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Maternal Newborn Notes

Mrs. Rebecca Slack

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Maternal/Newborn Nursing (NUR242)

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East Coast Polytechnic Institute

Academic year: 2023/2024

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Chapter 1: Perspectives on Maternal,

Newborn, and Women’s Health Care

Key Terms:

★ Affordable care act (ACA): the comprehensive health care reform law enacted in 2010, that increased health insurance coverage for the uninsured and implements reforms to the health insurance market. ★ Case management: a process of assessment, planning application, coordination, follow-up, and evaluation of the options and services required to meet an individual’s health needs through communication and available resources to promote quality cost-effective results. ★ Certified nurse midwife (CNM): a nurse that has postgraduate training in the care of normal pregnancy and childbirth and is certified by the American College of Nurse Midwives. ★ Cultural humility: a process of openness, self-awareness, egolessness, and self-reflection and critique after interacting with diverse culture individuals ★ Culture: a view of the world and set of traditions that are used by a specific social group and are transmitted to the next generation ★ Doula: a birth assistant who provides emotional, physical, and educational support to the women and family during childbirth and the postpartum period. ★ Evidence-based nursing practice: involves the use of research to establish a plan of care and to implement that care. This model of nursing practices includes the use of the best current evidence in making decisions about care. ★ Family: the basic social unit of our society. The U. Census Bureau defines family as a group of two or more people related by birth, marriage, or adoption and living together; However, earlier definitions of family emphasized the legal ties or genetic relationships of people living in the same household with specific roles. ★ Family-centered care: the delivery of safe, satisfying, high-quality health care that focuses on and adapts to the physical and psychosocial needs of the family. ★ Fetal mortality rate: the spontaneous intrauterine death of a fetus at any time during pregnancy per 1,000 live births. ★ Infant mortality rate: the number of deaths occurring in the first 12 months of life. It is also documented as the number of deaths of infants younger than 1 year of age per 1,000 live births. ★ Informed consent: a process of communication whereby a client is enabled to make an informed and voluntary decision about accepting or declining medical care. ★ Maternal mortality ratio: the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy. ★ Mortality: the incidence or number of individuals who have died over a specific period. ★ Neonatal mortality rate: the number of infant deaths occurring in the first 28 days of life per 1,000 live births.

Learning Objectives:

➢ Characterize the key milestones in the evolution of childbirth in America ➢ Outline the major components, concepts, and influences associated with the nursing management of women and their families ➢ Compare the past definitions of health and illness with the current definitions ➢ Examine the factors that affect maternal, newborn, and women’s health ➢ Evaluate how society and culture can influence the health of women and their families ➢ Distinguish the health care barriers affecting women and their families ➢ Review the ethical and legal issues that may arise when caring for women and their families

Notes:

Factors Affecting Change in Women’s Health Care ● Changes in childbirth methods ● Social trends ● Changes in health care system ● Federal and state regulations Historical Development: Maternal and Newborn Nursing ● Colonial America: childbirth was a difficult and dangerous experience ● Early 1900s: physician-assisted births; midwives for those who could not afford a doctor ● 1950s: introduction of natural childbirth practices ● Current: return of midwives and doulas; childbirth choices based on what works best for mother, child, and family Core Concepts of Maternal and Women’s Health Nursing ● Provide evidence-based care to the client within the context of the family unit ● Implement an interdisciplinary plan in a collaborative manner to ensure cost-effective, quality- oriented, outcome-focused continuity of care ● Focus on family-centered, evidence-based, case-managed care Question: ● True or false: natural childbirth classes were introduced in the 1900s. ○ False. Natural childbirth classes were introduced in the 1950s. Concepts of Family-Centered Care: ● Childbirth is considered a normal, healthy event in the life of the family ● Childbirth affects the entire family and relationships will change ● Families are capable of making decisions about their own care if given adequate information and support ● Mothers and newborns should stay together [Couplet Care] (Katz, 2018) Focus of Evidence-Based Nursing Practice ● Use of research to establish and implement a plan of care ● Use of problem-solving approach to make clinical decisions ● Use of various resources to collect, interpret, integrate, and validate research-derived evidence for use in practice. Components of Case-Managed Care ● Advocacy, communication, and resource management ● Client-focused comprehensive care across a continuum ● Coordinated care with interdisciplinary approach

children outside marriage, or adoption These families are likely to face challenges because of economic, social, and personal restraints; one person serves as the homemaker, caregiver, and financial provider

Commuter family Adults in the family live and work apart for professional or financial reasons, often leaving the daily care for children to one parent

Similar to single-parent family

Step-or blended family

Adults with children from previous marriages or from the new marriage

May lead to family conflict due to different expectations on the part of the children and adults; they may have different views and practices related to child care and health

Extended family Nuclear family and grandparents, cousins, aunts, and uncles

Need to identify the decision-maker and primary caretaker of the children Popular in some cultures, such as hispanic and asian cultures

LGBTI family Adults of the same sex living together with or without children

May face negative attitudes about their “different” lifestyle; are part of the American fabric Two million children are being raised by LGBTI parents. Public policy has not kept up with the changing reality of the American family

Communal family Group of people living together to raise together to raise children and manage household; unrelated by blood or marriage

May face negative attitudes about their “different” lifestyle; need to determine the decision-maker and caretaker of the children

Foster family A temporary family for children who are placed away from their parents to ensure their emotional and physical well-being

May include the foster family’s children and other foster children in the home Foster children are more likely to have unmet health needs and chronic health problems because they may have been in a variety of health systems

Grandparents-as- parents families

Grandparents raising their grandchildren due to the inability or absence of the parents

May increase the risk of physical, financial, and emotional stress on older adults; may lead to confusion and emotional stress for children if biological parents are in and out of the child's life.

Adolescent families Young parents who are still mastering the developmental tasks of their childhood

Are at a greater risk for health problems in pregnancy and delivery; more likely to have premature infants, which then leads to risk of subsequent health and developmental problems Probably still need support from their family related to financial, emotional, and school issues.

● Genetics ○ Gender ○ Race ● Society ○ Social roles and socioeconomic status ○ Communities and violence ○ Media ● Culture (Table 1) ○ Cultural groups ○ Nutrition ○ Lifestyle choices ● Environmental exposure ● Stress and coping ● Health care cost containment ○ Access to health care ○ Preventive care focus ○ Continuum of care emphasis ● Improvement in diagnosis and treatment ○ Empowerment of health care consumers Question: ● True or false: the definition of family and its structure has remained daily constant over the years. ○ False. The definition of family has changed over time, as has the typical family structure, such that the traditional nuclear family is no longer considered the dominant family structure in today’s society. Factors Impacting Maternal and Women’s Health: Genetics ● Study of heredity ● Gender determination: influence on physical characteristics, personal attributes, and behaviors ○ Some diseases more prevalent in a specific gender ● Race: biologic differences in members of a particular group ○ Some variations normal in a race but considered a disorder characteristic in other races Factors Impacting Maternal and Women’s Health: Society ● Social roles: important for developing self-concept ● Socioeconomic status: poverty and homelessness ● Violence: domestic violence ● Community: schools, peer groups, neighborhood connectedness ● Global health for women

Factors Impacting Maternal and Women’s Health: Empowerment of Health Care COnsumers ● Increase in responsibility by individuals and families for own health ● Family desire for information and participation in decision-making process ● Respect for family’s views and concerns; addressing of issues and concerns; regard for client, partner, and parents as important participants Question: ● Which of the following is a cost-effective strategy to provide more efficient and effective services to clients extending from acute care to outpatient settings? ○ Cost containment ○ Continuum of care ■ A continuum of care provides cost-effective continuity of care from the acute care setting, such as a hospital, to outpatient settings, such as rehabilitative units. Cost containment refers to the effort to maintain quality care while reducing healthcare costs. Consumer empowerment is the increased responsibility of consumers to take on their own health care as an informed consumer. Preventive care involves anticipatory guidance and client education. ○ Consumer empowerment ○ Preventative care Barriers to Health Care: ● Finances: limited to or no health insurance; poverty ● Transportation: lack of car; inability to use public transportation; need to bring smaller children along on a visit ● Language and culture: difficulties in communication information; beliefs related to some forms of treatment ● Health care delivery system: earlier discharge; possible limits for speciality care; clinic hours; negative attitudes toward poor or culturally diverse families by some health care providers ● Health literacy: lack of ability to obtain, process health information is barrier to informed health and/or making decisions about health Legal and Ethical Issues in Maternal and Women’s Health Care: ● Abortion: legal, social, and political issue; nurses struggling with personal beliefs and professional duty ● Substance abuse: fetal injury if woman is pregnant; possible charges of negligence and child endangerment ● Intrauterine therapy: medical technology versus nature; better quality of life via surgical intervention ● Maternal-fetal conflict: fetal care is an ethical issue Stem Cell Research: ● Goal is to relieve human suffering ● Ethical concerns vary depending on the origin of the stem cells ● Controversy focuses on the use of embryonic stem cells ● Umbilical cord blood banking is a vast source of primitive hematopoietic stem and progenitor cells available for clinical application Informed Consent: ● Nurse’s responsibility in the process: ○ Ensuring form completed with signatures ○ Serving as witness to signature process ○ Determining client, family understanding of what they are signing through 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 the individual responsibility for making the decision ● The decision must be voluntary, without coercion or force or under duress ● There must be a witness to the process of informed consent ● The witness must sign the consent form. Health Insurance Portability and Accountability Act (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 to establish national standards for electronic transmission of health information ● Promotes the security and privacy of health care information for all clients ● Exceptions exist, such as in cases of suspicion of abuse Implications for Nurses: ● Proactive role in advocating and empowering clients ● Need for solid knowledge base about factors impacting health and barriers to health care ● Need for anticipatory guidance ● Work within the framework of the nursing process ● Need to be alert to new technologies and treatments ● Integration of evidence-based interventions in care

Key Concepts:

❖ Maternal, newborn, and women’s health nurses provide care using a philosophy that focuses on the family and the use of EBP in a case management environment to provide quality, cost- effective care. ❖ Healthy People 2030 presents a national set of health goals and objectives for adults and children that focus on health promotion and disease prevention. ❖ One method to establish the aggregate health status of women and infants is with statistical data, such as mortality and morbidity rates. ❖ The infant mortality rate is the lowest in the history of the United States, but it is still higher than that of other industrialized countries. This high rate may be due to the number of low- birth-weight infants born in this country (CDC, 2019d). ❖ The family is considered the basic social unit of our society. The family greatly influences the development and health of its members because members learn health care activities, health beliefs, and health values from the family. ❖ Culture influences every aspect of development and is reflected in childbearing and child- rearing beliefs and practices designed to promote healthy adaptation. ❖ Other factors affecting the health of women and their families include health status and lifestyles, health care cost containment, improved diagnosis and treatment, and health care consumer empowerment. Finances, transportation, language, culture, and the health care delivery system can act as barriers to health care. ❖ Advances in science and technology have led to increased ethical dilemmas in health care. ❖ All clients have the right to refuse medical treatment based on the American Hospital Association’s Patient Care Partnership.

Chapter 2: Family-Centered Community-

Based Care

Key Terms:

★ Community: may be defined as a specific group of people, often living in a defined geographic area, who share common interested, interact with each other, and function collectively within a defined social structure to address common concerns ★ Community-based nursing: the movement from an illness-oriented “cure” perspective in hospitals to a focus on health promotion and primary health care. ★ Community health nursing: focuses on preventing illness and improving the health of populations and communities ★ Cultural humility: a process of openness, self-awareness, egolessness, and self-reflection and critique after interacting with diverse culture individuals ★ Epidemiology: (the study of the causes, distribution, and control of diseases in populations) can help determine the health and health needs of a population and assist in planning health services ★ Health promotion: focuses on keeping communities healthy. It aims to engage and empower individuals and communities to choose healthy behaviors and make changes that reduce the risk of developing chronic disease and other morbidities. ★ Population: a group of individuals who share personal or environmental characteristics. ★ Primary prevention: involves preventing the disease or condition before it occurs through health promotion activities, environmental protection, and specific protection against disease or injury. ★ Public health nursing: a specialized area of community health nursing ★ Secondary prevention: the early identification of people who have already developed a disease at an early stage in the disease's natural history through screening and early intervention. ★ Tertiary prevention: designed to reduce or limit the progression of a permanent irreversible disease or disability.

Learning Objectives:

➔ Examine the major components and key elements of family-centered community health care. ➔ Explain the reasons for the increased emphasis on community-based care. ➔ Differentiate community-based nursing from nursing in acute care settings. ➔ Integrate the different levels of prevention in community-based nursing, providing examples of each. ➔ Cite examples of cultural issues that may be faced when providing community-based nursing. ➔ Describe the dynamic factors contributing to cultural diversity and inclusion to adapt delivery of competent nursing care to women and their families. ➔ Construct strategies for integrating elements of complementary and alternative therapies and scientific health care practice. ➔ Identify the variety of settings where community-based care can be provided to women and their families. ➔ Outline the various roles and functions assumed by the community health nurse. ➔ Demonstrate the ability to use therapeutic communication skills when interacting with women

and their families. ➔ Evaluate the process of health teaching as it relates to women and their families. ➔ Determine the importance of discharge planning and case management in providing community-based care.

Notes:

Family-Centered Care ● Collaborative partnership among individual, family, and caregivers to determine goals, share information, offer support, and formulate plans for health care ● Types of support: ○ Informational ○ Emotional ○ Appraisal or esteem ○ Instrumental Philosophy of Family-Centered Care: ● Recognizes the family as the constant: the health of all the family members and their functional abilities influence the health of the client and other members of the family ● Core concepts: dignity and respect, sharing health care information, allowing patients and families to participate in care, and providing collaborative care for the client and family Community-Based Care: ● Definition of community: group of people in defined geographical area who share common interests, interact with each other, and function collectively in a defined social structure ot address common concerns ○ Person is part of many communities ○ Community is the unit of service ○ Concern for clients as well as for the larger population of potential or at-risk clients ● Population: a group of individuals who share personal or environmental characteristics (example: geographic location) 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 areas of community health nursing ● Uses epidemiology to determine the health needs of populations and assist in planning services ● Uses Healthy People 2030 for national health initiatives to follow Community-Based Nursing ● Focus on health promotion and primary health care ● Settings include ambulatory care, home health care, occupational health, school health, hospice ● Clinical practice includes case management, research, quality improvement, and discharge planning ● Employment opportunities in staff development, program development, and community education Community-Based Practice Settings:

Setting Description

Ambulatory care settings Physicians offices; Health maintenance organizations (HMOs); day surgery centers; freestanding urgent care centers; family planning

○ False. Health screenings are an important component of secondary prevention because they aid in the early detection of a disease. Cultural Humility ● Knowledge, willingness, and ability to adapt health care to enhance its acceptability to and effectiveness with clients from diverse cultures ● Box 2. ● Cultural aspects: perspectives, traditions, values, practices, and populations ● Dynamic, lifelong learning process ● Barriers: those related to providers and those related to system Steps to Developing Cultural Competence: ● Cultural awareness: ○ Be open to the values, beliefs, customs, and behaviors that have shaped diverse cultures. ○ Discover the cultural practices of the people who nurses provide holistic care to and serve. ○ Discover self-awareness of one’s values and beliefs. ○ Remain egoless by viewing the worth of everyone on a horizontal plane. ○ Recognize the influence of clients’ cultures on their health statuses. ○ Examine personal biases and prejudices toward other cultures. ○ Become aware of differences in personal and clients’ backgrounds. ● Cultural Knowledge ○ Apply knowledge of social and cultural factors across multiple backgrounds. ○ Engage in continual self-reflection and critique of one’s feelings and actions. ○ Seek resources that increase your understanding of different sociocultural groups. ○ Become familiar with culturally/ethnically diverse groups, world views, beliefs, practices, lifestyles, and problem-solving strategies. ○ Become supportive in every interaction with diverse cultures. ● Cultural skills ○ Apply relevant best evidence-based practices in providing care. ○ Learn how to perform a competent cultural assessment. ○ Develop a comfortable partnership with each client through open-ended questions. ○ Assess each client’s unique cultural values, beliefs, and practices without depending solely on written facts about specific cultural groups. ○ Incorporate diverse client cultures into everyday nursing practice. ○ Advocate for social justice to eliminate health disparities in diverse populations. ● Cultural Encounter ○ Promote safe and quality outcomes of care for all diverse individuals. ○ Learn about each client’s culture with every encounter to increase knowledge base. ○ Adapt care practices and therapies to be consistent with client values and beliefs. ○ Respect clients’ sociocultural identity in a nonjudgmental manner when interacting. ○ Learn key words or phases of clients’ languages to improve communication. ○ Engage in cross-cultural interactions with people from culturally diverse backgrounds, such as attending religious services or ceremonies and participating in important family events. ○ Participate in as many cultural encounters as possible to avoid cultural stereotyping Complementary and Alternative Medicine (CAM) in Maternity Nursing ● CAM not specific to one particular ethnic or cultural group; growing in popularity ● 38% of adults and 12% of children use CAM therapy ● Prayer is the most common form of CAM therapy

● CAM is being used increasingly by midwives for childbirth Integrative Medicine: ● Focuses on treating the whole person, not just disease ● Involves treating mind, body and spirit at the same time ● Combines conventional Western medicine with complementary treatments ● Nurses need to understand all aspects of CAM, including cost, client knowledge, and drug interactions Select Complementary and Alternative Therapies: ● Aromatherapy ● Homeopathy ● Acupressure ● Feng shui ● Guided imagery ● Reflexology ● Therapeutic touch ● Herbal medicine ● Spiritual healing ● Chiropractic therapy ● Massage therapy Most Commonly Used CAM during Pregnancy ● Massage ● Acupuncture ● Vitamins ● Herbs Instructions for Clients Using CAM Therapies ● Do not take for granted that the substance is beneficial or harmless ● Seek medical care when ill ● Inform provider if taking herbs ● Be sure package lists all ingredients and amounts ● Be aware that large doses of of CAM preparation may be harmful ● Research CAM in books, internet, and articles Community-Based Nursing Care Settings: ● Physicians offices ● Clinics ● Health departments ● Urgent care centers ● Hospital outpatient centers ● Churches and shelters ● Client homes Types of Settings for Labor and Birth ● Hospital ● Birthing center ○ “Home-like” setting ○ Close to hospital if complications ○ “Normalcy” of birth ● Home ○ Family-centered birth

■ As an advocate, the nurse ensures that the client’s and family’s needs are being met and that they have available resources and appropriate health care services. Coordinating health care services is a function of a case manager. Providing atraumatic care is a function of a direct care provider. Assessing health literacy is a function of an educator. Role of the Discharge Planner and Case Manager: ● Developing and implementing a comprehensive plan for the safe discharge of a client from a health care facility ● Continuing safe and effective care in the community and home ● Coordinating health care services while balancing quality and cost outcomes ● Initiating and maintaining the link between team members and the client

Key Concepts

❖ Family-centered care recognizes the concept of the family as the constant. The health and functional abilities of the family affect the health of the client and other members of the family. Family-centered care recognizes and respects family strengths and individuality, encourages referrals for family support, and facilitates collaboration. It ensures flexible, accessible, and responsive health care delivery while incorporating developmental needs and implementing policies to provide emotional and financial support to women and their families. ❖ Health care delivery has moved from acute care settings out into the community with an emphasis on health promotion and illness prevention (Rector, 2018). Community health nursing focuses on preventing health problems and improving the health of populations and communities, addressing the current and potential health needs of the population or community, and promoting and preserving the health of a population regardless of age or diagnosis. Community health nurses perform epidemiologic investigations to help analyze and develop health policy and community health initiatives. ❖ Community-based nurses focus on providing personal care to individuals and families in the community. They focus on promoting and preserving health as well as preventing disease or injury. They help women and their families cope with illness and disease. They focus on minimizing barriers to allow the client to develop to their full potential. ❖ Community-based nursing uses the nursing process in caring for clients in community settings and involves primary, secondary, and tertiary prevention levels. Nursing interventions in community-based settings include health screening, education, medication administration, telephone consultation, health system referral, instruction, nutritional counseling, and risk identification. ❖ Nurses working in the community need to develop cultural competence. Steps to gaining cultural competence include cultural self-awareness, cultural knowledge, cultural skills, and cultural encounters. ❖ Settings for community-based nursing include physicians’ offices, clinics, health departments, urgent care centers, clients’ homes, churches, and shelters (e., domestic violence shelters, homeless shelters, and disaster shelters). Nurses provide wellness care, episodic ill care, and chronic care to women and their families. ❖ Home health care situations have increased due to shorter hospital stays and cost containment measures along with an increase in the income and longevity of individuals with chronic and debilitating health conditions. Technology has also improved, which allows clients to be monitored and to undergo complicated procedures at home (Storfjell, 2018). ❖ The roles and functions of the community-based nurse include communicator, direct care

provider, educator, discharge planner and case manager, and advocate and resource manager. ❖ Open, honest communication is essential for community-based nurses. The use of an interpreter may be necessary to ensure effective communication. Maintaining confidentiality and providing privacy are key. ❖ A family’s knowledge related to the client’s health or illness is vital. Nurses working in the community play a major role in educating women and their families. ❖ Discharge planning provides a comprehensive plan for the safe discharge of a client from a health care facility and for continuing safe and effective care in the community. Case management focuses on coordinating health care services while balancing quality and costs. Discharge planning and case management contribute to improved transitions from the hospital to the community for women, their families, and the health care team. ❖ Community-based nurses act as resource managers to help ensure that the client and family have the necessary resources and appropriate health care services available to them.

Chapter Worksheet

A community based nurse is involved in secondary prevention activities. Which activities might be included? Select all that apply. a. Fecal occult blood testing b. Hearing screening c. Smoking cessation program d. Cholesterol testing e. Hygiene program f. Pregnancy testing
A woman is to undergo a colonoscopy at a freestanding outpatient surgery center. Which would the nurse identify as a major disadvantage associated with this community-based setting? a. Increased risk for infection versus a hospital b. Increased health care costs versus a hospital c. Need to be transferred if complications arise d. Increased disruption of family functioning
When developing a teaching plan for a pregnant client that experienced preterm labor who is to be discharged, what would the nurse do first? a. Decide which procedures and medications the client will need at home. b. Determine the client’s learning needs and styles. c. Ask the client if she has ever had preterm labor before. d. Tell the client what the goals of the teaching session are.
Which action by a nurse would best demonstrate cultural humility? a. Being well versed in the customs and beliefs of the nurse’s own culture b. Demonstrating an openness and reflecting on the values and beliefs of other cultures c. Applying previous knowledge about various cultures in the practice setting d. Playing a role in establishing policies to address diverse cultures
Nurses working with an interpreter should emphasize the need for the interpreter to a. elaborate on the content being interpreted. b. clarify misinformation in their own words. c. paraphrase statements to reduce time. d. maintain confidentiality of content interpreted.
Which factor would the nurse identify as being least likely to contribute to the rise in

organs. ➢ Outline the phases of the menstrual cycle, the dominant hormones involved, and the changes taking place in each phase. ➢ Identify external and internal male reproductive structures and the function of each in hormonal regulation.

Notes:

The Reproductive Systems: ● Collection of internal and external organs in males and females that work together for the purpose of procreating ● Female reproductive system ○ Reproductive cells (eggs) ○ Uterus ● Male reproductive system ○ Reproductive cells (sperm) ○ Penis Female: ● External reproductive organs ○ Vulva: protects the openings of the vagina and urethra, highly sensitive to touch to increase the female’s pleasure during sexual arousal ○ Labia majora and minora ○ Head of clitoris ○ Opening of the urethra ○ Opening of the vagina Female Reproductive Anatomy: ● External: ○ Mons pubis ○ Labia (majora and minora) ○ Clitoris ○ Prepuce ○ Vestibule ○ Perineum ○ Vagina ○ Breasts ● Internal ○ Uterus ■ Endometrium ■ Myometrium ■ Perimetrium ■ Fundus, corpus, cervix ○ Fallopian tubes (oviducts) ○ Ovaries Female External Anatomy:

Female Internal Anatomy:

Fallopian Tubes and Ovaries: ● Fallopian tubes: cylindrical structures that extend from uterus towards the ovaries ● 7-10 cm long ● End of each tube flares into a funnel shape - providing large opening for egg to fall into when it is released from the ovary

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Maternal Newborn Notes

Course: Maternal/Newborn Nursing (NUR242)

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University: East Coast Polytechnic Institute

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Chapter 1: Perspectives on Maternal,

Newborn, and Women’s Health Care

Key Terms:

★Affordable care act (ACA): the comprehensive health care reform law enacted in 2010, that

increased health insurance coverage for the uninsured and implements reforms to the health

insurance market.

★Case management: a process of assessment, planning application, coordination, follow-up, and

evaluation of the options and services required to meet an individual’s health needs through

communication and available resources to promote quality cost-effective results.

★Certified nurse midwife (CNM): a nurse that has postgraduate training in the care of normal

pregnancy and childbirth and is certified by the American College of Nurse Midwives.

★Cultural humility: a process of openness, self-awareness, egolessness, and self-reflection and

critique after interacting with diverse culture individuals

★Culture: a view of the world and set of traditions that are used by a specific social group and are

transmitted to the next generation

★Doula: a birth assistant who provides emotional, physical, and educational support to the

women and family during childbirth and the postpartum period.

★Evidence-based nursing practice: involves the use of research to establish a plan of care and to

implement that care. This model of nursing practices includes the use of the best current

evidence in making decisions about care.

★Family: the basic social unit of our society. The U.S. Census Bureau defines family as a group of

two or more people related by birth, marriage, or adoption and living together; However, earlier

definitions of family emphasized the legal ties or genetic relationships of people living in the

same household with specific roles.

★Family-centered care: the delivery of safe, satisfying, high-quality health care that focuses on

and adapts to the physical and psychosocial needs of the family.

★Fetal mortality rate: the spontaneous intrauterine death of a fetus at any time during pregnancy

per 1,000 live births.

★Infant mortality rate: the number of deaths occurring in the first 12 months of life. It is also

documented as the number of deaths of infants younger than 1 year of age per 1,000 live births.

★Informed consent: a process of communication whereby a client is enabled to make an informed

and voluntary decision about accepting or declining medical care.

★Maternal mortality ratio: the annual number of female deaths from any cause related to or

aggravated by pregnancy or its management (excluding accidental or incidental causes) during

pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the

duration and site of the pregnancy.

★Mortality: the incidence or number of individuals who have died over a specific period.

★Neonatal mortality rate: the number of infant deaths occurring in the first 28 days of life per

1,000 live births.