chapter 1 contemporary maternity care, family, and cultural considerations copyright © 2012, 2008...

Chapter 1

Contemporary Maternity Care, Family, and Cultural Considerations

Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc. 1

Maternity Nursing Care


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.


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.


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


Caregiver Focus

Expectant or new mother Developing fetus or newborn infant


Emphasis for Caregiving

Integrity of family unit Childbearing considered a normal physiologic

process Wellness

Overriding concern with symptoms/complications being treated if they occur.


Goal of Maternity Nursing Care

Pregnancy, labor, and birthing process to be as uneventful (normal) as possible


Current Trends

The Labor and Delivery Process


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.


Technology and Maternity Care


Technology and Maternity Care (cont.)

Electronic health records Computerized medication reconciliation Intelligent intravenous pumps Bed alarms Beds that rotate from side to side


Examples of Technology

High-flow oxygen ventilation machines 3-D ultrasonography Genetic testing Fetal surgery Stem cell research Cord blood banking


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


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


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


Preconception Genetic Therapy

Can reduce occurrence of genetic disorders Newborn screening is a standard procedure

in most countries around the world


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


Other Members of Health Care Team

Licensed practical/vocational nurse (LPN/LVN)

Geneticist Social worker Dietitian Lactation specialist


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


Health Care Delivery Systems

Need to address rising cost of health care Managed care

Health maintenance organizations (HMOs) Preferred provider organizations (PPOs)


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


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


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


Essential Skills for the Community-Based Nurse

Creativity Problem solving Coordination of multidisciplinary caregivers Case management Assessment Referrals when necessary


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


Home Health Care Team Members for Children with Disabilities

Nurses Obstetricians Pediatricians Occupational therapists Physical therapists Respiratory therapists Home teachers Social workers


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


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


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


Standards of Care

Establish minimum criteria for competent nursing care

Protect the public Used to judge quality of care provided


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])


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


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


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


Evidence-Based Practice and the Nursing Process


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.


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.


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


Communication

Essential in promoting positive interpersonal relationships

Exchanging ideas, beliefs, thoughts, and feelings

Can be verbal and nonverbal


Components of Communication

Listening Observation Documentation

Must be open-minded, honest, non-judgmental Promotes positive interpersonal relationships


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


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


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


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


Steps of the Nursing Process

Assessment Diagnosis Planning Implementation Evaluation


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


Culture

Body of socially inherited characteristics that one generation can hand down or tell to the next generations

Shaped by Values Beliefs Norms Practices


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


Family

A family is a group of two or more people who reside together and who are related by blood, marriage, or adoption.


Family Types

Nuclear Blended or reconstituted Cohabiting Communal Extended Same-sex Single-parent Step-parent


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


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


CAM Therapies (cont.)

Use of herbs, oils, therapeutic touch, forms of energy

Can be seen as Alternative health care Integrative health care


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.


chapter 1 contemporary maternity care, family, and cultural considerations copyright © 2012, 2008...

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