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Chapter 1
Contemporary Maternity Care, Family, and Cultural Considerations
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1
Maternity Nursing Care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 2
Objectives
Define key terms listed. Compare two current birth settings for
women. Review how technology and research have
influenced maternal-infant care. Discuss the Human Genome Project in
relation to development of gene therapy. Contrast a nursing care plan with a clinical
pathway.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 3
Objectives (cont.)
Identify the role of the nurse in the community-based setting.
State the influence of the federal government on maternity care.
List two reasons why statistics are important in maternal-infant care.
Discuss how standards of care influence nursing.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 4
Maternity Nursing Care
Viewed as the care, support, instruction, and health promotion provided by a nurse
Involves the pregnant woman and her family during the pregnancy and the labor and birth process
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 5
Caregiver Focus
Expectant or new mother Developing fetus or newborn infant
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 6
Emphasis for Caregiving
Integrity of family unit Childbearing considered a normal physiologic
process Wellness
Overriding concern with symptoms/complications being treated if they occur.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 7
Goal of Maternity Nursing Care
Pregnancy, labor, and birthing process to be as uneventful (normal) as possible
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 8
Current Trends
The Labor and Delivery Process
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 9
Birth Settings Acute care hospitals
Labor, delivery, and recovery room (LDR) Labor, delivery, recovery, postpartum room
(LDRP) Freestanding birthing centers
Homelike atmosphere Many do not have technology/medical care readily
available for emergencies Home births
Small number due to high malpractice costs and difficulty obtaining for midwives.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 10
Technology and Maternity Care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 11
Technology and Maternity Care (cont.)
Electronic health records Computerized medication reconciliation Intelligent intravenous pumps Bed alarms Beds that rotate from side to side
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 12
Examples of Technology
High-flow oxygen ventilation machines 3-D ultrasonography Genetic testing Fetal surgery Stem cell research Cord blood banking
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 13
Human Genome Project
Mapped all genetic materials within the human body
Has helped in identifying and isolating certain disease-causing genes
May enable gene therapy to replace missing or defective genes
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 14
Gender Selection
Assists couples in delivering a child of a desired sex
May prevent the passing on of a genetic disorder that may affect a specific sex
Accomplished via sperm separation
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 15
Global Genetics Therapy
Specific cultural and ethnic groups, including geographic locations, have been associated with genetic disorders Thalassemia—Mediterranean (i.e., Greek, Italian,
and Middle-Eastern) Sickle cell anemia—African descent Tay-Sachs disease—Ashkenazi Jewish population
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 16
Preconception Genetic Therapy
Can reduce occurrence of genetic disorders Newborn screening is a standard procedure
in most countries around the world
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 17
Providers of Maternity Care
Registered nurses (RNs) with advanced training and education, typically master’s-prepared Certified nurse-midwives (CNMs) Nurse practitioners (NPs)
Physicians who specialize (MDs or DOs) Obstetrician/gynecologists Neonatologists Pediatricians
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 18
Other Members of Health Care Team
Licensed practical/vocational nurse (LPN/LVN)
Geneticist Social worker Dietitian Lactation specialist
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 19
Collaborative Care
All members of health care team work together to ensure the best possible outcome of pregnancy, fetal development, delivery
The nurse is key in making referrals to appropriate resources
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 20
Health Care Delivery Systems
Need to address rising cost of health care Managed care
Health maintenance organizations (HMOs) Preferred provider organizations (PPOs)
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 21
Health Care Delivery Systems (cont.)
Focus is on controlling costs Diagnosis-related groups (DRGs)
Determine amount of money for providing health care services
Providers can make or lose money, depending on how care is provided
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 22
Clinical Pathways
Assist in identifying and addressing any deviations in progress or care of the patient Care paths Care maps Case management plans Coordinated care plans Clinical guidelines Outcome management
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 23
Community-Based Nursing Lillian Wald
Brought health care to poor children in New York City in the early 1900s
Margaret Sanger Provided care for poor women who were pregnant
Major health care delivery setting even today challenge to provide safe, caring, cost-
effective, high-quality care to families Nurse is patient advocate in influencing
government, business, and community to recognize need for preventive care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 24
Essential Skills for the Community-Based Nurse
Creativity Problem solving Coordination of multidisciplinary caregivers Case management Assessment Referrals when necessary
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 25
Therapeutic Care
Provided in home setting Nurse educates family regarding issues such
as: Fetal monitoring Apnea monitoring of the high-risk newborn Blood glucose monitoring of the gestational
diabetic woman Total parenteral nutrition Professional referral when necessary
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 26
Home Health Care Team Members for Children with Disabilities
Nurses Obstetricians Pediatricians Occupational therapists Physical therapists Respiratory therapists Home teachers Social workers
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 27
Specific Government Influencesin Maternal-Infant Care
National Institutes of Health (NIH) Supports/provides funds for maternity research
Title V of Public Health Service Act Established maternity-infant care centers in clinics
Title XIX of Medicaid program Care for the indigent woman
Center for Family Planning Contraception information
Women, Infants, and Children (WIC) Supplemental food and education for needy
Medicaid programCopyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 28
Health Care Reform Bill of 2010
Reduce overall care and make health plan accessible for all
Children will not be denied insurance due to pre-existing conditions
Allows children to stay on their parent’s health insurance until age 26
Will be paid for through Medicare payroll taxes
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 29
Goals of Healthy People 2020
Primary goals Increase years of healthy life Eliminate health disparities
Subgoals Promote healthy behaviors Protect health Provide access to high-quality health care Strengthen community prevention and provide
access to care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 30
Statistics Important to Maternal and Newborn Care
Need to obtain information about the way maternity care is given and outcomes of maternal/newborn care
Depict health status of a nation and a community All births recorded Maternal/infant mortality rates fall when overall
health improves Aid in the allocation of resources
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Standards of Care
Establish minimum criteria for competent nursing care
Protect the public Used to judge quality of care provided
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 32
Who Helps Set Standards of Care?
Professional nursing organizations (e.g., American Nurses Association [ANA], Association of Women’s Health and Obstetric and Neonatal Nurses [AWHONN])
Licensing and certification organizations (e.g., The Joint Commission, Centers for Medicare and Medicaid Services [CMS])
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 33
National Patient Safety Goals
The Joint Commission focuses heavily on the safety of patients
Health care facilities must be able to address these goals
Examples include Ensure accurate patient identification Provide medication reconciliation Reduce health care–associated infections
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 34
Nurse Practice Act
Nurses are responsible for practicing within the scope of their nursing license
It is the nurse’s responsibility to know what that scope allows
A nurse who fails to provide the standards of care within his or her scope of practice can be accused of negligence or malpractice
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 35
Audience Response System Question 1
Clinical pathways are designed from what type of standards?
A.Evidence-based
B.Medical decisions
C.Preventive care
D.Government regulations
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 36
Evidence-Based Practice and the Nursing Process
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 37
Objectives
Explain evidence-based practice. Recall three major components of
communication. Recognize the importance of documentation. Illustrate the HIPAA rights of patients. Discuss the five steps in the nursing
process. Define critical thinking and illustrate its use
in nursing and in test taking.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 38
Objectives (cont.)
Discuss how examining one’s own culture can affect care of a patient during labor and delivery process.
Contrast defining characteristics of four family types.
Contrast complementary and alternative health care with conventional health care.
Illustrate the role of the nurse in alternative or complementary health care.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 39
Evidence-Based Practice
Use of research data in the development of the care plan
Basis of modifications in the approach to care, nursing procedures, and practices
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 40
Communication
Essential in promoting positive interpersonal relationships
Exchanging ideas, beliefs, thoughts, and feelings
Can be verbal and nonverbal
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 41
Components of Communication
Listening Observation Documentation
Must be open-minded, honest, non-judgmental Promotes positive interpersonal relationships
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 42
SBAR
Provides structured communication that helps reduce the risk of miscommunication S: situation
• Patient ID, vitals, nursing concerns
B: background• Mental status, skin condition, O2 needs, updated meds,
critical labs values
A: assessment• Description of nursing assessment
R: recommendation • Response to report received
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 43
Documentation
Many forms Nursing notes Flowsheets Progress notes MAR (medication administration record)
Verifies nursing interventions and patient responses and helps other members of the health care team determine the progress of the patient
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 44
Patient Privacy, HIPAA, and HITECH
Privacy is protected by federal and state law Before any patient information is released,
signed informed consent must be obtained All patient information must be kept
confidential No names or other identifying information can
be visible to the public HITECH applies to the electronic health
record and its management related to HIPAA
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 45
The Nursing Process
A method that applies patient and nursing responses based on a structured problem-solving approach to a given clinical situation
Assists in the recollection of facts that can be applied to meet individual needs of patients
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 46
Steps of the Nursing Process
Assessment Diagnosis Planning Implementation Evaluation
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 47
Critical Thinking and the Nursing Process
Considers factors specific to the patient Entails application of creativity and ingenuity
for problem solving Combines basic standard principles and
patient data in the formation of a plan of care Decisions for care are based on all data
collected/evaluated Assists in prioritizing nursing care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 48
Culture
Body of socially inherited characteristics that one generation can hand down or tell to the next generations
Shaped by Values Beliefs Norms Practices
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Culture and the Challenge in Health Care Delivery
Providing culturally appropriate nursing care requires the nurse to be able to show or recognize Diversity Competence Differences
And respond accordingly
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 50
Family
A family is a group of two or more people who reside together and who are related by blood, marriage, or adoption.
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 51
Family Types
Nuclear Blended or reconstituted Cohabiting Communal Extended Same-sex Single-parent Step-parent
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 52
Complementary and Alternative Medicine (CAM)
Complementary: nontraditional methods used in conjunction with conventional therapy
Alternative: treatments not typically recommended by health care providers that differ from conventional or mainstream remedies
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 53
CAM Therapies
Knowledge of CAM therapies can aid the nurse in identifying the reason an individual is using them
Helps to recognize a contraindication or interaction with traditional medicine
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 54
CAM Therapies (cont.)
Use of herbs, oils, therapeutic touch, forms of energy
Can be seen as Alternative health care Integrative health care
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 55
Audience Response System Question 2
Validating an identified or potential problem is accomplished through a process known as:
A.Nursing Process.
B.Critical Thinking.
C.Nursing Diagnosis.
D.General Thinking.
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