NCM 107

Nursing Care Management

Care of Maternal, Child and
Adolescent
(Normal Clients)
 Maternal and Child Health Nursing
• refers to the relationship of
mother and child to one another
and consideration of the entire
family, as well as the culture and
socio-economic to environment
as framework of the clients.
• refers to the care of pregnant
woman, child and family
 Maternal and Child Nursing Framework
• Maternal and child health nursing can be visualized within a
framework in which nurses use nursing process, nursing
theory and other competencies
Philippine Professional Nursing Practice Standards
PPNPS
2012 National Core Competency Standards
NNCCS,
Standards of Nursing services), evidence-based
practice, to care for families during childbearing and
childrearing years and through the four phases of
health care:
Health promotion Health maintenance
Health restoration Health rehabilitation
 Nursing Process
(Maternal Child Nursing Framework)

• A scientific form of problem solving, serves as the

basis for assessing, making a nursing diagnosis,
planning, implementing, and evaluating care.
 Nursing Process
(Maternal Child Nursing Framework)

• It is a process broad enough to serve as

the basis for modern nursing care because
it is applicable to all health care settings,
from the home to ambulatory clinics to
intensive care units
 Evidence-Based Practice
(MCN Framework)
• is the conscientious, explicit, and judicious use of
current best evidence in making decisions about
the care of patients (Melnyk, 2010)
• Evidence can be a combination of research,
clinical expertise, and patient’s preferences and
values.

Evidence-Based Practice: Step by Step: The Seven Steps of Evidence-Based Practice

Melnyk, Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP, FAAN; Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN;
Stillwell, Susan B., DNP, RN, CNE; Williamson, Kathleen M., PhD, RN
AJN The American Journal of Nursing: January 2010 - Volume 110 - Issue 1 - p 51-53
 Nursing theories
(MCN Framework)

Are designed to offer helpful ways to view patients so

nursing activities can be created to best meet patient’s
needs:
1. Calistra Roy’s theory- Adaptation Model

2. Dorothea Orem’s theory- Self-care Deficit Theory

3. Patricia Benner’s theory- “From Novice to Expert:

Excellence and Power in Clinical Nursing Practice”
 Nursing Research
(MCN Framework)

• the systematic investigation of problems that have

implications for nursing practice and usually carried out
by nurses) plays an important role in evidence-based
practice as bodies of professional knowledge only grow
and expand to the extent people in that profession are
able to carry out research (Christian, 2012).
- examining nursing care in this way results in
improved and cost-effective patient care as it
provides evidence for action and justification
for implementing activities.
Quality and safety education for nurses (QSEN)
• the goal of this QSEN is to address the challenge of preparing
future nurses with the abilities necessary
• to continuously improve the quality and safety of the health care
systems in which they work

QSEN Competencies Required for MC nursing

Patient Centered Quality Safety- nurses minimize the risk of harm to
Improvement patients and providers through both system
effectiveness & individual performance

Teamwork & Evidence- Based Informatics-nurses use information and

Collaboration Practice technology to communicate, manage , mitigate
error and support decision making.
A new Objective added in 2010,

1. 100% of prelicensure programs in Nursing must

include core content
• Counseling for health promotion and disease
prevention
• Cultural diversity including (LGBT) populations
• Evaluation of health sciences lit.,
• Environmental health
• Public health systems and Global health
The 2020 national health goals:

1. To help citizen more easily understand the importance of

health promotion and disease prevention.
2. To encourage wide participation in improving health in the
next decade.
 Global Health Goals

The Global health goals:

1.To end poverty and hunger-
2. To achieve universal primary education
3. To promote gender equality and empower women
4. To reduce child mortality
5. To improve maternal health
6. To combat HIV/AIDS, malaria and other diseases.
7. To ensure environmental sustainability
8. To develop a global partnership for development
Roles and responsibilities of maternal
and child nurse
1. Considers the family as a whole and as a partner in
care when planning or implementing or evaluating
the effectiveness of care.
2. Serves as an advocate to protect the rights of all
family members including the fetus.
3. Demonstrates a high degree of independent
nursing functions.
Roles and responsibilities of maternal
and child nurse

3. Promotes health and disease prevention-

4. Serves as an important resource for families during
childbearing and child-rearing.
5. Respects personal, cultural and spiritual
6. attitudes and beliefs.
7. Encourages developmental stimulation during both
health and illness.
Roles and responsibilities of maternal
and child nurse

8. Assesses family for strengths as well as specific

needs or challenges.
9. Encourages family bonding through rooming in and
family visiting in maternal and child healthcare setting.
10.Encourages early hospital discharge options to
reunite families as soon as possible.
11.Encourages families to reach out to their community.
 NATIONAL HEALTH SITUATION

What is the National Health Situation of the

Philippines?

• Many Filipinos continue to die or suffer from

illnesses that have well-proven, cost-effective
interventions such tuberculosis, HIV and dengue, or
diseases affecting mothers and children. Many
people lack sufficient knowledge to make informed
decisions about their own health.
 Measuring Maternal and Child Health

• A more objective view of health can be provided by using

national or regional health statistics to describe degrees of
illness.
• Such statistics are useful for comparisons among states
and nations and for anticipating future health care needs of
a community.
• Statistics require accurate recording, collection, and
analysis and, because, play such a major role in the
accurate collection and recording of health-related data,
nurses play a major role in allowing the nation’s present
and future health to be described in these ways
Common Statistical Terms Used for
Maternal and Child Health

1. Birth rate – the number of birth per 1.000 population

2. Fertility rate – the number of pregnancies per 1,000
women of childbearing age
3. Fetal death rate – the number of fetal deaths ( over
500g ) per 1,000 live births
4. Neonatal death rate – the number of deaths per
1,000 live births occurring at birth or in the first 28
days of life
Common Statistical Terms Used for
Maternal and Child Health

5. Perinatal death rate – the number of deaths during

the perinatal time period (beginning when a fetus
reaches 500 g, about week 20 of pregnancy, and
ending about 4 t0 6 weeks after birth); it is the sum
of the fetal and neonatal rates
6. Maternal mortality rate – the number of maternal
deaths per 100,000 live births that occur as a direct
result of the reproductive process
Common Statistical Terms Used for
Maternal and Child Health

7. Infant mortality rate – the number of deaths per

1,000 live births occurring at birth or in the first
12 months of life
8. Childhood mortality rate – the number of
deaths per 1,000 population in children age 1
to 14 years
Birth Rate
• 20.377 births per 1000 people
• The birth rate for Philippines in 2019 was
20.377 births per 1000 people, a 0.97%
decline from 2018.
• The birth rate for Philippines in 2018 was
20.576 births per 1000 people, a 3.31%
decline from 2017.
• The birth rate for Philippines in 2017 was
21.280 births per 1000 people, a 3.2%
decline from 2016.
Fertility rate
• 2.530 births per woman
• The current fertility rate for Philippines
in 2020 is 2.530 births per woman, a
0.98% decline from 2019.
• Philippines Fertility Rate 1950-2020.

Philippines - Historical Fertility Rate Data

• Year Fertility Rate Growth Rate
• 2020 2.530 -0.980%
• 2019 2.555 -0.970%
• 2018 2.580 -3.520%
 Infant mortality rate

• total: 20.9 deaths/1,000 live births

(2018 est.)
• male: 23.8 deaths/1,000 live births
• female: 17.9 deaths/1,000 live births
This entry gives the number of deaths of infants
under one year old in a given year per 1,000 live
births in the same year. This rate is often used as
an indicator of the level of health in a country.
Common causes of Neonate Mortality
The three major causes of neonatal
deaths worldwide are
1. infections (36%, which includes sepsis/pneumonia,
tetanus and diarrhoea),
2. pre-term (28%), and
3. birth asphyxia (23%).

There is some variation between countries depending

on their care configurations.
 Leading causes of neonatal deaths
in Philippines (2017)

• 31% Preterm birth complications.

• 24% Intrapartum related events.
• 17% Congenital abnormalities.
• 1% Diarrhea.
Three leading cause of Infant Mortality

1. Congenital malformations disorders

related to short gestation
2. low birthweight
3. Sudden Infant Death Syndrome
(SIDS)
 Philippines - Under-five mortality rate

• 27.35 deaths per thousand live births

• In 2018, under-5 mortality rate for Philippines was

27.35 deaths per thousand live births.

• Under-5 mortality rate of Philippines fell

gradually from 84.9 deaths per thousand live births in 1969
to 27.35 deaths per thousand live births in 2018.
 What is Under-5 mortality rate?

• The child mortality rate, also under- five mortality rate,

refers to the probability of dying between birth and exactly
five years of age expressed per 1,000 live births. It
encompasses neonatal mortality.
 Leading causes of death among
children under-5 years old
• According to the World Health Organization (WHO),
more than half of deaths among children under - 5
years old can be attributed to “ diseases that are
preventable and treatable through simple, affordable
interventions.” However, under – 5 child deaths may
also be caused by factors other than illness.
 Maternal mortality ratio
(MMR) Philippines 2017

• The maternal mortality ratio (MMRatio) is the annual

number of female deaths per 100,000 live births from
any cause related to or aggravated by pregnancy or its
management (excluding accidental or incidental
causes).
• The MMRatio includes deaths during pregnancy,
childbirth, or within 42 days of termination of
pregnancy, irrespective of the duration and site of the
pregnancy, for a specified year.
 Maternal mortality ratio (MMR) –
Philippines 2017

• Philippines - Maternal mortality ratio. 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%.
 Maternal Mortality
• A maternal death is the death of a woman while
pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and the site of
the pregnancy*, from any cause related to or
aggravated by the pregnancy or its management, but
not from accidental or incidental causes.

• Causes:
Postpartum hemorrhage
Eclampsia
Obstructed labor
Sepsis
 Maternal Morbidity
- any health condition attributed to and /or aggravated by
pregnancy and childbirth that has a negative impact on the
woman’s well-being
- The causes of maternal morbidity are many and complex.
They vary in duration and severity and cover a broad range of
diagnoses requiring a wide variety of treatments.
- Maternal morbidity can be conceptualized as a spectrum
ranging, at its most severe, from a “maternal near miss”
- defined by the World Health Organization (WHO) as the near
death of a woman who has survived a complication occurring
during pregnancy or childbirth or within 42 days of the
termination of pregnancy5 – to non-life-threatening morbidity,
which is more common by far.
 Total Deaths as Denominator

Formula
1. Infant Mortality Rate ( deaths under 1 year of age per 1,000 live births )
IMR = deaths under 1 year of age in a year x 1,000
Registered live births during the same year

2. Neonatal Mortality Rate (deaths mainly due to prenatal or genetic

factors)
• NMR = no. of deaths among those under
28 days of age in a calendar year x 1,000
No. of registered live births in the same year
3. Post – Neonatal Mortality Rate ( deaths influenced by infection,
nutritional, genetic or environmental factors)
PNMR = no. of deaths among those under 28 days
to less than 1 year of age in a calendar year x 1,000
No. of registered live births in the same year

4. Maternal Mortality Rate ( deaths related to pregnancy per 1,000 live

births)
MMR = no. of deaths from causes related to pregnancy,
delivery, puerperium in a calendar year x 1,000
• No. of registered live births in the same year
 Fertility Measures:

1. Crude Birth Rate – measures the neutral growth or increase in

population through births.
CFR = no. of registered live births x 1,000
Average mid-year population
CBR is affected by:
• Accuracy of registered live births
• Influence the fertility status of female population
• Number of female in the child bearing stage
• The cultural or social practices (family planning)

\
 Fertility Measures:

2. General Fertility Rate – relates birth to the segment of

population who are actually at risk of giving birth
GFR = no. of registered live births x 1,000
No. of women 15-44 years old

3. Age – Specific Fertility Rate

• SFR = no. of live births to women of certain age x 1,000
• Estimated female population of that age
Basic emergency obstetric and newborn care (BEmONC) is a primary health care level
initiative promoted in low- and middle-income countries to reduce maternal and newborn
mortality
ESSENTIAL INTRAPARTUM & NEWBORN CARE: An Introduction
ANTHONY CALIBO, MD, DPPS Medical Specialist IV, DOH Family Health Office
ESSENTIAL INTRAPARTUM & NEWBORN CARE: An Introduction
ANTHONY CALIBO, MD, DPPS Medical Specialist IV, DOH Family Health Office
 DOH NATIONAL SAFE MOTHERHOOD
PROGRAM

• For more information of DOH National Safe

Motherhood Program, please visit this link
below.
• https://www.doh.gov.ph/national-safe-
motherhood-program
 References:

• Pilliteri (2019) Maternal & Child Health Nursing 8th Edition Flagg
.Australia Nursing and Midwifery Council.
• Canadian Nurses Association, Canadian Nurse Practitioner Core
Competency Framework. Available at
http://cno.org/globalassets/for/rnec/pdf/competencyframework_.pdf
• DOH (2018) Philippines
• Evidence-Based Practice: Step by Step: The Seven Steps of
Evidence-Based Practice
• Melnyk, Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP,
FAAN; Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN; Stillwell,
Susan B., DNP, RN, CNE; Williamson, Kathleen M., PhD, RN
• AJN The American Journal of Nursing: January 2010 - Volume 110 -
Issue 1 - p 51-53