Primary issues affecting the health of mothers and infants are birthrates for teenagers, tobacco use during pregnancy, sub- stance abuse during pregnancy, obesity, and health disparities.
Birthrate for Teenagers
The birthrate for women age 10–19 in the United States:
■ Has decreased by 43% from 1990 to 2010 (Hamilton et al., 2011).
■ The greatest percentage of decrease occurred in ages 10–14 (Table 1-8).
■ Is higher than in other developed countries, with birthrate of 34.3 compared to Switzerland’s rate of 3.9 (Table 1-9).
The U.S. birthrates for women 15–19 years of age by race are:
■ Hispanic—55.7
■ Non-Hispanic black—51.5
■ American Indian/Alaska Native—38.7
■ Non-Hispanic white—23.5
■ Asian/Pacific Islander—10.9 (Hamilton et al., 2011).
Teen births not only affect teen mothers but also have a long-term effect on their children and present a variety of issues for both the teen parents and society.
■ Poverty and income disparities
■ 75% of teen mothers begin receiving welfare within 5 years of the birth of their first child (The National Campaign to Prevent Teen Pregnancy, 2012).
TABLE 1–7 MATERNAL MORTALITY RATIOS 1990 TO 2009 (NUMBER OF MATERNAL DEATHS PER 100,000 LIVE BIRTHS)
DATE 1990 1995 2000 2005 2009
RATE 12 11 14 24 24
WHO (2010) and Martin et al. (2010)
TABLE 1–8 BIRTHRATES FOR TEENAGE WOMEN (RATES PER 1,000 LIVE BIRTHS)
PERCENTAGE AGE 1990 2005 2010 OF CHANGE
10–14 1.4 0.7 0.4 ↓71%
15–17 37.5 21.4 17.3 ↓54%
18–19 88.6 69.9 58.3 ↓34%
Hamilton et al. (2011) and Martin et al. (2011)
■ 25% of teen mothers will have a second child within 24 months, which further decreases their ability to complete school and qualify for a well-paying job (The National Campaign to Prevent Teen Pregnancy, 2012).
■ 64% of children of teen mothers live in poverty (March of Dimes, 2009).
■ Health issues for teen mothers
■ Teen mothers are at higher risk for sexually transmitted illnesses and HIV.
■ Chlamydia – increased risk of newborn eye infection and pneumonia
■ Syphilis – neonatal blindness and increased risk of maternal and neonatal death
■ Teen mothers are at higher risk for hypertensive problems during pregnancy.
■ Health issues of infants born to teen mothers
■ Infants born to teen mothers are at greater risk for health problems that include prematurity and/or low birth weight.
■ Prematurity and/or low birth weight places the infant at higher risk for infant death, respiratory distress syndrome, intraventricular bleeding, vision problems, and intestinal problems.
■ Infant mortality rate is higher: 16.4 for infants of women under 15 years of age compared to 6.8 for infants of women of all ages (National Campaign to Prevent Teen Pregnancy, 2012).
■ Educational issues
■ Only 40% of teen mothers graduate from high school (The National Campaign to Prevent Teen Pregnancy, 2007).
■ Children of teen mothers are at higher risk for not completing high school and they have lower scores on standardized tests.
■ Teen fathers
■ Teenage males without an involved father are at a higher risk for dropping out of school, abusing alcohol and/or drugs, and being incarcerated (The National Campaign to Prevent Teen Pregnancy, 2007).
■ Unmarried teen fathers pay less than $800 a year in child support (The National Campaign to Prevent Teen Pregnancy, 2007).
Tobacco Use During Pregnancy
Tobacco use during pregnancy is associated with an increased risk of LBW, intrauterine growth restriction, miscarriage, abruptio placenta, premature birth, SIDS, and respiratory problems in the newborn.
■ Cigarette smoking during pregnancy declined from 19.5% in 1989 to 13% in 2008 (Tong et al., 2009).
■ Women who smoke during pregnancy are less likely to breastfeed their infants.
■ 45% of women who smoked prior to pregnancy quit dur- ing pregnancy (Tong et al., 2009).
■ 17% of women ages 18–24 and 19.8% of women ages 25–44 smoke cigarettes (MMWR, 2011).
■ Based on race, the highest percentage of female smokers are American Indian and Alaskan Native (Table 1-10).
■ Based on educational level, the highest percentage of female smokers are women with a GED (MMWR, 2011).
Substance Abuse During Pregnancy
The use of alcohol and illicit drugs during pregnancy can have a profound effect on the developing fetus and the health of the neonate.
■ Exposure to alcohol during pregnancy places the develop- ing fetus at higher risk for fetal death, low birth weight, TABLE 1–9 2010 INTERNATIONAL
FERTILITY RATE (BIRTHRATE PER 1,000 WOMEN AGES 15–19)
NATION RATE NATION RATE
Switzerland 3.9 Turkey 30.5
Italy 4.0 Egypt 40.6
Denmark 5.1 Botswana 43.8
France 6.0 Philippines 46.5
Japan 6.0 South Africa 50.4
Iceland 11.6 Argentina 54.2
Canada 11.3 Costa Rica 61.9
Australia 12.5 Mexico 65.5
Saudi Arabia 22.1 India 74.7
Russian 23.2 Brazil 76.0
Federation
Unites States 27.4 Iraq 85.9
of America
United Kingdom 29.7 Democratic Republic 170.6 of the Congo
United Nations Statistics Division (2011)
CRITICAL COMPONENT Teen Pregnancies
■ The average related cost for teen pregnancies to federal, state, and/or local government has increased from $9.1 billion in 2004 to $10.9 billion in 2008.
■ The majority of the cost is related to consequences to the children of teen women, such as:
■ Increased health issues
■ Reduced educational achievement
■ Increased interactions with child welfare and criminal jus- tice system. (The National Campaign to Prevent Teen Pregnancy, 2012)
C H A P T E R 1 ■ Trends and Issues 7
intrauterine growth retardation, mental retardation, and fetal alcohol syndrome.
■ Exposure to illicit drugs during pregnancy is associated with incidences of preterm birth, abruptio placenta, drug withdrawal for the neonate, and a variety of congenital defects.
Obesity
Obesity is defined as a body mass index (BMI) greater than or equal to 30. In the United States, 35.7% of adults and 16.9% of children are obese (Ogden et al., 2012).
■ 31.9% of women 20–39 years are obese.
■ 17.1% of girls 12–19 years are obese (Ogden et al., 2012).
Obesity in childbearing women has adverse effects on both the woman and her child. Obese pregnant women are at higher risk for:
■ Gestational hypertension
■ Preeclampsia
■ Gestational diabetes
■ Thromboembolism
■ Cesarean birth
■ Wound infections
■ Shoulder dystocia related to macrosomia (birth weight of
≥4,000 grams)
■ Sleep apnea
■ Anesthesia complications (Nodine et al., 2012)
The fetuses and/or infants of obese pregnant women are at higher risk for:
■ Fetal abnormalities
■ Spina bifida
■ Heart defects
■ Anorectal atresia
■ Hypospadias
■ Intrauterine fetal death
■ Birth injuries related to macrosomia
■ Childhood obesity and diabetes (March of Dimes, 2012)
Health Disparities
The topic of health disparities addresses the differences in access, use of health care services, and health outcomes for various factors such as age, race, ethnicity, socioeconomic status, and geographic groups and health status of these populations.
The Agency for Healthcare Research and Quality (AHRQ) evaluates the quality of health care based on six core measures:
■ Effectiveness
■ Patient safety
■ Timeliness
■ Patient centeredness
■ Efficiency
■ Access to care (AHRQ, 2011)
In the AHRQ 2010 National Healthcare Disparities Report, it was reported that:
■ Based on race, Hispanics experienced the worst health care
■ Based on income, poor experienced the worst health care (AHRQ, 2011)
TABLE 1–10 PERCENTAGES OF WOMEN WHO ARE CIGARETTE SMOKERS
RACE PERCENTAGE
American Indian and Alaskan Native 36.0
Non-Hispanic white 19.6
Non-Hispanic black 17.1
Hispanic 9
Asian or Pacific Islander 4.3
MMWR, 2011
CRITICAL COMPONENT Prenatal Care
Low-income women are less likely to seek early and continuous prenatal care. These health care behaviors place both the woman and her unborn child at higher risk for complications during pregnancy, labor, and birth, and postpartum.
■ The percentages of women who begin prenatal care late in the pregnancy or receive no prenatal care based on race are listed in Table 1-11.
■ Women under 15 years of age are the highest percentage of women of all ages who begin prenatal care late or receive no prenatal care (Martin et al., 2006).
■ Disparities exist in birth outcomes as measured by percentages of premature births and low birth weight (Table 1-12).
■ Disparities exist in infant mortality rates based on race (Table 1-13).
These disparities can partially be attributed to barriers to access to health care for low-income families. Examples of barriers to access to health care are limited finances, lack of transportation, difficulty with dominant language, and atti- tudes of the health care team.
POSITION STATEMENT Access to Health Care
“AWHONN (Association of Women Health, Obstetric and Neonatal Nurses) considers access to affordable and acceptable health care services as a basic human right. Therefore, AWHONN strongly supports policy initiatives that guarantee access to such health care services for all people” (AWHOON, 2008).
TABLE 1–11 PERCENTAGES OF WOMEN RECEIVING LATE OR NO PRENATAL CARE BY RACE AND HISPANIC ORIGIN, 2006
AMERICAN INDIAN ASIAN OR
OR ALASKA NATIVE PACIFIC ISLANDER HISPANIC NON-HISPANIC BLACK NON-HISPANIC WHITE
8.1 3.1 5.0 5.7 2.3
Child Trends (2010a)
TABLE 1–12 2004 REPORTED PERCENTAGES OF PRETERM BIRTH AND LOW BIRTH WEIGHT BY RACE
PRETERM (BORN PRIOR VERY LOW BIRTH WEIGHT LOW BIRTH WEIGHT TO 37 WEEKS) (>1,500 GRAMS) (>2,500 GRAMS)
ALL 12.2 1.5 8.5
AMERICAN INDIAN/ 13.5 1.3 7.3
ALASKA NATIVE
ASIAN/PACIFIC ISLANDER 10.8 1.1 8.3
HISPANIC 12.0 1.2 6.9
NON-HISPANIC BLACK 17.2 3.0 13.3
NON-HISPANIC WHITE 11.2 1.5 7.1
Martin et al. (2010)
M
ATERNAL AND CHILD HEALTH GOALS The health of a nation is reflected in the health of expectant women and their infants (CDC and Health Resources and Service Administration, 2000). Diseases and illness related to complications during pregnancy and the neonatal period can have a lifelong impact on the health of that individual.Low birth weight and premature neonates are at higher risk for chronic respiratory diseases and abnormalities in neurological development. The CDC and Health Resources and Services have set national health goals that are pub- lished in Healthy People 2020 (Table 1-14). Improving the health of women before and during pregnancy and the health of infants will have lifelong effects on the health of the nation.
TABLE 1–13 DEATH RATES OF INFANTS BY RACE AND HISPANIC ORIGIN, 2007 (DEATHS PER 100,000)
AMERICAN INDIAN ASIAN OR
OR ALASKAN NATIVE PACIFIC ISLANDER HISPANIC NON-HISPANIC BLACK NON-HISPANIC WHITE
922 442 587 1,250 560
Child Trends (2010b)
C H A P T E R 1 ■ Trends and Issues 9
Continued
TABLE 1–14 HEALTHY PEOPLE 2020 MATERNAL AND INFANT HEALTH GOALS
OBJECTIVES BASELINE 2010 TARGET
Reduction in fetal and infant deaths.
• Fetal deaths at 20 or more weeks of gestation
• Fetal and infant deaths during the perinatal period (28 weeks of gestation to 7 days after birth)
• All infant deaths
• Neonatal deaths
• Postnatal
• Infant deaths related to birth defects (all birth defects)
• Infant deaths related to congenital heart defects
• Infant deaths from sudden infant death syndrome (SIDS)
• Infant deaths from sudden unexpected infant deaths (includes SIDS, unknown causes, accidental suffocation, and strangulation in bed)
Reduction of 1-year mortality rate for infants with Down syndrome.
Reduce the rate of maternal mortality.
Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery).
Reduce cesarean births among low-risk (full-term, singleton, vertex presentation) women.
• Women giving birth for first time
• Prior cesarean section
Reduce low birth weight (LBW) and very low birth weight (VLBW).
• Low birth weight (LBW)
• Very low birth weight (VLBW) Reduce preterm births.
• Total preterm births
• Live births at 34 to 36 weeks of gestation
• Live births at 32 to 33 weeks of gestation
• Live births at less than 32 weeks gestation
Increase proportion of pregnant women who receive early and adequate prenatal care.
• Prenatal care beginning in first trimester
• Early and adequate prenatal care
Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women.
• Alcohol
• Binge drinking
6.2 per 1,000 live births and fetal deaths
6.6 per 1,000 live births and fetal deaths
6.7 per 1,000 live births 4.5 per 1,000 live births 2.2 per 1,000 live births 1.4 per 1,000 live birth 0.38 per 1,000 live births 0.55 per 1,000 live births 0.93 per 1,000 live births
48.6 per 1,000 infants diagnosed with Down’s syndrome
12.7 maternal deaths per 100,000 live births
31.1%
26.5%
90.8% of low-risk women giving birth with prior cesarean section
8.2 % of live births 1.5% of live births
12.7% of live births 9.0%
1.6%
2.0%
70.8% women delivering live births 70.5% of pregnant females
89.4% of pregnant females abstained from alcohol
95% abstained from binge drinking
5.6 per 1,000 live births and fetal deaths
5.9 per 1,000 live births and fetal deaths
6.0 per 1,000 live births 4.1 per 1,000 live births 2.0 per 1,000 live births 1.3 per 1,000 live births 0.34 per 1,000 live births 0.50 per 1,000 live births 0.84 per 1,000 live births
43.7 per 1,000 infants diag- nosed with Down’s syndrome 11.4 maternal deaths per
100,000 live births 28.0%
23.9%
81.7%
7.8%
1.4%
11.4%
8.1%
1.4%
1.8%
77.9%
77.6%
98.3%
100%
89.6% of pregnant females abstained from smoking 94.9% abstained from illicit drugs 23.8% of non-pregnant women
aged 15 to 44 years
24.5% of non-pregnant females aged 15 to 44 years
30.1%
77.6%
51%
48.5%
69%
74%
43.5%
22.7%
33.6%
14.1%
25%
24.2%
2.9%
98.6 100%
26.2%
22.1%
33.1%
85.4%
56.4%
53.4%
75.9%
81.9%
60.6%
34.1%
46.2%
25.5%
38%
14.2%
8.1%
TABLE 1–14 HEALTHY PEOPLE 2020 MATERNAL AND INFANT HEALTH GOALS—cont’d
OBJECTIVES BASELINE 2010 TARGET
• Cigarette smoking
• Illicit drugs
Increase the proportion of women of childbearing potential with intake of at least 400 µg of folic acid from fortified foods or dietary supplements.
Reduce the proportion of women of childbearing potential who have low red blood cell folate concentrations.
Increase the proportion of women delivering a live birth who received preconception care services and practiced key recommended preconception health behaviors.
• Took multivitamins/folic acid prior to pregnancy
• Did not smoke prior to pregnancy
• Did not drink alcohol prior to pregnancy (at least 3 months prior to pregnancy)
• Had a healthy weight prior to pregnancy
Increase the proportion of infants who are put to sleep on their backs.
Increase the proportion of infants who are breastfed.
• Ever
• At 6 months
• At 1 year
• Exclusively through 3 months
• Exclusively through 6 months
Increase the proportion of employers that have worksite lactation support programs.
Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life.
Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies.
Healthy People 2020 (2011)
■ ■ ■
Review Questions
■ ■ ■1. The population with the lowest birthrate but highest premature birthrate is:
A. Non-Hispanic white B. Non-Hispanic black
C. American Indian or Alaska Native D. Asian or Pacific Islanders
E. Hispanic
2. Moderately premature neonates are neonates born:
A. At less than 28 weeks of gestation
B. Between 28 weeks and 30 weeks of gestation C. Between 30 and 32 weeks of gestation D. Between 32 and 34 weeks of gestation E. Between 34 and 36 weeks of gestation
3. The two most important predictors of an infant’s health and survival after birth are:
A. Gestational age and birth weight B. Gestational age and early prenatal care
C. Gestational age and complication during labor and birth
D. Gestational age and Apgar score
4. The greatest increase in birthrate is in women ________.
A. 15–19 years of age B. 25–29 years of age C. 30–34 years of age D. 40–45+ years of age
C H A P T E R 1 ■ Trends and Issues 11 5. A maternal and infant goal stated in Healthy People
2020 is:
A. Increase abstinence from smoking during pregnancy to 100%.
B. Reduce cesarean birth for first-time mothers to 23.9%.
C. Increase the proportion of infants who are breastfed at 6 months to 50%.
D. Reduce the rate of maternal mortality to 5%.
6. The leading cause of infant death in 2010 was _______.
A. Sudden infant death syndrome (SIDS) B. Congenital malformations
C. Respiratory distress syndrome of newborns D. Accidents
7. The highest percentage of women who smoke during pregnancy are ____________.
A. American Indian and/or Alaskan Native B. Asian and/or Pacific Islander
C. Hispanic
D. Non-Hispanic black E. Non-Hispanic white
8. Infant mortality is defined as a death before _________.
A. 28 days of age B. 6 months of age C. 1 year of age D. 18 months of age
9. Very low birth weight (VLBW) is defined as a birth weight less than __________.
A. 500 grams B. 1,000 grams C. 1,500 grams D. 2,000 grams
10. True or False: Very low birth weight (VLBW) neonates account for 1.45% of births but account for 45% of all infant deaths.
A. True B. False
References
Agency for Healthcare Research and Quality. (2011). National Healthcare Disparities Report 2010. Retrieved from www.ahrq.
gov/qual/nhdr10/nhdr10.pdf
Anderson, R., Kockanek, K., & Murphy, S. (1997). Report of final mortality statistic, 1995. Monthly vital statistics report, 45, 11, sup 2.
Hyattsville, MD: National Center for Health Statistics. Retrieved from www.cdc.gov/nchs/data/mvsr/supp/mv45
Centers for Disease Control and Prevention (CDC). (2007). NCHS Definitions [online]. Retrieved from www.cdc/gov/data/series/
sr_21_008acc.pdf
Centers for Disease Control and Prevention, and Health Resources and Service Administration. (2000). Healthy People 2010 [online].
Retrieved from www.healthypeople.gov/Document/HTML/
Volume2/16MICH.htm
Central Intelligence Agency (CIA). (2011). Rank Order—Infant Mortality Rates. Retrieved from www.CIA.gov/library/publications/
the-world-factbook/rankorder/2011rank.html
Child Trends Data Bank. (2010b). Infant, child, and youth death rates. Retrieved from www.childtrendsdatabank.org/?q=node/74 Child Trends Data Bank. (2010a). Late or no prenatal care. Retrieved
from www.childtrendsdatabank.org/?q=node/243
Child Trends Data Bank. (2012). Birth and fertility rates. Retrieved from www.childtrendsdatabank.org
Hamilton, B., Martin, J., & Ventura, S. (2006). Births: Preliminary data for 2005. Health E-Stats. Retrieved from www.cdc/gov/nchs/
products/pubs/pubd/hestats/prelimbirths05/prelimbirths05.htm Hamilton, B., Martin, J., & Ventura, S. (2007). Preliminary data for
2006. National Vital Statistics Reports, 56, 1–28 [online].
Hyattsville, MD: National Center for Health Statistics. Retrieved from www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf Hamilton, B., Martin, J., & Ventura, S. (2009). Preliminary data for
2007. National Vital Statistics Reports, 57, 1–23. Hyattsville, MD:
National Center for Health Statistics.
Hamilton, B., Martin, J., & Ventura, S. (2011). Preliminary data for 2010. National Vital Statistics Reports, 60, 1–25. Hyattsville, MD:
National Center for Health Statistics. Retrieved from www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf
Healthy People 2020. (2011). Maternal, infant and child health.
Retrieved from www.healthypeople.gov/2020/topicsobjectives2020/
overview.aspx?topics=26
Hoyert, D. (2007). Maternal mortality and related concepts.
National Center for Human Statistics. Vital Health Stats, 3, 1–13.
MacDorman, M., & Mathews, T. (2008). Recent trends in infant mortality in the United States. NCHS data brief no. 9. Hyattsville, MD: National Center for Health Statistics. Retrieved from www.cdc.gov/nchs/data/databriefs/db09.htm
March of Dimes. (2009). Teen pregnancy. Retrieved from www.
marchofdimes.com/printableArticles/medicalresources_
teenpregnancy.html
March of Dimes. (2012). Overweight and obesity during pregnancy.
Retrieved from www.marchofdimes.com/pregnancy/complications_
obesity.html
Martin, J., Hamilton, B., Sutton, P., Ventura, S., Menacker, F., &
Kirmeyer, S. (2006). Final data for 2004. National vital statistics reports, 55, 1–20. Retrieved from www.cdc.gov/nchs/data/nvsr/
nvsr55/nvsr545_11.pdf
Martin, J., Hamilton, B., Ventura, S., Osterman, M., Kirmeyer, S., Mathews, T., & Wilson, E. (2011). Birth: Final data for 2009.
National Vital Statistic Reports, 57, 1. Hyattsville, MD: National Center for Health Statistics.
MMWR (2011). Vital signs: Current cigarette smoking among young adults age ≥18 year. Retrieved from www.cdc.gov/tobacco/
data_statistics/tables/trends/cig_smoking/index.htnm
Murphy, S., Xu, J., & Kochanek, K. (2012). Deaths: Preliminary data for 2010. National vital statistics report, 60, 4. Hyattsville, MD: National Center for Health Science.
The National Campaign to Prevent Teen Pregnancy. (2012).
Counting it up: The public costs of teen childbearing. Retrieved from www.thenationalcampaign.org
The National Campaign to Prevent Teen Pregnancy. (2007). Why it matters. Retrieved from www.thenationalcampaign.org Nodine, P., & Hstings-Tolsma, M. (2012). Maternal obesity:
Improving pregnancy outcomes. MCN, 37, 110–115.
Ogden, C., Carroll, M., Kit, B., & Flegal, K. (2012). Prevalence of obesity in the United States, 2009–2010. NCHS data brief, no. 82.
Retrieved from www.cdc.gov/nchs/data/databriefs/db82.pdf Tong, V., Jones, J., Dietz, P., D’Angelo, D., & Bombard, J. (2009).
Trends in smoking before, during and after pregnancy—
Pregnancy risk monitoring system, United States, 31 sites, 2000–
2005. Retrieved from www.cdc.gov/mmwr/preview/mmwrhtml/
ss5804al.htm
United Nations Statistics Division. (2011). Indicators on childbear- ing. Retrieved from www.unstats.un.org/unsd/demographic/
products/socind/childbearing.htm
World Health Organization (WHO). (2007). Maternal mortality in 2005.
Retrieved from www.who.int/reproductive-health/publications/
maternal_mortality_2005/mme_2005.pdf
World Health Organization (WHO). (2012). Maternal mortality.
Retrieved from www.who.int/mediacentre/factsheet/fs348/en/
Ethics and Standards
of Practice Issues 2
I
NTRODUCTIONMaternity nursing is an exciting and dynamic area of nursing practice. With that excitement come issues related to ethical challenges, high rates of litigation in obstetrics, and the challenge of practicing safe and evidence-based nursing care that is respon- sive to the needs of women and families. This chapter presents the foundational principles set forth by the American Nurses Association (ANA) Code of Ethics and specialty practice stan- dards from the Association for Women’s Health, Obstetric and Neonatal Nurses (AWHONN) that outline duties and obliga- tions of obstetric and neonatal nurses. Ethical principles are reviewed within the context of perinatal dilemmas and ethical decision making. Common issues in litigation in maternity nurs- ing are presented. Evidence-based practice and challenges in research utilization in the perinatal setting are explored.
E
THICS IN NURSING PRACTICEThe study of ethics is based in philosophical discussions of ancient Greek scholars about the nature of good and evil or right and wrong. Ethics is an integral part of nursing practice and represents the ideal of social order. The ethical tradition of nursing is self-reflective, enduring, and distinctive. Nurses’
moral and ethical responsibility to do the right thing is dis- cussed in the ANA Code of Ethics for Nurses (2001).
ANA Code of Ethics
The ANA Code of Ethics makes explicit the primary goals, values, and obligations of the profession of nursing (ANA, 2001). The code of ethics for nursing serves as:
■ A statement of the ethical obligations and duties of every nurse
■ The profession’s non-negotiable ethical standard
■ An expression of nursing’s own understanding of its com- mitment to society
The ANA Code of Ethics for Nurses describes the most fundamental values and commitments of the nurse, bound- aries of duty and loyalty, and aspects of duties beyond individ- ual patient encounter (Table 2-1).
Ethical Principles
Ethical and social issues affecting the health of pregnant women and their fetus are increasingly complex. Some of the complexity arises from technological advances in reproductive technology, maternity care, and neonatal care (McCrink, 2010). Nurses are autonomous professionals who are required to provide ethically competent care. Some ethical principles related to patient care include (Lagana & Duderstadt, 2004):
■ Autonomy:The right to self-determination
■ Respect for others: Principle that all persons are equally valued
■ Beneficence: Obligation to do good
■ Nonmaleficence: Obligation to do no harm
■ Justice: Principle of equal treatment of others or that others be treated fairly
■ Fidelity: Faithfulness or obligation to keep promises
■ Veracity: Obligation to tell the truth
■ Utility: The greatest good for the individual or an action that is valued
Ethical Approaches
Clinical situations arise where ethical principles conflict with each other. For example, the patient’s right to self- determination, autonomy, includes the right to refuse treat- ment that may be beneficial to the pregnancy outcome for the
13 EXPECTED STUDENT OUTCOMES
Upon completion of this chapter, the student will be able to:
䊐 Define key terms.
䊐 Debate ethical issues in maternity nursing.
䊐 Explain standards of practice in maternity nursing.
䊐 Describe legal issues in maternity nursing.
䊐 Examine concepts in evidence-based practice.