BACHELOR OF SCIENCE IN NURSING:

CARE OF MOTHER, CHILD AND

ADOLESCENT (Well Clients)
COURSE MODULE COURSE UNIT WEEK

1 1 1
Framework for Maternal and Child Health Nursing

 Discuss the course and unit objectives

 Comprehend study guide prior to class attendance
 Read required learning resources; refer to unit terminologies for jargons
 Actively participate in classroom discussions
 Accomplish and submit assigned course unit tasks on time
 Participate in weekly discussion board (Canvas) Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Describe the evolution, scope, standards, and professional roles for nurses in maternal and child
health nursing.
2. Describe family-centered care and ways that maternal and child health nursing could be made more
family centered.
3. Identify legal and ethical issues important to maternal and child health nursing.
 4. Identify the goals and philosophy of maternal and child health nursing.
5. Define common statistical terms used in the field, such as infant and maternal mortality.
6. Discuss the interplay of nursing process, evidence-based practice, and nursing theory as they relate to
the future of maternal and child health nursing practice..
Affective
1. Listen attentively during class discussions
2. Demonstrate tact and respect of other students opinions and ideas
3. Accept comments and reactions of classmates openly.
Psychomotor:
1. Participate actively during class discussions
2. Follow Class rule and Apply Netiquettes
3. Use critical thinking to identify areas of care that could benefit from additional research or
application of evidence-based practice.
4. Integrate knowledge of trends in maternal and child health care with the nursing process to
achieve quality maternal and child health nursing care.

standards-for-improving-quality-of-maternal-and-newborn-care-in-health-facilities
https://www.who.int/docs/default-source/mca-documents/advisory-groups/quality-of-care/standards-
for-improving-quality-of-maternal-and-newborn-care-in-health-facilities.pd

I. STANDARDS OF MATERNAL AND CHILD HEALTH NURSING PRACTICE

1. Health promotion
- Educating clients to be aware of good health through teaching and role modeling
2. Health maintenance
- Intervening to maintain health when risk of illness is present
3. Health restoration
- Promptly diagnosing and treating illness using interventions that will return client to wellness
most rapidly.
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

STANDARDS OF CARE AND MEASURES OF QUALITY (WHO)

Standard 1: Every woman and newborn receives routine, evidence-based care and management of
complications during labor, childbirth and the early postnatal period, according to WHO
guidelines.
1.1a: Women are assessed routinely on admission and during labour and childbirth and are
given timely, appropriate care.
1.1b: Newborns receive routine care immediately after birth.
1.1c: Mothers and newborns receive routine postnatal care.
1.2: Women with pre-eclampsia or eclampsia promptly receive appropriate interventions,
according to WHO guidelines.
 1.3: Women with postpartum haemorrhage promptly receive appropriate interventions, according
to WHO guidelines.
Standard 2: The health information system enables use of data to ensure early, appropriate action
2.1: Every woman and newborn has a complete, accurate, standardized medical record during
labour, childbirth and the early postnatal period.
2.2: Every health facility has a mechanism for data collection, analysis and feedback as part of
its activities for monitoring and improving performance around the time of childbirth.to improve
the care of every woman and newborn.
Standard 3: Every woman and newborn with condition(s) that cannot be dealt with effectively with
the available resources is appropriately referred.
3.1: Every woman and newborn is appropriately assessed on admission, during labour and in
the early postnatal period to determine whether referral is required, and the decision to refer is
made without delay.
3.2: For every woman and newborn who requires referral, the referral follows a pre-established
plan that can be implemented without delay at any time.
3.3: For every woman and newborn referred within or between health facilities, there is
appropriate information exchange and feedback to relevant health care staff.
Standard 4: Communication with women and their families is effective and responds to their needs
and preferences.
4.1: All women and their families receive information about the care and have effective
interactions with staff.
4.2: All women and their families experience coordinated care, with clear, accurate information
exchange between relevant health and social care professionals.
Standard 5: Women and newborns receive care with respect and preservation of their dignity.
5.1: All women and newborns have privacy around the time of labour and childbirth, and their
confidentiality is respected
5.2: No woman or newborn is subjected to mistreatment, such as physical, sexual or verbal
abuse, discrimination, neglect, detainment, extortion or denial of services.
5.3: All women have informed choices in the services they receive, and the reasons for
interventions or outcomes are clearly explained.
Standard 6: Every woman and her family are provided with emotional support that is sensitive to their
needs and strengthens the woman’s capability.
6.1: Every woman is offered the option to experience labor and childbirth with the companion of
her choice.
6.2: Every woman receives support to strengthen her capability during childbirth.
Standard 7: For every woman and newborn, competent, motivated staff are consistently available to
provide routine care and manage complications.
7.1 Every woman and child has access at all times to at least one skilled birth attendant and
support staff for routine care and management of complications.
7.2: The skilled birth attendants and support staff have appropriate competence and skills mix to
meet the requirements of labour, childbirth and the early postnatal period.
7.3: Every health facility has managerial and clinical leadership that is collectively responsible for
developing and implementing appropriate policies and fosters an environment that supports
facility staff in continuous quality improvement.
 Standard 8: The health facility has an appropriate physical environment, with adequate water,
sanitation and energy supplies, medicines, supplies and equipment for routine maternal and
newborn care and management of complications.
8.1 Water, energy, sanitation, hand hygiene and waste disposal facilities are functional, reliable,
safe and sufficient to meet the needs of staff, women and their families.
8.2: Areas for labor, childbirth and postnatal care are designed, organized and maintained so
that every woman and newborn can be cared for according to their needs in private, to facilitate
the continuity of care.
8.3: An adequate stock of medicines, supplies and equipment is available for routine care and
management of complications
II. ADVANCED-PRACTICE ROLES FOR NURSES IN MATERNAL AND CHILD HEALTH
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.
• Neonatal nurse specialists - manage the care of infants at birth and in intensive care settings; they
provide home follow-up care to ensure the newborn remains well. Childbirth educators teach
families about normal birth and how to prepare for labor and birth.
• Lactation consultants- educate women about breastfeeding and support them while they learn how
to do this.
• Genetic nurse counselors- consult with families about patterns of inheritance and offer support to
families with a child who has inherited a genetic disorder. Case Manager
• 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.
• Case management can be a vastly satisfying nursing role, because if the healthcare setting is
“seamless,” or one that follows people both during an illness and on their return to the community,
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. 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. 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.
• If the PNP determines that a child has a common illness (such as iron deficiency anemia), he or
she orders the necessary laboratory tests and prescribes appropriate drugs for therapy.
• If the PNP determines that the child has a major illness (such as congenital subluxated hip, kidney
disease, heart disease), he or she consults with an associated pediatrician; together.
Neonatal Nurse Practitioner
• 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.

Family Nurse Practitioner (FNP)

 • (FNP) is an advanced-practice role that provides health care not only to women and children but
also to the family as a whole.
• In conjunction with a physician, an FNP can provide prenatal care for a woman with an
uncomplicated pregnancy. Certified Nurse-Midwife
• (CNM) is an individual educated in the two disciplines of nursing and midwifery and licensed.
• Plays an important role in assisting women with pregnancy and childbearing. Either independently
or in association with a physician, the nurse-midwife assumes full responsibility for the care and
management of women with uncomplicated pregnancies.

III. LEGAL CONSIDERATIONS OF MATERNAL-CHILD PRACTICE

• Maternal and child health nursing carries some legal concerns that extend 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 for medical procedures. In addition, labor and birth of a neonate
are considered “normal” events, so the risks for a lawsuit are greater when problems arise (O’Grady
et al., 2007)
• 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.
• Understanding the scope of practice and standards of care can help nurses practice within
appropriate legal parameters.
• Documentation is essential for protecting a nurse and justifying his or her actions.
• Nurses need to be conscientious about obtaining informed consent for invasive procedures and
determining that pregnant women are aware of any risk to the fetus associated with a procedure or
test.
• Adolescents who support themselves or who are pregnant are termed “emancipated minors” or
“mature minors” and have the right to sign for their own health care.

IV. 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:
• Conception issues, especially those related to in vitro fertilization, embryo transfer, ownership of
frozen oocytes or sperm, cloning, stem cell research, and surrogate mothers
• Abortion, particularly partial-birth abortions
• Fetal rights versus rights of the mother
• Use of fetal tissue for research
• Resuscitation (for how long should it be continued?)
• Number of procedures or degree of pain that a child should be asked to endure to achieve a
degree of better health
• Balance between modern technology and quality of life
V. Nursing Theory
One of the requirements of a profession (together with other critical determinants, such as member-set
standards, monitoring of practice quality, and participation in research) is that the concentration of a
discipline’s knowledge flows from a base of established theory.
Nursing theorists offer helpful ways to view clients so that nursing activities can best meet client needs
—for example, by seeing a pregnant woman not simply as a physical form but as a dynamic force with
important psychosocial needs, or by viewing children as extensions or active members of a family as well
as independent beings. Only with this broad theoretical focus can nurses appreciate the significant effect
on a family of a child’s illness or of the introduction of a new member.
Another issue most nursing theorist’s address is how nurses should be viewed or what the goals of
nursing care should be. Extensive changes in the scope of maternal and child health nursing have
occurred as health promotion, or keeping parents and children well, has become a greater priority.
 With health promotion as a major nursing goal, teaching, counseling, supporting, and advocacy are
also common roles (Vonderheid et al., 2007). Nurses care for clients who are more critically ill than ever
before. Because care of women during pregnancy and of children during their developing years helps
protect not only current health but also the health of the next generation, maternal-child health nurses fill
these expanded roles to a unique and special degree.

VI. Philosophy of Maternal and Child Health Nursing

• Maternal and child health nursing is family centered; assessment must include both family and individual
assessment data.
• Maternal and child health nursing is community centered; the health of families depends on and
influences the health of communities.
• Maternal and child health nursing is evidence based, because this is the means whereby critical
knowledge increases.
• A maternal and child health nurse serves as an advocate to protect the rights of all family members,
including the fetus.
• Maternal and child health nursing includes a high degree of independent nursing functions, because
teaching and counseling are major interventions.
• Promoting health and disease prevention are important nursing roles because these protect the health
of the next generation.
• 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.
• Personal, cultural, and religious attitudes and beliefs influence the meaning and impact of childbearing
and childrearing on families.
• Circumstances such as illness or pregnancy are meaningful only in the context of a total life.
• Maternal and child health nursing is a challenging role for nurses and a major factor in keeping families
well and optimally functioning.
VII. Goals of Maternal and Child Health Nursing
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 child- bearing and childrearing.
The goals of maternal and child health nursing care are necessarily broad because the scope of
practice (the range of services and care that may be provided by a nurse based on state requirements)
is so broad. The range of practice includes:
 Preconceptual 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 (6 weeks before conception to 6 weeks after birth)
 Care of children from birth through adolescence
 Care in settings as varied as the birthing room, the pediatric intensive care unit, and the home
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 an essential goal. This is because the level of a family’s functioning affects
the health status of its members (Vonderheid, Norr, & Handler, 2007). A healthy family, on the other
hand, establishes an environment conducive to growth and health-promoting behaviors that sustain
family members during crises. Similarly, the health of an individual and his or her ability to function
strongly influence the health of family members and overall family functioning. For these reasons, a
family-centered approach enables nurses to better understand individuals and their effect on others
and, in turn, to provide holistic care.
VIII. World Health Organization’s 17 Sustainable Development Goals
 EBSCO HOST http://search.ebscohost.com Usersname: OLFU PW: #fatima2020
http://dbctle.erau.edu/initiatives/seven/ Iowa State Center for Excellence in Learning and Teaching.

Infant Mortality rate - is the number of deaths among infants from birth to 1 year of age per 1000 live
births.

Maternal Mortality Rate - is the number of resident maternal deaths within 42 days of pregnancy
termination due to complications of pregnancy, childbirth, and the puerperium in
a specified geographic area.

MATERNITY NURSING – involves direct personal care to maternity pts and their newborn infants or
to related activities on their behalf during the various phases of the child
bearing experience.

The most meaningful and important measure of maternal and child health is the infant mortality rate.
This rate is declining steadily, but in the United States it is still higher than in 32 other nations.

1. Look for the most recent statistics for maternal and infant mortality rate in the Philippines. What are the
programs implemented to decrease the number of maternal and infant deaths?
2. What are the latest trends in maternal and child healthcare environment to meet the sustainable
developmental goals of WHO?
 Please include your resources or references.

Textbook:

Pilliteri, Silbert-Flagg. (2018). Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing Family. (8 th Ed.) Wolters Kluwer

Devakumar (2019). Oxford Textbook of Global Health of Women, Newborns, Children, and Adolescents.
PB Publishing.

Murray (2019). Foundations of Maternal-Newborn and Women’s Health Nursing, 7th edition. Elsevier.

Flagg (2018). Maternal and Child Health Nursing: Care of the Childbearing and Chilrearing Family.
Wolters Kluwer

Wolters Kluwer. Audrey Berman, Shirlee J. Snyder, Geralyn Frandsen. (n.d.). Fundamentals of Nursing
by Kozier and Erbs (10th ed.).

Pearson. Maternal and Child Health. (n.d.). https://apha.org/topics-and-issues/maternal-and-child-health

Maternal, newborn and adolescent health. (n.d.). https://www.who.int/maternal_child_adolescent/en/

Rosalinda Parado Salustiano. (2009). Dr. RPS Maternal & Newborn Care: A Comprehensive Review
Guide and Source Book for Teaching and Learning. C & E Publishing, Inc.