Chapter 2 OB: Caring for women and children

Core concepts

1983: medicare changed way hospitals are paid

• changed from cost reimbursement to fixed rated (DRGs)

• HOW DO YOU THINK THIS AFFECTED HEALTH CARE?

Core concepts

Standards set by

• American Nurses Association (ANA)

• Association of Women’s Health, Obstetrics, and Neonatal Nurses (AWHONN)

Core concepts

Family centered Care

• shifts power of care from nurse to family

• family as constant

• self determination, decision making, control and self efficacy

• provides sense of empowerment

• use of LDRPs, LDR;s, rooming in, liberal visiting hours

Core concepts

Evidence based Care

• use of research to plan care for best outcomes

• decreases variations in care and provides set standards

• safest and most effective treatment plan

Core concepts

collaborative care

• eliminates Silos

• promotes interprofessional collaboration

• promotes accountability and communication

• provides more support

Core concepts

Atraumatic care

• key principles

  • preventing or minimizing physical stressors

  • preventing or minimizing separation

  • promoting a sense of control

• Provide a sense of control and allow pt to make decision

client and family education

• Assess client

• Develop plan

• Implement plan/services

• Follow up evaluation

• Document

• WHAT DOES THIS REMIND YOU OF?????? - Nursing process

Things to Consider: Culture, literacy, practical interventions, resources* (social work)

Levels of prevention

Primary

secondary

tertiary

Primary prevention

• prevention before disease or condition occurs

• done through health promotion activities, environmental protection, and specific protection against disease and injury

• Ex: nutrition, good hygiene, sanitation, immunizations, uv ray protection, genetic counseling, smoking cessation

secondary prevention

• early detection and treatment of adverse health condition

• aim is to halt disease

• Ex: health screenings, pregnancy test BP monitoring, breast exams, colonoscopies, vision and hearing screens

Tertiary prevention

• Reduces progression of disease/disability, tries to restore patient to maximum potential, supportive & restorative

• supportive and restorative

cultural competent nursing care

• culutral diversity

• competence *time orientation, personal space, family orientation, language)

  • cultural awareness, cultural knowledge, cultural skills, cultural encounter

• Barriers to cultural competence

  • provider related (ex: provider stubbornness)

  • system-related

Communication

• effective therapeutic communication crucial to quality nursing care

• Trust, respect, empathy

• confidentiality and privacy

• Verbal and nonverbal

  • communicating across cultures

  • working with an interpreter, communicating with deaf or hearing impaired clients and families

COmmunity based care for women and children

• prenatal care

• labor and birth care: hospital, birthing center, home

  • birthing center: home like setting; close to hospital if complications; normalcy of birth

  • Home birth: family centered birth: appropriate for women at low risk for complications

COmmunity based care for women and children

• postpartum and newborn care

  • telephone consultation

  • outpatient clinics

  • postpartum home visits

  • support groups for new moms

  • high risk newborn care

Discharge planning and case management

• development and implementation of comprehensive plan for safe discharge from a facility and for continuing safe and effective care in community and at home