Intro to Maternity & Women’s Health Care Chapters 1,2 Maternity & Women’s Health Care (9 th 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 (ex- care & 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 3 rd 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