�ݺ�ߣ

Maternal
and Child
Health
NURSING: Care of the
Childbearing & Childrearing
Family

• Goals & Philosophies
• Goals & Standard
• Theories
• Roles & Responsibilities
• WHO’s 17 Sustainable
Development Goals
FRAMEWORK FOR MATERNAL & CHILD NURSING

 the care of women
during childbirth, is
derived from the
Greek word obstare,
which means “to keep
watch.”
OBSTETRICS

Pediatrics
pais
(Greek)
“child”

PRIMARY GOAL OF MATERNAL
AND CHILD HEALTH NURSING
The promotion
and maintenance
of optimal family
health to ensure
cycles of optimal
childbearing
and childrearing.

● To have healthy adults, you must
have healthy children.
● To have healthy children, it is
important to promote the health
of the childbearing woman and
her family from the time before
children are born until they
reach adulthood.
The care of childbearing and childrearing
families is a
major focus of nursing practice.

 PRIMARY GOAL- the promotion and maintenance
of optimal family health to ensure cycles of optimal childbearing and
childrearing.
 Scopes of practice includes:
 Preconceptual health care
 Care of women during three trimesters of pregnancy and the puerperium
 Care of infants during the perinatal period
 Care of children from birth through late adolescence
 Care in a variety of hospital and home care settings
Goals & Philosophies of Maternal & Child Health Nursing

●Maternal and child health nursing is family
centered; assessment must include both
family and individual assessment data.
●Maternal and child health nursing is
community centered; the health of families
depends on and influences the health of
communities.
Philosophy of Maternal and Child
Health Nursing

●Maternal and child health nursing is evidence
based, because this is the means whereby
critical knowledge increases.
●A maternal and child health nurse serves as an
advocate to protect the rights of all family
members, including the fetus.
Health Nursing

●Maternal and child health nursing includes a
high degree of independent nursing functions,
because teaching and counseling are major
interventions.
●Promoting health and disease prevention
are important nursing roles because these
protect the health of the next generation.
Health Nursing

●Maternal and child health nurses serve as
important resources for families during
childbearing and childrearing as these can be
extremely stressful times in a life cycle.
●Personal, cultural, and religious attitudes and
beliefs influence the meaning and impact of
childbearing and childrearing on families.
Health Nursing

●Circumstances such as illness or pregnancy are
meaningful only in the context of a total life.
●Maternal and child health nursing is a
challenging role for nurses and a major factor
in keeping families well and optimally
functioning.
Health Nursing

 The preferred focus of nursing care
 Enables nurses to better
understand individuals and their
effect on others, in turn, provides
more holistic care.
 Nurses provide guidance and
monitor the interaction between
family members to promote the
health and well-being of the family
unit.
Family Centered Approached

FOUR PHASES OF HEALTH CARE
Health
Promotion
Health
Maintenance
Health
Restoration
Health
Rehabilitatio
n

Definitions and Examples of Phases of Health
Care
TERM DEFINITION EXAMPLES
Health
Promotion
Educating clients to be
aware of good health
through teaching and
role modeling
Teaching women the importance
of rubella immunization before
pregnancy; teaching children the
importance of safer sex practices
Health
Maintenance
Intervening to maintain
health when risk of
illness is present
Encouraging women to come for
prenatal care; teaching parents
the importance of safeguarding
their home by childproofing it
against poisoning.

Definitions and Examples of Phases of Health
Care
TERM DEFINITION EXAMPLES
Health
Restoration
Promptly diagnosing and
treating illness using
interventions that will
return client to wellness
most rapidly
Caring for a woman during
complication of pregnancy or
a child during an acute illness
Health
Rehabilitation
Preventing further
complications from an
illness; bringing an ill client
back to an optimal state of
wellness or helping a client
to accept inevitable death
Encouraging a woman with
gestational trophoblastic
disease to continue therapy or
a child with a renal transplant
to continue to take necessary
medications

● A form of problem solving based
on the scientific method, serves as
the basis for assessing, making a
nursing diagnosis, planning,
implementing, and evaluating
care.
● Multidisciplinary care maps
The Nursing Process

Evidence-Based Practice
• The conscientious, explicit, and
judicious use of current best evidence
in making decisions about the care of
patients.
• Evidence can be a combination of
research, clinical expertise, and
patient preferences when all three
combine in decision making.

Trends in
Maternal and
Child Health
Care

TRENDS IMPLICATION FOR NURSING
Families are not as extended
so are smaller than
previously.
Fewer family members are present as
support people in a time of crisis.
Nurses are called on to fulfill this role
more than ever before.
Single parents have become
the most common type of
parent.
A single parent may have fewer
financial resources than dual
employed parents; this is more likely
if the parent is a woman.
90% of women work outside
the home at least part-time.
Health care must be scheduled at
times a working parent can come for
care for herself or bring a child for

Families are more mobile
than previously; there is an
increase in the number of
homeless women and
children.
Good interviewing and health
monitoring are necessary with mobile
families so a health database can be
established and there can be
continuity of care.
Both child and intimate
partner abuse is increasing in
incidence
Screening for child or intimate
partner abuse should be included in
all family contacts. Nurses must be
aware of the legal responsibilities for
reporting abuse.

Families are more health
conscious than ever before.
Families are ripe for health education;
providing this can be a major nursing
role.
Healthcare must respect cost
containment
Comprehensive care is necessary in
primary care settings because referral
to specialists may no longer be an
option. Health insurance is not
available for all families.

● Initiating Cost Containment
○ systems of health care delivery that
focus on reducing the cost of health
care by closely monitoring the cost
of personnel, use and brands of
supplies, length of hospital stays,
number of procedures carried out,
and number of referrals requested
while maintaining quality care.
Trends in Health Care Environment

● Increasing Alternative Settings and
Styles for Health Care
○ Lying-in
○ Advanced-practice nurses: nurse-
midwife, nurse practitioner
○ Home births
○ Home care
○ Ambulatory clinics

● Including the Family in Health Care
● Increasing Use of Alternative Treatment
Modalities
● Increasing Reliance on Home Care
● Increasing Use of Technology
● Freebirthing
○ Women giving birth without any
health care provider present.

Health Care Concerns and Attitudes
Increasing
emphasis on
preventive care
Increasing concern
for quality of life
Increase awareness
of the individuality
of clients
Empowerment of
health care
consumers

Legal and
Ethical Issues in
Maternal and
Child Health
Nursing

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.
• Nurses are autonomous professionals who are
required to provide ethically competent care.

Ethical Principles
• The right to self-determination
Autonomy
• Principle that all persons are equally valued
Respect for others
• Obligation to do good
Beneficence
• Obligation to do no harm
Non-maleficence

Ethical Principles
• Principle of equal treatment of others or that
others be treated fairly
Justice
• Faithfulness or obligation to keep promises
Fidelity
• Obligation to tell the truth
Veracity
• The greatest good for the individual or an
action that is valued
Utility

Ethical Approaches
The Rights Approach
• The focus is on the
individual’s right to
choose, and the rights
include the right to
privacy, to know the
truth, and to be free
from injury or harm.
The Utilitarian Approach
• This approach posits
that ethical actions are
those that provide the
greatest balance of
good over evil and
provides for the greatest
good for the greatest
number.

● An ethical dilemma is a choice that has the potential
to violate ethical principles.
● In nursing it is often based on the nurse’s commitment
to advocacy.
● Patient advocacy - Action taken in response to our
ethical responsibility to intervene on behalf of those in
our care.
● Advocacy also involves accountability for nurses’
responses to patients’ needs.
Ethical Dilemma

● 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
Clinical Examples of Perinatal Ethical
Dilemmas

● Using organs from an anencephalic 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
Clinical Examples of Perinatal Ethical
Dilemmas

• Maternal and child health nursing carries some
legal concerns that extend above and beyond
other areas of nursing, because care is often
given to:
• an “unseen client”—the fetus
• clients who are not of legal age for giving
consent for medical procedures.
• Contributing to this is the complexity of caring
for two patients, the mother and the fetus.
Legal Issues in the Delivery of Care

● Nurses are legally responsible for protecting
the rights of their clients, including
confidentiality, and are accountable for the
quality of their individual nursing care and
that of other health care team members.
● Understanding the scope of practice and
standards of care can help nurses practice
within appropriate legal parameters.

● Documentation is essential for protecting a
nurse and justifying his or her actions.
● Nurses need to be conscientious about
obtaining informed consent for invasive
procedures and determining that pregnant
women are aware of any risk to the fetus
associated with a procedure or test.

• The birth of a disabled child when the parents would have chosen to end the
pregnancy if they had been informed about the disability during pregnancy.
Wrongful birth
• A claim that negligent prenatal testing on the part of a health care provider
resulted in the birth of an unperfect child.
Wrongful life
• Denotes a contraceptive measure that failed, allowing an unwanted child to
be conceived and born.
Wrongful conception

Five Common Clinical Situations Of Fetal and
Neonatal Injuries and Obstetric Litigation
• Inability to recognize and/or inability to appropriately respond to
intrapartum fetal compromise
• Inability to affect a timely cesarean birth (30 minutes from decision to
incision) when indicated by fetal or maternal condition
• Inability to appropriately initiate resuscitation of a depressed neonate
• Inappropriate use of oxytocin or misoprostol leading to uterine
hyperstimulation, uterine rupture, and fetal intolerance of labor and/or fetal
death
• Inappropriate use of forceps/vacuum and/or preventable shoulder dystocia

Allegations related to fetal monitoring:
• Failure to accurately assess maternal and fetal status
• Failure to appreciate a deteriorating fetal status
• Failure to treat a nonreassuring FHR
• Failure to correctly communicate maternal/fetal status to the care provider
• Failure to institute the chain of command when there is a clinical
disagreement

Allegations related to fetal monitoring:
• The nurse must initiate the course of action when the clinical situation is a
matter of maternal or fetal well-being.
• In a case of a primary care provider not responding to an abnormal FHR or
a deteriorating clinical situation, the nurse should use the chain of
command to resolve the situation, advocate for the patient’s safety, and
seek necessary interventions to avoid a potentially adverse outcome.
• At the first level, notify the immediate supervisor to provide assistance.
Further steps are defined by the structure of the institution, and a policy
outlining communication for the chain of command should be present.

 Reducing Maternal & Child Mortality
 “Implementing Health Reforms for the Rapid Reduction of Maternal and
Neonatal Mortality”.
 Administrative Order 2008-0029 –DOH
 MOP- Maternal Neonatal & Child Health & Nutrition Strategy
MNCHN strategy is intended to guide Local Government Units (LGUs) in designing
approaches to deliver MNCHN services especially to populations that are most at risk
from maternal and child deaths.
Maternal & Child Health Goals and Standards

 National Safe Motherhood Program
 Guided by the DOH FOURmula One Plus thrust and the Universal Health Care
Frame
 Vision “ For Filipino Women to have full access to health services towards
making their pregnancy and delivery safe”.
Goals & Standards

 BeMONC – Basic Emergency Obstetrics and Newborn Care
 It refers to lifesaving services for emergency maternal and newborn
conditions/complications being provided by a health facility or professional to
include the following services:
 Administration of parenteral oxytocic drugs (uterotonic)
 Administration of parenteral anticonvulsants
 Administration of parenteral antibiotics
 Administration of maternal steroids for preterm labor
 Performance of assisted vaginal deliveries
 Removal of retained placental products
 Manual removal of retained placenta
Goals & Standards

Cont…. BeMONC
 Neonatal Interventions
 Newborn resuscitation
 Provision to warmth
 Referral
 Blood Transfusion
 Staffs
 1 – Medical Doctor
 1 – Registered Nurse
 1 – Registered Midwife

 To increase quality and years of healthy life
 To eliminate health disparities
 A new objective added in 2010 – recommends that 100% of prelicensure programs in
nursing include core content on counseling
 For health promotion
 Disease prevention
 Cultural diversity – including for lesbian, gay, bisexual and transgender populations
 Evaluation of health sciences literature
 Environmental health
 Public health system and global health
 And all important areas of maternal and child health
2020 National Health Goals

Concentrate on improving the health of women
and children.
 To end poverty & hunger
 To achieve universal primary education
 To promote gender equality & empower
women
 To reduce child mortality
 To improve maternal health
 To combat HIV/AIDS, malaria and other
diseases
 To ensure environmental sustainability
 To develop a global partnership for
development
Global Health Goals

Theoretical basis can help us appreciate the significant effect of a child’s
illness or the introduction of a new member on the total family.
 Calista Roy – the important role of the nurse is to help the patient
adopt to change caused by illness or other stressor.
 Dorothea Orem – concentrates on examining patients ability to
perform self-care.
 Patricia Benner – describes the way nurses move from novice to expert
as they become more experienced and prepared to give
interprofessional care.
Nursing Theories

Service Provider
 Provision of ante natal care
 Monitoring the growth of the fetus & its well being
 Supplementation of requisite vitamins & micro nutrients
 Provision of health aspects related to new born
 Promotion of good delivery practices
 Promotion of breast feeding & maternal bonding
 Promotion of optimal new born care
 Ensuring appropriate immunization services
 Screening for mal formations, congenital anomalies & other deviations
Roles & Responsibilities of MCN

 Promotion of child rearing practices
 Periodic growth, development & milestone monitoring
 Promotion of school enrolment
 Provision of de-worming services & nutritional supplementation services
Role As An Administrator
 Evolve policy related to MCH
 Serve as an information provider to policy makers in relation to MCH
services
 Serves as liaison with the Govt, community & NGO in organizing &
implementing MCH services
 Develop counseling & MCH assistance network in the state

Educationist
 Organize training program for health care professionals
 Conduct workshops & conferences relating to MCH care & sensitize the
community, health care professionals & policy makers
 Design curriculum in medical & para medical curriculum incorporating
aspects of MCH services
 Design health education materials & distribute
 Develop separate channels in order to sensitize the public on MCH
services.

Researcher
 Identify researchable areas in MCH & conduct research
 Pool grant in aids to support research activities in the areas of
MCH services
 Support research scholars undertaking research in the area of
MCH
 Coordinate & network research activities
 Design models based on research findings

(1st lesson) FRAMEWORK FOR MATERNAL & CHILD NURSING [Autosaved].pptx

�ݺ�ߣ

(1st lesson) FRAMEWORK FOR MATERNAL & CHILD NURSING [Autosaved].pptx

Recommended

More Related Content

Similar to (1st lesson) FRAMEWORK FOR MATERNAL & CHILD NURSING [Autosaved].pptx (20)

Recently uploaded (20)

(1st lesson) FRAMEWORK FOR MATERNAL & CHILD NURSING [Autosaved].pptx

Editor's Notes