NURS 3450 Module 1 CH 1 PDF

1. What is maternity nursing?  Encompasses care of childbearing women, neonates, and their families through all stages of pregnancy, birth, and the first 6 weeks after birth.  Focuses on women and their newborns and families during the childbearing cycle. What is women’s health nursing? Focuses on...

1. What is maternity nursing?  Encompasses care of childbearing women, neonates, and their families through all stages of pregnancy, birth, and the first 6 weeks after birth.  Focuses on women and their newborns and families during the childbearing cycle. What is women’s health nursing? Focuses on the special physical, psychologic, and social needs of women throughout their life spans. 2. Review Sherpath Lesson Women, Infants, and Families in the Community and take notes below. Do we need to include the notes on the ALG? 3. Give 5 examples of Health People 2030 goals that are directly related to women and newborns. You may search at the site Objectives and Data. United Nations Sustainable Development Goals ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ No poverty Zero hunger Good health and well-being Quality education Gender equality Clean water and sanitation Affordable and clean energy Decent work and economic growth Industry, innovation, and infrastructure Reduced inequalities Sustainable cities and communities Responsible consumption and production Climate action Life below water Life on land Peace, justice, and strong institutions Partnerships for goals 4. List and describe at least four current problems with the U.S. healthcare system (as described in Chapter 1). Structure of the Health Care Delivery System The US health care delivery system is often fragmented and expensive and is inaccessible to many. Opportunities exist for nurses to alter nursing practice and improve the way care is delivered through managed care, integrated delivery systems, and redefined roles. Information about health and health care is readily available on the internet (e-health). Consumers use this information to participate in their own care and consult health care providers when they have further questions. Reducing Medical Errors Medical errors are the third leading cause of death in the United States, and they are the most common mistakes made in US hospitals (Leapfrog Group, 2019). Since the Institute of Medicine (IOM) released its report, To Err Is Human: Building a Safer Health System (IOM, 2000), a concerted effort has been under way to analyze causes of errors and develop strategies to prevent them. Rodziewicz, Houseman, & Hipskind, (2022) presented comprehensive information for how health care providers can decrease interruptions and distractions that contribute to medical errors. Recognizing the multifaceted causes of medical errors, the Agency for Healthcare Research and Quality (AHRQ, 2020) prepared a fact sheet in 2020: 20 Tips to Help Prevent Medical Errors. Clients are encouraged to be knowledgeable consumers of health care and to ask questions of providers, including physicians, nurse-midwives, nurses, nurse practitioners, and pharmacists. Table 1.1 lists several safe practices for better health care. Brent (2021) reported that a nurse was convicted for wrongful death due to a medication error. High Cost of Health Care Health care is one of the fastest-growing sectors of the US economy. In 2020, 19.7% of the gross domestic product was spent on health care (Centers for Medicare & Medicaid, 2021). These high costs are related to higher prices, readily accessible technology, and greater obesity. Nurse-midwifery and advanced practice nursing care have helped contain some health care costs. However, not all insurance carriers reimburse nurse practitioners and clinical nurse specialists as direct care providers, and they do not reimburse for all services provided by nurse-midwives, a situation that continues to be a problem. Nurses must become involved in the politics of cost containment because they, as knowledgeable experts, can provide solutions to many health care problems at a relatively low cost. Nurse practitioners are among the health care providers included in the Patient Protection and Affordable Care Act (ACA). Despite this, only 25 states and the District of Columbia allow nurse practitioners to practice to their fullest potential without physician involvement (Clarke, 2022). Limited Access to Care Barriers to access must be removed so that pregnancy outcomes and care of children can be improved. The most significant barrier to access is the inability to pay. Some improvement in ability to pay has been seen as a result of the ACA. The uninsured rate in 2018 was 8.5%, or 27.5 million people, but this was increased from 2017, when the rate of the uninsured was 7.9% (Berchick, Barnett, & Upton, 2019). Lack of transportation and childcare are other barriers. In addition to a lack of insurance and high costs, a lack of providers for women with low-income exists because many physicians either refuse to take Medicaid clients or take only a few such clients. This presents a serious problem because a significant proportion of births is to mothers who receive Medicaid. Health Care Reform In early 2010, President Barack Obama signed into law the ACA. The Act aimed to make insurance affordable, contain costs, strengthen and improve Medicare and Medicaid, and reform the insurance market. The ACA contained provisions to promote prevention and improve the health care delivery system. In the early years of its implementation, the ACA gained ground on many of its goals, including the reduction in the number of uninsured Americans. Professional associations such as the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Nurse-Midwives (ACNM) advocated successfully for the inclusion in the ACA of contraceptive methods, services, and counseling, without any out-of-pocket costs to clients; preventive services such as mammograms, wellwoman visits, and screening for gestational diabetes; and providing breastfeeding equipment and counseling for pregnant and nursing women in new insurance plans. Accountable Care Organizations The Centers for Medicare & Medicaid Services (CMS) developed rules under the ACA to help health care providers and hospitals better coordinate care for Medicare clients through Accountable Care Organizations (ACOs). An ACO is a group of health care providers and health care agencies that are accountable for improving the health of populations while containing costs. These groups of health care providers and hospitals voluntarily come together to coordinate high-quality care, eliminate duplication of services, and prevent medical errors, which results in savings of health care dollars. 5. Compare & contrast the definitions of birth rate and fertility rate.  Birth rate: Number of live births in 1 year per 1000 population.  Fertility rate: Number of births per 1000 women between 15 and 44 years of age (inclusive), calculated on an annual basis. 6. According to the text, what contributes to the infant and maternal morbidity and mortality rates in the United States? Structural and systemic racism contributes to rates of maternal morbidity and mortality in the United States. Infant Mortality Trends A common indicator of the adequacy of prenatal care and the health of a nation as a whole is the infant mortality rate. The most recent statistics indicate that the infant mortality rate decreased 2.9% from 2019 to 2020, with 541.9 infant deaths/100,000 live births (Murphy, Kochanek, Xu, 2021). The disparity in infant mortality rate between Black infants and non-Hispanic White infants has increased over time. Blacks have 2.3 times the infant mortality rate as Whites; Blacks have 4 times the infant mortality rate due to low–birth weight babies; Black infants experienced twice the sudden infant death rate as compared with White infants; and Black pregnant women were twice as likely to receive no or late prenatal care as compared with Whites (US Department of Health & Human Services, Office of Minority Health, 2021). While many reasons are cited for these disparities, all of the reasons can be considered part of systemic racism. Limited maternal education, young maternal age, unmarried status, poverty, lack of prenatal care, and smoking appear to be associated with higher infant mortality rates. Poor nutrition, alcohol use, and maternal conditions such as poor health or hypertension also are important contributors to infant mortality. All of these factors are rooted in racism. Leading causes of neonatal death include birth defects (congenital malformations), preterm and LBW, pregnancy complications, sudden infant death syndrome, and injuries (such as those leading to suffocation) (Murphy et al., 2021). Racial differences in infant mortality rates continue to challenge public health experts. Increased rates of survival during the neonatal period have resulted largely from high-quality prenatal care and improvement in perinatal services, including technologic advances in neonatal intensive care and obstetrics. Commitment at national, state, and local levels is required to reduce the infant mortality rate. More research is needed to identify the extent to which financial, educational, sociocultural, and behavioral factors individually and collectively affect perinatal morbidity and mortality. Barriers to care must be removed and perinatal services modified to meet contemporary health care needs. In 2018 the infant mortality rate in the United States ranked 11th when compared with infant mortality rates of other industrialized countries (Organisation for Economic Cooperation and Development [OECD], 2018). Decreases in the infant mortality rate in the United States do not keep pace with the rates of other industrialized countries. One reason for this is the high rate of LBW infants in the United States in contrast to other countries. Global Infant Mortality Trends Every day 7000 babies die within 28 days of birth (United Nations Inter-agency Group for Child Mortality Estimation, 2017), a rate that has increased since 2000. Half of all neonatal deaths occur in five countries: India (24%), Pakistan (10%), Nigeria (9%), the Democratic Republic of the Congo (4%), and Ethiopia (3%). In 2016 the infant mortality rate of Cuba, 2.4/1000 births, was the lowest in the Americas; that of the United States was 3.7/1000 births (WHO). Maternal Mortality Trends The United Nations estimated that 303,000 women died of problems related to pregnancy or birth in 2015, a decline from approximately 358,000 in 2008 and 532,000 in 1990 (WHO, 2018b). In 2020 the annual maternal mortality rate was 23.8 per 100,000 live births in the United States, with 55.3 per 100,000 live births for Black women, which was 2.9 times that of non-Hispanic White women (Hoyart, 2022). The CDC began working with national and international groups in 2001 to develop and implement programs to promote safe motherhood. Although the overall number of maternal deaths in the United States is small (about 700 each year), maternal mortality remains a significant problem because 60% of deaths are preventable, primarily through access to and use of prenatal care services (CDC, 2022b). In the United States, there is significant racial disparity in the rates of maternal death: Black and Native American/Alaska Native women are three times more likely to die of pregnancy-related causes compared with White women (CDC, 2021b). There is an act in Congress, the Black Maternal Health Momnibus Act of 2020, introduced by the Black Maternal Health Caucus. This is a package of nine bills that seek to close the gap in racial disparities and provide comprehensively improved maternal outcomes (Kai, 2020; Underwood, 2020). As of this writing, this bill is moving through Congress with some provisions of the bill being signed into law. In California, it was signed into law by Governor Newsom (DurivageJacobs, 2022). The leading causes of maternal death attributable to pregnancy differ throughout the world. In general, three major causes have persisted for the past 50 years: hypertensive disorders, infection, and hemorrhage. Many states have formed maternal mortality review committees to examine maternal deaths and determine which are pregnancy-related deaths and which are pregnancy-associated deaths, meaning due to circumstances such as social structural issues. The three leading causes of maternal mortality in the United States currently are cardiovascular disease, infection/sepsis, and cardiomyopathy (CDC, 2022b). Factors that are strongly related to maternal death include age (younger than 20 years and 35 years or older), lack of prenatal care, low educational attainment, unmarried status, and non-White race. College-educated Black women in the United States have a 1.6 times higher likelihood of experiencing a pregnancy-related death compared with White women without a high school diploma; among college-educated women, pregnancy-related mortality in Black women is 5.2 times that of White women (Underwood, 2020). These disparities are not due to race; they are due to racism (McLemore, 2019). Rather than blaming Black women for poor health, we instead must tackle the underlying causes that are rooted in racism. Racism is a systemic part of the structure of society in the United States. The Aspen Institute (2020) describes systemic, structural racism as “a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. It identifies dimensions of our history and culture that have allowed privileges associated with ‘whiteness’ and disadvantages associated with ‘color’ to endure and adapt over time.” The Healthy People 2020 goal of 3.3 maternal deaths per 100,000 live births posed a significant challenge and was not achieved. The Healthy People 2030 goal is 15.7 maternal deaths per 100,000 live births, which may also be difficult to achieve. Worldwide strategies to reduce maternal mortality rates include improving access to skilled attendants at birth, providing postabortion care, improving family planning services, and providing adolescents with better reproductive health services. Maternal Morbidity Although mortality is the traditional measure of maternal health, and maternal health is often measured by neonatal outcomes, pregnancy complications are important. Currently no surveillance method is available to measure the incidence of maternal morbidity. This includes such conditions as acute renal failure, amniotic fluid embolism, cerebrovascular accident, eclampsia, pulmonary embolism, liver failure, obstetric shock, respiratory failure, septicemia, and complications of anesthesia (pulmonary, cardiac, central nervous system). Maternal morbidity results in a high-risk pregnancy. The diagnosis of high risk imposes a situational crisis on the family. The combined efforts of an interprofessional health care team are required to care for these clients, who often need the expertise of physicians and nurses trained in both critical care obstetrics and intensive care medicine or nursing. Obesity Approximately 31% of women ages 20 through 39 are obese (body mass index [BMI] of 30 or higher); including those who are overweight (BMI 25.0 to