Theories Related to maternal and Child Health Nursing

 Perinatal nursing is the care and support of women and their families before, during, and after childbirth.
Perinatal nurses provide education and resources about pregnancy and childbirth, and help oversee the mother
and child during pregnancy, childbirth, and postpartum to ensure the health of both.
 A perinatal nurse’s involvement in the patient’s care depends on the nurse’s license, as well as the patient’s needs.
For example, someone who is certified as a nurse-midwife may be the primary care provider for a mother and
child, while a lactation consultant works with a mother after childbirth to help her breastfeed her infant. Some
perinatal nurses work in obstetrics and gynecology offices to provide care for a woman during her pregnancy,
while others work in labor and delivery to provide a safe, healthy environment for childbirth, and assist other
health care providers during a woman’s labor and delivery.
 Perinatal nurses must be compassionate when dealing with pregnant and postpartum women, as well as be able
to communicate with a patient’s family in order to provide a nursing care plan that ensures the health of the
mother and her baby.
Theories
1. Mercer’s Maternal Role Attainment Theory
 The Maternal Role Attainment Theory was developed to 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. This mid-range theory can be used throughout pregnancy and postnatal care, but is
also beneficial for adoptive or foster mothers, or others who find themselves in the maternal role
unexpectedly. The process used in this nursing model helps the mother develop an attachment to the
infant, which in turn helps the infant form a bond with the mother. This helps develop the mother-child
relationship as the infant grows.
 The primary concept of this theory is the developmental and interactional process, which occurs over a
period of time. In the process, the mother bonds with the infant, acquires competence in general
caretaking tasks, and then comes to express joy and pleasure in her role as a mother.
 As a head nurse in pediatrics and staff nurse in intrapartum, postpartum, and newborn nursery units,
Ramona Mercer had a great deal of experience in nursing care for mothers and infants. This gave her a
strong foundation for creating her Maternal Role Attainment Theory for nursing.
2. Roy’s Adaptation Model of Nursing
 The Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. After working with
Dorothy E. Johnson, Roy became convinced of the importance of describing the nature of nursing as a
service to society. This prompted her to begin developing her model with the goal of nursing being to
promote adaptation. She first began organizing her theory of nursing as she developed course curriculum
for nursing students at Mount St. Mary’s College. She introduced her ideas as a basis for an integrated
nursing curriculum.
 The key concepts of Roy’s Adaptation Model are made up of four components: person, health,
environment, and nursing.
 According to Roy’s model, a person is a bio-psycho-social being in constant interaction with a changing
environment. He or she uses innate and acquired mechanisms to adapt. The model includes people as
individuals, as well as in groups such as families, organizations, and communities. This also includes
society as a whole.
 The Adaptation Model states that health is an inevitable dimension of a person’s life, and is represented
by a health-illness continuum. Health is also described as a state and process of being and becoming
integrated and whole.
3. Casey’s Model of Nursing
 Casey’s Model of Nursing focuses on the nurse working in partnership with the child and his or her family.
It was one of the earliest attempts to develop a nursing model designed specifically for child health
nursing.
 The five aspects of this nursing theory are child, family, health, environment, and the nurse.
 The philosophy of Casey’s model is that the best people to care for the child are the members of the
family, with health care professionals assisting. This necessitates a relationship between the parent(s)
and nurse.
 Anne Casey is an English nurse who developed a nursing theory known as Casey’s Model of Nursing. The
model was developed in 1988 while she was working in pediatric oncology at the Great Ormond Street
Hospital in London.
4. Parse’s Human Becoming Theory
 Parse’s Human Becoming Theory guides the practice of nurses to focus on quality of life as it is described
and lived. The human becoming theory of nursing presents an alternative to both the conventional bio-
medical approach as well as the bio-psycho-social-spiritual approach of most other theories and models
of nursing. Parse’s model rates quality of life from each person’s own perspective as the goal of the
practice of nursing. Rosemarie Rizzo Parse first published the theory in 1981 as the “Man-living-health”
theory, and the name was changed to the “human becoming theory” in 1992.
  The assumptions underpinning the theory were synthesized from works by European philosophers. The
theory is structured around three abiding themes: meaning, rhythmicity, and transcendence.
 The model makes assumptions about man and becoming, as well as three major assumptions about
human becoming.
a)The Human Becoming Theory makes the following assumptions about man:
b) The human is coexistent while co-constituting rhythmical patterns with the universe.
c)The human is open, freely choosing meaning in a situation, as well as bearing responsibility for
decisions made.
d) The human is unitary, continuously co-constituting patterns of relating.
e)The human is transcending multidimensionally with the possibles.
 The Human Becoming Theory makes the following assumptions about becoming
a)Becoming is unitary with human-living-health.
b) Becoming is a rhythmically co-constituting the human-universe process.
c)Becoming is the human’s patterns of relating value priorities.
d) Becoming is an intersubjective process of transcending with the possibles
e)Becoming is the unitary human’s emerging.
 The three major assumptions about human becoming are: meaning, rhythmicity, and transcendence.
5. Nightingale’s Environment Theory
 As the founder of modern nursing, Florence Nightingale’s Environment Theory changed the face of
nursing practice. She served as a nurse during the Crimean War, at which time she observed a correlation
between the patients who died and their environmental conditions. As a result of her observations, the
Environment Theory of nursing was born. Nightingale explained this theory in her book, Notes on
Nursing: What it is, What it is Not. The model of nursing that developed from Nightingale, who is
considered the first nursing theorist, contains elements that have not changed since the establishment of
the modern nursing profession. Though this theory was pioneering at the time it was created, the
principles it applies are timeless.
 There are seven assumptions made in the Environment Theory, which focuses on taking care of the
patient’s environment in order to reach health goals and cure illness. These assumptions are:
a)natural laws
b) mankind can achieve perfection
c)nursing is a calling
d) nursing is an art and a science
e)nursing is achieved through environmental alteration
f) nursing requires a specific educational base
g)nursing is distinct and separate from medicine
 The focus of nursing in this model is to alter the patient’s environment in order to affect change in his or
her health. The environmental factors that affect health, as identified in the theory, are: fresh air, pure
water, sufficient food supplies, efficient drainage, cleanliness of the patient and environment, and light
(particularly direct sunlight). If any of these areas is lacking, the patient may experience diminished
health. A nurse’s role in a patient’s recovery is to alter the environment in order to gradually create the
optimal conditions for the patient’s body to heal itself. In some cases, this would mean minimal noise and
in other cases could mean a specific diet. All of these areas can be manipulated to help the patient meet
his or her health goals and get healthy.
 The Environment Theory of nursing is a patient-care theory. That is, it focuses on the care of the patient
rather than the nursing process, the relationship between patient and nurse, or the individual nurse. In
this way, the model must be adapted to fit the needs of individual patients. The environmental factors
affect different patients unique to their situations and illnesses, and the nurse must address these factors
on a case-by-case basis in order to make sure the factors are altered in a way that best cares for an
individual patient and his or her needs.
6. Neuman’s Systems Model
 Betty Neuman’s Systems Model provides a comprehensive holistic and system-based approach to nursing
that contains an element of flexibility. The theory focuses on the response of the patient system to actual
or potential environmental stressors and the use of primary, secondary, and tertiary nursing prevention
intervention for retention, attainment, and maintenance of patient system wellness.
 The basic assumptions of the model are:
a)Each patient system is a unique composite of factors and characteristics within a range of
responses contained in a basic structure.
b) Many known, unknown, and universal stressors exist. Each differ in their potential for
upsetting a client’s usual stability level.
c)Each patient has evolved a normal range of responses to the environment referred to as the
normal line of defense. It can be used as a standard by which to measure health deviation.
d) The particular inter-relationships of patient variables can, at any point in time, affect the
degree to which a client is protected by the flexible line of defense against possible reaction to
stressors.
 e)When the flexible line of defense is incapable of protecting the patient against an environmental
stressor, that stressor breaks through the line of defense.
f) The client is a dynamic composite of the inter-relationships of the variables, whether in a state of
illness or wellness. Wellness is on a continuum of available energy to support the system in a
state of stability.
g)Each patient has implicit internal resistance factors known as LOR, which function to stabilize
and realign the patient to the usual state of wellness.
h) Primary prevention is applied in patient assessment and intervention, in identification
and reduction of possible or actual risk factors.
i) Secondary prevention relates to symptomatology following a reaction to stressors, appropriate
ranking of intervention priorities, and treatment to reduce their noxious effects.
j) Tertiary prevention relates to adjustive processes taking place as reconstitution begins, and
maintenance factors move them back in a cycle toward primary prevention.
k) The patient is in dynamic, constant energy exchange with the environment.
7. Rogers’ Theory of Unitary Human Beings
 Martha E. Rogers’ Theory of Unitary Human Beings views nursing as both a science and an art. The
uniqueness of nursing, like any other science, is in the phenomenon central to its focus. The purpose of
nurses is to promote health and well-being for all persons wherever they are. The development of Rogers’
abstract system was strongly influenced by an early grounding in arts, as well as a background in science
and interest in space. The science of unitary human beings began as a synthesis of ideas and facts.
 The nursing theory provides a way to view the unitary human being, who is integral with the universe.
The unitary human being and his or her environment are one. Nursing focuses on people and the
manifestations that emerge from the mutual human-environmental field process. A change of pattern and
organization of the human and environmental fields is transmitted by waves. The manifestations of the
field patterning that emerge are observable events. By identifying the pattern, there can be a better
understanding of human experience.
 There are eight concepts in Rogers’ nursing theory: energy field, openness, pattern, pan-dimensionality,
homeodynamic principles, resonance, helicy, and integrality.
 The energy field is the fundamental unit of both the living and the non-living. It provides a way to view
people and the environment as irreducible wholes. The energy fields continuously vary in intensity,
density, and extent. There are no boundaries that stop energy flow between the human and
environmental fields, which is the openness in Rogers’ theory.
8. Erickson’s Modeling and Role Modeling Theory
 The Modeling and Role Modeling Theory was developed by Helen Erickson, Evelyn M. Tomlin, and Mary
Anne P. Swain. It was first published in 1983 in their book Modeling and Role Modeling: A Theory and
Paradigm for Nursing. The theory enables nurses to care for and nurture each patient with an awareness
of and respect for the individual patient’s uniqueness. This exemplifies theory-based clinical practice that
focuses on the patient’s needs.
 The theory draws concepts from a variety of sources. Included in the sources are Maslow’s Theory of
Hierarchy of Needs, Erikson’s Theory of Psychosocial Stages, Piaget’s Theory of Cognitive Development,
and Seyle and Lazarus’s General Adaptation Syndrome.
 The Modeling and Role Modeling Theory explains some commonalities and differences among people.
 The commonalities among people include:
 Holism, which is the belief that people are more than the sum of their parts. Instead, mind, body, emotion,
and spirit function as one unit, affecting and controlling the parts in dynamic interaction with one
another. This means conscious and unconscious processes are equally important.
 Basic needs, which drive behavior. Basic needs are only met when the patient perceives they are met.
According to Maslow, whose hierarchical ordering of basic and growth needs is the basis for basic needs
in the Modeling and Role Modeling Theory, when a need is met, it no longer exists, and growth can occur.
When needs are left unmet, a situation may be perceived as a threat, leading to distress and illness. Lack
of growth-need satisfaction usually provides challenging anxiety and stimulates growth. Need to know
and fear of knowing are associated with meeting safety and security needs.
 Affiliated Individuation is a concept unique to the Modeling and Role Modeling Theory, based on the
belief that all people have an instinctual drive to be accepted and dependent on support systems
throughout life, while also maintaining a sense of independence and freedom. This differs from the
concept of interdependence.
 Attachment and Loss addresses the idea that people have an innate drive to attach to objects that meet
their needs repeatedly. They also grieve the loss of any of these objects. The loss can be real, as well as
perceived or threatened. Unresolved loss leads to a lack of resources to cope with daily stressors, which
results in morbid grief and chronic need deficits.
 Psychosocial Stages, based on Erikson’s theory, say that task resolution depends on the degree of need
satisfaction. Resolution of stage-critical tasks lead to growth-promoting or growth-impeding residual
attributes that affect one’s ability to be fully functional and able to respond in a healthy way to daily
 stressors. As each age-specific task is negotiated, the person gains enduring character-building strengths
and virtues.
 Cognitive Stages are based on Piaget’s theory, and are the thinking abilities that develop in a sequential
order. It is useful to understand the stages to determine what developmental stage the patient may have
had difficulty with.
9. Orlando’s Nursing Process Discipline Theory
 The Dynamic Nurse-Patient Relationship , published in 1961 and written by Ida Jean Orlando, described
Orlando’s Nursing Process Discipline Theory. The major dimensions of the model explain that the role of
the nurse is to find out and meet the patient’s immediate needs for help. The patient’s presenting
behavior might be a cry for help. However, the help the patient needs may not be what it appears to be.
Because of this, nurses have to use their own perception, thoughts about perception, or the feeling
engendered from their thoughts to explore the meaning of the patient’s behavior. This process helps
nurses find out the nature of the patient’s distress and provide the help he or she needs.
 The concepts of the theory are: function of professional nursing, presenting behavior, immediate reaction,
nursing process discipline, and improvement.
 The function of professional nursing is the organizing principle. This means finding out and meeting the
patient’s immediate needs for help. According to Orlando, nursing is responsive to individuals who suffer,
or who anticipate a sense of helplessness. It is focused on the process of care in an immediate experience,
and is concerned with providing direct assistance to a patient in whatever setting they are found in for
the purpose of avoiding, relieving, diminishing, or curing the sense of helplessness in the patient. The
Nursing Process Discipline Theory labels the purpose of nursing to supply the help a patient needs for his
or her needs to be met. That is, if the patient has an immediate need for help, and the nurse discovers and
meets that need, the purpose of nursing has been achieved.
10. Kolcaba’s Theory of Comfort
 Kolcaba’s Theory of Comfort was first developed in the 1990s. It is a middle-range theory for health
practice, education, and research. This theory has the potential to place comfort in the forefront of
healthcare. According to the model, comfort is an immediate desirable outcome of nursing care.
 The Theory of Comfort was developed when Katharine Kolcaba conducted a concept analysis of comfort
that examined literature from several disciplines, including nursing, medicine, psychology, psychiatry,
ergonomics, and English. After the three forms of comfort and four contexts of holistic human experience
were introduced, a taxonomic structure was created to guide for the assessment, measurement, and
evaluation of patient comfort. According to Kolcaba, comfort is the product of holistic nursing art.
 Kolcaba described comfort existing in three forms: relief, ease, and transcendence. If specific comfort
needs of a patient are met, the patient experiences comfort in the sense of relief. For example, a patient
who receives pain medication in post-operative care is receiving relief comfort. Ease addresses comfort in
a state of contentment. For example, the patient’s anxieties are calmed. Transcendence is described as a
state of comfort in which patients are able to rise above their challenges. The four contexts in which
patient comfort can occur are: physical, psychospiritual, environmental, and sociocultural.
 The Theory of Comfort considers patients to be individuals, families, institutions, or communities in need
of health care. The environment is any aspect of the patient, family, or institutional surroundings that can
be manipulated by a nurse or loved one in order to enhance comfort. Health is considered to be optimal
functioning in the patient, as defined by the patient, group, family, or community.
 In the model, nursing is described as the process of assessing the patient’s comfort needs, developing and
implementing appropriate nursing care plans, and evaluating the patient’s comfort after the care plans
have been carried out. Nursing includes the intentional assessment of comfort needs, the design of
comfort measures to address those needs, and the reassessment of comfort levels after implementation.
Assessment can be objective, such as the observation of wound healing, or subjective, such as asking the
patient if he or she is comfortable.
11. Orem’s Self-Care Deficit Nursing Theory
 The Self-Care Deficit Theory developed as a result of Dorothea E. Orem working toward her goal of
improving the quality of nursing in general hospitals in her state. The model interrelates concepts in such
a way as to create a different way of looking at a particular phenomenon. The theory is relatively simple,
but generalizable to apply to a wide variety of patients. It can be used by nurses to guide and improve
practice, but it must be consistent with other validated theories, laws and principles.
 The major assumptions of Orem’s Self-Care Deficit Theory are:
a)People should be self-reliant, and responsible for their care, as well as others in their family who
need care.
b) People are distinct individuals.
c)Nursing is a form of action. It is an interaction between two or more people.
d) Successfully meeting universal and development self-care requisites is an important
component of primary care prevention and ill health.
e)A person’s knowledge of potential health problems is needed for promoting self-care behaviors.
f) Self-care and dependent care are behaviors learned within a socio-cultural context.
g)Orem’s theory is comprised of three related parts: theory of self-care; theory of self-care deficit;
and theory of nursing system.
 h) The theory of self-care includes self-care, which is the practice of activities that an
individual initiates and performs on his or her own behalf to maintain life, health, and well-being;
self-care agency, which is a human ability that is “the ability for engaging in self-care,”
conditioned by age, developmental state, life experience, socio-cultural orientation, health, and
available resources; therapeutic self-care demand, which is the total self-care actions to be
performed over a specific duration to meet self-care requisites by using valid methods and
related sets of operations and actions; and self-care requisites, which include the categories of
universal, developmental, and health deviation self-care requisites.
i) Universal self-care requisites are associated with life processes, as well as the maintenance of the
integrity of human structure and functioning. Orem identifies these requisites, also called
activities of daily living, or ADLs, as:
12. King’s Theory of Goal Attainment
 The Theory of Goal Attainment was developed by Imogene King in the early 1960s. It describes a
dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. The
theory explains that factors which can affect the attainment of goals are roles, stress, space, and time.
 The model has three interacting systems: personal, interpersonal, and social. Each of these systems has its
own set of concepts. The concepts for the personal system are perception, self, growth and development,
body image, space, and time. The concepts for the interpersonal system are interaction, communication,
transaction, role, and stress. The concepts for the social system are organization, authority, power, status,
and decision-making.
 The following propositions are made in the Theory of Goal Attainment:
a)If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur.
b) If the nurse and patient make transaction, the goal or goals will be achieved.
c)If the goal or goals are achieved, satisfaction will occur.
d) If transactions are made in nurse-patient interactions, growth and development will be
enhanced.
e)If role expectations and role performance as perceived by the nurse and patient are congruent,
transaction will occur.
f) If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-
patient interaction will occur.
g)If a nurse with special knowledge communicates appropriate information to the patient, mutual
goal-setting and goal achievement will occur.
13. Watson’s Philosophy and Science of Caring
 The Philosophy and Science of Caring has four major concepts: human being, health,
environment/society, and nursing.
 Jean Watson refers to the human being as “a valued person in and of him or herself to be cared for,
respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully
functional integrated self. Human is viewed as greater than and different from the sum of his or her parts.
 Health is defined as a high level of overall physical, mental, and social functioning; a general adaptive-
maintenance level of daily functioning; and the absence of illness, or the presence of efforts leading to the
absence of illness.
 Watson’s definition of environment/society addresses the idea that nurses have existed in every society,
and that a caring attitude is transmitted from generation to generation by the culture of the nursing
profession as a unique way of coping with its environment.
 The nursing model states that nursing is concerned with promoting health, preventing illness, caring for
the sick, and restoring health. It focuses on health promotion, as well as the treatment of diseases. Watson
believed that holistic health care is central to the practice of caring in nursing. She defines nursing as “a
human science of persons and human health-illness experiences that are mediated by professional,
personal, scientific, esthetic and ethical human transactions.”
 The nursing process outlined in the model contains the same steps as the scientific research process:
assessment, plan, intervention, and evaluation. The assessment includes observation, identification, and
review of the problem, as well as the formation of a hypothesis. Creating a care plan helps the nurse
determine how variables would be examined or measured, and what data would be collected.
Intervention is the implementation of the care plan and data collection. Finally, the evaluation analyzes
the data, interprets the results, and may lead to an additional hypothesis.
 Watson’s model makes seven assumptions:
a)Caring can be effectively demonstrated and practiced only interpersonally.
b) Caring consists of carative factors that result in the satisfaction of certain human needs.
c)Effective caring promotes health and individual or family growth.
d) Caring responses accept the patient as he or she is now, as well as what he or she may
become.
e)A caring environment is one that offers the development of potential while allowing the patient
to choose the best action for him or herself at a given point in time.
f) A science of caring is complementary to the science of curing.
g)The practice of caring is central to nursing.
WHO’s 17 Sustainable Developmental Goals

 History:
Adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for
people and the planet, now and into the future. At its heart are the 17 Sustainable Development Goals (SDGs),
which are an urgent call for action by all countries - developed and developing - in a global partnership. They
recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health
and education, reduce inequality, and spur economic growth – all while tackling climate change and working to
preserve our oceans and forests.

 The SDGs build on decades of work by countries and the UN, including the UN Department of Economic and Social
Affairs
 In June 1992, at the Earth Summit in Rio de Janeiro, Brazil, more than 178 countries adopted Agenda 21, a
comprehensive plan of action to build a global partnership for sustainable development to improve human lives
and protect the environment.
 Member States unanimously adopted the Millennium Declaration at the Millennium Summit in September 2000 at
UN Headquarters in New York. The Summit led to the elaboration of eight Millennium Development Goals (MDGs)
to reduce extreme poverty by 2015.
 The Johannesburg Declaration on Sustainable Development and the Plan of Implementation, adopted at the World
Summit on Sustainable Development in South Africa in 2002, reaffirmed the global community's commitments to
poverty eradication and the environment, and built on Agenda 21 and the Millennium Declaration by including
more emphasis on multilateral partnerships.
 At the United Nations Conference on Sustainable Development (Rio+20) in Rio de Janeiro, Brazil, in June 2012,
Member States adopted the outcome document "The Future We Want" in which they decided, inter alia, to launch
a process to develop a set of SDGs to build upon the MDGs and to establish the UN High-level Political Forum on
Sustainable Development. The Rio +20 outcome also contained other measures for implementing sustainable
development, including mandates for future programmes of work in development financing, small island
developing states and more.
 In 2013, the General Assembly set up a 30-member Open Working Group to develop a proposal on the SDGs.
 In 2013, the General Assembly set up a 30-member Open Working Group to develop a proposal on the SDGs.
 In January 2015, the General Assembly began the negotiation process on the post-2015 development agenda. The
process culminated in the subsequent adoption of the 2030 Agenda for Sustainable Development, with 17 SDGs at
its core, at the UN Sustainable Development Summit in September 2015.
 2015 was a landmark year for multilateralism and international policy shaping, with the adoption of several major
agreements:
 Sendai Framework for Disaster Risk Reduction (March 2015)
 Addis Ababa Action Agenda on Financing for Development (July 2015)
 Transforming our world: the 2030 Agenda for Sustainable Development with its 17 SDGs was adopted at the UN
Sustainable Development Summit in New York in September 2015.
 Paris Agreement on Climate Change (December 2015)
 Now, the annual High-level Political Forum on Sustainable Development serves as the central UN platform for the
follow-up and review of the SDGs.
 Today, the Division for Sustainable Development Goals (DSDG) in the United Nations Department of Economic and
Social Affairs (UNDESA) provides substantive support and capacity-building for the SDGs and their related
thematic issues, including water, energy, climate, oceans, urbanization, transport, science and technology, the
Global Sustainable Development Report (GSDR), partnerships and Small Island Developing States. DSDG plays a
key role in the evaluation of UN systemwide implementation of the 2030 Agenda and on advocacy and outreach
activities relating to the SDGs. In order to make the 2030 Agenda a reality, broad ownership of the SDGs must
translate into a strong commitment by all stakeholders to implement the global goals. DSDG aims to help facilitate
this engagement.
WHO’s 17 Sustainable Developmental Goals
1. End poverty in all its forms everywhere
2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture
3. Ensure healthy lives and promote well-being for all at all ages
4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
5. Achieve gender equality and empower all women and girls
6. Ensure availability and sustainable management of water and sanitation for all
7. Ensure access to affordable, reliable, sustainable and modern energy for all
8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work
for all
9. Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation
10. Reduce inequality within and among countries
11. Make cities and human settlements inclusive, safe, resilient and sustainable
12. Ensure sustainable consumption and production patterns
13. Take urgent action to combat climate change and its impacts*
14. Conserve and sustainably use the oceans, seas and marine resources for sustainable development
15. 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. 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. Strengthen the means of implementation and revitalize the global partnership for sustainable development