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 born @ home– by 1960’s greater than 90% in hospitals– not family-centered, father in waiting room,

mother sedated, bonding was delayed, siblings not allowed

19th Century Discoveries

• Louis Pasteur (1822-1895)– Confirmed puerperal fever caused by bacteria– Spread by improper hand-washing and contact

with contaminated objects• Joseph Lister (1827-1912)

– 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

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