potential: actively seeking medical care and information about pregnancy, childbirth, parenthood
5. Family readiness for childbearing and child rearing:
   1. Physical maintenanc
   2. Allocation of resources: identify support system.
   3. Division of labor.
   4. Socialization of family members.
   5. Reproduction, recruitment, launching of family members into society.
   6. Maintenance of order (relationships within family).
6. Perceptions of present and projected family relationships.
7. Review lifestyle for smoking, drugs, alcohol (ETOH), attitudes to pregnancy, health care practices, and risks for hepatitis and human immunodeficiency virus (HIV).


7. Analysis/nursing diagnosis:
   1. Altered role performance related to stress imposed by developmental tasks.
   2. Ineffective coping: individual, family related to stress caused by developmental tasks/crises.
   3. Altered family process related to developmental tasks. First baby may precipitate individual or family developmental crisis.
   
   
8. Nursing care plan/implementation:
   1. Goal: anticipatory guidance/support.
      1. Discuss mood swings, ambivalent feelings, negative feelings.
      2. Reinforce “normalcy” of such feelings.
   2. Goal: increase individual/family coping skills, reduce intrafamily stress.
      1. Reinforce family strengths (both partners), sense of family identity.
         1. Encourage open communication between partners; share feelings and concerns.
         2. Increase understanding of mutual needs, encourage mutuality of support.
         3. Increase tendency of mother to turn to partner as most significant person (as opposed to physician).
         4. Enhance bond, success of childbirth preparation classes.
      2. Promote understanding/acceptance of role chang
         1. Facilitate/support achievement of developmental tasks.
         2. Reduce probability of postpartal psychological problems.
         3. Promote family bondin
   3. Goal: health teaching
      1. Siblings:
         1. Alert parents to sibling needs for security, love
         2. Include sibling in pregnancy experience
         3. Provide clear, simple explanations of happenings.
         4. Continue demonstrations of love
         5. Describe increased status (“big sister/ brother”).
         6. Discuss possible misbehavior to gain attention.
      2. Relatives: alert parents to possible negative feelings of in-laws.
      3. Referral to childbirth preparation/parenting classes.
      4. Appropriate community referrals for financial relief to decrease stress and provide aid.


9. Evaluation/outcome criteria:
   1. Actively participates in pregnancy-related decision making
   2. Expresses satisfaction with decisions mad
   3. Demonstrates growth and development in parenting role
   4. Prepared for the birth and for early parenthood