Introduction to Maternal-Neonatal Nursing
Just the factsIn this chapter, you’ll learn:
roles of maternal-neonatal nurses
dynamics of family-centered nursing care
structures and functions of families
factors that influence a family’s response to pregnancy
legal and ethical issues associated with maternal-neonatal nursing.
A look at maternal-neonatal nursing
In North America, nurses care for more than four million pregnant patients each year. Providing this care can be challenging and rewarding. After all, you must use technology efficiently and effectively, offer thorough patient teaching, and remain sensitive to and supportive of patients’ emotional needs.
Going down!
In recent decades, infant and maternal mortality rates have progressively declined, even among women older than age 35. Factors responsible for this decline include a reduction in such disorders as placenta previa and ectopic pregnancy and prevention of related complications. Better control of complications associated with gestational hypertension and decreased use of anesthesia with childbirth also contribute to this decline.
|
Room for improvement
Despite these advances, there’s still room for improvement in maternal and neonatal health care. Infant and maternal mortality rates remain high for poor patients, minorities, and teenage mothers—largely because of a lack of good prenatal care.
Maternal-neonatal nursing goals
The primary goal of maternal-neonatal nursing is to provide comprehensive family-centered care to the pregnant patient, the family, and the baby throughout pregnancy. (See Three pregnancy periods.)
|
Setting the standards
In 1980, the American Nurses Association’s Maternal Child Health Nursing Practice division set standards for maternal-neonatal nursing. These standards provided guidelines for planning care and formulating desired patient outcomes. Later, the Association of Women’s Health, Obstetric, and Neonatal Nurses built on these standards to create the current practice standards to promote the health of women and newborns. Today, these standards form the principles to provide benchmarks for nurses who provide evidence-based nursing care to these patient populations.
Three pregnancy periods
Pregnancy can be broken down into three periods:
The antepartum period refers to the period from conception to the onset of labor.
The intrapartum period extends from the onset of contractions that cause cervical dilation to the first 1 to 4 hours after the birth of the neonate and delivery of the placenta.
The postpartum period refers to the 6 weeks after delivery of the neonate and the placenta. Also known as the puerperium, this stage ends when the reproductive organs return to the nonpregnant state.
Practice settings
Maternal-neonatal nurses practice in various settings. These include community-based health centers, doctors’ offices, hospital clinics, acute care hospitals, maternity hospitals, birthing centers, and patients’ homes.
There’s no place like home …
Up until the year 2000, 98% of all births occurred in hospital labor and delivery suites or birthing units. Today, an increasing number of families are choosing to have their babies in alternative birth settings, such as birthing clinics or their homes. These alternative settings may give families more control over their birth experiences by allowing them to become more involved in the process.
… or a home away from home
In response to consumer demands for more relaxed, family-friendly birthing environments, hospitals have revamped their labor and delivery units to create more natural childbirth environments. Labor, delivery, and recovery rooms or labor, delivery, recovery, and postpartum suites are now found in most hospitals. In these homelike settings, partners, family members, and other support people may remain in the room throughout the birth experience. The patient then spends the postpartum-recovery period in the same room where she gave birth. These homelike environments allow for a more holistic and family-centered approach to maternal and neonatal health care.
|
Maternal-neonatal nursing roles and functions
Nurses involved in maternal-neonatal nursing assume many roles. These may include care provider, educator, advocate, and counselor. The functions involved for each of these roles depend on the nurse’s level of education. Nurses involved in maternal-neonatal nursing may be registered nurses, certified nursemidwives (CNMs), nurse practitioners (NPs), or clinical nurse specialists (CNSs).
Registered nurse
A registered nurse is a graduate of an accredited nursing program who has successfully passed the National Council Licensure Examination and is licensed by the state in which she works. To work in a maternal-neonatal department, a registered nurse goes through extensive on-site training, including competency checks and ongoing education. She plays a vital role in providing direct patient care, meeting the educational needs of the patient and her family, and functioning as an advocate and counselor.
Certified nurse-midwife
A CNM is a registered nurse who has achieved advanced education at a master’s level or has obtained CNM certification. A CNM works independently and is able to care for a low-risk obstetric patient throughout her pregnancy. A CNM is also licensed to deliver a neonate.
Nurse practitioners
An NP is also a registered nurse who has received advanced education at a master’s level or has obtained NP certification. An NP performs in an expanded advanced practice role. She obtains histories, performs physical examinations, and manages care (in consultation with a doctor) throughout the pregnancy and the postpartum period. She may practice as a women’s health, family, neonatal, or pediatric NP.
Women’s health nurse practitioner
A women’s health NP plays a vital role in educating women about their bodies and offering information on preventive health care. She cares for women with sexually transmitted diseases and counsels them about reproductive issues and contraceptive choices. A women’s health NP helps women remain well so they can experience a healthy pregnancy and maintain good health throughout life.
|
Family nurse practitioner
A family nurse practitioner (FNP) provides care to all patients throughout the life cycle. She performs health physicals, prepares pregnancy histories, orders and performs diagnostic and obstetric
examinations, plans care for the family throughout pregnancy and after birth, and can provide prenatal care in an uncomplicated pregnancy. An FNP cares for the entire family, focusing on health promotion, wellness, and optimal family functioning.
examinations, plans care for the family throughout pregnancy and after birth, and can provide prenatal care in an uncomplicated pregnancy. An FNP cares for the entire family, focusing on health promotion, wellness, and optimal family functioning.
Neonatal nurse practitioner
A neonatal nurse practitioner (NNP) is highly skilled in the care of neonates and can work in practice settings with various care levels, from well-baby term nurseries to high-level intensive care and preterm nurseries. She can also work in neonatal intensive care units (NICUs) or neonatal follow-up clinics. An NNP’s responsibilities include normal neonate assessment and physical examination as well as high-risk follow-up and discharge planning.
Pediatric nurse practitioner
A pediatric nurse practitioner (PNP) provides well-baby care and maternal counseling, performs physical assessments, and obtains detailed patient histories. The PNP serves as a primary health care provider. She can order diagnostic tests and prescribe appropriate drugs for therapy, although prescribing privileges depend on individual state regulations. If the PNP determines that a child has a major illness, such as heart disease, she may collaborate with a pediatrician or other specialists.
Clinical nurse specialist
A CNS is an RN who has received education at a master’s level. The CNS focuses on health promotion, patient teaching, direct nursing care, and research activities. A CNS serves as a role model and teacher of quality nursing care. She may also serve as a consultant to registered nurses working in the maternal-neonatal field.
|
A special specialist
A CNS may be trained:
to provide care in NICUs
as a childbirth educator who develops and provides childbirth education programs, prepares the expectant patient and her family for labor and birth, and cares for the patient and her family in normal birth situations
as a lactation consultant who teaches and assists the patient as she learns about breast-feeding.
Family-centered care
Maternal-neonatal nurses are responsible for providing comprehensive care to the pregnant woman, her fetus, and family members. This approach is known as familycentered care. Understanding the makeup and function of the family is essential to delivering family-centered care.
Family ties
A family is a group of two or more persons who possibly live together in the same household, perform certain interrelated social tasks, and share an emotional bond. Families can profoundly influence the individuals within them. Therefore, care that considers the family—not just the individual—has become a focus of modern nursing practice.
Changes such as the addition of a new family member alter the structure of the family. If one family member is ill or is going through a rough developmental period, other family members may feel a tremendous strain. Family roles must be flexible enough to adjust to the myriad changes that occur with pregnancy and birth.
|
Family structures
Several different family structures exist today. These structures may change over the life cycle of the family because of such factors as work, birth, death, and divorce. Family structures also may differ based on the family roles, generation issues, means of family support, and sociocultural issues.
Types of family structures include:
nuclear family
cohabitation family
extended or multigenerational family
single-parent family
blended family
communal family
gay or lesbian family
foster family
adoptive family.
|
Nuclear family
A nuclear family is traditionally defined as a family consisting of a wife, a husband, and a child or children. A nuclear family can provide support to and feel affection for family members because
of its relatively small size. However, small family size may also be a weakness for the nuclear family. For example, when a crisis arises, such as an illness, there are fewer family members to share the burden and provide support.
of its relatively small size. However, small family size may also be a weakness for the nuclear family. For example, when a crisis arises, such as an illness, there are fewer family members to share the burden and provide support.
Cohabitation family
A cohabitation family is composed of a heterosexual couple who live together but aren’t married. The living arrangement may be short- or long-term. A cohabitation family can offer psychological and financial support to its members in the same way as a traditional nuclear family.
Extended or multigenerational family
Extended or multigenerational families include members of the nuclear family and other family members, such as grandparents, aunts, uncles, cousins, and grandchildren. In this type of family, the main support person isn’t necessarily a spouse or intimate partner. The primary caregiver may be a grandparent, an aunt, or an uncle. This type of family typically has more members to share burdens and provide support but may experience financial problems because income must be stretched to accommodate more people.
Single-parent family
Today, single-parent families account for 50% to 60% of families with school-age children. Although in many of these families, the mother is the single parent present; an increasing number of fathers are also rearing children alone. Single-parent families exist for many reasons, including divorce, death of a spouse, and the decision to raise children outside of marriage.
Working hard for the money
Financial problems, such as low income, can be an issue for single parents. Even though an increasing number of single parents are fathers, most are mothers. Traditionally, women’s salaries have been lower than men’s salaries. This situation poses a problem when a mother’s salary is the only source of income for the family.
Flying solo
Another difficulty for the single-parent family is the lack of family support for childcare, which can be problematic if the single parent becomes ill. A single parent may also have difficulty fulfilling the multitude of parental roles that are required of her, such as being a mother and a “father” in addition to being the sole income provider for the family.
|
Blended family
In a blended family, two separate families have joined as one as a result of remarriage. Many times, conflicts and rivalries develop in these families when the children are exposed to new parenting methods. Jealousy and friction between family members may be an issue, especially when the new blended family has children of its own. On the other hand, children of blended families may also be more adaptable to new situations.
Communal family
A communal family is a group of people who have chosen to live together but aren’t necessarily related by marriage or blood; instead, they may be related by social or religious values. People in communal families may not adhere to traditional health care practices, but they may proactively participate in their health care and be receptive to patient teaching.
Gay or lesbian family
Some gay and lesbian couples choose to include children in their families. These children may be adopted, or they may come from surrogate mothers, artificial insemination, or previous unions or marriages.
|
Foster family
Foster parents provide care for children whose biological parents can no longer care for them. Foster family situations are usually temporary arrangements until the biological parents can resume care or until a family can adopt the foster child. Foster parents may or may not have children of their own.
Adoptive family
Families of all types can become adoptive families. Families adopt children for various reasons, which may include the inability to have children biologically. In some cases, families choose to adopt foster children whose parents are unable to provide care and are willing to have their children adopted. Sometimes, adoptive parents are the child’s biological siblings or a relative of the parent. This type of family can be very rewarding but also poses many challenges to the family unit, especially if biological children also live in the family. Adoptions can be arranged through an agency, an international adoption program, or private resources.
Family tasks
A healthy family typically performs eight tasks to ensure its success as a working unit and the success of its members as individuals. These include:
distribution of resources
socialization of family members
division of labor
physical maintenance
maintenance of order
reproduction, release, and recruitment of family members
placement of members into society
safeguarding of motivation and morale.
Distribution of resources
Because each family has limited resources, the family needs to decide how those resources should be distributed. In some cases, certain family needs will be met and others won’t. For example, one child may get new shoes, whereas another gets hand-me-down shoes.
Money isn’t everything
Money isn’t the only resource. Such resources as affection and space must also be distributed. For example, the eldest child may get his own room, whereas younger children may have to share a room. Most families can make these decisions well. Dysfunctional families or those with financial problems may have problems completing these tasks.
Socialization of family members
Preparing children to live in society and to socialize with other individuals in their society is another important family task. If the culture of the family differs from the community in which it lives, this may be a difficult task.
Division of labor
Division of labor is the family task that involves assignment of responsibilities to each family member. For example, family members must decide who provides the family with monetary resources, who manages the home, and who cares for the children. The division of labor may change within a family when a new baby arrives, especially if both parents work full-time.
|
Physical maintenance
The task of physical maintenance includes providing for basic needs, such as food, shelter, clothing, and health care. The family fulfills these needs by finding and maintaining employment and securing housing. It’s important to have enough resources to complete these tasks or the family may find itself in crisis. Improper distribution of resources can also lead to problems related to providing for basic needs. Physical maintenance also includes providing emotional support and caring for family members who are ill.
|
Maintenance of order
The task of maintenance of order includes communication among family members. It also involves setting rules for family members and defining each individual’s place within the family. For example, when a new baby arrives, a family with a healthy maintenance of order and well-defined rules and roles knows where that new member belongs. Family members welcome the new baby as a part of the family unit and understand the baby’s role as a family member. An unhealthy family may find this task difficult. Members of a family without a healthy maintenance of order may feel threatened that the baby will change their roles or take their places in the family. They may see the new baby as an intruder.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
