Search

Northwestern Perinatal Center in Chicago, Illinois, developed and implemented a maternal-fetal transport system. The system is unique not only because it is in a metropolitan area but also because the transport teams are nurses only in more than 95% of the maternal-fetal transports. Rationale and design of the system, development of the team, discussion of problems, and certification process for nurses is presented.

The overall positive response of the parent participants has validated the utility of the program. Future program expansion and revision will be based on social and technological change. Participant responses to the program will be monitored continually to determine whether their needs are being met. The program clarified the role nursing personnel have in teaching maternity patients. It serves to increase the new parents' self-confidence in being able to adjust to their new roles. One possible future expansion of the program might be post-discharge group discussion sessions, supervised by nursing personnel. During those sessions, mothers could discuss feelings that they are experiencing, any difficulties they may have adapting to their new roles, and other topics they feel are relevant. Nurses would attend these sessions to serve as resource persons and group facilitators. The need for patient teaching in obstetrics is being recognized increasingly as a priority by health professionals in the field of maternal-child health. A concise and accurate means of documentation is necessary to ensure that consistent, comprehensive instructions are given to all new parents.

Twenty Vietnamese families in Salt Lake City, Utah, were interviewed concerning postpartum practices. Results show that special dietary and activity proscriptions are widely accepted for Vietnamese primiparae and less rigidly accepted for multiparae. Activity proscriptions relate to the avoidance of cold, including drafts and showers, and avoidance of sexual intercourse. Bed rest and limitation of activity were also important to the subjects. Implications for nursing practice in the inpatient obstetrical unit are presented.

The role of the nurse in early recognition of risk factors in the perinatal period is very important. The author suggests that obstetrical units use a perinatal nursing team whose role would include the careful assessment of mother and infant for risk factors during the prenatal, intrapartal, and immediate neonatal periods. The perinatal assessment guide accompanying the text offers a comprehensive compilation of data to assist in the identification of perinatal risk factors. This guide will be useful for nurses working in obstetrical units and for nursing instructors teaching student nurses maternal-newborn nursing assessment.

The professional nurse plays a major role in counseling the older couple throughout the pregnancy, labor, delivery, and puerperium. Nurses need to keep abreast of the new testing and monitoring procedures used during pregnancy and labor and delivery, and these procedures need to be explained to the pregnant couple. Individual and group teaching are ways that the nurse can counsel and support the older couple, thereby increasing their confidence in the health team and their ability to incorporate a child into their lifestyle. In this article these concerns are addressed as related to 1) physical needs and 2) psychological needs.

In using Orem's self-care framework, the nurse operates within a client-centered system which encourages the individual to be responsible for her own care. The philosophy changes from "I am here to take care of you" (maternalistic) to "I am here to assist you in taking care of yourself" (helping relationship). Even very ill or disabled persons (or their families) can be included in decision-making processes when actual self-care is not possible. Every effort must be made to have the individual's self-worth and dignity remain intact. Perhaps ultimately, credibility may be added to the words "health" and "care" in health-care delivery systems.

The development of a monitrice service as an independent nursing practice is described including design, legality, implementation into several hospitals, and response by the consumer, provider, and hospital staff. Specific information also includes orientation to hospitals, scheduling, pricing, and a description of the service.

In 1972, 50 women on a postpartum unit were interviewed to investigate responses to fetal monitoring. Not one woman interviewed had a positive initial response; 31 women had negative initial responses. In 1977, in a replication of the study, 11 women had positive initial responses, 11 had negative initial responses, and 28 had neutral initial responses. Two significant findings: 1) older women initially reacted more positively to fetal monitoring than younger women; and 2) married women initially reacted more positively to fetal monitoring than single women. This indicates a need for nurses to be more sensitive to young, single women's initial responses to fetal monitoring. In the 1977 study subsequent responses were 37 positive, 4 negative, and 9 neutral.

Nurse practitioners have endless possibilities for innovative practice. Deciding on provision of independent practice, suggestions for implementation and service, possible barriers, and solutions are discussed. Future directions for services are outlined.

Up to 30% of the current American cesarean birth rate has been attributed to routine repeat cesareans . Social and psychological issues associated both with repeat cesarean birth and with vaginal birth after a cesarean are reviewed. Current changes in the obstetrical community and among consumers are described; factors that influence the decision-making process in women planning future births are discussed; suggestions are offered to nurses who work with pregnant and laboring women who have had previous cesareans .

Self-care consumer and nursing movements have emphasized the role of the patient as an active participant in the planning and implementation of care. A nursing model that focuses on the interaction that takes place between the nurse and patient as they develop and implement a collaborative plan of care is presented. Three examples of how the model has been used in maternal-child health settings are given.

Bladder assessment is a crucial function of the postpartum nurse. Information about the rationale for and the method of performing bladder assessment is meager in nursing literature as well as in other sources. The anatomical-physiological facts about the effects of pregnancy and delivery on the urinary tract are presented. Bladder distention and the methods of ascertaining it are described, along with ways to encourage voiding. The article also covers the issues of timing and volume of voidings of the postpartum patient.

Nursing care planning is not a new concept, but in contemporary nursing, this tool is taking on new meaning. In an area such as labor and delivery, the concept of the nursing process must be scrutinized and adapted to facilitate its usefulness in providing optimum care of the parturient. A perspective on the scope of care planning, its benefits to the parturient, and its value and implications is presented.

Priorities for research on prepared childbirth were identified by means of a statewide Delphi Study. Sample groups of childbirth educators and maternity nurses formulated research topics and set priorities among the topics. Overall, 50 items were specified in four categories: Prenatal Education/Preparation, Labor and Delivery (normal), Postpartum, and Complications. Data were analyzed to identify priorities in each category and to determine the levels of consensus among samples. The need for research on specific areas of prepared childbirth, as perceived by these sample groups, is reported. Although a high level of consensus is apparent, interesting differences emerged.

The use of epidural anesthesia for the obstetric patient is increasing in many areas of the country. The maternity nurse needs to have a basic understanding of the technique used by the physician to initiate this type of anesthesia, and also has a responsibility to know the contraindications, possible complications, and disadvantages and advantages of epidural anesthesia. This information is presented below. Skilled nursing and medical management will reduce the potential risks of epidural anesthesia for both the mother and fetus.

One of the ways to help meet consumer demands is by utilizing nurse practitioners in private Ob/Gyn practices. To determine consumer satisfaction with a nurse practitioner in one such practice, patients were asked to fill out a response sheet after their examination by the nurse practitioner. The 86 patients felt they received a good medical examination and would be willing to see the nurse practitioner on future visits. The physician and nurse practitioner found this change in delivery of health care to be a positive experience for both patient and professional.

Many women cannot or do not take classes to prepare themselves for the birth experience. Labor room nurses can use several prepared childbirth concepts to teach these women coping techniques in the course of labor, resulting in an increase in their comfort level and, possibly, a decrease in the amount of analgesia and/or anesthesia required. Suggestions are also made regarding the role of a significant other as a labor partner for the unprepared woman.

The presence of Eisenmenger's syndrome places the pregnant patient at high risk for maternal and neonatal mortality. Since patients with Eisenmenger's syndrome generally survive until the fourth decade, some patients with this disease process will become pregnant. A discussion of cardiovascular changes that occur during pregnancy is presented with a description of the manifestations of Eisenmenger's syndrome. The literature on Eisenmenger's syndrome in pregnancy is reviewed and a therapeutic approach to the management of the pregnant patient with this disease is presented.

Unmarried adolescents with unplanned pregnancies face, along with the usual physiologic and psychologic changes, parental force and/or peer pressure to leave home and live elsewhere and a decision about the relinquishment of the infant. An important figure during the parental and immediate postpartum periods is the nurse. Nursing care required by relinquishing mothers is outlined and recommendations are given.

Pregnancy gingivitis is one of the most frequent forms of periodontal disease seen by nurses. Nurses can be an invaluable "first line of defense" against this malady. A basic dental diagnostic procedure for the nurse is presented in this paper.

A 24-item tool, using a Likert attitudinal scale, was developed to measure labor and delivery nurses' attitudes toward fetal monitoring and was administered to 124 nurses. For each of the 24 attitude statements, cumulative responses were over 50% positive at least. Fifty-two percent of the nurses felt that routine continuous monitoring of all labor patients would be ideal, and 88% felt that the fetal surveillance achieved by monitoring cannot be matched by intermittent auscultation.

Existing parental and professional caring patterns are explored in an attempt to lay a foundation for the development of culturally relevant perinatal programs. Beliefs about bonding behavior are discussed as well as exploring whether this new knowledge is consistent with cross-cultural adaptations to the birth process. New rules and customs being introduced by professionals may be fostering a "detachment" phenomenon rather than the desired result of bonding behavior between parent and infant. Finally, a method of examining culturally divergent health beliefs and practices is discussed as a means of evaluating whether such practices are likely to be beneficial or harmful.

In regional perinatal projects, which include emphasis on service coordination and education, nursing must be planned to coordinate with the general goals of regionalization that go beyond the limits of individual institutions. This approach was applied in one such program where the nursing departments were successfully united to develop nursing care standards. A multifaceted educational program, based on these standards and a survey of 200 nurses, is in operation. This experience suggests that it is possible to organize perinatal nursing care throughout regions as long as due consideration of hospital individuality and autonomy is extended.