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Obstetrics
• Obstetrics – to “stand by”
• Maternity nursing – care given by the nurse to the expectant family
before, during and following the birth• Family-centered care
– Recognizes the family as the caregivers and decision makers
• Empowerment – ability of the family to accept and maintain
control over health care• Influenced by philosophy, culture & ethnic
practices
The Past: Maternity Care
• Europe Semmelweis (1890) – handwashing r/t “childbed fever”
• Crede’ – Silver nitrate in eyes prevented blindness
• Pasteur & Lister – antiseptic surgery
• United States: Before 1900’s most babies born @ home– by 1960’s greater than 90% in hospitals– not family-centered, father in waiting room,
mother sedated, bonding was delayed, siblings not allowed
19th Century Discoveries
• Louis Pasteur (1822-1895)– Confirmed puerperal fever caused by bacteria– Spread by improper hand-washing and contact
with contaminated objects• Joseph Lister (1827-1912)
– Experimented with chemical means to prevent infection
– Revolutionized surgical practice• Introduced concept of antiseptic surgery
The Present: Maternity Care
• Family-Centered Childbirth• all family members are
affected by the birth of a child
• LDR Rooms (Labor, Delivery, Recovery)
• Birthing Centers • for low-risk patients
• Current Cost Containment• 2 days for uncomplicated
cases• 4 days for cesareans
• 1950’s – 1 week!
Birthing Centers
• Usually staffed with midwives (CNM)• Provide comprehensive care
– Antepartum– Labor-delivery– Postpartum– Mothers’ classes– Lactation classes– Follow-up family planning
The Present
• Midwives – CNM– comprehensive prenatal and postnatal care– attends uncomplicated deliveries– assures that each patient has a backup
physician who will assume her care should a problem occur
The Present
• Technological Advances • Increased survival for preemies • Chronically ill and disabled children being
cared for at home
Cultural Nursing
• Cultural beliefs affect how a family perceives health and illness
• Holistic nursing includes– Being alert for cultural diversity– Incorporating this information into nursing care
plans
Cultural Nursing
• Cultural beliefs affect how a family perceives health and illness
• What does “cultural competence” mean?– The ability to adapt health care practices to
meet the needs of patients from various cultures
• Holistic nursing includes– Being alert for cultural diversity– Incorporating this information into nursing care
plans• How do you find out about a patient’s cultural beliefs?
Statistics
• The gathering and analyzing of numerical data• The nurse can use statistics to
– Become aware of birthing trends– Determine populations at risk– Evaluate the quality of prenatal care– Compare relevant information from state to
state
Health Care Delivery Systems
• Cost-containment a driver for change• Diagnosis-related groups (DRGs)
– determine payment for a hospital stay based on the diagnosis
• Push for early discharge• Established need for Nurse Case Managers
and Utilization Review Nurses
Health Care Delivery Systems (cont.)
• Two-tiered system– First is for more financially stable (HMO/PPO)
• A health maintenance organization that offers health care services for a fixed premium
– Second is for less financially stable • A preferred provider organization contracts with
providers for services on a discounted fee-for-service basis for members
• Medicaid and Medicare– ? Third tier ?
Advanced Nurse Practitioner
Focus on Prevention of illness and maintenance of health, rather than treatment of illness.
Developing Nursing Care Delivery
• Steps of the Nursing Process– Assessment/data collection– Nursing diagnosis– Outcomes identification– Planning– Implementation– Evaluation
NIC, NOC, NANDA-I
• NANDA-I—North American Nursing Diagnosis Association International– Provides standardized language for nursing
diagnoses• NOC—Nursing Outcomes Classification
– Focus on patient behavior• NIC—Nursing Interventions Classification
– Focus on nursing action
Critical Thinking in Nursing
• Requires the application of creativity and ingenuity to solve a problem
• Purposeful• Goal-directed
– Based on scientific evidence • Problem-solving is effective and prevention
occurs• A skill that must be learned
Process of Critical Thinking
• Identify the problem• Differentiate fact from assumption• Check reliability and accuracy of data• Determine relevant from irrelevant• Identify possible conclusions/outcomes• Set priorities and goals• Evaluate response of patient
Communication
• National patient safety goal• Used to improve communication between members
of the health care team• One example—SBAR
– Situation• Status of patient on the unit
– Background• Relevant history that may influence care
– Assessment• Analysis of the problem
– Recommendation
Documentation
• It is the LEGAL responsibility of the nurse• Facilities differ on the type of charting methods
– Paper– Computerized
• Regardless of method, if you did not document the care you provided, medicolegally, you did not do it!
The Future: Health Care Reform
• Conflict exists between cost-containment and quality of care
• Having health insurance does not guarantee access to expensive care
• Those who cannot afford health care often do not seek preventive services
Healthy People 2020
• A statement of national health promotion and disease prevention
• Identifies objectives in broad categories of effort– Health promotion– Health protection– Preventive services– Development of surveillance and data
systems
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