* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download MATERNITY NURSING in the 21st CENTURY
Survey
Document related concepts
Prenatal nutrition wikipedia , lookup
Patient safety wikipedia , lookup
Prenatal development wikipedia , lookup
Catholic Church and health care wikipedia , lookup
Licensed practical nurse wikipedia , lookup
Neonatal intensive care unit wikipedia , lookup
Maternal health wikipedia , lookup
Women's medicine in antiquity wikipedia , lookup
Long-term care wikipedia , lookup
Transcript
A GLIMPSE AT MATERNITY NURSING in the 21st CENTURY K. L. Ringgenberg, RNC, MSN, WHNP Shanghai Jiao Tong University SON April 5, 2006 Maternity Nursing in the 21st Century • Antepartum Care • Intrapartum Care • Technology in OB “Partum” • Parturition: birth • Partum: regarding time period to the birth • Antepartum: before birth or prenatal • Intrapartum: during the birth process • Postpartum: after the birth (usually regarded as the first 30 days) Antepartum Care in the 21st Century • Care beginning before the birth • “Prenatal” care History of Antepartum Care • Prior to 1925, no formal practice of antepartum care. • 2nd Century-warned against violent movements to prevent ROM, sexual intercourse harmful to pregnancy • 1513-first published OB text (Germany) • 1700s-forceps invented, male midwife developed theories for midwives in London • 1700s into 1800s-births attended by female community in US due to price History- continued • 20th Century-at the turn of the century, 50% of births in US conducted by midwives Home to Hospital-History • 1900 <5% USA babies born in hospital • 1940 50% • 1970 99% • 2005 99% Fast Facts-Maternal • 1900-maternal death rate 6-9/1000 USA • 40% of those deaths were due to infection • 2004-death rate at ~8-9/100,000 USA • 1989-maternal death rate in China 95/100,000 • 2004-48.3/100,000 Fast Facts-Infants • 1900-30% of infants in USA major cities died before 1st birthday • 2000s-infant mortality rate~7/1000 USA • <1950’s-infant mortality rate 300/1000 China • 2001-33/1000 in China (reportedly as low as 5/1000 in Beijing and Shanghai) 20th Century Influences • High infant & maternal mortality rates • 1914-coined term “nurse midwife” • Today-nurse midwife is defined as a RN with an advanced certification and master’s degree in midwifery • 1925-Children’s Bureau in the US recommended antepartum care to decrease mortality rates 20th Century Influences • 1965-Nurse Practitioner role (Peds) • 1972-NP role expanded to OB/GYN • 1989-US Public Health Panel examined prenatal care-recommendations made • 1950-2000-improvements in mortality due to changes in meds, antibiotics, blood products, nutrition-not prenatal care itself. 21st Century- Major Shifts caused by • Managed care • Rise of collaborative health care teams • Malpractice crises • Increased concerns for antepartum care and quality of care • Internet and computer technology 21st Century- more factors • Increased maternal age • ART-assisted reproductive technologies • Advances in genetic counseling and prenatal diagnosis • Evidence-based care • Efforts to meet goals of Healthy People 2010 and Safe Motherhood Initiatives in developing countries • Rising awareness of CAM (complimentary & alternative medicines) Twins 4/1000 West Triplets 1/7,000-10,000 Skopec Quads 1/600,000 Intrapartum Care in the 21st Century • Care provided during the birth process • Vaginal Delivery • Cesarean Section Where do delivers occur? • 96%-Hospital • 2.4%-Birthing Centers • 1%-Home *Delivers in US by CNMs Cesarean Sections • • • • • • • • • C/S rates are at an all time high. Rates vary from country to country. Some examples: Netherlands <10% Great Britain 20% USA 24-27% HK 50% in private hospitals China ~50% in some hospitals The jury is still out!!! Global Look • 70% on average-births attended by CNM in Western Europe • 85%-Holland (which WHO designates as ideal or #1 ranking) • 10%-United States • Refer to previous stats on mortality/morbidities. Nurse-Midwifery • Midwifery model-care that safeguard the birth process as natural and holistic. • Medical (or illness) model-care is based on birth is more of a disease state. • Intrapartum/neonatal mortality rate same for birth center or hospital (term/low risk) Certified Nurse Midwife • Registered Nurse • Advanced Practice Nurse (APN) • Master’s degree in Nursing • Specializing in Midwifery • Credentialing necessary for state licensing Defining Attributes • CNM-provides prenatal & gyn care to normal healthy (low risk) women; do delivers and postpartum care. • Practice in hospital setting, clinics, birthing centers and homes • May practice independently or in collaboration with a physician CNMs associated with• Personalized care • High-touch • Low-tech • Comforting care • Alternative approaches Competencies • Obtain admission history & physical • Assessments of mother and fetus • Order or initiate tests, medications or procedures • Perform ongoing exams of labor status • Attend the delivery Attending labor and birth • Provide safe, satisfying care • Patient and family are active participants • Informed consent • Appropriate use of technology Activities • Evaluation • Comfort • Assistance • Support • Reassurance • Management of complications Settings • Home • Birthing Centers • Hospitals-Labor, Delivery & Recovery Rooms (LDR), LDRP (post-partum), Single room maternity care, Birthing rooms Technology for the 21st Center • Birthing rooms • Delivery rooms • Operative suites Birthing Suite C-Section Rooms Latest Technologies • Electronic Fetal Monitoring (EFM) • Ultrasonography • Infusion pumps • Electronic monitoring devices: 1. Non-invasive 2. Invasive Fetal Surgeries Electronic Fetal Monitoring • Intermittent or continuous assessment of fetal heart rate (FHR) and uterine activity (UA) • Goal- to assist in identifying the fetus at risk EFM EFM • External (indirect) method • Internal (direct) Antepartum testing with EFM • NST-non-stress test • CST-contraction stress test • BPP-biophysical profile All assess fetal well-being Intrapartum EFM • External-tocodynamometer and transducer • Internal-spiral electrode and intrauterine pressure catheter • Fetal pulse oximetry Emerging EFM Technology • Computer analysis • Lack of clear definitions and standards at this point of fetal heart rate patterns, however, due to come out this year Electronic Health Record • Computers • Paperless charts • Integrates all aspects of assessment, intervention and evaluation Doppler Ultrasonography • Done at all stages of pregnancy • Transvaginal or transabdominal approach • Done for maternal or fetal indications • Done in office, clinic, mobile centers, ob unit, L & D Indications • Maternal diseases • Multiple gestations • Fetal growth • Establishment of fetal age • Placental location and grading • Assess fetal well-being (BPP) • Pre-term labor-cervical lengths It’s a Girl!!! 3-D & 4-D Ultrasound 3-D Early Gestation S/D Ratios Pulse Oximetry V/S Monitors Electronic B/P Monitor Critically Ill OB • Continuous cardiac monitoring • Invasive hemodynamic monitoring • CVP • Arterial lines • Pulmonary artery lines • Ventilator OB Critical Care Unit Flight Nurses Flight Nurse Genetics • Human Genome Project • Relationship to Maternity Nursing • Advanced maternal age • Patterns of inheritance • Prenatal testing • Genetic counseling • Ethics and other Telemedicine • Telemetry • Monitoring-FHR • Computer • Ultrasound images • Telephone Informatics • IT • Computers • Patient access to information • Nursing informatics Automated Medication Dispensing Machines • Cut down on errors • Bar codes • Chart medications • Labor saving • And more Summary • Past, present, future antepartum care aspects • Intrapartum care in the 21st Century as it relates to nursing and CNM • Technology today in maternity nursing with a glimpse into the future as well What is in your nursing future for the 21st Century? Questions or comments?