Smoking during Pregnancy

Smoking is a significant issue with numerous diseases attached to the habit in today’s society. Even nonsmokers experience health issues as a result of the inhalation of smoke from smokers. The nonsmokers are called passive smokers. It has been confirmed medically that both passive smokers and active smokers are subjected to equal health complications of smoking (Cao, 2015). Similarly, a pregnant woman that smokes would cause some health implications for the fetus and the newborn. In fact, the majority of adults, including pregnant smokers are aware of the health consequences of smoking on the baby in their womb (Flemming 2014). Therefore, it is essential that proper and adequate orientation should be given on the implications of smoking during pregnancy. The focus of this paper is to research the health implications of smoking on the fetus. Furthermore, the research will explore the ways of preventing the health effects and complications of smoking on the fetus by supplements or education.

Smoking during pregnancy causes an unexpected loss of pregnancy. Smoking during the early period of pregnancy has been observed to be a significant cause of loss of pregnancy. Research has shown that the probability of miscarriage occurs to a pregnant woman that indulge in smoking during the first three months of the pregnancy. In rare occurrences, the miscarriage occurs after 20 weeks of gestation (Walsh, 1994). The terrible loss of the fetus at the early stage of pregnancy is called stillbirth. Likewise, data obtained from the U. S. Centers for Disease Control and Prevention (CDC) shows that smoking increases the likelihoods of both early miscarriage and stillbirth. The loss of the fetus is highly related to the harmful chemical substances in the cigarette, such as carbon monoxide, nicotine, and tar (Ramsay, 2000).

Another consequence of smoking during pregnancy is Ectopic pregnancy. According to the information published by the world health organization, chemicals compound nicotine, which is among the constituents of cigarettes causes the fallopian tube of a pregnant woman to contract. The contraction further causes the passage of an egg to be a difficult task (Walsh, 1994). Consequently, the fertilized egg could be implanted in another region that is not the uterus. Ideally, eggs are implanted in the uterus, and fetus development takes place in the region. The type of pregnancy in which the egg is not implanted in the uterus is referred to as ectopic pregnancy.  In this case, the pregnancy must be aborted by a doctor as early as possible to avoid damaging the mother’s reproductive system. The ectopic pregnancy is also a loss of fetus, thereby constituting an adverse health effect to the fetus.

The placenta provides the food materials that sustain the fetus in the womb of a woman. The placenta is vital for the survival of the fetus, and it is regarded as the fetus’s lifeline; it is essential as it provides the fetus with oxygen and the necessary nutrients. However, smoking makes the placenta to detach itself from the umbilical cord earlier to the birth of a child; the situation is known as placental abruption. The condition leads to excessive bleeding that may be risky to the life of both the mother and the child. The only remedy to the abnormal medical condition is an early diagnosis. There is no medical procedure to reconnect the umbilical cord to the placenta. A study conducted confirms a positive relationship between cigarette smoking during pregnancy and placental abruption (Ananth CV, 1996). The authors conducted an epidemiologic study to assess the role of smoking cigarette during pregnancy as a potential risk factor for placental abruption, previa of the placenta, and bleeding of uterine of unknown etiology in pregnancy.  The study data were obtained from women seeking prenatal care at any of the two tertiary, seven regional, or 17 community hospitals in the province of Nova Scotia, Canada.

Smoking during pregnancy can lead to preterm birth. Preterm birth is when a mother delivers her baby very early before the expected date of delivery (EDD). Significant risks are linked with the early delivery of the baby. These include effect on the hearing and visual ability of the child, mental disorder, and health complications that subsequently can lead to the death of the baby. A study conducted among some group of pregnant smokers to ascertain the relationship between preterm birth and smoking during pregnancy revealed that the overall rate of preterm delivery was 4.3%. Also, it was revealed that smokers had a 40% higher risk of giving birth to preterm compared with nonsmokers. A dose-response relationship was found between smoking and the risk of preterm birth. The study further showed that the caffeine content of cigarette has a profound effect on giving birth to preterm. It revealed that taking more than 400 mg of caffeine per day increases the chance of preterm by almost threefold (Wisborg K, 1996). Furthermore, a dose-response association was established among women with a high intake of caffeine; women that smoke one to five cigarettes in a day had no increased risk of preterm birth relative with nonsmokers with the equal intake of caffeine, women that smoke six to ten cigarettes in a day had almost three times higher risk of preterm birth. Similarly, women that smoke more than ten cigarettes in a day had almost five times higher risk of preterm birth relative to nonsmokers with the same intake of caffeine.

Smoking can cause the weight of the child to be less than the standard weight at childbirth. Underweight at infancy has many health implications for the child. The implications include cerebral palsy, which is a set of perpetual movement disorders that occurs in early childhood. Symptoms are poor coordination, taut muscles, weak muscles, and tremors. Others include delay of development in a child, and vision and hearing impairment (Henry, 2004). American Cancer Society suggests that if a mother quits smoking before getting pregnant, the chances of giving birth to a child with lower weight than the standard weight is significantly lowered.

Also, smoking during pregnancy increases the probability of giving birth to a child with some congenital disabilities (Ramsay, 2000). Some of the defects include heart problems, breathing difficulties, and low immune system. In fact, in some situations, the formation of the structure of the heart is altered due as a result of the smoking effects.

Many studies have been carried on how to ameliorate the health effects of smoking on offspring. The use of supplements such as vitamin c has proven effective in reducing the challenges (McEvoy, 2014).  Smoking during pregnancy adversely affects the development of the lung of the offspring. It decreases the functions of the pulmonary and increases the asthma risk for an extended period in the offspring. The result of the research indicates that vitamin C blocked some of the in-utero effects of nicotine on the development of lung and pulmonary function of the offspring. Similarly, supplemental vitamin C that is used by pregnant smokers’ showed improved results of newborn PFT and reduced wheezing through 1 year in the offspring (McEvoy, 2014). Vitamin C use by pregnant smokers is a low-priced and straightforward approach to reduce the effects of smoking during pregnancy on newborn pulmonary function and respiratory morbidities

Sure, having new pregnant mothers eliminate smoking altogether from their normalcy would be ideal, but with smoking comes a type of addiction and need that in some individuals, it is simply unrealistic. How can we fix the issue? Education is an integral part of this, of course. Mothers tend to know smoking can complicate a pregnancy, but do they know how much risks it places the unborn baby in with respiratory issues and decrease the growth rate? These babies cannot control what the mother does while they are in the womb, yet they are the ones that suffer from what the mother chooses. How do these pregnant mothers justify their decisions to continue to smoke throughout pregnancy? According to a study asking this question, there were four major themes of why they chose to continue smoking. They included the mothers having a healthy baby previously while smoking throughout the pregnancy, the argument that smoking helps with personal gains and social lives, the belief that the consequences of smoking will never affect them, and the simple lack of desire to stop smoking is not present (Goszczyriska, Knol-Michalowska, & Petrykowska, 2016). Consequently, orientation on the therapeutic effects of smoking during pregnancy, as highlighted in this paper should be taken more seriously.

Conclusion

Smoking during pregnancy has been proven to be a dangerous act that can endanger the fetus. Some of the health complications on the fetus that could result from a pregnant woman that smokes have been identified. They include unexpected loss of a pregnancy, ectopic pregnancy, placental abruption, preterm birth, low birth weight, and congenital disabilities. However, it is sad that most mothers still indulge in smoking regardless of the imminent danger that smoking poses to the fetus and newborn. Even CDC report revealed that 10% of the total pregnant women admitted to having smoked during the first three months of their pregnancy (Henry, 2004). Nevertheless, the way to avoid smoking-related complications is to quit smoking. Also, the use of supplements like vitamin is effective. Education of pregnant women on the dangers of smoking should be accorded high priority. A pregnant woman that smokes should seek Experts’ advice such therapists and medical professionals.

References

• Ananth CV, e. (1996). Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. – PubMed – NCBI. Retrieved from
  
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• Cao, S., Yang, C., Gan, Y., & Lu, Z. (2015). The Health Effects of Passive Smoking: An Overview of Systematic Reviews Based on Observational Epidemiological Evidence. Retrieved from
  
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• Flemming, K., McCaughan, D., Angus, K., & Graham, H. (2014). Qualitative systematic review: barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth.
  
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• Gould, G., & Oncken, C. (2014). Management of smoking in pregnant women. Retrieved from https://search.proquest.com/docview/1499361199/fulltextPDF/A5CFAAE9F99347EDPQ/1?accountid=30659
• Henry, L. C. (2002). Predictors of stage movement toward smoking cessation in pregnant women. Lewiston, N.Y: E. Mellen Press.
• McEvoy, MD, C. T., Schilling, RRT, D., & Clay, BS, N. (2014, May 28). Vitamin C and Newborns of Pregnant Smokers. Retrieved from
  
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• Ramsay, M. C. (2000). The putative effects of smoking by pregnant women on birthweight, IQ, and developmental disabilities in their infants: A methodological review and multivariate analysis.
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Information Systems in Healthcare

Advancements in technology has placed the world at our fingertips. These advancements provide us the capability to share information in real-time and affords us the ability to document everything we do or come into contact with in our daily life. There are circumstances in life when being able to capture these moments are beneficial, such as snapping a picture of your baby’s first steps then sharing it on social media for your friends and family members to view as well. We cross an ethical line as healthcare individuals however, when we utilize this technology to our benefit and at the cost of a patient’s right to privacy. Throughout this paper HIPPA and regulatory requirements as well as a scenario in which a patient’s right to privacy is violated will be discussed. Included will be recommendations on what should be done to correct this violation in addition to advantages and disadvantages technology can provide to healthcare. In order to understand these things and how they corelate to the use of technology in healthcare, we first must know the law as outlined by the Health Insurance Portability and Accountability Act (HIPAA).

HIPAA, Legal, & Regulatory Discussion

Originally passed by the United States Congress in 1996, HIPAA was updated in 2003 adding the Privacy Rule, requiring that an individual’s personal health information be protected and remain confidential (United States, 2004). As defined in 45 CFR § 160.103, this rule applies to healthcare providers, health insurance plans and healthcare clearinghouses. Although the Privacy Rule of HIPAA does not stipulate how cellphones and social media should be utilized in the healthcare setting, it does require that electronic protected health information (ePHI) be safeguarded. Since this is difficult to achieve with each employee having their own personal devices, many organizations maintain that any device or outlet that puts the protected health information of patients at risk for being inappropriately accessed should not be utilized in the healthcare setting. But what is considered protected health information?

According to the Privacy Rule of HIPAA, protected health information (PHI) is any information that can be used to identify an individual including name, date of birth, social security number, address and medical record numbers. The Privacy Rule goes even further to include email address, phone number and full-face photographic images as well as 10 additional items it considers to be unique to an individual (United States, 2004). Should an employee of one of the entities mentioned be negligent and fail to protect PHI the entity may choose to take steps to rectify the matter with the potential of terminating the employee. In the event HIPAA law is deliberately violated due to an individual willfully sharing PHI, the Depart of Justice could decide that the person face criminal penalties including fines upwards of $250,000 with the possibility of having to pay restitutions to the victim involved as well. Therefore, it is the responsibility of the health entity to educate its employees on the necessary steps to protect a patient’s information and ensure that those employees comply with the HIPPA rules and regulations set forth by Congress. Nevertheless, an employee has the capability to disregard those rules and choose to act on their own freewill. An example of this would be the following scenario.

Also see:

Importance of HIPAA: Keeping Health Information Private

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Scenario Ending

You go on Facebook, on your day off, and talk about the night you had at work and how you didn’t really feel as bad having to miss the concert, because you actually got to meet Jerod in person and even “Got his number!” You then post a picture of Jerod on Facebook and Instagram, figuring that most of your contacts would never recognize him anyway. It’s your day off and your personal time, so no harm, no foul, right?

In this scenario the nurse chooses to deliberately disregard HIPAA law by posting the patient’s name and picture to social media outlets, Facebook and Instagram. Doing this means she has shared protected health information which identifies the patient. The nurse see’s nothing wrong with posting the information on social media because she believes she is only sharing it with her close contacts. Once posted on a public platform however, the information is now considered to be part of the public domain and she loses control of how the information is shared (Kouri, Rissasen, Weber, & Park, 2017). This action is rationalized even further by the nurse in her thinking that she is not at her job and on her personal time, so she is able to do whatever she wants. As a healthcare professional though, society holds her to a standard that she is always ‘on duty’ and by posting PHI she has compromised the privacy of the patient (Jones & Hayter, 2013).

Recommendation

The deliberate action of the nurse to share PHI of a patient falls on the healthcare facility she works for. In order to correct this wrongdoing administrators of the facility should perform an internal investigation to verify in what manner the PHI was obtained and by whom. The individual responsible for stealing the information should be terminated as the sharing of this information was deliberate and not an act of simple negligence. To prevent further sharing, the individual should be requested to remove the information from all social media platforms and delete the evidence from her smartphone. Willfully sharing the PHI of the patient was a criminal act and to ensure the integrity of the healthcare facility, this incidence should be made available to the Department of Justice so it can be fully investigated and determine if restitutions should be paid to the patient, who is a well-known celebrity.

To prevent an incidence like this from happening again, healthcare employees should not be allowed to utilize their own personal devices while caring for patients. The healthcare facility may consider purchasing cellular devices for inhouse use so team members can still communicate instantly but the software should be encrypted and secured with passwords specific to the individual who has the device, much like one will need when logging in to the computer system. In order to guarantee that employees do not forget the importance of HIPAA compliance, the facility should also implement yearly mandatory continuing education courses. By doing so, individuals would be reminded that they are the first line of defense for ensuring patients personal health information is protected.

Advantages and Disadvantages

The use of social media in the realm of healthcare does have advantages when it is utilized in a professional and educational manner. Twitter, a social media platform where individuals post short messages, also known as ‘tweeting,’ has been used for public research and for sharing health information related to healthy habits (Jones & Hayter, 2013). The research aspect comes from gathering user data based on searches for specific health related information. Nurse researchers, as well as other professionals, are able to collect these figures and determine if a lack of education exists in the community regarding certain illnesses. Should a lack of knowledge be identified, social media can then work by spreading the information to a vast number of individuals, especially those who are searching for the knowledge. Smartphones as well provide advantages such as being able to immediately call a physician while in a patient’s room instead of having to walk to the nurse’s station. While in the room, the nurse is able to ask the patient any questions his or she may have forgot to ask, preventing a delay in care provided. Unfortunately, the use of social media and smartphones in the healthcare setting come at a risk.

While there are advantages to utilizing this technology, there are also disadvantages. For instance, smartphones are handheld devices that can easily be laid down and forgotten about. In our scenario we read that the nurse placed her phone and the bedside table and forgot about it. By not having the capability to secure the device to oneself, the smartphone as well as any information stored within it is at risk for theft. Should an individual be able to hack into the phone, they would have access to a multitude of PHI, placing the patients they serve at risk for identification. Another disadvantage is the possibility of transmitting PHI via text message. It would be tempting for the nurse to simply text PHI to a physician when seeking orders for a patient. Those messages, however, are sent and received through unsecured networks which again leaves PHI accessible to individuals who are able to hack into the networks.

Conclusion

The use of technology in the healthcare realm today provides advantages and disadvantages that should be carefully evaluated when it comes to the Privacy Rule of HIPAA rules and regulations. The technology of social media and smartphones provides easier access to gathering data, sharing educational information and communicating with other members of the healthcare team. Technology also puts the privacy of individuals receiving care at risk when individual’s do not take safeguards to protect the information to the upmost of their ability. As healthcare members we must remember that we are the first line of defense when it comes to PHI. Some things we are able to do to secure PHI is logging off computers, sending messages through encrypted systems, and not posting anything about patient’s or their care to social media. Securing PHI can also be as simple as turning over a sheet of paper that has PHI on it, so no one is able to view the information. Should any member choose to blatantly disregard the rules set forth by HIPAA and share information they are privy to, that individual is subject to the criminal justice system and will be held responsible for their actions.

References

• Jones C, Hayter M. Editorial: social media use by nurses and midwives: a ‘recipe for disaster’ or a ‘force for good’?. J Clin Nurs. 2013;22(11-12):1495–1496. doi:10.1111/jocn.12239
• Kouri, P., Rissasen, M.-L., Weber, P., & Park, H.-A. (2017). Competences in Social Media Use in the Area of Health and Healthcare. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 183–193. doi: 10.3233/978-1-61499-738-2-183
• United States. (2004). The Health Insurance Portability and Accountability Act (HIPAA). Washington, D.C.: U.S. Dept. of Labor, Employee Benefits Security Administration.