2600_Module 1

Module 1: Perspectives of Family Health Care

Readings
 Maternity
o Ch 1
 Historical Development
 Core Concepts of Maternal and Child Health Nursing
 Health Status
 Barriers to Health Care
 Legal and Ethical Issues in Maternal Child Health Care
o Ch 2
 Cultural Context of Community Health Nursing
 Concepts Concerning Culture and Diversity
 Barriers to Cultural Competence
 Community Health Nursing Care Settings for Individuals and Families
 Prenatal Care
 Labour and Birth Care
 Postpartum and Newborn Care
Reading Notes
Learning Objectives Notes
Perspectives on Maternal and Child Health Care
Compare past and present Historical Development
definitions of health and illness. Maternal and Newborn
 Childbirth in the early history of Canada was a difficult and dangerous experience
 Early 1900s: midwives played an important role that later came to be performed by physicians
 1940s-50s: pain relief becomes the focus
 1960s-70s: “natural childbirth”
 Current: return of midwives and doulas; childbirth choices based on what works best for mother, child,
and family
Child Health
 19th century

Discuss measurements used to
assess health and illness in women
and children.
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o Immigration: increase in infectious diseases, epidemics
o Children viewed as commodity: development of public schools and changing view of children
as minors
 20th century
o Public health nursing: restricted parent involvement, nursing in public schools, first
professional course in pediatric nursing
o New knowledge of nutrition, sanitation, bacteriology, pharmacology and psychology
o 1966: creation of current Medicare program
o 1980s-90s: cost containment and outcomes emphasized
o Technological advanced by end of 20th century
Core Concepts of Maternal and Child Health Care
Family-centered care: the delivery of safe, satisfying, high-quality health care that focuses on and adapts to the
physical and psychosocial needs of the family
Evidence-based care: use of research or evidence for planning and implementing care
Case management: interdisciplinary collaborative approach
Atraumatic pediatric care: interventions to minimize physical and psychological distress for children and
families
Overall goal of maternal and newborn nursing care is to promote and maintain optimal health of the woman
and her family. Overall goal of pediatric nursing practice is to promote and assist the child in maintaining
optimal levels of health while recognizing the influence of the family on the child’s well-being.
Social and economic conditions are determinants of health:
 Healthy child development
o Family income
o Social status
o Parental education
o Culture
o Social supports
Health Status
Health was once defined as the absence of disease. The definition of health is complex; it is not merely the
absence of disease or an analysis of mortality and morbidity statistics
 over past century, focus has shifted to disease prevention, health promotion, and wellness
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Mortality: incidence of number of individuals who have died over a specific period
 Maternal mortality rate: the number of deaths from any cause during the pregnancy cycle per 100,000
live births
o 2009: Canadian MMR is 12
o Rise in MMR related to atonic postpartum hemorrhage
o Rise in MMR related with hysterectomy
o High mortality rates among Aboriginal women
 Fetal mortality rate: number of fetal deaths per 1000 births
o Provides an overall picture of the quality of maternal health and prenatal care
 Neonatal mortality rate: number of infant deaths occurring in the first 28 days of life per 1000 live
births
 Infant mortality rate: number of deaths occurring in the first 12 months of life per 1000 live births
o LBW and prematurity are major indicators of infant health
o Used as a general index of general health of a country
o 2004: Canada is 3.7
 Childhood mortality rate: number of deaths per 100000 children 1 to 14 years of age
o Canada's childhood mortality rate ranks 12th among the 21 most industrialized countries
Morbidity: measure of a prevalence of a specific illness in a population at a time; rates per 1000 population
 Difficult to define due to wide variations in definition (physician visits of diagnosis for hospital
admission
 Difficult to obtain data
 Women's health indictors: aboriginal health; AIDS; breast health (I.e., cancer and breast implants,
mammography); cancer, particularly lung, breast, and cervical cancer; complications of pregnancy;
chronic disease, particularity allergies, arthritis, back and limb problems, urethral conditions; diabetes;
family violence and sexual abuse; heart disease and stroke; lesbian health; medication use; mental
health issues, particularly depression; menopause and the use of hormone replacement therapy;
work-life balance
 Childhood morbidity
o Factors increasing morbidity: homelessness, poverty, low birthweight, chronic health
disorders, foreign-born adoptions, day care attendance, and barriers to health care
o Degree of disability most important aspect of morbidity
 Measurement of number of days missed from school or confined to bed
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Identify factors that affect Family

maternal, newborn, and child The family is recognized as the unit of care. Support and respect for family diversity is essential. Promotes
health. greater family self-determination, decision-making abilities, control, and self-efficacy.

Canada conforms to internationally recognized standards for the definition of family, which can be
summarized as a group of two or more persons related by birth, marriage, or adoption and living together
Family theories
 Friedman et al.’s (2003) structural functional theory: emphasizes the social system of family such as
the organization or structure of the family and how the structure relates to the function
 Duvall’s (1977) developmental theory: emphasizes the developmental stages through which all
families evolve, beginning with marriage; the longitudinal career of the family, also known as the
family life cycle
 Von Bertalanffy’s (1968) general systems theory applied to families: emphasizes the family as a system
with interdepended, interacting parts that endure over time to ensure the survival, continuity, and
growth of its components; the family is not the total sum of its parts but is characterized by wholeness
and unity
 Boss’ (2001) family stress theory: addresses the way families respond to stress and how the family
copes with the stress as a group and as individuals
 Resiliency model of family stress, adjustment, and adaptation: addresses the way that families adapt
to stress and can rebound from adversity
Family structure
The family’s structure, the roles assumed by family members, and social changes that effect the family’s life
can influence the child and his or her health status.
 Family structure: the composition of individuals who interact with one another on a regular, recurring
basis in socially sanctioned ways
o Organization of the family unit
o Members gained or lost through various events
o Traditional nuclear family no longer considered the dominant family structure
Examples of family structure
 Nuclear family: husband, wife, and children living in same household
 Binuclear family: child who is a member of two families due to joint custody; parenting is considered a
“joint venture”
 Single- or lone-parent family: one parent is solely responsible for care of children
 Commuter family: adults in the family live and work apart for professional or financial reasons, often
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leaving the daily care of children to one parent

 Step- or blended family: adults with children from previous marriages or from the new marriage
 Extended family: nuclear family and grandparents' cousins, aunts, and uncles
 Same-sex family: adults of the same sex living together with or without children
 Communal family: group of people living together to raise children and manage household; unrelated
by blood or marriage
 Foster family: a temporary family for children who are placed away from their parents to ensure their
emotional and physical well-being
 Grandparent's-as-parents' families: grandparents raising their grandchildren due to the inability or
absence of the parents
 Adolescent families: young parents who are still mastering the developmental tasks of their childhood
Family roles and functions
Each family member has a specific position or status and role when interacting with other members of the
family:
 Nurturer: primary caregiver
 Provider: primarily responsible for generating the family’s income
 Decision maker: responsible for making choices, especially related to lifestyle and leisure time
 Financial manager: works with the money, such as paying bills and saving
 Problem solver: person to whom other members go for help in solving problems
 Health manager: responsible for maintaining the family members’ health, such as scheduling visits and
ensuring that immunizations or screenings are up to date
 Gatekeeper: manages information inflow and outflow
Parental roles
 Providing physical and emotional care
 Imparting rules and expected societal behaviours
Parenting styles
 Authoritarian: expect unquestioning obedience from the child. Rules and standards are strictly
enforced and firm
 Authoritative: parents show some respect for the opinions of children. Although parents have ultimate
authority and expect adherence to rules, they allow children to be different and believe that each child
is an individual
 Permissive: exert little control over the behaviour of their children. Rules or standards may be
inconsistent, unclear, or non-existent
Parenting and discipline
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 Increasing desired behaviours and decreasing or eliminating undesirable behaviours

 Need of child to feel secure and loved
Changes in roles over time – evolve from societal, economic and individual family changes
Changes in family structure and roles due to divorce, single parenting, blending families, adoption, foster care
Genetics
Genetics: study of heredity and its variations
 Gender determination: influence on physical characteristics, person attributes, and behaviours
o Some diseases are more prevalent in a specific gender
 Race: biological differences in members of a group
o Some variations are normal in a race but considered a disorder in other races
Society
Social roles: important for developing self-concept
Socioeconomic status: an individual's relative position in society
 Poverty; in Canada, generally based on low-income-cut-off (LICO)
 Homelessness: families with children are the fastest-growing segment of homeless population
Media: images and information are not always in person’s best interest
Violence: domestic violence, youth violence
Community: schools, peer groups, neighbourhood connectedness
Culture
Culture: view of the world and a set of traditions that are used by a specific social group and are transmitted to
the next generation (e.g., beliefs, values, language, time, personal space, and view of the world)
 Need for cultural competence
 Cultural safety: approach in which practitioners are encouraged to recognize that they will never fully
understand another person’s culture and way of life because cultures and people are complex
Cultural groups:
 Subcultures exist throughout a main culture
 Ethnicity: group membership by virtue or common ancestry
 Ethnocentrism: a belief that one’s own ethnic group is superior to other groups, and thus one’s one
way of living, ideas, and practices re the best
o Leading to stereotyping and labelling
Spirituality and religion: Canadians with spiritual or religious beliefs and views find that they provide strength
and support during times of stress and illness
 Spirituality: basic human quality involving the belief in something greater than oneself and a faith that

Evaluate health care barriers
affecting women, children and
families.
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affirms life
 Religion: organized way of sharing beliefs and practicing worship
Cultural diversity
 Aboriginals and Muslims constitute two of the fastest growing populations in Canada
Health Status and Lifestyle
Developmental level and disease distribution: variable with age
Nutrition: deficiencies or excesses
Lifestyle choices: exercise, use of tobacco, drugs, or alcohol
Environmental exposure: in utero or after birth
Stress and coping: exposure to traumatic events, crises, inadequate support systems, violence
Health Care Cose Containment
Canadians have the luxury of a publicly funded health care system that is responsible for meeting the essential
health care needs of all Canadians
 This system is under significant financial pressure
 Cost containment efforts should not reduce the quality or safety of care delivered
Preventative care focus: anticipatory guidance and education
Current issues:
 Poor health outcomes among Aboriginal Canadians
 Shortages of health professionals
Empowerment of Health Care Consumers
Increase in responsibility by individuals and families for their own health
Family desire for information and participation in decision making process
Respect for family’s views and concerns, addressing issues and concerns, regard for client, partner, and
parents as important participants
Transportation
 Lack of car
 Inability to use public transportation
 Need to bring other children along on visit
Human resources
 There are shortages of caregivers and they are not equitably distributed
Language and culture
 Difficulties in communicating information
 Beliefs related to some forms of treatment

Discuss legal and ethical issues that
may be present when caring for
women, children and families.
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Health care delivery system
 Earlier discharge
 Possible limits for specialty care
 Clinic hours
 Negative attitudes towards poor or culturally diverse families by some health care providers
Abortion
 Legal, social, and political issue
 Practitioners struggle with personal beliefs and professional duty
 Pro-choice: right of any woman to make decisions about her reproductive functions based on her own
moral or ethical beliefs
 Pro-life: life starts at conception and abortion is murder
Substance abuse
 Fetal injury if woman is pregnant
 Possible charges of negligence and child endangerment
Fetal therapy
 Medical technology vs. nature
 Better quality of life via surgical intervention
Informed consent
 Four key components: disclosure, comprehension, competency, and voluntariness
 Age of majority
 Parental autonomy for children in refusal of treatment
 Exceptions: emancipated minor, mature minor, specific situations
 Assent: dependent on child’s developmental level and maturity
Patient’s rights
 During pregnancy, 2 rights: those of the mother and fetus
 Canada does not have a patient’s bill of rights
 The Canadian Institute of Child Health published the “Rights of the Hospitalized Child” in 1980 to raise
awareness of the issues faced by hospitalized children
Confidentiality
 Protected by various provincial laws
 Exceptions: mandatory reporting for abuse, injuries due to weapons or criminal acts, infectious
diseases, threat to an identifiable person
Implications for Paramedics

Family-Centered Community Based Care
Examine the major components of
family-centred care.
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Proactive role in advocating, empowering patients
Need for solid knowledge base about factors affecting health and barriers to health care
Anticipatory guidance
Working within framework of the paramedic process
Need to be alert to new technologies and treatments
Integration of evidence-based interventions in care
Family-Centered Care
Family-centered care: delivery of safe, satisfying, high-quality health care that focuses and adapts to the
physical and psychosocial needs of the family.
 Collaborative partnership
 Key elements
o Interpersonal sensitivity
o General health information
o Valuable resource
o Communication
o Respect
 Health and function of family influencing health of the patient and other members
 Family empowerment, strengthening, and security
Cooperative effort between family and caregivers
 Childbirth is considered a normal, healthy event in the life of a family
 Childbirth affects the entire family, and relationships and roles will change
 Families can make decisions about their own care if given adequate information and professional
support
Community-Based Care
Community: a specific group of people, often living in a defined geographical area, who share a common
culture, values, and norms and who are arranged in a social structure according to relationships the
community has developed over a period
 A person can be simultaneously part of many communities
Community as the unit of service:
 Concern for clients
 Concern for the larger population of potential or at-risk clients
Epidemiology: the study of the causes, distribution, and control of disease in populations

List cultural issues that may be
faced when providing care in the
community.
Identify various settings where
community health care can be
provided to women, children, and
societies.
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Canada is a multicultural nation
 Need for cultural competence:
o “a set of congruent behaviour, attitudes and policies that come together in a system, agency,
or among professionals and enables... [them] to work effectively in cross-cultural situations”
 Cultural attunement: way of being in relation to another
 Cultural safety
Barriers to cultural competence
 Related to providers
o Lack of knowledge of client’s cultural practices and beliefs or when provider's beliefs digger
from those of the client
 Related to systems
o Found at the unit, programme, policy, or organization level
Prenatal care
Labour and birth care
 Hospital: safest for women who are at risk due to medical or social factors
 Birthing centre: “home-like” setting, close to hospital if there are complications, “normalcy” of birth
 Home: family-centred birth, appropriate for women at low risk for complications
o Advantages - more comfortable and relaxed, family-centered birth, least expensive, woman
can maintain control, minimizes unnecessary interventions, one-on-one care from midwife
o Disadvantages - limited pain medication and safety issues
Postpartum and newborn care
 Telephone consultation
 Outpatient clinics
 Postpartum home visits
 High-risk newborn home care
Women’s health care
 Free-standing or hospital-based programs
 Screening, education, counselling, wellness, and alternative/wholeness healing centres
Child health care
 Outpatient and ambulatory care
 Telephone services
 Schools (individualized health plans)
 Child care centers, camps, public health clinics, and shelters

List the various roles and functions
that may apply to the community
care paramedic.
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 Pediatric home care
o Home care nursing responsibilities
o Care of technology-dependent child
Levels of prevention in community-based paramedicine:
 Primary prevention: initiatives to promote health and prevent disease by identifying and addressing
modifiable risk factors
 Secondary prevention: early detection and treatment of health concerns
 Tertiary prevention: ensuring that appropriate interventions for illness and diseases for high-needs
populations are identified and met
Roles and Functions
Communicator
 Verbal and nonverbal communication
 Communication with children and families
 Confidentiality and privacy
 Developing appropriate communication techniques for children
 Working with an interpreter
 Thorough documentation is imperative
Direct Care Provider
Educator
 Patient and family education
o Assessing teaching and learning needs
o Planning education
o Intervening to enhance learning
o Documenting teaching and learning
Advocate and Resource Manager