MATERNAL & CHILD NURSING (LECTURE)
NCM 107 PRELIMS
Module 1 - Maternal and Child Health Nursing
(FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING)
MATERNAL & CHILD HEALTH NURSING
➔ Includes care of the pregnant woman,
child, and family.
A. GOALS & PHILOSOPHIES OF MATERNAL &
CHILD HEALTH NURSING:
➔ Primary goal of both maternal and
child health nursing is the promotion
and maintenance of optimal family
health.
➔ Childbearing and childrearing families
is a major focus of nursing practice in
promoting health for the next
generation.
A. GOALS & PHILOSOPHIES
OF MATERNAL & CHILD:
Maternal & Child Health Nursing Practice
Throughout the Childbearing‒Childrearing
Continuum
1. Provision of preconception healthcare.
2. Provision of nursing care of women
throughout pregnancy, birth, and
postpartum period.
3. Provision of nursing care of children
from birth through adolescence.
4. Provision of nursing care to families in
all settings.
A. PHILOSOPHY OF MATERNAL & CHILD HEALTH
NURSING
I. Maternal and child health nursing is:
A. Family-centered
B. Community-centered
C. Evidence-based
a. FAMILY-CENTERED
➔ Assessment should always include the
family as well as an individual.
b. COMMUNITY-CENTERED
➔ The health of families is both affected
by and influences the health of
communities.
c. EVIDENCE-BASED
➔ This is the means whereby critical
knowledge increases.
➔ A challenging role for nurses and a
major factor in keeping families well
and optimally functioning.
MATERNAL & CHILD HEALTH NURSE:
● Considers the family as a whole and
as a partner in care when planning or
implementing or evaluating the
effectiveness of care.
● Serves as an advocate to protect the
rights of all family members, including
the fetus.
● Demonstrates a high degree of
independent nursing functions
because teaching and counseling are
major interventions.
● Promotes health and disease
prevention because these protect the
health of the next generation.
● Serves as an important resource for
families during childbearing and
childrearing as these can be
extremely stressful times in a life cycle.
● Respects personal, cultural, and
spiritual attitudes and beliefs as these
so strongly influence the meaning and
impact of childbearing and
childrearing.
● Encourages developmental
stimulation during both health and
illness so children can reach their
ultimate capacity in adult life.
● Assesses families for strengths as well
as specific needs or challenges.
● Encourages family bonding through
rooming-in and family visiting in
maternal and child healthcare
settings.
● Encourages early hospital discharge
options to reunite families as soon as
possible in order to create a seamless,
helpful transition process.
● Encourages families to reach out to
their community so the family can
develop a wealth of support people
they can call on in a time of family
crisis.
B. MATERNAL & CHILD HEALTH
GOALS & STANDARDS
● 2020 NATIONAL HEALTH GOALS:
THE TWO PILLARS:
1. To increase quality and years of
healthy life.
2. To eliminate health disparities.
➔ New objective recommends that all
prelicensure programs in nursing
include core content on:
● Counseling for health promotion and
disease prevention
● Cultural diversity
● Evaluation of health sciences literature
● Environmental health
● Public health systems
● Global health
2020 NATIONAL HEALTH GOALS:
● are intended to help citizens more
easily understand the importance of
health promotion and disease
prevention and to encourage wide
participation in improving health in the
next decade.
● nurses play such a vital role in helping
the nation achieve these objectives
through both practice and research.
● serve as the basis for grant funding
and financing of evidence-based
practice.
EMBRACING AMBISYON NATIN 2040
➔ Early into his administration, President
Rodrigo Roa Duterte issued Executive
Order No. 5, s.2016, "approving and
adopting the twenty five-year
long-term vision entitled AmBisyon
Natin 2040 as guide for development
planning.”
➔ AmBisyon Natin 2040 represents the
collective aspirations of Filipinos to
enjoy a "matatag, maginhawa at
panatag na buhay." This was the result
of various focus group discussions and
nationally representative surveys
undertaken by the National Economic
and Development Authority (NEDA) in
early 2016.
➔ AmBisyon Natin 2040 reveals the many
dimensions of well-being that Filipinos
value the most: strong family and
community ties, a comfortable
lifestyle, and a secure future. It should
then be the mission of the government
to steer development processes to
enable and empower every Filipino to
achieve these aspirations.
➔ The same EO adopted the following
vision for the Philippines:
➔ By 2040, the Philippines shall have
been a prosperous, predominantly
middle-class society where no one is
poor; our peoples live long and
healthy lives, are smart and
innovative, and live in a high-trust
society.
➔ The strategies to achieve this
objective are organized under the
three major pillars of "Malasakit,"
"Pagbabago," and "Patuloy na
Pag-unlad."
a. MALASAKIT PILLAR
➔ The Malasakit pillar is about
enhancing the social fabric. The
strategies aim to build the foundations
for a high-trust society by ensuring a
clean, efficient, and people-centered
governance; guaranteeing swift and
fair administration of justice; and
increasing awareness of the different
 cultures and values across Philippine
society.
b. PAGBABAGO PILLAR
➔ The Pagbabago pillar is about
effecting inequality-reducing
transformation. It consists of strategies
to expand economic opportunities,
accelerate human capital
development, reduce vulnerability,
and build safe and secure
communities.
c. PATULOY NA PAG-UUNLAD PILLAR
➔ The Patuloy na Pag-unlad pillar is
about increasing potential growth. It
consists of strategies to enhance the
factors necessary to accelerate and
sustain growth and development
through 2040. It is about promoting
science, technology, and innovation.
It also covers strategies to reap the
demographic dividend.
GLOBAL HEALTH GOALS
● To end poverty and hunger.
● To achieve universal primary
education.
● To promote gender equality and
empower women.
● To reduce child mortality.
● To improve maternal health.
● To combat HIV/AIDS, malaria, and
other diseases.
● To ensure environmental sustainability.
● To develop a global partnership for
development.
C. THEORIES RELATED TO
MATERNAL & CHILD NURSING
➔ A Framework for Maternal and Child
Health Nursing Care
● Nurses use Nursing Process, Nursing
Theory, and Quality & Safety
Education for Nurses (QSEN)
competencies to care for families
during childbearing and childrearing
years.
PROVISIONS OF THE FOUR PHASES OF HEALTH
CARE:
1. Health Promotion
2. Health Maintenance
3. Health Restoration
4. Health Rehabilitation
QUALITY & SAFETY EDUCATION FOR NURSES
(QSEN)
➔ The overall goal is to address the
challenge of preparing future nurses
with the abilities necessary to
continuously improve the quality and
safety of the healthcare systems in
which they work.
SIX COMPETENCIES:
● Patient-centered Care
● Teamwork & Collaboration
● Evidence-Based Practice
● Quality Improvement
● Safety
● Informatics
PATIENT-CENTERED CARE
➔ The patient or designee is thought of
as the source of control and full
partner in the provision of
compassionate and coordinated care
based on respect for the patient’s
preferences, values, and needs.
TEAMWORK & COLLABORATION
➔ Nurses function effectively within
nursing and interprofessional teams,
fostering open communication,
mutual respect, and shared decision
making as they achieve quality
patient care.
EVIDENCE-BASED PRACTICE
➔ Nurses integrate the best current
evidence with clinical expertise and
patient/family preferences and values
for delivery of optimal health care.
QUALITY IMPROVEMENT
➔ Nurses use data to monitor the
outcomes of care and use
improvement methods to design and
 test changes to continuously improve
the quality and safety of healthcare
systems.
MEASURING MATERNAL & CHILD HEALTH
➔ Statistical Terms Used to Report
Maternal and Child Health.

SAFETY
BIRTH RATE Number of births per
➔ Nurses minimize the risk of harm to
1000 population.
patients and providers through both
system effectiveness and individual FERTILITY RATE Number of
performance. pregnancies per 1000
women of
INFORMATICS childbearing age.

➔ Nurses use information and

FETAL DEATH Number of fetal deaths
technology to communicate, manage
RATE (weighing more 500 g)
knowledge, mitigate error, and
per 1000 live births.
support decision making.
NEONATAL Number of deaths per
NURSING PROCESS DEATH RATE 1000 live births
occurring at birth or in
➔ A scientific form of problem solving.
the first 28 days of life.
➔ Steps:
● Assessment PERINATAL Number of deaths of
● Nursing Diagnosis DEATH RATE fetuses weighing more
● Planning than 500 g and within
● Implementation the first 28 days of life
● Evaluation per 1000 live births.

NURSING THEORY MATERNAL Number of maternal

MORTALITY deaths per 100,000 live
➔ Designed to offer helpful ways to view
RATE births that occur as a
patients so nursing activities can be
direct result of the
created to best meet patient needs.
reproductive process.
➔ Examples of Theories Related to
Maternal and Child Nursing: INFANT Number of deaths per
● Role Attainment Theory – Becoming a MORTALITY 1000 live births
Mother RATE occurring at birth or in
● Chery Tatano Beck – Postpartum the first 12 months of
Depression Theory life.
➔ Extensive changes in the scope of
maternal and child health nursing CHILDHOOD Number of deaths per
have occurred as health promotion MORTALITY 1000 population in
has become a greater priority in care. RATE children, 1 to 14 years
- teaching, counseling, supporting, and of age.
advocacy, or keeping parents and
children well.
➔ As promoting healthy pregnancies ROLES & RESPONSIBILITIES OF A MATERNAL &
and keeping children well protects not CHILD NURSE:
only patients at present but also the
health of the next generation. a. CAREGIVERS
➔ Maternal - child health nurses fill these
expanded roles to a unique and ➔ Nurse provides direct patient-centered
special degree. care to women, infants, children, and
their families in times of childbearing,
illness, injury, recovery, and wellness.
 b. CLIENT ADVOCATES
➔ One who speaks on behalf of another.
➔ As an advocate the nurse considers
the family’s wishes and preferences
when planning and implementing
care.
c. RESEARCHER
➔ Nurses contribute to their profession’s
knowledge base by systematically
investigating theoretic or practice
issues in nursing.
d. TEACHER
➔ Education is an essential role of
today’s nurse.
➔ Teaching begins early, before and
during a woman’s prenatal care, and
continues through her recovery from
childbirth and learning to care for her
newborn, and into her care in
women’s health.
e. COLLABORATOR
➔ Care is improved by an
interdisciplinary approach as nurses
work together with dietitians, social
workers, physicians, and others.
WHO’S 17 SUSTAINABLE
DEVELOPMENT GOALS
1. NO POVERTY
➔ End Poverty in all Its Forms
everywhere.
➔ Eradicating poverty in all its forms
remains one of the greatest
challenges facing humanity. from 1.9
billion in 1990, to 836 million in 2015 –
too many people are still struggling to
meet the most basic human needs.
2. END HUNGER/ ZERO HUNGER
➔ achieve food security and improved
nutrition and promote sustainable
agriculture.
➔ Ending hunger also includes ending
malnutrition, protecting small farmers,
and changing farming itself so that
agriculture and ecosystems can
co-exist.
➔ It also means protecting the genetic
diversity of the crops we grow, while
investing in research to make farming
more and more productive, especially
in developing countries.
3. GOOD HEALTH & WELL-BEING
➔ Ensure healthy lives and promote
well-being for all at all ages.
➔ Aims to achieve universal health
coverage and provide access to safe
and effective medicines and vaccines
for all.
4. QUALITY EDUCATION
➔ Ensure inclusive and equitable quality
education and promote lifelong
learning opportunities for all.
➔ Cover the need for access to
university-level education, vocational
training, and entrepreneurship skills,
and they pay special attention to
issues of equity.
5. GENDER EQUALITY
➔ Achieve gender equality and
empower all women and girls.
➔ Equality and empowerment includes
freedom from discrimination and
violence.
➔ Ensuring universal access to sexual
and reproductive health and
affording women equal rights to
economic resources such as land and
property, are vital targets to realizing
this goal.
6. CLEAN WATER & SANITATION
➔ Ensure access to water and sanitation
for all.
➔ Basic water scarcity affects 40% of the
global population, and nearly a billion
people do not have access to that
most basic of technologies: a toilet or
latrine.
➔ Ensuring universal access to safe and
affordable drinking water by 2030
requires we invest in adequate
infrastructure, provide sanitation
 facilities and encourage hygiene at
every level.
➔ Protecting and restoring water-related
ecosystems such as forests, mountains,
wetlands and rivers is essential if we
are to mitigate water scarcity.
7. AFFORDABLE & CLEAN ENERGY
➔ Ensure access to affordable, reliable,
sustainable and modern energy for all.
➔ Ensuring universal access to
affordable electricity by 2030 means
investing in clean energy sources such
as solar, wind and thermal.
➔ Expanding infrastructure and
upgrading technology to provide
clean energy sources in all developing
countries is a crucial goal that can
both encourage growth and help the
environment.
12. RESPONSIBLE CONSUMPTION, PRODUCTION
8. DECENT WORK &
ECONOMIC GROWTH
➔ Promote inclusive and sustainable
economic growth, employment and
decent work for all.
➔ (SDGs) aim to encourage sustained
economic growth by achieving higher
levels of productivity and through
technological innovation.
➔ Promoting policies that encourage
entrepreneurship and job creation are
key to this, as are effective measures
to eradicate forced labour, slavery
and human trafficking.
➔ With these targets in mind, the goal is
to achieve full and productive
employment, and decent work, for all
women and men by 2030.
9. INDUSTRY, INNOVATION & INFRASTRUCTURE
➔ Build resilient infrastructure, promote
sustainable industrialization and foster
innovation.
➔ Technological progress is also key to
finding lasting solutions to both
economic and environmental
challenges, such as providing new
jobs and promoting energy efficiency.
10. REDUCED INEQUALITIES
➔ Reduce inequality within and among
countries.
➔ The Goal includes a range of
measures, including regulation of the
financial markets, to make the playing
field more level. Importantly, it also
covers the issue of migration, which
should be “orderly, safe, regular and
responsible.”
11. SUSTAINABLE CITIES & COMMUNITIES
➔ Make cities inclusive, safe, resilient and
sustainable.
➔ This Goal also covers issues like
transportation, disaster preparedness,
and even the preservation of the
world’s cultural and natural heritage.
➔ Ensure sustainable consumption and
production patterns.
➔ This Goal references that, but also
covers topics like reducing food
waste, corporate sustainability
practice, public procurement, and
making people aware of how their
lifestyle choices make a difference.
13. CLIMATE ACTION WILL
➔ Take urgent action to combat climate
change and its impacts.
➔ Global warming is causing long-lasting
changes to our climate system, which
threatens irreversible consequences if
we do not take action now.
➔ Strengthening the resilience and
adaptive capacity of more vulnerable
regions, with efforts to raise awareness
and integrate measures into national
policies and strategies.
14. LIFE BELOW WATER
➔ Conserve and sustainably use the
oceans, seas and marine resources.
➔ The world’s oceans – their
temperature, chemistry, currents and
life – drive global systems that make
the Earth habitable for humankind.
How we manage this vital resource is
essential for humanity as a whole, and
 to counterbalance the effects of
climate change.
The Nursing Role in Reproductive and
15. LIFE ON LAND
➔ Sustainably manage forests, combat
desertification, halt and reverse land
degradation, halt biodiversity loss.
➔ The Sustainable Development Goals
(SDGs) aim to conserve and restore
the use of terrestrial ecosystems such
as forests, wetlands, drylands and
mountains by 2020.
➔ Promoting the sustainable
management of forests and halting
deforestations is also vital to mitigating
STORY OF CREATION IN THE BOOK OF GENESIS
the impact of climate change.
16. PEACE, JUSTICE & STRONG INSTITUTIONS
➔ Promote just, peaceful and inclusive
societies.
➔ Peace, stability, human rights and
effective governance based on the
rule of law are important conduits for
sustainable development.
➔ The Sustainable Development Goals
(SDGs) aim to significantly reduce all
forms of violence, and work with
governments and communities to find
lasting solutions to conflict and
insecurity.
17. PARTNERSHIPS FOR THE GOALS
➔ Revitalize the global partnership for
sustainable development.
➔ The Sustainable Development Goals
(SDGs) can only be realized with a
strong commitment to global
partnership and cooperation.
➔ The world today is more
interconnected than ever before.
➔ Improving access to technology and
knowledge is an important way to
share ideas and foster innovation.
➔ “Strengthening global solidarity”
Module 1.2
Sexual Health
THEORY OF EVOLUTION
➔ Asserts that all life forms are the result
of procreation.
➔ It is based on the idea that all species
are related and gradually change
over time.
➔ The theory is defended on common
features and ascending complexity.
➔ Making of all thing from nothing by an
act of God.
➔ Single pair of ancestors (Adam and
Eve)
➔ Man and woman are to be
“two-in-one flesh”
➔ “increase and multiply”
➔ Stewards of creation.
INTRAUTERINE DEVELOPMENT
➔ A gonad is a body organ that
produces the cells necessary for
reproduction (the ovary in females,
the testis in males).
➔ At approximately week 5 of
intrauterine life, mesonephric (wolffi
an) and paramesonephric (mullerian)
ducts, the tissue that will become
ovaries and testes, have already
formed.
➔ By week 7 or 8, in chromosomal
males, this early gonadal tissue begins
formation of testosterone.
➔ Under the influence of testosterone,
the mesonephric duct develops into
male reproductive organs and the
paramesonephric duct regresses.
➔ If testosterone is not present by week
10, the paramesonephric duct
becomes dominant and develops into
female reproductive organs.
➔ When ovaries form, all of the oocytes
(cells that will develop into eggs
throughout the woman’s mature years)
are already present (Edmonds, 2012).
 PUBERTAL DEVELOPMENT years) when it rises to influence
pubertal changes in the testes,
➔ Puberty is the stage of life at which
scrotum, penis, prostate, and seminal
secondary sex changes begin.
vesicles; the appearance of male
➔ These changes in girls are stimulated
pubic, axillary, and facial hair;
when the hypothalamus synthesizes
laryngeal enlargement with its
and releases gonadotropin-releasing
accompanying voice change;
hormone (GnRH), which then triggers
maturation of spermatozoa; and
the anterior pituitary to release
closure of growth plates in long bones
follicle-stimulating hormone (FSH) and
(termed adrenarche ).
luteinizing hormone (LH).
➔ In girls, testosterone influences
➔ FSH and LH because they begin the
enlargement of the labia majora and
production of androgen and estrogen,
clitoris and formation of axillary and
which in turn initiate secondary sex
pubic hair.
characteristics, but also because they
continue to cause the production of
SECONDARY SEX CHARACTERISTICS
eggs and influence menstrual cycles
throughout women’s lives ➔ Adolescent sexual development has
(Christensen, Bentley, Cabrera, et al., been categorized into stages (Tanner,
2012). 1990).
➔ There is wide variation in the time
THE ROLE OF ESTROGEN required for adolescents to move
through these developmental stages;
➔ When triggered at puberty by FSH,
however, the sequential order is fairly
ovarian follicles in females begin to
constant.
excrete a high level of the hormone
➔ In girls, pubertal changes typically
estrogen.
occur as:
➔ This increase influences the
➔ Growth spurt
development of the uterus, fallopian
➔ Increase in the transverse diameter of
tubes, and vagina; typical female fat
the pelvis
distribution; hair patterns; and breast
➔ Breast development
development.
➔ Growth of pubic hair
➔ It also closes the epiphyses of long
➔ Onset of menstruation
bones in girls the same way
➔ Growth of axillary hair
testosterone closes the growth plate in
➔ Vaginal secretions
boys.
➔ The beginning of breast development
SECONDARY SEX CHARACTERISTICS
is termed thelarche , which usually
starts 1 to 2 years before menstruation. ➔ Secondary sex characteristics of boys
usually occur in the order of:
THE ROLE OF ANDROGEN ➔ Increase in weight
➔ Growth of testes
➔ Androgenic hormones are the
➔ Growth of face, axillary, and pubic
hormones responsible for muscular
hair
development, physical growth, and
➔ Voice changes
the increase in sebaceous gland
➔ Penile growth
secretions that cause typical acne in
➔ Increase in height
both boys and girls during
➔ Spermatogenesis (production of
adolescence.
sperm)
➔ In males, androgenic hormones are
produced by the adrenal cortex and
the testes, and, in females, by the
adrenal cortex and the ovaries.
➔ The level of the primary androgenic
hormone, testosterone, is low in males
until puberty (between ages 12 and 14
 MALE REPRODUCTIVE SYSTEM

➔ Internal structures:
➔ Ovaries
➔ Maturation of oocytes
➔ Andrology is the study of the male ➔ Fallopian tubes
reproductive organs. ➔ Uterus:
➔ The male reproductive system consists ➔ Uterine wall layers
of both external and internal divisions. ➔ Uterine blood supply
➔ External structures: ➔ Uterine nerve supply
➔ Scrotum ➔ Uterine supportive structures
➔ Testes ➔ Vagina
➔ Penis
➔ Internal structures: UTERINE DEVIATIONS
➔ Epididymis
➔ Vas deferens
➔ Seminal vesicles
➔ Ejaculatory duct
➔ Prostate gland
➔ Bulbourethral glands
➔ Urethra

FEMALE REPRODUCTIVE SYSTEM

Uterine Deviations:
A. Bicornuate Uterus
B. Anteversion
C. Retroversion
D. Anteflexion
E. Retroflexion
➔ Gynecology is the study of the female
reproductive system. ANTEVERSION the entire uterus tips
➔ External structures: far forward.
➔ Mons veneris
➔ Labia minora RETROVERSION the entire uterus tips
➔ Labia majora far back.
➔ Vestibule
➔ Clitoris ANTEFLEXION the body of the
➔ Skene glands uterus is bent
➔ Bartholin glands sharply forward at
➔ Fourchette the junction with the
➔ Hymen cervix.

RETROFLEXION the body of the

 uterus is bent sharply Increased in diameter and
back just above the (temperature, increases in length
cervix. perspiration, RR, HR Increase in size and
and BP) change in the color of
Increased muscle the labia, uterus, and
HUMAN SEXUAL RESPONSE
tension in both breasts.
➔ Masters and Johnson, 1996. smooth and skeletal Flushing of the skin
➔ The sexual experience is unique to muscle Increased in
each individual; how the body temperature,
responds to sexual arousal has perspiration, RR, HR,
common features. and ВР
Increased muscle
HUMAN SEXUAL RESPONSES CYCLE tension in both
smooth and skeletal
● Excitement muscle
● Plateau
● Orgasm
● Resolution PLATEAU PHASE

➔ Period during which sexual tension

EXCITEMENT PHASE increases to levels nearing orgasm,
➔ Begins with the onset of erotic feeling which may last from 30 seconds to 3
and sensation which occurs with minutes.
physical and psychological
stimulation (sight, sound, emotion, or PLATEAU PHASE
thought) that causes parasympathetic
nerve stimulation. Male Female
➔ Two primary physiologic changes:
➔ Vasocongestion – increased blood Vasocongestion The clitoris is drawn
supply (arterial dilation and venous leads to full forward and retracts
constriction in genital area and other distention of the under the clitoral
different body parts). penis prepuce
➔ Myotonia – an increased muscular HR (100 - 175 bpm) The lower part of the
tension (contraction). and RR (40 cpm) vagina becomes
extremely congested
(formation of
EXCITEMENT PHASE "orgasmic platform"
HR (100 - 175 bpm)
Male Female
and RR (40 cpm)
Erection of the penis Erection of the clitoris
and nipples of the and nipples of breast
ORGASMIC PHASE/ ORGASM
breast (increased size =
(parasympathetic vasocongestion); ➔ Is the involuntary climax of sexual
nerve simulation) sensitive to touch tension, accompanied by physiologic
Scrotal thickening and temperature; and psychologic release.
and elevation of the center of sexual ➔ It lasts for 3 – 10 seconds; shortest
testes (muscle arousal and orgasm stage in the sexual response cycle;
contraction) in female; increased intense pleasure affecting the whole
Presence of clear arterial blood supply body.
lubricating droplets Presence of mucoid
at the urethral fluid or lubrication of ORGASMIC PHASE/ ORGASM
meatus the vaginal walls
(bulbourethral (Bartholin's gland) Male Female
gland) Vagina widens in
 ➔ Has both biologic and cultural diversity
Muscle contractions A vigorous
components.
surrounding the contraction of
➔ It encompasses and gives direction to
seminal vessels and muscles in the pelvic
a person’s physical, emotional, social,
prostate project area - expels blood
and intellectual responses throughout
semen into the and fluid from area of
life.
proximal urethra congestion
A. Biologic Gender
Contractions are An average of 8 - 15
B. Gender Identity or Sexual Identity
followed contractions at
C. Gender Role
immediately by 3 intervals of one every
- 7 propulsive 0.8 seconds
"ejaculatory BIOLOGIC GENDER
contractions", ➔ Is the term used to denote a person’s
occurring at the chromosomal sex:
same time interval ➔ male (XY) or female (XX).
as in women which
forces semen from
GENDER IDENTITY/ SEXUAL IDENTITY
the penis
➔ Is the inner sense a person has of
being male or female, which may be
RESOLUTION PHASE the same as or different from biologic
➔ Is the 30-minute period during which gender.
the external and internal genital
organs return to unaroused state or GENDER ROLE
pre-coital stage.
➔ Is the male or female behavior a
person exhibits, which, again, may or
RESOLUTION PHASE may not be the same as biologic
gender or gender identity.
Male Female

2020 NATIONAL HEALTH GOALS RELATED TO

REFRACTORY PERIOD Women do not go
REPRODUCTIVE AND SEXUAL HEALTH
occurs during which through this period, so
further orgasm is it is possible for ➔ Increase the proportion of
impossible from a women to have adolescents who, by age 15, have
few hours or days, additional orgasms never engaged in sexual intercourse
depending on age immediately after the to 80.2% of girls and 79.2% of boys
and other factors first if properly from baselines 72.9% and 72.0%.
stimulated ➔ Increase to at least 91.3% the
proportion of sexually active 15- to
19-year-olds at risk for unintended
THE INFLUENCE OF PREGNANCY ON SEXUAL
pregnancy who used contraception
RESPONSE
at last sexual intercourse from a
➔ Following a pregnancy, many women baseline of 83.0%.
continue to experience increased ➔ Reduce deaths from cancer of the
sexual interest because the new uterine cervix to no more than 2.2 per
growth of blood vessels during 100,000 women, from a baseline rate
pregnancy lasts for some time and of 2.4 per 100,000.
continues to facilitate pelvic ➔ Reduce breast cancer deaths to no
vasocongestion. more than 20.6 per 100,000 women,
from a baseline rate of 22.9 per
SEXUALITY 100,000.
➔ Improve the health, safety, and
➔ Is a multidimensional phenomenon
well-being of lesbian, gay, bisexual,
that includes feelings, attitudes, and
and transgender (LGBT) individuals.
actions.

SEXUAL HARASSMENT AND VIOLENCE
SEXUAL HARASSMENT
➔ Is unwanted, repeated sexual
advances, remarks, or behavior
toward another that is offensive to the
recipient or interferes with job or
school performance.
➔ It can involve actions as obvious as a
job superior demanding sexual favors
from an employee, or it could be a
man or woman sending sexist jokes by
e-mail to another person in the
department.
➔ In school, it can refer to bullying
(Marks, Mountjoy, & Marcus, 2011).
➔ Rules apply to same-gender as well as
opposite-gender harassment.
➔ In addition to causing occupational
disruption, sexual harassment may be
so distressing that it can lead to short-
or long-term psychosocial
consequences for victims and their
families such as emotional distress
(e.g., anxiety, depression,
posttraumatic stress disorder,
substance abuse), interpersonal
conflict, and impaired intimacy and
sexual functioning (Stock & Tissot,
2012).
TWO TYPES OF SEXUAL HARASSMENT
➔ One is quid pro quo (an equal
exchange), in which an employer asks
for something in return for sexual
favors, such as a hiring or promotion
preference.
➔ The second is a hostile work
environment, in which an employer
creates an environment in which an
employee feels uncomfortable and
exploited (such as being addressed as
“honey” or “babe,” asked to wear
revealing clothing, or working where
walls are decorated with sexist
posters).
INDIVIDUAL WITH UNIQUE NEEDS AND
CONCERNS
INDIVIDUAL WITH A DISABILITY
➔ Individuals who are physically
challenged have sexual desires and
needs the same as all others
(Meaney-Tavares & GavidiaPayne,
2012).
➔ Manual stimulation of the penis or
psychological stimulation can,
however, achieve erection in most
men with spinal cord lesions, allowing
the man a satisfying sexual relationship
with his partner.
➔ Most women with spinal cord injuries
cannot experience orgasm but are
able to conceive and have children
➔ Sexuality is a facet of rehabilitation
that has not always received
attention.
➔ If a person can accomplish activities
of daily living such as eating,
elimination, and mobility, then he or
she is often considered to be leading
a normal or near-normal life.
➔ However, establishing a satisfying
sexual relationship is an important part
of living as well and so should be
included in assessments of clients in
rehabilitation programs.
INDIVIDUAL WITH A HYPOACTIVE SEXUAL
DESIRE
➔ Decreased sexual desire can also be
a side effect of many medicines.
➔ Chronic diseases, such as peptic
ulcers or chronic pulmonary disorders
that cause frequent pain or
discomfort, may interfere with a man’s
or a woman’s overall well-being and
interest in sexual activity.
➔ Obese men and women may not feel REPRODUCTIVE LIFE PLANNING
as much satisfaction from sexual
relations as others because they have
difficulty achieving deep penetration
due to the bulk of their abdomens.
➔ An individual with an STI such as
genital herpes may choose to forgo
sexual relations rather than inform a
partner of the disease. Some women
experience a decrease in sexual
desire during perimenopause.
➔ Administration of androgen
(testosterone) to both women and ➔ Includes all the decisions an individual
men may be helpful at that time, or couple make about whether and
because it can improve interest in when to have children, how many
sexual activity (Shelton & Rajfer, 2012; children to have, and how they are
White, Grady, Giudice, et al., 2012). spaced.
➔ Counseling may include the topics of
avoiding conception, increasing
RESPONSIBLE PARENTHOOD AND FAMILY
fertility, and/or what to do if
PLANNING
contraception has failed.

RESPONSIBLE PARENTHOOD CONTRACEPTIVES

➔ Is the will and ability of parents to
respond to the needs and aspirations
of the family and children.
➔ It is a shared responsibility of the
husband and the wife to determine
and achieve the desired number,
spacing, and timing of their children
according to their own family life
aspirations, considering psychological
preparedness, health status,
socio-cultural, and economic
concerns.
(https://doh.gov.ph/faqs/What-is-mea
nt-by-Responsible-Parenthood)
➔ An ideal contraceptive should be:
➔ Safe
➔ Effective
➔ Compatible with spiritual and cultural
beliefs and personal preferences of
both the user and sexual partner
➔ Free of bothersome side effects
➔ Convenient to use and easily
➔ obtainable
➔ Affordable and needing few
instructions for effective use
➔ Free of effects (after discontinuation)
on future pregnancies

ELEMENTS OF RESPONSIBLE PARENTHOOD

1. Awareness and preparedness of

duties and responsibilities of parents
2. Promotion and protection of the rights
of children
3. Nurturing parent and child relationship
and observance of effective ➔ Fertility awareness methods rely on
communication detecting when a woman is capable
4. Efffectice shared home management of impregnation and using periods of
5. Practicing family planning abstinence or contraceptive use
6. Promoting safe motherhood and child during that time.
health nutrition
7. Fostering community involvement and NATURAL FAMILY PLANNING
participation
➔ Also called “periodic abstinence
methods”
➔ No chemical or foreign material into
body
➔ Failure rate ranges from 3% to 25%
➔ Need for couple to be conscious of
time period when woman is most likely
to be fertile
➔ This higher level is then maintained for
the rest of her menstrual cycle.
➔ This pattern is the basis of the BBT
method of contraception.
CERVICAL MUCUS (BILLINGS) METHOD

ABSTINENCE 0% failure rate

Most effective
method to prevent
sexually transmitted
infections (STIs).

PERIODIC A method to avoid

ABSTINENCE pregnancy by
avoiding sex on the
days a woman may
conceive.

COITUS 25% effective; does

INTERRUPTUS not prevent STIs. SYMPTOTHERMAL METHOD

CALENDAR (RHYTHM) METHOD

➔ This method of birth control combines

➔ The calendar method requires a
couple to abstain from coitus on the
days of a menstrual cycle when the
woman is most likely to conceive (3 or
4 days before until 3 or 4 days after
ovulation).
BASAL BODY TEMPERATURE
the cervical mucus and BBT methods.
➔ The woman takes her temperature
daily, watching for the rise in
temperature that marks ovulation.
➔ She also analyzes her cervical mucus
daily.

LACTATION AMENORRHEA METHOD

➔ As long as a woman is breast-feeding

an infant, there is some natural
suppression of ovulation.
➔ Because women may ovulate but not
menstruate while breast-feeding, the
woman may still be fertile even if she
➔ Just before the day of ovulation, a
has not had a period since childbirth.
woman’s basal body temperature
➔ You can use this method for the first 6
(BBT) falls about 0.5 °F.
➔ At the time of ovulation, her BBT rises a months after giving birth by only
full degree because of the influence nursing your baby from the breast (no
of progesterone. pumping).
➔ This is called continuous breastfeeding.
➔ If you use this method, you should:
➔ Breastfeed your baby at least every 4
hours during the day.
➔ Breastfeed your baby every 6 hours at
night.

BARRIER METHODS

➔ Cocoa butter and glycerin-based

➔ Are those that place a chemical or
latex barrier between the cervix and
advancing sperm.
SPERMICIDES
➔ The advantages of spermicides
include the following:
➔ They may be purchased without a
prescription
➔ When used in conjunction with
another contraceptive, they increase
the other method’s effectiveness.
➔ Various preparations are available,
including gels, creams, sponges, films,
foams, and suppositories.
➔ Gels or creams are inserted into the
vagina before coitus with an
applicator.
➔ The woman should do this no more
than 1 hour before coitus for the most
effective results.
➔ Films are glycerin impregnated with a
spermicidal agent that is folded and
inserted vaginally.
➔ On contact with vaginal secretions or
precoital penile emissions, the film
dissolves and carbon dioxide foam
forms to protect the cervix against
invading spermatozoa.
vaginal suppositories filled with a
spermicide.
➔ Inserted vaginally, these dissolve and
release the spermicidal ingredients.
➔ Because it takes about 15 minutes for
a suppository to dissolve, it must be
inserted 15 minutes before coitus.
➔ Sponges are foam-impregnated
synthetic sponges that are inserted
vaginally to block sperm access to the
cervix.
➔ They should remain in place for 6 hours
after intercourse to ensure sperm
destruction.
MALE AND FEMALE CONDOMS
➔ Male condom is a latex rubber or
synthetic sheath that is placed over
the erect penis before coitus begins.
➔ It prevents pregnancy, because
spermatozoa are deposited not in the
vagina but in the tip of the condom.
➔ To be effective, condoms must be
applied before any penile-vulvar
contact, because even
pre-ejaculation fluid may contain
some sperm.
 MALE CONDOMS
FEMALE CONDOMS
➔ Female condoms are latex sheaths
made of polyurethane and
pre-lubricated with a spermicide.
➔ The inner ring (closed end) covers the
cervix, and the outer ring (open end)
rests against the vaginal opening.
DIAPHRAGM
➔ Is a circular rubber disk that is placed
over the cervix before intercourse; it
forms a barricade against the
entrance of spermatozoa.
CERVICAL CAPS
➔ Are made of soft rubber, are shaped
like a thimble, and fit snugly over the
uterine cervix.
INTRAUTERINE DEVICES (IUDS)
➔ A small plastic device inserted into the
uterus to prevent fertilization and/or
decrease sperm motility.
➔ Copper T380
➔ Mirena IUS
➔ Originally, it was thought that the
presence of a foreign substance in the
uterus interfered with the ability of an
ovum to develop as it traversed the
fallopian tube.
➔ Today, the IUD is thought to be
preventing fertilization as well as
creating a local sterile inflammatory
condition that prevents implantation.
➔ When copper is added to the device,
sperm mobility appears to be
affected.
➔ This decreases the possibility that
sperm will successfully cross the uterine
space and reaches the ovum.
 HORMONAL METHOD
➔ Hormones that cause fluctuations in
the normal menstrual cycle to prevent
ovulation or normal transport.
A. Oral
B. Transdermal
C. Intravaginal
D. Intramuscular
COMBINED ORAL CONTRACEPTIVES
➔ Combined Oral Contraceptive Pills
(COCs)
➔ Are composed of varying amounts of
synthetic estrogen combined with
small amounts of synthetic
progesterone (progestin).
➔ The estrogen acts to suppress
follicle-stimulating hormone (FSH) and
LH, thereby suppressing ovulation.
➔ The progesterone action
complements that of estrogen by
causing a decrease in the
permeability of cervical mucus,
thereby limiting sperm motility and
access to ova.
➔ Progesterone also interferes with tubal
transport and endometrial
proliferation to such degrees that the
possibility of implantation is
significantly decreased.
COMBINED ORAL CONTRACEPTIVES
● Management if a woman forgets to
take an oral contraceptive pill
1. If you forget to take one pill, take it as
soon as you remember. Continue the
following day with your usual
schedule. Doing so might mean taking
two pills on one day, if you don’t
remember until the second day.
Missing one pill this way should not
initiate ovulation.
2. If you miss two consecutive pills, take
two pills as soon as you remember
and two pills again the following day.
Then continue the following day your
usual schedule. You may experience
some breakthrough bleeding (vaginal
spotting) with two forgotten pills. Do
not mistake this bleeding for your
menstrual flow. Missing two pills may
allow ovulation to occur, so an added
contraceptive should be used for the
remainder of the month.
3. If you miss three or more pills in a row,
throw out the rest of the pack and
start a new pack of pills the following
Sunday. You might not have a period
because of this routine and should use
extra protection until 7 days after
starting a new pack of pills.
PROGESTERONE ONLY PILL (POP)
➔ Mini pills containing only
progesterone.
➔ Without estrogen content, ovulation
may occur but, because the
progestins have not allowed the
endometrium to develop fully,
implantation will not take place.
➔ It does not interfere with milk
production; it may be taken during
breast-feeding.
TRANSDERMAL PATCHES
➔ Transdermal patch that slowly but
continuously release a combination of
estrogen and progesterone.
➔ Patches are applied once a week for
3 weeks.
➔ During the week on which the woman
is patch free, a menstrual flow will
occur.
➔ Patches may be applied to one of
four areas: upper outer arm, upper
torso (front or back, excluding the
breast), abdomen, or buttocks.
VAGINAL RINGS
➔ Is a silicone ring that surrounds the
cervix and continually releases a
combination of estrogen and
progesterone.
➔ The ring is inserted by the woman and
left in place for 3 weeks, then
removed for 1 week.
➔ Menstrual bleeding occurs during the
ring-free week.
➔ The hormones released are absorbed
directly by the mucous membrane of
the vagina, thereby avoiding a “first
pass” through the liver; this is an
advantage for woman with liver
disease.
INTRAMUSCULAR INJECTIONS
➔ Is a single injection of
medroxyprogesterone acetate
(Depo-Provera) given every 12 weeks
or injections of Lunelle ( a synthetic
estrogen and progesterone) given
every 30 days inhibit ovulation, alter
the endometrium and change the
cervical mucus.
➔ The effectiveness rate of these
methods is almost 100%, making them
an increasingly popular contraceptive
method.
SURGICAL METHODS
➔ Tubal Ligation
➔ The fallopian tubes are occluded by
cautery, crushing, clamping or
blocking and thereby preventing
passage of both sperm and ova.
CONTRACEPTIVES: SURGICAL METHODS
➔ The most common operation to
achieve tubal ligation is laparoscopy.
➔ After a menstrual flow and before
ovulation, an incision as small as 1 cm
is made just under the woman’s
umbilicus with the woman under
general or local anesthesia.
➔ A lighted laparoscope is inserted
through the incision.
➔ Carbon dioxide is then pumped into
the incision to lift the abdominal wall
upward and out of the line of vision.
➔ The surgeon locates the fallopian
tubes by viewing the field through the
laparoscope.
➔ An electrical current to coagulate
tissue is then passed through the
instrument for 3 to 5 seconds, or the
 tubes are clamped and cut or filled
with a silicone gel to seal them.
SURGICAL METHODS
➔ Vasectomy
➔ A small incision is made on each side
of the scrotum.
➔ The vas deferens at that point is then
cut and tied, cauterized and plugged,
blocking the passage of spermatozoa.
➔ Spermatozoa that were present in the
vas deferens at the time of surgery
can remain viable for as long as 6
months.
➔ Therefore, although the man can
resume sexual intercourse within 1
week, an additional birth control
method should be used until two
negative sperm reports have been
obtained, usually requiring 10 to 20
ejaculations.
REPRODUCTIVE LIFE PLANNING: EMERGENCY
POSTCOITAL CONTRACEPTION
➔ For use in emergency only (such as
rape):
➔ High-dose progestin-based pills
➔ Insertion of copper IUD
➔ Levonorgestrel 1.5 mg are available
over the counter without a
prescription by males or females
➔ One or two pills containing a high
dose of levonorgestrel, a progestin,
are taken anytime within 72 hours (3
days) of unprotected coitus to
interrupt a pregnancy.
2020 NATIONAL HEALTH GOALS RELATED TO
REPRODUCTIVE LIFE PLANNING
➔ Increase the proportion of
adolescents who receive formal
instruction on abstinence before 18
years of age from a baseline of 87.2%
to a target of 95.9%.
➔ Increase the proportion of females less
than 15 years of age who have never
had sexual intercourse from a baseline
of 82.9% to a target of 91.2%; of males,
from 82.0% to 90.2%.
➔ Reduce the proportion of females
experiencing pregnancy despite use
of a reversible contraceptive method
from a baseline of 12.4% to a target of
9.9%.
➔ Increase the proportion of intended
pregnancies from a baseline of 51% to
a target of 56%.
➔ Decrease the proportion of births
occurring within 18 months of a
previous birth from a baseline of 35.3%
to a target of 31.7%.
AREAS TO ASSESS IN MAKING CHOICES ABOUT
CONTRACEPTIVE METHODS
➔ Personal values
➔ Ability to use method correctly
➔ Impact on sexual enjoyment
➔ Financial factors
➔ Length of projected relationship (short
term versus long term)
➔ Past experience with contraception
➔ Future plans regarding pregnancy
➔ Vital signs, Pap smear, gonococcal
and chlamydial screening
➔ Obstetric history, including STIs, past
pregnancies, previous elective
abortions, failure of previously used
methods and compliance history with
past methods.
➔ Clients’ beliefs, needs, feelings, and
understanding of conception
 ➔ Current and anticipated sexual ➔ In other words, the PICOT question is
practices, number of partners, the search strategy.
feelings, and body image ➔ The search strategy leads to an
unbiased and effective search.

Module 1.3
Evidenced Based Practice in Nursing HOW IS PICOT USED IN EBP?

➔ PICO is a mnemonic device used in

nursing that helps a person remember
EVIDENCE-BASED PRACTICE (EBP)
the components of a well focused
➔ An approach to health care that
clinical question.
combines best available evidence,
➔ It is a strategy used in the first step of
healthcare professionals' expertise,
Evidence Based Practice (EBP) to
and patient preferences, yielding
assess and ask when researching to
benefits for patients, healthcare
formulate a searchable clinical
professionals, and organizations.
question by helping to develop key
➔ However, globally, EBP
terms.
implementation remains inconsistent
among nurses.
➔ Research studies show that
evidence-based practice (EBP) leads
to higher quality care, improved
patient outcomes, reduced costs, and
greater nurse satisfaction than
traditional approaches to care.

PATIENT Who are the relevant

EBP ORG. CULTURE & ENVIRONMENT
PROBLEM patients? Think about
➔ Organizational culture is the set of age, sex, geographic
shared beliefs, values, and norms that location, or specific
influence the way members think, feel, characteristics that
would be important
and behave.
to your question.
➔ Culture is created by means of
terminal and instrumental values, INTERVENTION/ What is the
heroes, rites and rituals, and INDICATOR management
communication networks. strategy,
diagnostic test, or
➔ Examples include integrity, teamwork,
exposure that you
transparency, and accountability. The
are interested in?
purpose of organizational value is to
differentiate your organization from COMPARE/ Is there a control or
others and act as a model for CONTROL alternative
decision-making processes. management
strategy you would
like to compare to
WHAT IS THE PURPOSE OF A PICOT QUESTION? the intervention or
➔ It is the mechanism to identify the indicator?

terms to be used to search for the best

OUTCOME What are the
evidence to answer a burning clinical patient-relevant
question. consequences of the
 intervention? Module 1.4A
Physiology of Menstruation
TIME/ TYPE OF What time periods
QUESTION should. Be
considered, MENSTRUAL CYCLE
What clinical domain
➔ A menstrual cycle (the female
does your question
reproductive cycle) is episodic uterine
fall under?
bleeding in response to cyclic
hormonal changes.
PURPOSE OF EBP ➔ During the menstrual cycle, the ovum
reaches its maturity, and a new
➔ Evidence-based practice provides the
uterine bed is made ready for the
foundation for safe care, leading to implantation of the fertilized ova.
increased effectiveness and
efficiency, timeliness, and more
CHARACTERISTICS
appropriate focus of research-based
data within the framework of the MENARCHE Average age of
patient's current situation and needs. onset 12 to 14 years
old; average range
of age onset is 9 – 17
STEPS OF EBP years old.

INTERVAL Average interval

CYCLES between cycles is 28
days; 23-35 days is
also normal.

DURATION OF Average is 4 – 6 days;

MENSTRUAL 2 – 9 days is also
FLOW normal.

AMOUNT OF Average amount of

MENSTRUAL menstrual flow is
FLOW 30-80 mL.

COLOR OF Dark red; a

BARRIERS OF EVIDENCE-BASED PRACTICE
1. Lack of support and supervision
2. Lack of training and education
3. Limited resources
4. Time restriction
INDIVIDUAL BARRIER TO EBP
1. Lack of nurses' knowledge", "skills and
awareness regarding use the
Evidence-based practice",
2. lack of professional characteristic
3. Nurses' attitude and experience in
using" and "language barrier in using
or implementing Evidence-based
practice"
MENSTRUAL combination of
CYCLE blood, mucus and
endometrial cells.
PHYSIOLOGY OF MENSTRUAL CYCLE
➔ Four body structures are involved in
the physiology of the menstrual cycle:
the hypothalamus, the pituitary gland,
the ovaries, and the uterus.
➔ The First Phase of the Menstrual Cycle
(Proliferative)
➔ The Second Phase of the Menstrual
Cycle (Secretory)
➔ The Third Phase of the Menstrual Cycle
(Ischemic)
➔ The Fourth Phase of the Menstrual
Cycle (Menses)