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Chapter 1

The Past, Present, and Future


Objectives

Contrast present-day concepts of maternity


and child care with those of the past.
Recall the contributions of persons in history
to the fields of maternity and pediatric care.
List the organizations concerned with setting
standards for the nursing care of maternity
and pediatric patients.

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Objectives (cont.)

Name two international organizations


concerned with maternity and child care.
List three federal programs that assist
mothers and infants.
State the influence of the federal government
on maternity and pediatric care.
Discuss how culture affects childbirth and
child care.
List four reasons why statistics are important.
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Objectives (cont.)

Discuss common terms used in expressing vital


statistics.
State two types of health care delivery systems
in the United States.
Discuss the role of the advanced-practice nurse.
List the five steps of the nursing process.
Understand the legal responsibilities of the
nurse to report certain diseases or conditions to
the public health authorities.

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Objectives (cont.)

Contrast a nursing care plan with a clinical


pathway.
Define the Nursing Interventions
Classification (NIC) and its relationship to the
nursing process.
Describe the Nursing Outcomes
Classification (NOC) and its influence on the
nursing process.

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Objectives (cont.)

Compare and contrast nursing and medical


diagnosis frameworks with focus on North
American Nursing Diagnosis Association
International (NANDA-I) taxonomy.
Define critical thinking.
Discuss the role of critical thinking in the
nursing process and in clinical judgment.

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Objectives (cont.)

Discuss the role of critical thinking as it


relates to test-taking and lifelong learning.
Discuss the objectives of Healthy People
2010/2020 as it relates to maternity and
pediatric care.
Examine the importance of documentation as
a nursing responsibility.
Describe the role of the community health
nurse as a health care provider.
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Obstetrics

Branch of medicine
Physician is called an obstetrician
Pertains to the care of women during
Pregnancy
Childbirth
Postpartum period (puerperium)

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Maternity Nursing

Care given by a nurse


To the expectant family
Before
During
Following birth

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Pediatrics

Branch of medicine
Physician is called a pediatrician
Deals with child development
Provision of health care
Treatment of illness/disease
Specific to childhood

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Family-Centered Care

Core of planning and implementing health


care
Recognizes the strength and integrity of the
family unit
The family as caregivers and decision-
makers
Integral part of both obstetric and pediatric
nursing

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Nurses Role in Maternity and
Pediatrics
Enter into a contract or partnership with the
family
The goal is to achieve and maintain control
over the health of all its members
Empowerment

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The Past: Maternity Care

Europe
Soranus, a Greek physicianfather of
obstetrics
Practiced Podalic version
Procedure used to rotate the second fetus to a
breech (footling) position to help with delivery
Scientific exploration ended at the beginning
of the Dark Ages

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Middle Ages and Children

The concept of childhood did not exist


Infancy lasted until around age 7
Had to assimilate into adult world
Did not attend school

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19th Century Discoveries

Karl Cred (1819-1892)


Recommended instillation of silver nitrate into
newborns eyes to prevent blindness from
gonorrhea

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19th Century Discoveries (cont.)

Ignaz Semmelweis (1818-1865)


Discovered relationship between puerperal
fever and examinations by physicians and
students fresh from the cadaver labs
Found puerperal fever was a form of sepsis;
was contagious and transmitted through
unwashed hands

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19th Century Discoveries (cont.)

Louis Pasteur (1822-1895)


Confirmed puerperal fever caused by bacteria
Spread by improper handwashing and contact
with contaminated objects
Joseph Lister (1827-1912)
Experimented with chemical means to prevent
infection
Revolutionized surgical practice
Introduced concept of antiseptic surgery

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The United States

Samuel Bardcredited with writing the first


textbook for midwives in 1807
Oliver Wendell Holmes (1809-1894)
Wrote in support of Semmelweis theory about
germs
Highly criticized by his colleagues for this
Germ theory slowly took on and was proven
to save the lives of mothers and babies

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The 1900s

Early in the century, the majority of births


were in the home
Hospitals began to develop training programs
for nurses
By the 1950s, hospital practice in obstetrics
was well-established
By 1960, more than 90% of births in the U.S.
were in hospitals

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The Birth Process in the 1960s

Fathers waited outside of the delivery room


Mothers were placed in a twilight sleep and
had little involvement in the delivery process
The infant was kept from parents for hours
after birth, which delayed the parent-infant
bonding process

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Advocates of Change in the
Mother-Infant Bonding Process
American College of Nurse-Midwives
(ACNM)
Association of Womens Health, Obstetric,
and Neonatal Nurses (AWHONN)
American Nurses Association (ANA), division
of Maternal Nursing

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The Past: Pediatrics

Abraham Jacobi (1830-1919)


Father of pediatrics
Established pediatric nursing as a specialty
Founded childrens hospitals
Developed separate units for children in
foundling homes and general hospitals

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Culture

Strong influence on the standards of child


care
Primitive tribes were nomads
Strong survived and stayed with the tribe
Weak were left behind to die
As time progressed, children were valued
more on what they could produce
Today, as in the past, culture affects how a
family perceives health and illness
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Government Influences in
Maternity and Pediatric Care
Sheppard-Towner Act of 1921
Funded state-managed programs for
maternity care
Title V of the Social Security Act
Provided funds for maternity care
Title V amendment of the Public Health
Services Act
Established maternal-infant care centers in
public clinics

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Government Influences in Maternity
and Pediatric Care (cont.)
Title XIX of the Medicaid Program
Increased access to care by indigent women
Head Start
Established to increase educational exposure
of preschool children

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Government Influences in Maternity
and Pediatric Care (cont.)

National Center for Family Planning


Provides contraceptive information
Women, Infants, and Children (WIC)
Provides supplemental food and education for
families in need of assistance

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Family Medical Leave Act (FMLA)

Became law in 1993


Allows for employees to take up to 12 weeks
of unpaid leave to care for a newborn or
family member
Employee cannot lose benefits or pay status
if they take FMLA

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HIPAA

Healthcare Information Portability and


Accountability Act (HIPAA)
Enacted in 2003
Set standards to protect a patients health
information
Allowed patients access and control over their
health information

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HIPAA (cont.)

Health care personnel are expected to


maintain strict confidentiality
Regulations mandate that the names and
personal information of patients be kept in a
secure and private place

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The Childrens Bureau

Established by Lillian Wald in 1912


Focused attention on problems of infant
mortality
Was followed by maternal mortality
Led to birth registration in all states
In the 1930s, led to development of hot lunch
programs in the schools

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Fair Labor Standards Act of 1938

Established a general minimum working age


16 years for non-hazardous jobs
18 years for hazardous jobs

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White House Conferences

First one in 1909, Theodore Roosevelt was


president
Continues to be held every 10 years
1930Childrens Charter was established
1980involved all states in an effort to see
what problems families were facing in various
parts of the country

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Federal Legislation Enacted
to Protect Children
1974-75Child Abuse Prevention and
Treatment Act
Education for All Handicapped Children
1982Community Mental Health Center
funded
Missing Childrens Actprovided for a
national clearinghouse for missing children

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United Nations Assembly

The United Nations Declaration of the Rights


of the Child
Passed in 1959
Reaffirmed in 1980

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Public Health Department

Responsible for disease prevention and


control
Community
Statewide
Nationally
Includes laws about licensing of health care
providers (i.e., physicians and pharmacists)

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Public Health Department (cont.)

Pure Food and Drug Act


Controls medicines, poisons, and the purity of food
Programs include
Disaster relief
Care and rehabilitation of handicapped children
Foster child care
Protective services for abused or neglected children

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Reportable Situations

Nurse has legal responsibility to report


certain diseases or conditions to local public
health authorities
An illness that poses a health hazard to the
public
Suspected child abuse or suicidal behavior
must be reported immediately to protect the
child from further harm

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The Present: Maternity Care

Family involvement during pregnancy and


birth
Necessary for bonding and support
Three separate sections of the maternity unit
Labor-delivery
Postpartum
Newborn nursery
Some facilities have merged all three areas
into one
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Birthing Centers

Provide comprehensive care


Antepartum
Labor-delivery
Postpartum
Mothers classes
Lactation classes
Follow-up family planning

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Clinical Pathways

Collaborative guidelines define care within a


timeline
Expected progress of the patient
Becomes the standard of care
Deviations easier to identify, called variances
Use improves quality of care
Reduces unnecessary hospitalization time

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Midwives

First school of nurse-midwifery


Opened in New York City, 1932
Certified Nurse-Midwife (CNM)
Registered nurse
Graduate from an accredited midwife program
National certification
Provides comprehensive prenatal and
postnatal care
Attends uncomplicated deliveries
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Cross-Cultural Considerations

Culturesocially inherited characteristics


Becomes a patterned expression of thoughts
and actions
Also called traditions
Consists of
Values
Beliefs
Practices
Shared by members of a group

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Cultural Nursing Tip

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

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Awareness, Sensitivity,
Competence
Ask the patient what she considers normal
practice
Questions can include
How she views her pregnancy
If she views birth as dangerous
What kind of help she will need before and
after delivery
The role her immediate or extended family
plays in relation to the pregnancy and birth
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The Pediatric Nurse as Advocate

An advocate is a person who intercedes or


pleads on behalf of another
If the nurse believes the childs needs are not
being met, the nurse must seek assistance
The nurse must also document his/her efforts
to seek instruction/assistance, including from
whom it was sought

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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

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Technology and Specialty
Expertise
Number of chronically ill children continues to
grow
Increased need for technology now in the
home setting
Mechanical ventilators
Tracheostomy
Intravenous fluid administration

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Genomics

Study of the functions of all the genes in the


human body
Gene therapyused to replace missing
genes or alter defective genes
Earlier diagnosis, intervention, patient
education

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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

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Health Care Delivery Systems (cont.)

Two-tiered system
First is for more financially stable (HMO/PPO)
Second is for less financially stable (Medicaid
and Medicare)

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Health Promotion

Preventing illness or disabilitycost-effective


Chronically ill children live well into adulthood
Increased need for complex medical care, in
both hospital and home settings
Mainstreaming physically or mentally
challenged children to assist them in
becoming as independent as possible and
integrated into society

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Older Children and
Life-Threatening Illness
Nurse assists as an advocate to ensure that
the older child is included in planning
modified advance directives with their
families and the medical team

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Advanced-Practice Roles in
Maternity and Pediatric Nursing
Certified Nurse Midwife (CNM)
Clinical Nurse Specialist (CNS)
Neonatal Nurse Practitioner (NNP)
Pediatric Nurse Practitioner (PNP)
School Nurse Practitioner
Family Nurse Practitioner (FNP)

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Developing Nursing Care Delivery

Steps of the Nursing Process


Assessment/data collection
Nursing diagnosis
Outcomes identification
Planning
Implementation
Evaluation

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Nursing Care Plans

Used as an instrument of communication


among caregivers
Focuses on the individual patient
Provides a picture
Helps the nurse to prioritize the needs of the
patient

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NIC, NOC, NANDA-I

NANDA-INorth American Nursing


Diagnosis Association International
Provides standardized language for nursing
diagnoses
NOCNursing Outcomes Classification
Focus on patient behavior
NICNursing Interventions Classification
Focus on nursing action

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General Thinking

Random or memorized thoughts


Occurs naturally

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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

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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

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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

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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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Communication

National patient safety goal


One exampleSBAR
Situation
Background
Assessment
Recommendation

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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!

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Community-Based Nursing

Challenge is to provide safe, caring, cost-


effective, quality care to mothers, infants,
children, and families
The nursing care plan must expand to a
family care plan
Therapeutic care is also provided in the home
setting; therefore, educating family members
on how to care for their loved one is essential

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Review

Objectives
Key Terms
Key Points
Evolve Resources

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