Safe Maternity and Pediatric Nursing Care, Second Edition PDF

Safe Maternity and Pediatric Nursing Care, Second Edition. Chapter 1 Introduction to Maternity and Pediatric Nurs...

Safe Maternity and Pediatric Nursing Care, Second Edition. Chapter 1 Introduction to Maternity and Pediatric Nursing Copyright ©2021 F.A. Davis Company  Introduction  Maternity nursing has a broad range of opportunities Provide care from puberty to menopause Specialties include: prenatal care, labor and delivery, postpartum care, newborn care, neonatal intensive care, women’s health, and infertility care Copyright ©2021 F.A. Davis Company  Introduction (continued)  Pediatric nursing Involves caring for children between birth and 18 years Safety is an important aspect of the care of children Focus on normal growth and development, acute, chronic, and critical care issues, and end-of-life and palliative care (Fig 1.1, Box 1.1) Copyright ©2021 F.A. Davis Company  Quality  Nursing Manager definition: Wise use of resources Lack of errors in providing care Positive patient feedback  Bedside nurse definition: Delivery of safe and effective care  Physician/midwife definition: Positive patient response to medications and interventions without complications Copyright ©2021 F.A. Davis Company  Quality (continued_1)  Patient definition: Meets expectations for improvement and recovery  Institute of Medicine definition: “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Copyright ©2021 F.A. Davis Company  Quality (continued_2)  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 Deliver family and patient-centered care with attention to specific needs, values, and expectations of patient and family Identify errors and hazards, implement safety principles Copyright ©2021 F.A. Davis Company  Quality (continued_3)  Ways for nurses to improve quality (continued): Collaborate with health team members to reduce errors and improve care Utilize hospital resources in a cost- effective manner by not wasting materials and time Provide equal care to all patients that does not vary in quality based upon gender, ethnicity, culture, or socioeconomic status Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing  Focus on childbearing women, newborn infants, children, and families  Provide patient-centered and family- centered care  Roles include: Licensed practical/vocational nurses Registered nurses Nurse practitioners Clinical nurse specialists Certified nurse midwives Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing (continued_1)  Certified Nursing Assistant (CNA) Assists with patient’s daily needs of nutrition, dressing, and movement Takes vital signs, collects specimens, assists with transportation Under direct supervision of registered nurse (RN), nurse practitioner (NP), physician assistant (PA), or physician Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing (continued_2)  Licensed practical/vocational nurse (LPN/LVN): Completed a program, passes the NCLEX for LPN/LVNs Provides nursing care in multiple settings under RN, NP, physician or midwife May help prep patients for pregnancy and delivery Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing (continued_3)  Registered nurse: Graduated from accredited nursing program ‒ Associate Degree in Nursing (ADN) ‒ Bachelor’s Degree in Nursing (BSN) Passed the NCLEX for RNs 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 Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing (continued_4)  Nurse practitioner: Graduated from accredited program ‒ Masters Degree in Nursing (MSN) ‒ Doctorate Degree in Nursing (DNP) Passed a certification exam Prescribe medications Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing (continued_5)  Nurse practitioner (continued): Emphasis on contraception, fertility problems, pre-pregnancy care, pregnancy care, postpartum care, lactation problems, newborn care, and menopause care Pediatric NPs care for children across the developmental period Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing (continued_6)  Clinical nurse specialist (CNS): RN who obtained an advanced degree and clinical preparation MSN level with a focus on education, management, and research roles relative to patient care Works alongside nurses providing education and support Copyright ©2021 F.A. Davis Company  Roles in Maternal-Child and Pediatric Nursing (continued_7)  Certified nurse midwife (CNM): MSN or DNP, passed certification exam in pregnancy and delivery Provides care through pregnancy, labor, delivery, and postpartum Prescribes medications Has hospital privileges to deliver babies Copyright ©2021 F.A. Davis Company  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 A. RN to provide care? suited B. NP C. CNS D. CNM Copyright ©2021 F.A. Davis Company  Clicker Check (continued_1) Correct answer: D 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. Copyright ©2021 F.A. Davis Company  Legalities and Ethics  Be aware of state laws regarding care  Nurses who do not meet expected standards can be held legally responsible  Adhere to the scope of practice Scope of practice: Legal outline of nursing functions according to state laws Determined by licensing state Copyright ©2021 F.A. Davis Company  Legalities and Ethics (continued_1)  Delegation Delegator must know scope of practice of person carrying out task Delegator assumes responsibility for appropriateness of delegated activity All boards of nursing in US have information on their websites about state laws and rules that govern nurses’ practice Copyright ©2021 F.A. Davis Company  Legalities and Ethics (continued_2)  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 Copyright ©2021 F.A. Davis Company  Legalities and Ethics (continued_3)  Standards of care: Definition: model of established practice as correct way to provide care Guidelines used to determine nursing actions Identifies knowledge, skills, attitude, and judgment needed Defined by federal and state laws and professional organizations Copyright ©2021 F.A. Davis Company  Legalities and Ethics (continued_4)  Standards of care (continued): Association of Women’s Health, Obstetric, and Neonatal Nurses (AHHONN) established standards for maternity/newborn care Society of Pediatric Nurses establishes standards for care of children and families Copyright ©2021 F.A. Davis Company  Legalities and Ethics (continued_5)  Institution Policies Nurses held accountable for upholding agency or health-care institution policies Policy and procedures handbook: ‒ Outlines how care is to be provided ‒ Provides specific guidelines ‒ Following policy and procedures will prevent errors and promote safe patient care Copyright ©2021 F.A. Davis Company  Evidence-Based Practice  Nursing care in which all interventions are based on current valid research evidence  Nursing research in practice at the bedside  Uses scientific studies to answer why interventions should be changed when providing care Copyright ©2021 F.A. Davis Company  Informed Consent  Informed consent: patient understands and accepts risks and benefits of procedure Doctors job to give information to procedures 18 years and older ‒ Written consent must be signed by health- care provider and adult patient before procedure/treatment Children ‒ Legal caregiver, parent or guardian, signs consent Copyright ©2021 F.A. Davis Company  Informed Consent (continued_1)  Assent Feedback from child 7 more than years of age regarding medical treatment Includes child in decision-making process Child is asked if he/she has any questions or concerns Not all children are developmentally ready Copyright ©2021 F.A. Davis Company  Informed Consent (continued_2)  Emancipation of minor Grants adult rights to a child of age and appropriate developmental level Minor is able to process complex information related to decisions in health care and medical treatments Married pregnant teenager - automatic emancipation Copyright ©2021 F.A. Davis Company  Informed Consent (continued_3)  Emancipation of minor (continued) Unmarried pregnant teenager - not emancipated Definition of emancipated minor varies among states Check state government website for more info (Box 1.2) Copyright ©2021 F.A. Davis Company  Children’s Rights  Children have the right to provisions, protection, and participation Right to Provisions ‒ Provisions of safe living, health care, education, clean water, appropriate diets, adequate rest, sleep, play, and recreation Right to Protection ‒ Protected from abuse, exploitation, neglect, discrimination at home, school, community areas, and health-care institutions Copyright ©2021 F.A. Davis Company  Children’s Rights (continued)  Children have the right to provisions, protection, and participation (continued) Right to Participation ‒ Offered full participation in community activities, art, sports, cultural events Copyright ©2021 F.A. Davis Company  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 Right to active participation in cultural beliefs and practices whenever possible Copyright ©2021 F.A. Davis Company  Family Rights (continued_1)  Families are entitled to protected rights within a health-care institution including (not limited to) (continued): Right to visitation and family participation in the treatment and care of the child Right to comfort by having pain and discomfort addressed and treated promptly Right to have interpretation services by a translator when a language barrier Copyright ©2021 F.A. Davis Company  Family Rights (continued_2)  Families are entitled to protected rights within a health-care institution including (not limited to) (continued): Right to personal dignity and privacy during assessments, diagnostics, procedures, and treatments Right to receive emergency treatment regardless of the ability to pay Copyright ©2021 F.A. Davis Company  Family Rights (continued_3)  Families are entitled to protected rights within a health-care institution including (not limited to) (continued): Right to be free of restraints or seclusion unless clinically necessary Right to refuse care provided by students Right to decline to participate in research programs or projects Copyright ©2021 F.A. Davis Company  Ethics  Definition: moral principles that guide a person’s behavior  Concerned with right/wrong and good/evil  Doing the right thing for the best patient outcome  American Nurses Association Code of Ethics is used to guide nursing practice  Fairness, honesty, and respect for human beings are important in Copyright ©2021 F.A. Davis Company  Ethics (continued_1)  Autonomy: Right to have control of body and make decisions  Beneficence: Spirit of compassion and kindness to benefit others Balance the benefits of treatment against the risks and costs Copyright ©2021 F.A. Davis Company  Ethics (continued_2)  Nonmaleficence: “Do no harm” Inflict the least possible harm to reach a beneficial outcome  Justice: Fairness for individuals, groups, organizations, and communities Fair allocation of services and resources Copyright ©2021 F.A. Davis Company  Ethics (continued_3)  No answer fits every situation and every patient  Ethics committees that can provide guidance  Follow the chain of command with ethical situations  Obligated to follow legal care, adhering to standards of practice, regardless of feelings  Avoid imposing own values onto the patient Copyright ©2021 F.A. Davis Company  Ethics (continued_4)  Ethical issues a nurse may encounter Abortion Pregnant mother smoking, drinking alcohol, using illicit drugs Patient wanting elective c-section Provision of futile care for an extremely premature newborn A young adolescent with no family support leaving hospital with a newborn Copyright ©2021 F.A. Davis Company  Ethics (continued_5)  Ethical issues a nurse may encounter (continued) Infertility treatment that is expensive and not successful A teenager with aggressive cancer who wants to be allowed to die A homeless child living in a car with his family being discharged with a new diagnosis of asthma A child with type 1 diabetes being cared for by a mother who has dual mental health diagnoses Copyright ©2021 F.A. Davis Company  Clicker Check (continued_2) A physician caring for a laboring patient requests a medication that is categorized as pregnancy X. What should the nurse A. Report the physician do? B. Provide the medication C. Ask the CNM to give the medication D. Explain that the medication is categorized as an X Copyright ©2021 F.A. Davis Company  Clicker Check (continued_3) Correct answer: D The nurse has the ethical and legal responsibility to follow standards of practice within the scope of practice and should explain that the medication is category X. Reporting the physician might need to be considered later. Providing the medication could violate the ethical principle of nonmaleficence. Asking the CNM to give the medication will place the CNM in the same situation – as a nurse, the CNM must provide legal, ethical, and Copyright ©2021 F.A. Davis Company  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 Families can be nuclear, alternative, adoptive, foster, communal Figs. 1.2, 1.3 and Box 1.3 A family is who they say they are Copyright ©2021 F.A. Davis Company  Family-Centered Care (continued_1)  Family is the constant in the child’s life  All members are affected by illness, injury, or hospitalization  Strengthens family unit, enhances communication and outcomes of the experience  Provides safe, child-friendly environment  Assists child and family as a unit Copyright ©2021 F.A. Davis Company  Family-Centered Care (continued_2)  Overarching goals: Empowerment - interaction between family and health-care providers where family maintains sense of control over their lives Enabling - providing opportunities for family members to master the child’s care  Families should be encouraged to be present with the child whenever possible  Copyright ©2021 F.A. Davis Company  Clicker Check (continued_4) An older school-age child introduces several adults as being members of the family. How should the nurse interpret this A. The family is binuclear information? B. The child lives in a commune C. Family is who the child says they are D. Any adult is viewed as being a family member Copyright ©2021 F.A. Davis Company  Clicker Check (continued_5) Correct answer: C The family is recognized as being who they say they are. There is not enough information to determine the family structure. It is unlikely that any adult is viewed as being a family member. Copyright ©2021 F.A. Davis Company  Therapeutic Communication  Nurses support autonomy, allowing patients to make their own decisions  Help clarify patient’s values and viewpoints  Therapeutic-communication strategies: “Are you considering another course of action? Tell me about it.” “How will you discuss this with your family?” Copyright ©2021 F.A. Davis Company  Therapeutic Communication (continued)  Therapeutic-communication strategies (continued): “Will it be difficult for you to discuss this with your family?” “Now that you have made a decision, how do you feel?” “What information do you need to make a decision?” “How can I help you with this decision?” Copyright ©2021 F.A. Davis Company  The Maternal-Child & Pediatric Nursing Student  Common fears: Being childless Being a male student Insufficient knowledge  Avoid talking about own experiences  Promote patient safety Copyright ©2021 F.A. Davis Company