Contemporary Maternity Care, Family, and Cultural Considerations
Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
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Copyright © 2012, 2008 by Saunders, an imprint of Elsevier Inc.
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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.
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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.
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Viewed as the care, support, instruction, and health promotion provided by a nurse
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Involves the pregnant woman and her family during the pregnancy and the labor and birth process
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Expectant or new mother
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Developing fetus or newborn infant
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Integrity of family unit
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Childbearing considered a normal physiologic process
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Wellness
 Overriding concern with symptoms/complications being treated if they occur.
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Pregnancy, labor, and birthing process to be as uneventful (normal) as possible
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The Labor and Delivery Process
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Acute care hospitals
 Labor, delivery, and recovery room (LDR)
 Labor, delivery, recovery, postpartum room
(LDRP)
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Freestanding birthing centers
 Homelike atmosphere
 Many do not have technology/medical care readily available for emergencies
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Home births
 Small number due to high malpractice costs and difficulty obtaining for midwives.
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Electronic health records
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Computerized medication reconciliation
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Intelligent intravenous pumps
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Bed alarms
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Beds that rotate from side to side
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High-flow oxygen ventilation machines
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3-D ultrasonography
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Genetic testing
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Fetal surgery
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Stem cell research
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Cord blood banking
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Mapped all genetic materials within the human body
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Has helped in identifying and isolating certain disease-causing genes
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May enable gene therapy to replace missing or defective genes
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Assists couples in delivering a child of a desired sex
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May prevent the passing on of a genetic disorder that may affect a specific sex
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Accomplished via sperm separation
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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
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Can reduce occurrence of genetic disorders
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Newborn screening is a standard procedure in most countries around the world
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Registered nurses (RNs) with advanced training and education, typically master’sprepared
 Certified nurse-midwives (CNMs)
 Nurse practitioners (NPs)
Physicians who specialize (MDs or DOs)
 Obstetrician/gynecologists
 Neonatologists
 Pediatricians
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Licensed practical/vocational nurse
(LPN/LVN)
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Geneticist
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Social worker
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Dietitian
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Lactation specialist
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All members of health care team work together to ensure the best possible outcome of pregnancy, fetal development, delivery
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The nurse is key in making referrals to appropriate resources
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Need to address rising cost of health care
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Managed care
 Health maintenance organizations (HMOs)
 Preferred provider organizations (PPOs)
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Focus is on controlling costs
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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
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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
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Lillian Wald
 Brought health care to poor children in New York
City in the early 1900s
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Margaret Sanger
 Provided care for poor women who were pregnant
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Major health care delivery setting even today
 challenge to provide safe, caring, costeffective, high-quality care to families
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Nurse is patient advocate in influencing government, business, and community to recognize need for preventive care
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Creativity
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Problem solving
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Coordination of multidisciplinary caregivers
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Case management
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Assessment
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Referrals when necessary
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Provided in home setting
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Nurse educates family regarding issues such as:
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Fetal monitoring
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Apnea monitoring of the high-risk newborn
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Blood glucose monitoring of the gestational diabetic woman
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Total parenteral nutrition
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Professional referral when necessary
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Nurses
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Obstetricians
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Pediatricians
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Occupational therapists
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Physical therapists
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Respiratory therapists
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Home teachers
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Social workers
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National Institutes of Health (NIH)
 Supports/provides funds for maternity research
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Title V of Public Health Service Act
 Established maternity-infant care centers in clinics
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Title XIX of Medicaid program
 Care for the indigent woman
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Center for Family Planning
 Contraception information
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Women, Infants, and Children (WIC)
 Supplemental food and education for needy
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Medicaid program
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Reduce overall care and make health plan accessible for all
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Children will not be denied insurance due to pre-existing conditions
Allows children to stay on their parent’s health insurance until age 26
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Will be paid for through Medicare payroll taxes
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Primary goals
 Increase years of healthy life
 Eliminate health disparities
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Subgoals
 Promote healthy behaviors
 Protect health
 Provide access to high-quality health care
 Strengthen community prevention and provide access to care
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Need to obtain information about the way maternity care is given and outcomes of maternal/newborn care
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Depict health status of a nation and a community
 All births recorded
 Maternal/infant mortality rates fall when overall health improves
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Aid in the allocation of resources
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Establish minimum criteria for competent nursing care
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Protect the public
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Used to judge quality of care provided
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Professional nursing organizations (e.g.,
American Nurses Association [ANA],
Association of Women’s Health and Obstetric and Neonatal Nurses [AWHONN])
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Licensing and certification organizations (e.g.,
The Joint Commission, Centers for Medicare and Medicaid Services [CMS])
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The Joint Commission focuses heavily on the safety of patients
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Health care facilities must be able to address these goals
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Examples include
 Ensure accurate patient identification
 Provide medication reconciliation
 Reduce health care –associated infections
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Nurses are responsible for practicing within the scope of their nursing license
It is the nurse’s responsibility to know what that scope allows
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A nurse who fails to provide the standards of care within his or her scope of practice can be accused of negligence or malpractice
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Clinical pathways are designed from what type of standards?
A.
Evidence-based
B.
Medical decisions
C.
Preventive care
D.
Government regulations
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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.
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Discuss how examining one’s own culture can affect care of a patient during labor and delivery process.
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Contrast defining characteristics of four family types.
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Contrast complementary and alternative health care with conventional health care.
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Illustrate the role of the nurse in alternative or complementary health care.
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Use of research data in the development of the care plan
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Basis of modifications in the approach to care, nursing procedures, and practices
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Essential in promoting positive interpersonal relationships
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Exchanging ideas, beliefs, thoughts, and feelings
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Can be verbal and nonverbal
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Listening
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Observation
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Documentation
 Must be open-minded, honest, non-judgmental
 Promotes positive interpersonal relationships
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Provides structured communication that helps reduce the risk of miscommunication
 S: situation
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Patient ID, vitals, nursing concerns
 B: background
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Mental status, skin condition, O2 needs, updated meds, critical labs values
 A: assessment
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Description of nursing assessment
 R: recommendation
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Response to report received
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Many forms
 Nursing notes
 Flowsheets
 Progress notes
 MAR (medication administration record)
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Verifies nursing interventions and patient responses and helps other members of the health care team determine the progress of the patient
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Privacy is protected by federal and state law
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Before any patient information is released, signed informed consent must be obtained
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All patient information must be kept confidential
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No names or other identifying information can be visible to the public
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HITECH applies to the electronic health record and its management related to HIPAA
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A method that applies patient and nursing responses based on a structured problemsolving approach to a given clinical situation
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Assists in the recollection of facts that can be applied to meet individual needs of patients
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Assessment
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Diagnosis
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Planning
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Implementation
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Evaluation
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Considers factors specific to the patient
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Entails application of creativity and ingenuity for problem solving
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Combines basic standard principles and patient data in the formation of a plan of care
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Decisions for care are based on all data collected/evaluated
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Assists in prioritizing nursing care
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Body of socially inherited characteristics that one generation can hand down or tell to the next generations
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Shaped by
 Values
 Beliefs
 Norms
 Practices
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Providing culturally appropriate nursing care requires the nurse to be able to show or recognize
 Diversity
 Competence
 Differences
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And respond accordingly
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A family is a group of two or more people who reside together and who are related by blood, marriage, or adoption.
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Nuclear
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Blended or reconstituted
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Cohabiting
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Communal
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Extended
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Same-sex
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Single-parent
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Step-parent
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Complementary: nontraditional methods used in conjunction with conventional therapy
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Alternative: treatments not typically recommended by health care providers that differ from conventional or mainstream remedies
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Knowledge of CAM therapies can aid the nurse in identifying the reason an individual is using them
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Helps to recognize a contraindication or interaction with traditional medicine
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Use of herbs, oils, therapeutic touch, forms of energy
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Can be seen as
 Alternative health care
 Integrative health care
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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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