The Nurse’s Role in Maternity, Women’s Health, and Pediatric Nursing



The Nurse’s Role in Maternity, Women’s Health, and Pediatric Nursing


Learning Objectives


After studying this chapter, you should be able to:



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As care changed from the category-specific care of the woman, newborn, or child to family-centered care, maternity, women’s health, and nursing care of children entered a new era of autonomy and independence. Women may have problems unique to women, such as menstrual or menopausal issues. However, health care realizes that women may not respond to disorders such as cardiovascular disease as a man does, and women’s health care became a specialty. Nurses today must be able to communicate with and teach effectively people of many ages and levels of development and education. They must be able to think critically and use the nursing process to develop a plan of care that meets the unique needs of each person and the person’s family. Nurses are expected to use current evidence to solve problems and to collaborate with other health care providers.


The Role of the Professional Nurse


The professional nurse has a responsibility to provide the highest quality care to every patient. The American Nurses Association (ANA) Code of Ethics for Nurses (Box 2-1) provides guidelines for ethical and professional behavior. The code emphasizes a nurse’s accountability to the person, the community, and the profession. The nurse should understand the implications of this code and strive to practice accordingly. Professional nurses have a legal obligation to know and understand the standard of care imposed on them. It is critical that nurses maintain competence and a current knowledge base in their areas of practice.



BOX 2-1


ANA CODE OF ETHICS FOR NURSES



1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.


2. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.


3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.


4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.


5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.


6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.


7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development.


8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.


9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.


From American Nurses Association. Code of ethics for nurses with interpretive statements. (2001). © 2001 by American Nurses Association. Reprinted with permission. All rights reserved.


Standards of practice describe the level of performance expected of a professional nurse as determined by an authority in the practice. For example, perinatal nurses are held to the standards published by the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN). AWHONN recently published the seventh edition of its Standards for Professional Nursing Practice in the Care of Women and Newborns and Standards for Perinatal Nursing Practice and Certification in Canada to guide practice and shape institutional guidelines (AWHONN, 2009).


Nurses who care for children in all clinical settings can use the ANA/Society of Pediatric Nurses (SPN) Standards of Care and Standards of Professional Performance for Pediatric Nurses and the SPN/ANA Guide to Family Centered Care as guides for practice. Other standards of practice for specific clinical areas, such as pediatric oncology nursing or emergency nursing, are available from nursing specialty groups.


As health care continues to move to family-centered and community-based health services, all nurses should expect to care for children, adolescents, and their families. The document Health Care Quality and Outcome Guidelines for Nursing of Children and Families can serve as a framework for practice when caring for children and their families. Educators and administrators in health care should find the Guidelines useful when planning programs (Betz, Cowell, Craft-Rosenberg, et al., 2007). The Guidelines address such important issues as maintaining a health care home, collaboration in care, accessibility to a full range of services, and care that is developmentally appropriate, among others (Betz et al., 2007).


Maternity, women’s health, and pediatric nurses function in a variety of roles, including those of care provider, teacher, collaborator, researcher, advocate, and manager.


Care Provider


The nurse provides direct patient-centered care to women, infants, children, and their families in times of childbearing, illness, injury, recovery, and wellness. Nursing care is based on the nursing process. The nurse obtains health histories, assesses patient needs, monitors growth and development, performs health-screening procedures, develops comprehensive plans of care, provides treatment and care, makes referrals, and evaluates the effects of care. Nursing of children is especially based on an understanding of the child’s developmental stage and is aimed at meeting the child’s physical and emotional needs at that level. Developing a therapeutic relationship with and providing support to patients and their families are essential components of nursing care. Maternity and pediatric nurses practice family-centered care, embracing diversity in family structures and cultural backgrounds. These nurses strive to empower families, encouraging them to participate in their self-care and the care of their child. Nurses who practice women’s health care may need to coordinate care with pediatric nurses in families headed by grandparents rather than parents of the child.


Teacher


Education is an essential role of today’s nurse. Teaching begins early, before and during a woman’s prenatal care, and continues through her recovery from childbirth and learning to care for her newborn, and into her care in women’s health (Figure 2-1). Nurses who care for children prepare them for procedures, hospitalization, or surgery, using knowledge of growth and development to teach children at various levels of understanding. Families need information, as well as emotional support, so that they can cope with the anxiety and uncertainty of a child’s illness. Nurses teach family members how to provide care, watch for important signs, and increase the child’s comfort. They also work with new parents and parents of ill children so that the parents are prepared to assume responsibility for care at home after the child has been discharged from the hospital.



Education is essential to promote health. The nurse applies principles of teaching and learning to change the behavior of family members. Nurses motivate women, children, and families to take charge of and make responsible decisions about their own health. For teaching to be effective, it must incorporate the family’s values and health beliefs.


Nurses caring for children and families play an important role in preventing illness and injury through education and anticipatory guidance. Teaching about immunizations, safety, dental care, socialization, and discipline is a necessary component of care. Nurses offer guidance to parents with regard to child-rearing practices and preventing potential problems. They also answer questions about growth and development and assist families in understanding their children. Teaching often involves providing emotional support and counseling to children and families.


Factors Influencing Learning


A number of factors influence learning at any age. They include:



• Developmental level. Teenage parents often have very different concerns than older parents. Grandparents who must assume long-term care of a child often need information that may not have existed when their own child was the same age. Developmental level also influences whether a person learns best by reading printed material, using computer-based materials, watching videos, participating in group discussions, play, or other means. When teaching children, teaching must be adapted to the child’s developmental level rather than the child’s chronologic age.


• Language. The ability to understand the language in which teaching is done determines how much the family learns. Families for whom English is not the primary language may not understand idioms, nuances, slang terms, informal use of words, or medical words. An interpreter for the deaf may be necessary for the person who is hearing impaired.


• Culture. People tend to forget or disregard content with which they disagree. The nurse’s teaching can be most effective if cultural considerations are weighed and incorporated into the education.


• Previous experiences. Parents who have other children may need less education about pregnancy care or infant and child care. They may, however, have additional concerns about meeting the needs of several children and about sibling rivalry.


• Physical environment. The nurse must consider privacy when discussing sensitive issues such as adolescent sexuality or domestic violence, also called intimate partner violence. A group discussion, however, may prompt participants to ask questions of concern to all members of the group, such as the experiences they can expect in labor.


• Organization and skill of the teacher. The teacher must determine the objectives of the teaching, develop a plan to meet the objectives, and gather all materials before teaching. The nurse must determine the best way to present the material for the intended audience. A summary of the information is helpful when concluding a teaching session.


Principles of Teaching and Learning


Applying the following principles will help nurses become effective teachers in the childbearing or childrearing setting:



• Real learning depends on the readiness of the family to learn and the relevance of the content.


• Active participation increases learning. Whenever possible, the learner should be involved in the educational process and not act as a passive listener or viewer. A discussion format in which all can participate stimulates more learning than a straight lecture.


• Repetition of a skill increases retention and promotes a feeling of competence.


• Praise and positive feedback are powerful motivators for learning. They are particularly important when the family is trying to master a frustrating task, such as breastfeeding an unresponsive infant or changing a wound dressing on a young child.


• Role modeling is an effective method for demonstrating behavior. Nurses must be aware that their behavior is scrutinized carefully at all times and that it may be copied later.


• Conflicts and frustration impede learning, and should be recognized and resolved for learning to progress.


• Learning is enhanced when teaching is structured to present simple tasks before more complex material. For example, the nurse teaches how to care for the umbilical cord, which is simple, before teaching how to bathe and shampoo the newborn, which is more difficult for inexperienced parents.


• A variety of teaching methods is necessary to maintain interest and to illustrate concepts. Posters, videos, and printed materials supplement lectures and discussion. Models may be especially useful for teaching family planning or the processes of labor or for teaching a child how to use a peak expiratory flow meter.


• Information is retained better when it is presented in small segments over a period of time. Short hospital stays do not support this practice, making follow-up care particularly important for some patients.


Collaborator


Nurses collaborate with other members of the health care team, often coordinating and managing the patient’s care. Care is improved by an interdisciplinary approach as nurses work together with dietitians, social workers, physicians, and others. Comprehensive and thorough interdisciplinary communication enhances the effectiveness of collaboration and increases the provision of high quality and safe care (Miller, Riley, & Davis, 2009). Such communication tools as SBAR, which stands for Situation, Background, Assessment, and Recommendation, hand-off reports, and closed loop communication (message sent, receiver acknowledges, receiver verifies with sender) facilitate the delivery of reliable and safe care (Miller et al., 2009).


Managing the transition from a hospital or any other acute-care setting to the patient’s home or another facility involves discharge planning and collaboration with other health care professionals. The trend toward home care makes collaboration increasingly important. The nurse must be knowledgeable about community resources, appropriate home care agencies for the type of patient or problem, and social work resources. Cooperation and communication are essential because patients, including parents of children, are encouraged to participate in their care.


Researcher


Nurses contribute to their profession’s knowledge base by systematically investigating theoretic or practice issues in nursing. Nursing does much more than simply “borrow” scientific knowledge from medicine and basic sciences. Nursing generates and answers its own questions based on evidence within its unique subject area. The responsibility for providing evidence-based, patient-centered care is not limited to nurses with graduate degrees. It is important that all nurses appraise and apply appropriate research findings to their practice, rather than basing care decisions merely on intuition or tradition.


Evidence-based practice is no longer just an ideal but an expectation of nursing practice. Nurses can contribute to the body of professional knowledge by demonstrating an awareness of the value of nursing research and assisting in problem identification and data collection. Nurses should keep their knowledge current by networking and sharing research findings at conferences, by publishing, and by evaluating research journal articles.


Advocate


An advocate is one who speaks on behalf of another. Care can become impersonal as the health care environment becomes more complex. The wishes and needs of children and families are sometimes discounted or ignored in the effort to treat and to cure. As the health professional who is closest to the patient, the nurse is in an ideal position to humanize care and to intercede on the person’s behalf. As an advocate the nurse considers the family’s wishes and preferences when planning and implementing care. The nurse informs families of treatments and procedures, ensuring that the families are involved directly in decisions and activities related to their care. The nurse must be sensitive to families’ values, beliefs, and customs.


Nurses must be advocates for health promotion for vulnerable groups such as children, victims of domestic violence, or elders in the family. Nurses can promote the rights of children and families by participating in groups dedicated to their welfare, such as professional nursing societies, support groups, religious organizations, and voluntary organizations. Through involvement with health care planning on a political or legislative level and by working as consumer advocates, nurses can initiate changes for better quality health care. Nurses possess unique knowledge and skills and can make valuable contributions in developing health care strategies to ensure that all patients receive optimal care.


Manager of Care


Because of shorter stays in acute-care facilities, nurses often are unable to provide total direct patient care. Instead they delegate concrete tasks, such as giving a bath or taking vital signs, to others. As a result, nurses spend more time teaching and supervising unlicensed assistive personnel, planning and coordinating care, and collaborating with other professionals and agencies. Nurses are expected to understand the financial effects of cost-containment strategies and to contribute to their institutions’ economic viability. At the same time they must continue to act as patient advocates and to maintain a standard of care.


Advanced Preparation for Maternity and Pediatric Nurses


The increasing complexity of care and a focus on cost containment have led to a greater need for nurses with advanced preparation. Advanced practice nurses may practice as certified nurse-midwives (CNMs), nurse practitioners, clinical nurse specialists, or clinical nurse leaders (CNLs®), among others. Advanced practice nurses also may work as nurse administrators, nurse educators, and nurse researchers. Preparation for advanced practice involves obtaining a master’s or doctoral degree.


Certified Nurse-Midwives


CNMs are registered nurses who have completed an extensive program of study and clinical experience. They must pass a certification test administered by the American College of Nurse-Midwives. CNMs are qualified to provide complete care during pregnancy, childbirth, and the postpartum period in uncomplicated pregnancies. They provide information about preventive measures and preparation for normal pregnancy and childbirth. They spend a great deal of time counseling and supporting the childbearing family. The CNM also provides gynecologic services as well as family planning and counseling.


Despite the proven effectiveness of nurse-midwives, for many years they were restricted in the scope and location of their practice. In 1970, however, many of these restrictions were alleviated when the American College of Obstetricians and Gynecologists, together with the Nurses Association of the American College of Obstetricians and Gynecologists—now known as the Association of Women’s Health, Obstetric and Neonatal Nurses—issued a joint statement that admitted nurse-midwives as part of the health care team. In 1981, Congress authorized Medicaid payments for the services of CNMs. This measure has greatly increased the use of nurse-midwives, particularly by health maintenance organizations (HMOs), in birthing centers, and in some hospitals.


Nurse Practitioners


Nurse practitioners are advanced practice nurses who work according to protocols and provide many primary care services that were once provided only by physicians. Most nurse practitioners collaborate with a physician, but, depending on their scope of practice and their individual state’s board of nursing mandates, they may work independently and prescribe medications. Nurse practitioners provide care for specific groups of patients in a variety of settings (primary care facilities, schools, acute care facilities, rehabilitation centers). They may address occupational health, women’s health, family health, and the health of the elderly or the very young.


Women’s health nurse practitioners provide wellness-focused, primary, reproductive, and gynecologic care over the life span but do not usually manage care of women during pregnancy and birth. Common responsibilities include performing well-woman examinations, screening for sexually transmitted diseases, and providing family planning services. Some hospitals employ women’s health nurse practitioners to assess and screen women who present to obstetric triage units, many of whom have nonobstetric problems.


Family nurse practitioners are prepared to provide care for people of all ages. They may care for women during uncomplicated pregnancies and provide follow-up care for the mother and infant after childbirth. Unlike certified nurse-midwives, they do not assist with childbirth. They diagnose and treat patients holistically, with a strong emphasis on prevention.


Pediatric nurse practitioners use advanced skills to assess and treat well and ill children according to established protocols. The health care services they provide range from physical examinations and anticipatory guidance to the treatment of common illnesses and injuries. It is becoming more common for newborn nurseries and some children’s hospital specialty units to be staffed by neonatal or pediatric nurse practitioners.


School nurse practitioners receive education and training that is similar to that of pediatric nurse practitioners. However, because of the setting in which they practice, the school nurse practitioners receive advanced education in managing chronic illness, disability, and mental health problems in a school setting, as well as developing skills required to communicate effectively with students, teachers, school administrators, and community health care providers. School nurse practitioners expand the traditional role of the school nurse by providing on-site treatment of acute care problems and providing extensive well-child examinations and services.


Clinical Nurse Specialists


Clinical specialists are registered nurses who, through study and supervised practice at the graduate level (master’s or doctorate), have become expert in the care of childbearing families or pediatric patients. Four major subroles have been identified for clinical nurse specialists: expert practitioner, educator, researcher, and consultant. These professionals often function as clinical leaders, role models, patient advocates, and change agents. Unlike nurse practitioners, clinical nurse specialists are not prepared to provide primary care.


Clinical Nurse Leaders


As newly defined by the American Association of Colleges of Nursing (2011), the CNL is a master’s prepared generalist whose focus is on quality, safety, and optimal patient outcomes at point of care. All CNLs receive the same basic preparation in a master’s program, which includes advanced pathophysiology, pharmacology, and health assessment, among other courses that prepare them to assume leadership roles within their specific practice settings. Extensive practicum experiences assist them with assessing quality and safety at the micro- and macrosystems levels in order to improve direct patient care. A certification examination is available. CNLs work in a variety of settings, some providing safe and optimal care to women, children, and families.


Implications of Changing Roles for Nurses


As nursing care has changed, so also have the roles of maternity and pediatric nurses with both basic and advanced preparation. Nurses now work in a variety of areas. Although they previously worked almost exclusively in the hospital setting, many now provide home care and community-based care. Some of the settings for care of maternity and pediatric patients include:


Related posts:

  1. Prenatal Diagnostic Tests
  2. Newborn Feeding
  3. Emergency Care of the Child
  4. Medication Administration and Safety for Infants and Children

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Oct 8, 2016 | Posted by in NURSING | Comments Off on The Nurse’s Role in Maternity, Women’s Health, and Pediatric Nursing

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