Intro to Maternity &
Women’s Health Care
Chapters 1,2
Maternity & Women’s
Health Care (9th edition)
Lowdermilk & Perry
Contemporary Issues & Trends
Changing health care delivery structure
 Changing childbirth practices
 Changing views of women
 Trends in fertility & birthrate
 Trends toward consumer involvement &
self-care

Contemporary Issues & Trends
Trends to high-technology care
 Trends & issues of high costs
 Managed care expands
 Access to care problems
 Home health care flourishes

Trends in Nursing Practice
Nursing interventions classification
 Evidence-based practice
 Outcomes orientation
 Telemedicine
 A global perspective

Standards of Practice & Legal
Issues in Delivery of Care
American Nurses Association (ANA)
 Association of Women’s Health,
Obstetric, and Neonatal Nurses
(AWHONN)
 National Association of Neonatal
Nurses (NANN)
 Individual agencies and institutions

ANA Position Statement:
The American Nurses Association
issued a position statement supporting
the promotion of health and prevention
of disease and illness and disability.
 This position advocates comprehensive
primary, secondary, and tertiary levels
of prevention and engaging client
participation.

Health Indicators:
Mortality rates = the ratio of the number
of deaths in various categories to a
given population.
 Morbidity rates = statistics indicating the
number of people who have a disease.
 Objectives = specific short-term
achievements esxpected to result in the
accomplishment of a goal.

ANA Statement (cont.):
Prevention has long been within the
scope of nursing as nurses work toward
wellness with clients, families, and
communities.
 ANA, 1995.

Ethical Issues in Perinatal
Nursing
Concerns have multiplied with increases
in knowledge and technology.
 Research in practice – necessary to
develop nursing as a science-based
practice. (move to evidence-based and
outcomes-oriented practice)

Community care: The Family
and Culture
Chapter 2
Defining “FAMILY”
Nuclear Family
 Extended Family
 Single-Parent Family
 Binuclear Family
 Reconstituted Family
 Homosexual (Lesbian & gay) Family
 Family Unit – may be self defined

Family Functions
Families function for the well-being of
members & the wider society.
 Defined as: affective, socialization,
reproductive, economic & health care
functions.
 Certain functions are emphasized more
in 1 phase of the family’s life cycle (excare & socialization of the children).

Family Dynamics
Families work cooperatively to
accomplish family functions.
 Roles are often complementary.
 Negotiation brings roles into new
alignment. Essential for equilibrium.
 Boundaries are set between family &
society.
 Families use own form of verbal &
nonverbal communication.
 Families develop protocols for problem
solving.

FAMILY SYSTEMS THEORY
A family system is part of a larger
suprasystem & comprises many
subsystems.
 The family as a whole is greater than
the sum of its individual members.
 A change in all family members affects
all family members.

FAMILY SYSTEMS THEORY
(cont.)
The family is able to create a balance
between change & stability.
 Family members’ behavior is best
understood from a view of circular
rather than linear causality.

Implications for Maternity Nsg.
Nurses are encouraged to view
individual family members as part of a
larger family system, influenced by and
influencing others.
 Application of concepts can guide
assessment and interventions for a
family.

FAMILY DEVELOPMENTAL
THEORY
Focuses on the family as it moves in
time.
 Family structure and function varies
over time.
 These stages, together, constitute the
family life cycle.

Implications for Maternity Nsg.

Knowing the phases of the life cycle can
assist nurses in providing anticipatory
guidance for families.
 The family as a group and as individuals
simultaneously engages in developmental
tasks.
 If the developmental task of the family doesn’t
correspond with that of the person,
disharmony occurs.
FAMILY STRESS THEORY
“Family Life Cycle (Developmental) Theory:
– Carter & McGoldrick, 1999
Families move through stages
 The family life cycle is the context in which
to examine the identity and development
of the individual.
 Relationships among family members go
through transitions.
 Developmental stresses may disrupt the
life cycle process.

FAMILY STRESS THEORY
(cont.)

“Family Stress Theory”
– Boss, 2002
Ways families react to stressful events is
the focus.
 Family stress can be studied within the
internal and external contexts in which the
family is living.

Internal = elements a family can change.
External = elements in which a family has no
control.
FAMILY STRESS THEORY
(cont.)

“McGill Model of Nursing”
– Allen, 1997
It is a “Strength-based approach” in
clinical practice with families, as opposed
to a deficit approach.
 Identification of family strengths and
resources.
 Provision of feedback about strengths.
 Assistance given to family to develop
and elicit strengths and use resources.

FAMILY STRESS THEORY
(cont.)

“Health Belief Model”
– Becker, 1974; Janz & Becker, 1984)
The goal is to reduce cultural and
environmental barriers that interfere with
access to health care.
 Key elements include the following:
perceived susceptibility, perceived
severity, perceived benefits, perceived
barriers, cues to action, and confidence.

FAMILY STRESS THEORY
(cont.)

“Human Developmental Ecology”
– Bronfenbrenner, 1979; Bronfenbrenner,
1989
Behavior is a function of interaction of
traits and abilities with the environment.
 Major concepts include:

– Ecosystem, niches (social roles), adaptive
range, and ontogenetic development.

Change over time is incorporated into the
chronosystem.
Implications for Maternity Nsg.
Theories are useful for their realistic and
practical approach.
 Nurses who understand components of
family stress theory and stress mgt can
intervene to reduce family stress levels.
 Stress of “normal” childbirth can be
complicated by unexpected or
situational stressor events.

KEY FACTORS IN FAMILY
HEALTH

Cultural factors
– Cultural context of the family
– Childbearing beliefs & practices

The reproductive beliefs & practices of a
culture are embedded in its economic,
religious, kinship, and political structures.
 The expression of parental roles & the way
that children are viewed reflect cultural
differences.
CULTURAL CONTEXT

Culture = a set of guidelines, which
individuals inheret as members of a particular
society, that tell people how to view the world
& how to relate to other people, supernatural
forces and natural environment.
 Subculture = a group existing within a larger
cultural system that retains its own
characteristics.
 Acculturation = changes that take place in
one or both grps when people from different
cultures come in contact with one another.
CULTURAL CONTEXT (cont.)
Assimilation = when a cultural group
loses its identity and becomes a part of
the dominant culture.
 Ethnocentrism = a view that one’s
culture’s way of doing things is the right
and natural way”.
 Cultural relativism = learning about and
applying the standards of another
person’s culture to activities within that
culture. (opposite of Ethnocentrism).

CHILDBEARING BELIEFS &
PRACTICES
To provide culturally competent care,
the nurse should be aware of the
cultural beliefs & practices important to
individual families.
 Products of culture:

– Communication
– Space
– Time
– Family roles
Questions to Ask
What do you and your family think you
should do to remain healthy during your
pregnancy?
 What are the things you can do or not
do to improve the health of your infant?
 Who do you want with you during labor?
 What things or actions are important to
you and your family after the infants
birth?

Questions to Ask (cont.)
What do you and your family expect
from the nurse or nurses caring for you?
 How will family members participate in
your pregnancy, childbirth, and
parenting?

Refer to the page 27 in text.
Community Assessment
“A complex process through which the
unique characteristics of the populations
and their special needs are identified to
plan and evaluate health services for the
community as a whole”.
 The Community Health Assessment
Wheel addresses mental, physical and
social well-being as a goal for care.
 3 groups are identified: People,
Environment, and Health Care Delivery
System


People:
– Demographics
– Biologic
Acquired: Social and Cultural

Environment:
– Physical
– Biologic / chemical
– Social

Health Care Delivery System:
– Organizational
– Resources
– Services
Protocol: Perinatal Home Care

Previsit Interventions:
– Arrange for visit, contact family.
– Review and clarify data
– Review records, previous nursing data
– Identify community resources
– Plan visit: prepare equipment, supplies, etc
for assessments of mom, mom & baby, or
mom and fetus.
– Anticipate care and teaching.
Protocol (cont.)

In-Home Interventions: Establishing a
Relationship
– Reintroduce yourself and establish the
purpose of the visit for the mother, infant,
and family.
– Offer the family the opportunity to clarify their
expectations and needs.
– Briefly socially interact with the family to
become acquainted and establish a trusting
relationship.
Protocol (cont.)

In-Home Interventions: Working with the
Family
– Perform a systematic assessment of mom &
fetus / newborn.
– Assess the emotional adjustment of the
family members to the pregnancy, birth &
associated life style changes.
– Determine adequacy of support system.
– Observe home environment for adequacy of
resources. (space, safety, cleanliness,
stairs, refrigeration & food storage, bathing,
toilet, laundry, formula, diapers, etc)
Protocol (cont.)
– Observe home environment for overall state
of repair, and safety hazards.
– Provide care to mother, newborn, or both (in
accordance with protocol).
– Provide teaching, on the basis of needs.
– Refer to appropriate community agencies or
resources.
– Alert mom to potential problems to watch for
& what to do or who to call if they occur.
– Be sure that disposable items are disposed of
properly & reusable items are cleaned &
ready for use (bottles, pacifiers, pumps,etc).
Protocol (cont.)

In-Home Interventions: Ending the Visit
– Summarize the activities and main points of
the visit (particularly if changes need to be
made).
– Clarify future expectations, including
schedule of next visit.
– Review teaching plan. Put major points in
writing.
– Provide info regarding reaching the nurse or
agency, between visits.
Protocol (cont.)

Postvisit Interventions
– Document the visit thoroughly, using the
necessary agency forms. This serves as a
legal record, and allows for 3rd party
reimbursement.
– Initiate plan of care on which next visit will
be based.
– Communicate appropriately (phone, letter,
progress notes, or referral form) with
primary care provider, other health
professionals, or referral agencies.
Psychosocial Assessment
Includes:
 Language
 Community resources / access to care
 Social support
 Interpersonal relationships
 Caregiver
 Stress and coping