OB Ch 2 EXAM |59 QUESTIONS FULLY SOLVED WITH VERIFIED CORRECT ANSWERS

SHORTAGE OF NURSES ... What is a 'Baby Boomer' and how have they effected the current nursing shortage? -People born between 1946 and 1964 -Large population group and their need for health care is expected to increase as they age. -Many nurses are baby boomers and are nearing retirement age, therefore greatly contributing to the shortage. What have nursing schools done in response to the nursing shortage? Tried to increase enrollment with government and public assistance to college and to nursing students. What has lead to a decline in the number of admitted nursing students? -Average age of nursing faculty is over 50 years old. -Limited availability of sufficient clinical and classroom facilities for basic nursing education. What factors lead to nurses leaving acute-care or leave the profession and what have the nursing facilities done about it? -Lengthy shifts are hard on aging nurses, the new parent, and the nurse trying to earn a higher degree. -Many facilities support education by offering scholarships to non-RN employees. -Still, facilities must learn to limit time demands and reduce the nurse-client ratio. ADVANCED PREPARATION FOR MATERNAL NEWBORN AND WOMEN'S HEALTH NURSES ... What has increased the need for advanced practice nurses? Greater complexity of care and the need to contain costs. Describe the role of the CNM -Certified Nurse-Midwives -Qualified to take complete health histories and perform physical examinations. They can provide complete care during pregnancy, childbirth, and the postpartum period. They attend the mother and infant as long as the mother's progress is normal. -They also provide counseling and teaching to the child-bearing family. -The practice approach of the CNM to childbirth is noninterventionist and supportive, and pregnancy and birth are regarded as normal processes. Describe the role of the NP. -Take complete health history, perform physical exams, order and interpret laboratory and other diagnostic studies, and provide primary care for health maintenance and health promotion. -Subroles include: Women's Health Nurse Practitioner, Family Nurse Practitioner, and Neonatal Nurse Practitioner. Describe the role of the Women's Health Nurse Practitioner (WHNP). -Provides wellness-focused, primary, reproductive, and gynecologic care over the life span, beginning during adolescence. -Usually does not delivery babies. Describe the role of the Family Nurse Practitioner (FNP). -Provides preventive, holistic care for young and old family members. -Care for women during uncomplicated pregnancies and provide follow-up care for mothers and infants after childbirth. -Do not assist with childbirth. Describe the role of the Neonatal Nurse Practitioner (NNP). -Assist in the care of high-risk newborns in the immediate post-birth care or in a neonatal intensive care unit. -Provide health maintenance care for infants and children who do not require the services of physicians. Describe the role of the Clinical Nurse Specialist. -Perinatal clinical nurse specialists are RNs who, through study and supervised practice at the graduate level, have become expert in the care of childrearing women with complex problems. -Subroles include: expert practitioner, educator, researcher, and consultant. -Do not provide primary care. IMPLICATIONS OF CHANGING ROLES FOR NURSES ... What are some skills nurses must develop in response to the added responsibilities of teaching and counseling? Communication, effective teaching, critical thinking, and the use of the nursing process to identify and intervene for a variety of problems. What is therapeutic communication? -Purposeful, goal directed, and focused communication that requires conscious effort and considerable practice. List some guidelines for therapeutic communication. 1. Choose a restful, distraction-free setting. 2. Being with introductions and explanation of the nurse's role. 3. Focus on meeting the needs of that family by beginning with an open-ended question. 4. Attend to nonverbal behaviors (active listening). 5. Be sensitive to cultural differences. 6. Clarify communication so each person understands what the other is saying. 7. Reflect feelings that are expressed verbally or nonverbally. What are communication techniques? Techniques that focus both on the content of the message and the feeling accompanying the message. They include clarifying, reflecting, maintaining silence, questioning, and directing. You must also be aware of blocks to communication. What are some principles that can help nurses become effective teachers? -Learning depends on the readiness of the individual/family to learn and the relevance of the content. -The learner should be involved int he educational process and not act as a passive listener or viewer. -Repetition of a skill increases retention and feelings of competence. -Praise and positive feedback are powerful motivators for learning. -Role modeling is an effective method to demonstrate behavior. -Conflicts and frustration impede learning and so, must be addressed and resolved. -Learning is enhanced when teaching is structured to present simple tasks before more complex material. -Retention is greater when material is presented in small segments over time. List some factors that influence learning. -Developmental level -Language -Culture -Previous experiences -Physical environment -Organization and skill of the instructor What are the effects of early discharge? -Requires modification in when and how you teach. -Teaching self-care and infant care during the prenatal period is emphasized. This information must be reviewed before the mother and infant leave the birth facility. Describe the nurse's role as collaborator. Nurses work together with dietitians, social workers, physicians, and others in an effort to improve care through a interdisciplinary approach. Describe the nurse's role as researcher. Nurses recognize the importance of applying valid research findings to their practices, rather than basing care decisions merely on intuition or tradition. Nurses can contribute to the body of professional knowledge by demonstrating an awareness of the value of nursing research and assisting in problem identification and data collection to identify best practices. Describe the nurse's role as advocate. The nurse is in an ideal position to humanize care and to intercede on the client's behalf. As an advocate the nurse considers the family's wishes in planning and implementing care. Describe the nurse's role as manager. Nurses may provide less direct patient care and delegate tasks such as ambulation or taking vital signs to others. As a result, nurses spend more time teaching women and families, and supervising unlicensed personnel. CRITICAL THINKING ... What is the purpose of critical thinking? To help nurses make the best clinical judgments. Nurses must also be able to apply this knowledge to specific clinical situations and thus reach conclusions that provide the effective care in each situation. What are the ABCDEs of critical thinking? (A)ssumptions (B)iases (C)losure (D)ata (E)motions Recognizing Assumptions -Assumptions are ideas, beliefs, or values that are taken for granted without basis in fact or reason. -A list of everything known about a specific situation may help in the ID of assumptions. Each item on the list should be analyze to determine whether it is true, whether it could be true, and whether it is untrue or evidence is insufficient to determine its truth. Examining Biases -Biases are prejudices that sway the mind toward a particular conclusion or course of action on the basis of personal theories or stereotypes. What questions can you ask to identify biases? "Why do you think that?" "What if this was a different client?" "What if there were different circumstances?" "What might someone who disagrees say?" "What is influencing my thinking?" Determining the Need for Closure -As a result of ambiguity, some nurses feel pressure to come to a decision or to reach closure as early as possible. -Those who feel pressure to reach an early decision or find a quick solution often do so with insufficient data. -To overcome pressure to reach an early conclusion, a conscious effort must be made to suspend judgment (reflective skepticism). What questions can you ask to avoid jumping to conclusions? "What alternatives do we have?" "What else might work?" "What information supports this?" "What effect would that have?" ""Is there good evidence to support that decision?" "Is there reason to doubt that evidence?" What questions can you ask to avoid postponing making a decision? "What signs indicate something is wrong?" "Do I need to do something about it?" "How much time do I have?" "What happens f I don't do something about this?" "What should I do first?" "What resources can help me?" *This is called Priority Setting, and it is one of the most important aspects of critical thinking in nursing. Becoming Skillful in Data Management -Collecting Data: ask open-ended questions and follow up -Validating Data: Recheck vitals, collect additional info, determine whether a perception is accurate -Organizing and Analyzing Data: first separate into relevant and irrelevant data; next compare to expected norms and determine what is within normal range and what isn't. Acknowledging Emotions and Environmental Factors -Fatigue, lack of confidence, anger, and frustration all pose a barrier to critical thinking. -Recognize/acknowledge factors or emotions that impede thinking. Ask for assistance, verification, or validation. NURSING PROCESS IN MATERNAL-NEWBORN AND WOMEN'S HEALTH NURSING ... What are the five steps in the nursing process? 1. Assessment 2. Analysis/Diagnosis 3. Planning 4. Implementation 5. Evaluation How is implementing the nursing process in this setting different than in other settings? It is often devoted to the assessment and diagnosis of client strengths and healthy functioning to achieve a higher or more satisfying level of wellness. In most other settings, the nursing process and care is aimed at clients who are usually ill by the time the nurse encounters them. What are the two levels of nursing assessment? -Screening Assessment: gathers information about all aspects of the client's health (baseline data) which describe the client's health status before interventions begin. -Focused Assessment: gathers information specifically related to an actual health problem or a problem that the woman or family is at risk for acquiring. What is a nursing diagnosis? -Health needs that nurses can treat independently and for they are legally accountable for. -Includes the following components: the title, defining characteristics, and etiologic and related factors (which may be pathophysiologic, situational, or maturational).