Goals And Philosophies of Maternal and Child Health Nursing o Health Restoration

 Obstetrics- Care of women during childbirth o Health Rehabilitation

o obstare (Greek) “to keep watch” Definitions and Examples of Phases of Health Care
 Pediatrics- pais (Greek) “child”
 The care of childbearing and childrearing families is a major focus of nursing
practice.
o To have healthy adults, you must have healthy children.
o To have healthy children, it is important to promote the health of the
childbearing woman and her family from the time before children are born
until they reach adulthood.
 PRIMARY GOAL OF MATERNAL AND CHILD HEALTH NURSING
o The promotion and maintenance of optimal family health to ensure cycles
of optimal childbearing and childrearing.
 Philosophy of Maternal and Child Health Nursing
o Maternal and child health nursing is family centered; assessment must
include both family and individual assessment data.
o Maternal and child health nursing is community centered; the health of
families depends on and influences the health of communities.
o Maternal and child health nursing is evidence based, because this is the
means whereby critical knowledge increases.
o A maternal and child health nurse serves as an advocate to protect the
rights of all family members, including the fetus.
o Maternal and child health nursing includes a high degree of independent
nursing functions, because teaching and counseling are major interventions.
o Promoting health and disease prevention are important nursing roles
because these protect the health of the next generation.
o 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.
o Personal, cultural, and religious attitudes and beliefs influence the meaning
and impact of childbearing and childrearing on families. The Nursing Process
o Circumstances such as illness or pregnancy are meaningful only in the  A form of problem solving based on the scientific method, serves as the basis for
context of a total life. assessing, making a nursing diagnosis, planning, organizing, and evaluating care.
o Maternal and child health nursing is a challenging role for nurses and a  Multidisciplinary care maps
major factor in keeping families well and optimally functioning. Evidence-Based Practice
A Framework for Maternal and Child Health Nursing Care  The conscientious, explicit, and judicious use of current best evidence in making
 FOUR PHASES OF HEALTH CARE decisions about the care of patients.
o Health Promotion  Evidence can be a combination of research, clinical expertise, and patient
o Health Maintenance preferences when all three combine in decision making.
Scope and Standards of Maternal and Child Health Nursing  Standard V: Ethics- The pediatric nurse’s assessment, actions, and
 Scope of Practice recommendations on behalf of children and their families are
o Preconceptual Health determined in an ethical manner.
o Care of women during pregnancy and the puerperium  Standard VI: Collaboration- The pediatric nurse collaborates with
o Care of infants during the perinatal period the child, family, and other health care providers in providing client
o Care of children from birth through adolescence care.
o Care in various settings  Standard VII: Research- The pediatric nurse contributes to nursing
 American Nurses Association/Society of Pediatric Nurses Standards of Care and and pediatric health care through the use of research methods and
Professional Performance findings.
o Standards of Care- Comprehensive pediatric nursing care focuses on helping  Standard VIII: Resource Utilization- The pediatric nurse considers
children and their families and communities achieve their optimum health factors related to safety, effectiveness, and cost in planning and
potentials. This is best achieved within the framework of family-centered delivering patient care.
care and the nursing process, including primary, secondary, and tertiary  Association of Women’s Health, Obstetric, and Neonatal Nurses Standards and
care coordinated across health care and community settings. Guidelines (Standards of Professional Performance)
 Standard I: Assessment- The pediatric nurse collects patient health o Standard III: Education- The nurse acquires and maintains current
data. knowledge in nursing practice.
 Standard II: Diagnosis- The pediatric nurse analyzes the assessment o Standard IV: Collegiality- The nurse contributes to the professional
data in determining diagnoses. development of peers, colleagues, and others.
 Standard III: Outcome Identification- The pediatric nurse identifies o Standard V: Ethics- The nurse’s decisions and actions on behalf of patients
expected outcomes individualized to the child and the family. are determined in an ethical manner.
 Standard IV: Planning- The pediatric nurse develops a plan of care o Standard VI: Collaboration- The nurse collaborates with the patient,
that prescribes interventions to obtain expected outcomes. significant others, and health care providers in providing patient care.
 Standard V: Implementation- The pediatric nurse implements the o Standard VII: Research- The nurse uses research findings in practice.
interventions identified in the plan of care. o Standard VIII: Resource Utilization- The nurse considers factors related to
 Standard VI: Evaluation- The pediatric nurse evaluates the child’s safety, effectiveness, and cost in planning and delivering patient care.
and family’s progress toward attainment of outcomes. o Standard IX: Practice Environment- The nurse contributes to the
o Standards of Professional environment of care delivery within the practice settings.
 Performance Standard I: Quality of Care- The pediatric nurse o Standard X: Accountability- The nurse is professionally and legally
systematically evaluates the quality and effectiveness of pediatric accountable for his/her practice. The professional registered nurse may
nursing practice. delegate to and supervise qualified personnel who provide patient care.
 Standard II: Performance Appraisal- The pediatric nurse evaluates Trends in Maternal and Child Health Care
his or her own nursing practice in relation to professional practice
standards and relevant statutes and regulations.
 Standard III: Education- The pediatric nurse acquires and maintains
current knowledge and competency in pediatric nursing practice.
 Standard IV: Collegiality The pediatric nurse interacts with and
contributes to the professional development of peers, colleagues,
and other health care providers.
 o Home care
o Ambulatory clinics
 Including the Family in Health Care
 Increasing Use of Alternative Treatment Modalities
 Increasing Reliance on Home Care
 Increasing Use of Technology
 Freebirthing
o Women giving birth without any health care provider present.
 Health Care Concerns and Attitudes
o Increasing emphasis on preventive care
o Increasing concern for quality of life
o Increase awareness of the individuality of clients
o Empowerment of health care consumers
Legal and Ethical Issues in Maternal and Child Health Nursing
 Ethical Principles
o Ethical and social issues affecting the health of pregnant women and their
fetus are increasingly complex.
o Some of the complexity arises from technological advances in reproductive
technology, maternity care, and neonatal care.
o Nurses are autonomous professionals who are required to provide ethically
competent care.
o Autonomy- The right to self-determination
o Respect for others- Principle that all persons are equally valued
o Beneficence- Obligation to do good
o Non-maleficence- Obligation to do no harm
o Justice- Principle of equal treatment of others or that others be treated
fairly
o Fidelity- Faithfulness or obligation to keep promises
o Veracity- Obligation to tell the truth
Trends in Health Care Environment
o Utility- The greatest good for the individual or an action that is valued
 Initiating Cost Containment
o systems of health care delivery that focus on reducing the cost of health  Ethical Approaches
o The Rights Approach- The focus is on the individual’s right to choose, and
care by closely monitoring the cost of personnel, use and brands of supplies,
length of hospital stays, number of procedures carried out, and number of the rights include the right to privacy, to know the truth, and to be free
referrals requested while maintaining quality care. from injury or harm.
o The Utilitarian Approach- This approach posits that ethical actions are those
 Increasing Alternative Settings and Styles for Health Care
o Lying-in that provide the greatest balance of good over evil and provides for the
greatest good for the greatest number.
o Advanced-practice nurses: nurse-midwife, nurse practitioner
 Ethical Dilemma
o Home births
 o An ethical dilemma is a choice that has the potential to violate ethical  Four Topics Method
principles. o Medical Indications- A review of diagnosis and treatment options
o In nursing it is often based on the nurse’s commitment to advocacy. o Patient Preferences- Clinical patients’ values preferences are integral to all
o Patient advocacy - Action taken in response to our ethical responsibility to clinical situations.
intervene on behalf of those in our care. o Quality of Life- Objective is to improve, or at least address, quality of life for
o Advocacy also involves accountability for nurses’ responses to patients’ the patient.
needs. o Contextual Features- In the wider societal context beyond care providers
 Clinical Examples of Perinatal Ethical Dilemmas and patient, to include family, the law, hospital policy, insurance companies,
o Withdrawal of life support etc.
o Harvesting of fetal organs or tissue  Legal Issues in the Delivery of Care
o In vitro fertilization and decisions for disposal of remaining fertilized ova o Maternal and child health nursing carries some legal concerns that extend
o Allocation of resources in pregnancy care during the previable period above and beyond other areas of nursing, because care is often given to:
o Fetal surgery  an “unseen client”—the fetus
o Treatment of genetic disorders or fetal abnormalities found on prenatal  clients who are not of legal age for giving consent for medical
screening procedures.
o Equal access to prenatal care o Contributing to this is the complexity of caring for two patients, the mother
o Maternal rights versus fetal rights and the fetus.
o Extraordinary medical treatment for pregnancy complications Clinical o Nurses are legally responsible for protecting the rights of their clients,
Examples of Perinatal Ethical Dilemmas including confidentiality, and are accountable for the quality of their
o Using organs from an anencephalic infant individual nursing care and that of other health care team members.
o Genetic engineering o Understanding the scope of practice and standards of care can help nurses
o Cloning practice within appropriate legal parameters.
o Surrogacy o Documentation is essential for protecting a nurse and justifying his or her
o Drug testing in pregnancy actions.
o Sanctity of life versus quality of life for extremely premature or severely o Nurses need to be conscientious about obtaining informed consent for
disabled infants invasive procedures and determining that pregnant women are aware of
o Substance abuse in pregnancy any risk to the fetus associated with a procedure or test
o Borderline viability: to resuscitate or not o Wrongful birth- The birth of a disabled child when the parents would have
o Fetal reduction chosen to end the pregnancy if they had been informed about the disability
during pregnancy.
o Preconception gender selection
o Wrongful life- A claim that negligent prenatal testing on the part of a health
 Ethics in Neonatal Care- The role of nurses in the neonatal intensive care unit (NICU)
care provider resulted in the birth of an unperfect child.
requires a dual role for nurses to protect the well-being of vulnerable infants as well
o Wrongful conception- Denotes a contraceptive measure that failed, allowing
as supporting and respecting parental decisions.
an unwanted child to be conceived and born.
o Infants in whom aggressive care would probably be futile, where prognosis
 Five Common Clinical Situations Of Fetal and Neonatal Injuries and Obstetric
for a meaningful life is extremely poor or hopeless
Litigation
o Infants in whom aggressive care would probably result in clear benefit to
o Inability to recognize and/or inability to appropriately respond to
overall wellbeing, where prevailing knowledge and evidence indicate
intrapartum fetal compromise
excellent chances for beneficial outcomes and meaningful interactions
o Infants in whom the effect of aggressive care is mostly uncertain
 o Inability to effect a timely cesarean birth (30 minutes from decision to  Pubertal Development- The stage of life at which secondary sex changes begin.
incision) when indicated by fetal or maternal condition o Hypothalamus synthesized and releases gonadotropin-releasing hormone
o Inability to appropriately initiate resuscitation of a depressed neonate (GnRH). >> Anterior pituitary begin releasing follicle-stimulating hormone
o Inappropriate use of oxytocin or misoprostol leading to uterine (FSH) and luteinizing hormone (LH) >> FSH and LH initiate the production of
hyperstimulation, uterine rupture, and fetal intolerance of labor and/or androgen and estrogen >> Secondary sex characteristics.
fetal death o Age of onset: 9-12 years old
o Inappropriate use of forceps/vacuum and/or preventable shoulder dystocia o Although it is not proved, the theory is that a girl must reach a critical
 Allegations related to fetal monitoring: weight of approximately 95 lb (43 kg) or develop a critical mass of body fat
o Failure to accurately assess maternal and fetal status before the hypothalamus is triggered to send initial stimulation to the
o Failure to appreciate a deteriorating fetal status anterior pituitary gland to begin the formation of gonadotropic hormones.
o Failure to treat a nonreassuring FHR o Studies of female athletes and girls with anorexia nervosa reveal that a lack
o Failure to correctly communicate maternal/fetal status to the care provider of fat can delay or halt menstruation.
o Failure to institute the chain of command when there is a clinical o The phenomenon of why puberty occurs is even less well understood in
disagreement boys.
o The nurse must initiate the course of action when the clinical situation is a
matter of maternal or fetal well-being.
o In a case of a primary care provider not responding to an abnormal FHR or a  Role of Androgen
deteriorating clinical situation, the nurse should use the chain of command
to resolve the situation, advocate for the patient’s safety, and seek
necessary interventions to avoid a potentially adverse outcome.
o At the first level, notify the immediate supervisor to provide assistance.
Further steps are defined by the structure of the institution, and a policy
outlining communication for the chain of command should be present.
Reproductive and Sexual Health
Reproductive Development- Reproductive development and change begin at the moment of
conception and continue throughout life.
 Intrauterine Development
o The sex of an individual is determined at the moment of conception by the
chromosome information supplied by the particular ovum and sperm that
joined to create the new life.
o Gonad - a body organ that produces the cells necessary for reproduction
 Females = ovary
 Males = testis  Role of Estrogen
o Week 5- Primitive gonadal tissue is already formed. o Three compounds:
o Week 7-8- In chromosomal males, this early gonadal tissue differentiates  Estrone [E1]
into primitive testes and begins formation of testosterone.  Estradiol [E2]
o Week 10- If testosterone is not present, the gonadal tissue differentiates  Estriol [E3]
into ovaries. o Increase in estrogen  development of the uterus, fallopian tubes, and
o Week 12- External genitalia develops. vagina; end to growth because it closes the epiphyses.
 o Thelarche – the beginning of breast development.
 Secondary Sex Characteristics- Adolescent sexual development is categorized into
stages. There is wide variation in the time required for adolescents to move through
these developmental stages; however, the sequential order is fairly constant.
o Female- Growth spurt, Increase in the transverse diameter of the pelvis,
Breast development, Growth of pubic hair, Onset of menstruation, Growth
of axillary hair, &Vaginal secretions.
o Male: Increase in weight, Growth of testes, Growth of face, axillary, and
pubic hair; Voice changes, Penile growth, Increase in height, &
Spermatogenesis (production of sperm)
o Irregular menstrual periods are the rule rather than the exception for the
first year. Menstrual periods do not become regular until ovulation
consistently occurs with them (menstruation is not dependent on
ovulation), and this does not tend to happen until 1 to 2 years after
menarche.
o This is one reason why estrogen-based oral contraceptives are not
commonly recommended until a girl’s menstrual periods have become
stabilized or are ovulatory
Anatomy & Physiology of the Reproductive System- Although the structures of the female
and male reproductive systems differ greatly in both appearance and function, they are
homologues—that is, they arise from the same or matched embryonic origin
 Male Reproductive System
o External Structures: Testes, Scrotum, & Penis
o Internal Structures: Epididymis, Vas deferens, Seminal vesicles, Ejaculatory
ducts, Prostate gland, Urethra, & Bulbourethral gland