Chapter 1: Introduction to Maternity and Pediatric Nursing. PDF

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Introduction to Maternity and Pediatric Nursing....

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Chapter 1: Introduction to Maternity and Pediatric Nursing. Introduction. 

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Maternity nursing has a broad range of opportunities. •

Provide care from puberty to menopause.

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Specialties include: prenatal care, labor and delivery, postpartum care, newborn care, neonatal intensive care, women’s health, and infertility care.

Pediatric nursing. •

Involves caring for children between birth and 18 years.

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Safety is an important aspect of the care of children.

Focus on normal growth and development, acute, chronic, and critical care issues, and end-oflife and palliative care. Quality. 

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Nursing Manager definition: •

Wise use of resources.

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Lack of errors in providing care.

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Positive patient feedback.

Bedside nurse definition: •

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Physician/midwife definition: •

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Meets expectations for improvement and recovery.

Institute of Medicine definition: •

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Positive patient response to medications and interventions without complications.

Patient definition: •

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Delivery of safe and effective care.

“The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

Ways for nurses to improve quality: •

Work within the scope of practice, utilize standards of care based on evidence-based practice, and make sound decisions in providing care.

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Deliver family and patient-centered care with attention to specific needs, values, and expectations of patient and family.

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Identify errors and hazards, implement safety principles.

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Collaborate with health team members to reduce errors and improve care.

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Utilize hospital resources in a cost-effective manner by not wasting materials and time.

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Provide equal care to all patients that does not vary in quality based upon gender, ethnicity, culture, or socioeconomic status.

Roles in Maternal-Child and Pediatric Nursing. 

Focus on childbearing women, newborn infants, children, and families.

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Provide patient-centered and family-centered care.

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Roles include:

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Licensed practical/vocational nurses.

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Registered nurses.

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Nurse practitioners.

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Clinical nurse specialists.

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Certified nurse midwives.

Certified Nursing Assistant (CNA). •

Assists with patient’s daily needs of nutrition, dressing, and movement.

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Takes vital signs, collects specimens, assists with transportation.

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Under direct supervision of registered nurse (RN), nurse practitioner (NP), physician assistant (PA), or physician.

Licensed practical/vocational nurse (LPN/LVN): •

Completed a program, passes the NCLEX for LPN/LVNs.

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Provides nursing care in multiple settings under RN, NP, physician or midwife.

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May help prep patients for pregnancy and delivery.

Registered nurse: •

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Graduated from accredited nursing program. 

Associate Degree in Nursing (ADN).

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Bachelor’s Degree in Nursing (BSN).

Passed the NCLEX for RNs.

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Nurse practitioner: •

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Assess, plan, and provide care to include teaching, monitoring the pregnancy through delivery, providing postpartum and newborn care, and caring for pediatric patients across developmental period.

Graduated from accredited program. 

Masters Degree in Nursing (MSN).

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Doctorate Degree in Nursing (DNP).

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Passed a certification exam.

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Prescribe medications.

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Emphasis on contraception, fertility problems, pre-pregnancy care, pregnancy care, postpartum care, lactation problems, newborn care, and menopause care.

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Pediatric NPs care for children across the developmental period.

Clinical nurse specialist (CNS): •

RN who obtained an advanced degree and clinical preparation.

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MSN level with a focus on education, management, and research roles relative to patient care.

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Works alongside nurses providing education and support.

Certified nurse midwife (CNM): •

MSN or DNP, passed certification exam in pregnancy and delivery.

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Provides care through pregnancy, labor, delivery, and postpartum.

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Prescribes medications.

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Has hospital privileges to deliver babies.

Clicker Check. A pregnant patient has been receiving care in the maternal-child clinic. During labor the fetus demonstrates signs of distress. Which nursing professional is best suited to provide care? The CNM is educationally prepared to provide care during the labor and delivery process. The NP provides care during pregnancy and after delivery. The RN and CNS would provide support; however, they are unable to prescribe medications or actively deliver the baby. Legalities and Ethics. 

Be aware of state laws regarding care.

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Nurses who do not meet expected standards can be held legally responsible.

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Adhere to the scope of practice. •

Scope of practice: Legal outline of nursing functions according to state laws.

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Determined by licensing state.

Delegation. •

Delegator must know scope of practice of person carrying out task.

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Delegator assumes responsibility for appropriateness of delegated activity.

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All boards of nursing in US have information on their websites about state laws and rules that govern nurses’ practice.

Use three steps to determine if task is appropriate for delegation: 1. Clarify what the specific activity/task is by defining all aspects of issue. 2. Review legal standards of task. 3. Decide if the above elements support or reject the delegated action or task.

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Standards of care: 1. Definition: model of established practice as correct way to provide care. 2. Guidelines used to determine nursing actions. 3. Identifies knowledge, skills, attitude, and judgment needed. 4. Defined by federal and state laws and professional organizations. 5. Association of Women’s Health, Obstetric, and Neonatal Nurses (AHHONN) established standards for maternity care. 6. Society of Pediatric Nurses establishes standards for care of children and families.

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Institution Policies. 1. Nurses held accountable for upholding agency or health-care institution policies. 2. Policy and procedures handbook: 

Outlines how care is to be provided.

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Provides specific guidelines.

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Following policy and procedures will prevent errors and promote safe patient care.

Evidence-Based Practice. 

Nursing care in which all interventions are based on current valid research evidence.

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Nursing research in practice at the bedside.

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Uses scientific studies to answer why interventions should be changed when providing care.

Informed Consent. 

Informed consent: patient understands and accepts risks and benefits of procedure. 

18 years and older. 

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Children. 

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Written consent must be signed by health-care provider and adult patient before procedure/treatment.

Legal caregiver, parent or guardian, signs consent.

Assent. 

Feedback from child 7 more than years of age regarding medical treatment.

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Includes child in decision-making process.

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Child is asked if he/she has any questions or concerns.

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Not all children are developmentally ready.

Emancipation of minor. 

Grants adult rights to a child of age and appropriate developmental level.

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Minor is able to process complex information related to decisions in health care and medical treatments.

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Married pregnant teenager - automatic emancipation.

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Unmarried pregnant teenager - not emancipated.

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Definition of emancipated minor varies among states.

Children’s Rights. 

Children have the right to provisions, protection, and participation. •

Right to Provisions. ‒

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Right to Protection ‒

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Provisions of safe living, health care, education, clean water, appropriate diets, adequate rest, sleep, play, and recreation.

Protected from abuse, exploitation, neglect, discrimination at home, school, community areas, and health-care institutions.

Right to Participation. ‒

Offered full participation in community activities, art, sports, cultural events.

Family Rights. 

Families are entitled to protected rights within a health-care institution including (not limited to): •

Right to full participation in health-care discussions and decision-making concerning the child.

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Right to active participation in cultural beliefs and practices whenever possible.

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Right to visitation and family participation in the treatment and care of the child.

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Right to comfort by having pain and discomfort addressed and treated promptly.

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Right to have interpretation services by a translator when a language barrier exists.

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Right to personal dignity and privacy during assessments, diagnostics, procedures, and treatments.

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Right to receive emergency treatment regardless of the ability to pay.

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Right to be free of restraints or seclusion unless clinically necessary.

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Right to refuse care provided by students.

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Right to decline to participate in research programs or projects.

Ethics. 

Definition: moral principles that guide a person’s behavior.

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Concerned with right/wrong and good/evil.

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Doing the right thing for the best patient outcome.

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American Nurses Association Code of Ethics is used to guide nursing practice.

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Fairness, honesty, and respect for human beings are important in maternity and pediatric settings.

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Autonomy: Right to have control of body and make decisions.

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Beneficence: Spirit of compassion and kindness to benefit others.

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Balance the benefits of treatment against the risks and costs.

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Nonmaleficence: “Do no harm”.

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Inflict the least possible harm to reach a beneficial outcome.

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Justice: Fairness for individuals, groups, organizations, and communities.

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Fair allocation of services and resources.

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No answer fits every situation and every patient.

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Ethics committees that can provide guidance.

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Follow the chain of command with ethical situations.

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Obligated to follow legal care, adhering to standards of practice, regardless of feelings.

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Avoid imposing own values onto the patient.

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Ethical issues a nurse may encounter. •

Abortion.

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Pregnant mother smoking, drinking alcohol, using illicit drugs.

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Patient wanting elective c-section.

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Provision of futile care for an extremely premature newborn.

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A young adolescent with no family support leaving hospital with a newborn.

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Infertility treatment that is expensive and not successful.

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A teenager with aggressive cancer who wants to be allowed to die.

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A homeless child living in a car with his family being discharged with a new diagnosis of asthma.

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A child with type 1 diabetes being cared for by a mother who has dual mental health diagnoses.

Family-Centered Care. 

Family: biological, legal, and/or emotional relation between two or more persons. •

Child’s family: family is who they say they are.

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Families can be nuclear, alternative, adoptive, foster, communal.

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A family is who they say they are.

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Family is the constant in the child’s life.

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All members are affected by illness, injury, or hospitalization.

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Strengthens family unit, enhances communication and outcomes of the experience.

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Provides safe, child-friendly environment.

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Assists child and family as a unit.

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Overarching goals:

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Empowerment - interaction between family and health-care providers where family maintains sense of control over their lives.

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Enabling - providing opportunities for family members to master the child’s care.

Families should be encouraged to be present with the child whenever possible.

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Siblings are to be included.

Therapeutic Communication. 

Nurses support autonomy, allowing patients to make their own decisions.

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Help clarify patient’s values and viewpoints.

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Therapeutic-communication strategies: •

“Are you considering another course of action? Tell me about it.”

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“How will you discuss this with your family?”

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“Will it be difficult for you to discuss this with your family?”

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“Now that you have made a decision, how do you feel?”

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“What information do you need to make a decision?”

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“How can I help you with this decision?”

Special Considerations in Pediatric Nursing. 

Children are not little adults; do not treat them as such.

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There are 13 anatomical and physiological differences between children and adults. •

Provides a framework for safety for pediatric health-care team members.

Special Considerations. 

Anatomic and physiologically different from adults: •

Airways anatomically small.

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Nose breathers for first several weeks.

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Heads disproportionately large.

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Large posterior head bone occiput.

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Poorly developed intercostal chest muscles.

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Less lung tidal volume.

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Larger body surface area.

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Less total circulating blood volume.

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High glucose needs.

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Relatively healthy cardiovascular system.

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Immature temperature regulation.

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Immature immune system.

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Challenges in assessment and treatment of the six human symptoms.

By adolescence, differences lessen compared with adults. •

How child is affected by trauma/injuries.

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Child’s physical illnesses in relation to severity.

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Child’s rapid rate of decompensation.

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Blood pressure (BP) changes demonstrate late sign of shock.

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Slower rate of metabolism of medications.

The Maternal-Child & Pediatric Nursing Student. 

Common fears: •

Being childless.

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Being a male student.

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Insufficient knowledge.

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Avoid talking about own experiences.

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Promote patient safety....