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OVERVIEW OF MATERNAL AND CHILD FRAMEWORK FOR MATERNAL AND CHILD

NURSING IN THE PHILIPPINES TOPICS: HEALTH NURSING

 NATIONAL HEALTH SITUATION AND Maternal and child health nursing can be
GOALS IN MNC visualized within a framework in which nurses use
 FRAMEWORK FOR MATERNAL AND nursing process, nursing theories, and Quality and
CHILD HEALTH NURSING Safe Education for Nurses competencies to care for
 LEGAL AND ETHICAL families during childbearing and childrearing years
CONSIDERATION OF MATERNAL- through the four phases of health care:
CHILD PRACTICE
 Health promotion
NATIONAL HEALTH GOALS IN MNC  Health maintenance

2020 NATIONAL HEALTH GOALS  Health restoration

 Health rehabilitation
- The national health goals are intended to
help citizens more easily understand the NATIONAL HEALTH SITUATION AND GOALS
importance of health promotion and disease IN MCN
prevention and to encourage wide MILLENIUM HEALTH GOALS
participation in improving health in the next
1. To end poverty and hunger
decade.
2. To achieve universal primary education
 TO INCREASE QUALITY AND
3. To promote gender equality and empower
YEARS OF HEALTH LIFE
women
 TO ELIMINATE HEALTH
4. To reduce child mortality
DISPARITIES
5. To improve maternal health
RECENT STATISTICS 6. To combat HIV/AIDS, malaria and other
diseases
7. To ensure environmental sustainability
8. To develop a global partnership for
development

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MILLENIUM HEALTH GOAL # 4
To reduce child mortality
 Executive Order 51 – “The National Code of
Marketing of Breastmilk Substitutes, Breast
milk supplements, and other related
products” or “The Milk Code”
 Republic Act No. 10028 - “Expanded
Breastfeeding Promotion Act of 2009”.
 Republic Act No. 10152 - “Mandatory
Infants and Children Health Immunization
Act of 2011”
 Administrative Order 2009-0025 – The
adaptation and implementation of the
Essential Newborn Care Protocol
 Republic Act 9288 - Newborn Screening
Act of 2004
EXECUTIVE ORDER 51
The Code applies to the marketing, and practices
related thereto, of the following products:
breastmilk substitutes, including infant formula;
other milk products, foods and beverages, including
bottle-fed complementary foods, when marketed or
otherwise represented to be suitable, with or without
modification, for use as a partial or total
replacement of breastmilk; feeding bottles and teats.
It also applies to their quality and availability, and
to information concerning their use.
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REPUBLIC ACT NO. 10028
The State adopts rooming-in as a national policy to
encourage, protect and support the practice of
breastfeeding. It shall create an environment where
basic physical, emotional, and psychological needs
of mothers and infants are fulfilled through the
practice of rooming-in and breastfeeding.
“The State shall likewise protect working women by
providing safe and healthful working conditions,
taking into account their maternal functions, and
such facilities and opportunities that will enhance
their welfare and enable them to realize their full
potential in the service of the nation. This is
consistent with international treaties and
conventions to which the Philippines is a signatory
such as the Convention on the Elimination of
Discrimination Against Women (CEDAW), which
emphasizes provision of necessary supporting social
services to enable parents to combine family
obligations with work responsibilities; the Beijing
Platform for Action and Strategic Objective, which
promotes harmonization of work and family
responsibilities for women and men; and the
Convention on the Rights of the Child, which
recognizes a child’s inherent right to life and the
State’s obligations to ensure the child’s survival and
development.
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4. Non-separation of the mother and baby for

REPUBLIC ACT NO. 10152
The mandatory basic immunization for all infants
and children provided under this Act shall cover the
following vaccine-preventable diseases:
(a) Tuberculosis;
early breastfeeding initiation
REPUBLIC ACT NO. 10354
The law passed which guarantees universal
access to methods on contraception, fertility
control, sexual orientation, and maternal care.

(b) Diphtheria, tetanus and pertussis;

The State likewise guarantees universal access
(c) Poliomyelitis;
to medically-safe, non-abortifacient, effective,
(d) Measles; legal, affordable, and quality reproductive health

(e) Mumps; care services, methods, devices, supplies which

do not prevent the implantation of a fertilized
(f) Rubella or German measles;
ovum as determined by the Food and Drug
(g) Hepatitis-B; Administration (FDA) and relevant information
and education thereon according to the priority
(h) H. Influenza type B (HIB); and
needs of women, children and other
(I) Such other types as may be determined by
underprivileged sectors, giving preferential
the Secretary of Health in a department circular.
access to those identified through the National
The mandatory basic immunization shall be given Household Targeting System for Poverty
for free at any government hospital or health center Reduction (NHTS-PR) and other government
to infants and children up to five (5) years of age. measures of identifying marginalization, who
shall be voluntary beneficiaries of reproductive
ADMINISTRATIVE ORDER 2009-0025
health care, services and supplies for free.
Steps in EINC:

1. Immediate and thorough drying of the baby

2. Early-skin-to-skin contact between the
mother and the newborn
3. Properly-timed cord clamping

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The expanded screening will include 22 more

REPUBLIC ACT 9288
Obliges any health care practitioner who
delivers or assists in the delivery of a newborn
in the Philippines shall, prior to delivery, inform
the parents or legal guardian of the newborn of
the availability, nature, and benefits of newborn
screening. Newborn screening is defined in the
law means the process of collecting a few drops
of blood from a newborn onto an appropriate
collection card and performing biochemical
testing for determining if the newborn has a
hereditary condition. A heritable condition
under this law, is in any condition that can result
disorders such as hemoglobinopathies and
additional metabolic disorders, namely, organic
acid, fatty acid oxidation, and amino acid
disorders. The latter are included in the standard
care across the globe.
MILLENIUM HEALTH GOALS #5
Republic Act No. 10354 - The Responsible
Parenthood and Reproductive Health Act of
2012, also known as the Reproductive Health
Law or RH Law.
REPUBLIC ACT NO. 10354
The Responsible Parenthood and Reproductive

in mental retardation, physical deformity or Health Act of 2012, also known as the

death if left undetected and which is usually Reproductive Health Law or RH Law, and

inherited from the genes of either or both officially designated as Republic Act No.

biological parents of the newborn. 10354, is a law in the Philippines, which

guarantees universal access to methods on
Newborn screening program in the Philippines
contraception, fertility control, sexual education,
currently includes screening of six disorders
and maternal care.
 Congenital hypothyroidism (CH)
 Congenital adrenal hyperplasia (CAH)
 Phenylketonuria (PKU)
 Glucose-6- phosphate dehydrogenase
(G6PD) deficiency
 Galactosemia (GAL)
 Maple syrup urine disease (MSUD)

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COMMON STATISTICAL TERMS USED IN
MCN
 Birth rate – The number of births per 1,000
population
 Fertility rate - The number of pregnancies
per 1,000 women of childbearing age
 Fetal death rate – The number of fetal deaths
(over 500g) per 1,000 live births
 Neonatal death rate – The number of deaths
per 1,000 live births occurring at birth or in
the first 28 days of life
 Perinatal death rate – The number of deaths
during the perinatal time period, or the sum
of the fetal and neonatal rates
 Maternal mortality rate – The number of
maternal deaths per 100,000 live births that
occur as a direct result of the reproductive
process
 Infant mortality rate – The number of deaths
per 1,000 live births occurring at birth or in
the first 12 months of life.
 Childhood mortality rate – The number of
deaths per 1,000 population in children aged
1 to 14 years.
LEGAL AND ETHICAL CONSIDERATIONS OF
MATERNAL-CHILD PRACTICE
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LEGAL CONSIDERATIONS OF MATERNAL-
CHILD PRACTICE
 Patient’s Rights
 Scope of practice
 Reproductive Health Rights
 Proper documentation
 Informed consent
- Divorced or blended families
- Minors or emancipated minors
PATIENT’S RIGHT
1. Right to Appropriate Medical Care and
Humane Treatment.
2. Right to Informed Consent
3. Right to Privacy and Confidentiality
4. Right to Information
5. The Right to Choose Health  Care Provider 
and Facility
6. Right to Self-Determination
7. Right to Religious Belief
8. Right to Medical Records
9. Right to Leave
10. Right to Refuse Participation in Medical
Research
11. Right to Correspondence and to Receive
Visitors
12. Right to Express Grievances
13. Right to be Informed of His Rights and
Obligations as a Patient
PATIENT’S BILL OF RIGHTS
1. The patient has the right to considerate and
respectful care.
2. The patient has the right to and is
encouraged to obtain from physicians and
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other direct caregivers relevant, current, and
understandable information concerning
diagnosis, treatment and prognosis. Except
in emergencies when the patient lacks
decision-making capacity and the need for
treatment is urgent, the patient is entitled to
the opportunity to discuss and request
information related to the specific
procedures and/or treatments, the crisis
involved, the possible length of
recuperation, and the medically reasonable
alternatives and their accompanying risks
and benefits. The patient has the right to
know the identity of physicians, nurses, and
others involved in his/her care, as well as
when those involved are students, residents,
or trainees. The patient also has the right to
know the immediate and long-term financial
implications of treatment choices, in so far
as they are known.
3. The patient has the right to make decisions
about the plan of care prior to and during the
course of treatment and to refuse a
recommended treatment or plan of care to
the extent permitted by law and hospital
policy and to be informed of the medical
consequences of this action. In case of such
refusal, the patient is entitled to other
appropriate care and services the hospital
provides or transfer to another hospital. The
hospital should notify patients of any policy
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that might affect patient choice within the
institution.
4. The patient has the right to have an advance
directive (such as a living will, health care)
concerning treatment or designating a
surrogate decision maker with the
expectation that the hospital will honor the
intent of that directive to the extent
permitted by law and hospital policy. Health
care institutions must advise patients of their
rights under state law and hospital policy to
make informed medical choices, ask if the
patient has an advance directive, and include
that information in patient records. The
patient has the right to timely information.
5. The patient has the right to every
consideration of his privacy. Case
discussion, consultation, examination, and
treatment should be conducted so as to
protect each patient’s privacy.
6. The patient has the right to expect that all
communications and records pertaining to
his/her care should be treated as confidential
by the hospital, except in cases such as
suspected public health hazards where
reporting is permitted or required by law.
The patient has the right to expect that the
hospital will emphasize the confidentiality
of this information when it releases it to any
other parties entitled to review information
in these records.
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7. The patient has the right to review the
records pertaining to his/her medical care
and to have the information explained or
interpreted as necessary except when
restricted by law.
8. The patient has the right to expect that,
within its capacity and policies, a hospital
will make reasonable response to the request
of a patient for appropriate and medically
indicated care and services. The hospital
must provide evaluation, service, and /or
referral as indicated by the urgency of the
case. When medically appropriate and
legally permissible, or when a patient has so
requested, a patient may be transferred to
another facility. The institution to which the
patient is to be transferred must first have
accepted the patient for transfer. The patient
must also have the benefit of complete
information and explanation concerning the
need for, risks, benefits, and alternatives to
such a transfer.
9. The patient has the right to ask and be
informed of the existence of business
relationships among the hospital,
educational institutions, other health care
providers, or players that may influence the
patient’s treatment and care.
10. The patient has the right to consent to or
decline to participate in proposed research
studies or human experimentation affecting
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his care and treatment or requiring direct
patient involvement, and to have those
studies fully explained prior to consent. A
patient who declines to participate in
research or experimentation is entitled to the
most effective care that the hospital can
otherwise provide.
11. The patient has the right to expect
reasonable continuity of care when
appropriate and to be informed by
physicians and other caregivers available
and realistic patient care options when
hospital care is no longer appropriate.
12. The patient has the right to be informed of
hospital policies and practices that relate to
patient care, treatment, and responsibilities.
The patient has the right to be informed of
available resources for resolving disputes,
grievances, and conflicts, such as ethics
committees, patient representatives, or other
mechanisms available in the institution. The
patient has the right to be informed of the
hospital’s charges for services and available
payment methods.
SCOPE OF PRACTICE
Scope of practice describes the services that a
qualified health professional is deemed competent
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to perform, and permitted to undertake – in keeping
with the terms of their professional license
Nursing Practice in the Philippines is governed by
the Republic Act 9173 or the Philippine Nursing
Act of 2002.
limited to, traditional and innovative
approaches, therapeutic use of self,
executing health care techniques and
procedures, essential primary health
care, comfort measures, health
teachings, and administration of
written prescription for treatment,

SCOPE OF NURSING PRACTICE IN THE therapies, oral topical and parenteral

PHILIPPINES medications, internal examination

during labor in the absence of
A person shall be deemed to be practicing nursing
antenatal bleeding and delivery. In
within the meaning of this Act when he/she singly
case of suturing of perineal
or in collaboration with another, initiates and
laceration, special training shall be
performs nursing services to individuals, families
provided according to protocol
and communities in any health care setting. It
established;
includes, but not limited to, nursing care during
(b) Establish linkages with community
conception, labor, delivery, infancy, childhood,
resources and coordination with the
toddler, preschool, school age, adolescence,
health team;
adulthood, and old age. As independent
(c) Provide health education to
practitioners, nurses are primarily responsible for
individuals, families and
the promotion of health and prevention of illness. A
communities;
member of the health team, nurses shall collaborate
(d) Teach, guide and supervise students
with other health care providers for the curative,
in nursing education programs
preventive, and rehabilitative aspects of care,
including the administration of
restoration of health, alleviation of suffering, and
nursing services in varied settings
when recovery is not possible, towards a peaceful
such as hospitals and clinics;
death. It shall be the duty of the nurse to:
undertake consultation services;
engage in such activities that require
the utilization of knowledge and
(a) Provide nursing care through the
decision-making skills of a registered
utilization of the nursing process.
nurse; and
Nursing care includes, but not
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(e) Undertake nursing and health human
resource development training and
research, which shall include, but not
limited to, the development of
advance nursing practice; Provided,
that this section shall not apply to
nursing students who perform
nursing functions under the direct
supervision of a qualified faculty:
 Provided, further, that in the practice of
nursing in all settings, the nurse is duty-
bound to observe the Code of Ethics for
nurses and uphold the standards of safe
nursing practice. The nurse is required to
maintain competence by continual learning
through continuing professional education to
be provided by the accredited professional
organization or any recognized professional
nursing organization: Provided, finally, That
the program and activity for the continuing
professional education shall be submitted to
and approved by the Board.
PROPER DOCUMENTATION
Nursing Documentation is the record of care that a
nurse planned and delivered to the patient/s. It is the
nurse’s legal and professional requirement in the
course of taking care of the patient.
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It also serves as a way to exchange information
about the patient’s status among health care
professionals.
Different types of documentations used:
 SOAP OR SOAPIE
 ADPIE
 FOCUS CHARTING OR FDAR
 CRITICAL PATHWAYS
WHY IS DOCUMENTATION IMPORTANT?
1. The chart serves as a written record of the
patient’s case; history of present illness,
chief complaints, treatments, medications,
and the response of the patient to the
interventions given.
2. It shows the flow of care; the condition of
the patient, care given, treatments.
3. Provides data for quality assurance and
shows progress of the patient toward
expected outcomes.
4. The chart is a legal record that can be used
as evidence of events that occurred or
treatments given.
INFORMED CONSENT
Is an agreement by a client to accept a course of
treatment or a procedure after being provided
complete information, including the benefits and
risks of treatment, alternatives to the treatment, and
prognosis if not treated by a health care provider.
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Usually, the client signs a form provided by the  Advantages and disadvantages of possible
agency (hospital). The form is a record of the alternatives to the treatment
informed consent, not the informed consent itself.
THREE MAJOR ELEMENTS OF INFORMED
 A COMPETENT ADULT is a person of CONSENT
legal age, who is conscious and oriented. A
1. The consent must be given voluntarily
client who is confused, disoriented and
2. The consent must be given by a client or
sedated is not considered functionally
individual with the capacity and competence
competent. A legal guardian or
to understand
representative can provide or refuse consent
3. The client or individual must be given
for an incompetent adult.
enough information to be the ultimate
 EXPRESSED CONSENT – may either be
decision maker.
oral or written agreement. Usually, the more
For a consent to be considered VOLUNTARY,
invasive a procedure and/or the greater the
the client must not feel coerced. Coercion
potential risk to the client, the greater the
invalidates consent. Cultural perspective also
need for written permission.
needs to be considered.
 IMPLIED CONSENT – exists when the
individual’s non-verbal behavior indicates Technical and language barriers can inhibit
agreement. understanding. If the client can’t read, the
consent form must be read to the client and the
The law says that a “reasonable amount” of
client must state understanding before the form
informed required for the client to make an
is signed. For patients who does not speak the
informed decision is what any other reasonable
same language, an interpreter must be present.
physician or practitioner would disclose under
similar circumstances:

 Purpose of the treatment EXEMPTIONS:

 What the client can expect to feel or
 Minors
experience
 Unconscious or injured
 The intended benefits of the treatment
 Mentally ill persons who have been
 Possible risks or negative outcomes of the
diagnosed by professionals to be
treatment
incompetent

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main principles of ethics: autonomy, beneficence,

justice, and non-maleficence.

NURSE’S ROLE
AUTONOMY - self-directing freedom and
 Obtain a signed consent form. The nurse is
especially moral independence
NOT responsible for explaining the
procedure but for witnessing the client’s BENEFICENCE – a nurses act is to promote good
signature on the form.
JUSTICE – to care for a patient with no bias,
 Notify the health care provider of the
impartiality; to be fair
client’s decision, whether they accepted or
NON- MALIFICENCE – to do no harm to the
refused.
patient
 Proper documentation.
VERACITY – being truthful, informing the patient
ETHICAL CONSIDERATIONS IN MATERNAL
of the truth regarding their health care
CHILD PRACTICE
CONFIDENTIALITY – information about the
Here are some of the common ethical issues that
patient’s health care status and treatment must only
nurses encounter:
be between the nurse, the patient, and doctors
 HIV / AIDS involved
 Abortion
FIDELITY – keeping promises, the nurse must
 Organ Transplantation
provide patient care in a safe and competent manner
 End-of life issues
 Advance Directives SAMPLE QUESTION
 Euthanasia and Assisted Suicide
1. The nurse is to administer a dose of pain reliever
 Termination of Life-sustaining treatments
to a patient with Trypanophobia (fear of needles).
 Withdrawing and Withholding Foods and
She was asked by the patient not to give any
Fluids
injection because of her trypanophobia. Since the
FOUR MAIN PRINCIPLES OF NURSING patient is in pain with pain scale of 8/10, the pain
ETHICS reliever is in immediate need. The nurse continued
to give the injection. Which ethical principle was
Nurses are advocates for patients and must find a
violated?
balance while delivering patient care. There are four
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A. Autonomy
B. Fidelity
C. Veracity
D. Beneficence

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