CHAPTER 1: FOUNDATIONS FOR NURSING CARE OF CHILDBEARING FAMILIES

CHANGES THROUGHOUT THE 20 T H CENTURY

 Increases in knowledge
 Technological advances
 Government funding
 Oversight and regulations
 Cost containment efforts
 Consumers as decision-makers
 Increased complexity of care
SAFETY AND QUALITY
 Maternal and infant mortality
Ø Pregnancy-related maternal mortality due to chronic diseases (eg: HTN, DM,
chronic heart disease) -> cause complications: infection/sepsis, hemorrhage,
CVD, including cardiomyopathy
Ø Infant mortality due to congenital malformations, premature birth, maternal
complications of pregnancy.
 Rural vs. urban areas
 Racial and social disparities
Ø Social determinants
Ø Implicit bias
Ø Racism
Ø Other inequities
PROGRAMS TO IMPROVE SAFETY AND QUALITY
 The Joint Commission
Ø Independent org that credits health care organizations
Ø A set of Perinatal Core Measures for best practice in perinatal care (5 core
measures:  elective delivery,  C-section births;  antenatal administration of
steroids in preterm labor,  newborns w/ septicemia or bacteremia,  exclusive
breastfeeding
 Interprofessional Collaboration and Education
Ø IPEC encourages health professional schools to incorporate interprofessional
learning experiences into their curricula & defines core competencies for
interprofessional collaborative practice.
 Alliance for Innovation on Maternal Health
Ø AIM has developed pt safety bundles for maternal care
• Pt safety bundles: a set of evidence-based practices performed together
to improve pt outcomes, including maternal mental health (depression &
anxiety), OB hemorrhage, severe HTN, VTE, C-birth,  peripartum
racial/ethnic disparities, & support after a severe maternal event).
 Women’s Health and Perinatal Nursing Care Quality Measures
 Ø B/c nurse’s actions has impacts on pt outcomes, AWHONN is in process of
developing nursing care quality measures -> guide efforts to measure the quality
of nursing care.
CHOICES IN CHILDBIRTH
 Healthcare provider
Ø Physician, PA: treat during pregnancy & postpartum period, perform deliveries
Ø NP: treat during pregnancy & postpartum period, BUT don’t perform deliveries;
work in physician’s office & see women for routine prenatal care
Ø CNM, CM, CPM: treat during pregnancy & postpartum period; are for women at
low risk for complications & refer them to a backup physician.
 Birth setting
Ø Hospitals
- LDL room: for vaginal birth; family member can remain with a pregnant
woman (pw) during labor; mother & baby stay together in LDR room in 1-
2hr after giving birth; mother transfers to postpartum room until discharge
(baby transfers to nursery/remain with mother for extensive assessment).
- LDRP room: same as LDR room, but mother & baby remain in the LDRP after
recovery, not transferred to the postpartum unit.
Ø Birth Centers
- Maternity care to low-risk women: classes to prepare for childbirth,
breastfeeding & infant care; follow-up care during the 1st 6 weeks after
birth.
- Provide gynecologic services: annual well-woman examination &
contraceptive counseling.
- Assisted by CNM
- Pros: less expensive, a familiar, homelike setting & personnel
- Cons: not equipped for OB emergency -> ambulance to a nearby hospital for
the care of back-up physician.
Ø Home Births
Pros: family-centered care, bonding with infant, a feeling of control (self-
planning)
Cons: mother has to take care of herself & infant w/o immediate help; takes long
time to transfer to a hospital in emergency situation.
 Support persons
Ø Doulas: a trained support person who provides physical & emotional support
during postpartum.
Ø Siblings: need adult support for the child: gauging his response, explanations &
reassurance, take him out of the room if needed.
 Education: perinatal edu -> helps couples learn about pregnancy, birth, & parenting
(prepare to welcome babies)
FACTORS AFFECTING PERINATAL AND WOMEN’S HEALTH CARE
 Healthy People 2030
 Cost Containment
 Ø Affecting the length of stay (LOS)
Ø Short LOS -> mothers unable to accomplish teaching before discharge
Ø Tired mother is likely to have enough prenatal care/lack of family care
 Community Based Perinatal and Women’s Health Nursing
Ø Antepartum home care: provide low-risk antepartum care in private
offices/public clinics. High-risk conditions can be seen in the home by nurses (eg:
preterm labor, hyperemesis gravidarum, bleeding problems, preterm premature
rupture of membrane, HTN, DM during pregnancy.
Ø Postpartum & Neonatal home care: educate new mothers about self-care, basic
care of infants, s/sx of problems they need to report
Ø Home care for high-risk neonates: provide care for infants from acute care with
serious conditions (eg: preterm/low-birth-wt infants, infants w/ congenital
anomalies)
 Advances in technology
Ø Telemedicine
Ø Storing fetal monitoring data on electronic media
Ø Video & digital imaging methods
Ø Electronic medical record
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)
 CAM differ from conventional Western medicine.
Ø CAM is integrated with conventional tx -> complementary
Ø CAM is used to replace mainstream practices -> alternative
 Safety issues
Ø Self-referrals – delay care from physicians/nurse-midwife
Ø Delay seeking care
Ø Harmful therapies b/c CAM & conventional meds can combine and cause harm.
Ø Less strict regulations b/c CAM is classified as food (eg: herbs, vitamins)
STANDARDS OF PRACTICE
 Statements of responsibility or duty
 Practice guidelines established by an authority such as the government, State Board of
Nursing, accrediting agency, or professional organization
 Legal standards
 Policies, procedures, and protocols based on evidence-based practice
 Frequent updates and periodic reviews
ESSENTIAL SKILLS FOR PROFESSIONAL NURSING P.8,9
 Critical Thinking
Ø Purpose: apply knowledge to specific clinical situations and thus reach
conclusion -> provide most effective care. Examine the thought process for flaws
that could lead to inaccurate conclusions/poor judgements
Ø Steps: ABCDEs of critical thinking:
• Recognition of Assumptions: unexamined thoughts/unsound actions;
items need to be examined if it is true or evidence is insufficient to
determine its truth
 • Examination of personal Biases: unexamined belief that are widespread;
• Analysis of the amount of pressure for Closure
• Examination of how Data are collected & analyzed
• Evaluation of how Emotions may interfere with critical thinking
 Clinical Judgement
 The Nursing Process
Ø Assessment:
• Screening assessment: performed at 1st contact, info about all aspects of
the person’s health (called database)
• Focused assessment: performed at the beginning of a shift and centers
on areas relevant to childbearing, newborn, or women’s health nursing;
specific info related to an actual health problems
Ø Analysis: data is validated and grouped into cues & inferences -> identify
existing/potential problems.
Ø Planning
• Prioritizing
- Which problems need immediate attention (life-threatening)
- Potential problems need to call for physician’s order
- Actual problems that take precedence over an increased risk.
• Goals/objectives: goals should link with specific & measurable outcomes
Ø Interventions
• For actual pt problem: aimed at reducing/eliminating the causes or
related factors.
• For risk for pt problems:
- Monitor for the onset of the problem
- Minimize the risk factor
- Preventing the problems
- Wellness interventions: focus on health enhancement; promote
pt success through teaching of self-care.
Ø Evaluations: determine effectiveness of the plan; assess the status of pt &
compare the current status w/ the goals.
• Should the plan be continued? Modified? Abandoned?
• Are the problems resolved or the causes diminished?

 Individualized Plan of Care

Question
Which is a program that works to improve client safety and quality of care? (SELECT ALL THAT
APPLY)
a. National League for Nursing
b. The Joint Commission
c. Alliance for Innovation on Maternal Health
d. State Boards of Nursing
e. Interprofessional Collaboration and Education
f. Women’s Health and Perinatal Nursing Care Quality Measures