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.

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 2
 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.
Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3
 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.

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4
 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.

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5
 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.

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6
 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.
Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7
 Obstetrics

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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8
 Maternity Nursing

Care given by a nurse

To the expectant family
Before
During
Following birth

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9
 Pediatrics

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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 10
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14
 19th Century Discoveries

Karl Cred (1819-1892)

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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22
 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
Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23
 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

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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 30
 Fair Labor Standards Act of 1938

Established a general minimum working age

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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 32
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 33
 United Nations Assembly

The United Nations Declaration of the Rights

of the Child
Passed in 1959
Reaffirmed in 1980

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34
 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)

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 37
 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
Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38
 Birthing Centers

Provide comprehensive care

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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 40
 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
Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 41
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 42
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 43
 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
Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 44
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 45
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 46
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 47
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 48
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 49
 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)

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 50
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 51
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 52
 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)

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 53
 Developing Nursing Care Delivery

Steps of the Nursing Process

Assessment/data collection
Nursing diagnosis
Outcomes identification
Planning
Implementation
Evaluation

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 54
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 55
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 56
 General Thinking

Random or memorized thoughts

Occurs naturally

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 57
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 58
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 59
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 60
 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. 61
 Communication

National patient safety goal

One exampleSBAR
Situation
Background
Assessment
Recommendation

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 62
 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!

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 63
 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

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 64
 Review

Objectives
Key Terms
Key Points
Evolve Resources

Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 65