NCM 107

Framework for MCHN

GOALS AND PHILOSOPHIES OF MATERNAL
AND CHILD HEALTH NURSING
• The medical term “obstetrics” or care of women during childbirth, is derived from the greek
word obstitre, which means “to keep watch”. “Pediatrics” is a word derived from the greek
word “pair”, meaning child.
• In nursing, these terms are seldom used in preference to “maternity” and “child health” to stress
the importance of the nurse as a partner in care (not just keeping watch) and to stress the
child’s family is also included.
• The area of childbearing and childrearing families is a major focus of nursing practice today
because to have healthy adults, you must promote healthy lifestyles of childbearing women
and their families from the time before children are born until they reach adulthood.
• This makes preconceptual and prenatal care and helping a family achieve emotional
preparation for childbearing and childrearing essential to the health of a woman and her family.
• As children grow, families need continued health supervision and support to ensure children
remain well. As teenagers or young adults reach maturity and begin to plan for their own
families, the cycle repeats and a new generation of support becomes necessary.
• Although nursing has, in the past, typically divided its concerns for families, during childbearing
and childrearing, into two separate entities, maternity care and child health care are not two
separate entities, but a continuum.
• The primary goal of both maternal and child health nursing can be stated simply as the
promotion and maintenance of optimal family health to ensure cycles of optimal child
bearing and child rearing. Major philosophical assumptions about combined maternal and child
health nursing care, Because the ages covered in this area are so large, concerns and goals of
maternal and child health nursing care are also broad.
• Examples of the scope of practice include:
1. Preconceptual health care
2. Care of women during three trimesters of pregnancy and the puerperium (the 6 weeks after
birth, sometimes termed the fourth trimester of pregnancy
3. Care of infants during the perinatal period
4. Care of children from birth through young adulthood
5. Care in settings as diverse as a birthing room, a pediatric intensive care unit, or the home
 Philosophy of Maternal and Child Health Nursing
Materal and Child health nursing is:
• Family centered; assessment should always include the family as well as an individual.
• Family centered care means working in partnership with children and their families in the delivery of
health care.
• It also means being aware of and responding to child’s and family needs.
• The philosophy of family centered services are based upon the belief that the best place for children to
grow up is in a family and the most effective way to ensure children’s safety.
• Community centered the health of families is both affected by and influences the health of
communities.
• Community based care is coordinated integrated care provided in range of community settings, such
as people’s home, health clinics, physician’s offices, public health units, hospices and workplaces.
• A challenging role for nurses and a major factor in keeping families well and optimally functioning.
• Community centered care is coordinated approach by local agencies and facilities to address such
problems in a community or catchment area as mental disorder, delinquency and substance abuse.
• For people of all ages who need health care assistance at home.
A maternal and child health nurse:
• Considers the family as a whole and as a partner in case 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
next generations
• 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 religious 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
• Assess families for strengths as well as specific needs of challenges
• Encourages family bonding through rooming in and family visiting in maternal
and child health care settings.
• Encourages early hospital discharge option to reunite families as soon as
possible in order to create 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.
• In all settings and types of care, keeping the family at the center of care or considering the family as
the primary unit of care is important because the level of a family’s functioning is important to the
health status of its members
• A healthy family establishes an environment conducive to growth and health promoting behaviours
to sustain family members during crises.
• if a family’s level of functioning is found to be low, the emotional, physical, and social health and
potential of individuals in that family may also fall below a healthy level. Similarly, the health of an
individual and his or her ability to function as a member of a family can strongly influence and
improve over all family functioning.
• Some men, for example, relate so closely to during their wife’s or partner’s pregnancy, they
experience morning sickness at the same level as she does.
• For all these reasons, a family centered or relationship approach enables nurses to better
understand individuals and their effect on others and, in turn, to provide more holistic care.
• Family centered care includes when children must be admitted to hospital, respecting open visiting
hours so parents can visit as much as possible, as well as a parent’s bed placed next to the child’s
so a parent can sleep over.
• An important nursing role is to encourage parents to do as much for their child as
they wish, such as feeding and bathing or administering oral medicine.
• Most of a parentstime, however, should be spent simply being close by to provide
a comfortable, secure influence on their child.
• For the same reasons, the most important role of parents on a family-centered
maternity unit is to room-in and give total care to their newborn.
• Caring for families , rather than just an individual newborn or child, has an
immeasurable effect on the health of children and parents as well as client
satisfaction.
Maternal and Child Health Goals
and Standards
• Health care 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 couples than ever before to conceive and have
children, the ability to delay preterm birth and improve life for both early premature and late premature
infants has increased dramatically;
• And 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.
• In addition, a growing trend toward health care consumerism, or self care, has made child bearing and
child rearing families active participants in their own health monitoring.
• Even in light of this changes, much more needs to be done. Health care may be more advanced, but it is
still not accessible to everyone.
• These and other social changes and trends have expanded the roles of nurses in maternal and child
health and, at the same time, made the delivery of quality maternal and child health nursing care a
continuing challenge.
 2020 National Health Goals
• The importance a society assigns to human life can best be
measured by the concern a nation places on its most vulnerable
members—its elderly, its disadvantaged, and its youngest citizens.
• In light of this, in 1979, the US Public Health Service first
formulated health care objectives for the nation.
• In 2010, new goals to be achieved by 2020 were set.
• Many of these objectives directly involve maternal and child health
care, because improving the health of these age groups will have
long term effects.
• The 2 main overarching national health goals:
1.Increase quality and years of healthy life.
2. Eliminate health disparities
• A new objective added in 2010 recommends that 100% of prelicensure programs in nursing
include core content on counseling for health promotion and disease prevention, cultural
diversity, evaluation of health sciences literature, environmental health, public health systems,
and global health, all important areas for maternal and child health.
• The 2020 National Health Goals are intended to help citizens more easily understand the
importance of health promotion and disease prevention and to encourage wide participation in
improving health in the next decade.
• It’s important for maternal and child health nurses to be familiar with these goals because
nurses play such a vital role in helping the nation achieve these objectives through both
practice and research.
• The goals also serve as the basis for grant funding and financing of evidence based practice.
• Each of the following sections highlights goals as they relate to that specific area of care.
 Nursing Theory
• One of the requirements of a profession is that a discipline’s knowledge flows from a base of established
theory
• Nursing theories are designed to offer helpful ways to view clients so nursing activities can be created to
best meet client needs.
• Example, Calistra Roy’s theory stresses that an important role of the nurse is to help patients adapt to
change caused by illness or other stressors; Dorothea Orem Orem’s theory concentrates on examining
patients’ ability to perform self care; Patricia Benner’s theory describes the way nurses move from
novice to expert as they become more experienced and prepared to give interprofessional care.
• Using theoretical basis such as these can help you appreciate the significant effect of a childs illness or
the introduction of a new member on the total family.
• Other issues most nursing theorists address include how nurses should be viewed or what should be the
goals of nursing care.
• Extensive changes in the scope of maternal and child health nursing have occurred as health promotion
has become a greater priority in care.
• As promoting healthy pregnancies and keeping children well protects not only clients at present but the
health of the next generation, maternal-child health nurses fill these expanded roles to a unique, and
special degree.
Legal Considerations of Maternal –
Child Practice
• Legal concerns arise in all areas of health nursing carries some legal concerns above and beyond other
areas of nursing because care is often given to an “unseen client”—the fetus—or to clients who are not of
legal age for giving consent.
• New technologies can lead to potential legal actions, especially if clients are uninformed about the reason
or medical necessity for these procedures.
• Nurses are legally responsible for protecting the rights of their clients, including confidentiality, and are
accountable for the quality of their individual nursing care and that of other health care team members.
• New regulations on patient confidentiality guarantee patients can see their medical record if they choose,
but health information must be kept confidential from others.
• Understanding scope of practice and standards of care can help nurses practice within appropriate legal
patterns.
• Documentation is essential for justifying actions. This concern is long lasting, because children who feel
they were wronged by health care personnel can bring a lawsuit at the time they reach legal age.
• This means a nursing note written today may need to be defended as many as 21 years into the future.
• Personal liability insurance is strongly recommended for all nurses, so they do not incur great financial
losses during a malpractice or professional negligence lawsuit.
• Nurses need to be conscientious about obtaining informed consent for invasive procedures in children and
determining if pregnant women are aware of any risk to the fetus associated with a procedure or test.
• A parent can be contacted by phone or email if not present with the child at the time the consent is needed
• In divorced or blended families, it is important to establish who has the right tp give consent for health care.
• Adolescents who support themselves or who are pregnant are frequently termed “emanciated minors” or
the matured minors and have the right to sign for their own health care.
• The term “wrongful birth” is the birth of a disabled child whose pregnancy the parents would have chosen
to end if they had been informed about the disability during pregnancy.
• “Wrongful life” is a claim that negligent prenatal testing on the part of a health care provider resulted in the
birth of a disabled child.
• “Wrongful conception” denotes that a contraceptive method failed, allowing an unwanted child to be
conceived and born.
• As many genetic disorders can be identified prenatally, the scope of both wrongful birth and wrongful life
grows yearly
• If a nurse knows the care provided by another practitioner was inappropriate or insufficient, he or she is
responsible for reporting the incident.
• Failure to do so can lead to a charge of negligence or breach of duty.
Ethical Considerations of Practice

Some of the most difficult ethical quandaries in health care today are those that involve children and their
families. Examples are:
1. Conception issues, especially those related to in vitro fertilization, embryo transfer, ownership of frozen
oocytes or sperm, and surrogate motherhood
2. Abortion, particularly partial-birth abortion
3. Fetal rights versus rights of the mother
4. Stem cell research
5. Resuscitation
6. Number of procedures or degree of pain a child should be asked to endure to achieve a degree of better
health
7. Balance between modern technology and quality of life
8. Difficulty maintaining confidentiality of record when there are multiple caregivers
• Legal and ethical aspects of issues are often interviewed, which makes the decision making
process in this area complex
• Because maternal and child health nursing is so strongly family centered, it is common to
encounter some situations in which the interests of one family member are in conflict with those of
another or the goals of a health care provider are different from the family’s.
• Maintaining privacy yet aiding problem solving in this instances can be diffcult but is a central
nursing role.
• Nurses can help clients by providing factual information and supportive listening, and helping the
family and health care providers clarify their values.
• The Pregnant Woman’s Bill of Rights and the United Nations Declaration of Rights of the Child
provide guidelines for determining the rights of the women and children with regard to maternal
and child care.
 17 Sustainable development 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 17. Strengthen the means of
oceans, seas and marine resources for implementation and revitalize the
sustainable development
global partnership for sustainable
15. Protect, restore and promote
development
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