Nursing paper

Running head: ADVANCING ADHERENCE TO THE CAFFEINE INTAKE GUIDELINES TO IMPROVE PRE – PREGNANCY, PREGNANCY, AND BIRTH OUTCOMES

2

Advancing Adherence to the Caffeine Intake Guidelines to Improve Pre – Pregnancy,

Pregnancy, and Birth Outcomes

Advancing Adherence to the Caffeine Intake Guidelines to Improve Pre – Pregnancy,

Pregnancy, and Birth Outcomes

Benedicte Mbui

Mount Mercy University

Nu 471

Audrey Sheller

03/31/2021

Pregnant women form a demographic that requires policies and guidelines that are critical in improving their public health and the next generation's health (Li et al., 2015). Specifically, these policies involve reducing certain substances like toxins and drugs that have been identified as harmful to the child and the mother during gestation. These issues have become critical to the medical society. Therefore, it is critical to understand how change can be implemented to help women eliminate caffeine consumption and interventions that can promote healthy behavior—the risk of such substances to mothers' fetuses and fertility warrants the need for intervention and change (Loomans et al., 2012). Although caffeine's exact effects on the fetus remain primarily misunderstood, there is a need to impact change and ensure that women can understand the benefits and risks of caffeine consumption pre-pregnancy and during pregnancy. Caffeine remains one of the most consumed beverages by men and women alike. There are underlying effects of caffeine consumption that are becoming more apparent from recent studies and research. The effects may vary from one individual to the next. This paper, therefore, proposes an intervention set to help pregnant women eliminate caffeine consumption before and after pregnancy. It will include strategies to assist the patients in understanding the need for the change, involve all stakeholders, and ensure they are all trained and are on board with the program. The analysis will include the possible challenges and barriers that can affect change and the best ways to overcome them. Current studies on caffeine's effect before and during pregnancies used the rodent model to examine the effects in pregnancy, the effects after birth, and the fetus's growth. Prior research showed that limiting the amount of caffeine could lower the risk of complications. However, throughout the pregnancy, daily consumption of the recommended minimum can still cause issues. This report, therefore, focuses on the implementation of change in caffeine consumption in a health setting. It involves the patients, doctors, the medical staff, the nurses, and family members and friends.

PICO Question

Does changing the caffeine intake guidelines improve pre – pregnancy, pregnancy, and birth outcomes?

Supportive Evidence

This section investigates the evidence that relates to the effect of taking caffeine during prenatal and postnatal periods. The section will also aim to establish the research gaps that exist in the previous studies. Besides, this section will use the previous papers to validate this study. Additionally, it will also assess the effectiveness of this study on other environments and the precautions that ought to be taken to ensure that it is effective. Further, it will also critically evaluate the literature while pointing out the effects at each stage and the interventions to implement during the various stages. Finally, the section will highlight the findings that arise from the review of the existing literature.

Guillán-Fresco et al. (2020) indicate that caffeine belongs to a family of methylxanthines. Since caffeine comes from coffee, tea, and soda, then its consumption is high as preferred beverages. Caffeine is a natural alkaloid with no nutritional value and has various adverse effects, especially among pregnant women.

Effects of Caffeine Consumption at the Prenatal Stage

According to Qian et al. (2020), the various effect of caffeine consumption during the prenatal stage include intrauterine growth restriction, and miscarriage. Another risk is that despite causing miscarriage, it can cause the pregnancy to attach wrongly in the uterus. He indicates that continued consumption of caffeine during pregnancy dramatically increases the chances of the above conditions, among others Guillán-Fresco et al., (2020); (Galéra et al., 2016) indicates that consumption of caffeine influences the birth outcome as well as compromising the pregnancy. A cup of coffee contains 100mg of caffeine. Therefore, it was widely thought that consuming three cups a day is not likely to have any effect and was thus referred to as a safe dosage. However, further research has revealed more damning results not previously highlighted (Bakker et al., 2011). Other studies also show that the effect during the various stages of pregnancy contrary to what was widely thought. Studies show that the consumption of caffeinated products is almost 89% per day in the United States alone. Further, other than other drugs, consumption is not restricted in any way, with Africans and Asians consuming tea, and soda t increase caffeine levels while Americans and Europeans and drink coffee and soda (Galéra et al., 2016); (Guillán-Fresco et al. 2020). Either way, despite the caffeine’s high consumption rates, the effects are evident and adequate steps should be implemented to limit the impact of consuming it.

According to Loomans et al. (2012), for pregnant mothers, there are no caffeine levels that are considered safe. Many analysts suggest that consuming two cups of coffee has an equivalent of about 200mg, which is still not safe for both the unborn child and the mother. Responsible bodies ought to take decisive action to minimize the consumption of caffeine. First, an important step is to encourage caffeine consumers to go for alternative products. There are many alternative products whose consumption is guaranteed to offer vitamins and more health benefits such as vitamins. According to Bakker et al. (2011), since caffeine products do not have vitamins, there are better products with higher vitamins, which can be more helpful to such women. Therefore, even though caffeine products such as tea and coffee, which lack nutrition value, are preferred by many Americans, starting an initiative to encourage expectant mothers against it would help reduce the effects associated with caffeine consumption (Loomans et al., 2012). The alternative products such as fruit juices and milk are of higher nutritional value, and therefore, responsible bodies should encourage expectant women to consume such products over tea and coffee.

The other meaningful way to minimize caffeine consumption is to educate pregnant mothers about the possible effects of caffeine consumption. Most postnatal patients are not aware of the many consequences of consuming caffeine products and therefore consume them ignorantly (Bakker et al., 2011). Several training programs will help health care facilities cut down on the costs incurred in treating some advanced effects of consuming caffeine (Galéra et al., 2016). Taking such precautions will reduce miscarriage and other negative consequences that can be attributed to the consumption of caffeine.

Effects on Postnatal Consumption of Caffeine

Keeping to the findings of Guillán-Fresco et al. (2020), Mothers who consume high levels of caffeine bear children who are likely to develop impaired cognitive development. Sometimes, such children have a very low IQ. Additionally, Qian et al. (2020) demonstrate that in the model of rodents’ expectant mothers who consume high caffeine levels influence children's brain development. Other studies show that even the lowest consumption of caffeine products influences the cognitive development of such children.

Obesity is another common problem with children born of mothers who had a high caffeine consumption during pregnancy. Guillán-Fresco et al. (2020) Explain that a high percentage of children born of mothers with a high caffeine consumption rate undergo childhood obesity. Several studies indicate that the mother's caffeine consumption influences the weight of the child (Loomans et al., 2012). Obesity is a significant challenge in the United States that is responsible for high motility rate mothers ought to take action to ensure their children's health. in addition to the caffeine consumption causing Obesity among children, it is also responsible for childhood acute lymphoblastic leukemia (Peacock et al., 2018). The childhood acute lymphoblastic leukemia condition is responsible for many childhood deaths, and mothers ought to reduce or eliminate caffeine consumption to save their children.

   Another effect of consuming high levels of caffeine during child pregnancy is that it is responsible for children with low birth weight and small head circumference. According to Qian et al. (2020), several factors influence the birth weight of a child. These factors include heart disease, anemia, and childhood acute lymphoblastic leukemia. Childhood acute lymphoblastic leukemia has a high mortality rate of around 70%; therefore, mothers should stop consuming caffeine to stop exposing their children to the condition.

Interventions for Postnatal

Loomans et al. (2012) Indicate that consuming high levels of caffeine leads to impaired cognitive development. Therefore, mothers should desist from consuming or reduce the amount of caffeine intake. The reduction will lead to a decrease in the number of children affected by impaired cognitive development. Guillán-Fresco et al. (2020) Indicate that the mental development process begins before birth. Therefore, any force that influences such an approach should be altered before it affects the responsible person.

Obesity among children is still one of the most common killer conditions in the United States.  As such, responsible parties should take proper initiative to ensure that the children born are free from any life-threatening condition (Loomans et al.., 2012); (Galéra et al., 2016). Additionally, implementing proper measures is critical to ensure that conditions such as do not affect the child later.

The small head circumference condition is at times an indication of a brain that is not fully developed. Additionally, when children are born underweight, they have to be put in an incubator until they are fully developed (Peacock et al., 2018). However, in some instances, these conditions can hurt the children and, in worst cases, result in death. Therefore, caffeine consumption during prenatal and postnatal stages should be discouraged to ensure that the children do not develop such possibly fatal conditions. Qian et al. (2020) indicate that in some instances have associated caffeine with heart conditional among children. Therefore, since several studies have demonstrated the adverse conditions influenced by mothers consuming caffeine during pregnancy, it is prudent to cease losing children at an instance.

In conclusion, the articles reviewed lay bare the effects of consuming caffeine on children. Some authors still indicate that taking small quantities has only limited effects on then the patient. The impact of postnatal and prenatal caffeine is quite prominent (Galéra et al., 2016). First, the postnatal stage's impact includes impaired cognitive development, childhood acute lymphoblastic leukemia, Obesity among children, cancer, low birth weight, and small head circumference. These conditions can be easily altered if only mothers are responsible enough for their children. These conditions are fatal in some instances, meaning that they make the United States' mortality rate remain high. On the other hand, the prenatal stage's effects are that the combination of the impact in both stages indicates that caffeine consumption harms the children born by such mothers. Therefore, this review establishes that it is crucial to reduce caffeine consumption throughout the pregnancy cycle.

Implementation Potential

Many people are naturally resistant to change, and more so when it involves strong habits such as caffeine consumption. Therefore, to effectively implement change and eliminate caffeine consumption before and during pregnancy, there has to be an unfreezing stage. Since it is a challenge to eliminate consumption at once, there must be a plan to help the individual eliminate caffeine consumption gradually. The role of unfreezing is to create awareness and inform the woman that the current status quo is not the most suitable for conceiving and the child's health (Li et al., 2015). This stage also involves informing the patient that the degree of acceptance and the current belief they hold on caffeine consumption can affect them and affect the outcome of the pregnancy.

At this stage of the implementation, the medical personnel involved in the intervention must educate the person. Understanding that the old way of thinking must be dealt with before undertaking the process of change and convincing the patient that there is a need for change is critical to eliminating caffeine (Modzelewska et al., 2019). There are many beliefs and arguments about caffeine, and therefore the woman may hold some of her own, so communication as a tool must be effectively implemented.

At the unfreezing stage of every intervention, communication is essential as the woman, the spouse, and other family members and the medical personnel have to work hand in hand to realize change. The role of communication is to point out the benefits of caffeine elimination and the need for imminent change. The more the woman and the family members understand more about the change, the more they will be more willing to accept it and work towards it (Jahanfar & Jaafar, 2015). The process of conceiving and during pregnancy is a delicate one, and therefore, as long as the family feels the urgency, they will be willing to cooperate and accept the change. To shift from a culture that a person is used to already and accept change requires an internal drive. Therefore, such drive for change has to originate from the top. That is the physicians. The medical team supporting the mother before and during pregnancy must set the intervention's tone and the need for change (Rodda et al., 2020). Unless the medical team sets the best place for the practice, the chances of the patients following through are minimized.

Barriers to Change

Availing information is, therefore, the best way to raise the desire to change for the woman. The use of information and data is the perfect tool for nurses and doctors to convince patients to change. With tests and measurements, a physician can raise an issue to the woman at this stage of the intervention. This stage, therefore, involves consultations between the medical team and the patient (Hillier & Olander, 2017).

Caffeine elimination is challenging progress and promises to be difficult for the mother and the family. There are several barriers to change. These must be identified. For a person to prioritize caffeine elimination, there are specific barriers that they have to deal with and face. There is the fear of withdrawal which can be scary for a person, especially during pregnancy. Some people also justify their case that they are unable to concentrate without caffeine and the impossibility of stopping (Stoll et al., 2018). Fighting caffeine addiction is associated with relapses and challenges and may scare a person from attempting to quit.

Another barrier to eliminating caffeine is the social functions it plays in the lives of many people worldwide. Many people hold the idea that without regular caffeine, they are unable to concentrate and remain productive. Many people apply caffeine in employment settings, such as those who work extra hours (Jahanfar & Jaafar, 2015). A person may also associate caffeine with studying and working on assignments regularly and may fear that elimination might affect their routine.

A barrier to implementing change is that caffeine is consumed as a part of a ritual or routine. Many people have caffeine as an essential part of their daily activities and changing may affect their routine. The woman can also resist change if they use caffeine to deal with mental health complications such as lack of sleep and anxiety (Rodda et al., 2020). Caffeine can also be used in sports settings as a stimulant or gym works.

To achieve the change needed, there must be feedback on various people's behavior, including family members and medical personnel. It is essential to explain whether caffeine consumption is an issue and a need to change (Hillier & Olander, 2017). There is a need to self-assess the woman to understand the extent of caffeine they consume and the degree of tolerance and dependence. The benefits and costs of the elimination must be assessed thoroughly by the patient, the medical team, and family members. It is critical to understand the severity of the withdrawal and the effects that women can face if she attempts to eliminate consumption (Chen et al., 2018). Understanding the quantity of caffeine consumption and how it affects health is a critical factor in making the right decision about the change.

The potential benefits of the change must be clear. These for the woman include better sleep, an increase in better health, more energy, and mental health. Caffeine consumption affects blood pressure and adrenaline functioning (Modzelewska et al., 2019). It also causes anxiety, panic attacks, and irritability. All healthcare personnel who work with the mother can instruct caffeine during pregnancy due to the possibility of surgical procedures, dental issues, and general health problems. There should be moderation which warrants the need for the implementation (Evatt et al., 2016). Lowering the consumption of coffee and related substances such as dairy and sugar can also have health effects and reduce the financial burden associated with the habit as reasons for change.

Development and Implementation

Training is critical to attaining the goals of the change among pregnant women. The primary source of information is from the medical team and professionals. Additional sources can provide information on external sources such as blogs, websites, and books (Modzelewska et al., 2019). All the intervention stakeholders must understand caffeine as a substance, strategies to change dependency, symptoms of caffeine deficiency. The process of training also involves the psychological burdens and effects of continuous consumption of caffeine. For a person to understand the need for the change, they have to be well versed in the substance's knowledge (Rodda et al., 2020). People must understand whether the type of caffeine they consume is natural or has additional additives and the caffeine industry issues.

Further information and discussions during the training must include how coffee is metabolized in the body and how it differs when pregnant. Without a proper understanding of the scientific side, the patients can be resistant to change. It is also critical to understand the process of manufacturing and production. In the past, the urgency has been in limiting the consumption to an average minimum; however, there is a need to convince women that the best way to ensure the pregnancy's best outcome is to eliminate consumption (Hillier & Olander, 2017).

Training Stakeholders

The patients and the staff must be trained on dealing with withdrawals and scenarios that can occur while quitting. The training should also involve discussions with other people who have gone through the same situation (Hashmi et al., 2016). The patients should talk to other women who went through pregnancy and had to eliminate their caffeine consumption. Hearing from the experiences of women in similar situations can assist in eliminating the barriers to change. They can get guidance from people who have dealt with withdrawal and managed to go through with the pregnancy until birth. Seeing the health benefits of the change to the baby and the mother can motivate other women to keep going (Jahanfar & Jaafar, 2015). The internet is a good source of information and case stories about people who have dealt with caffeine addiction during pregnancy.

This stage involves the actual change and move, which is the reality of the intervention. At this stage, the medical team must understand that many people struggle with accepting the new status quo. The patients can face fear and uncertainty, which can make overcoming a significant challenge. The more the patients are prepared to face the issue, it will be easier for them to complete it. Therefore support, education, and communication are critical between the doctors, the nurses, the patients, and families as they familiarize themselves with the change (Rodda et al., 2020). The nursing team must be fully aware of the change's benefits and why it should be implemented.

The patients should be supported by all parties involved and taught to believe in themselves. It is accepting that they can achieve the goal of eliminating caffeine during pregnancy. The nurses must keep a positive mind and attitude. Their training can include a non-medical professional such as a dietician or psychologist. The patients can require remote counseling sessions and medical care, and nurses should understand natural supplements and medications to help with the withdrawal symptoms. Quitting caffeine is associated with muscle pain, depressive episodes, muscle pain, headaches, and other cases that can be alleviated by appropriate medication (Stoll et al., 2018). The medical personnel must also track the consumption of caffeine among the patients.

The patient's feelings and thoughts must also be sourced to understand the changes in moos, anxiety, and energy. These factors are critical in understanding how their bodies respond to withdrawal. This stage must involve the support system, including the family, work colleagues, friends, and nurses who understand the change's intention. Accountability is critical for success; therefore, the support system should be constantly involved as family and friends assist the patients in caffeine consumption (Jahanfar & Jaafar, 2015). The patients, however, reserve the decision on whether to continue with the process or if they choose to stop due to inability to avoid the barriers.

A strategy to ensure the change's success includes withdrawal management in the initial days of caffeine elimination. All stakeholders must be trained and willing to deal with real-time scenarios rather than reverse the need. Well-being as a strategy can involve a range of approaches to improve patients' general health based on factors such as diet and sleep. Although factors such as these are not directly related to caffeine elimination, some consumers believe that caffeine helps develop resilience and capabilities (Stoll et al., 2018). Controlling consumption must include substitutions, antecedents, and associations.

In managing the change process in a medical setting, the people who have to change must participate in all the change processes. The hospital setting must develop a team spirit and culture whereby everyone understands the intended change and its need. This way, the nurses, doctors, and patients can work towards attaining the same common goal. The common goal in this discussion is the elimination of caffeine consumption among pregnant women (Rodda et al., 2020). This vision must be well communicated to the patients and the staff, and family members.

The change's specifics must be precise, with both the patients and the nurses treating each other with mutual respect. Achieving change at such a level requires a clear explanation of expectations as every stakeholder is evident on the role they play in the change, understands others' role, and feels the collective sense of accountability for the process. In the implementation of change, individuals need to know how much change they are making, and this can be achieved through feedback from the nurses' data throughout the period.

Evaluation

The intervention's deliverables will seek to reduce and eliminate caffeine consumption among women pre-pregnancy and during pregnancy. One way that will be used to measure the success of the intervention is self-reported data collected via surveys. The nurses will periodically contact the women to report the progress on caffeine intake since the training on caffeine withdrawal. The surveys will be sent online and will ask questions regarding withdrawal from caffeine. The survey will also investigate whether the women have been able to withdraw successfully and manage the symptoms, caffeine substitutes that they are currently using, the effects of withdrawal, and how they are dealing with them, among others. The survey's results will be data-savvy and coded and analyzed to present findings of the caffeine withdrawal and use before, during, and after the intervention. The second approach will be clinical and will seek to measure known outcomes of caffeine use that nurses are inherently duty-bound to measure and manage. These approaches will seek to explore the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of both the mother and the child, families, communities, and populations. Clinical data will be corrected to measure caffeine intake's effect on all involved parties before, during, and after the intervention and launch of the Caffeine Intake Guideline. Among the clinical data that will be collected including fetal abnormalities, pregnancy complications such as miscarriages, fetal developmental issues, among other issues related to caffeine intake.

The surveys will be conducted every three months after the interventions are initiated. On the other hand, clinical data will be collected during pregnancy and pregnancy clinics that women attended periodically in local healthcare institutions. The target will be to affirm the abnormalities and defects that are related to caffeine intake are reduced by at least 55% in the first two years since the intervention and caffeine intake guidelines are put in place. Still, measurements will be taken in the long run to develop an intense database that can be used to affirm how the intervention works each financial year and identify areas of improvement. The proper budgeting and accounting measures will be put in place to measure the project budget and expenses on cost versus benefit analysis. Each quarter, the healthcare organization will present a financial report of the intervention program with clear information relating to investments in capital, expenses, and costs. These costs overall cost differences will be measure against the pre-existing accounts of budgets and expenses that have previously been spent on managing and treating caffeine-related complications and defects during pregnancies. The intention is to contain lower costs than the expenses on managing and treating caffeine-related defects while changing and improving both the mother and the child's lives. Therefore, cost-benefit will be measured purely on accounting grounds using comparative analysis of costs and expenses before and during the interventions. The cost-benefit evaluation is in line with the principles and practices in healthcare, where cost-benefit analysis (CBA) involves comparing interventions and their consequences in whereby both costs and resulting benefits (health outcomes and others) are expressed in monetary terms.

Conclusion

It is critical to limit caffeine consumption during pregnancy due to the mother and the fetus's potential harm. High levels of use are connected to complications for the baby and the mother. There have been limitations to the amount a pregnant person can consume in a day, but recent studies show that it can still lead to stillbirths and miscarriage. Therefore, with this information, there is a need to implement this report's strategies to help reduce the risks of complications. The intervention must be carried out respectfully and understandably, as all parties should be willing to play their part. This report highlights the strategies that can be used to achieve the goals. It highlights the possibilities of carrying out the strategies and the perceived costs and benefits to the patients. It also highlights the functions and duties. All parties involved, families, friends, and healthcare service providers involved, must be trained to deal with the situations that arise and possible barriers. The barriers to change are also highlighted and accordingly dealt with the implementation of appropriate strategies. The process will collect data for the evaluation and refreezing stage of the implementation to understand and monitor the changes.

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