1. The Past, Present, and Future
Chapter 1
The Past, Present, and Future

2. 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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3. 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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4. 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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5. 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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6. 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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7. 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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8. Obstetrics Branch of medicine Pertains to the care of women during
Physician is called an obstetrician
Pertains to the care of women during
Pregnancy
Childbirth
Postpartum period (puerperium)
Obstetrics is a Latin term meaning “stand by.”
What is the correlation between the Latin meaning and how obstetrics is viewed?
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9. Maternity Nursing Care given by a nurse To the expectant family Before
During
Following birth
The nurse plays an invaluable role in the care of the expectant family.
Review each of the phases in which nursing care is provided to the expectant family.
What are the roles of the nurse in each of the phases?
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10. Pediatrics Branch of medicine Deals with child development
Physician is called a pediatrician
Deals with child development
Provision of health care
Treatment of illness/disease
Specific to childhood
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11. 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
Family-centered care provides integrated care in which the family plays a key role.
Which members of the family are included in this definition?
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12. Nurse’s 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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13. The Past: Maternity Care
Europe
Soranus, a Greek physician—father 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
The earliest references to obstetrics are documented with the Egyptians; later work is documented by the Greeks.
Amazing care advances marked the end of the Dark Ages.
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14. 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
The development and recognition of pediatrics as a specialized area of care was revolutionary.
What would be the impact of not having a branch of care designed to manage the needs of infants and children?
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15. 19th Century Discoveries
Karl Credé ( )
Recommended instillation of silver nitrate into newborn’s eyes to prevent blindness from gonorrhea
What advances made during the 19th century are still applied today?
Discuss the differences that can be attributed to these discoveries.
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16. 19th Century Discoveries (cont.)
Ignaz Semmelweis ( )
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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17. 19th Century Discoveries (cont.)
Louis Pasteur ( )
Confirmed puerperal fever caused by bacteria
Spread by improper handwashing and contact with contaminated objects
Joseph Lister ( )
Experimented with chemical means to prevent infection
Revolutionized surgical practice
Introduced concept of antiseptic surgery
The changes in medicine credited to Louis Pasteur and Joseph Lister cross boundaries beyond maternal/child care.
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18. The United States
Samuel Bard—credited with writing the first textbook for midwives in 1807
Oliver Wendell Holmes ( )
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
Oliver Wendell Holmes wrote about germ theory in a document in which he took his peers to task for their lack of action in the prevention of germ-related diseases.
How has the work of Oliver Wendell Holmes changed the face of obstetrical care?
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19. 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
During the 1900s, the face of maternal/child care underwent great changes.
These changes were in large part due to the change in location for childbirth from home to hospital.
What factors can be associated with this shift in care sites?
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20. 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
Reflect on your own deliveries and those of your children and grandchildren.
Compare and contrast the stories shared.
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21. Advocates of Change in the Mother-Infant Bonding Process
American College of Nurse-Midwives (ACNM)
Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN)
American Nurses Association (ANA), division of Maternal Nursing
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22. The Past: Pediatrics Abraham Jacobi (1830-1919) Father of pediatrics
Established pediatric nursing as a specialty
Founded children’s hospitals
Developed separate units for children in foundling homes and general hospitals
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23. 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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24. 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
Elevated mortality and morbidity rates spurred the interest and action of the government to intervene financially with programs designed to promote the health and wellness interests of children.
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25. 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
Medicaid, Head Start, and WIC are widely recognized and respected agencies that work to promote the health needs of women and children.
Review the focus of each of these agencies.
What are the implications of these agencies not being available to women and children today?
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26. 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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27. 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
In the mid 1990s, families gained the legal right to have time away from work to manage the health needs of their families.
How many of you have been able to take family leave?
How would the inability to have this time off have impacted your family?
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28. HIPAA
Healthcare Information Portability and Accountability Act (HIPAA)
Enacted in 2003
Set standards to protect a patient’s health information
Allowed patients access and control over their health information
HIPAA has become a driving force in health care today.
Health care providers are educated about HIPAA.
Failure to comply with regulations can result in hefty fines.
How have you been personally affected by HIPAA?
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29. 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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30. The Children’s 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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31. 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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32. White House Conferences
First one in 1909, Theodore Roosevelt was president
Continues to be held every 10 years
1930—Children’s Charter was established
1980—involved all states in an effort to see what problems families were facing in various parts of the country
White House Conferences were implemented as a means to review the health concerns of children.
What impact do the location and participants have on this endeavor?
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33. Federal Legislation Enacted to Protect Children
—Child Abuse Prevention and Treatment Act
Education for All Handicapped Children
1982—Community Mental Health Center funded
Missing Children’s Act—provided for a national clearinghouse for missing children
Children are afforded protection from abuse under the laws associated with the Child Abuse Prevention and Treatment Act.
Under the law, handicapped children are entitled to education.
What are your views on providing education to children who are profoundly handicapped?
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34. United Nations Assembly
The United Nations Declaration of the Rights of the Child
Passed in 1959
Reaffirmed in 1980
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35. 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)
Where is your local health department located?
What professions are found within the department?
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36. 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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37. 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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38. 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
Various facilities have modified the traditional settings.
Review the division of care at local facilities.
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39. Birthing Centers Provide comprehensive care Antepartum Labor-delivery
Postpartum
Mothers’ classes
Lactation classes
Follow-up family planning
A new trend in the care of the childbearing family is the emergence of freestanding birthing centers; these centers are separate from the rest of the acute care facility.
What options are available in your community?
Providing maternal/child-related classes is vital to the promotion of positive outcomes for families during this time.
What potential topics are discussed in these classes?
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40. 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
Clinical pathways are utilized by numerous facilities.
Does your local maternity center employ them?
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41. Midwives First school of nurse-midwifery Certified Nurse-Midwife (CNM)
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
The availability of a CNM will vary by geographic location.
Are there CNMs in your community?
The CNM manages uncomplicated deliveries, not cesarean deliveries.
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42. Cross-Cultural Considerations
Culture—socially inherited characteristics
Becomes a patterned expression of thoughts and actions
Also called traditions
Consists of
Values
Beliefs
Practices
Shared by members of a group
The U.S. is recognized for blending numerous cultural groups.
What is cultural awareness? Cultural awareness is the recognition of differing beliefs held by others.
Providing quality nursing care requires the ability to be culturally aware and sensitive to those with different values.
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43. 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
Audience Response Question #1
It is important to be aware of a family’s religious and cultural beliefs because:
1. reimbursement is based on cultural and religious beliefs.
2. patient care can be adapted to meet cultural and religious beliefs.
3. physician’s treatment options must correspond to these beliefs.
4. caregivers’ beliefs should be the same as those of their patients.
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44. 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
Determining the patient’s beliefs and desires will help to ensure she and her family receive care that is unbiased and sound.
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45. The Pediatric Nurse as Advocate
An advocate is a person who intercedes or pleads on behalf of another
If the nurse believes the child’s 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
The role of advocate is a chief one for nurses.
The nurse has legal responsibility to intervene when the needs of a child are not being met.
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46. 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
Refer to Table 1-2 on pages
Review the information listed for your state and bordering states.
Audience Response Question #2
Complete the analogy. Morbidity : Illness as Mortality : _________
1. Trauma
2. Death
3. Relapse
4. Wellness
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47. 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
What are some technological advances in the obstetrical and pediatric specialties?
Review the ethical impact and dilemmas associated with these advances.
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48. Genomics Study of the functions of all the genes in the human body
“Gene” therapy—used to replace missing genes or alter defective genes
Earlier diagnosis, intervention, patient education
What is the Human Genome Project?
Review its role in relation to maternal/child nursing.
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49. 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
The cost for health care is a chief concern for all Americans.
The growing health care related expenditures have spurred efforts to “manage” costs.
One such means to manage health care costs and resources is the use of Utilization Review Nurses and Case Managers.
Review the roles for these professionals.
HMOs and PPOs are health care delivery systems. Compare and contrast HMOs and PPOs.
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50. 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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51. Health Promotion Preventing illness or disability—cost-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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52. 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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53. 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)
What are potential sources of employment for each of the nurses listed on the slide?
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54. Developing Nursing Care Delivery
Steps of the Nursing Process
Assessment/data collection
Nursing diagnosis
Outcomes identification
Planning
Implementation
Evaluation
The nursing process provides a means for nurses to take in and interpret data, and to make care decisions.
Assessment – the collection of patient data
Diagnosis – analysis of data in terms of NANDA-I
Outcomes identification – individualized expected patient outcomes
Planning – preparation of a plan of care designed to achieve stated outcomes
Implementation – patient care
Evaluation – review of the patient’s progress
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55. 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
Refer to Box 1-7, Steps in preparing a care plan, page 13.
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56. 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
NIC, NOC, and NANDA-I are integrated segments that assist the nurse in the critical thought processes required to plan and implement patient care.
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57. General Thinking Random or memorized thoughts Occurs naturally
What are examples of general thinking?
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58. 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
Critical thinking is an active process.
Successful patient care employs critical thinking.
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59. 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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60. 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
The ever-increasing cost of health care, combined with the increasing number of citizens who do not have access to affordable care, has caused an outcry for health care reform.
Access to desired health care is a concern being experienced by both the insured and uninsured.
The insured patient might not be allowed by the insurance provider to obtain treatments deemed “excessive or too expensive.”
Uninsured patients might not be able to seek care due to a lack of financial resources.
What are barriers experienced by the uninsured patient?
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61. 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
Healthy People 2020 is facilitated by the federal government.
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62. Communication National patient safety goal One example—SBAR Situation
Background
Assessment
Recommendation
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63. 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!
What are the basic principles of documentation?
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64. 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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65. Review Objectives Key Terms Key Points Evolve Resources
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