Today's Healthcare for women
Today's Healthcare for women Nurs 3550
Popular in Nursing caring for adult childbearing family
Popular in Women and Gender studies
This 10 page Class Notes was uploaded by Brianne Knight on Saturday February 6, 2016. The Class Notes belongs to Nurs 3550 at Middle Tennessee State University taught by Dr. Lancaster in Winter 2016. Since its upload, it has received 60 views. For similar materials see Nursing caring for adult childbearing family in Women and Gender studies at Middle Tennessee State University.
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Date Created: 02/06/16
Exam 1 Maternal-Newborn and Women’s Health Nursing Chapter 1 Maternity and Women’s Health Care Today Historical Perspectives Granny Midwives: birth the baby and took care of families ( No physicians) Preferred attendant for wealthy was a midwife/ homebirth Maternal and newborn death rates high both home/hospital Primary causes for a woman: postpartum hemorrhage, Postpartum infection (puerperal sepsis/childbed fever), and toxemia (now known as preeclampsia or gestational hypertension). Primary causes for newborn: prematurity, dehydration from diarrhea, and contagious disease. Medical Management Arrives th Late 19 Century: decline un homebirth and increase in physician assisted. ( developments that were available to physicians, but not always to midwives) Discovery by Semmelewis that puerperal infection could be prevented by hygienic practices. o Development of forceps to facilitate birth o Discovery of Chloroform, which was used to control pain during childbirth and was available only to physicians o Use of drugs to start or induce labor and increase uterine contractions (augmentation of labor) o Advances in operative procedures such as cesarean birth with good intentions to prevent infections, hospitals hurried to develop policies and procedures to meet the needs of physicians and take advantage. By 1960, 90% of births occurred in hospitals Maternity care became highly regimented for most women. o Physicians managed all antepartum(before onset of labor), intrapartum( time of labor), and postpartum( first 6 weeks after childbirth) care. o The woman’s role on childbirth was seen as passive: The physician “delivered” the infant. o Primary function of Midwife were to assist the physician and follow prescribed medical orders after childbirth. Unlike homebirths, hospital births hindered bonding between parents and infants. Despite technologic advances and the move from home to hospital, maternal and infant mortality rates declined slowly. o The slow decline primarily resulted from problems that could have been prevented, such as poor malnutrition, infectious disease, and inadequate prenatal care. Food for Thought Mary Breckinridge and Florence Nightingale Mary pioneered the frontier Nursing Services-midwives in 1924-1925. Rural area in Kentucky Recruited Nurses and taught them the basic concepts She dropped the infant and mother mortality rate Government Involvement 2 Two concurrent trends, federal government involvement and consumer demands, led to additional changes in maternity care. o Cause of high rates of maternal and infant mortality Sheppard-Towner Act of 1921, the first federally sponsored program, provide funds for state-managed programs for mothers and children. o Later repealed, it set the stage for future allocation of federal funds. Ongoing problem of providing health care for women and children with inadequate health care coverage left the door open for pared nurses as certified nurse- midwives(CNMs), nurse practitioners, and clinical nurse specialists. Effects of Consumer Demands on Health Care In the early 1950s, consumers began to insist on their right to be involved in their own health care. o Pregnant women were no longer willing to accept only what was offered. Early in the 1950s, Dr. Grantly Dick-Read proposed a method of childbirth that allowed the mother to control her fear and thus control her pain during labor, allowing for birth without pharmacologic intervention. Consensus among child psychologists and families that babies being away from mothers after birth is not good… dawning of… o Methods such as Lamaze and Bradley also gained favor. Family Centered Care Families didn’t want the nursery setting 3 o Proven babies do better with mom and dad Family-centered care describes safe, high-quality care that recognizes and adapts to both the physical and psychosocial needs of the family, including the newborn. Goal is to foster family unity while maintaining physical safety Developed in response that families wanted NO NURSERY Follows the premise that children are usually a normal healthy event in life of a family and that childbirth affects the entire family Family-Centered care greatly increased the responsibilities of nurses. Nurses now assume a major role in teaching, counseling, and supporting families in their decisions about childbirth. Hospital vs. Birth Center vs Home In the past, labor occurred in a functional labor room, similar too small hospital room or an emergency department room. o Move from the labor room to the delivery room just before the birth of the baby was particularly difficult for the mother. o Each move disrupted the family’s time together and often separated the parents and the infant. o Because of these disadvantages, hospitals began to devise settings that were more comfortable and enhanced family participation. Labor, Delivery, and Recovery Rooms (LDR): the most common location for vaginal birth. o In an LDR room, normal labor, birth, and recovery from birth take place in one setting. 4 o LDR rooms are homelike, often with refrigerators, entertainment media, and soothing lightening. o The mother typically stays in the LDR room for 1-2 hours and then transferred to a postpartum room until her stay. o The healthy infant may remain with the mother throughout her stay in the LDR room, receiving continuing evaluation for adaption to neonatal life. When the mother is transferred to her postpartum room, the infant may be transferred to the nursery for some mote extensive assessment or may remain with the mother in a mother-baby postpartum room while being assessed. Some hospitals offer rooms similar to LDR rooms in layout and function, with exception that the mother is not transferred to a postpartum unit after recovery. o She and the infant remain in the Labor, Delivery, Recovery, Postpartum Room until discharge (LDRP) Free standing Birth centers are designed to provide maternity care to low risk women outside a hospital setting. Both the mother and the infant continue to receive follow- up care during the first 6 weeks after birth. o This may include help for breastfeeding problems, a postpartum examination at 4 to 6 weeks, family planning information, and examination of the newborn. Birth Centers are less expensive compared with traditional hospitals, which provide advanced technology that may be unnecessary for low-risk women. 5 Main disadvantage is that most independent birth centers are not equipped for major obstetric emergencies. Home Birth provides the advantage of keeping the family together in its own familiar environment throughout the childbirth experience. Women who plan a home birth must be screened carefully to male sure that they have a very low risk for complications. Need for parents to provide a setting and adequate supplies for the birth. Moreover, the mother must take care of herself and the infant without the immediate help she would have in a hospital or birth center setting. Complementary and Alternative Medicine(CAM) Its use is not restricted to recent immigrants to North America, although some techniques originated thousands of years ago in Eastern cultures. CAM can be defined as those systems, practices, interventions, modalities, professions, therapies, applications, theories, and claims that are currently not an integral part of the conventional medical system in North America. The therapies may be used alone (alternative therapy), combined with other therapies or used in addition to conventional medical therapy Massage, chiropractic, acupuncture, herbal, homeopathy, naturopathic, aromatherapy Safety is a major concern with the use of CAM. Many people who use these techniques or substances are self-referred. 6 Some CAM therapies are harmful if combined with conventional medications or when taken in excess. Also, many people may not consider some therapies as alternative because they are considered mainstream in their cultures. Family Traditional families or nuclear families are headed by a father and mother who view parenting as a major priority in their lives and whose energies are less likely to be depleted by stressful conditions such as poverty, illness or substance abuse. Nontraditional families are defined by their unique structure and may be single parent, blended, or extended. o Single-parent families: Millions of families are now headed by a single parent, most often the mother, who must function as a homemaker and caregiver and is often the major financial provider for the family’s needs. Divorce is the most common cause of single parenting, although childbirth among unmarried women is also a factor. Widowhood of the parent sometimes occurs as well o Blended families: are formed when divorced or widowed parents remarry and bring children from a previous marriage into the new relationship. o Extended families: includes members from at least three generations living under one roof. o This family structure is becoming increasingly common in the US and has given rise to the term boomerang families. 7 o Elderly parents may live with their adult children, or single if married adults with children of their own return to their parents’ home because they either are unable to support their families or want additional support that grandparents provide for grandchildren o Characteristics of a healthy family: communication, flexible, agree on basic principles of parenting, adaptable, mature, ask for help. o High risk families include those that live below poverty level, those headed by a single teenager parent, and those with unanticipated stress such as an infant who is preterm, ill, or handicapped. o In addition to families with lifestyle problems such as alcoholism, substance abuse, and family violence are considered at high risk for problems in providing adequate care for the infant. May need specialized services that can provide comprehensive care. The most common referrals are to social service agencies for financial assistance, crisis intervention, home visits, and drug rehabilitation programs. Culture perspectives Culture-sum of the beliefs and values that are learned, shared and transmitted from generation to generation in a particular group Ethnic-pertains to religious, racial, national or cultural group characteristics such as speech, social customs, and physical characteristics Transcultural nursing- concerned with the provision of nursing care in a manner that is sensitive to the needs of individuals, families, and groups. 8 Nurse must be aware that culture has visible and invisible layers that could be said to resemble an iceberg. Observable behaviors can be compared with visible part the top of the iceberg. The history, beliefs, values, and religion are not observed, but they are the hidden foundation on which behaviors are based and can be likened to the large submerged part of the iceberg. Western: Nursing practice in the US is based largely on Western beliefs. Asian: Speak softly and avoid prolonged aye contact, which they consider rude, in contrast to the western belief that eye contact denotes honesty and forthrightness. Hispanic: Usually have a close extended family and place a high value on children. And can not get to the point or directly confront because they take it as being insulted if a problem is addressed directly without taking time for small talk. African Americans: close extended family. Heads of households are usually women. Use a communication style that may cause conflict when they seek a healthcare provider. Statistics A country such as the US, which has one of the highest gross national products(GNP) in the world, is expected to have one of the lowest infant mortality rates. Yet in 2008, the most recent years for the comparative data among countries area availableththe infant mortality rate in the US ranked 27 among developing nations. 9 Cardiovascular disease and the many accompanying problems affect females from adolescence through old age. o CVD is the leading cause of death in the US, and 51% of the deaths occur in women. o The epidemic of obesity contributes to the growing problems of hypertension, high blood cholesterol, and diabetes mellitus. o Poverty not race is an important factor…live below poverty= unlikely good health. o Fastest growing group of homeless is women and children To learn more and get OneNote, visit www.onenote.com. 10
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