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Chapter 1 The Past, Present, and Future Elsevier items and derived items © 2015, Chapter 1 The Past, Present, and Future Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Lesson 1. 1 Objectives 1. Recall the contributions of persons in history to the Lesson 1. 1 Objectives 1. Recall the contributions of persons in history to the fields of maternity and pediatric care. 2. List the organizations concerned with setting standards for the nursing care of maternity and pediatric patients. 3. Name two international organizations concerned with maternity and pediatric care. Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 2

Objectives (cont. ) 4. State the influence of the federal government on maternity and Objectives (cont. ) 4. State the influence of the federal government on maternity and pediatric care. 5. List three federal programs that assist mothers and infants. 6. Understand the legal responsibilities of the nurse to report certain diseases or conditions to the public health authorities. Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3

Obstetrics (p. 2) Branch of medicine ØPhysician is called an obstetrician Pertains to the Obstetrics (p. 2) Branch of medicine ØPhysician is called an obstetrician Pertains to the care of women during ØPregnancy ØChildbirth ØPostpartum period (puerperium) Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4

Maternity Nursing (p. 3) Care given by a nurse ØTo the expectant family • Maternity Nursing (p. 3) Care given by a nurse ØTo the expectant family • Before • During • Following birth Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5

Pediatrics (p. 2) Branch of medicine Ø Physician is called a pediatrician Pertains to Pediatrics (p. 2) Branch of medicine Ø Physician is called a pediatrician Pertains to child development and health care Treatment of illness/disease Ø Specific to childhood Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6

Family-Centered Care (p. 2) Recognizes the strength and integrity of the family unit Core Family-Centered Care (p. 2) Recognizes the strength and integrity of the family unit Core of planning and implementing health care The family as caregivers and decision-makers Ø Integral part of both obstetric and pediatric nursing Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7

Nurse’s Role in Maternity and Pediatrics (p. 3) Enter into a contract or partnership Nurse’s Role in Maternity and Pediatrics (p. 3) Enter into a contract or partnership with the family The goal is for the family to achieve and maintain control over the health of all of its members Ø Empowerment Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8

The Past: Maternity Care (p. 2) Europe Ø Soranus, a Greek physician —father of The Past: Maternity Care (p. 2) Europe Ø Soranus, a Greek physician —father of obstetrics • Practiced podalic version • Procedure used to rotate the second fetus to a breech (footling) position to help with delivery Ø Scientific exploration ended at the beginning of the Dark Ages Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9

19 th Century Discoveries (p. 2) Karl Credé (1819 -1892) Ø Recommended instillation of 19 th Century Discoveries (p. 2) Karl Credé (1819 -1892) Ø Recommended instillation of silver nitrate into newborn’s eyes to prevent blindness from gonorrhea Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 10

19 th Century Discoveries (cont. ) (p. 2) Ignaz Semmelweis (1818 -1865) Discovered relationship 19 th Century Discoveries (cont. ) (p. 2) Ignaz Semmelweis (1818 -1865) Discovered relationship between puerperal fever (Childbed fever – deaths among women in wards and new mothers) and examinations by physicians and students fresh from the cadaver labs Ø Found puerperal fever was a form of sepsis; was contagious and transmitted through unwashed hands Ø His work was published in 1861, but not accepted until 1890. Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11

19 th Century Discoveries (cont. ) (p. 2) Louis Pasteur (1822 -1895) Confirmed puerperal 19 th Century Discoveries (cont. ) (p. 2) Louis Pasteur (1822 -1895) Confirmed puerperal fever caused by bacteria Ø Spread by improper handwashing and contact with contaminated objects Ø Joseph Lister (1827 -1912) Experimented with chemical means to prevent infection Ø Revolutionized surgical practice • Introduced concept of antiseptic surgery Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12

Middle Ages and Children (p. 2) Culture of a society has strong influence on Middle Ages and Children (p. 2) Culture of a society has strong influence on standards of child care The concept of childhood did not exist Infancy lasted until around age 7 Children valued only for their productivity Did not attend school Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13

 Oliver Wendell Holmes (1809 -1894) United States Wrote in support of Semmelweis’ theory Oliver Wendell Holmes (1809 -1894) United States Wrote in support of Semmelweis’ theory about germs Ø Highly criticized by his colleagues for this Ø “Germ theory” slowly took hold and was proven to save the lives of mothers and babies Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14

The Past: Pediatrics Abraham Jacobi (1830 -1919) Father of American pediatrics Ø Established pediatric The Past: Pediatrics Abraham Jacobi (1830 -1919) Father of American pediatrics Ø Established pediatric nursing as a specialty Ø Founded children’s hospitals Ø Developed separate units for children in foundling homes and general hospitals Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15

The 1900 s (p. 3) Early in the century, the majority of births were The 1900 s (p. 3) Early in the century, the majority of births were in the home High morbidity/mortality at lying-in hospitals due to poor conditions and care Hospitals began to develop training programs for nurses By the 1950 s, hospital practice in obstetrics was well-established By 1960, more than 90% of births in the U. S. were in hospitals Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16

The Birth Process in the 1960 s (p. 3) Fathers waited outside of the The Birth Process in the 1960 s (p. 3) Fathers waited outside of the delivery room Mothers were placed in a “twilight sleep” and had little involvement in the delivery process The infant was kept from parents for hours after birth, which delayed the parentinfant bonding process Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17

Advocates of Change in the Mother. Infant Bonding Process (p. 3) American College of Advocates of Change in the Mother. Infant Bonding Process (p. 3) American College of Nurse-Midwives (ACNM) Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) American Nurses Association (ANA), Division of Maternal Nursing Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18

International Organizations Concerned with Children (p. 3) UNICEF—United Nations International Children’s Fund WHO—World Health International Organizations Concerned with Children (p. 3) UNICEF—United Nations International Children’s Fund WHO—World Health Organization Ø Advocate for children’s rights, including health care and education Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19

International Year of the Child 1979 (p. 3) The United Nations Declaration of the International Year of the Child 1979 (p. 3) The United Nations Declaration of the Rights of the Child Originated in 1923 in Geneva by Save the Children Ø Passed in 1959 Ø Reaffirmed in 1980 Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20

Government Influences in Maternity and Pediatric Care (pp. 3 -4) Sheppard-Towner Act of 1921 Government Influences in Maternity and Pediatric Care (pp. 3 -4) Sheppard-Towner Act of 1921 Ø Title V of the Social Security Act Ø Funded state-managed programs for maternity care Provided funds for maternity care Title V amendment of the Public Health Services Act Ø Established maternal-infant care centers in public clinics Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21

Fair Labor Standards Act of 1938 (p. 4) Established a general minimum working age Fair Labor Standards Act of 1938 (p. 4) Established a general minimum working age 16 years for nonhazardous jobs Ø 18 years for hazardous jobs Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22

Government Influences in Maternity and Pediatric Care (cont. ) (pp. 3 -5) Title XIX Government Influences in Maternity and Pediatric Care (cont. ) (pp. 3 -5) Title XIX of the Medicaid Program Ø Increased access to care by indigent women Head Start Ø Established to increase educational exposure of preschool children Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23

Government Influences in Maternity and Pediatric Care (cont. ) (pp. 3 -5) National Center Government Influences in Maternity and Pediatric Care (cont. ) (pp. 3 -5) National Center for Family Planning Ø Provides contraceptive information WIC Ø Provides supplemental food and education for families in need of assistance Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24

Federal Legislation Enacted to Protect Children (p. 3) 1974 -75—Child Abuse Prevention and Treatment Federal Legislation Enacted to Protect Children (p. 3) 1974 -75—Child Abuse Prevention and Treatment Act 1975—Education for All Handicapped Children 1982—Community Mental Health Center funded Missing Children’s Act—provided for a national clearinghouse for missing children Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25

Family Medical Leave Act (FMLA) (p. 3) Became law in 1993 Allows employees to Family Medical Leave Act (FMLA) (p. 3) Became law in 1993 Allows employees to take up to 12 weeks of unpaid leave to care for a newborn or family member Employee cannot lose benefits or pay status if they take FMLA Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26

HIPAA Healthcare Information Portability and Accountability Act (HIPAA) of 1996 Law enacted in 2003 HIPAA Healthcare Information Portability and Accountability Act (HIPAA) of 1996 Law enacted in 2003 Ø Set standards to protect a patient’s health information Ø Allowed patients access to and control over their health information Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27

HIPAA (cont. ) (p. 4) Health care personnel are expected to maintain strict confidentiality HIPAA (cont. ) (p. 4) Health care personnel are expected to maintain strict confidentiality Can only access minimum necessary protected health information Regulations mandate that the names and personal information of patients be kept in a secure and private place Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28

HITECH (p. 4) Health Information Technology for Economic and Clinical Health Act (HITECH) Law HITECH (p. 4) Health Information Technology for Economic and Clinical Health Act (HITECH) Law enacted in 2009 Ø Protects electronic health records Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29

Patient Protection and Affordable Care Act of 2010 (p. 4) Known as the Affordable Patient Protection and Affordable Care Act of 2010 (p. 4) Known as the Affordable Care Act Expands health care coverage to millions who were previously uninsured Under the law, those with preexisting conditions can no longer be denied access to affordable health insurance coverage U. S. Supreme Court upheld constitutionality Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 30

Federal Laws and Programs Affecting Public Health (p. 4) Pure Food and Drug Act Federal Laws and Programs Affecting Public Health (p. 4) Pure Food and Drug Act Ø Controls medicines, poisons, and the purity of food Programs include Disaster relief Ø Care and rehabilitation of handicapped children Ø Foster child care, family day care Ø Protective services for abused or neglected children Ø State licensing of health care providers Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31

The Children’s Bureau (p. 4) Established by Lillian Wald in 1912 Focused attention on The Children’s Bureau (p. 4) Established by Lillian Wald in 1912 Focused attention on problems of infant mortality Was followed by maternal mortality Led to birth registration in all states In the 1930 s, led to development of hot lunch programs in the schools Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 32

White House Conferences (p. 4) First one in 1909, Theodore Roosevelt was president Continues White House Conferences (p. 4) First one in 1909, Theodore Roosevelt was president Continues to be held every 10 years 1930—Children’s Charter was established 1980—involved all states in an effort to see what problems families were facing in various parts of the country Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 33

Department of Public Health (p. 4) Responsible for disease prevention and control Community Statewide Department of Public Health (p. 4) Responsible for disease prevention and control Community Statewide Nationally Includes laws about licensing of health care providers (i. e. , physicians and pharmacists) Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34

Department of Public Health (cont. ) (p. 4) Pure Food and Drug Act Controls Department of Public Health (cont. ) (p. 4) Pure Food and Drug Act Controls medicines, poisons, and the purity of food Programs include Disaster relief Ø Care and rehabilitation of handicapped children Ø Foster child care Ø Protective services for abused or neglected children Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35

Reportable Situations (p. 6) Nurse has legal responsibility to report certain diseases or conditions Reportable Situations (p. 6) Nurse has legal responsibility to report certain diseases or conditions to local public health authorities Ø An illness that poses a health hazard to the public Suspected child abuse or suicidal behavior must be reported immediately to protect the child from further harm Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36

The Present: Family-Centered Care (p. 6) Family involvement during pregnancy and birth Ø Necessary The Present: Family-Centered Care (p. 6) Family involvement during pregnancy and birth Ø Necessary for bonding and support Three separate sections of the maternity unit Labor-delivery Ø Postpartum Ø Newborn nursery Ø Some facilities have merged all three areas into one Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 37

Birthing Centers (p. 6) Provide comprehensive care Antepartum Ø Labor-delivery Ø Postpartum Ø Mothers’ Birthing Centers (p. 6) Provide comprehensive care Antepartum Ø Labor-delivery Ø Postpartum Ø Mothers’ classes Ø Lactation classes Ø Follow-up family planning Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38

Financial Considerations (p. 6) Cost-containment Regulate expenditures Early discharge postpartum Elsevier items and derived Financial Considerations (p. 6) Cost-containment Regulate expenditures Early discharge postpartum Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39

Changing Perceptions of Childbearing (p. 6) Normal, healthy event Prepared for changes taking place Changing Perceptions of Childbearing (p. 6) Normal, healthy event Prepared for changes taking place during pregnancy Prepared for changes in family dynamics after delivery Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 40

Midwives (p. 6) First school of nurse-midwifery Ø Opened in New York City, 1932 Midwives (p. 6) First school of nurse-midwifery Ø Opened in New York City, 1932 Certified Nurse-Midwife (CNM) Registered nurse Ø Graduate from an accredited midwife program Ø National certification Ø Provides comprehensive prenatal and postnatal care Ø Attends uncomplicated deliveries Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 41

Role of the Consumer (p. 6) Early 1960 s recognized need for education and Role of the Consumer (p. 6) Early 1960 s recognized need for education and involvement of expectant parents Fathers now attend births Liberal visiting hours Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 42

Cultural Considerations (pp. 6 -8) Culture—socially inherited characteristics Becomes a patterned expression of thoughts Cultural Considerations (pp. 6 -8) Culture—socially inherited characteristics Becomes a patterned expression of thoughts and actions Ø Also called traditions Consists of Values Ø Beliefs Ø Practices Ø Shared by members of a group Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 43

Awareness, Sensitivity, Competence (p. 7) Ask the patient what she considers normal practice Questions Awareness, Sensitivity, Competence (p. 7) Ask the patient what she considers normal practice Questions can include How she views her pregnancy Ø If she views birth as dangerous Ø What kind of help she will need before and after delivery Ø The role her immediate or extended family plays in the pregnancy and birth Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 44

Cultural Consideration (p. 9) Cultural beliefs affect how a family perceives health and illness Cultural Consideration (p. 9) Cultural beliefs affect how a family perceives health and illness Holistic nursing includes Being alert for cultural diversity Ø Incorporating this information into nursing care plans Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 45

Technology and Specialty Expertise (p. 8) Number of chronically ill children continues to grow Technology and Specialty Expertise (p. 8) Number of chronically ill children continues to grow Increased need for technology now in the home setting Mechanical ventilators Ø Tracheostomy Ø Intravenous fluid administration Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 46

Genomics (p. 8) Study of the functions of all of the genes in the Genomics (p. 8) Study of the functions of all of the genes in the human body “Gene” therapy—used to replace missing genes or alter defective genes Earlier diagnosis, intervention, patient education Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 47

Health Care Delivery Systems (pp. 8 -9) Cost-containment a driver for change Diagnosis-related groups Health Care Delivery Systems (pp. 8 -9) Cost-containment a driver for change Diagnosis-related groups (DRGs): determine payment for a hospital stay based on the diagnosis Push for early discharge Established need for nurse case managers and utilization review nurses Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 48

Nursing Care (pp. 9 -10) Adherence to standard precautions (infection prevention) Emphasis on data Nursing Care (pp. 9 -10) Adherence to standard precautions (infection prevention) Emphasis on data entry and retrieval in electronic medical record Families smaller and single-parent households increasing Tailor teaching to family needs, culture, and ethnicity Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 49

The Pediatric Nurse as Advocate (p. 10) An advocate is a person who intercedes The Pediatric Nurse as Advocate (p. 10) An advocate is a person who intercedes or pleads on behalf of another If the nurse believes the child’s needs are not being met, the nurse must seek assistance The nurse must also document his/her efforts to seek instruction/assistance, including from whom it was sought Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 50

Health Promotion (p. 10) Preventing illness or disability—cost-effective Chronically ill children live well into Health Promotion (p. 10) Preventing illness or disability—cost-effective Chronically ill children live well into adulthood Ø Increased need for complex medical care, in both hospital and home settings Mainstreaming physically or mentally challenged children to assist them in becoming as independent as possible and integrated into society Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 51

Advanced-Practice Roles in Maternity and Pediatric Nursing (pp. 10 -11) Certified Nurse Midwife (CNM) Advanced-Practice Roles in Maternity and Pediatric Nursing (pp. 10 -11) Certified Nurse Midwife (CNM) Clinical Nurse Specialist (CNS) Neonatal Nurse Practitioner (NNP) Pediatric Nurse Practitioner (PNP) School Nurse Practitioner Family Nurse Practitioner (FNP) Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 52

Nursing Tools (p. 11) Steps of the nursing process Assessment/data collection Ø Nursing diagnosis Nursing Tools (p. 11) Steps of the nursing process Assessment/data collection Ø Nursing diagnosis Ø Outcomes identification Ø Planning Ø Implementation Ø Evaluation Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 53

Nursing Care Plans (pp. 11 -12) Used as an instrument of communication among caregivers Nursing Care Plans (pp. 11 -12) Used as an instrument of communication among caregivers Focuses on the individual patient Provides a “picture” Helps the nurse prioritize the needs of the patient Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 54

Clinical Pathways (p. 12) Collaborative guidelines define care within a timeline Expected progress of Clinical Pathways (p. 12) Collaborative guidelines define care within a timeline Expected progress of the patient Ø Becomes the standard of care Deviations easier to identify, called variances Use improves quality of care Reduces unnecessary hospitalization time Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 55

Statistics (pp. 12 -14) The gathering and analyzing of numerical data The nurse can Statistics (pp. 12 -14) The gathering and analyzing of numerical data The nurse can use statistics to Become aware of birthing trends Ø Determine populations at risk Ø Evaluate the quality of prenatal care Ø Compare relevant information from state to state Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 56

NIC, NOC, NANDA-I (pp. 12 -14) NANDA-I—North American Nursing Diagnosis Association International Ø NOC—Nursing NIC, NOC, NANDA-I (pp. 12 -14) NANDA-I—North American Nursing Diagnosis Association International Ø NOC—Nursing Outcomes Classification Ø Provides standardized language for nursing diagnoses Focus on patient behavior NIC—Nursing Interventions Classification Ø Focus on nursing action Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 57

Comparison of Medical and Nursing Diagnoses (p. 11) Gestational diabetes mellitus Ø Deficient knowledge Comparison of Medical and Nursing Diagnoses (p. 11) Gestational diabetes mellitus Ø Deficient knowledge related to gestational diabetes mellitus (GDM) and its effects on pregnant woman and fetus; manifested by crying, anxiety Cystic fibrosis Ø Ineffective airway clearance related to mucus accumulation; manifested by rales, fatigue Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 58

Critical Thinking in Nursing (p. 15) Requires the application of creativity and ingenuity to Critical Thinking in Nursing (p. 15) Requires the application of creativity and ingenuity to solve a problem Purposeful Goal-directed Based on scientific evidence Problem-solving is effective and prevention occurs A skill that must be learned Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 59

Process of Critical Thinking (p. 15) Identify the problem Differentiate fact from assumption Check Process of Critical Thinking (p. 15) Identify the problem Differentiate fact from assumption Check reliability and accuracy of data Determine relevant from irrelevant Identify possible conclusions/outcomes Set priorities and goals Evaluate response of patient Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 60

Evidence-Based Practice (p. 14) Combines information with critical thinking process Includes patient needs Leads Evidence-Based Practice (p. 14) Combines information with critical thinking process Includes patient needs Leads to safe and effective nursing care Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 61

Documentation (p. 15) It is the LEGAL responsibility of the nurse Facilities differ on Documentation (p. 15) It is the LEGAL responsibility of the nurse Facilities differ on the type of charting methods Paper Ø Computerized Ø Regardless of method, if you did not document the care you provided, medicolegally, you did not do it! Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 62

Communication (p. 16) National patient safety goal One example—SBAR Situation Ø Background Ø Assessment Communication (p. 16) National patient safety goal One example—SBAR Situation Ø Background Ø Assessment Ø Recommendation Ø Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 63

The Future: Health Care Reform (p. 16) Conflict exists between cost-containment and quality of The Future: Health Care Reform (p. 16) Conflict exists between cost-containment and quality of care Having health insurance does not guarantee access to expensive care Those who cannot afford health care often do not seek preventive services Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 64

Community-Based Nursing (pp. 16 -17) Challenge is to provide safe, caring, costeffective, quality care Community-Based Nursing (pp. 16 -17) Challenge is to provide safe, caring, costeffective, quality care to mothers, infants, children, and families The nursing care plan must expand to a family care plan Therapeutic care is also provided in the home setting; therefore, educating family members on how to care for their loved one is essential Elsevier items and derived items © 2015, 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 65