Review for Exam 1 Chapters 1, 2, 8, 9

1. Impact of technology on care (P4) In many areas of the United States there is a
movement
from a natural, family-focused, low-tech form of childbirthsometimes called normal
childbirthto high-tech birthing. This movement is influenced in part by childbearing
families, sometimes called generation Y or the iGeneration, who have grown up with
technology and know no other way. They may view elective induction and mother-requested
cesarean birth as accepted options, for example. This movement is often reinforced by
caregivers who, aware of legal liability issues, practice defensive medicine. Furthermore,
many hospitals now support a high-tech model of maternity care because it is easier to
manage more patients if their pain is controlled by epidurals and their contractions are
monitored by electronic fetal
monitors. This high-tech approach can potentially interfere with family-focused care.
2. Roles of Nurses in OB setting: include advance practice( P9)
A professional nurse is a graduate of an accredited basic program in nursing and is currently
licensed
as a registered nurse (RN). Professional nurses are typically educated as generalists.
A certified registered nurse (RNC) has shown expertise in a particular field of nursing such
as labor and delivery by taking a national certification examination.
A nurse practitioner (NP) is a professional nurse who has received specialized education in
either a Doctor of Nursing Practice (DNP) or masters degree program and thus can function
in an expanded role. (Note: Early nurse practitioner programs were sometimes certificate
programs.) The area of specialization determines the NPs title, so that there are family
nurse practitioners, neonatal nurse practitioners, pediatric nurse practitioners, womens
health nurse practitioners, and so forth. Nurse practitioners often provide ambulatory care
services to the expectant family.
A clinical nurse specialist (CNS) is a professional nurse with a masters degree who has
additional specialized knowledge and competence in a specific clinical area. CNSs assume a
leadership role within their specialty and work to improve patient care both directly and
indirectly.
A certified nurse-midwife (CNM) is educated in the two disciplines of nursing and midwifery
and is certified by the American College of Nurse-Midwives (ACNM). The certified nursemidwife is prepared to manage independently the care of women at low risk for
complications during pregnancy and birth and the care of normal newborns
The nurse researcher has an advanced doctoral degree, typically a Doctor of Philosophy
(PhD) and assumes a leadership role in generating new research. Nurse researchers are
typically found in university settings although more and more hospitals are employing them
to conduct research relevant to patient care, administrative issues, and the like.
3. Levels of Care: Ex: Tertiary Care
Primary Care: he OB/GYN Clinic provides care for all women throughout the duration of

their pregnancy and then they and their babies they return back to their primary gynecologist
for routine checkups.

Secondary Care: is when the pregnancy/mother have conditions which warrant a

specialist to ensure mother/baby healthy outcomes. Can be a smaller hospital, not as
specialized or equipped to handle a high risk issue.
Tertiary Care: Specialized consultative care, usually on referral from primary or
secondary medical care personnel, by specialists working in a center that has personnel and
facilities for special investigation and treatment.
Quaternary care: is considered to be an extension of tertiary care - even more
specialized and highly unusual. Because it is so specialized, not every hospital or medical
center even offers quaternary care.

4. Negligence (P 11) Negligence is defined as omitting or committing an act that a

reasonably prudent person would not omit or commit under the same or similar
circumstances. In determining whether nursing negligence occurred, the care that was given
is compared with the standard of care. If the
standard was not met, negligence occurred. Negligence consists of four elements:
1. There was a duty to provide care.
2. The duty was breached.
3. Injury occurred.
4. The breach of duty caused the injury (proximate cause).
5. Malpractice (PPT) negligence caused by failure to perform as other competent
professionals would in the same set of circumstances
6. Ethics versus Law (P 11)
Ethcs: provide rules and principles that can be used for resolving ethical dilemmas:
Personal involve values and beliefs
Focus on the interests of the individual
Law: are rules that govern behavior of individuals and represent the minimum
standard of morality.
External to the individual, societal rules
Written for the interests of society
Both: Provide guidance for actions and ways to resolve disputes
Ethical and legal situation: informed consent
Legal situation with ethical issues: abortion
Ethical situation with legal issues: assisted suicide
Professional nurses must consider the ethical implications of legal decisions and the legal
implications of ethical decisions.
Nursing: Ethics of Care:
recognizes the personal concerns and vulnerabilities of clients in health and illness
considers the welfare of others and incorporates empathy, support, and compassion
promotes well-being of clients
7. Role of Policies and Procedures: Always follow facility roles and scope of practice and
procedures laid out by each facility
Autonomy: ex informed consent; making an informed decision
Nonmaleficence: preventing harm to others (Nurses; due care)
Beneficence: Doing good, key to nursing actions
Justice: How we divide benefits and burdens in society
Veracity: truthfulness
Fidelity: Keeping promises
Legal Concepts:
Criminal Law: address public concerns and punishes wrongs against society
Civil Law: punishes against individuals (ex; malpractice)
Tort: civil wrong; intentional or unintentional
Ethical issues:

Maternal fetal conflict

Abortion
Fetal research; intrauterine surgery
Reproductive assistance (TI and ART)
Embryonic stem cell research
Cord blood banking

8. Acculturation (P 33) This process by which people adapt to a new cultural norm is called
acculturation. Moreover, when a group completely changes their cultural identity to become
part of the majority culture, assimilation occurs.
9. Family Roles (P 25) Family roles are homogeneous sets of behaviors that are normatively
defined and expected of an occupant of a given social position. Roles vary depending on
age, position within the family, conflict within the family, stressors, cultural backgrounds,
health status of family members, and demographic trends. However, within each family,
roles commonly encountered include breadwinner, homemaker, nurturer, social planner, and
peacemaker. Although roles are sometimes perceived to be gender specific, they are more
accurately assigned to the family member who performs that specific function
10. Family Models (P 27)

11. Cultural Assessment (P 32)

A cultural assessment can assist the nurse in identifying cultural norms and providing
culturally appropriate nursing care.
A family assessment is a collection of data regarding the familys current
level of functioning, support systems, sociocultural information, environmental information,
type of family, family structure, and needs
Name, age, sex, and family relationship of all family members residing in the
household
Cultural associations, including cultural norms and customs related to childbearing,
childrearing,
and infant feeding
Religious affiliations, including specific religious beliefs and practices related to
childbearing
Support network, including extended family, friends, and religious and community
associations
Family type, structure, roles, and values
Communication patterns, including verbal and written language barriers
12. Chinese Client; expression (P 25, 50) Personal independence is not important. Chinese
patients may
avoid taking action regarding a health matter unless a family leader gives permission. Yin
and yang cannot exist independently because they are complementary and both are
essential. Certain foods, behaviors, and environmental factors are believed to increase yin,
whereas others increase yang. Good health requires a balance of both. So after birth a
Chinese woman should be kept warm.
13. Dietary concerns with different cultures (P 39)

Note food preferences: Adhering to Care is key in knowing diet preference

(1) Make as many adjustments in diet as health status and long-term benefits will allow and
that dietary department can provide.
(2) Note dietary practices that may have serious implications for the client.
14. Influence of culture on OB care and complimentary health care (P 35) A familys culture
may influence its beliefs about and practices surrounding many aspects of childbearing and
childrearing, including beliefs about the importance of children, beliefs and attitudes about
pregnancy, health practices, and infant feeding behaviors. Culture plays a significant part in
a familys development; roles; and observance of traditions, customs, and taboos.
15. Ethnocentrism/ cultural biases (P37 ) Ethnocentrism is the conviction that the values and
beliefs of
ones own cultural group are the best ones or the only acceptable ones. It is characterized
by an inability or unwillingness to understand the beliefs or worldview of another group or
culture
16. Education of culturally diverse groups: You might need to use a translator for information
and also give information in their language. It is critical to understand that while you teach
information in regards to their care they will adhere strongest to their culture and beliefs
17. Role of Religion and spirituality (P 41) The goal of truly holistic care of the childbearing
family requires
that the nurse understand the influence that religion and spirituality may have on the
childbearing experience.
18. Comparable worth (P150) which means equal pay for work that is of comparable value
and requires comparable skills, responsibility, education, and experience. Comparable worth
legislation was opposed by business leaders, who argued that wage disparities were rooted
not in discrimination against women, but in differences in educational level and seniority,
and that basing wages on comparable worth would decrease U.S. manufacturers ability to
compete with foreign manufacturers and reallocate limited salary
resources away from lower-class, minority men to middle-class, Caucasian women. This law
did not pass and has not been revisited.
19. Feminization of Poverty (P 146) The fact that many more women than men live below the
poverty level is reflected in the phrase feminization of poverty, which was coined by Diana
Pearce in 1993.
20. Largest groups affected by poverty (P)
Women and children live @ 12%
More women declaring BK, Lower literacy than men
Factors: 50% from Div suffer fin, child care, wage gap ratio 76.5%,
21. FMLA Family Medical Leave Act (P 151) 1993 when President Clinton signed the Family
and Medical
Leave Act (FMLA) into law. FMLA permits employees to take up to 12 weeks of unpaid leave
from work following the birth or adoption of a child or the placement of a foster child.
Employees may also take leave if faced with serious illness or the illness of a spouse, child,
or parent. Health insurance benefits must be continued during the leave, and employees are
entitled to return to their former position or one considered comparable. Because the FMLA
applies only to companies with 50 or more employees,
however, the vast majority of companies are not subject to the law.

Issues: Discrimination against pregnant women, child care, wage discrepancy,

advocacy for working women, nurses role models
22. Effects of sexual orientation on care (P 161) Health and Human Services acknowledged
sexual orientation as a risk factor for inferior health care, citing reasons such as lack of
insurance, fear of discrimination on the part of providers, and provider ignorance of gay and
lesbian peoples healthcare needs. The first two factors limit access to health care, and the
third has a negative effect on healthcare quality. So they do not get the required screenings.
They more likely than heterosexual women to have never given birth, to be overweight, to
be stressed, and to smoke and drink alcohol. Many providers also
believe that lesbian women are not at risk for sexually transmitted infections (STIs) and
cervical cancer, both of which are untrue.
Quality of life
Employment discrimination
Spousal benefits/ none
Housing discrimination
Parenting issues
Social barriers
Effects on health of lesbian/bi womens health
23. Female Genital Mutilation (FGM) (P 161) also known as female genital cutting, female
circumcision, and genital circumcision, refers to the practice of removing all or parts of a
girls or womans genitalia for cultural reasons.
Performed in 28 countries, generally by women, male dominated cultures
5-12 yoa, one country at birth
Associated with womens identity
Believe if baby touches clitoris will grow long if not cut off and can kill baby if touched
If not done a woman is seen as ugly and impure
No anesthesia
Primitive instruments
An elaborate ritual
Nature of Procedures:
Most severe of FGM is imfubulation (P 162): the clitoris, the labia minora, and most of the
labia majora are removed and the raw surfaces of the remaining stumps of the labia majora
are sewn together over the vaginal opening, leaving only a small hole for the passage of
urine and menstrual blood. The opening is widened (deinfibulated) somewhat at the time of
marriage, either rapidly, with a knife, or gradually, to permit sexual intercourse. Infibulation
accounts for 15% of women with FGM
Least invasive FGM: partial clitoridectomy (P162): in which the tip of the clitoris is removed.
The most common procedure (80% to 85% of all procedures) involves complete removal of
the clitoris with partial or
complete removal of the labia minora
Health Implications: Can be immediate with hemorrhaging or long term;bleeding, infection,
infertility, painful intercourse, and difficulties related to childbearing.
Efforts to eradicate: FGM has been denounced as a form of child abuse by the World Health
Organization and by many other international and national organizations. Healthcare-related
organizations, including the American Medical Association and the American Nurses
Association, have denounced it as well. FGM has been outlawed in 14 African countries and
some Arab countries in which it has traditionally
been practiced. It is illegal in many North American and European countries that have
sizable immigrant populations. However, it is still done.
Responding appropriately to the circumcised women: Nurses must provide culturally
sensitive care to women who have undergone procedures involving genital mutilation. Do
not use word mutilation. This is their culture. Do not judge.

24. Nursing Care and Battered Women (P169-) Nurses who wish to help battered women
need advanced
knowledge of the dynamics of battering; assessment skills for recognizing and documenting
abuse; and appropriate intervention skills in counseling, safety planning, and referral.
Research has shown that womens risk for homicide and additional violence are greatest
during separation or attempts at separation. Expected outcomes of nursing care include the
following:
The woman receives compassionate, respectful, and individualized medical attention.
The woman recovers from the physical effects of physical and sexual abuse.
The woman has the information she needs to make a decision about her future based on
thoughtful consideration of alternatives.
The woman is able to identify culturally appropriate community resources available to her
and develops strategies for keeping herself, her children, and her family as safe as possible.
If the woman chooses to apply for a restraining order or to prosecute her assailant, all
necessary documentation is recorded in her medical records, leading to a more successful
prosecution.
Reestablish feeling of control, make own decisions
Health promotion is the exit plan
25. Domestic Violence Education (P 166) Besides offering emotional support, medical
treatment, and counseling, the nurse should inform any woman who may be in an abusive
situation of the services available in the hospital, through agencies, and in the community.
The nurse can also provide the woman with the phone number of any local resources, as
well as the number for the National Domestic Violence
Hotline (1-800-799-SAFE).
Specifically, a woman who has been abused may need:
Medical treatment for injuries
Temporary shelter to provide a safe environment for herself and her children
Legal assistance for protection or prosecution of the batterer
Financial assistance to provide shelter, food, and clothing
Job training or employment counseling
Counseling to raise her self-esteem and help her understand the dynamics of domestic
violence, or an ongoing support group for herself and her children
Undesrtstand planning like hiding money, copies of important papers, check in people, exit
plan,
26. Factors Which Affect domestic Violence (P 167-168)
Childhood experiences
Male dominance in the family
Marital conflict
Unemployment/ low socioeconomic status
Traditional definitions of masculinity
27. Dealing with the Rape Victim (P 176)

The primary of purpose of care to meet needs of survivor

Evaluate and treat injuries
Conduct prompt examinations
Provide support, crisis intervention, and advocacy
Provide prophylaxis against sexually transmitted infections
Assess for pregnancy risk
The secondary purpose of care: ( SANE/SART)
Collect and preserve legal evidence: can be traumatic vaginal and rectal exams, informed
consent, collect
all evidence, chain of evidence, detailed hx is 1st step in
forensic data
Respect rights of survivor

Nursing Assessment: create safe envt, full mental status, scrupultous doc
Nursing Plan Implementation: Has 4 phases
Acute phase: (disorganized) safe envt and explain process
Outward adjustment phase: (denial) advocacy, support as requested, assistance to significant
others
Reorganizational Phase: (denial and suppression) trust relationship, assist victim to understand
its not their
fault, clarify feelings, assist in planning for future
Integration and recovery: This final phase brings resolution for the woman. She is able to
recognize that the blame for her assault lies with her assailant.
General Guidelines Dealing With the Rape Victim:

Believe the victimone of the greatest fears of sexual assault survivors is that they will not be believed.
Listen and be patientlet the person talk and tell the story at her/his own pace.
Reinforce the fact that the sexual assault was not the victims fault.
For recent assaults, encourage the victim to report the assault and preserve evidence.
Encourage the person to seek medical attention.
Suggest seeking counseling and other support services.
Help the victim to organize her/his thoughts, but let the survivor make her/his own decision on how to
proceed.
Take care of yourselfassisting a friend or family member can be stressful. Set aside time for yourself so
that you dont feel overwhelmed by the survivors problems.
Acknowledge your limits and realistically identify your abilities to assist the survivor

.
28. Standards of Care (P 11 and PPT) Documents developed by professional groups to
establish a level of practice agreed upon by members of the profession
Sources: Association of Womens Health, Obstetric and Neonatal Nurses ( AWHONN)
ANA
Assoc of Operating Nurses (AORN)
National Assoc. of Neonatal Nurses (NANN)
Council of Prenatal Nurses
Clinical Practice Guidelines, clinical pathways
Agency policies, procedures, protocols
JCAHO
29. Math
30. Contemporary childbirth (P22) is family centered, offers choices about birth, and
recognizes the needs of siblings and other family members.
The

self-care movement (P 22) emerged in the late 1960s, emphasizes personal health
goals, a holistic approach, and preventive care.