FILIPINO CULTURE,VALUES AND PRACTICES IN RELATION TO MATERNAL AND CHILD CARE.

a. Nursing care planning to respect cultural diversity

b. Myths and Beliefs related to Pregnancy
c. Birth Practices of Selected cultural Groups

CHAPTER 1

Maternal and child health nursing includes care of the pregnant woman, child, and family. (A) During a
prenatal visit, a nurse assesses that a pregnant woman’s uterus is expanding normally. (B) During a
health maintenance visit, a nurse assesses a child’s growth and development.

- The primary goal of both maternal and child health nursing is the promotion and maintenance
of optimal family health. 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

Maternal and child health nursing is:

• Family centered; assessment should always include the family as well as an individual.

• Community centered; the health of families is both affected by and influences the health of
communities.

• Evidence based; this is the means whereby critical knowledge increases.

• A challenging role for nurses and a major factor in keeping families well and optimally functioning. A
maternal and child health nurse:

• Considers the family as a whole and as a partner in care when planning or implementing or evaluating
the effectiveness of care.

• Serves as an advocate to protect the rights of all family members, including the

fetus.

• Demonstrates a high degree of independent nursing functions because teaching and counseling are
major interventions.

• Promotes health and disease prevention because these protect the health of the next generation.
• Serves as an important resource for families during childbearing and childrearing as these can be
extremely stressful times in a life cycle.

• Respects personal, cultural, and spiritual attitudes and beliefs as these so strongly influence the
meaning and impact of childbearing and childrearing.

• Encourages developmental stimulation during both health and illness so children can reach their
ultimate capacity in adult life.

• Assesses families for strengths as well as specific needs or challenges.

• Encourages family bonding through rooming-in and family visiting in maternal and child healthcare
settings.

• Encourages early hospital discharge options to reunite families as soon as possible in order to create a
seamless, helpful transition process.

• Encourages families to reach out to their community so the family can develop a wealth of support
people they can call on in a time of family crisis.

- Family-centered care enables nurses to better understand individuals and their effect on others
and, in turn, to provide more holistic care. Family members are encouraged to provide physical
and emotional care based on the individual situation and their comfort level. Nurses provide
guidance and monitor the interaction between family members to promote the health and well-
being of the family unit.
- provides guidance on how to assist a family to choose a healthcare setting that is family-
centered.

Maternal and Child Health Goals and Standards

- Healthcare technology has contributed to a number of important advances in maternal
and child health care. Through immunization, childhood diseases such as measles and
poliomyelitis almost have been eradicated. New fertility drugs and fertility techniques
allow more couples to conceive. The ability to prevent preterm birth and improve the
quality of life for both preterm and late preterm infants has increased dramatically.
- Access to health care and social determinants of health impact the role of the nurse and
the health of the patient. The two main overarching national health goals are:
• To increase quality and years of healthy life.
• To eliminate health disparities.

- These Global Health Goals are:

• To end poverty and hunger.
• To achieve universal primary education.
• To promote gender equality and empower women.
• To reduce child mortality.
• To improve maternal health.
• To combat HIV/AIDS, malaria, and other diseases.
• To ensure environmental sustainability.
• To develop a global partnership for development.
TWO PILLARS OF 2020 NATIONAL HEALTH GOALS
1. Increase quality and years of life
2. Eliminate health disparities

A Framework for Maternal and Child Health Nursing Care

Maternal and child health nursing can be visualized within a framework in which nurses use
nursing process, nursing theory, and Quality & Safety Education for Nurses (QSEN)
competencies to care for families during childbearing and childrearing years and through the four
phases of health care:
• Health Promotion- Educating parents and children to follow sound health practices through
teaching and role modeling.
• Health maintenance- Intervening to maintain health when risk of illness is present
• Health restoration- Using conscientious assessment to be certain that symptoms of illness are
identified and interventions are begun to return patient to wellness most rapidly
• Health rehabilitation- Helping prevent complications from illness; helping a patient with
residual effects achieve an optimal state of wellness and independence; helping a patient to
accept inevitable death.

NURSING PROCESS
- The nursing process, a scientific form of problem solving, serves as the basis for
assessing, making a nursing diagnosis, planning, implementing, and evaluating care. It is
a process broad enough to serve as the basis for modern nursing care because it is
applicable to all healthcare settings, from the home to ambulatory clinics to intensive care
units.

EVIDENCE-BASED PRACTICE
 - Evidence-based practice is the conscientious, explicit, and judicious use of current best
evidence to make decisions about the care of patients (Falk, Wongsa, Dang, et al., 2012).
Evidence can be a combination of research, clinical expertise, and patient preferences or
values.
- Use of evidence such as that obtained from randomized controlled trials helps to move
healthcare actions from “just tradition” to a more solid and therefore safer, scientific
basis.

NURSING RESEARCH
- Nursing research (the systematic investigation of problems that have implications for
nursing practice 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.

A Changing Discipline
Maternal and child health is an ever-changing area of nursing.

Birth rate: The number of births per 1,000 population.

Fertility rate: The number of pregnancies per 1,000 women of childbearing age.
Fetal death rate: The number of fetal deaths (over 500 g) per 1,000 live births.
Neonatal death rate: The number of deaths per 1,000 live births occurring at birth or in the first
28 days of life.
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 to 6 weeks after birth); it is
the sum of the fetal and neonatal rates.
Maternal mortality rate: The number of maternal deaths per 100,000 live births that occur as a
direct result of the reproductive process.
Infant mortality rate: The number of deaths per 1,000 live births occurring at birth or
in the first 12 months of life.
Childhood mortality rate: The number of deaths per 1,000 population in children
aged 1 to 14 years.

Cost containment refers to reducing the cost of health care by closely monitoring the costs of
personnel, use and brands of supplies, length of hospital stays, inpatient to outpatient ratios as is
clinically appropriate, number of procedures carried out, and number of referrals requested while
maintaining quality care.

The Family Medical Leave Act of 1993 is a federal law that requires employers with 50 or more
employees to provide a minimum of 12 weeks of unpaid, job-protected leave to employees under
four circumstances crucial to family life:
• Birth of the employee’s child
• Adoption or foster placement of a child with the employee
• Need for the employee to care for a parent, spouse, or child with a serious health condition
• Inability of the employee to perform his or her functions because of a serious
health condition

 scope of practice (the range of services and care that may be provided by a nurse based
on state requirements)
 Adolescents who support themselves or who arepregnant are frequently termed
“emancipated minors” or “mature minors” and have the right to sign for their own
health care.
 “Wrongful life” is a claim that negligent prenatal testing on the part of a healthcare
provider resulted in the birth of a disabled child.
 “Wrongful conception” denotes that a contraceptive measure failed, allowing an
unwanted child to be conceived and born.
 Legal and ethical aspects of issues are often intertwined, which makes the decision-
making process in this area complex. Maintaining privacy yet aiding problem solving in
these instances can be difficult but is a central nursing role (Kim etal., 2016). Nurses can
help patients by providing factual information and supportive listening, and helping the
family and healthcare providers clarify their values.

TRENDS IMPACTING MATERNAL ND CHILD HEALTH NURSING

- Families are more becoming mobile
- Families are more informed
- Child and intimate partner violence is increasing
- Balancing quality and cost containment in health care is an increasing initiative.

CHAPTER 2 DIVERSITY AND MATERNAL CHILD NURSING

  Diversity in a population means there is a mixture or variety of sociodemographic
groups, experiences, and beliefs in the population.
 Culture is a view of the world and a set of traditions a specific social group uses and
transmits to the next generation.
 minority or disadvantaged groups, groups not necessarily fewer in number but who hold
less power and wealth.

The term alternative healthcare practices refers to therapy such as acupuncture, homeopathy,
therapeutic touch, herbalism, and chiropractic care, or nontraditional sources of care such as
tribal medicine or Hispanic herbalists such as yerberos or curanderos.

 Stereotyping is expecting a person to act in a characteristic way without regard to his or

her individual traits.
 Prejudice is a negative attitude toward members of a group or is an intellectual act.
 Discrimination is the action of treating people differently based on their physical or
cultural traits or is a doing act.

The way people respond to pain is another example of a trait that is heavily influenced by
culture. Some women and children scream with pain; others remain stoic and quiet. Both are
“proper” responses, just culturally different.
Assessing for sexual orientation is not appropriate as a routine part of every health assessment.
However, it should be included when relevant, such as when discussing adolescent development
United States was viewed as a giant cultural “melting pot,” where all new arrivals gave up their
native country’s traditions and values and became Americans. Today, many people question the
idea that America was ever a melting pot; instead, the preferred concept is of a “salad bowl,” in
which cultural traditions and values are tossed together but with all their individual crispness and
flavor retained.
Women are often called the “keepers of the culture” or the people most influential in passing
on cultural traditions from one generation to another and in honoring the many cultural traditions
of childbirth and childrearing
 Transcultural nursing is care guided by cultural aspects and respects individual
differences
 The way people react to health care is a cultural value. Cultural values are preferred
ways of acting based on cultural traditions
 The usual values of a group are termed mores or norms.
 Actions not acceptable to a culture are called taboos. (murder, incest, and cannibalism)
SEXUAL ORIENTATION
- Heterosexual, homosexual, bisexual
GENDER IDENTITY
- Inner sense a person has of being male or female
- Maybe same or different from sex assigned at birth

CHAPTER 3
A genogram is a diagram that details family structure and provides information about the
family’s health history and the roles of various family members across several generations.
Another aspect of family assessment is to document the “fit” of a family into their community.
This is done by means of an ecomap, a diagram of family and community relationships

FAMILY TYPES
Family of orientation (the family one is born into; or oneself, parents, and siblings, if any)
Family of procreation (a family one establishes; or oneself, spouse or significant other, and
children, if any)

THE CONCEPT OF FAMILY

A family is defined by the U.S. Census Bureau (USCB, 2015) as “a householder and one or
more other people living in the same household who are related by birth, marriage, or adoption.”

Developmental Stages Goal

Marriage (stage 1) • Establish a mutually satisfying relationship.
• Learn to relate well to their families of orientation.
• Engage in reproductive life planning, if applicable.

The early childbearing family

(stage 2)
• Integrate the new member into the family.
• Make whatever financial and social adjustments are
 necessary to meet the needs of the new member
while continuing to meet the meets of the parents.

The family with a preschool

child (stage 3)

• Prevent unintentional injuries (accidents) such as

poisoning or falls.
• Begin socialization through play dates, child care, or
nursery school settings.

The family with a school-age

child (stage 4)

• Promote children’s health through immunizations,

dental care, and routine health assessments.
• Promote child safety related to home and
automobiles.
• Encourage socialization experiences outside the
home such as sports participation, music lessons, or
hobby activities.
• Encourage a meaningful school experience to make
learning a lifetime concern, not one of merely 12
years.

The family with an adolescent

(oldest child is between 13
and 20 years of age) (stage
5)
• Loosen ties enough to allow an adolescent more
 freedom while still remaining safe.
• Begin to prepare adolescents for life on their own.

The launching stage family:

the family with a late
adolescent (stage 6)
• Change their role from mother or father to once-
removed support persons or guideposts.
• Encourage independent thinking and adult-level
decision skills in their child.

The family of middle-aged

parents (stage 7)
• Adjust to “empty nest” syndrome by
reawakening
their relationship with their supportive partner.
• Prepare for retirement so when they reach that
stage they will not be unprepared socially or financially.

The family in retirement or

older age (stage 8)
• Maintain heath by preventive care in light of aging.
• Participate in social, political, and neighborhood
activities to keep active and enjoy this stage of life.

FAMILY TASK
Physical maintenance: A healthy family provides food, shelter, clothing, andhealth care for its
members. Being certain a family has enough resources toprovide for a new or ill member is an
important assessment.
Socialization of family members: This task includes being certain that children feel part of the
family and learning appropriate ways to interact with people outside the family such as teachers,
neighbors, or police.
Allocation of resources: This involves determining which family needs will be met and their
order of priority, including not only material goods but also affection and space. In healthy
families, there is justification, consistency, and fairness in the distribution. In many families,
resources are limited, so for example, no one has new shoes.
Maintenance of order: This task includes establishing family values, establishingrules about
expected family responsibilities and roles, and enforcing common regulations for family
members such as using “time out” for toddlers.
Division of labor: Healthy families not only evenly divide the workload among members but are
also flexible enough to interchange workloads as needed.
Reproduction, recruitment, and release of family members: Often, not a great deal of thought
is given to who lives in a family; membership often happens more by changing circumstances
than by true choice. Having to accept a new infant into an already crowded household may make
a pregnancy a less-than- welcome event; allowing a late adolescent to move to a college dorm
may be viewed as abandonment by a close-knit family.
Placement of members into the larger society: Healthy families realize they do not have to
operate alone but can reach out to other families or their community for help as needed.
Maintenance of motivation and morale: Healthy families are able to maintain a sense of unity
and pride in their family. When this is present, it helps members defend the family against threats
as well as allows them to support each other during a crisis.

- When children are first told they are adopted, they may exhibit “honeymoon behavior”
or may try to behave perfectly for fear of being given away again.
The Adoptive Family
- Families of a great many types (nuclear, extended, cohabitation, blended, single parent,
gay, and lesbian) adopt children today. No matter what the family structure is, adopting
brings joy and fulfillment to a family.
The 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 (Kubiak, Kasiborski, Karim, et al., 2012).
Foster parents may have children of their own; they receive remuneration for care of the
foster child.
The LGBT Family
- Lesbian, gay, bisexual, and transgender (LGBT) couples live together as partners for
companionship, financial security, and sexual fulfillment, or form the same structure as a
nuclear family.
The Blended Family
 - In a blended family (a remarriage or reconstituted family), a divorced or widowed person
with children marries someone who also has children.
The Single-Parent Family
- Single-parent families play a large role in childrearing. Unfortunately, low income is
often a problem encountered by single-parent families, especially if a woman is the head
of the household.
The Extended (Multigenerational) Family
- An extended family includes not only a nuclear family but also other family members
such as grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren.
The Nuclear Family
- The traditional nuclear family is composed of two parents and children.
The Cohabitation Family
- Cohabitation families are composed of couples, perhaps with children, who live together
but remain unmarried. Although such a relationship may be temporary, it may also be as
long-lasting as a legal marriage.
The Childfree or Childless Family
- A childfree or childless family is composed of two people living together without
children. This category refers to a growing trend of a voluntary choice to not have
children and be childfree.

CHAPTER 4
Direct care, - in which a nurse remains in continual attendance or visits frequently and actually
administers care
Indirect care, in which a nurse plans and supervises care given by others, such as home care
assistants
Nursing care is considered skilled home nursing care if it includes primary healthcare
provider–prescribed procedures such as dressing changes, administration of medication, health
teaching, or observation of a woman’s or child’s progress or status through such activities as
monitoring vital signs or fetal heart rate. Whether

REFERENCE
Maternal and Child Health Nursing Care of the Childbearing and Childrearing Family, Eight
Edition, by Joanne Silbert-flagg &Adele Pillitterl