Chapter 1
The Past, Present, and Future
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-forservice 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
General Thinking
• Random or memorized thoughts
• Occurs naturally
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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