Chapter 1 21st Century Maternity Nursing Copyright © 2018 by Elsevier Inc. All rights reserved. Health Disparities By 2060 minority of population non-Hispanic Whites Other ethnic groups experience: Shorter life expectancy Higher infant and maternal mortality rates More birth defects More STIs Copyright © 2018 by Elsevier Inc. All rights reserved. 2 Health Disparities (Cont.) Disparities linked to: Biologic factors Environment Socioeconomics Health behaviors Copyright © 2018 by Elsevier Inc. All rights reserved. 3 Initiatives to Eliminate Disparities Groups have specific initiatives HRSA: Health Resources and Services Administration NPA: National Partnership for Action to End Health Disparities IHI: Institute for Healthcare Improvement NIH: National Institutes of Health NINR: National Institute of Nursing Research CDC: Centers for Disease Control USDHHS: U.S. Department of Health and Human Services Copyright © 2018 by Elsevier Inc. All rights reserved. 4 Contemporary Issues and Trends Healthy People 2020 10-year national objectives 4 over arching goals 33 related to maternal, infant, and child health United Nations Millennium Development Goals 8 goals to be achieved by 2015 Copyright © 2018 by Elsevier Inc. All rights reserved. 5 Contemporary Issues and Trends (Cont.) Millennium Development Goals 2030 Agenda for Sustainable Development 17 Sustainable Development Goals All relevant to childbearing and childrearing Copyright © 2018 by Elsevier Inc. All rights reserved. 6 Contemporary Issues and Trends (Cont.) Integrative health care Complementary and alternative therapies • • • • • • • • Acupuncture Macrobiotics Herbal medicines Massage therapy Biofeedback Medication Yoga Chelation therapy Copyright © 2018 by Elsevier Inc. All rights reserved. 7 Contemporary Issues and Trends (Cont.) Interprofessional Education Collaborative learning environment Faculty and students from two or more health professions Improved patient care 4 practice competencies SBAR TeamSTEPPS Copyright © 2018 by Elsevier Inc. All rights reserved. 8 Copyright © 2018 by Elsevier Inc. All rights reserved. 9 Contemporary Issues and Trends (Cont.) Problems with U.S. health care–delivery system Structure of the system Reducing medical errors High cost of health care Limited access to care Health care reform Accountable care organizations Health literacy Copyright © 2018 by Elsevier Inc. All rights reserved. 10 Contemporary Issues and Trends (Cont.) Trends in fertility and birth rate Low birth weight and preterm birth International infant mortality trends Maternal mortality Maternal morbidity Obesity Copyright © 2018 by Elsevier Inc. All rights reserved. 11 Contemporary Issues and Trends (Cont.) Regionalization of perinatal services Ambulatory prenatal care High technology care Telehealth Social media Copyright © 2018 by Elsevier Inc. All rights reserved. 12 Contemporary Issues and Trends (Cont.) Community-based care Institution to ambulatory or home setting Childbirth practices Preconception care Prenatal care Family-centered care Certified Nurse Midwives Copyright © 2018 by Elsevier Inc. All rights reserved. 13 Copyright © 2018 by Elsevier Inc. All rights reserved. 14 Contemporary Issues and Trends (Cont.) Involving consumers Self-management International concerns Female genital mutilation Infabulation Female circumcision Human trafficking Copyright © 2018 by Elsevier Inc. All rights reserved. 15 Copyright © 2018 by Elsevier Inc. All rights reserved. 16 Contemporary Issues and Trends (Cont.) Women’s health Heart disease Breast cancer Race Age Violence Copyright © 2018 by Elsevier Inc. All rights reserved. 17 The Future of Nursing Institute of Medicine assessment and transformation of the nursing profession Nurses should practice to the full extent of their education and training Nurses should achieve higher levels of education Nurses should be full partners, with physicians and other health care professionals Effective workforce planning and policy making Copyright © 2018 by Elsevier Inc. All rights reserved. 18 The Future of Nursing (Cont.) Trends in Nursing Practice Nursing specialization Advance practice nurses • Nurse practitioners • Nurse midwives Lactation consultants Copyright © 2018 by Elsevier Inc. All rights reserved. 19 The Future of Nursing (Cont.) Nursing Interventions Classification (NIC) Common language Evidence-based practice Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Cochrane Pregnancy and Childbirth Database Joanna Briggs Institute A global perspective—World Health Organization (WHO) Quality and Safety Education for Nurses (QSEN) Copyright © 2018 by Elsevier Inc. All rights reserved. 20 The Future of Nursing (Cont.) Outcomes oriented practice OASIS • Outcome system NOC • Identifies outcomes Global perspective HIV/AIDS Zika virus World Health Organization Collaborating Centers Copyright © 2018 by Elsevier Inc. All rights reserved. 21 Standards of Practice and Legal Issues Prevention of errors The Joint Commission • “Do Not Use” list Sentinel events • Unexpected outcomes involving death or serious injury Failure to rescue • Evaluation of quality indicators of nursing care relative to outcomes Copyright © 2018 by Elsevier Inc. All rights reserved. 22 Standards of Practice and Legal Issues (Cont.) Ethical issues Technologies Scientific advances Informed consent Copyright © 2018 by Elsevier Inc. All rights reserved. 23 Ethical Issues in Perinatal Nursing Reproductive technology Induced ovulation In vitro fertilization Multifetal pregnancy reduction Menopausal women A woman who is HIV positive Rights of the embryo Cloning Copyright © 2018 by Elsevier Inc. All rights reserved. 24 Ethical Issues in Perinatal Nursing (Cont.) Innovations and allocation of resources Intrauterine fetal surgery Fetoscopy Therapeutic insemination Genetic engineering Stem cell research Surgery for infertility Surrogate childbearing Treatment of very low–birth-weight babies Copyright © 2018 by Elsevier Inc. All rights reserved. 25 Question 1 To assess a mother’s risk of having a low-birthweight (LBW) infant, the most important factor for the nurse to consider is: a. African-American race. b. cigarette smoking. c. poor nutritional status. d. limited maternal education. Copyright © 2018 by Elsevier Inc. 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