Chapter 1: A Framework for Maternal and Child
Health Nursing counseling are major interventions.
I. Goals and Philosophies of Maternal and
Child Health Nursing
► Obstetrics – care of women during childbirth
(obstare means “to keep watch”)
► Pediatrics – derived from Greek word pais,
meaning “child”
► The care of childbearing and childrearing
families is a major focus of nursing practice,
because to have healthy adults you must have
healthy children.
► 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 childbearing
and childrearing.
A. Scope of Practice
 The range of services and care that may be
provided by a nurse based on state
requirements.
1) Preconceptual health care
2) Care of women during three trimesters of
pregnancy and the puerperium (the 6 weeks
after childbirth, sometimes termed the
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
adolescence
5) Care in settings as varied as the birthing
room, the pediatric intensive care unit, and
the home
B. Philosophy of Maternal and Child Health
Nursing
1) Maternal and child health nursing is family
centered; assessment must include both
family and individual assessment data.
2) Maternal and child health nursing is
community centered; the health of families
depends on and influences the health of
communities.
3) Maternal and child health nursing is
evidence based, because this is the means
whereby critical knowledge increases.
4) A maternal and child health nurse serves as
an advocate to protect the rights of all
family members, including the fetus.
5) Maternal and child health nursing includes a
high degree of independent nursing
functions, because teaching and
6) Promoting health and disease prevention
are important nursing roles because these
protect the health of the next generation.
7) Maternal and child health nurses serve as
important resources for families during
childbearing and childrearing as these can
be extremely stressful times in a life cycle.
8) Personal, cultural, and religious attitudes
and beliefs influence the meaning and
impact of childbearing and childrearing on
families.
9) Circumstances such as illness or pregnancy
are meaningful only in the context of a total
life.
10) Maternal and child health nursing is a
challenging role for nurses and a major
factor in keeping families well and optimally
functioning.
C. Common Measures to Ensure Family-
Centered Maternal and Child Health Care
Principles
1) The family is the basic unit of society.
2) Families come in many different forms and
sizes and represent racial, ethnic, cultural,
and socioeconomic diversity.
3) Children grow both individually and as part
of a family.
Nursing Interventions
1) Consider the family as a whole as well as its
individual members.
2) Assess families for strengths as well as for
specific needs or challenges.
3) Respect diversity in families as a unique
quality of that family.
4) Share or initiate information on health
planning with family members so that care
is family oriented.
5) Encourage family bonding through rooming-
in in both maternal and child health hospital
settings.
6) Encourage families to give care to a
newborn or ill child.
7) Family members affect other members;
individual members affect the total family
group.
8) Encourage family and sibling visits in the
hospital to promote family contacts.
 9) Participate in early hospital discharge
programs to reunite families as soon as
possible.
10) Include developmental stimulation in
nursing care.
11) Encourage families to reach out to their
community so that family members are not
isolated from their community or from each
other.
II. Standards of Maternal and Child Health
Nursing Practice
► To promote consistency and ensure quality
nursing care and outcomes in these areas,
specialty organizations have developed
guidelines for care in their specific areas of
nursing practice.
► In maternal-child health, standards have been
developed by the Division of Maternal-Child
Health Nursing Practice of the American
Nurses Association in collaboration with the
Society of Pediatric Nurses.
► The Association of Women’s Health,
Obstetric, and Neonatal Nurses (AWHONN)
has developed similar standards for the nursing
care of women and newborns.
A. American Nurses Association/Society of
Pediatric Nurses Standards of Care and
Professional Performance
1) Standard I: Assessment - The pediatric
nurse collects patient health data.
2) Standard II: Diagnosis - The pediatric
nurse analyzes the assessment data in
determining diagnoses.
3) Standard III: Outcome Identification - The
pediatric nurse identifies expected
outcomes individualized to the child and the
family.
4) Standard IV: Planning - The pediatric
nurse develops a plan of care that
prescribes interventions to obtain expected
outcomes.
5) Standard V: Implementation - The
pediatric nurse implements the interventions
identified in the plan of care.
6) Standard VI: Evaluation - The pediatric
nurse evaluates the child’s and
B. Association of Women’s Health, Obstetric, and
Neonatal Nurses Standards and Guideline
1) Standard I: Quality of Care - The nurse
systematically evaluates the quality and
effectiveness of nursing practice.
2) Standard II: Performance Appraisal – The
nurse evaluates his/her own nursing
practice in relation to professional practice
standards and relevant statutes and
regulations.
3) Standard III: Education – The nurse
acquires and maintains current knowledge
in nursing practice.
4) Standard IV: Collegiality – The nurse
contributes to the professional development
of peers, colleagues, and others.
5) Standard V: Ethics – The nurse’s
decisions and actions on behalf of patients
are determined in an ethical manner.
6) Standard VI: Collaboration – The nurse
collaborates with the patient, significant
others, and health care providers in
providing patient care.
7) Standard VII: Research – The nurse uses
research findings in practice.
8) Standard VIII: Resource Utilization – The
nurse considers factors related to safety,
effectiveness, and cost in planning and
delivering patient care.
9) Standard IX: Practice Environment – The
nurse contributes to the environment of care
delivery within the practice settings.
10) Standard X: Accountability – The nurse is
professionally and legally accountable for
his/her practice. The professional registered
nurse may delegate to and supervise
qualified personnel who provide patient
care.
III. MCH Nurse Roles and Responsibilities
Care Provider
Advocate
Educator
Counselor
A. Advanced-Practice Roles for Nurses in MCN
1) Clinical Nurse Specialists
 Are nurses prepared at the master’s or
doctorate degree level who are capable
of acting as consultants in their area of
expertise, as well as serving as role
models, researchers, and teachers of
quality nursing care.
  Examples of areas of specialization are
neonatal, maternal, child, and
adolescent health care; genetics;
childbirth education; and lactation
consultation.
 Genetic nurse counselors consult with
families about patterns of inheritance
and offer support to families with a child
who has inherited a genetic disorder.
2) Case Manager
 A case manager is 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 or, in a
seamless care system, into their homes
as well, monitoring the effectiveness,
cost, and satisfaction of their health
care.
 They help prevent fragmentation of care
and ensure that such important qualities
as continuity of care and providing a
feeling of “medical home” are included
in care.
3) Nurse Practitioner
 Nurse practitioners are nurses educated
at the master’s or doctoral level. Recent
advances in technology, research, and
knowledge have amplified the need for
longer and more in-depth education for
nurse practitioners as they play pivotal
roles in today’s health care system.
 They have the highest level of practice
expertise integrated with the ability to
translate scientific knowledge into
complex clinical interventions.
 They have the potential to expand the
scientific basis for practice as well as
create leaders for organization and
system management, quality
improvement, health policy
development, and interdisciplinary
collaboration
4) Women’s Health Nurse Practitioner
 A women’s health nurse practitioner has
advanced study in the promotion of
health and prevention of illness in
women.
 Such a nurse plays a vital role in
educating women about their bodies
and sharing with them methods to
prevent illness; in addition, they care for
women with illnesses such as sexually
transmitted infections, and offer
information and counsel them about
reproductive life planning.
5) Pediatric Nurse Practitioner
 A pediatric nurse practitioner (PNP) is a
nurse prepared with extensive skills in
physical assessment, interviewing, and
well-child counseling and care.
 In this role, a nurse interviews parents
as part of an extensive health history
and performs a physical assessment of
the child.
6) Neonatal Nurse Practitioner
 A neonatal nurse practitioner (NNP) is
an advanced-practice role for nurses
who are skilled in the care of newborns,
both well and ill.
 NNPs may work in level 1, level 2, or
level 3 newborn nurseries, neonatal
follow-up clinics, or physician groups.
 The NNP’s responsibilities include
managing and caring for newborns in
intensive care units, conducting normal
newborn assessments and physical
examinations, and providing high-risk
follow-up discharge planning
 They also are responsible for
transporting ill infants to these different
care settings.
7) Family Nurse Practitioner
 A family nurse practitioner (FNP) is an
advanced-practice role that provides
health care not only to women and
children but also to the family as a
whole.
8) Certified Nurse-Midwife
 A certified nurse-midwife (CNM) is an
individual educated in the two
disciplines of nursing and midwifery and
licensed according to the requirements
of the American College of Nurse-
Midwives (ACNM) who plays an
important role in assisting women with
pregnancy and childbearing.
 Nurse-midwives play a large role in
making birth an unforgettable family
event as well as helping to ensure a
healthy outcome for both mother and
child
IV. A Framework for Maternal and Child Health
Nursing Care
A. 4 Phases of Health Care (PMRR)
1) Health Promotion
 Educating clients to be aware of good
health through teaching and role
modeling.
 Ex: Teaching women the importance of
rubella immunization before pregnancy;
teaching children the importance of
safer sex practices.
2) Health Maintenance
 Intervening to maintain health when risk
of illness is present.
 Ex: Encouraging women to come for
prenatal care; teaching parents the
importance of safeguarding their home
by childproofing it against poisoning
their home by childproofing it against
poisoning.
3) Health Restoration
 Promptly diagnosing and treating illness
using interventions that will return client
to wellness most rapidly.
 Ex: Caring for a woman during a
complication of pregnancy or a child
during an acute illness.
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.
 Encouraging a woman with gestational
trophoblastic disease to continue
therapy or a child with a renal transplant
to continue to take necessary
medications.
B. The Nursing Process
 The nursing process, a form of problem
solving based on the scientific method,
serves as the basis for assessing, making a
nursing diagnosis, planning, organizing, and
evaluating care.
 These also serve to accentuate the
increasingly important role of the nurse as a
coordinator of client care and member of a
collaborative team.
C. Evidence-Based Practice
 Evidence-based practice is the
conscientious, explicit, and judicious use of
current best evidence in making decisions
about the care of patients.
 Evidence can be a combination of research,
clinical expertise, and patient preferences
when all three combine in decision making.
1) Level I: Evidence obtained from at least
one properly designed randomized
controlled trial.
2) Level II: Evidence obtained from well-
designed controlled trials without
randomization, well-designed cohort or
case-control analytic studies, or multiple
time series with or without an intervention.
Evidence obtained from dramatic results in
uncontrolled trials might also be regarded
as this type of evidence.
3) Level III: Opinions of respected authorities,
based on clinical experience, descriptive
studies, or reports of expert committees.
D. Nursing Theory
 It is a set of concepts, definitions,
relationships, and assumptions or
propositions derived from nursing models or
from other disciplines and project a
purposive, systematic view of phenomena
by designing specific inter-relationships
among concepts for the purposes of
describing, explaining, predicting, and/or
prescribing.
 Nursing theories are “attempts to describe
or explain the phenomenon (process,
occurrence and event) called nursing”
1) Patricia Benner
 Nursing is a caring relationship. Nurses
grow from novice to expert as they
practice in clinical settings.
2) Dorothy Johnson
 A person comprises subsystems that
must remain in balance for optimal
functioning. Any actual or potential
threat to this system balance is a
nursing concern
3) Imogene King
 Nursing is a process of action, reaction,
interaction, and transaction; needs are
identified based on client’s social
system, perceptions, and health; the
role of the nurse is to help the client
achieve goal attainment.
4) Madeleine Leininger
  The essence of nursing is care. To
provide transcultural care, the nurse
focuses on the study and analysis of
different cultures with respect to caring
behavior.
5) Florence Nightingale
 The role of the nurse is viewed as
changing or structuring elements of the
environment such as ventilation,
temperature, odors, noise, and light to
put the client into the best opportunity
for recovery
6) Betty Neuman
 A person is an open system that
interacts with the environment; nursing
is aimed at reducing stressors through
primary, secondary, and tertiary
prevention.
7) Dorothea Orem
 The focus of nursing is on the individual;
clients are assessed in terms of ability to
complete self-care. Care given may be
wholly compensatory (client has no
role); partly compensatory (client
participates in care); or supportive-
educational (client performs own care).
8) Ida Jean Orlando
 The focus of the nurse is interaction with
the client; effectiveness of care depends
on the client’s behavior and the nurse’s
reaction to that behavior. The client
should define his or her own needs.
9) Rosemarie Rizzo Parse
 Nursing is a human science. Health is a
lived experience. Man-living-health as a
single unit guides practice.
10) Hildegard Peplau
 The promotion of health is viewed as the
forward movement of the personality;
this is accomplished through an
interpersonal process that includes
orientation, identification, exploitation,
and resolution.
11) Martha Rogers
 The purpose of nursing is to move the
client toward optimal health; the nurse
should view the client as whole and
constantly changing and help people to
interact in the best way possible with the
environment.
12) Sister Callista Roy
 The role of the nurse is to aid clients to
adapt to the change caused by illness;
levels of adaptation depend on the
degree of environmental change and
state of coping ability; full adaptation
includes physiologic interdependence.
13) Ramona Mercer
 It provides appropriate health care
interventions for nontraditional mothers
in order for them to develop a strong
maternal identity. This helps in the
building of the mother-child relationships
as the infant grows.
V. WHO’s 17 Sustainable Development Goals
Mission: “A blueprint to achieve a better and more
sustainable future for all people and the world by
2030”
Type of Project: Non-Profit
Location: Global
Owner: Supported by UN and owned by
community
Founder: United Nations
Established: 2015
1) Goal 1: No poverty
 SDG 1 is to: "End poverty in all its forms
everywhere"
2) Goal 2: Zero hunger (No hunger)
 SDG 2 is to: "End hunger, achieve food
security and improved nutrition, and
promote sustainable agriculture".
3) Goal 3: Good health and well-being
 SDG 3 is to: "Ensure healthy lives and
promote well-being for all at all ages".
4) Goal 4: Quality education
 SDG 4 is to: "Ensure inclusive and
equitable quality education and promote
lifelong learning opportunities for all".
5) Goal 5: Gender equality
 SDG 5 is to: "Achieve gender equality
and empower all women and girls"
6) Goal 6: Clean water and sanitation
 SDG 6 is to: "Ensure availability and
sustainable management of water and
sanitation for all".
7) Goal 7: Affordable and clean energy
  SDG 7 is to: "Ensure access to
affordable, reliable, sustainable and
modern energy for all".
8) Goal 8: Decent work and economic
growth
 SDG 8 is to: "Promote sustained,
inclusive and sustainable economic
growth, full and productive employment
and decent work for all".
9) Goal 9: Industry, Innovation and
Infrastructure
 SDG 9 is to: "Build resilient
infrastructure, promote inclusive and
sustainable industrialization, and foster
innovation".
10) Goal 10: Reduced inequality
 SDG 10 is to: "Reduce income
inequality within and among countries".
11) Goal 11: Sustainable cities and
communities
 SDG 11 is to: "Make cities and human
settlements inclusive, safe, resilient, and
sustainable".
12) Goal 12: Responsible consumption and
production
 SDG 12 is to: "Ensure sustainable
consumption and production patterns".
13) Goal 13: Climate action
 SDG 13 is to: "Take urgent action to
combat climate change and its impacts
by regulating emissions and promoting
developments in renewable energy".
14) Goal 14: Life below water
 SDG 14 is to: "Conserve and
sustainably use the oceans, seas and
marine resources for sustainable
development".
15) Goal 15: Life on land
 SDG 15 is to: "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) Goal 16: Peace, justice and strong
institutions
 SDG 16 is to: "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) Goal 17: Partnership for the goals
 SDG 17 is to: "Strengthen the means of
implementation and revitalize the global
partnership for sustainable
development".
VI. Sustainable Development Goal 3 Targets
1) By 2030, reduce the global maternal
mortality ratio to less than 70 per 100,000
live births.
2) By 2030, end preventable deaths of
newborns and children under 5 years of
age, with all countries aiming to reduce
neonatal mortality to at least as low as 12
per 1,000 live births and under-5 mortality to
at least as low as 25 per 1,000 live births.
3) By 2030, end the epidemics of AIDS,
tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne
diseases and other communicable
diseases.
4) By 2030, reduce by one third premature
mortality from non-communicable diseases
through prevention and treatment and
promote mental health and well-being.
5) Strengthen the prevention and treatment of
substance abuse, including narcotic drug
abuse and harmful use of alcohol.
6) By 2020, halve the number of global deaths
and injuries from road traffic accidents.
7) By 2030, ensure universal access to sexual
and reproductive health-care services,
including for family planning, information
and education, and the integration of
reproductive health into national strategies
and programmes.
8) Achieve universal health coverage,
including financial risk protection, access to
quality essential health-care services and
access to safe, effective, quality and
affordable essential medicines and vaccines
for all.
9) By 2030, substantially reduce the number of
deaths and illnesses from hazardous
chemicals and air, water and soil pollution
and contamination.
10) Strengthen the implementation of the World
Health Organization Framework Convention
on Tobacco Control in all countries, as
appropriate.
11) Support the research and development of
vaccines and medicines for the
communicable and non-communicable
diseases that primarily affect developing
countries, provide access to affordable
essential medicines and vaccines, in
accordance with the Doha Declaration on
 the TRIPS Agreement and Public Health,
which affirms the right of developing
countries to use to the full the provisions in
the Agreement on Trade-Related Aspects of
Intellectual Property Rights regarding
flexibilities to protect public health, and, in
particular, provide access to medicines for
all.
12) Substantially increase health financing and
the recruitment, development, training and
retention of the health workforce in
developing countries, especially in least
developed countries and small island
developing States.
13) Strengthen the capacity of all countries, in
particular developing countries, for early
warning, risk reduction and management of
national and global health risks.