NUR207_Ch1_The Past, Present and Future

Chapter 1: The Past, Present, and Future

Definitions of Key Terms

Obstetrics

  • Definition: The branch of medicine focused on the care of women during pregnancy, childbirth, and the postpartum period (puerperium).

  • Practitioner: Physicians in this field are known as obstetricians.

Pediatrics

  • Definition: A branch of medicine dedicated to child health, development, and the treatment of illnesses specific to childhood.

  • Practitioner: Physicians are known as pediatricians.

Maternity Nursing

  • Definition: Nursing care provided to expectant families before, during, and after birth.

Family-Centered Care

  • Definition: An approach to health care recognizing the family's strength and integrity, involving them as caregivers and decision-makers in obstetric and pediatric nursing.

Historical Context of Maternity Care in the U.S.

  • Early 1900s: Most births occurred at home, leading to high morbidity and mortality due to poor hospital conditions.

  • Late 1950s: Hospitals began to establish training programs for nurses in obstetrics, leading to over 90% of births being in hospitals by 1960.

The Birth Process in the 1960s

  • Fathers were often excluded from delivery rooms.

  • Mothers experienced “twilight sleep,” reducing their involvement in delivery.

  • Infants were frequently kept from parents after birth, hindering early bonding.

Government Influences in Maternity and Pediatric Care

Sheppard-Towner Act of 1921

  • Purpose: Funded state-managed maternity care programs.

Title V of the Social Security Act

  • Provides funding for maternity care.

Medicaid Title XIX

  • Expanded access to maternity care for low-income women.

Head Start Program

  • Designed to enhance preschool children's educational exposure.

WIC (Women, Infants, and Children Program)

  • Provides supplemental nutrition and education to families needing assistance.

Key Legislation Impacting Family Leave and Health Care

Family Medical Leave Act (FMLA)

  • Became law in 1993 allowing up to 12 weeks unpaid leave for newborn care without losing benefits or pay status.

HIPAA (1996)

  • Established standards for protecting patients' health information and confidentiality.

Patient Protection and Affordable Care Act (ACA) (2010)

  • Expanded health coverage and protections for people with preexisting conditions.

American Health Care Act (AHCA)

  • President Trump's attempt to repeal ACA, affecting family planning and maternity care.

Reporting and Legal Responsibilities

  • Nurses are mandated reporters for suspected child abuse or significant health hazards.

  • Documentation of reportable situations is required as part of legal healthcare responsibilities.

The Present: Family-Centered Care

  • Focus on family involvement during pregnancy, childbirth, and postpartum periods in unified maternity and pediatric care facilities.

Changing Perceptions of Childbearing

  • Childbearing is increasingly recognized as a normal and healthy event requiring preparedness for physical and emotional changes in family dynamics.

Cultural Considerations in Nursing

  • Nurses must recognize cultural diversity in health perceptions and practices, essential for holistic nursing care.

  • Skills needed: cultural awareness, sensitivity, and competence.

Health Care Delivery Systems

  • Cost containment is a primary driver for change within healthcare, resulting in diagnosis-related groups (DRGs) that determine hospital stay payments and promote early discharges.

  • Importance of nursing roles in coordinating care and accessing community resources for families.

Interprofessional Nursing Care

  • Adherence to infection prevention standards and the use of electronic records are crucial.

  • Increasingly smaller family units call for tailored teaching that meets cultural and ethnic needs.

Health Promotion Strategies

  • Mainstreaming children with health challenges to promote independence and quality of life.

  • Focus on preventing illness and disability as a cost-effective measure.

Nursing Plans of Care

  • Nursing care plans serve as communication tools among caregivers, guiding focus on individual patient needs.

  • Clinical pathways outline collaborative care within a structured timeline for expected patient progress.

Evidence-Based Practice in Nursing

  • Incorporates critical thinking about patient needs to ensure safe and effective nursing care.

Documentation and Communication

  • Documentation is a legal responsibility; errors in documentation can have significant implications.

  • SBAR (Situation, Background, Assessment, Recommendation) is a standard communication tool in nursing.

QSEN: Quality & Safety in Nursing Education

  • Nursing education must focus on competencies in client-centered care, teamwork, collaboration, evidence-based practice, quality improvement, safety, and informatics.

The Future: Health Care Reform

  • Ongoing conflicts between cost containment and quality care ensure future healthcare reform is critical.

  • Access to healthcare doesn’t guarantee affordability, especially for preventive services.

Global Health Nursing

  • Enhancing quality and visibility of nursing care globally while fostering interprofessional collaboration and cultural competence is essential.

Trauma-Informed Care (TIC)

  • This approach emphasizes understanding the impacts of trauma on care delivery, prioritizing patient empowerment and control.

Community-Based Nursing

  • Addresses the challenge of providing quality care in home settings while ensuring family involvement in care for mothers, infants, and children.