ch. 1 & 2

social determinants of health

• Housing and Neighborhood

• Environment

• Economic Stability

• Access to health care and quality of care

• Community and social context, including the impact of racism

what is infant mortality

death before first birthday

five leading causes of infant deaths

1. Congenital malformations and chromosomal abnormalities

2. Disorders related to short gestation and low birth weight

3. Sudden Infant Death Syndrome (SIDS)

4. Respiratory Distress in Newborns

5. Newborns affected by maternal complications of pregnancy

Maternal Mortality

• Death of a woman during pregnancy or within 42 days of pregnancy termination

what are two types of maternal mortality

• direct obstetric death

• indirect obstetric death

direct obstetric death

Complications during pregnancy, labor, birth, or the postpartum period; interventions that are completed that cause the death (incorrect treatment)

indirect obstetric death

Caused by pre-existing disease that develops during pregnancy (Ex: complications r/t someone that has systemic lupus that becomes exacerbated due to pregnancy; development of gestational DM or preeclampsia).

other probs in maternal newborn nursing

• teen preg

• tobacco use - causes low birth weight; blood clots and high BP for mother

• substance abuse

• overweight/obese - more risks for comorbidities and risks for infants starting from birth throughout childhood

• violence - screen all women for IPV

• LGBTQ - higher rates of miscarriage, preterm birth, low birth weight, and stillbirth; face discrimination

• racism

ethical principles

1. Beneficence - Acting for patient’s benefit

2. Nonmaleficence - To do no harm

3. Respect for Autonomy - Educate patient for informed consent and making own decisions

4. Justice - Fairness for everyone

ethical dilemmas

• Obligations and duties to mother and fetus

• Dilemmas - Difficulty deciding which action for mother or fetus takes precedence over the other

• Moral distress

ethics in neonatal care

• Ethical obligations

• Counterbalancing–to do no harm

• Veracity to parents

• Autonomy: respect parental decisions, facilitate communication and collaboration

categories for neonates in NICU may include

• Infants for whom aggressive care would probably be futile, where prognosis for a meaningful life is extremely poor or hopeless.

• Infants for whom aggressive care would probably result in clear benefit to overall well-being, where prevailing knowledge and evidence indicate excellent chances for beneficial outcomes and meaningful interactions.

• Infants for whom the effect of aggressive care is mostly uncertain.

nurses rights and responsibilities

• should not abandon a patient nor refuse to provide care based on prejudice or bias.

• have the professional responsibility to provide high-quality, impartial nursing care to all patients in emergency situations, regardless of the nurses’ personal beliefs.

• have a professional obligation to inform their employers of any attitudes and beliefs that may interfere with essential job functions.

AWHONN core values: CARING

•  Commitment to professional and social responsibility

•  Accountability for personal and professional contribution

•  Respect for diversity of and among colleagues and clients

•  Integrity in exemplifying the highest standards in personal and professional behavior

•  Nursing excellence for quality outcomes in practice, education, research, advocacy, and management

•  Generation of knowledge to enhance the science and practice of nursing to improve the health of women and newborns

legal issues

• Maternity: most litigious practice area (most lawsuits) 

• Evidence-based practice (EBP) is the gold standard. Problem areas include clinical judgment, communication, & collaboration.

• “Failure to communicate” leads to most malpractice suits against nurses.

Five clinical situations account for most fetal and neonatal injuries and litigation in obstetrics

• Inability to recognize or inability to appropriately respond to intrapartum fetal compromise

•  Inability to perform a timely cesarean birth (30 minutes from decision to incision) when indicated by fetal/maternal condition

•  Inability to appropriately initiate resuscitation of a depressed neonate

•  Inappropriate use of oxytocin or misoprostol, leading to uterine tachysystole, uterine rupture, & fetal intolerance of labor or fetal death

•  Inappropriate use of forceps/vacuum or preventable shoulder dystocia

fetal heart rate monitoring

• Legally important: failure to assess correctly

• Safe and effective fetal heart rate (FHR) assessment

• Risk management issues - Want to avoid preventable adverse outcomes by monitoring fetal HR to have timely interventions