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Chapter 1

21st Century Maternity


and Womens Health
Nursing

Copyright 2016 by Elsevier Inc. All rights reserved.

Learning Objectives
Describe the scope of maternity and womens health

nursing.
Evaluate contemporary issues and trends in maternity and
womens health care.
Examine social concerns in maternity nursing and womens
health care.
Integrate evidenced-based practice into care plans.
Explain risk management and standards of practice in the
delivery of nursing care.
Discuss legal and ethical issues in perinatal nursing.
Examine Healthy People 2020 goals related to maternal and
infant care.

Copyright 2016 by Elsevier Inc. All rights reserved.

What Is Maternity and


Womens Health Nursing in
the
21st
Century?
Maternity care
Womens health care
Role of nurses in
womens health care
Significant advances
in care

Copyright 2016 by Elsevier Inc. All rights reserved.

Womens Health
Disparities
Efforts to decrease disparities

HRSA Health Disparities Collaboratives


The National Institutes of Health
National Institute of Nursing Research
Centers for Disease Control and Prevention
(CDC)
First Periodic Health Disparities and Inequalities
ReportUnited States, 2011

U.S. Department of Health and Human Services

HHS Disparities Action Plan

Copyright 2016 by Elsevier Inc. All rights reserved.

Contemporary Issues and


Trends
Healthy People 2020 goals
Eliminate preventable disease, disability,
injury and premature death
Achieve health equity
Create social and physical environments that
promote good health for all
Promote healthy development and healthy
behaviors across every stage of life

Copyright 2016 by Elsevier Inc. All rights reserved.

Contemporary Issues and Trends


(Cont.)
Healthy People 2020 goals related to
maternal health:
Reduce the rate of fetal and infant deaths
Reduce the rate of maternal mortality
Reduce preterm births
Reduce cesarean births among low risk
women

Copyright 2016 by Elsevier Inc. All rights reserved.

Contemporary Issues and


Trends (Cont.)
Millennium development goals
8 goals to be achieved by 2015
Respond to the worlds main development
challenges
Adopted by 189 nations

Goals specific to womens health


Promote gender equality and empower
women

Reduce child mortality


Improve maternal health
Copyright 2016 by Elsevier Inc. All rights reserved.

Contemporary Issues and Trends


(Cont.)
Interprofessional education
Client care will improve when health professionals
work together.

The interprofessional collaborative practice


competency domains include
Values/ethics for interprofessional practice
Roles/responsibilities
Interprofessional communication
Teams and teamwork

Copyright 2016 by Elsevier Inc. All rights reserved.

Contemporary Issues and


Trends (Cont.)
Problems with the U.S. health care system

Structure of the health care delivery system


Reducing medical errors
High cost of health care
Limited access to care

Health care reform


In early 2010, President Obama signed into
law the Patient Protection and Affordable Care
Act (ACA)

Copyright 2016 by Elsevier Inc. All rights reserved.

Contemporary Issues and


Trends (Cont.)
Accountable care organizations (ACOs)

Coordinate high-quality care


Eliminate duplication of services
Prevent medical errors
Health literacy
E-health literacy

Copyright 2016 by Elsevier Inc. All rights reserved.

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Trends in fertility and


birth rates
Trends:
Fertility rate
Birth rate
Low birth weight and preterm birth

Infant mortality in the United States


International infant mortality trends
Maternal mortality trends
Maternal morbidity
Obesity
Copyright 2016 by Elsevier Inc. All rights reserved.

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Regionalization of Perinatal
Health Care Services
Ambulatory care
High-technology care
Social media and its impact
Community-based care
Childbirth practices

Prenatal care
Certified nurse-midwives or physicians
Family-centered care
Involving consumers and promoting selfmanagement

Copyright 2016 by Elsevier Inc. All rights reserved.

12

Contemporary Issues and


Trends
International
concerns
Female genital
mutilation

Human trafficking
Womens health
Heart disease
Violence

Copyright 2016 by Elsevier Inc. All rights reserved.

13

Future of Nursing
Practice
Transforming the nursing profession
Nursing Interventions Classification (NIC)
Evidence-based practice
Association of Womens Health, Obstetric and
Neonatal Nurses

Cochrane Pregnancy & Childbirth Database


Joanna Briggs Institute

Outcomes-oriented practice
A global perspective
Copyright 2016 by Elsevier Inc. All rights reserved.

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Standards of Practice and Legal


Issues in Provision of Care
Standards
ANA
AWHONN
Standards and Guidelines for Professional
Nursing Practice in the Care of Women and
Newborns (United States)

Standards for Professional Perinatal Nursing


Practice and Certification in Canada

ACNM
NANN
Copyright 2016 by Elsevier Inc. All rights reserved.

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Standards of Practice and


Legal Issues in Delivery of Care
Risk management
System of checks and balances to minimize
risk for injury

Sentinel events
The Joint Commission

Failure to rescue: key components


Careful surveillance and identification of

complications
Quick action to initiate appropriate
interventions and activate a team response

Copyright 2016 by Elsevier Inc. All rights reserved.

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Standards of Practice and


Legal Issues in Delivery of Care
(Cont.)
Quality and Safety Education for Nurses
(QSEN)
Teamwork and Communication
Situation, background, assessment,
recommendation (SBAR)
Team STEPPS
Developed by the Department of Defense and
the Agency for Healthcare Research and
Quality

Copyright 2016 by Elsevier Inc. All rights reserved.

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Ethical Issues in Perinatal Nursing and


Womens Health Care

Reproductive technology
Allocation of resources
Older-age pregnancies
Third-party payers
Induced ovulation and in vitro fertilization
Multifetal pregnancy reduction
Intrauterine fetal surgery
Treatment of very low-birth-weight infants

Copyright 2016 by Elsevier Inc. All rights reserved.

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Research in Perinatal Nursing


and Womens Health Care

Ethical guidelines for nursing research

Must protect rights of human subjects


Ensure that subjects are fully informed and aware of
rights
Be sensitive to ethical issues in perinatal research

Analysis of benefits and risks


ANA ethical guidelines in conduct,
dissemination, and implementation of nursing
research

Copyright 2016 by Elsevier Inc. All rights reserved.

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Key Points
Maternity nursing focuses on women

and their infants and families during the


childbearing cycle.
Womens health nursing focuses on the
special physical, psychologic, and social
needs of women throughout their life
spans.
Nurses caring for women can play an
active role in shaping health care
systems to be responsive to the needs of
contemporary women.
Copyright 2016 by Elsevier Inc. All rights reserved.

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Key Points (Cont.)


Childbirth practices have changed to
become more focused on the family and
allow alternatives in care.
A variety of factors, including race, age,
violence, and human trafficking, affect
womens health.
Canada ranks twenty-ninth and the
United States ranks thirty-first among
industrialized nations in infant mortality
rates.
Copyright 2016 by Elsevier Inc. All rights reserved.

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Key Points (Cont.)


Evidence-based practice and outcomes
orientation are emphasized in current
practice.
Risk management and learning from
sentinel events can improve quality of
care.
Healthy People 2020 provides an update
on goals for maternal and infant health.

Copyright 2016 by Elsevier Inc. All rights reserved.

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Key Points (Cont.)


Research plays a vital role in
establishing a scientific base for the
care of women and infants.
Ethical concerns have multiplied with
the increasing use of technology and
scientific advances.

Copyright 2016 by Elsevier Inc. All rights reserved.

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The Family in a Cultural Context


Chp. 2

Cultural factors related to family health

Culture
Subculture
Acculturation
Assimilation
Implications for nursing
Ethnocentrism

Copyright 2016 by Elsevier Inc. All rights reserved.

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The Family in a Cultural


Context (cont.)
Childbearing beliefs and practices

Communication (language, dialects)


Use of Interpreters
Personal space
Time orientation
Family roles

( found on p. 23)

Copyright 2016 by Elsevier Inc. All rights reserved.

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Developing Cultural
Competence

Key components of cultural competence


Recognizing disparity between ones own culture and
that of the client
Educating and promoting healthy behaviors in a
cultural context
Taking abstract knowledge about other cultures and
applying it in a practical way

Copyright 2016 by Elsevier Inc. All rights reserved.

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Chapter 5

Violence Against Women

Copyright 2016 by Elsevier Inc. All rights reserved.


Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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Violence Against Women


One of every six women worldwide has been a
victim of intimate partner violence (IPV)
IPV: actual or threatened physical, sexual, or
psychologic or emotional abuse by a spouse, exspouse, boyfriend, ex-boyfriend, girlfriend, exgirlfriend, date, or cohabiting partner
Other terms: partner abuse, domestic or family
violence

Copyright 2016 by Elsevier Inc. All rights reserved.

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Violence Against Women


(cont.)

1 in 5 murders in the U.S. are IPV related


Women abused during pregnancy have a

threefold increase in risk of being murdered


In the U.S., the percentage of women killed by
an intimate partner rose from 40% to 45%
over a 10-year period
Data significantly underestimate prevalence of
IPV

Copyright 2016 by Elsevier Inc. All rights reserved.

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Women Experiencing IPV


(cont.)
IPV during pregnancy
Most women abused before pregnancy will
be abused during pregnancy
Abuse may happen for first time during
pregnancy

Peaks during the first trimester


Pregnant adolescents are abused at higher
rates than are adult women
Risk of fetal injury is high

Copyright 2016 by Elsevier Inc. All rights reserved.

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Care Management
(cont.)
Plan of care and interventions
ABCDES of caring for abused women

Alone
Belief
Confidentiality
Documentation
Education
Safety

Pg. 107

Copyright 2016 by Elsevier Inc. All rights reserved.

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Question
1. When managing health care for pregnant
women at a local prenatal clinic, the nurse
should recognize that the most significant
barrier for access to care is the pregnant
womans:
a. Age
b. Minority status
c. Educational level
d. Inability to pay
Copyright 2016 by Elsevier Inc. All rights reserved.

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