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 home –by 1960’s greater than 90% in hospitals –not family-centered, father in waiting room, mother sedated, bonding was delayed, siblings not allowed

19 th Century Discoveries Louis Pasteur ( ) –Confirmed puerperal fever caused by bacteria –Spread by improper hand-washing and contact with contaminated objects Joseph Lister ( ) –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-for- service 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

Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.24