A Framework for Maternal and Child Health Nursing
attitudes and beliefs as these so strongly
Goals and Philosophies of Maternal and Child Health
Nursing
The primary goal of both maternal and child
health nursing is the promotion and maintenance of
optimal family health.
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 Philosophy of Maternal and Child Health Nursing
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
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.
Maternal and Child Health Goals and Standards
● 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.
● As specific genes responsible for children’s
health disorders are identified, stem cell therapy
may make it possible to replace diseased cells
with new growth cells and cure these illnesses.
GLOBAL HEALTH GOALS
● The United Nations (UN) and the World Health
Organization established millennium health
goals in 2000 in an effort to improve health
worldwide.
● The goals are to concentrate on improving the
health of women and children because
increasing the health in these two populations
can have such long-ranging effects on general
health.
➢ 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.
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
Health maintenance
Health restoration
Health rehabilitation
NURSING PROCESS
“ADPIE”
1. Assessment
2. Nursing Diagnosis
3. Planning
4. Intervention
5. Evaluation
NURSING THEORY
● Designed to offer helpful ways to view patients
so nursing activities can be created to best meet
the patient needs.
Calista Roy “Adaptation Model”
Dorothea Orem “Self-Care Deficit Theory”
Patricia Benner “Novice to Expert Theory”
QSEN COMPETENCIES
● QSEN Learning Collaborative created 6
competencies necessary for quality care. 5
competencies originated from a study by the
Institute of Medicine.
1. Patient-Centered Care
2. Teamwork and Collaboration
3. Quality Improvement
4. Informatics
5. Evidenced-Based Practice
6. Safety
*viewed in SKILLS, KNOWLEDGE &
ATTITUDE
EVIDENCE-BASED PRACTICE
● It is the conscientious, explicit, and judicious use
of current best evidence to make decisions about
the care of patients.
● Evidence can be a combination of research,
clinical expertise, and patient preferences or
values.
NURSING RESEARCH
● Is 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.
● 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.
Roles and Responsibilities of a Maternal Child Health
Nurse
● M&C health nursing carries some legal concerns
above and beyond other areas of nursing because
care is often given to patients who are not of
legal age for giving consent.
● Reproductive healthcare rights and laws are
complex and varies.
➢ Understanding scope practice
➢ Documentation
➢ Informed Consent
Roles and Responsibilities of a Maternal Child Health
Nurse
● “Wrongful Birth” – birth of a disabled child
whose parents would have chosen to end if they
have been informed about the disability during
pregnancy.
● “Wrongful Life” – 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
Ethical Considerations of Practice
● Conception issues (in vitro fertilization, embryo
transfer, cryopreservation, surrogacy).
● Pregnancy termination
● Fetal rights vs. Maternal rights
● Stem cell research
● Resuscitation (DNR, length of continuation)
● Number of procedures and degree of pain
● Confidentiality of record with multiple
caregivers
17 SUSTAINABLE DEVELOPMENT GOALS
1. GOAL 1: No Poverty - To end poverty, everyone
should have basic healthcare, security and
education.
2. GOAL 2: Zero Hunger - Globally, one in nine
people are undernourished. This goal aims to
end hunger.
3. GOAL 3: Good Health and Well-being -
Ensuring people live healthy lives can cut child
mortality and raise life expectancy.
4. GOAL 4: Quality Education - The UN wants
everyone to have access to inclusive, equitable
quality education.
5. GOAL 5: Gender Equality - Gender equality is a
human right, and is vital for a peaceful,
prosperous world.
6. GOAL 6: Clean Water and Sanitation - Clean
water protects people from disease, yet three in
10 people lack access to it.
7. GOAL 7: Affordable and Clean Energy - Targets
for 2030 include using more renewable,
affordable energy.
8. GOAL 8: Decent Work and Economic Growth -
The aim is for sustainable economic growth and
decent employment for all.
9. GOAL 9: Industry, Innovation and Infrastructure
- This involves building resilient infrastructure
and fostering innovation.
10. GOAL 10: Reduced Inequality - The poorest 40
per cent of the population should be able to grow
their income faster than average.
11. GOAL 11: Sustainable Cities and Communities -
The UN wants to increase affordable housing
and make settlements inclusive, safe and
sustainable.
12. GOAL 12: Responsible Consumption and
Production - This goal aims to foster
eco-friendly production, reduce waste and boost
recycling.
13. GOAL 13: Climate Action - Urgent action is
needed, by regulating emissions and promoting
renewable energy.
14. GOAL 14: Life Below Water - The aim is to
conserve and sustainably use the oceans, seas
and marine resources.
15. GOAL 15: Life on Land - To stop degradation,
we must preserve forest, desert and mountain
ecosystems.
16. GOAL 16: Peace and Justice Strong Institutions
- The aim is inclusive societies with strong
institutions that provide justice for all.
17. GOAL 17: Partnerships to achieve the Goal - If
all countries are to achieve the goals,
international cooperation is vital.
The Family ● Intimacy and sexually unite (a defining reason
why many marriages stay together)
Definition of family ● Cooperate economically
● “... a group of persons united by ties of marriage, ● May give birth or adopt
blood, or adoption; constituting a single 50 years ago this was central reason for
household; interacting and communicating with marriage.
each other in their respective social roles of Purpose for marriage has become much
husband and wife, mother and father, son and more diverse.
daughter, brother and sister, and creating and ● Legally recognized union
maintaining a common culture.” (Burgess and ○ Marriage license
Locke, 1953). ■ Not open on Saturday.
● “ ... A basic unit of kinship composed of two or ■ Fee: $50 in the USA
more members who are united by ties of blood, ■ City & County offices on 21st
marriage or adoption, and who live together S. State.
constituting a single household.” (Wong, 1975) ■ Good for 30 days, good
● “The family is a social group characterized by immediately.
common residence, economic co-operation and ■ 18 years without parents
reproduction. It includes adults of both sexes, at consent.
least two of whom maintain a socially approved ■ Second cousins may marry.
sexual relationship, and one or more children, ■ No blood tests or physical
own or adopted, of the usually co-habiting exams required.
adults.” (George Peter Murdock, 1949). ■ Both bride & groom must be
● “... a social group made up of members related present place of birth.
to one another by blood or marital ties and ■ Need to know mothers maiden
usually constituting a household.”(Lee, 1991, name & parents.
p.42)
CULTURE DEFINES WHAT A MARRIAGE IS OR
Concepts of the Family NOT
Karpel and Strauss summarizes different concepts of the ● Monogamy - one man, one woman. All 1st
family: world countries are monogamous.
(1) the functional family - defined by shared household, ● Polygamy - more than one wife or husband.
shared activities, shared responsibility for daily life and Example: Islam & Fundamental Mormons
child rearing; ● Bigamy – Marrying another person while still
(2) the legal family - defined by legal structure, altered married to someone else. It is against the law.
by divorce and adoptive placement of children; ● Serial Monogamy or Modified Polygamy –
(3) the family as seen by its members - defined by the Succession of marriages over time. Typical of
perceptions of its members; and seen as “in” the family US marriages.
by family members;
(4) the family of long-term commitments - defined by Family Structure
long-term expectations of loyalty and commitment; trust, 2 Basic Family Structures
reliability, and fairness are basic expectation; 1. Family of Orientation – the family one is born
(5) the biological family - defined by blood into; or oneself, mother, father and siblings if
relationships; parent-child relationship. What are the any
strengths and weaknesses of these definitions? 2. Family of Procreation – a family one
establishes; or oneself, spouse or significant
WHAT IS MARRIAGE? other and children.
● A legal bond or union between a man & woman.
● Commitment
Family Types
1. The Dyad Family
2. The Nuclear Family
3. The Cohabitation Family
4. The Extended (Multigenerational) Family
5. The Single-Parent Family
6. The Blended Family
7. The Communal Family
8. The Gay or Lesbian Family
9. The Foster Family
1. The Dyad Family – refers to 2 people living together,
usually a woman and a man without children.
● Many young adults live together as a dyad in
shared apartments, dorms or homes for
companionship and financial security while
completing school or beginning their careers.
● Generally viewed as temporary arrangements.
The Childfree or Childless Family
● Positive aspects: companionship, possibly
shared resources
● Potential negative aspects: feelings of guilt for
the couple who decided to delay a family and
who then may experience infertility issue
2. The Nuclear Family – traditional structure that is
composed of a husband, wife and children.
● Positive aspects: support for family members;
sense of security
● Possible negative aspects: may lack support
people in a crisis situation
3. The Cohabitation Family – composed of
heterosexual couples who live together like a nuclear
family but remain unmarried.
4. The Extended (Multigenerational) Family –
includes not only the nuclear family but also other
family members such as grandparents, aunts, uncles,
cousins and grandchildren.
● Positive aspects: support for family members;
sense of security
● Possible negative aspects: may lack support
people in a crisis situation
5. The Single-Parent Family
● Positive aspects: support for family members;
sense of security
● Possible negative aspects: may lack support
people in a crisis situation
6. The Blended Family – the remarriage or reconstituted
family.
● Positive aspects: increased security and
resources; exposure to different customs or
culture may help children become more
adaptable to new situations
● Possible negative aspects: rivalry or competition
among children; difficulty adjusting to a
stepparent
7. The Communal Family – groups of people who have
chosen to live together as an extended family. Usually
motivated by social, religious values rather than kinship.
8. The Gay or Lesbian Family
9. 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.
● Positive aspects: prevents children from being
raised in large orphanage settings
● Possible negative aspects: insecurity and
inability to establish meaningful relationships
because of frequent moves
Adopted Family
● Positive aspects: Children grow up well cared
for and experiencing a sense of love; a woman
who relinquishes her child for adoption can feel
a sense of relief her baby will have a lifestyle
better than what she could provide.
● Possible negative aspects: Divorce of the
adopting parents can be devastating if the child
views himself as the cause of the separation or
as a child unable to find a secure family for a
second time.
Family Functions and Roles
● The family roles that people view as appropriate
are the ones they saw their own parents
fulfilling.
● As new generations takes on the values of the
previous generation, traditions and culture pass
from generation to generation.
● As nurse, it is important to identify the roles that
the family members assume because family
 roles are changing and often not as well defined Assessment of Family Structure and Function
as in the past. THE WELL FAMILY
Assessment of psychosocial family wellness
Family Task requires a measurement of how the family relates and
1. Physical Maintenance interacts as a unit, including communication patterns,
2. Socialization of Family Members bonding, roles and role relationships, division of tasks
3. Allocation of Resources and activities, governance, decision making, problem
4. Maintenance of Order solving, and leadership within the family unit.
5. Division of Labor
6. Reproduction, Recruitment and Release of
Family
7. Placement of Members into the Larger Society
8. Maintenance of Motivation and Morale

Family Stages/ Life Cycles

Stage 1: Marriage and the Family
Stage 2: The Early Child-Bearing Family Universal Characteristics of Families
Stage 3: The Family with Preschool Children ● Universality
Stage 4: The Family with School-Age Children ● Emotional basis
Stage 5: The Family with Adolescent Children ● Limited size
Stage 6: The Family of Middle Years ● Formative influence
Stage 7: The Family in Retirement or Older Age ● Nuclear position in the social structure
● Responsibility of the members
● Social regulation

Universal Characteristics of Families

A. Universality:
There is no human society in which some form
of the family does not appear. Malinowski writes the
typical family a group consisting of mother, father and
their progeny is found in all communities, savage,
barbarians and civilized. The irresistible sex need, the
urge for reproduction and the common economic needs
have contributed to this universality.

B. Emotional basis:
The family is grounded in emotions and
sentiments. It is based on our impulses of mating,
procreation, maternal devotion, fraternal love and
parental care. It is built upon sentiments of love,
affection, sympathy, cooperation and friendship.

C. Limited size:
The family is smaller in size. As a primary
group its size is necessarily limited. It is a smallest social
unit.
D. Formative influence:
The family welds an environment which
surrounds, trains and educates the child. It shapes the
personality and moulds the character of its members. It
emotionally conditions the child.
E. Nuclear position in the social structure:
The family is the nucleus of all other social
organizations. The whole social structure is built of
family units.
F. Responsibility of the members:
The members of the family has certain
responsibilities, duties and obligations. Maclver points
out that in times of crisis men may work and fight and
die for their country but they toil for their families all
their lives.
G. Social regulation:
The family is guarded both by social taboos and
by legal regulations. The society takes precaution to
safeguard this organization from any possible
breakdown.
● Abiding familiarity with others. Can know
ourselves and others well.
● Economic benefits.
CHARACTERISTICS OF HEALTHY FAMILIES
● Appreciation – notice the less obvious things,
express appreciation often.
● Kindness –tends to be catching.
● Communication – listen so others will talk, talk
so others will listen.
● Time Together – plan it, don’t wait to find it,
need quantity to have quality.
● Values and Standards – communicate them
clearly, follow them consistently.
● Strictness & Permissiveness – firm, fair, and
friendly.
● Problem Solving – look for solutions, not for
blame.
● Traditions –give a sense of identity.
● Fun & laughter – plan it, use props, bring home
jokes.

Functions of Families
● Family ties like intimacy.
● Economic cooperation - families are consuming
and producing units.
● Reproduction and socialization.
● Only a family can produce a socialized adult.

WHAT SHOULD A CHILD LEARN IN A FAMILY?

● Values, moral
● Culture and traditions
● Self concept
● How to solve problems/conflict resolution
● Commitment to family is first
● Each member must contribute
● Change is possible
● How to make a decision
● Communication

WHY LIVE IN A FAMILY?

● Love and closeness
● Offer continuity in emotional attachments,
rights, and obligations.
● Close proximity which facilitates cooperation
and communication.
 Sociocultural Aspects of Mother
& Child Health
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.
Transcultural nursing is care guided
by cultural aspects and respects
individual differences (Darnell &
Hickson, 2015)
Techniques of Sociocultural
Assessment
Communication Pattern/Language
- (not only what people say but also
how they say it) are determined by
culture and are increasingly
important during times of stress.
- Confirm it to the patient
- Written Information or Interpreter
- Cultural variations are respected
- Using short, easy sentence
b. Nonverbal Communication
• Eye to eye contact
• Touch
• Shaking hands
• Tattoos
c. Use of Conversational Space –
being aware of that use of space is
culturally determined helps you to
respect the use of space. Respect
to modesty is a way to respect
close space.
c. Time Orientation
- Cultural pattern that is geared
toward punctuality regarding
appointments or concern for time.
- Differs whether a culture
concentrates on the past, present
& future.
d. Family Orientation
- Family and structure and roles may
be culturally determined.
- Identifying the family decision-
maker is important.
e. Male and Female Roles
- In most culture, man is the
dominant figure.
- In contrast, in some culture, the
woman may be the dominant
person in the family, esp. the oldest
woman.

g. Religion
– because religion guides a person’s
overall life philosophy, it influences
how he or she feels about health
and illness.
h. Health Belief
- Health beliefs are not universal
I.Nutrition Practices
- Food and methods of preparation are
strongly culturally related.
j. Pain Responses
- A person’s response to pain is both
individually and culturally
determined.
- Threshold sensation-amount of
stimulus that results in pain
- Pain Threshold-individual reports
that a stimulus is painful
- Pain Tolerance-individual
withdraws from a stimulus
Chapter 5: Reproductive and Sexual
Health
Reproductive Development
• Physiologic readiness for
childbearing begins during
intrauterine life
• Puberty
Reproductive Development
1. Intrauterine Development
- The sex of an individual is
determined at the moment of
conception by the chromosome
information of the particular ovum
and sperm that joined.
- Week 5 of intrauterine life-
primitive gonad is formed.
Mesonephric (wolffian) &
Paramesonephric (műllerian)
undifferentiated ducts are
present.
- Week 7 or 8 – in chromosomal
males, early gonadal tissues
differentiates into primitive testes
and begins formation of
testosterone.
- Week 10 – if testosterone is not
present, the gonadal tissue
differentiates into ovaries.
2. Pubertal Development
- The Hypothalamus, under the direction
of the Central Nervous System
may serve as a gonadostat or
regulation mechanism set to
“turn on” gonad functioning.
- The theory that the girl must reach
a critical weight of approximately
95 lbs (43 kg) or develop a critical
mass of fat before the
hypothalamus is triggered to send
initial stimulation to APG to begin
gonadotropic hormone formation.
Pubertal Development
• Role of Androgen
- Responsible for muscular
developement, physical growth and
increase in sebaceous gland
secretions.
- Males- produced by the adrenal
cortex and testes
- Females- produced by the adrenal • Growth of face, axillary and pubic
cortex and ovaries hair

- Adrenarche- development of pubic • Voice Changes

and axillary hair
• Penile Growth
• Role of Estrogen
• Increase in Height
- Increse in levels during puberty
• Spermatogenesis
(females) influences the
development of the uterus,
fallopian tubes and vagina; typical
fat distribution; hair pattern; breast Anatomy & Physiology of the
development and end to growth Reproductive System
(epiphesial closure). Male Reproductive System

- Thelarche- the beginning of breast

development.

Secondary Sex Characteristics

Females

• Growth Spurt

• Increase in the transverse diameter

of pelvis

• Breast development

• Growth of Pubic Hair

• Onset of Menstruation

• Growth of Axillary Hair

• Vaginal Secretions
Suppose Kevin Matthews tells the nurse
he is planning on having a vasectomy
• Menarche – first menstrual period
after the birth of his new child but is
worried about having his testes removed
this way. The nurse would want the
clinic’s educational material on
Secondary Sex Characteristics
vasectomy to clearly state that this
Males
procedure involves which of the
• Increase in Weight following structures?
a. The seminal vesicles
• Growth of Testes b. The epididymis
c. The vas deferens
d. The ducts of the bulbourethral glands
 Physiology of Menstruation (Secretory Phase)

CHARACTERISTICS DESCRIPTION

Beginning (menarche) Average age onset, 12-13 years; average range 9-17 years

Interval between cycles Average of 28 days; cycles of 23 to 35 days not usual

Duration of menstrual flow Average flow, 2-7 days; ranges 1-9 days not abnormalPhysiology of Menstru

Amount of menstrual flow Difficult to estimate; average 30-80 ml

Color of menstrual flow Dark red; a combination of blood mucus and endometrial cells

Odor Similar to that of marigolds

Female reproductive system

• Menstruation • Third Phase of Menstrual Cycle
Defined as episodic uterine (Ischemic Phase)
bleeding in response to cyclic
hormonal changes. • Fourth/Final Phase of Menstrual
Cycle
(Menses)
Characteristics of Normal Menstrual
Cycle

Menstrual Cycle

• First Phase of Menstrual Cycle

(Proliferative Phase)

• Second Phase of Menstrual Cycle

 participants in helping plan or
prevent conception of children

Menopause

•The cessation of menstrual

cycles.

•Usually occurs between 40-55

years old.

•Both age of menarche and age

of menopause is familial.

CERVICAL CHANGES
•The earlier the age of
menarche, he earlier the age of
menopause.

Sexuality and Sexual Identity

• Sexuality is a multidimensional
phenomenon that includes
feelings, attitudes and actions.

• It encompasses and gives direction

to a person’s physical, emotional,
social and intellectual responses
throughout life

• Each person is born a sexual being

and his or her gender identity and
role behavior evolve from and
usually conform to the societal
expectations within that person’s
culture.

• Nurses can play a major role in

promoting sexual health through
education and discussion.
Education Regarding Menstruation

- Vital to girls’ future child-bearing

and their self concept as women.

- Equally important for boys so that

they can appreciate the cyclic
process of women’s reproductive
system and can be active
Human Sexual Response
• The plateau stage is reached just
before orgasm.

• In the woman, the clitoris is drawn

forward and retracts under the
clitoral prepuce, the lower part of
the vagina becomes extremely
congested (formation of the
orgasmic platform), and there is
increased breast nipple elevation

• Orgasm occurs when stimulation

proceeds through the plateau
stage to a point at which a vigorous
contraction of muscles in the pelvic
Sexual Response Cycle
area expels or dissipates blood
and fluid from the area of
congestion

• As the shortest stage in the sexual

response cycle, orgasm is usually
experienced as intense pleasure
affecting the whole body, not just
the pelvic area

1. Excitement • The resolution is a 30-minute

2. Plateau period during which the external
3. Orgasm and internal genital organs return
4. Resolution to an unaroused state

• Excitement occurs with physical

Men VS Women
and psychological stimulation Female Sexual Response Cycle
(sight, sound, emotion, or
thought) that causes
parasympathetic nerve
stimulation. This leads to arterial
dilation 251 and venous
constriction in the genital area.
The resulting increased blood
supply leads to vasocongestion
and increasing muscular tension
 Types of Sexual Expression
Female Sexual Response Cycle
• Celibacy

• Masturbation

• Erotic Stimulation

• Fetishism

• Transvestism

• Voyeurism

• Sadomasochism
Other types of sexual expression
- Exhibitionism
- Pedophiles
Male Sexual Response Cycle
Disorders of Sexual Function

• Primary Sexual Dysfunction

• Erectile Dysfunction
• Premature Ejaculation
• Failure to achieve orgasm/
decreased sexual desire
• Vaginismus
• Dyspareunia
• Inhibited sexual desire

Secondary Sexual Dysfunction

Types of Sexual Orientation

• Caused by chronic diseases such
• Heterosexuality as peptic ulcers, chronic pulmonary
ds, obesity, STDs and other
• Homosexuality debilitating ds.

• Bisexuality

• Transsexuality