● Evidence-based means critical
Chapter 1: Framework for Maternal and Child
Health Nursing (Global)
Goals and Philosophies of MCHN
Area of childbearing and childrearing
- Major focus of nsg practice in promoting
health for the next generation
- interrelated
Comprehensive preconception and prenatal
care
- Essential in ensuring healthy outcomes
for mother and child
Primary Goal of MCHN
- the promotion and maintenance of
optimal family health to ensure cycles of
optimal chidbearing and childrearing.
MCHN Practice Throughout
Chilbearing-Childrearing Continuum
● Preconception healthcare
● Care of women during 3 trimesters of
pregnancy and puerperium (6 weeks
after childbirth or 4th trimester)
● Care of infants during perinatal period
(20 weeks of pregnancy to 4 weeks after
birth)
● Care of children from birth to late
adolescence
● Care in a variety of hospital and home
care settings
NOTE: MCHN includes care of pregnant person
(mother), child, and family.
Philosophy of MCHN
● Family-centered assessment data must
include family and individual
● Community-centered the health of
families depends on and influences the
health of communities.
●
knowledge increases.
Both nursing theory and evidence-based
practice provide a foundation for nursing care.
Approach
Family-Centered Approach
- Preferred focus of nsg care
- The (1) health of an individual along
with their (2) ability to function as
members of the family can influence
and improve overall family functioning
- Enables nurses to better understand
individuals and their effects on others, to
provide a more holistic care
MCHN Nurses:
- Provide guidance and monitor family
interactions
- Promote health and well-being of the
family unit
- Considers the family as a whole and as
a partner in care
- Serves as an advocate
- Shows high degree of independent
nursing functions
- Promotes health and disease prevention
- Serves as an important resource
- Respects personal, cultural, and
spiritual attitudes and beliefs
- Encourages developmental stimulation
- Assesses families for strengths, needs,
and challenges
- Encourages family bonding and early
hospital discharge
- Encourages families to reach out to their
community
MCH Goals and Standards
Access to healthcare and social
determinants of health impact the role of the
nurse and the health of the patient.
1

National Healthy People 2030 Goals
US Public Health Service (1979)
- First formulated healthcare objectives
for the nation
- Healthcare goals are reviewed every 10
years
Healthy People 2030 (2020)
- New goals set by the gov’t to be
achieved by 2030
- Help Americans easily understand
importance of health promotion and
disease prevention, encourage wide
participation in improving health, and
serve as basis for grant funding and
financing of evidence-based practice
- Many of these objectives directly involve
maternal and child healthcare
3 Overall Health and Well-Being Measures:
1. Well-being, including overall life satisfaction
2. Life expectancy in good health
3. Summary mortality and health measures
Global Health Goals
UN and WHO (2000)
- Established millenium health goals in an
effort to improve health worldwide
- 169 sustainable development goals with
17 targets
- Healthcare issues are addressed in
SDG 3
Health Setting Magnet Status
Magnet Status
- A credential made by the ANCC to
hospitals that meet a set of criteria
designed to improve strength and
quality of nursing care.
5 Major Categories:
1. Transformational Leadership
- Ability of nurses to convert the
organization's values, beliefs, and
behaviors to create a high professional
level of nursing care
2. Structural Empowerment
- Ability of nurses to provide an innovative
environment where they can flourish
with regard to the hospital’s mission,
vision, and values
3. Exemplary Professional Practice
- Demonstrates comprehensive
understanding of the role of nursing
4. New Knowledge, Innovation, and
Improvements
- Demonstrates strong nursing leadership
and exemplary practice while
contributing to patient care
5. Empirical Quality Results
- Demonstrates solid structure and
processes where nurses can flourish,
and where the mission, vision, and
values of the hospital/organization come
to life
Magnet hospitals demonstrate a high level of
nursing job satisfaction. They have policies that
include nurses in the SDMs regarding patient
care.
Framework for MCHN Care
4 Phases of Healthcare
1. Health Promotion
- Health education - follow sound health
practices; no known risk
2. Health Maintenance
- Intervening to maintain health; there is
a known risk
2
3. Health Restoration
6 QSEN Competencies
- Using conscientious assessment to deemed necessary for quality care
identify symptoms of illness;
interventions are begun Patient is the source of
control and a full partner.
4. Health Rehabilitation Patient-Centered Care is based on respect
- Prevent complications from illness Care for the patient’s
preferences, values, and
needs.
Nursing Process
Nurses foster open
Teamwork and communication, mutual
Nursing Care Collaboration respect, and shared
- Designed and implemented in a decision making (SDM)
thorough manner using an organized among others.
series of steps to ensure quality and
Nurses integrate best
consistency of care
current evidence with
- Scientific form of problem solving Evidence-Based clinical expertise and
- Basis for assessing, making NDx, Practice px/fam preference for
planning, implementing, and evaluating delivery of optimal
care healthcare.
- Basis for modern nursing care
Nurses use data to
monitor outcomes of care
Nursing Theory and use improvement
Quality methods to design and
Improvement test changes to
Nursing Theories continuously improve the
- Designed to offer helpful ways to view quality and safety of
patients so nursing activities can be healthcare systems.
created to best meet patient needs
Nurses minimize the risk
of harm to px and
1. Calista Roy (Adaptation Theory) Safety providers through system
- help px adapt to change caused by effectiveness and
illness or other stressors individual performance.

2. Dorothea Orem (Self-Care Deficit Theory) Nurses use information

- to check px’s selfcare abilities and technology to
Informatics communicate, manage
knowledge, mitigate
3. Patricia Benner (Novice to Expert Theory) error, and support
- ability of the nurse to give decision making.
interprofessional care

Evidence-Based Practice
Quality and Safety Education for Nurses (QSEN)

Evidence-Based Practice
Overall Goal: To address the challenge of - Important element of nursing practice
preparing future nurses with the abilities needed prior to the dev’t of QSEN
to improve the quality and safety of healthcare - Conscientious, explicit, and judicious
systems where they work. use of current best evidence to make
decisions about the care of patients

3
Evidence can be a combination of research, care options and
clinical expertise, and patient preferences or available to provide a
values backup opinion as
needed.
Nursing Research 90% (ninety percent) Healthcare must be
of people who identify scheduled at times a
as women in the US working parent can
Nursing Research work outside their come for care or can
- Systematic investigation of problems home at least bring a child for care.
that have implications for nursing part-time; many are Problems of children
practice usually carried out by nurses the main wage earners left home alone and
for their families the number and safety
- Examining nursing care through of childcare centers
research results in an improved, need to be addressed
cost-effective patient care as it provides
Families are more Good interviewing and
evidence for action and justification for
mobile than health monitoring are
implementing such activities. previously; there is an necessary with mobile
increase in the families so a health
number of people and database can be
A Changing Discipline families without established and there
homes can be continuity of
care
Maternal and child health
- An ever-changing area of nursing. Both child abuse and Screeening for child
- E.g. childhood infections (whooping intimate partner abuse or intimate
violence are partner violence
cough, measles) can be prevented so increasing in should be included
children do not usually require care for incidence in all family
these conditions. assessments. Nurses
- E.g. illnesses that could not be treated must be aware of the
legal responsibilities
before (cystic fibrosis, hypertension of for reporting violence
pregnancy) can now be treated so the
number of settings and critical aspects Families are more Families are ripe for
health-conscious than health education;
of care increases and the nature of
ever before; the use of providing
nursing evolves. websites to monitor evidence-based
their health or ask information can be a
health questions is major nursing role
Trends in the Maternal and Child Health rapidly increasing
Nursing Population
Healthcare must cost Comprehensive care
containment by is necessary in
creating “healthcare primary care settings
Trend Implications for
homes” or “medical because referral to
Nursing
homes” specialists may not be
an option depending
Families are not as Fewer family members on a family type or
extended as in are available as lack of health
previous generations, support people in insurance.
so they contain fewer times
members
Patient advocacy is Patient advocacy is
necessary as it is easy safeguarding and
The number of A single parent may for families to feel lost advancing the
single-parent families have fewer financial in the healthcare interests of patients
is increasing so resources than dually system and their families.
rapidly it now equals employed parents. Familiarity with the
the number of nuclear Nurses need to be healthcare services
families in the US aware of alternative available in a

4
 community, Maternal mortality The number of
establishing and rate maternal deaths per
maintaining a 100,000 live births
relationship with that occur as a
families as well as
helping them make
direct result of the
informed choices reproductive
about what course of process
action to take or what
services would be Infant mortality rate The number of
best to use are deaths of per 1,000
important nursing live births occurring
roles. at birth or in the
first 12 months of
life
Measuring Maternal and Child Health
Childhood mortality The number of
rate deaths per 1,000
Common Statistical Terms Used to Report population in
Maternal and Child Health children aged 1 to
14 years
Birth rate The ratio of the
number of total live
births to the total Birth Rate
population;
expressed as births
per 1,000 population In the United States
- The country’s birth rate has continued to
Fertility rate The number of gradually decrease in recent years (to
pregnancies per 11.6 per 1,000 population in 2018).
1,000 biologic
- Substantially decreased from a high of
women of
chilbearing age 30.2 per 1,000 population in 1909.

Fetal death rate The number of fetal In Early Last Century

deaths (over 500 g) - Births to teenage mothers were steadily
per 1,000 live births increasing
- HOWEVER, due to additional
Neonatal death rate The number of
deaths per 1,000 counseling and increased availability of
live births occurring contraception, the rate is now steadily
at birth or in the declining (at 17.4/1,000 from a high of
first 28 days of life 618/1,000 in 1961)

Perinatal death rate The number of

Birth Rate for Women 20 to 24 years of age
deaths during the
perinatal time - At 68.0/1,000, is gradually declining
period (beginning (people choose to postpone having
when a fetus children until past college age)
reaches 500 g about - In contrast, the number of children born
week 20 of to mothers older than 40 years of age is
pregnancy and steadily increasing (presently at
ending about 4 to 6
11.8/1,000 from a low of almost no births
weeks after birth);
the sum of the fetal in this age group in 1901)
and neonatal rates

5

Fertility Rate
Low fertility rates
- In countries where there are fewer
nutritional resources
- Poor nutrition makes conceiving difficult
- In countries where the proportion of men
young adults are low because of war or
disease
High fertility rates
- In countries where the average person
has access to good nutrition and feel
safe to begin a family
US Fertility rate
- Currently at 59.1% (typical rate of a
healthy, high-resource country)
Fetal Death Rate
Cause of fetal death
- Occurs because of maternal factors and
also fetal factors
Fetal death rate
- Important in evaluating the health of a
nation because it reflects the overall
quality of maternal health and whether
common services such as prenatal care
are available
Neonatal Death Rate
- Reflects not only the quality of care
available to patients during pregnancy
and childbirth, also the quality of care
available to infants during the first month
of life.
Number of infant deaths per 100,000 live births
in 2018: 566.2
Leading cause of death
- During 1st month: prematurity with
associated low birth weight, congenital
malformations, maternal complications,
sudden infant death syndrome, injuries
Proportion of infants born with low birth weight
- About 8.28% of all births in 2018
- Number of low birth weight infants has
declined after steadily increasing since
2006.
Highest rate of neonatal and infant deaths
- Infants born to birthing parents under
age 54 of 20 years between ages 40
and 54 years.
Infant Mortality Rate
- The infant mortality rate of a country is a
good index of its general health because
it measures the quality of pregnancy
care, overall nutrition and sanitation,
and infant health and available care.
- This rate is the traditional standard used
to compare the health of a nation to
previous years or to other countries.
- Infant mortality is not equal among all
demographic groups of America
Factors that cause differences in Infant Mortality
Rate
- Unequal provision of and access to
healthcare in different communities
- Vary from state to state within the United
States
- Differences in reporting capability as
well as the type of health insurance and
care available (national variances)
Mississippi
- Highest infant mortality rate in the US
(8.3%)
New Hampshire
- Lowest infant mortality rate in the US
(3.6%)
US
- Has one of the highest infant mortality
rates
6
 8. Cerebral vascular accidents
Organization for Economic Cooperation and 9. Amniotic fluid embolism
Development 10. Anesthesia complications
- Promoting economic development and
social well-being of people worldwide
Child Mortality Rate
Causes of infant mortality rate in the US
- Prematurity
- Low birth weight - In 1980, mortality rate was about 6,400
- Congenital malformations per 100,000 for children aged 1-4 years.
- SIDS - In 2017, 23.3 per 100,000
- Children in 5-14 years have the lowest
American Academy of Pediatrics mortality rate at 13.4 per 100,000
recommendations to avoid SIDS - Between 15 and 24 years old, rate
- Place infants back to sleep increased to 69.7 per 100,000
- Use room sharing BUT NOT bed
sharing Major Causes of Death in Childhood
- Avoid exposure to overheating or
cigarette smoke 1. Under 1 year
- Congenital malformations and
chromosomal abnormalities
- Disorders related to short
Maternal Mortality Rate gestation age and low birth
weight
In the early 20th century - Maternal complications of
- Maternal mortality rate in the US: high pregnancy
as 600 per 100,000 live births - Sudden infant death syndrome
- Accidents
As of 2017, 2. 1 - 4 years
- 17.3 per 100,000 live birth - Unintentional injuries
(accidents)
General improvements in the rates of maternal - Congenital malformations and
mortality: chromosomal abnormalities
- Increased participation of individuals in - Malignant neoplasms
prenatal care - Homicide
- Greater detection of disorders - Diseases of the heart
- Increased control of complications
- Decreased use of anesthesia 3. 5 - 9 years
- Ability to better prevent or control - Accidents
hemorrhage and infection - Malignant neoplasms
- Congenital anomalies
Known causes for maternal mortality: - Homicide
1. Noncardiovascular disease - Diseases ofthe heart
2. Cardiovascular disease 4. 10 - 14 years
3. infection/sepsis - Accidents
4. Hemorrhage - Suicide
5. Cardiomyopathy - Malignan neoplasms
6. Pulmonary embolism - Homicide
7. Hypertensive disorders of pregnancy - Congenital anomalies

7
 5. 15 - 24 years
- Accidents
- Suicide
- Homicide
- Malignant neoplasms
- Diseases of the heart
*refer nalang sa book sa childhood morbidity
rate huhu
Trends in the Healthcare Environment
1. Initiating Cost Containment
2. Changes in Health Insurance Coverage
3. Increasing Alternative Settings and Styles for
Healthcare
4. Increasing Use of Technology
5. Meeting Work needs of Pregnant and
Breastfeeding Individuals
6. Regionalizing Intensive Care
7. Increasing Use of Alternative Treatment
Modalities
8. Increasing reliance on Home Care
Healthcare Concerns and Attitudes
1.Increasing Concern for Quality of Life
2.Increasing Awareness of the Individuality and
Diversity of Patients
3.Empowerment of Healthcare Consumers
Legal Considerations Specific to
Maternal-Child Nursing Practice
1. Informed Consent related to fetal well-being
2. Informed consent and legal guardianship for
procedures performed on children
3. Length of time between healthcare incident
and child’s ability to bring lawsuit
4. Identifying and reporting suspected child
abuse
5. Concepts of “wrongful birth”, “wrongful life”,
and “wrongful conception”
Ethical considerations of Maternal-Child
Nursing Practice
1. Conception issues, especially those related to
in vitro fertilization, embryo transfer, ownership
of frozen oocytes or sperm, and surrogate
motherhood
2. Pregnancy termination
3. Fetal rights versus rights of the mother
4. Stem cell research
5. Resuscitation (and length of its continuation)
6. Number of procedures or degree of pain a
child should asked to endure to achieve a
degree of better health
7. Balance between modern technology and
quality of life
8. Difficulty maintaining confidentiality of records
when there are multiple caregivers
Chapter 2: Diversity and Inclusion Maternal Child
Nursing
Diversity - there is a mixture or variety of
sociodemographic groups, experiences, and
beliefs in the population
Culture - a view of the world and a set of
traditions a specific social groups uses and
transmits to the next generation
● Cultural inclusion and competency in
healthcare is a responsibility of nurses
and is exemplified by demonstrating
cultural respect for others and for nurses
themselves as well as by being sensitive
to individuals’ cherished beliefs and
cultures
8

● Families have evolved dramatically from
the “nuclear family” of male and female
parents with children.
Cultural differences - occur across not only
different etnic backgrounds but also different
socio demographic groups. Respecting these
cultures is just as important as respecting ethnic
differences (Example: adolescents in different
geographic areas, those with hearing
impairment, and gay, lesbian, and trasngender
couples)
● Assessing for diverse backgrounds
and beliefs of families and patients
can reveal why people choose the type
of preventive health measures they do
or why they seek a particular type of
care.
Nursing Care Planning Based on Healthy People
2030 Goals
ASSESSMENT
A number of Healthy People 2030 goals are
directly concerned with health practices that can
be influenced by cultural diversity and LGBTQ+
health:
● Increase the proportion of pregnant
people who receive early and adequate
prenatal care from a baseline of 76.4% to
80.5%
● Increase the proportion of infants who are
breastfed at 1 year from 35.9% to 54.1%
● Increase the proportion of healthy
full-term infants who are put down to
sleep on their backs from a baseline of
78.8% to 88.9%
● Decrease the percentage of children who
receive no vaccines that have been
recommended for universal administration
to 1.3%
● Reduce the rate of suicide from 14.2 per
100,000 to 12.8 per 100,000
NURSING DIAGNOSIS
● Reduce the adolescent suicide attempt
rate from 2.4 per 100 to 1.8 per 100
● Increase the proportion of homeless
adults with mental health problems who
receive mental health services
● Increase the number of nationally
representative, population-based surveys
that collect data on or for transgender
populations from two to four
● Increase the number of nationally
representative, population-based surveys
that collect data on lesbian, gay, and
bisexual populations from 8 to 10
Nurses can help the nation achieve these goals
by helping design prenatal and childcare services
that take into account cultural diversity and
LGBTQ+ health and by promoting the nutritional
and immunologic advantages of breastfeeding in
a culturally competent manner.
Nursing Process Overview:
For Care that Respects Cultural Diversity
- Is important so care can be planned
based not on predetermined
assumptions but on the actual
preferences of a family
- Poverty can be a major problem for
many minority ethnic groups. Cultural
limitations (characteristic responses) are
the consequences of poverty. (e.g.,
parents seeking medical care late in the
course of an illness or a person not
taking prenatal vitamins during
pregnancy)
- To assess patients for aspects of
diversity, assess them as individuals, not
as one of a group.
- Note any cultural characteristic that
differs from the usual expectations of
your care setting so potential conflicts
can be acknowledged and culturally
care can be planned
9
 - Powerlessness related to expectations
of care not being respected
- Altered verbal communication related to
limited English proficiency
- Malnutrition risk related to unmet
cultural food preferences
- Anxiety related to a cultural preference
for not wanting to bathe while ill
- Fear related to possible ethnic
discrimination
OUTCOME IDENTIFICATION AND PLANNING
- Planning needs to be specific for
individual families because cultural
diversity preferences tend to be
personal.
- Begin care with an in-service education
for team members who are unfamiliar
with a particular cultural practice and its
importance to a specific family involved
- You also might want to ask if your
agency could change a policy to
accommodate a family’s cultural
preferences (e.g. length of visiting
hours, types of food served or type of
hospital clothing provided)
ONLINE RESOURCES
- National Association of Hispanic Nurses
(www.nahnnet.org)
- National Black Nurses Association
(www.nbna.org)
- Transcultural Nursing Society
(www.tcns.org)
- National Coalition of Ethnic Minority
Nurse Associations
(http://www.ncemna.org/associations.ht
m)
- U.S. Department of Health and Human
Services Office of MInority Health
Resource Center
(https://minorityhealth.hhs.gov/omh/)
- The Joint Commission Advancing
Effective Communication, Cultural
COmpetence, and Patient- and
Family-Centered Care for the Lesbian,
Gay, Bisexual, and Transgender (LGBT)
Community: A Field Guide
(https://www.jointcomission.org/lgbt/)
- World Professional Association for
Transgender Health
(http://www.wpath.org/)
IMPLEMENTATION
- Be certain not to force your cultural
values and biases on others, and be
aware of your own values and biases
that you may have
- Don’t feel that you or your healthcare
agency are always the ones who must
adapt, but a particular situation may call
for both sides to adjust (i.e., cultural
negotiation)
OUTCOME EVALUATION
- Should reveal that a family’s diversity
preferences have been considered and
respected during care. If this was not
achieved, procedures or policies may
need to be modified until this can be
realized
- Examples of expected outcomes that
might be established:
● Parents list three ways they are
attempting to preserve cultural
traditions in their children
● Child states the no longer feel
socially isolated because of their
family’s differences
● Family members state they
have learned to substitute easily
purchased foods for traditional
but unavailable foods to obtain
adequate nutrition
● Child with severe hearing
impairment writes that they feel
communication with ambulatory
care staff has been adequate
● Adolescent patient states they
are ready to tell family about
gender identity and sexual
orientation
Assessing for Cultural Values
10

Area of Questions to Ask or
Assessment Observations to Make
Ethnicity Where were the parents
and grandparents born?
What ethnicity does the
family state is theirs?
Communication What is the main language
used in the home?
Touch Does the family ty[ically
touch or hug each other?
Do they mainly use intimate
or conversational space?
Time Is being on time important?
Is planning for the future
important?
Pain Does the patient express
pain or remain stoic in the
face of it? What do family
members believe best
relieves pain?
Family Is the family nuclear?
Structure Extended? Single-parent?
Are the parents the same
sex? Are family roles clear?
Male and Is the family male- or
female roles female-dominant? What is
the patient’s gender identity
and which pronouns do
they prefer?
Religion What is the family’s
religion? Do members
actively practice? WIll any
of their beliefs directly
affect your care or their
treatment?
Health Beliefs What does the family
believe makes one
healthy? Causes illness?
Makes illness better? DO
members use
complementary and
alternative therapies or
mainstream medical
practices?
Nutrition Does the family mainly eat
culture-specific foods? Are
the foods they enjoy easily
accessible in their
community?
Community Is the predominant culture
in the community the same
as the family’s? Can
members name a neighbor
they could call on in a
crisis?
Methods to Respect Diversity and INclusion in
Maternal and Child Health Nursing
Dominant/Advantaged Group
- Hold greater share of wealth in the
nation and hold the majority of political
offices
Minority/Disadvantaged Group
- May not necessarily always be fewer in
number, but they hold less power and
wealth
● It is important to avoid stereotyping and
assumptions rooted in accepting the
dominant group as the norm; it can
prevent you from planning care that is
accurate, individualized, and valuable. It
is also important not to ignore cultural
characteristics in an attempt to not
stereotype.
Stereotyping
- Expecting a person to act in a
characteristic way without regard to their
individual traits
Prejudice
- A negative attitude toward members of a
group
Discrimination
- The action of treating people differently
based on their physical or cultural traits
11
 ● Cultural differences cause behavior to
vary widely from one community to
another. The way people respond to
pain is an example of a behavior that is
heavily influenced by culture. Some
people scream and others remain stoic
and quiet. Both are “proper” responses,
just culturally different.
● Stereotyping is generally derogatory in
nature. It generally occur because of a
lack of exposure to people in a particular
group and consequently a lack of
understanding of the wide range of
differences among people who belong to
a particular group.
● You can acknowledge and celebrate a
patient’s culture without stereotyping
● It is important to acknowledge sexual
and gender-based diversity. Assessing
and verifying secual orientation and
gender indentity at the appropriate times
should be included when relevant.
Gender identity can greatly affect how a
person feels during a standard health
assessment.
Understanding Cultural Diversity and Inclusion in
Maternal and Child Health Nursing
● In the past, the prevailing view was that
the United States was viewed as a giant
cultural “melting pot,” where all new
arrivals gave up their native countries’
traditions and values and became
Americans. Today, a better analogy may
be a “salad bowl,” in which cultural
traditions and values are tossed
together, but retain individual crispness
and unique flavors.
● Females are often considered the
“keepers of the culture” or the people
most influential; in passing on cultural
traditions from one generation to
another.
Transcultural nursing
- care guided by cultural aspects and
respects individual differences nursing
care is about improving the health of
individuals and populations
● Trust between the nurse and patient
requires careful relationship building to
establish communication,
understanding, and respect for the
patient and their family.
● Developing cultural competency is
an important aspect of complete care for
patients.
Cultural values
- Preferred ways of acting informed by
cultural traditions
- Often arise from environmental
conditions (e.g., in country where water
is scarce, daily bathing is not valued)
- Differing cultural values can be a major
source of conflict between parents and
children because children learn
opposing values from friends and school
peers.
Mores or Norms
- The usual values of a group
Taboos
- Actions not acceptable to a culture
- Three universal taboos are murder,
incest, and cannibalism
- Abortion, robbery, and lying are
controversial as taboos because these
are taboos only to some people, not
everyone.
Nursing Care PLanning Based on Family Teaching
PRESERVING A FAMILY”S CULTURAL
HERITAGE
Q. I’m proud of my family’s cultural traditions.
What are some good ways to help my family
preserve these?
A. Preserving individual heritage traditions
while living among another culture calls for
12
 creative planning. Some common suggestions
for doing this include: Acculturation - the loss of ethnic traditions
● Plan a “heritage night” once per week because of disuse
when only culturally traditional food is
served. Encourage children to invite Cultural Assimilation - people blend into the
friends for the meal and discuss the general population or adopt the values of the
traditions behind the various foods. dominant culture
● Reserve one night per week when
family members speak only the native
language so children come to value Ethnocentrism - the belief one’s own culture is
multiple languages. superior to all others and the “norm”
● Choose books for children written by
authors from your culture or that Cultural Awareness - being aware cultural
positively describe your culture. Read differences exist
them together as a family and discuss
the stories.
● Monitor television for programs that Cultural Competence - respecting cultural
focus positively on your culture, differences or diversity
Watch them with your children and
comment on how such traditions Cultural Humility - lifelong process of
enrich family life. self-reflection and self-critique that begins not
● Speak to your children about your with an assessment of a patient’s beliefs, but
childhood and traditions and values at
rather with an assessment of one’s own.
bedtime or “talk time,” so they can
appreciate how long these values
have been revered by your family ● Numerous levels of cultural intolerance
● Celebrate holidays in your traditional or acceptance persist because people
manner. Including cultural inferences hold different beliefs along a cultural
in holiday celebrations adds a rich competence continuum.
ingredient and feeling of security to
these occasions.

A Cultural Competence Continuum

Cultural Competency Terminology for Nurses

Cultural Making everyone fit the
Destructiveness same cultural pattern and
Culture-Specific Values - norms and patterns excluding those who don’t
of behavior informed by a particular culture fit (forced assimilation).
Emphasis on differences
Culture-universal values - refer to values, as barriers.
norms, and patterns shared across almost all
cultures Cultural Do not see or believe
Blindness there are cultural
differences among
Ethnicity - cultural group into which a person people. Everyone is the
was born, though the term is sometimes used in same.
a narrower context to mean only race
Cultural Being aware that we all
Race - social construct that refers to a category Awareness live and function within a
culture of our own and
of people who share a socially recognized
that our identity is shaped
physical characteristic, often skin color or facial by it.
features. Can also refer to a group of people
who share the same ancestry.

13

Cultural Understanding and
Sensitivity accepting different cultural
values, attitudes, and
behaviors.
Cultural The capacity to work
Competence effectively and with
people, integrating
elements of their culture -
vocabulary, values,
attitudes, rules, and
norms. Translation of
knowledge into action.
Cultural Lifelong process of
Humility self-reflection and
self-critique that begins
not with an assessment of
a patient’s belief, but
rather an assessment of
your own.
Communication Patterns
● Communication patterns are strongly
influenced by culture.
Language
- Communication problems can arise from
both translation difficulties from dialect
differences within a country
- To care for each patient, learn their
dialect’s cadence and common words,
but don’t attempt to use them yourself
unless that is your own dialect.
- Trying to speak in a dialect not your own
could be misinterpreted as mockery.
- When caring for patients who speak a
different dialect or language than your
own:
● Ask them to repeat patient
teaching to be certain it was
interpreted correctly
● Repeat what the patient said so
you both can confirm you
understood correctly
● Don’t be reluctant to ask for an
interpreter to help clarify forms
● Provide written information or
instructions in the patient’s
native language
- Some patients prefer to consult a
Chinese herbalist or a Hispanic yerbero
or curandero rather than or in concert
with other healthcare providers because
they can relate health problems with no
language barrier.
- In many instances, written
communication is even more
problematic than oral communication
because many people can speak a
second language but cannot write or
read it.
Nonverbal Communication
- Some people gesture wildly to express
any topic; others rarely raise their
hands.
- Whether people look at one another
when talking is also culturally
determined
- Touch, such as whether to greet another
person with a kiss or hug, is a form of
communication and thus is culturally
determined.
- Tattoos are often meaningful for the
patient. It is important that nursing care
reflect respect for individual differences
in body expression.
Use of Conversational Space
- People of different cultures use
surrounding space differently:
● Intimate space - space closely
surrounding a person. Physical
examinations are conducted in
this tight space because of
palpation and auscultation
● Conversational Space -
usually 18 in. to 4 ft. away
● Business space - beyond 4 ft,
this amount allows room for a
desk between parties
● Public space - any distance
beyond business space; space
across which to shout in a
parking lot;
14
 - Respect for Modesty is another way to
respect a patient’s space.
Time Orientation
- “Time is money” is an often-quoted
axiom.
- People who do not have a strict time
orientation may have difficulty following
a strict medical regimen
- If a family’s orientation is for the present
or the past, members may have difficulty
integration a long-term rehabilitation
plan into their lives
- People with strong religious convictions
may be future-oriented. Past-oriented
people adhere to time-honored
traditions that do not include
technological advancement. People
from lower socioeconomic groups tend
to be present-oriented because the
struggle to get through each day and an
uncertain future limits them to the
present.
Family Structure
- The way families structure themselves
and the roles members play within the
family are also culturally determined.
- Be careful not to assume the nature of
parent, caregiver, family members,
child/sibling relationships, and/or gender
roles when working with different
families
- Some cultures stress that family
boundaries should be carefully guarded
or information about a family should not
be given freely at healthcare visits
- When caring for children, be certain to
identify a child’s primary caregiver
before asking what the child likes or
giving healthcare instructions
Concepts of Male and Female Roles
- The self-identified male or female is the
dominant figure in the family
- In a strongly male-dominant culture, if
approval for hospital admission or
therapy is needed, the oldest male in
the family would give this approval
- If the nondominant member becomes ill
during pregnancy, the nurse has to act
as an advocate
- The incidence of intimate partner
violence may be higher in
male-dominant cultures and may rise
with pregnancy
- Evaluating male and female roles this
way can help you understand the impact
of illness on a family
Religion and Spirituality
- Because religion guides a person’s
overall life philosophy, it influences how
people feel about health and illness
- Knowing which religion a family
practices can help you locate the correct
religious support person if one is
needed
- It can also have important implications
for decision making during a difficult
pregnancy or for childhood terminal care
Health Beliefs
- Health beliefs are not universal
- Cause of illness is another area that is
strongly culturally influenced
- People in developed countries
understand that illness is caused by
documented factors such as bacteria,
viruses, or trauma. In other cultures,
illness may be viewed primarily as a
punishment from God, the effect of an
evil spirit, or as the work of a person
who wishes the sick person harm.
- Understanding different beliefs of this
kind allows you to better work out
mutual goals even when opposing
beliefs are present.
Nutrition Practices
- Foods and their methods of preparation
are yet another area strongly related to
culture.
- In many instances, people cannot find
any food on a hospital menu that
appeals to them because of cultural
likes and dislikes.
15
 - Fortunately, in most instances, a family
member can provide food that is
appealing culturally and is still within
prescribed dietary limitations.
- When counseling a person about
nutrition during pregnancy, remember
that respect for culturally preferred foods
is important.
- Before beginning nutrition counseling,
try to learn the dominant types of food
stocked in stores in the community of
your healthcare agency because people
who cannot buy the foods you
recommend in their own neighborhoods
may not comply due to the
inconvenience and increased costs.
Pain Responses
- A person’s response to pain is both
individually and culturally influenced.
- Threshold Sensation (the amount of
stimulus that results in pain.)
- Pain Threshold (the point at which the
individual reports a stimulus is painful.)
- Pain Tolerance (the point at which an
individual withdraws from a stimulus.)
- Assessing differing responses to pain
that occur because of cultural
differences is an important role,
UNDERSTANDING SEXUAL ORIENTATION IN
MATERNAL AND CHILD HEALTH NURSING
- There is a potential for major barriers for
healthcare providers when caring for
individuals who are different from them;
this is due to implicit bias.
- Identifying personal implicit biases can
be addressed through self-reflection,
trying to understand and reflect why
these differences might bother you, and
setting those feelings aside while
providing care.
- Understanding sexual orientation is part
of providing culturally competent and
inclusive healthcare.
Development of Sexual Orientation
- There is evidence that sexual orientation
is genetically determined, developing
due to complex effect of estrogen or
testosterone in utero.
- It is essential to realize that sexual
orientation is a societal label and
construct and may not correspond to the
full range of a person’s sexual behavior
or emotions.
- This can cause additional stress during
adolescent development because
revealing sexual orientation to family
and friends (“coming out”) may be
difficult.
Sexual Orientation Terminologies
1. Heterosexual- someone who finds
sexual fulfillment with a member of the
opposite sex,
2. Homosexual- someone who finds
sexual fulfillment with a member of thei
own sex.
3. Gay- male-identifying individuals who
are sexually attracted to male partners.
4. Lesbian- female-identifying individuals
who are sexually attracted to female
partners.
5. MSM- men who have sex with men.
6. WSW- women who have sex with
women.
7. Bisexual- if they achieve sexual
satisfaction for both same-sex and
heterosexual relationships.
8. Transgender- umbrella term for people
whose gender identity and/or gender
expression differs from what is typically
associated with the sex they were
assigned at birth.
9. Queer- and adjective used by some
people to indicate their sexual
orientation is not exclusively
heterosexual.
Healthcare Barriers Based on Sexual
Orientation
- LGBTQ+ patients may be hesitant to
reveal their sexual orientation to their
healthcare providers because they are
16
 often already the victims of bullying,
family rejection, and sexual assault.
- 30% of LGBTQ+ patients had a negative
experience with a healthcare provider
because of their sexual orientation.
Communication Related To Sexual
Orientation
- When asking about a patient’s needs,
always ask about the patient’s partner or
partners.
- Make sure to tailor education to the
patient’s specific needs.
- A nurse can build trust and ensure the
individual will return for care as needed
by using neutral terminology and asking
what the patient needs or wants.
- Address mental and social healthcare
needs.
UNDERSTANDING GENDER IDENTITY IN
MATERNAL AND CHILD HEALTH NURSING
- A person has both a sexual orientation
and a gender identity.
Gender Identity Terminology for Nurses
1. Binary- male/female
2. Nonbinary- not identifying as
male/female
3. Cisgender- feels their gender and sex
match
4. Transgender- feels their gender and
sex do not match
5. MTF- male-to-female transition; may
prefer female pronouns
6. FTM- female-to-male transition; may
prefer male pronouns
7. Hormone Replacement Therapy- use
of estrogen and antiandrogens for MTF
and testosterone for FTM
8. Gender Affirmation Surgery- surgical
procedure to change body
characteristics
Gender Identity
- Is the inner sense of a person has of
being a male, female, or nonbinary,
which may be the same as of different
from the sex assigned at birth.
Sex Assigned at Birth
- Is usually based on a person’s
chromosomal sex: male (XY) or female
(XX) and/or visual inspection of external
genitalia.
Gender Expression
- Refers to the behavior a person exhibits,
which may or may not be the same as
the person’s gender identity or sex
assigned at birth.
Development of Gender Identity
- Gender Dysphoria (the realization
one’s physical sex and gender are
mismatched, and this can cause a lot of
stress and anxiety.
- Transition (when they begin to live as
the gender they feel they are)
Healthcare Barriers Based on Gender
Identity
- Just as individuals who have minority
sexual orientation are often the victims
of bullying, sexual assault, and societal
isolation, transgender individuals are
also often marginalized.
- FTM may seek pregnancy.
Communication Related to Gender Identity
- It is important not to make any
assumptions.
- A patient may be listed as a sex with
what they don’t idenify on their medical
chart. It is best to ask which pronouns to
use.
- A partner’s gender should not be
assumed either.
17

Chapter 3: The Childbearing and Childrearing
Family in the Community
Nursing Process Overview:
For Promotion of Family Health
For Promotion of Family Health
ASSESSMENT
- Assessment of the structure and
function, as well as the strengths and
challenges, of families provides
information on the ability of a family to
remain well during either calm or
stressful times.
- Is vital to understanding what a
pregnancy or childhood illness will mean
to different family members
NURSING DIAGNOSIS
- Nursing diagnoses formulated for
families and the community generally
relate to the family’s ability to handle
stress and to provide a positive
environment for the growth and
development of the members.
Examples:
● Impaired parenting related to
unplanned pregnancy
● Parental role conflict related to
prolonged separation from the
child during a long hospital stay
● Interrupted family processes
related to emergency hospital
admission of the oldest child
● Ineffective family coping
mechanisms related to an
inability to adjust to the mother’s
illness during pregnancy
● Readiness for enhanced family
coping mechanisms related to
improved perceptions of the
child’s capabilities
● Health-seeking behaviors
related to the birth of a first child
● Inadequate community support
for family related to pregnancy
OUTCOME AND IDENTIFICATION
PLANNING
- Planning for nursing care is
most effective if it includes a
design that is both family and
community-centered and also
both appropriate and desired by
the majority of family members
- National Partnership for Women
& Families is to help parents
keep up to date on health
insurance issues, family leave,
and family rights
IMPLEMENTATION
- To improve family health should flow
smoothly if family members have agreed
on a plan of action in support of one
another.
- To encourage family members to agree
to a plan or to abide by a chosen plan.
OUTCOME EVALUATION
- An evaluation should reveal not only
that a goal has been achieved but also
that the family feels more cohesive after
working together toward the goal
- If the evaluation does not reveal these
two factors, reassess the goal
Examples:
● Family members state they are
adapting well to a newborn
joining the family.
● The mother states she feels
prepared to manage home care
for her ill child.
● Parents state they have
arranged the family finances to
accommodate new healthcare
expenses for the family.
● The grandmother states she will
omit trans-fatty acids from
18
 cooking to better safeguard the
health of her family.
MATERNAL-CHILD NURSING CARE AND
THE COMMUNITY
Nursing a community refers to nurses’ ability
and responsibility to help make communities
safer by participating in community activities and
organizations with the goal of strengthening the
community.
Identified community nursing issues can include:
● Families feeling unsafe walking outside
because of broken street lights
● Multiple automobile accidents occurring
at a particular street corner due to a
malfunctioning traffic light
● Need for better signage at a nearby park
to indicate a duck pond is over 3 ft deep
It is easy to fall into the mindset that a
single telephone call or an e-mail about
a problem won’t make a difference
● Participating in fundraising charity
events such as a walkathon
● Encouraging a block of homeowners to
form a block parent association to
ensure safe passage for students to and
from school or activities
● Organizing adolescents from a local
high school to begin a reading program
at a grade school to increase interest in
reading and improve the literacy rate in
their neighborhood
Knowing the individual aspects of a community
also helps you understand why some people
reach the illness level they do before they seek
health care
THE FAMILY AS PART OF COMMUNITY
Because the health of individuals and their
families are influenced by the health of their
community, it is important to become acquainted
with the community in which you practice or
where a specific patient lives.
A community can be defined in many ways, but
it is generally understood to be a group of
individuals interacting within a limited
geographic area.
A community assessment can reveal if there are
aspects about the community that contributed to
a person’s illness (and therefore need to be
corrected).It also helps determine whether a
person will be able to return to their community
without extra help and counseling after
recovering from an illness
ASSESSING A COMMUNITY
Area of Questions to ask
Assessment
Age span Is the community a “young,” a
“settled-in,” or a “retired” one?
Is the family within the usual
age span of residents in the
community and thereby
assured of support people?
Education If the family has school-age
children, are there schools
nearby? Is there a public
library for self-education? Is
there easy access to such
places if the person becomes
physically challenged? If a
special program such as diet
counseling is needed, does it
exist?
Environment Are environmental risks
present, such as air pollution?
Busy highways? Train yards?
Pools of water where
drowning could occur? Could
hypothermia be a problem?
Financial Is there a high rate of
status unemployment in the
community, which could
increase the crime rate? What
is the average occupation?
Will this family have adequate
finances to manage
comfortably in this
neighborhood? Are
supplemental aid programs
available?
Health care Is there a healthcare agency
the family can use for
comprehensive care? Is it
19
 convenient in terms of
finances, time, and
transportation? Is it accessible
for people with disability?
Housing Are houses mainly privately
owned or apartments or
condos? Are homes close
enough together to afford easy
contact? Are they in good
repair? Will new construction
or deteriorated housing be a
safety problem?
Politics Is the community active
politically? Can adults reach a
local polling place to vote, or
do they know how to apply for
absentee ballots?
Recreation Are recreational activities of
interest available? Are they
economically feasible? Are
there some sites that are apt
to create health problems
such as ski resorts (broken
bones), a lake (drowning), or
horse racing tracks
(smoke-filled air)?
Spirituality Is there a facility where the
family can worship as they
choose? Is there a mixture of
worship centers to show the
community accepts cultural
diversity?
Safety Is there adequate protection
so family members can feel
safe to hike or jog? Do they
feel safe to remain home
alone? Do they know about
available hotlines and local
police and fire department
numbers? Do houses have
smoke and carbon monoxide
alarms in the bedrooms and
near the kitchen?
Culture What is the dominant culture
in the community? Does the
family fit into this
environment? Are foods that
are culturally significant
available?
Transportati Is there public transportation?
on Will family members have
access to it if they become
physically challenged?
FAMILY STRUCTURES
How well a family works together when times
are good and how well it can organize itself
against potential threats depends on both its
structure (who its members are) and its function
(the activities or roles family members carry out).
The Concept of Family
- A family is defined by the U.S. Census
Bureau (USCB, 2015) as “a
householder and one or more other
people living in the same household
who are related by birth, marriage, or
adoption.”
- Allender (2013) defines the family in a
much broader context as “two or more
people who live in the same household
[usually], share a common emotional
bond, and perform certain interrelated
social tasks.”
Family Types
- What type of family a person belongs to
changes over time, as a family is
affected by birth, death, possibly
divorce, and the growth of family
members.
For the purposes of assessing families, two
basic family types can be described:
● Family of orientation - the family one is
born into; or oneself, parents, and
siblings, if any.
● Family of procreation - a family one
establishes; or oneself, spouse or
significant other, and children, if any.
The Child-free or Childless Family
- Composed of two people living together
without children.
20
 - Positive aspects: companionship,
possibly shared resources.
- Potential negative aspects: feelings of
guilt for the couple who decided to delay
a family and later experiences infertility
issues
The Cohabitation Family
- Composed of couples, perhaps with
children, who live together but remain
unmarried.
- Provides the same benefits as a legal
marriage and includes companionship
and financial security while the couple is
living together.
- It does not always provide for long-term
financial security or additional legal
benefits if the couple ends the
relationship.
- When children are involved in the
relationship, determining custody and
financial care may be a challenge.
The Nuclear Family
- Composed of two parents and a child or
children.
- Biggest advantage is the ability to
provide support for and from each other.
- The same characteristic may become a
challenge because of few family
members to share the burden or look at
the problem objectively.
- The Binuclear family is created by
divorce when the child is raised in two
families.
- Positive aspects: support for family
members; sense of security
- Possible negative aspects: may lack
support people in a crisis situation
The Extended (Multigenerational) Family
- Includes not only a nuclear family but
also other family members such
grandmothers, grandfathers, aunts,
uncles, cousins, and grandchildren.
- Advantage: more people who are
available to provide help when needed
and act as role models for younger
members of the family.
- Disadvantage: in a typical extended,
family, there is usually one main income
provider, a situation that can strain the
family’s resources.
- Positive aspects: many people for
childcare and member support
- Possible negative aspects: resources
may be stretched thin because of few
wage earners
The Single-Parent Family
- Plays a large role in childrearing
- Unfortunately, low income is often a
problem encountered by single-parent
families, especially if a female is the
head of the household.
- Single parents have difficulty working full
time plus taking total care of young
children. Trying to fulfill all parenting
roles is not only time consuming but
also mentally and physically exhausting
and, in many instances, not rewarded.
- Such a parent may develop low
self-esteem if things are not going well,
especially if the spouse left them for
another or the other parent refuses to
help with child support or shared
custody.
- At times of illness, both parents often
participate in the hospital and are eager
to receive reports of the child’s progress.
- Identifying who is the custodial parent is
especially when consent forms for care
need to be signed, so be certain this is
clearly marked in the child’s healthcare
records.
- Singe-mother-by-choice family:
unpartnered female who desires
children enters parenthood with a
variety of methods including adoption or
donor insemination; often financially
secured with education completed
- Positive aspects: ability to offer a
unique and strong parent-child bond
- Possible negative aspects: resources
may/may not be limited.
The Blended Family
- A remarriage or reconstituted family
21
 - A divorced or widowed person with
children marries someone who also has
children
- Problems encountered: each parent
may encounter difficulties in caring for
the other’s children if their philosophies
of childrearing differ, particularly in terms
of discipline; children may not welcome
a stepparent because they have not yet
resolved their feeling about the
separation of their biologic parents
(through divorce or death; they may
believe the stepparent threatens their
relationship with their biologic parent;
children may also have heard of evil
stepparents from children’s books that
they come into the new family already
prejudiced against their new parent.
- Positive aspects: increased security
and resources; exposure to different
customs or culture may help children
become more adaptable to new
situations.
- Possible negative aspects: rivalry or
competition among children; difficulty
adjusting to a stepparent
The LGBTQ+ Family
- LGBTQ+ people live together as
partners for companionship, financial
security, and sexual fulfillment, and they
may form the same structure as a
nuclear family.
- Lack of understanding by healthcare
providers of the strength and richness of
these unions can impede healthcare.
- LGBTQ+ individuals and families suffer
greater healthcare disparities than their
cisgender heterosexual counterparts.
The Foster Family
- Children whose parents can no longer
care for them may be placed in a foster
or substitute home by a child protection
agency through the age of 17
- Theoretically, foster home placement is
temporary until children can be returned
to their own parents.
- Positive aspects: prevents children
from being raised in large insecure
settings
- Possible negative aspects: emotional
insecurity and inability to establish
meaningful relationships because of
frequent moves
The Adoptive Family
- Many types of families (nuclear,
extended, cohabitation, blended,
single-parent, LGBTQ+) adopt children
today
- Adoption can bring joy into the family
and fulfillment to a family no matter what
its structure is
- Positive aspects: Children grow up
well cared for and experiencing a sense
of love; a person who relinquishes their
child for adoption can feel a sense of
relief their baby will have a lifestyle
better than what they could provide
- Possible negative aspects: Divorce of
the adopting parents can be devastating
if the child views themselves as the
cause of the separation or as a child
unable to find a secure family for a
second time
Family Functions and Roles
A family is a small community group
and, as such, works best if it can designate
certain people to complete necessary tasks. The
roles family members view as appropriate for
themselves are usually the ones they saw their
own parents fulfilling.
Because family roles tend to be more
flexible and often not as rigidly defined in the
past, an important part of family assessment is
to identify what roles family members have
assumed.
Family Roles
Nurturer - the primary caregiver to
22
 children or a member
who is physically or
cognitively challenge
Provider - who brings in the bulk of
the family’s income
Decision maker - who makes decisions,
particularly in the areas
of lifestyle and how
leisure time is spent
Financial - who supervises the
manager family finances (pays
bills, provides savings for
the future)
Problem solver - one the family depends
on to provide a solution
to problems
Health manager - makes healthcare
decisions, ensures family
members keep health
appointments,
immunizations are kept
current, and preventive
care, such as a
mammogram is
scheduled
Culture bearer - who maintains family and
community customs so
children can develop a
sense of where they
belong in history
Environmentalist - responsible for recycling
and not wasting
electricity or water
Gatekeeper - determines what
information will be
released from the family,
or what new information
can be introduced
Family Tasks
In addition to family roles, Duvall and
Miller (1990) identified eight tasks essential for a
family to perform to survive as a healthy unit.
● Physical maintenance: A healthy
family provides food, shelter, clothing
and healthcare to its members.
● Socialization of family members: This
task includes being certain that children
feel part of the family and learn
appropriate ways to interact with people
outside of the family such as teachers,
neighbors, or the police.
● Allocation of resources: This involves
determining which family needs will be
met and their order of priority, including
not only material goods but also
affection and space.
● Maintenance of order: This task
includes establishing family values,
establishing rules about expected family
responsibilities and roles, and enforcing
common regulations for family members
such as using “time out” for toddlers.
● Division of labor: Healthy families not
only evenly divide the workload among
members but are also flexible enough to
interchange workloads as needed.
● Reproduction, recruitment, and
release of family members: Often not
a great deal of thought is given to who
lives in a family; membership often
happens more by changing
circumstances rather than by true
choice. Having to accept a new infant in
an already crowded household may
make pregnancy a less-than-welcomed
event; allowing a late adolescent to
move to a college dorm may be viewed
as abandonment by a close-knit family.
● Placement of members into the larger
society: Health families realize they do
not have to operate alone but can reach
out to other families or their community
for help as needed.
● Maintenance of motivation and
morale: Healthy families are able to
maintain a sense of unity and pride in
their family. When this is present, it
helps members defend the family
against threats as well as allows them to
support one another during a crisis.
23
 Child immunization,
dental care, and
Developmental Stages routine health
assessment
● promote child
- Families have specific tasks to carry out safety related to
and will pass through predictable home and
developmental stages automobiles
● encourage
- The age of the oldest child is used to
socialization
determine the stage the family is experiences
experiencing ensuring correct usage of outside the home
stage-appropriate health promotion. such as sport
participation,
music lessons, o
Developmental Goal hobby activities
Stages ● encourage
meaningful school
1 Marriage ● establish a experience to
mutually satisfying make learning a
relationship lifetime concern,
● learn to relate well not one of merely
to their families of 12 years
orientation
● engage in 5 Family with ● loosen ties
reproductive life an enough to allow
planning, if Adolescent an adolescent
desired more freedom
(older while remaining
2 Early ● integrate the new children are safe
Childbearing member into the between 13 ● begin to prepare
Family family and 20 yrs. adolescents for
● make whatever old) life on their own
financial and
social adjustment 6 Launching ● change the role
are necessary to Family; from parents to
met the needs of Family with a once-removed
that new member Late support persons
while continuing to Adolescent or guideposts
meet the needs of ● encourage
the parents independent
thinking and
3 Family with a ● prevent adult-level
Preschool unintentional decision skills in
Child injuries (accident) their child
such as poisoning
or falls 7 Family of ● adjust to “empty
● begin socialization Middle-aged nest” syndrome by
through play Parents reawakening their
dates, childcare, relationship with
or nursery school their supportive
setting partner
● prepare for
4 Family with a ● promotechildren’s retirement so
School-aged health through when they reach

24
 that stage they will ● provides information
not be unprepared about the family’s
socially or health history
financially ● presents the roles of
various family members
8 Family in ● maintain health by across several
Retirement / preventive care in generation
Older Age light of aging ● provide basis of
● participate in discussion and analysis
social, political, of family interaction at
and neighborhood healthcare visits
activities to keep ● this DOES NOT provide
active and enjoy specific details about
this stage of life the patient

Ecomap ● a diagram of family and

Assessment of Family Structure and community relationship
Function ● shows how ‘fit’ the
family is to their
- family characteristics are assessed community
based on a variety of levels and in ● ‘Fit’ families have many
varying degrees of detail; e.g.: outside circles or
- observation community contacts
- general history questions ● this shows if the family
is new to the
- if more detailed information is
community by having
required, assessment tools few circles surrounding
developed for that purpose is it
most effective ● it also serve as a mark
- type of family data collected and the of an abusive or
method of collection should match the dysfunctional family if
way the data is used. such family deliberately
keeps outside people
separate from them
The Well Family ● assesses emotional
- assessment of psychosocial family support available to a
wellness requires a measurement of family in a time of crisis
how the family relates and interacts as a ● an increased nursing
unit, this includes: contact and support in
1. communication pattern order for a family with
less contact to remain a
2. bonding well family
3. roles and role relationship
4. division of tasks and activities
5. governance Changing Patterns of Family Life
6. decision making
7. problem solving, and
➔ family life changed within the last 50
8. leadership with in the family unit
years due to many complex and
- assessment looks at how the family
interrelated factors:
relates to the outside community
◆ divorce
◆ dual-earner families (both
Genogram ● a diagram that details parents work outside the home)
family structure

25
 ◆ legalization of marriage for
new home
LGBTQ+ couples ➢ possible realization of a
◆ single parent families marked difference in
◆ shared child rearing finances
responsibilities ➢ mos children wish they
◆ delayed marriage and child had their old lives back
rearing - an implication of fertility as they grieve for the
missing parent
and need for assisted
reproduction technology 3rd Phase ➢ Involves reshaping
➔ Understanding the impact these lives
changes have on family structure and ➢ family becomes a
family life can help you create care single-parent family, or
plans that are realistic and better if the custodial parent
remarries, a blended
meet the needs of today's families.
one
➢ a stabilized financial
Increased Divorce Rate arrangement, whether
higher or lower
➢ children realize their
● emotional entanglement and dramatic lives are permanently
change of roles of parents causes them changed, and they
to be unable to give their children the cannot go back and so
must move forward.
support they need, leaving them with
long-term, negative effects.
● children react in different ways - all children may manifest their feelings
depending on their age and with physical symptoms or by a change
understanding of what is happening and in behaviour, and a decreasing school
the explanation of their parents performance
● Divorce follow 3 separate phases in - when noncustodial parent remarries it
which children follow a course similar to is the most hardest moment for them
grief because they have no choice but to
accept the finality of the divorce

1st Phase ➢ apt to be an

How to help them?
antagonistic time as
parents realize they are - children needs an explanation of why
no longer compatible: the divorce occurred
quarreling, hurt - reassure them that it is not their fault
feelings, and whispered why the divorce happened
conversation - parents raising the children may need
➢ can be particularly help in avoiding playing the role of the
upsetting for children -
injured party or portraying the former
they usually haven’t
been told what is partner as dishonorable, selfish, or
happening yet unreliable
➢ children assume the
quarreling is their fault
Decreased Family Size
2nd Phase ➢ Actual separation stage
➢ everyone is forced to - a steady decline from 1990 to the
take on an unfamiliar
present are seen on the US birth rate
role, perhaps move to a

26
 - average number of children in families
has decreased from four or five ate the
beginning of the last century to 1.9
children today
What causes it?
● Parents in small families spend less
total time providing direct child care.
Limiting the parents’ experience in
childrearing resulting in an increase of
childrearing counseling time by nurses
per parent.
● As children have fewer older sibling role
models than before, they may need
more counseling in behaviour. this
includes:
○ managing stress
○ how to cope with a failing grade
at school, or
○ how to deal with a sports team’s
loss, for example
Increased Dual-Parent Employment
❖ as of 2019, approximately 66.4% of
people who identify as mothers with
small children under the age of 6 were
included as part of the labor force
The implication of this trend for healthcare
providers is that:
1. Healthcare facilities need to schedule
appointments at times when parents
are free to come - willingly miss work if
their children is sick
2. Instructions about how to give
medication must take into account
both the child’s and the parents’
schedules - tailoring administration of
medicine to the times they will be with
the child to supervise the administration.
3. Increased in the number of children
attending day care centers or
after-school programs. This increased
incidence of infections such as acute
diarrhea and upper respiratory
infections.
Nursing Responsibility:
a. Helping parents choose a
quality day care center or
after-school program that takes
the necessary precautions
against infections and includes
physical as well as academic
activities.
b. Parents may require
school-aged children to spend
some time alone after school
before parents return from work.
This helps parents prevent
loneliness in these children as
well as helping children make
good use of their time alone.
High Levels of Violence in Families
➔ An alarming statistic in today's families
is that the incidence and reports of
intimate partner violence and child
maltreatment remain high.
➔ This is partly related to:
◆ high stress levels in families,
and
◆ better reporting of violence and
maltreatment
➔ Detecting these behaviours begins with
the awareness that they occur.
Chapter 4: Home Care and the Childbearing and
Childrearing Family
Home Care
➢ Care of persons in their homes,
provided by employees of a certified
home healthcare or community
healthcare agency.
➢ Means of promoting personalized
prenatal surveillance and initiating
specific health teaching for high-risk
pregnancies.
27
 ➢ Appropriate patients for home
care:
✔ Children following surgery or
recovering from acute illness.
✔ Many children in terminal
stages of disease are also
cared for at home
✔ Pregnant patients who
require additional resources.
Important Nursing Responsibilities in
Home Care:
■ Assessing and orienting families to
home care
■ Home visiting
■ Supervising and coordinating home
health personnel
■ Providing health teaching
■ Evaluating the appropriateness of
continuing home care
Nursing Process Overview for the
Pregnant Person or Child on Home Care:
● Assessment
➢ Assessment will ensure that
care is congruent with the
family’s usual self-care or
childrearing practices.
● Nursing Diagnosis
➢ Nursing diagnoses for home
care may address the
physiologic reason for
supervised home care or the
Examples of Conditions that can be
effect of the experience on
managed at home:
the family, such as:
○ Coping impairment
related to bed rest at
home
○ Acute anxiety related
to complication of
Advantages of Home Care:
pregnancy, which has
required home care.
● Outcome Identification and
Planning
➢ Both outcome identification
and planning for home care
require close collaboration
between the healthcare
providers supervising care at
home and the family
experiencing home care.
● Implementation
➢ Intervention performed for a
patient at home range from
patient and family teaching
and counseling to hands-on
nursing care.
● Outcome Evaluation
➢ The outcome evaluation for
the pregnant person
receiving home care includes
determining whether the
patient and the fetus are
stable and progressing as
expected in the home
environment and whether,
with the patient’s input, home
care is acceptable.
● Understanding Home Care
➢ Home care is possible
because parenteral nutrition,
fetal monitoring, pharmacy
care, mental healthcare, and
laboratory analysis are now
available in the home setting.
■ Hyperemesis gravidarum- a
severe manifestation of nausea and
vomiting of pregnancy.
■ Gestational Hypertension
✔ It prevents extensive disruption of
the family.
28
 ✔ It is less costly for the healthcare
delivery system. Assessing a Family for Home Care:
✔ Technologic advances have made it ➢ Interview with the patient and family
possible for potentially complicated ➢ Thorough health history and physical
procedures. examination to document a person’s
✔ It presents the opportunity to focus or child’s current status
not only on a specific health problem ➢ Environmental, community, and
but also on promoting healthy social assessment.
behaviors for the entire family.
✔ It can increase a person’s or child’s The Home Care Process:
self-confidence and self-efficacy 1. Previsit
because it allows for more self-care ➢ Typically, a first home visit is
and often more control of made within 24 hours of
circumstances. discharge or notice from an
✔ Families can be better assessed in acute care or ambulatory
their own environments because care facility.
family interactions, values, and ○ Ensuring Personal
priorities are more obvious at home Safety- be certain to
than in a healthcare setting. take measures to
ensure your personal
Disadvantages of Home Care: safety on your way to
❖ Cost containment has to be weighed a client’s home,
against the safety and quality of during a visit, and
care. afterward.
❖ The physical care required can be 2. Visit
overwhelming for family caregivers. ➢ Upon arrival at the home,
knock or ring the bell and
Features of Home Care wait for someone to
➢ Home care visits vary in frequency physically or verbally let you
depending on a patient’s condition enter.
and the ability of the patient or family ➢ Greet the client, any other
to learn and maintain specific family members present, and
procedures. pets if they come to greet
Care at home may include: you (but don’t pet strange
■ Direct Care- in which a nurse dogs).
remains in continual attendance or ➢ As in any health care setting,
visits frequently and actually wash your hands before
administers care. touching a client for
■ Indirect Care- in which a nurse assessment and follow
plans and supervises care given by standard precautions while
others, such as home care giving care.
assistants. ○ Assessing the
*Nursing care is considered skilled home Client- At a first
nursing care. home visit, you are

29
 going to be
conducting a
thorough health Home Healthcare Goals
assessment,
Several goals can be achieved with home health
including a health care for the pregnant patient or the child with
history and physical complex medical needs.
examination, as well
as an evaluation of The following can all be achieved in home
the social setting:
environment, ● Health Promotion
medications, nutrition, ● Health Maintenance
safety, and adherence ● Health Intervention
● Health Rehabilitation
to treatment thus far.
○ Assessing the
Environment- During
a visit, observe Health Promotion
whether the house Promoting both a healthy environment
will be or is safe for and healthy family function are the typical
home care. interventions carried out in homes.
○ Home Care
➔ Identify a Child’s Primary Caregiver
Assistants- home
Arrange to include the person
care assistants can
primarily responsible for care (usually
supply the bulk of the grandparents or older sibling in
personal care some homes) in planning and problem
services such as solving because they know best what
assisting with strategy of care will be most effective
ambulation, or with the child as well as what strategy
helping to feed will be most appropriate in light of
patients. physical layout of the home and the
family’s financial ability and lifestyle.
3. Postvisit Planning
➢ Postvisit planning consists ➔ Determine Knowledge (Health Literacy)
of completing all required Level of Family
documentation identified in Teaching will be required so the
the assessment, care family understands the illness and
principles of care. Include in teaching
provided, evaluation of
both the things that must be learned
care, and planning for immediately and additional care
future care. measures that will need to be taught as
○ Follow-Up Visits- the patient’s condition changes.
subsequent home
➔ Identify Available Resources
visits are planned
Assess where the nearest fire
depending on the and rescue company is located in
patient’s relation to the home in case CPR is
circumstances. necessary, whether a backup resource

30
 is available to power needed equipment
if a blackout should occur, and if the
patient can be evacuated easily in case
of a fire.

NURSING CARE PLANNING

AN INTERPROFESSIONAL CARE MAP FOR A PREGNANT ADOLESCENT AT HOME ON BED REST

L.P. is a 16-year-old who is 20 weeks pregnant. Since the beginning of her pregnancy, she had been vomiting at least
four times daily and was losing weight. At 14 weeks, she was admitted to the hospital for 3 days and placed on a
program of gastrostomy feedings. She managed well until last week when she was also diagnosed with gestational
hypertension and placed on bed rest with fetal and uterine surveillance at home. She tells you it's impossible for her to
rest at home; she's bored with school assignments and her friends (and boyfriend) no longer visit. You notice she's
missed at least three doses of her antihypertensive agent. She asks to be hospitalized again for care.

Family Assessment: Patient lives with parents in a two-story home. Patient's bedroom is on the second floor with a
bathroom located approximately 20 ft from the patient's bed. Patient's mother is the primary wage earner in the family;
works full-time as a travel agent. Father drives a delivery van; is home until noon daily.

Patient Assessment: Vital signs: temperature, 98.4°F; pulse, 76 beats/min; respirations, 22 breaths/min; blood
pressure (BP), 144/94 mm Hg; FHR, 148 beats/min. Mild facial edema, +1 protein in urine, 2-lb weight gain in the last
week.

Nursing Diagnosis: Coping impairment related to need for bed rest secondary to nausea and gestational hypertension

Outcome Criteria: Patient identifies methods to continue in school while maintaining bed rest, expresses increased
satisfaction with imposed bed rest, and is able to maintain bed rest until fetal maturity. BP remains 140/80 mm Hg or
less FHR within acceptable parameters, urine for protein remains +1 or less, weight gain limited to 1 lb/week, edema
limited and without increase for the duration of pregnancy.

Team Member Assessment Intervention Rationale Expected Outcome

Responsible

Activities of Daily Living, Including Safety

Nurse Assess vital signs, Instruct the patient how Assessment of vital Patient demonstrates
including heart rate, to take their own vital signs and fetal she is able to
BP, and FHR at every signs. Review how to activity provides a accurately obtain their
visit. do a "count-to-10" baseline for future own pulse, BP, and
assessment daily to comparison and fetal activity. Findings
assess fetal movement evidence of the compare with the
patient's and fetus's nurse's weekly
statuses. findings.

Teamwork and Collaboration

Nurse/primary Assess what care Arrange for home care Home care functions Patient agrees to
healthcare services are most visits by the hospital best when it is part services of the
provider appropriate for an home care team. Care of a "seamless" hospital home care
adolescent patient. assistant: daily; service. team.
registered nurse: once
a week.

31
Procedures/Medications for Quality Improvement

Nurse Assess random urine Instruct the patient to Proteinuria +1 Patient voices an
specimens for protein assess the urine suggests potentially understanding of the
at each home visit. specimen and weigh limited kidney need for bed rest and
herself every day. function or infection. adheres to restriction.
Assess what the
patient interprets home Review concept of Weight gain Patient demonstrates
bed rest to mean. complete bed rest. suggests fluid the ability to carry out
Arrange for a bed-side retention. Bed rest procedures
commode if necessary. will reduce accurately.
symptoms of
gestational
hypertension.

Nutrition

Nurse/nutritionist Obtain a 24-hour recall Ensure the patient is An adequate Patient describes a
of gastrostomy feeding using the prescribed nutritional intake is 24-hour intake of
pattern to determine if liquid feeding; needed for fetal gastrostomy feedings
nutritional intake is encourage additional growth. adequate for
adequate. fluid intake. pregnancy.

Patient-Centered Care

Nurse/social Assess what the Assist the patient with Planning concrete Patient demonstrates
worker patient feels are her planning effective bed methods to make ways she has
chief needs that could rest; discuss possible bed rest more adapted to bed rest
make her more sources of help from tolerable alleviates restrictions.
agreeable to remaining friends and family. stress.
on bed rest at home. Patient voices plan for
Urge parents to speak Collaboration with creative measures
Assess what measures to school for more school officials taken so she can
would make her more creative schooling should help the remain in contact with
agreeable to continuing arrangements. teenager to remain school.
school work. in school.

Psychosocial/Spiritual/Emotional Needs

Nurse Discuss usual activities Encourage the patient Discussion provides Patient lists at least
with the patient and to plan activities such baseline information three restful activities
how lack of these has as reading and listening to identify the she can use to
led to boredom. to music that are both patient's needs, occupy her day so
enjoyable and beliefs, and she feels less
compatible with bed responsibilities. boredom.
rest.

Informatics for Seamless Healthcare Planning

Nurse Assess for readiness to Instruct patient and Knowledge of Patient lists signs and
continue with home family to report danger signs allows symptoms she will
care. increased BP or sharp for early report to the primary
headache to the identification and care provider if they
primary care provider. prompt intervention. should occur.

32
➔ Promote Healthy Family Functioning
❖ A family that is supportive of all
its members and provides an
environment conducive to each
member's continued growth and
development is more likely to be
able to manage home care than
a family with a history of
ineffective or dysfunctional
coping strategies.
Examples:
● a family in which parents have
unrealistic expectations of family
members
● a family with a history of abusive
relationships
● members who do not cope
effectively with stressors
❖ A careful assessment is
necessary because even a
family that appears to be
functioning well may become so
adversely affected by factors
such as the loss of employment
income, resentment over
missed promotions, or cramped
living space all caused by home
care that its members' ability to
be successful can fail.
❖ Every family operates differently
and handles stress in different
ways. This means events that
may seem overwhelming for a
visiting healthcare provider may
actually be easy for the family to
handle. Conversely, problems
that seem minor could be
disruptive enough to affect the
family's ability to continue
adequate care at home.
❖ General rule: Support people
can only be supportive if they
understand the need for and
importance of their role.
Arranging for a homemaker
service to help care for children
or an aging parent or to help
with light housework may be
necessary to prevent support
people from feeling stretched
thin when the usual manager of
the home is ill.
❖ At home visits, ask the patient
how their support people are
coping and if there are ways this
experience could be made
easier for them all. The ability to
be allowed to make decisions
about their care can make a
significant difference in whether
a person thinks their home care
experience is satisfactory.
Health Maintenance
Health maintenance actions are a step beyond
health promotion or are taken when a specific
risk of ill health is present.
➔ Maintain Skin Integrity
Both adults and children who
are on long-term home care can
develop pressure injuries the same as
hospital patients if their caretakers don't
use preventive measures against this
(Vanzi & Toma, 2017).
Examples:
● good nutrition
● position changes
● cleaning skin
● promoting mobility
➔ Promote Elimination
Constipation occurs at a high
rate during pregnancy and can occur in
children on bed rest from lack of
33
 exercise. Encourage a diet high in fiber
and fluid to minimize this problem.
➔ Ensure Bed Rest
● One solution to help both adults
and children cope with the
stress of bed rest is for them to
keep busy in some way, such as
using their time to learn a new
skill. Most adults can name
activities they would like to do
but have never had time before
to begin. For example, bed rest
could provide an ideal time for
an individual to catch up on
reading that was previously
neglected.
● Electronic readers make it
possible for adults and children
to download reading material
immediately. If a pregnant
person has children, they could
spend time reading together. A
pregnant patient could also use
the time to take a home-study
course, learn a craft, write a
short story, or study for a
certifying examination related to
their work. In any event, helping
plan meaningful activities such
as these can help improve the
view of home care-not as
wasted time but as time
invested in family or carcer.
● Children need to involve
themselves in schoolwork of
play, perhaps by learning a new
game or solving sudoku or
crossword puzzles. Otherwise,
they may spend their time
simply watching television,
playing video games, or
napping.
● Although play is a universal
activity of children, not all
parents realize how important it
is to children, so nurses can
play an important role in
teaching this. When a child is
not proficient in English and
English is the language of the
healthcare provider, games
such as stacking blocks or
building with Tinkertoy sets can
be played despite
communication difficulty. Playing
recordings of well-loved
children's songs can also be
effective because the child
doesn't need to be able to
understand the words to enjoy
the music or clap with the
rhythm.
➔ Teach Monitoring of Vital Signs
● Monitoring vital signs in the
home does not differ from
monitoring them in a healthcare
agency. Although the mercury
thermometer has been banned
in many states due to concerns
about poisoning, there may be
some in the home settings still.
The family should be advised to
properly dispose of the mercury
thermometer and obtain an
electronic one.
● Blood pressure is best
measured on the same arm and
when the person is in the same
position (lying down or sitting
up) each time. Using an
automated cuff simplifies taking
blood pressure. These can be
purchased for a low cost from
pharmacies or from home care
agencies.
➔ Teach Self-Monitoring of Uterine Height,
Contractions, and Fetal Heart Rate
● Uterine (fundal) height during
pregnancy is measured by using
a paper tape measure according
to McDonald's rule. If a
34
 pregnant person is asked to
record weekly fundal height
measurements, demonstrate the
correct technique and have
them give a return
demonstration, as this
measurement varies greatly
depending on where the tape
measure is placed. Be sure the
pregnant patient is measuring
the height in the same manner
each time.
● Many pregnant people conduct
fetal movement counts (also
called kick counts) daily to help
assess fetal well-being (Bellussi
et al., 2020).
● FHR is usually recorded by the
home care nurse at each home
visit. In addition, a patient may
be taught how to obtain this
themselves. FHR can be
recorded by listening with a
Doppler or an electronic
monitoring device supplied as
part of the home care program.
● The patient can self-monitor
uterine contractions using a
uterine monitor, the same as in
a healthcare facility, or by
palpation. A nonstress test can
be conducted using a portable
monitor no bigger than 3 X 4 in.
in size. A birthing parent straps
this device to the abdomen for
20 to 30 minutes at a set time
every day or at any time they
feel contractions or are
concerned about the lack of
fetal movement. The monitor
records both uterine
contractions and FHR. At the
conclusion of the monitoring
period, the tracing is transmitted
to a central facility for
evaluation.
● If you discover a patient is
omitting something such as
counting fetal movement, ask
why they're omitting it. It may be
because they're unsure of the
correct technique, or it may be
because they're afraid it will
reveal the fetus is not doing well
(the philosophy of what you
don't know won't hurt you). It's
helpful to try to turn fear into
positive action; discovering
decreased fetal movement will
allow a healthcare provider to
initiate an action to save the
baby and so is a helpful step,
nor one to fear.

NURSING CARE PLANNING BASED ON EMPOWERING A FAMILY

Q. L.P. tells you, “I feel like I’m wasting my time being home all the time this way. Tell me what to
do to keep busy.”

A. Try these suggestions:

● Concentrate on school work; make this a time to really delve into a subject.
● Ask your teacher if there is a special project you could work on from home while on bed rest for
extra credit.
● Renew an old hobby or begin a new one such as solving crossword puzzles.
● Ask someone to bring you books on newborn care from the library or download them on an
electronic reader (you'll be an expert on newborn care by the time your baby is born).

35
 ● Call your friends. Rest next to your phone so friends know they won't be disturbing you when
they return calls.
● Catch up on your correspondence. Friends and family will be surprised and delighted to receive
a letter.
● Investigate whether there is a local community project (such as phone banking for a political
campaign, urging neighbors to write letters of support for a new playground) you could work on
while on bed rest.
● E-mail friends or join a social media site (if you have a limited data plan, be conscious of the
extra charges that might result). If you have FaceTime or Zoom, invite friends to talk about
what is new with them.
● Learn a second language; many books and websites are available on this.
● Take an internet course on something you want to learn more about (such as creative writing,
learning to be a paralegal, how to cook French sauces).
● Ask your home care nurse about preparation-for-childbirth information or download a book on
this. By conscientiously practicing breathing exercises while on bed rest, you can become well
prepared for labor and birth.

(Kern-Goldberger & Srinivas,

2020).
Health Intervention

● Caution individuals that there

Health intervention begins when illness is
present so that symptoms are not allowed to
progress to a more serious state.
➔ Explain Advances in Technology
● A family may assume one
advantage of home care is that
their child will no longer be held
captive by so much monitoring
or oxygen equipment as
surrounded the child in a
hospital. Because so much of
the equipment is portable,
however, a child in home care
can often receive the same level
of monitoring instructions over
the internet. Webcasting or
telemedicine by as in a hospital.
Parents may also need to adjust
to receiving a healthcare agency
that can be used to supply them
information, treat patient
conditions, lend
encouragement, and answer
questions they have about care
are some downsides to too
much internet use. There is an
apparent association between
depression and excessive
amounts of time spent in social
media forums; so much so, a
syndrome termed "Facebook
depression" has been identified
(Timpano & Beard, 2020).
● Parents also need to alert
children and adolescents that
not all websites are safe to visit
because of the possibility that
sexual predators also visit such
sites, putting them at risk
(Samreen et al., 2020).
➔ Provide Health Teaching
Because the home setting is
private, a home care visit can provide
many more opportunities for one-on-one
health teaching than a healthcare
agency setting. An important aspect of
teaching for a pregnant parent might be
providing childbirth education. A birthing
parent restricted to the home setting will
not be able to attend formal classes. For

36
 a child, it could be teaching the whole pregnant patients to halt preterm labor
family about the child's illness and why or chemotherapy for children because of
the current therapy is needed. cancer (Rundell & Panchal, 2017).
Review the rules of safe medication
administration with the family to
➔ Provide for Safe Medicine minimize mistakes such as taking the
Administration medicine more frequently than
Most people receiving home prescribed or forgetting to take it.
care are prescribed some type of
medicine, such as a tocolytic for

NURSING CARE PLANNING BASED ON FAMILY TEACHING

Safety Tips For Safely Taking Medicine At Home

● Keep drugs in a safe place. In most homes, this is in a locked medicine cabinet or drawer
above the height a child could reach.
● Keep alert that most childhood poisonings occur when a family is under stress; this is because
during these times the family can forget usual procedures such as locking away medicine.
Famílies need to take more and more precautions the higher the stress level rises in the home.
● Never take medicine in front of children (children can imitate this action with the parent's
medication).
● Don't pour or prepare medicine in the dark. Because almost all medicine bottles dispensed
from local pharmacies look and feel the same, it is easy to pour the wrong liquid, extract the
wrong pills, or read the bottle instructions incorrectly without adequate light.
● Read instructions as to whether medicine should be taken with food or pills can be chewed.
Drink a full glass of water with pills to ensure they reach the stomach.
● Create a reminder sheet and hang it in a prominent place. Cross off each time the medication
is taken.
● Purchase a medicine box with an individual compartment for each day of the week to eliminate
confusion over whether medicine was taken or not.

● As ill children don't get as much

➔ Provide for Adequate Nutrition and
Hydration
● A pregnant parent who is on
home care often needs help
maintaining adequate nutrition.
If ordinarily they are the person
who plans menus, shops for
food, and cooks for the family,
other family members must
assume these roles. If other
family members are
inexperienced at cooking, the
entire family, including the
pregnant person, may not eat
enough healthy foods.
activity as usual, they may not
be as hungry at mealtime as
usual. You may need to make
suggestions for healthy snacks
so a child's total daily intake is
adequate even if not a lot of
food is eaten at formal meals.
● All people during pregnancy
should drink six to eight full
glasses of fluid a day to obtain
adequate fluid for effective
kidney function and placental
exchange (Zhang et al., 2020),
Be certain birthing parents
receiving home care have a
supply of fluid within reach, such

37
 as a bottle of water, so they can
do this easily.
● Many children or pregnant
people on home care receive
intravenous therapy as a route
of medication or fluid
administration. Those with
hyperemesis gravidarum
(uncontrolled vomiting during
pregnancy) or an isolated
incident of oligohydramnios
(less than normal amount of
amniotic fluid) receive it as a
means of hydration (Fejzo et al.,
2019). Children and adults with
blood dyscrasias may receive
blood transfusions in the home
(Ribeil et al., 2018).
● Because peripheral intravenous
lines frequently become
dislodged, in the home setting,
intravenous fluid is often
administered by a central line or
a peripherally inserted central
catheter (PICC) line threaded to
a central blood vessel. Many
drugs, especially antibiotics, are
given through bagged
"piggyback" infusions kept
frozen until the time of
administration. Specially
pressurized fluid containers
allow for fast and easy
administration of special
solutions. To be certain fluid
infuses slowly and accurately,
an intravenous infusion pump is
strongly recommended. Be
certain a patient or a family
member knows how to operate
a pump, how to monitor
intravenous insertion sites for
inflammation and infiltration,
how to protect the site from
becoming infected (e.g., cover it
with plastic rather than letting it
get wet), when to remind a
healthcare provider the site
should be changed, and how to
monitor the amount and kind of
fluid or medication infused.
➔ Home Enteral Nutrition
Chronically ill children and
people who have hyperemesis
gravidarum may receive nutrition by a
gastrostomy or nasogastric tube. The
supplies necessary for enteral feedings,
such as feeding tubes and enteral
pumps, are available for rent or
purchase through pharmacies, medical
supply houses, or the home care
agency. Such tubes are usually changed
every 2 to 4 weeks. The home care
nurse will likely be the person
responsible for changing the tube, but
this depends on the home care agency's
policies. In addition to assessing the
amount of formula infused by this route,
be certain the patient or a family
member is familiar with all aspects of
care for the tube, equipment, and
administration of the feeding. Caution
the family to monitor the amount of
formula for the feedings they have on
hand so they don't run out, especially
over weekends or holidays when their
suppliers may be closed. Patients on
enteral feedings probably will need to
weigh themselves periodically and
record their weight. They may need to
test blood serum for glucose with a
glucometer. Be certain they use the
same scale, wear consistent clothing,
and know when to call for advice if they
are unsure if their weight is remaining
adequate
ing adequate.
➔ Total Parenteral Nutrition
● Total parenteral nutrition (TPN)
is yet another way to supply
complete nutrition and fluid to
patients on home care. The
home care agency or a separate
vendor will furnish and deliver
38
 the formula, tubing, clean
dressings, and an infusion
pump. The formula, which
consists of amino acids,
hypertonic glucose, vitamins,
and minerals in solution, needs
to be stored in the patient's
refrigerator until 1 to 2 hours
before use; it is then removed
from the refrigerator and
allowed to warm to room
temperature. Pregnant people
or children requiring this type of
intravenous nutritional therapy
usually have a central venous
access device such as a central
venous catheter or PICC line
inserted. The home care nurse
plays a key role in teaching
family members about the
therapy and also in assessing
the patient's or child's response
to therapy.
● Throughout therapy, be certain
the patient or a family member
knows how to monitor the
infusion of the solution and the
patency of the tube, how to
change dressings (if that will be
their responsibility), how to
observe the insertion site for
redness or inflammation, and
how to assess body
temperature for a possible
infection. They also must be
aware of any restrictions that
should be adhered to (such as
no baths if the water level will
rise above the catheter insertion
site) and the interval at which
blood should be drawn for
monitoring. Because TPN
solutions are hypertonic, a
patient or a family member
needs to obtain blood glucose
levels as necessary, test them
with a glucometer, and keep a
record of these. Be sure the
family knows what findings they
should report immediately to a
healthcare provider.
➔ Teach Self-Monitoring by Serum or
Urine Testing
Patients who develop
gestational diabetes will be required to
self-monitor their serum glucose level
using a glucometer at least once daily,
three or four times daily (Saravanan et
al., 2020). Children with diabetes also
require glucose monitoring. The role of
continuous glucose monitoring in the
home and school settings is beginning
to show efficacy (Erie et al., 2018). Both
children and pregnant people need
support to be conscientious about
continuing to do these actions when
home care extends for a long time. A
nurse can be instrumental in being the
person to supply this support.
➔ Manage Pain
Children who are on home care
after surgery or those with a chronic or
terminal illness may need efficient pain
management for long periods of time.
Be certain parents understand the
principles of pain management such as
to give medication before pain becomes
acute.
Health Rehabilitation
Health rehabilitation begins at the point when
complications have arisen and a patient is
learning to adapt to chronic illness or take active
steps toward restoring function. It can also mean
accepting end-of-life care.
Long-Term Home Care
● Although many families are good
candidates for home care in the
beginning, they have difficulty
maintaining this high level of
commitment as home care becomes
39
 long term. They may need both advice
and support to continue to adapt
constructively to the changing phases of
an illness. They can develop low
self-esteem and depression, feelings
which can harm a marital relationship or
prevent parents from spending time with
other children.
● Help families maintain healthy
functioning by promoting communication
with each other and encouraging family
members to identify and share their
feelings about the situation at home.
Encourage members to voice the
frustration they can feel at being
constantly confined at home or what
they perceive to be a lack of progress in
the ill person's condition. If a child has a
terminal illness, support parents to
express their grief and not grow
discouraged because the work they are
accomplishing is making the child
comfortable. Continued successful
coping will require the family to
acknowledge and take seriously the
impact of home care on each family
member and work together to solve
identified problems. To do this
effectively, they may need to renegotiate
roles and responsibilities within the
family or seek outside
● Children on home care need to continue
with school if at all possible so they can
maintain contact with friends, so they
don't fall behind a grade level, and so
they can continue the stimulation of
learning. This means parents should
make some sort of arrangement for
schooling either through their local
school district (many schools can
establish a remote learning setup for
children ill at home) or investigate their
ability to home school.
● When a family has difficulty functioning
well at the beginning of home care or
does not adjust readily to continued
care, nursing measures to support
family functioning become even more
important. A family whose coping
strategies are maladaptive may not be
able to care for a sick family member at
home for long without strong nursing
and other healthcare professional
support.
KEY POINTS FOR REVIEW
Advantages of home care include the
ability to provide care to chronically ill
children and people with a complication
of pregnancy in a cost-effective manner
while keeping families intact and
encouraging them to provide meaningful
comfort and support.
Disadvantages of home care include
possible fatigue for families, possible
financial hardship if there is a loss of job
for the primary caregiver, and social
isolation and disruption of normal home
life.
Home care requires careful planning
and a combined effort between
healthcare providers and the family to
ensure collaboration and continuity of
care.
Not all homes are ideal for home care.
Assessing that a primary family care
provider is present; that the family is
knowledgeable about the care
necessary; necessary resources are
available; and safety features such as a
smoke detector, a safe area for oxygen
storage, and a working refrigerator for
food or medicine are present are
important nursing actions.
Parents may need respite care to
continue to be effective care providers
for children just as professionals need
time off. Help family members take turns
giving care so each has some free time
during the week.
Considering a family as both a single
patient and as part of a community
helps in planning nursing care that
40
meets not only Quality and Safety
Education for Nurses (QSEN)
competencies but also the family's total
needs.

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