Women's Health: Historical Context and Trends

Changes in Women's Health Care

• Changes in childbirth methods
• Social trends
• Changes in the health care system
• Federal and state regulations

Historical Development

• Colonial America: Childbirth was a difficult and dangerous experience
• Early 1900s: Physician-assisted births and midwives were available for those who could not afford a doctor
• 1950s: Natural childbirth practices were introduced
• Current: Midwives and doulas have made a return, and childbirth choices are based on what works best for the mother, child, and family

Components of Maternal and Women's Health Nursing Concepts

• Provide evidence-based care to clients within the context of the family unit
• Implement an interdisciplinary plan in a collaborative manner to ensure cost-effective, quality-oriented and outcome-focused continuity of care
• Focus on family-centered, evidence-based care

Family-Centered Care

• Childbirth is considered a normal healthy event in the life of the family
• Childbirth may affect the entire family and relationships will change
• Families can make decisions about their own care if given adequate information and support
• Mothers and newborns should stay together

Evidence Based Nursing Practice

• Research is used to establish and implement a plan of care
• A problem-solving approach is used to make clinical decisions
• Various resources are used to collect, interpret, integrate, and validate research-derived evidence for use in practice

Managed Care Components

• Advocacy, communication, and resource management
• Client-focused comprehensive care across a continuum of the life span
• Coordinated care with an interdisciplinary approach

Mortality Rate

• Maternal mortality refers to the number of deaths from any cause during pregnancy per 100,000 live births
• Fetal mortality refers to spontaneous intrauterine deaths at any time in the pregnancy per 1,000 live births
• Neonatal mortality refers to the number of infant deaths (in the first 28 days) in 1,000 live births
• Infant mortality refers to the number of infant deaths (in the first 12 months) in 1,000 live births
• The CDC reported that about 700 to 900 women die each year in the U.S. due to pregnancy/childbirth related complications

Morbidity

• Morbidity is related to disease state or conditions
• No state has focused enough attention on preventative measures
• Many women lack health insurance coverage
• There is limited research on health conditions that primarily affect women or affect women differently
• The Affordable Care Act (ACA) as well as Healthy People 2030, both put emphasis on access to preventative health care, and hold great promise for women's health

Healthy People 2030 Overarching Goals

• Attain thriving lives and well-being, free of preventable diseases, disability, injury, and premature deaths
• Eliminate health disparities, achieve health equity, and attain health literacy to improve health and well-being for all
• Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all
• Promote healthy development, healthy behaviors, and well-being across all life stages
• Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being for all

Health People 2030 Goals

• The United States ranks 47 of 240 nations in rates of maternal deaths (in 100,000 live births) based on 2019 data
• The 2018 baseline was 17.4 maternal deaths per 100,000 live births
• The target is 15.7 maternal deaths per 100,000 live births.
• Most (60%) pregnancy related complications are preventable
• The top 5 are postpartum hemorrhage, postpartum infection, preeclampsia, eclampsia and cardiovascular disease
• 2-3 women die in the US every day due to complications of Pregnancy

Fetal Mortality

• Fetal death, demise, stillbirth and stillborn all refer to an intrauterine demise of a fetus with no sign of life
• Spontaneous intrauterine death during pregnancy in the US currently is 6.0/1000 live births
• Fetal mortality impacts families in the US because it provides a picture into the quality of maternal health and prenatal care

Factors Impacting Maternal and Women's Health

• Family: Includes changes in parental roles
• Genetics: Includes gender and race
• Society: Includes social roles and socioeconomic status; communities and violence; and media

Increased Disparities Amongst Women of Color

• Lack of health promotion and disease prevention
• Lack of delivery of appropriate and timely care
• Research is needed to determine the cause of these disparities

Factors Impacting Maternal Health

• Culture which includes cultural groups, nutrition, and lifestyle choices
• Environmental exposure
• Stress and coping

Factors Impacting Maternal Health (barriers)

• Health care cost containment
• Access to health care
• Preventative care focus
• Continum of care emphasis
• Improvement in diagnosis and treatment
• Empowerment of health care consumers

Social Determinants of Health

• Family structure and the roles assumed by family members as well as the social changes that affect the family's life influence the woman and newborn's health
• Access to health care
• Access to nutritious foods
• A safe living environment
• Socioeconomic status

Maternal and Women's Health: Genetics

• Study of heredity
• Gender determination: influences on physical characteristics, personal attributes, and behaviors.
• Some diseases are more prevalent in a specific gender
• Race: there is variance in biological differences among members of a particular group
• Some variations are normal in a race, but considered a characteristic disorder in other races

Women's Health: Society

• Social roles are important for developing self-concept
• Socioeconomic status: Poverty and homelessness
• Violence: Includes domestic violence
• Community: Schools, peer groups, and neighborhoods
• Global health for women

Caring for Patients

• Routinely screen every client for abuse. (R)
• Acknowledge and affirm feelings and assess abuse. (A)
• Documentation of your findings. (D)
• Assess your client's safety. (A)
• Review options and make referrals. (R)
• Violence against women is a major public health concern with long-term health and social consequences, it impacts thousands of lives and millions of health care dollars

Health Status and Lifestyle

• Developmental level influences disease distribution and are variable with age
• Nutrition concerns include deficiencies or excesses
• Includes coping with exposures to traumatic events, crises, inadequate support system and violence
• Lifestyle choices refers to exercise, use of tobacco, drugs, or alcohol.

Health Care Consumers

• There is an increased responsibility by individuals and families for their own health
• Families desire information and participation in the decision-making process
• Respect shown for family's views and concerns ; address any issues and concerns ; regard clients, partners and parents as important participants

Barriers to Health Care (SDOH)

• Finances: Limited or no health insurance or poverty
• Transportation: Lack of car; inability to use public transportation; may need to bring smaller children along on each visit
• Language and culture: difficulties in communication; belief system related to some forms of treatment
• Heath care delivery system: earlier discharge; clinic with limited hours; or possible limits for specialty care and possible lack of compassion towards poor or culturally diverse patients by some health care providers.

Legal and Ethical Issues

• Abortion represents a legal, social, and political issue; nurses struggle with personal beliefs and professional duty
• Substance abuse can cause fetal injury if the woman is pregnant; potential charges of negligence and child endangerement
• Intrauterine therapy: medical technology vs natue
• Maternal Fetal conflict is an ethical issue

Stem Cell Research

• The ethical concern varies depending on the origin of the stem cells
• The controversy focuses on the use of embryonic stem cells
• The goal of research is to relieve human suffering
• Umbilical cord blood banking is a vast source of primitive hematopoietic stem and progenitor cells for clinical application

Informed Consent

• Nurses are responsible in the process to ensure completion of forms with signatures
• Nurses serve as a witness to the signature process
• Nurses assess whether the client and family understands the consent form by posing appropriate questions

Key Elements of Informed Consent

• The decision maker must be of legal age in that state with full civil rights and must be competent (have the ability to make the decision}
• Information is presented in a manner that is simple, concise and appropriate to the level of education and language of individual responsible for making the decision.
• The decision must be voluntary, without coercion or force or under duress
• The witness must sign the consent form

HIPAA

• Confidentiality of Health care is mandated by law
• Primary intent is to protect health insurance coverage for workers when they change or lose jobs
• Requires DHHS (Department of Health and Human Services) to establish national standards for transmission of health information electronically
• There is security surrounding the transmission of health care information
• Exceptions exist for example, suspicion of abuse

Implications for Nurses

• Take a Proactive role in advocating and empowering clients
• Maintain a solid knowledge base about factors impacting health and barriers to health care
• Utilize work within the nursing process
• Provide anticipatory guidance
• Become alert to new technologies and treatments
• Integrate evidence based interventions in care

Family-Centered Care

• Family partnerships among individual, family, and caregivers help to determine goals, share information, offer support, and formulate plans for health care
• Support includes informational, emotional, appraisal or esteem, and instrumental

Family-Centered Care Philosophy

• Recognizes the family as the constant: The health of ALL the family members and functional abilitiies influence the health of the client and other members of the family
• Core Concepts: Dignity and respect, sharing health care information, collaboration

Community Based Care Definition

• Community is a group of people in defined geographical area who share common interests and social structures
• A person is part of many communities
• A community is the unit of service
• Includes a concern not only for the individual, but for the population of potential and at risk clients

Community Health Nursing

• Focuses on prevention of illness and improvement of the health of populations and communities
• Includes geographically and culturally diverse settings
• Allows public health nurses to specialize in certain areas of community health nursing
• Uses epidemiology to determine the health needs of populations and assist in planning services
• Uses healthy people 2020 for national health initiatives to follow

Community-Based Nursing

• Includes focus on health promotion and primary health care
• Settings include ambulatory care; home health care; occupational health; school health and hospice

Community Based Nursing Interventions

• Instructional
• Nutritional counseling
• Risk identification

Home Care Visitation Planning

• Review previous interventions to eliminate unsuccessful ones
• Prioritize patient's needs
• Develop goals that reflect prevention of disease
• Bear in mind client's readiness to accept interventions
• Consider the timing of each visit
• Outline nursing activities to be completed during visit
• Determine effectiveness of the visit

Levels of Prevention in Community Based Nursing

• Primary prevention refers to education before the occurrence of disease
• Secondary prevention refers to early detection and treatment
• Tertiary prevention refers to reduction or limitation of disease progression or rehabilitation

Cultural Humility

• The process of openness, self-awareness, egolessness, self-reflection and critique after interacting with diverse culture individuals involved
• The end results include mutual empowerment, partnerships, respect for optimal care needs and lifelong learning
• Awareness improve the quality of care and healthcare outcomes
• There are barriers related to providers and barriers related to the system

Complementary and Alternative Medicine

• Complementary and alternative medicine is not specific to any one ethnic or cultural group
• It is increasingly use by midwives for childbirth
• It involves growing in popularity
• Prayer is the most common
• 38% of adults and 12% of children utilize CAM

Integrative Medicine

• Focuses on treating the whole person, not just a disease
• Involves treating mind, body, and spirit at that time
• Combines conventional, western medicine with complementary treatments
• Nurses need to understand all aspects of CAM, including cost, client knowledge, and drug interactions

Most Used CAM During Pregnancy

• Aromatherapy, massage, reflexology, guided imagery and therapeutic touch
• Accupuncture
• Vitamins and herbs
• Prayers

Instructions for Clients Using CAM Therapies

• Do not assume the substance is harmless
• Seek medical care when needed
• Inform health care provider if taking herbs
• Do research
• Always read the package and be sure all ingredients are listed
• Be aware that large doses can be harmful

Community-Based Nursing Settings

• Physicians offices
• Clinics
• Health Departments
• Urgent Care Centers
• Hospital Outpatient Centers
• Churches and Shelters
• Client's Homes

Types of Settings for Labor and Birth

• Hospital
• Birthing Center is a home-like setting but is relatively close to a hospital should any complications arise
• There is family-centered birth in the home, but there are limited options for pain medication and limited availability

Community Resources Available to New Mothers

• Telephone consultation
• Outpatient clinics
• Postpartum home visits
• Support groups for new mothers
• High-risk newborn home care

Communication Role for Nurses

• Providing client and family education
• Assessing teaching and learning needs
• Planning
• Intervention to enhance learning
• Documentation of teaching and learning

Techniques to Facilitate Learning With Patients

• Slow down, speak in plain language, chunk information, and use visuals

The Role of Advocate in Nursing

• Nurses ensure access to available health resources

Discharge Instructions

• Developing and implementing a comprehensive plan for the safe discharge of clients from a health care facility
• Continuing safe and effective care in community and home
• Coordinating health care services while balancing quality and cost outcomes
• Initiating and maintaining the link between team members and the clients

Direct Care Providers

• Assessments extends beyond physical assessments and extend to assessment of the environment and community
• This involves nurses and direct care for things like; contraception, abortion, infertility, screenings for STIs, and perconceptional risk assessment and provides education to clients and families manage their own health care

Nursing Documentation

• It is imperative that nursing practices are documented and objectives outlined because it ensures patient education and is serves as documentation that education has been received
• It verifies standards set by organizations for accreditation purposes and let's third party payers know of services that provide reimbursement