SoutheasternNurse

Gail Notes

Self development-

Start with self at center—partner/kids --- extended family--- friends/culture ---schools/agencies---- community and nature

Three phases of self-development

1. Intellectual- problem solving, critical thinking, prioritizes, and making professional judgment.
2. Interpersonal- communication, listening, show interest, compassion, develop own personal characteristics, and "can do" attitude.
3. Technical- psychomotor skills and learn to use the equipment.

Goals and philosophies of Maternal and Child Health Nursing:

1. The primary goal of Maternal and child health nursing is the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing.

Family orientated and community centered. The birth of a child affects the entire family; therefore, the assessment data should include family as well as individual assessments.

Community centered – the health of families depends on and influences the health of communities.

Staff should be cross orientated (L&D should be able to work in the nursery and vice versa)

Mother and baby is referred to as a couplet

2. Research based nursing- research is the means whereby critical knowledge is gained.

3. It is based on nursing theory particularly Orem’s self care theory

1. Provide nursing care when the patient is unable to
2. Partially assist if needed
3. Supportive and educational

1. The nurse is an advocate to protect the rights of all members of the family including the fetus.
2. Requires autonomy and is a challenging role. Uses a high degree of independent functions because teaching and counseling are frequently required.
3. Focused on health maintenance, health promotion, and illness prevention.
4. Recognize that religion, culture, and personal attitudes can influence the meaning of an illness and will impact on the family.
5. Recognize that pregnancy and childhood illness can be a source of strength or stress.

Range of practice includes:

1. Preconceptual health care
2. Care of women during the three trimesters of pregnancy and the puerperium period (6 weeks following childbirth, AKA the fourth trimester)
3. Care of children during the Perinatal period (6 weeks before conception to 6 weeks after birth)
4. Care of children from infancy through adolescence.
5. Care in varied health care settings

Phases of health care

1. Health promotion- educating clients to be aware of good health practice through teaching and role modeling. (Immunizations)
2. Health maintenance- intervening to maintain health when risk factors are present. (Cancer screening, prenatal care, child proofing home)
3. Health restoration- Prompt diagnosis and treatment of illness using interventions that will return the client to wellness most rapidly. (Pregnancy complications or respiratory illness)
4. Health rehabilitation- Preventing further complications from an illness, bring the ill client back to optimal state of wellness, or helping the client accept inevitable death. (Helping someone with a disease continue therapy or a child with chronic renal disease to continue going to school)

Trends in maternal and child health nursing:

1. Smaller sized families. Decreased birth rate and people are living longer. The life span of an American is 75-76 years.
2. Increase in single parent families by choice or through divorce, desertion, and having kids outside of marriage.
3. Increase in working mothers and fathers staying at home
4. Dual employment
5. Mobility of workers
6. Increase in domestic abuse
7. Increase in health consciousness
8. Increase in health care costs- some can’t afford it.

1. We have a high rate of low birth weight babies (less than 2500 grams or 5 lb 8 oz.)
2. We have high preterm deliveries- less than 37 weeks

1. Lack of prenatal care, substance abuse, teen age pregnancy, poor nutrition, poverty, underlying medical conditions like diabetes, single moms are at risk, lack of providers to low income women, Medicaid doesn’t reimburse the anesthesiologist.

Teen pregnancy is decreasing in the U.S because of contraception

Accidents are the leading cause of childhood death

SIDS- occurs 60% at home and infants of smoking mothers are at risk.

MVA is the leading cause of death among 16-24 year olds.

Homicide/suicide is the second cause of death among 16-24 year olds

The risk of death is higher in the first year of life than any other year under 55.

Trends in health care settings:

Managed care:

Cost containment health care system. The agency receives a certain amount of money for the care of a client no matter how many supplies, procedures, or personnel are used. It can erode the quality of care and funding. Helping to curtail cost is an important nursing function. The unlicensed personnel perform many tasks under the RN’s supervision.

Rules to follow when delegating:

1. Right task for the situation
2. Right person to complete the task
3. Right communication concerning what is to be done
4. Right feedback or evaluation that the task was completed.

Community based care settings- birthing centers

Acute care settings- PICU, NICU, MICU, are a few examples

Alternative therapy settings- chiropractors, herbal medicines (no FDA control, could be dangerous). These types of settings are less invasive

Home health care

Rationalization of health care – delivers quality and appropriate care using the team effort concept providing care to high-risk pregnancies and deliveries. If it is known in advance that a child may be born with a life threatening condition, it is best to transport the mother to the center while pregnant because the uterus is a better place for the baby than an incubator.

Changing health care attitudes:

1. Cost vs. quality of care- LBW costs 500,000 vs. 400 to prevent
2. Preventative care vs. acute care
3. Political influence- Family medical leave act. Family members can take leave from work to care for a sick child, parent or spouse; Adoption or foster placement of a child with the employee; or the employee is unable to perform his/her function because of an illness without worrying about losing a job.

1. Documents that regulate practice
1. Standards of practice

1. Nurse practice act
2. Agencies policy and procedure manual- has qualification of person performing procedure and the steps
3. Association of women’s health (NAACOG) regulates nursing process
4. American Nurses association society of pediatric nurses- ANASPN- regulates standards of practice of pediatric nursing

1. If a standard is breached resulting in injury you may be sued for malpractice

Birth injury is the #1 cause of being sued, unexpected complications, and long-term disabilities. Statute of limitation is 18 years in NC. It is the length of time from the injury

2. Pregnant patient bill of rights is similar to the patient bill of rights.
3. Suspected abuse must be reported
4. Informed consent- the patient gives without coercion must be able to understand what they sign, and have a full disclosure of the procedure. Consent in an emergency delivery is not a priority.
5. Minor-we have to know who has custody. An emancipated minor lives alone and lives as an adult.
6. Documentation- demonstrates accountability and responsibility to the client. Follow the nursing process, write good notes and fetal monitor strips are good to save.
7. Professional liability insurance
8. Confidentiality
9. Negligence- can lead to malpractice. If you know that care provided by another practitioner was inappropriate or insufficient, you are legally responsible for reporting the incident otherwise you face negligence or breach of duty.
10. Infant abduction
11. Patient advocacy
12. Early discharge- mothers are unable to recognize signs and symptoms of complications. Delayed post partum bleeding can occur and acute respiratory distress syndrome infants to name a few.
13. Refusal of care
14. High-risk behavior of the mother like substance abuse and sexual promiscuity may affect seeking prenatal care.
15. Technology- pay for the high cost vs. helping high risk babies
16. Domestic violence

ETHICAL CONSIDERATIONS:

1. Abortion- elective abortion before the period of viability (20 weeks in NC). A partial birth abortion is abortion after 20 weeks gestation up to 3 weeks before delivery.
1. When does life begin?
2. When is abortion justifiable?
3. Who takes precedence the fetus or the mother?
4. Is the fetus a person?
5. Is abortion a medical procedure or 1^st degree murder?

1. The decision to terminate pregnancy rests on the pregnant woman and health care provider during the first trimester
2. The state cannot intervene during the second trimester if the woman’s life is in danger
3. The state can prohibit abortion if pregnancy has reached the point of viability- after 20 weeks.

Abortion and nursing implications:

1. Know the laws and regulations of the state you are working in and the agency
2. Disclose to your employer about your opinion of abortion
3. Your personal value will determine your willingness to participate in the care of a patient and the procedure
4. Acknowledge that there are strong emotions on both sides of the issue.
5. Realize that you may have to care for a patient that has had an abortion regardless of your views on the subject. Do not abandon the patient.

1. Contraception-

1. Who has the freedom to control ones own body?
2. What age should a person be before being put on contraception?
3. Where should contraception be available?
4. Who will support the child if there is a contraception failure?

1. Conception issues- artificial assistive reproduction
1. Invitro fertilization
2. Gamete intrafallopian transfer
3. Zygote intrafallopian transfer
4. Ownership of oocytes and sperm
5. Surrogate motherhood
6. Sterilization- is considered permanent but becomes an issue when it comes to who gives consent
2. Fetal rights vs. the rights of mothers and father
3. Use of fetal parts for transplant
4. High technology vs quality of life- amniocentesis is a screen for genetic disorders or abnormalities
5. Genetic engineering
6. Resuscitation- how long should we resuscitate a baby?
7. Multi-fetal pregnancy reduction

Some of the information was taken from Maternal and Child Health Care Nursing 3^rd ed. By Pillitteri

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