Maternal and Child Health Nursing

• Follows the family from the pregnancy period, through labor, delivery, and the post- partum period

• it then follows the child in the family from birth through adolescence.

Framework for Maternal and Child Health Nursing Care

1. Nursing Process

   • a scientific form of problem solving serves as the basis for assessing, making a nursing diagnosis, planning, implementing, and evaluating care.

2. Nursing Theory

   • conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care

3. Evidenced – Based Practice

   • a combination of research, clinical expertise, and patient preference or values

4. Nursing Research

   • the controlled investigation of problems that provides evidence for practice and implementing activitiesresulting in improved and cost-effective patient care.

Standards of Maternal and Child Health Nursing Practice

1. Health Pomotion

   • Educating clientsto be aware of good health through teaching and role modeling

2. Health Maintenance

   • Intervening to maintain health when risk of illness is present

3. Health Restoration

   • Promptly diagnosing and treating illness using interventions that will return client to wellness most rapidly.

4. 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.

WHO Standards of Care and Measures of Quality

• Standard 1

  • Every woman and newborn receives routine, evidence-based care and management of complications during labor, childbirth and the early postnatal period, according to WHO guidelines.

    1. Women are assessed routinely on admission and during labor and childbirth and are given timely, appropriate care.

       a. Newborns receive routinee care immediately after birth.

       b. Mothers and newborns receive routine postnatal care.

    2. Women with pre-eclampsia or eclampsia promptly receive appropriate interventions, according to WHO guidelines

• Standard 2

  • The health information system enables the use of data to ensure early, appropriate action

  • has a complete, accurate, standardized medical record during labor, childbirth and the early postnatal period.

• Standard 3

  • Every woman and newborn with condition(s) that cannot be dealt with effectively with the available resources is appropriately referred.

  • appropriately assessed on admission, during labor and in the early postnatal period to determine whether referral is required, and the decision to refer is made without delay.

  • For every woman and newborn who requires referral, the referral follows a pre-established plan that can be implemented without delay at any time.

• Standard 4

  • Communication with women and their familiesis effective and responds to their needs and preferences

  • All women and their families experience coordinated care, with clear, accurate information exchange between relevant health and social care professionals.

• Standard 5

  • Women and newborns receive care with respect and preservation of their dignity

  • No woman or newborn is subjected to mistreatment, such as physical, sexual or verbal abuse, discrimination, neglect, detainment, extortion or denial of services.

• Standard 6

  • Every woman and her family are provided with emotionalsupport that is sensitive to their needs and strengthens the woman’s capability.

  • Every woman is offered the option to experience labor and childbirth with the companion of her choice.

• Standard 7

  • Every woman and newborn, competent, motivated staff are consistently available to provide routine care and manage complications

  • Every woman and child has access at all times to at least one skilled birth attendant and support staff for routine care and management of complications.

• Standard 8

  • The health facility has an appropriate physical environment, with adequate water, sanitation and energy supplies, medicines, supplies and equipment for routine maternal and newborn care and management of complications

Philosophy of Maternal and Child Health Nursing

1. Family-Centered

   • assessment must include both family and individual assessment data

2. Community-Centered

   • the health of families depends on the influences the health of communities

3. Evidence-Based Practice

   • this is the means whereby critical knowledge increases

4. MCHN

   • includes a high degree of independent nursing functions, teaching and counselling are major interventions

5. Advocate

   • MCH nurse serves as an advocate to protect the rights of all family members, including the fetus

6. Health Education

   • MCH Nursing includes a high degree of independent nursing functions, teaching and counselling

7. Promote

   • Promoting health and disease prevention to protect the health of the next generation

8. Resources

   • MCH Nurse serve as an important resources for family during childbearing and childrearing.

9. Beliefs

   • Personal, cultural, and religious attitudes and beliefs influence the meaning and impact of childbearing and childrearing

10. Circumstances such as illness or pregnancy are meaningful only in the context of a total life.

Goals of Maternal and Child Health Nursing

• The primary goal of maternal and child health nursing care can be stated simply as the promotion and maintenance of optimal family health to ensure cycles of optimal child- bearing and childrearing.

• The goals of Maternal and Child Health Nursing care are necessarily broad because the scope of practice.

Range of Practice includes:

1. Preconceptual health care

2. Care of women during three trimesters of pregnancy and the puerperium.

   • Puerperium (6 wks. after childbirth) or Fourth trimester of pregnancy

3. Care of infants during the perinatal period

   • (6 weeks before conception to 6 weeks after birth)

4. Care of children from birth through young adolescence

Advanced-Practice Roles for Nursesin Maternal and Child Health Nurses

Clinical Nurse Specialists

• Master’s or doctorate degree level - who are capable of acting as consultants in their area of expertise

• Serves as role model, researchers, and teachers of quality nursing care.

1. Neonatal Nurse Specialists

   • manage the care of infants at birth and in Intensive care settings and they provide home follow-up care to ensure the newborn remains well

2. Childbirth Educators

   • teach the families about normal birth and how to prepare for labor and birth.

3. Lactation Consultants

   • educate women about breastfeeding ands support them while they learn how to do this.

4. Genetic Nurse Counselors

   • consult with families about patterns of inheritance and offer support to families with a child who has inherited a genetic disorder

5. Case Manager

   • a graduate-level nurse who supervises a group of patients from the time they enter a health care setting until they are discharged from the setting

Nurse Practitioners

• Master’s or doctoral level

• Recent advancesin technology, research, and knowledge and play pivotal roles in today’s health care system.

1. Pediatric Nurse Practitioner

   • skills in physical assessment, interviewing, and well-child counseling and care.

   • Major illness (Congenital subluxated hip, kidney disease, heart disease),consults with an associated pediatrician

   • they can orders the necessary laboratory tests and prescribes appropriate drugs for therapy.

2. Neonatal Nurse Practitioner

   • is an advanced-practice role for nurses who are skilled in the care of newborns, both well and ill.

   • Level 1 – Healthy babies

   • Level 2 – infants with moderate health problems

   • Level 3 – Neonatal ICU

   • Newborn nurseries, neonatal follow-up clinics, or physician groups.

3. Family Nurse Practitioner

   • an advanced-practice that provides health care to women and children and to the family as a whole.

   • FNP can provide prenatal care for a woman with an uncomplicated pregnancy

4. Certified Nurse-Midwife

   • plays an important role in assisting women with pregnancy and childbearing either independently or in association with a physician

   • Nurse-midwife assumes full responsibility for the care and management of women with uncomplicated pregnancies.

Legal Considerations of Maternal-Child Practice

• MCHN carries some legal concerns that extend above and beyond other areas of nursing, because care is often given to an “unseen client”—the fetus—or to clients who are not of legal age for giving consent for medical procedures.

• In addition, labor and birth of a neonate are considered “normal” events, so the risks for a lawsuit are greater when problems arise (O’Grady et al., 2007)

1. Nurses are legally responsible for protecting the rights of their clients, including confidentiality and are accountable for the quality of their individual nursing care and that of other health care team members.

   • Confidentiality – protection of patients' personal health information

   • Accountability – ability to answer for one’s professional actions

2. Understanding the scope of practice and standards of care can help nurses practice within appropriate legal parameters.

3. Documentation is essential for protecting a nurse and justifying his or her actions

   • Documentation – is a nursing action that produces a written account of patient data, nursing clinical decisions, and intervention and patient response

4. Nurses need to be conscientious about obtaining informed consent for invasive procedures and determining that pregnant women are aware of any risk to the fetus associated with a procedure or test.

   • Informed Consent – process of obtaining permission from a patient to perform a specific test or procedure after describing all risks, side effects, and benefits

5. Adolescents who support themselves or who are pregnant are termed “emancipated minors” or “mature minors” and have the right to sign for their own health care.

Ethical Considerations of Practice

• Ethics – concerned with determining what is good or valuable for individuals, groups, and society.

• acts that are ethical reflects a commitment to standards that individuals, professionals, societiesstrive to meet.

• Difficult Ethical quandaries in Health care involves children and their families

Examples

1. Conception issues -related to in-vitro fertilization, embryo transfer, ownership of frozen oocytes or sperm, cloning,stem cell research, and surrogate mothers

2. Abortion, particularly Partial-birth abortions

3. Fetal rights versus rights of the mother

4. Use of Fetal tissue for research

5. Resuscitation (for how long should it be continued?)

6. Number of procedures or degree of pain that a child should be asked to endure to achieve a degree of better health

7. Balance between modern technology and quality of life

Statistical Terms

1. Birth rate: Number of births per 1000 population.

2. Fertility rate: Number of pregnancies per 1000 women of childbearing age.

3. Fetal death rate: Number of fetal deaths (weighing more 500 g) per 1000 live births.

4. Neonatal death rate: Number of deaths per 1000 live births occurring at birth or in the first 28 days of life.

5. Perinatal death rate: Number of deaths of fetuses weighing more than 500 g and within the first 28 days of life per 1000 live births.

6. Maternal mortality rate: Number of maternal deaths per 100,000 live births that occur as a direct result of the reproductive process.

7. Infant mortality rate: Number of deaths per 1000 live births occurring at birth or in the first 12 months of life.

8. Childhood mortality rate: Number of deaths per 1000 population in children, 1 to 14 years of age

Infant Mortality Rate

• The infant mortality rate for Philippines in 2019 was 19.239 deaths per 1000 live births, a 2.16% decline from 2018.

• The top three leading causes of infant mortality

  1. Pneumonia (3,146; 14.3%)

  2. Bacterial sepsis of newborn (2,731; 12.4%)

  3. Respiratory distress of newborn (2,347; 10.7%)

Maternal Mortality Rate

• Maternal Mortality Rate - is the number of resident maternal deaths within 42 days of pregnancy termination due to complications of pregnancy, childbirth, and the puerperium in a specified geographic area

• Philippines maternal mortality ratio was at level of 121 deaths per 100,000 live births in 2017, down from 124 deaths per 100,000 live births previous year, this is a change of 2.42%