【PPT文档】185妇产科护理课件-A-GLIMPSE-ATMATERNITY-NURSING-in-the-21st-CENTURY.ppt

A GLIMPSE AT MATERNITY NURSING in the 21st CENTURY K.L.Ringgenberg,RNC,MSN,WHNPShanghai Jiao Tong University SONApril 5,2006Maternity Nursing in the 21st CenturyAntepartum CareIntrapartum CareTechnology in OB“Partum”Parturition:birthPartum:regarding time period to the birthAntepartum:before birth or prenatalIntrapartum:during the birth processPostpartum:after the birth(usually regarded as the first 30 days)Antepartum Care in the 21st CenturyCare beginning before the birth“Prenatal”careHistory of Antepartum CarePrior to 1925,no formal practice of antepartum care.2nd Century-warned against violent movements to prevent ROM,sexual intercourse harmful to pregnancy1513-first published OB text(Germany)1700s-forceps invented,male midwife developed theories for midwives in London1700s into 1800s-births attended by female community in US due to priceHistory-continued20th Century-at the turn of the century,50%of births in US conducted by midwivesHome to Hospital-History1900 5%USA babies born in hospital1940 50%1970 99%2005 99%Fast Facts-Maternal1900-maternal death rate 6-9/1000 USA40%of those deaths were due to infection2004-death rate at 8-9/100,000 USA1989-maternal death rate in China 95/100,0002004-48.3/100,000Fast Facts-Infants1900-30%of infants in USA major cities died before 1st birthday2000s-infant mortality rate7/1000 USA1950s-infant mortality rate 300/1000 China2001-33/1000 in China(reportedly as low as 5/1000 in Beijing and Shanghai)20th Century InfluencesHigh infant&maternal mortality rates1914-coined term“nurse midwife”Today-nurse midwife is defined as a RN with an advanced certification and masters degree in midwifery1925-Childrens Bureau in the US recommended antepartum care to decrease mortality rates20th Century Influences1965-Nurse Practitioner role(Peds)1972-NP role expanded to OB/GYN1989-US Public Health Panel examined prenatal care-recommendations made1950-2000-improvements in mortality due to changes in meds,antibiotics,blood products,nutrition-not prenatal care itself.21st Century-Major Shifts caused byManaged careRise of collaborative health care teamsMalpractice crisesIncreased concerns for antepartum care and quality of careInternet and computer technology21st Century-more factorsIncreased maternal ageART-assisted reproductive technologiesAdvances in genetic counseling and prenatal diagnosisEvidence-based careEfforts to meet goals of Healthy People 2010 and Safe Motherhood Initiatives in developing countriesRising awareness of CAM(complimentary&alternative medicines)Twins 4/1000West Triplets 1/7,000-10,000Skopec Quads 1/600,000Intrapartum Care in the 21st CenturyCare provided during the birth processVaginal DeliveryCesarean SectionWhere do delivers occur?96%-Hospital2.4%-Birthing Centers1%-Home*Delivers in US by CNMs Cesarean SectionsC/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 hospitalsChina 50%in some hospitalsThe jury is still out!Global Look70%on average-births attended by CNM in Western Europe85%-Holland(which WHO designates as ideal or#1 ranking)10%-United StatesRefer to previous stats on mortality/morbidities.Nurse-MidwiferyMidwifery 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 MidwifeRegistered NurseAdvanced Practice Nurse(APN)Masters degree in NursingSpecializing in MidwiferyCredentialing necessary for state licensingDefining AttributesCNM-provides prenatal&gyn care to normal healthy(low risk)women;do delivers and postpartum care.Practice in hospital setting,clinics,birthing centers and homesMay practice independently or in collaboration with a physicianCNMs associated with-Personalized careHigh-touchLow-techComforting careAlternative approachesCompetenciesObtain admission history&physicalAssessments of mother and fetusOrder or initiate tests,medications or proceduresPerform ongoing exams of labor statusAttend the deliveryAttending labor and birthProvide safe,satisfying carePatient and family are active participantsInformed consentAppropriate use of technologyActivitiesEvaluationComfortAssistanceSupportReassuranceManagement of complicationsSettingsHomeBirthing CentersHospitals-Labor,Delivery&Recovery Rooms(LDR),LDRP(post-partum),Single room maternity care,Birthing roomsTechnology for the 21st CenterBirthing roomsDelivery roomsOperative suites Birthing SuiteC-Section RoomsLatest TechnologiesElectronic Fetal Monitoring(EFM)UltrasonographyInfusion pumpsElectronic monitoring devices:1.Non-invasive 2.InvasiveFetal SurgeriesElectronic Fetal MonitoringIntermittent or continuous assessment of fetal heart rate(FHR)and uterine activity(UA)Goal-to assist in identifying the fetus at riskEFMEFMExternal(indirect)methodInternal(direct)Antepartum testing with EFMNST-non-stress testCST-contraction stress testBPP-biophysical profileAll assess fetal well-beingIntrapartum EFMExternal-tocodynamometer and transducerInternal-spiral electrode and intrauterine pressure catheterFetal pulse oximetryEmerging EFM TechnologyComputer analysisLack of clear definitions and standards at this point of fetal heart rate patterns,however,due to come out this yearElectronic Health RecordComputersPaperless chartsIntegrates all aspects of assessment,intervention and evaluationDopplerUltrasonographyDone at all stages of pregnancyTransvaginal or transabdominal approachDone for maternal or fetal indicationsDone in office,clinic,mobile centers,ob unit,L&DIndicationsMaternal diseasesMultiple gestationsFetal growthEstablishment of fetal agePlacental location and gradingAssess fetal well-being(BPP)Pre-term labor-cervical lengthsIts a Girl!3-D&4-D Ultrasound3-D Early GestationS/D RatiosPulse OximetryV/S MonitorsElectronic B/P MonitorCritically Ill OBContinuous cardiac monitoringInvasive hemodynamic monitoringCVPArterial linesPulmonary artery linesVentilatorOB Critical Care UnitFlight NursesFlight NurseGeneticsHuman Genome ProjectRelationship to Maternity NursingAdvanced maternal agePatterns of inheritancePrenatal testingGenetic counselingEthics and otherTelemedicineTelemetryMonitoring-FHRComputerUltrasound imagesTelephoneInformaticsITComputersPatient access to informationNursing informaticsAutomated Medication Dispensing MachinesCut down on errorsBar codesChart medicationsLabor savingAnd moreSummaryPast,present,future antepartum care aspectsIntrapartum care in the 21st Century as it relates to nursing and CNMTechnology today in maternity nursing with a glimpse into the future as wellWhat is in your nursing future for the 21st Century?Questions or comments?