1
Week 1: Maternal Child Health
Care; Ethical Issues (5-7)
Understand the term infant and maternal mortality rates
- Infant
- Death before the first birthday
- Leading cause of infant deaths:
- Congenital malformations and chromosomal abnormalities
- Maternal
- death of a woman during pregnancy or within 42 days of pregnancy termination
caused by conditions aggravated by the pregnancy or associated medical
treatments
- Black women higher risk of death than white and hispanic
Describe current issues and trends that affect perinatal nursing and
women’s health nursing
- Perinatal clinical nurses with advanced education and licensure are prepared to provide
primary care for women and children as CNMs and NPs
- AWHONN supports nurses’ rights
- Association of Women's Health, Obstetric and Neonatal Nurses
- Federal law: right to refuse to assist
- AWHONN core values (Box 2-2, 2-3): CARING acronym
- Caring
- Accountability
- Respect
- Integrity
- Nursing Excellence
- Generation of Knowledge
- Maternity is most litigious practice area
- Often maternity healthcare related issues are brought into court
- EBP (evidence based practice)
- ”failure to communicate”=most malpractice suits against nurses
- legally important: failure to assess correctly
Cultural difference when providing for care
- Set aside biases when caring for patients
- Black women more likely to suffer from preterm birth than hispanic women or white
women
- Maternal mortality rate is 2x greater for black women than white and hispanic
- Black women twice as likely to experience severe maternal complications
- American indian and indigenous native have 3-4x higher MMR
, 2
Understand ethical terms and know examples of dilemmas faced in
this discipline
- Nurses in maternity field advocate for the mother
- In difficult situations where the mother and the infant may either suffer or benefit
from a decision, nurses should advocate for the mother
- Example: mother is pregnant but has cancer and needs treatment but
treatment could be detrimental for the fetus. Do we hold the meds?
- Obligation fetus depends on the decisions made by mom
- Nurse might not agree with mom’s decision as it might interfere with their own beliefs
- Culture concerns, religion, spiritual beliefs, differing attitudes towards health care
- Topics of ethical dilemma
- Court-ordered treatment
- Withdrawal of life support
- Harvesting of fetal organs or tissue
- In vitro fertilization and decisions for disposal of remaining fertilized ova
- Allocation of resources in pregnancy care during the previable period
- Fetal surgery
- Treatment of genetic disorders or fetal abnormalities found on prenatal screening
- Equal access to prenatal care
- Maternal rights versus fetal rights
- Extraordinary medical treatment for pregnancy complications
- Using organs from an anencephalic (no hemispheres & large part of skull absent)
infant
- Genetic engineering
- Cloning
- Surrogacy
- Drug testing in pregnancy
- Sanctity of life versus quality of life for extremely premature or severely disabled
infants
- Substance abuse in pregnancy
- Borderline viability: to resuscitate or not
- Fetal reduction
- Preconception gender selection
- Sex selection
Ethics in neonatal care
- Counterbalancing in making decision with family to decide which is the best option and
do no harm to the neonate if it will suffer
- veracity (honesty) to parents
- autonomy: respect parental decisions, facilitate communication and collaboration but
duty to neonate
Social disparity
- SDOH
, 3
- health equity
- ANA code of ethics
Approach for making ethical decisions: Jonsen Model (4 topics model)
1. medical indications
- What is the situation and will the patient benefit from treatment?
2. patient preferences
- Wishes and values from patient
3. quality of life
- Will treatment affect quality of life
4. contextual features
- Pt situation in relations to SOD, religion, culture, etc
Week 2: Genetics, Conception, and
Fetal Development
Genetics- know the differences among genetic inheritance along
with some examples of anomalies
- Pattern of inheritance
- Recessive: need 2 copies
- Sickle cell anemia: distorted red blood cells and oxygen carrying capacity
is diminished
- Cystic fibrosis: mucus plug on the bronchial tree
- Tay sachs: degeneration of neurons
- Phenylketonuria: unable to metabolize phenylalanine
- Dominant: need only 1 copy
- Huntington’s disease: uncontrollable muscle spasm
- Sex linked
- Y-linked: can only be passed onto the son
- X-linked: daughters are carriers but sons would be affected
- Hemophilia: impaired chemical clotting
- Duchenne’s muscular dystrophy: replacement of muscle tissue
with scar tissue/ adipose
- May choose to get carrier testing
- used to identify individuals who carry one copy of a gene mutation when there is
a family hx of a genetic disorder
Examples of teratogens and when does it cause the most impact?
- Teratogens: drugs, viruses, infections, or other exposures that have the potential to
cause embryonic or fetal developmental abnormality
Week 1: Maternal Child Health
Care; Ethical Issues (5-7)
Understand the term infant and maternal mortality rates
- Infant
- Death before the first birthday
- Leading cause of infant deaths:
- Congenital malformations and chromosomal abnormalities
- Maternal
- death of a woman during pregnancy or within 42 days of pregnancy termination
caused by conditions aggravated by the pregnancy or associated medical
treatments
- Black women higher risk of death than white and hispanic
Describe current issues and trends that affect perinatal nursing and
women’s health nursing
- Perinatal clinical nurses with advanced education and licensure are prepared to provide
primary care for women and children as CNMs and NPs
- AWHONN supports nurses’ rights
- Association of Women's Health, Obstetric and Neonatal Nurses
- Federal law: right to refuse to assist
- AWHONN core values (Box 2-2, 2-3): CARING acronym
- Caring
- Accountability
- Respect
- Integrity
- Nursing Excellence
- Generation of Knowledge
- Maternity is most litigious practice area
- Often maternity healthcare related issues are brought into court
- EBP (evidence based practice)
- ”failure to communicate”=most malpractice suits against nurses
- legally important: failure to assess correctly
Cultural difference when providing for care
- Set aside biases when caring for patients
- Black women more likely to suffer from preterm birth than hispanic women or white
women
- Maternal mortality rate is 2x greater for black women than white and hispanic
- Black women twice as likely to experience severe maternal complications
- American indian and indigenous native have 3-4x higher MMR
, 2
Understand ethical terms and know examples of dilemmas faced in
this discipline
- Nurses in maternity field advocate for the mother
- In difficult situations where the mother and the infant may either suffer or benefit
from a decision, nurses should advocate for the mother
- Example: mother is pregnant but has cancer and needs treatment but
treatment could be detrimental for the fetus. Do we hold the meds?
- Obligation fetus depends on the decisions made by mom
- Nurse might not agree with mom’s decision as it might interfere with their own beliefs
- Culture concerns, religion, spiritual beliefs, differing attitudes towards health care
- Topics of ethical dilemma
- Court-ordered treatment
- Withdrawal of life support
- Harvesting of fetal organs or tissue
- In vitro fertilization and decisions for disposal of remaining fertilized ova
- Allocation of resources in pregnancy care during the previable period
- Fetal surgery
- Treatment of genetic disorders or fetal abnormalities found on prenatal screening
- Equal access to prenatal care
- Maternal rights versus fetal rights
- Extraordinary medical treatment for pregnancy complications
- Using organs from an anencephalic (no hemispheres & large part of skull absent)
infant
- Genetic engineering
- Cloning
- Surrogacy
- Drug testing in pregnancy
- Sanctity of life versus quality of life for extremely premature or severely disabled
infants
- Substance abuse in pregnancy
- Borderline viability: to resuscitate or not
- Fetal reduction
- Preconception gender selection
- Sex selection
Ethics in neonatal care
- Counterbalancing in making decision with family to decide which is the best option and
do no harm to the neonate if it will suffer
- veracity (honesty) to parents
- autonomy: respect parental decisions, facilitate communication and collaboration but
duty to neonate
Social disparity
- SDOH
, 3
- health equity
- ANA code of ethics
Approach for making ethical decisions: Jonsen Model (4 topics model)
1. medical indications
- What is the situation and will the patient benefit from treatment?
2. patient preferences
- Wishes and values from patient
3. quality of life
- Will treatment affect quality of life
4. contextual features
- Pt situation in relations to SOD, religion, culture, etc
Week 2: Genetics, Conception, and
Fetal Development
Genetics- know the differences among genetic inheritance along
with some examples of anomalies
- Pattern of inheritance
- Recessive: need 2 copies
- Sickle cell anemia: distorted red blood cells and oxygen carrying capacity
is diminished
- Cystic fibrosis: mucus plug on the bronchial tree
- Tay sachs: degeneration of neurons
- Phenylketonuria: unable to metabolize phenylalanine
- Dominant: need only 1 copy
- Huntington’s disease: uncontrollable muscle spasm
- Sex linked
- Y-linked: can only be passed onto the son
- X-linked: daughters are carriers but sons would be affected
- Hemophilia: impaired chemical clotting
- Duchenne’s muscular dystrophy: replacement of muscle tissue
with scar tissue/ adipose
- May choose to get carrier testing
- used to identify individuals who carry one copy of a gene mutation when there is
a family hx of a genetic disorder
Examples of teratogens and when does it cause the most impact?
- Teratogens: drugs, viruses, infections, or other exposures that have the potential to
cause embryonic or fetal developmental abnormality
