Framework for Maternal and Child Health Nursing

Lesson 1
LESSON: 1
DURATION: 3 hours

Framework for Maternal and Child Health Nursing

SPECIFIC OBJECTIVES:

At the end of the lesson, the students should be able to:

1. Identify its specific goals and philosophies of maternal and child health nursing and apply
these to nursing practice.
2. Describe the evolution, scope, competencies, and professional roles of nurses in maternal
and child health nursing.
3. Describe the functions of the family.
4. Describe the different types of families.
5. Describe family-centered care and ways maternal and child health nursing could be made
both more family centered and respectful of diversity.
6. Identify and describe the issues and trends in maternal and child health and its
implications.

LESSON PROPER:

INTRIODUCTION

“Maternal and child health services can be defined as promoting, preventing, therapeutic
or rehabilitation facility or care for the mother and child.” – World Health Organization
“Maternal and Child Health (MCM) refers to a package of comprehensive health care
services which are developed to meet promotive, preventive, curative, rehabilitative
needs for mothers such as family planning and pregnant women before, during and after
delivery and children from birth to adolescence including handicapped children, children
in special setting such as day care”
Obstetrics, or the care of women during childbirth, is derived from the Greek word
obstare, which means “to keep watch”.
Pediatrics refers to the child. Derived from the Greek word pais meaning child
Major concerns of the nursing practice are the care for the mother and child
o It consists of the prenatal, antenatal, and postnatal care of the mother.
The health care provider should ensure that every pregnant mother must maintain good
health and knows the art of childcare and raise healthy child.
o It starts from the time before the child is born until they reach adolescent stage
The entire patient’s family, the culture, socio- economic status and others must be taken
into consideration
Care for ideally every child should:
o live in grows up in a family with love and belongingness, safety and security and
receive sufficient nutrition.
I. Goals and Philosophies of Maternal and Child Health Nursing

1. Primary Goal of Maternal and Child Nursing (mcn): “Promotion and

maintenance of optimal family health to ensure cycles of optimal childbearing and
childrearing”.
The care of childbearing and childrearing families is a major focus of nursing
practice, because to have healthy adults you must have healthy children.
Maternal and child health nursing extends from preconception to menopause
with an expansive array of health issues and healthcare providers. Examples of
the scope of practice include:
 Preconception health care
 Care of women during three trimesters of pregnancy and the puerperium
(the 6 weeks after childbirth, sometimes termed the fourth trimester of
pregnancy)
 Care of infants during the perinatal period (the time span beginning at 20
weeks of pregnancy to 4 weeks [28 days] after birth)
 Care of children from birth through late adolescent
 Care in a variety of hospital and home care settings
2. 2020 National Health Goal
To increase quality and years of healthy life
To eliminate health disparities.

3. Philosophy of Maternal and Child Health Nursing

a. MCN is family centered
 Assessment should always include the family as well as each member.
 The nurses see the family as a whole and as a partner in the care of the
mother and child.
b. MCN is community centered
 The health of families is both affected by and influences the health of
communities
c. MCN is evidenced based
 Means that increases critical thinking
4. The care given is based on the
5. product of research
6. The care given is based on the
7. product of research
8. The care given is based on the
9. product of research.
 The care given is based on the product of research.
 Includes high degree of independent nursing interventions.
 this is the means thereby critical knowledge increases.
d. MCN is a challenging role
 Nurses role is dynamic and evolving keeping families well and optimally
functioning.
4. Four Phases of Health Care
a. Health Promotion
 Educating clients to be aware of good health through teaching and role
modeling
 Teaching women the importance of rubella immunization before
pregnancy
 Teaching children the importance of safer sex practices
b. Health Maintenance
 Intervening to maintain health when risk of illness is present
 Encouraging women to come for prenatal care
 Teaching parents the importance of safeguarding their home by child
proofing it against poisoning
c. Health Restoration
 Promptly diagnosing and treating illness using interventions that will return
client to wellness moves rapidly
 Caring for a woman during a complication of pregnancy or a child
during an acute illness
d. Health Rehabilitation
 Preventing further complications from an illness
 Bringing an ill client back to an optimal state of wellness or helping
a client to accept inevitable death
 Encouraging a woman with gestational trophoblastic disease to
continue therapy or a child with a renal transplant to continue to take
necessary medications.
5. Family
 “a group of people related by blood, marriage or adoption living together”. It
consists of those individuals, male or female, youth or adult, legally or not legally
related, genetically or not genetically related, who are considered by the others to
represent their significant people.

2 Basic Types of Family:

1. Family of orientation
 The family to which one is born, reared and socialized. It consists of a father,
mother, brothers and sisters
2. Family of procreation
 The family established by the person by his/her marriage consists of a
husband, wife, sons and daugthers.

a. Dyadic family- consists of two people living together, usually a woman and a
man, without children.
b. Nuclear family- composed of a husband, wife and children.
 c. Cohabitating family- are composed of heterosexual couples who live
together like a nuclear family but remain unmarried.

d. Extended family- includes not only the nuclear family but also other family
members such as grandmothers, grandmothers, uncles, aunties, cousins and
grandchildren.

e. Single parent family

f. Blended family- a divorced or widowed person with children marries

someone who also has children.

g. Communal family- comprises of groups of people who have chosen to live

together as an extended family. They are also motivated by “social or
religious values”

h. LGBT family- individuals of the same sex live together as partners for
companionship, financial security, and sexual fulfillment.

i. 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.

j. Adoptive family

Methods of adoption

a. Agency adoption
b. International adoption
c. Private adoption

*How do we take care of adoptive families?

8 tasks for a family to survive as a healthy unit (Duvall and Miller 1990)

1. Physical maintenance
2. Socialization of family members
3. Allocation of resources
4. Maintenance of order
5. Division of labor
6. Reproduction, recruitment and release of family members
7. Placement of members into the larger society
8. Maintenance of motivation and morale

STAGES OF FAMILY DEVELOPMENT

 Marriage and family

 The early childbearing family
 The family with preschool children
 The family with school age children
 The family with adolescent children
 The launching center family
 The family of middle years
The family in retirement or older age

A. MATERNAL AND CHILD HEALTH GOALS AND GOALS AND STANDARDS

1. Global Health Goals

Adopted by the world leaders in Sept. 2015 at a historic UN Summit
Defined as development that meets the needs of the present without
compromising the ability of future generations to meet their own needs.
Eradicating poverty in all its forms and dimensions is an indispensable
requirement for sustainable development.

a. To end poverty and hunger.

o Everyone should have basic healthcare security and education
b. To achieve universal primary education.
o The UN wants everyone to have access to inclusive, equitable quality
education
c. To promote gender equality and empower women.
o Gender equality is a human right, and is vital for peaceful, prosperous
world
d. To improve maternal health.
o Ensuring people live healthy lives can cut child mortality and raise life
expectancy
e. To combat HIV/AIDS, malaria and other diseases.
o Clean water protects people from disease, yet three in 10 people lack
access to it.
f. To ensure environmental sustainability.
o The UN wants to increase affordable housing and make settlements
inclusive, safe and sustainable
g. To develop a global partnership for development.
o If all countries are to achieve the goals, international cooperation is vital.

2. Standards of Care

Focuses on helping children and their families and communities achieve their
optimum health potentials. This can be achieved within the framework of
family centered care and nursing process
I. Assessment
 Collection of patient health data (subjective and objective data)
II. Diagnosis
 Analysis of the assessment data in determining diagnoses
 III. Outcome identification
 Identification of expected outcomes individualized to the child and the
family
IV. Planning
 Development of plan of care
V. Implementation
 Implementation of interventions identified in the care plan

VI. Evaluation
 Evaluation of client’s progress toward attainment of outcomes
3. Standard of Professional Care

I. Quality of Care
 Nurse systematically evaluates quality and effectiveness of care
II. Performance Appraisal
 Nurse evaluates his/her own nursing practice in relation to professional
practice standards and relevant statutes and regulations
III. Education
 Nurse acquire and maintain knowledge level
IV. Collegiality
 Nurse contribute to the professional development of peers and colleagues
V. Ethics
 A nurse’s assessment, actions, and recommendations on behalf of children
and their families are determined in unethical manner.
 Examples: informed consent, respect to human right, beneficence, non-
maleficence
VI. Collaboration
 Nurse collaborate with the patient in providing client care
VII. Research
 Nurses uses research findings in practice
VIII. Resource Utilization
 Nurse considers factors related to safety, effectiveness and cost in planning
and delivering patient care
 Warm compress – must have doctor’s order – no longer an independent role
of a nurse
IX. Practice Environment
 Nurse contributes to the environment of care delivery within the practice of
setting
X. Accountability
 The nurse is professionally and legally accountable for his/her practice.

B. ROLES AND RESPONSIBILITIES OF A MATERNAL CHILD NURSE

1. Clinical Nurse Specialist

  Prepared at the master’s degree
o Also a researcher, trainer of quality nursing care

2. Case manager
 Graduate-level who supervises a group of patients from the time they enter
a health care
 Supervises the patient from admission to discharge
3. Women’s Health Nurse Practitioner
 A nurse with advanced study in the promotion of health and prevention of
illness in women
4. Family Nurse Practitioner
 Advanced practice role that provides health care not only to women but to
total families
o At home and in the health centers
5. Neonatal Nurse Practitioner
 An advanced practice role for nurses who are skilled in the care of
newborn-both ill and well
6. Nurse-Midwife
 An individual educated in two disciplines of nursing and midwifery

A maternal and child nurse:

1. Consider the family as a whole and as a partner
2. Serves as an advocate
3. Demonstrate high degree of nursing function
4. Serves as important resources for families during childbearing and childrearing
5. Promotes health and disease prevention
6. Respect personal, cultural and spiritual attitude and beliefs
7. Encourages developmental stimulation during both health and illness
8. Assess families for strength as well as specific needs or challenges
9. Encourages family bonding through rooming in and family visiting in maternal
and child health care setting
10. Encourages early hospital discharge options
11. Encourages families to reach out to the community

C. THEORIES RELATED TO MATERNAL AND CHILD NURSING

1. Mercer's Maternal Role Attainment Theory
 Serve as a framework for nurses to provide appropriate health care
interventions for nontraditional mothers in order for them to develop a
strong maternal identity
Four Stages of Acquisition
a. Anticipatory
b. Social and psychological adaptation to the maternal role. This includes
learning expectations and can involve fantasizing about the role of the
mother.
Ex: A mother before the delivery date
 1. Formal - The assumption of the maternal role at birth. In this stage,
behaviors are guided by others in the mother’s social system or
network, and relying on the advice of others in making decisions.
 Ex: A mother few hours after birth.
2. Informal - Mother develops her own methods of mothering which
are not conveyed by a social system.
Ex: A mother exploring her own ways of changing the diaper of
her newborn
c. Personal
d. The joy of motherhood. The mother finds harmony, confidence, and
competence in the maternal role. In some cases, she may find herself ready
for or looking forward to another child
2. Roy's Adaptation Model of Nursing
 Stresses the importance of a nurse/patient to adapt to change cause by
illness and other stressors.
 A person is holistic adaptive system in constant interaction with external
and internal environment.
 The main task of the human system is to maintain integrity in the face of
environmental stimuli. The goal is to foster successful adaptation.
3. Benner’s Theory
 Describes how nurses move from novice to expert
Stage 1: Novice
 This would be a nursing student in his or her first year of clinical
education; behavior in the clinical setting is very limited and inflexible.
Novices have a very limited ability to predict what might happen in a
particular patient situation.
Stage 2: Advanced Beginner
 Those are the new grads in their first jobs; nurses have had more
experience that enable them to recognize recurrent, meaningful
components of a situation. They have the knowledge and the know-how
but not enough in-depth experience.
Stage 3: Competent
 These nurses lack the speed and flexibility of proficient nurses, but
they have some mastery and can rely on advance planning and
organizational skills.
Stage 4: Proficient
 At this level, nurses are capable to see situations as “wholes” rather
than parts. Proficient nurses learn from experience what events typically
occur and are able to modify plans in response to different events.

Stage 5: Expert:
 Nurses who are able to recognize demands and resources in
situations and attain their goals. These nurses know what needs to be
done. They no longer rely solely on rules to guide their actions under
certain situations
4. Florence Nightingale
  The role of the nurse viewed as changing or structuring elements of the
environment such as ventilation, temperature, odors, noise, and light.

D. WHO’S 17 SUSTAINABLE DEVELOPMENT GOALS

 The Sustainable Development Goals (SDGs) are a collection of 17 global goals

designed to be a "blueprint to achieve a better and more sustainable future for all".
1. No Poverty - End poverty in all its forms everywhere.
2. Zero Hunger - End hunger, achieve security and improved nutrition and promote
sustainable agriculture.
3. Good Health and Well Being - Ensure healthy lives and promote well-being for
all.
4. Quality Education - Ensure inclusive and equitable quality education and promote
lifelong learning opportunities for all.
5. Gender equality - Achieve gender equality and empower all women and girls.
6. Clean water and sanitation - Ensure availability and sustainable management of
water and sanitation for all.
7. Affordable and clean energy - Ensure access to affordable, reliable, sustainable
and modern energy for all.
8. Decent work and economic growth - Promote sustained, inclusive and sustainable
economic growth, full and productive employment and decent work for all.
9. Industry, Innovation, and Infrastructure - Build resilient infrastructure, promote
inclusive and sustainable industrialization, and foster innovation.
10. Reducing inequalities - Reduce income inequality within and among countries.
11. Sustainable cities and communities - Make cities and human settlements
inclusive, safe, resilient, and sustainable.
12. Responsible consumption and production - Ensure sustainable consumption and
production patterns.
13. Climate action - Take urgent action to combat climate change and its impacts by
regulating emissions and promoting developments in renewable energy.
14. Life below water - Conserve and sustainably use the oceans, seas and marine
resources for sustainable development.
15. Life on land - Protect, restore and promote sustainable use of terrestrial
ecosystems, sustainably manage forests, combat desertification, and halt and reverse
land degradation and halt biodiversity loss.
16. Peace, justice and strong institutions - Promote peaceful and inclusive societies
for sustainable development, provide access to justice for all and build effective,
accountable and inclusive institutions at all levels.
17. Partnerships for the goals - strengthen the means of implementation and revitalize
the global partnership for sustainable development.

REFERENCES/ADDITIONAL RESOURCES/READINGS:

National Center for Health Statistics. (2016). Child health. Retrieved

from https://www.cdc.gov/nchs/fastats/child-health.htm
Pillitteri, Adele (2018). Maternal and Child Health Nursing, Care of the Childbearing and
Childrearing Family, 8th edition.

Ricci, Susan Scott (2007). Essentials of Maternity, Newborn, and Women’s Health Nursing,
Lippincott Williams and Wilkins.