LESSON 1 - GOALS AND

PHILOSOPHIES OF MATERNAL
AND CHILD HEALTH NURSING
INTRODUCTION
This lesson presents an overview of maternal and child health nursing. The use
of nursing process, nursing research, and nursing theory in the provision of quality care
is discussed. The standards of maternal and child health nursing practice, the changing
discipline, and the varied roles assumed by nurses in maternal and child health nursing
are also explored.

LEARNING OBJECTIVES
After mastering the contents of this chapter, you should be able to do the following:
1. Identify the goals and philosophy of maternal and child health nursing.
2. Describe the evolution, scope, standards, and professional roles for nurses in
maternal and child health nursing.
3. Describe family-centered care and ways that maternal and child health nursing
could be made more family centered.
4. Identify legal and ethical issues important to maternal and child health nursing.
5. Discuss the interplay of nursing process, evidence-based practice, and nursing
theory as they relate to the future of maternal and child health nursing practice.
6. Integrate knowledge of trends in maternal and child health care with the nursing
process to achieve quality maternal and child health nursing care.
LEARNING CONTENTS

Let’s start…

A. GOALS OF MATERNAL AND CHILD HEALTH NURSING

T h e p r i m a r y g o
promotion and maintenance of optimal family health to
ensure cycles of optimal childbearing and childrearing.
The goals of maternal and child health nursing care are
necessarily broad because the scope of practice is so
broad. The range of practice includes
 Preconceptual health care
 Care of women during three trimesters of pregnancy and the puerperium (the 6
weeks after childbirth, sometimes termed the fourth trimester of pregnancy) Care
of children during the perinatal period (6 weeks before conception to 6 weeks
after birth)
 Care of children from birth through adolescence • Care in settings as varied as
the birthing room, the pediatric intensive care unit, and the home

In all settings and types of care, keeping the family at the center of care delivery is an
essential goal.

B. PHILOSOPHIES OF MATERNAL AND CHILD HEALTH NURSING

 Maternal and child health nursing is family centered; assessment data must
include a family and individual assessment.
 Maternal and child health nursing is community centered; the health of families
depends on and influences the health of communities.
  Maternal and child health nursing is research oriented, because research is the
means whereby critical knowledge increases.
 Both nursing theory and evidence-based practice provide a foundation for
nursing care.
 A maternal and child health nurse serves as an advocate to protect the rights of
all family members, including the fetus.
 Maternal and child health nursing includes a high degree of independent nursing
functions, because teaching and counseling are so frequently required.
 Promoting health is an important nursing role, because this protects the health of
the next generation.
 Pregnancy or childhood illness can be stressful and can alter family life in both
subtle and extensive ways.
 Personal, cultural, and religious attitudes and beliefs influence the meaning of
illness and its impact on the family. 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 a nurse and is a major
factor in promoting high-level wellness in families.

C. MATERNAL AND CHILD HEALTH STANDARDS

The Maternal and Child Health Service Program Standards
 Standard 1: Universal access
 Standard 2: Optimal health and
development
 Standard 3: Partnerships and collaboration.
 Standard 4: Responsive and accountable
service delivery
 Standard 5: Quality and safety

Standard 1: Universal access

The Maternal and Child Health Service provides universal access to its services
for children from birth to school age, their mothers and families.
Rationale
The early years of a child's life provide a critical opportunity to give a child the
best start in life, in order to achieve optimal health, development and wellbeing. There
are a large number of risk factors associated with these years that have negative
impacts on the child's health, developmental, learning and social outcomes. Conversely,
there are a large number of protective factors in early childhood that are associated with
prevention of adverse events for the child's health, developmental, learning and social
wellbeing (Dixon et al. 2000). Evidence suggests that action taken to reduce risk, and to
develop protective factors, provides the foundation for cognitive, coping and emotional
skills that positively affect learning, behaviour and health throughout life (National Public
Health Partnerships 2005).
Through the delivery of a universal Maternal and Child Health Service for
children, the Service plays a unique and integral part in reducing the risk factors and
increasing the protective factors for adverse outcomes for children. In order to do this,
the Service must provide a flexible service that responds to the needs of all young
children and their families. In addition to providing a universal service, the Service
focuses on approaches to include families not engaged by the Service and those with
the greatest burden of morbidity and risk. The Service actively seeks to identify and
respond to children at risk of poor outcomes, and engage all families regardless of their
cultural and linguistic background (COAG 2007).
Criteria for Standard 1
1) Universal access and participation
2) Responsive service delivery
3) Culturally competent service delivery

Standard 2: Optimal health and development

The Maternal and Child Health Service promotes optimal health and
development outcomes for children from birth to school age through a focus on the
child, mother and family.
Rationale
The early years of life are critical, and influence learning, health and behaviour
throughout life. Through the use of targeted interventions in the early years, the
Maternal and Child Health Service has the opportunity to influence the health,
wellbeing, learning, development and safety of the child, that in turn will influence their
learning, health and behaviour throughout life (Schmied et al. 2008).
The Service promotes optimal health and development outcomes for children
through targeted service delivery (DEECD 2009): a flexible approach to meet the needs
of the child, mother and family: professional judgement, and the use of validated tools
and evidence-based interventions. The Service uses promotion of health and
development to reduce health risks, and to increase the capacity of the mother and
family, empowering them to make decisions in order to improve the health, wellbeing.
learning, development and safety of the child (National Public Health Partnerships 2005;
Schmied et al. 2008; Vimpani 2004).
The health and wellbeing of the mother is a key element in influencing the health,
wellbeing, development and safety of the child (National Scientific Council on the
Developing Child 2004), and is a core component of the Maternal and Child Health
Service. The unique role of the father is also recognised in the health and development
of the child (Lamb 2004; Day and Lamb 2004) and the Service supports the father in his
role. In order to optimise outcomes, support and intervention provided by the Maternal
and Child Health Service acknowledges and recognises the determinants of health
(NHMRC 2005; AIHW 2004) for each child, mother and family.

Criteria for Standard 2

1) Health and wellbeing of the child
2) Health and wellbeing of the mother
3) Role of the father
4) Role of the family
 5) Service delivery based on evidence

Standard 3: Partnerships and collaboration

The Maternal and Child Health Service builds partnerships with families and
communities and collaborates and integrates with other services and organisations.
Rationale To maximise the child's health, wellbeing, learning, development and safety,
high levels of family involvement are required. A successful Maternal and Child Health
Service optimises the child's health, wellbeing, learning, development and safety, and
the wellbeing of the mother and family by adopting a family-centered approach. This
approach involves the Service working in partnership with the child and family and
identifying the strengths of the family. The Service also works with families to strengthen
their capacity, in order to provide the child with a safe and supportive environment
(Department of Education and Early Childhood Development 2008).
In order to meet the needs of the child the Service collaborates and works in
partnership with early years services, health services, family services, programs, and
organisations. These partnerships support effective linkages and referrals between the
Maternal and Child Health Service and other services, and enable the provision of
cohesive service delivery when more than one service is involved with the child, mother
and family. Working in partnership with other organisations and services is particularly
important when providing a service for the vulnerable child (Schmied et al. 2008; Centre
for Community Child Health 26).

Criteria for Standard 3

1) Working with the mother and family
2) Working with other services and organisations
3) Working with the community

Standard 4: Responsive and accountable service delivery

The Maternal and Child Health Service, supported by local government or the
governing authority, provides a responsive and accountable service for children,
mothers and families through effective governance and management.
 Rationale Governance incorporates the systems by which the Maternal and Child
Health Service is managed, and supports responsive and accountable service
provision. Effective leadership and management are required so as to provide a
framework for governance within the Maternal and Child Health Service and the local
government or governing authority. Lines of accountability and management structures
support an accountable and responsive service (Braithwaite and Travaglia 2008:
Balding 2008). Effective management ensures the Maternal and Child Service and its
workforce meet legislative requirements, through clear understanding of these
requirements being communicated to the workforce, and supported through policies and
procedures. The foundation of corporate governance is supported through development
of, and adherence to, strategic and operational plans, underpinned by effective
communication and change management strategies. Governance is assisted by well-
constructed and effective policies and procedures, which are current, appropriate,
relevant, and accessible to the maternal and child health workforce. These plans,
strategies and policies should be integrated within the plans, strategies and policies of
the local government or governing authority, rather than stand-alone documents solely
for the Maternal and Child Health Service (Berwick and Nolan 1998).

Criteria for Standard 4

1) Leadership and direction
2) Accountability
3) Information systems

Standard 5: Quality and safety

The Maternal and Child Health Service delivers a quality and safe service.
Rationale Quality improvement is the method through which the effectiveness of
activities within the Maternal and Child Health Service are reviewed, and changes
identified in order to improve service delivery. The process for identification of areas for
improvement, implementation of strategies to support improvement and review of these
strategies is supported through a quality improvement framework. The framework
assists in identification of the process or activity to be improved, understanding of the
issues behind the process or activity to be improved, implementation of an improvement
strategy, evaluation of the strategy and sustaining the strategy (Department of
Education and Early Childhood Development 2008). The framework supports the
delivery of a quality and safe service. The Maternal and Child Health Service delivers a
safe service for the child and family by ensuring the environment in which services are
provided supports the health, safety and wellbeing of the workforce providing the
Service and for each child, mother and family accessing it. The environment is also
accessible by each child, mother and family wishing to engage with the Service. This is
provided through occupational health and safety compliance, emergency management,
infection control, and the provision of suitable equipment and environments for the
Service.
Criteria for Standard 5
1) Improving performance
2) Safe and accessible

D. ROLES AND RESPONSIBILITIES OF A NURSE

As maternity care changed from regimented care of mother and newborn to a
family-centered approach, maternity nursing evolved to a new level of independence.
Women's health has evolved from nursing that did not focus on the care of women from
the early years of adolescence to late life. Little was known about how men and women
might differ in the best care for the same condition
For the best care during the years preceding childbearing through the time after
the reproductive years, nurses must communicate and teach effectively. They must be
able to think critically and use the nursing process to develop a plan of care that meets
the unique needs of each family. Nurses are expected to base their practice on valid
and current research and to collaborate with other health care providers. Moreover,
many nurses complete advanced programs of education that allow them to provide
primary care to girls and women before, during, and after their childbearing years.
Within the rising expectations for high-quality nursing practice is the real crisis of too few
nurses.
LEARNING CONTENT

Let’s start…

The Nurse's Role as Collaborator

Nurses collaborate with other members of the health

care team in coordinating and managing a woman's or
infant's care. Care is mproved by an interdisciplinary
approach as nurses work together with dietitians, social
workers, physicians, and others. Managing the transition
from an acute care setting to the home involves discharge
planning and collaboration with other health care
professionals. The nurse must be knowledgeable about
community and financial resources to promote a smooth transition. Cooperation and
communication are essential to best encourage women to participate in their care and
meet the needs of newborns.

The Nurse's Role as Researcher

Nurses contribute to their profession's knowledge base by systematically

investigating theoretic or practice-related issues in nursing. Nursing does not merely
"borrow" scientific knowledge from medicine and basic sciences. Nursing generates and
answers its own questions based on research of its unique subject matter. The
responsibility for research within nursing is not limited to nurses with graduate degrees.
It is important that all nurses apply valid research findings to their practices, rather than
basing care decisions merely on intuition or tradition. Evidence-based practice is no
longer just an ideal but an expectation of nursing practice. 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. Nurses should keep their knowledge current by networking and sharing
research findings at conferences, by publishing, and by reading research in professional
journals. A minimal number of continuing education (CE) hours is needed for license
renewal in each U.S. state and territory.

The Nurse's Role as Advocate

An advocate speaks on behalf of another person. As the health care environment

becomes increasingly complex, care may become impersonal. As the health
professional who is closest to the woman, the nurse is in an ideal position to humanize
care and to intercede on her behalf. As an advocate the nurse considers the family's
wishes in planning and implementing care. The nurse provides information to women
and their families to ensure that they are involved in decisions and activities related to
the care of the newborn. Nurses must be advocates for health promotion of vulnerable
groups such as victims of domestic violence or women unable to pay for low-cost
preventive care such as yearly well-woman examinations.

The Nurse's Role as Manager

The role of nurses has changed from that of primary caregiver to that of manager
and teacher with cost-containment measures such as brief inpatient stays or treatment
at outpatient clinics. Nurses may provide less direct patient care and delegate tasks
such as ambulationor taking vital signs to others. As a result, nurses spend more time
teaching women and families and supervising unlicensed personnel. Nursing case
managers often provide coordination of care for many patients. Nurses are expected to
understand the financial “squeeze" resulting from cost-containment strategies and to
contribute to their institutions' economic viability. At the same time they must continue to
act as patient advocates and maintain standards of care.