A Framework for Maternal and Child Health Nursing ● Respects personal, cultural, and spiritual

attitudes and beliefs as these so strongly

Goals and Philosophies of Maternal and Child Health influence the meaning and impact of
Nursing childbearing and childrearing.
The primary goal of both maternal and child ● Encourages developmental stimulation during
health nursing is the promotion and maintenance of both health and illness so children can reach
optimal family health. their ultimate capacity in adult life.
● Assesses families for strengths as well as
Examples of the scope of practice include: specific needs or challenges.
● Preconception health care ● Encourages family bonding through rooming-in
● Care of women during three trimesters of and family visiting in maternal and child
pregnancy and the puerperium (the 6 weeks after healthcare settings.
childbirth, sometimes termed the fourth ● Encourages early hospital discharge options to
trimester of pregnancy) reunite families as soon as possible in order to
● Care of infants during the perinatal period (the create a seamless, helpful transition process.
time span beginning at 20 weeks of pregnancy to ● Encourages families to reach out to their
4 weeks [28 days] after birth) community so the family can develop a wealth
● Care of children from birth through late of support people they can call on in a time of
adolescent family crisis.
● Care in a variety of hospital and home care
settings Maternal and Child Health Goals and Standards
● Immunization, childhood diseases such as
Maternal and child health nursing is: measles and poliomyelitis almost have been
● Family centered; assessment should always eradicated.
include the family as well as an individual. ● New fertility drugs and fertility techniques allow
● Community centered; the health of families is more couples to conceive.
both affected by and influences the health of ● The ability to prevent preterm birth and improve
communities. the quality of life for both preterm and late
● Evidence based; this is the means whereby preterm infants has increased dramatically.
critical knowledge increases. ● As specific genes responsible for children’s
● A challenging role for nurses and a major factor health disorders are identified, stem cell therapy
in keeping families well and optimally may make it possible to replace diseased cells
functioning. with new growth cells and cure these illnesses.

A Philosophy of Maternal and Child Health Nursing GLOBAL HEALTH GOALS

A maternal and child health nurse: ● The United Nations (UN) and the World Health
● Considers the family as a whole and as a partner Organization established millennium health
in care when planning or implementing or goals in 2000 in an effort to improve health
evaluating the effectiveness of care. worldwide.
● Serves as an advocate to protect the rights of all ● The goals are to concentrate on improving the
family members, including the fetus. health of women and children because
● Demonstrates a high degree of independent increasing the health in these two populations
nursing functions because teaching and can have such long-ranging effects on general
counseling are major interventions. health.
● Promotes health and disease prevention because ➢ To end poverty and hunger.
these protect the health of the next generation. ➢ To achieve universal primary education.
● Serves as an important resource for families ➢ To promote gender equality and
during childbearing and childrearing as these empower women.
can be extremely stressful times in a life cycle. ➢ To reduce child mortality.
 ➢ To improve maternal health. QSEN COMPETENCIES
➢ To combat HIV/AIDS, malaria, and ● QSEN Learning Collaborative created 6
other diseases. competencies necessary for quality care. 5
➢ To ensure environmental sustainability. competencies originated from a study by the
➢ To develop a global partnership for Institute of Medicine.
development. 1. Patient-Centered Care
2. Teamwork and Collaboration
A Framework for Maternal and Child Health Nursing 3. Quality Improvement
Care 4. Informatics
● Maternal and child health nursing can be 5. Evidenced-Based Practice
visualized within a framework in which nurses 6. Safety
use nursing process, nursing theory, and Quality *viewed in SKILLS, KNOWLEDGE &
& Safety Education for Nurses (QSEN) ATTITUDE
competencies to care for families during
childbearing and childrearing years and through EVIDENCE-BASED PRACTICE
the four phases of health care: ● It is the conscientious, explicit, and judicious use
Health promotion of current best evidence to make decisions about
Health maintenance the care of patients.
Health restoration ● Evidence can be a combination of research,
clinical expertise, and patient preferences or
Health rehabilitation
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.
NURSING PROCESS
“ADPIE”
Roles and Responsibilities of a Maternal Child Health
1. Assessment
Nurse
2. Nursing Diagnosis
● M&C health nursing carries some legal concerns
3. Planning
above and beyond other areas of nursing because
4. Intervention
care is often given to patients who are not of
5. Evaluation
legal age for giving consent.
● Reproductive healthcare rights and laws are
NURSING THEORY
complex and varies.
● Designed to offer helpful ways to view patients
➢ Understanding scope practice
so nursing activities can be created to best meet
➢ Documentation
the patient needs.
➢ Informed Consent
Calista Roy “Adaptation Model”
Dorothea Orem “Self-Care Deficit Theory”
Patricia Benner “Novice to Expert Theory”
Roles and Responsibilities of a Maternal Child Health 8. GOAL 8: Decent Work and Economic Growth -
Nurse The aim is for sustainable economic growth and
● “Wrongful Birth” – birth of a disabled child decent employment for all.
whose parents would have chosen to end if they 9. GOAL 9: Industry, Innovation and Infrastructure
have been informed about the disability during - This involves building resilient infrastructure
pregnancy. and fostering innovation.
● “Wrongful Life” – claim that negligent prenatal 10. GOAL 10: Reduced Inequality - The poorest 40
testing on the part of a healthcare provider per cent of the population should be able to grow
resulted in the birth of a disabled child their income faster than average.
● “Wrongful Conception” – denotes that a 11. GOAL 11: Sustainable Cities and Communities -
contraceptive measure failed, allowing an The UN wants to increase affordable housing
unwanted child to be conceived and born and make settlements inclusive, safe and
sustainable.
Ethical Considerations of Practice 12. GOAL 12: Responsible Consumption and
● Conception issues (in vitro fertilization, embryo Production - This goal aims to foster
transfer, cryopreservation, surrogacy). eco-friendly production, reduce waste and boost
● Pregnancy termination recycling.
● Fetal rights vs. Maternal rights 13. GOAL 13: Climate Action - Urgent action is
● Stem cell research needed, by regulating emissions and promoting
● Resuscitation (DNR, length of continuation) renewable energy.
● Number of procedures and degree of pain 14. GOAL 14: Life Below Water - The aim is to
● Confidentiality of record with multiple conserve and sustainably use the oceans, seas
caregivers and marine resources.
15. GOAL 15: Life on Land - To stop degradation,
17 SUSTAINABLE DEVELOPMENT GOALS we must preserve forest, desert and mountain
ecosystems.
1. GOAL 1: No Poverty - To end poverty, everyone 16. GOAL 16: Peace and Justice Strong Institutions
should have basic healthcare, security and - The aim is inclusive societies with strong
education. institutions that provide justice for all.
2. GOAL 2: Zero Hunger - Globally, one in nine 17. GOAL 17: Partnerships to achieve the Goal - If
people are undernourished. This goal aims to all countries are to achieve the goals,
end hunger. international cooperation is vital.
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.
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 ● Possible negative aspects: may lack support
1. The Dyad Family people in a crisis situation
2. The Nuclear Family
3. The Cohabitation Family 6. The Blended Family – the remarriage or reconstituted
4. The Extended (Multigenerational) Family family.
5. The Single-Parent Family ● Positive aspects: increased security and
6. The Blended Family resources; exposure to different customs or
7. The Communal Family culture may help children become more
8. The Gay or Lesbian Family adaptable to new situations
9. The Foster Family ● Possible negative aspects: rivalry or competition
among children; difficulty adjusting to a
1. The Dyad Family – refers to 2 people living together, stepparent
usually a woman and a man without children.
● Many young adults live together as a dyad in 7. The Communal Family – groups of people who have
shared apartments, dorms or homes for chosen to live together as an extended family. Usually
companionship and financial security while motivated by social, religious values rather than kinship.
completing school or beginning their careers.
● Generally viewed as temporary arrangements. 8. The Gay or Lesbian Family

The Childfree or Childless Family 9. The Foster Family- Children whose parents can no
● Positive aspects: companionship, possibly longer care for them may be placed in a foster or
shared resources substitute home by a child protection agency.
● Potential negative aspects: feelings of guilt for ● Positive aspects: prevents children from being
the couple who decided to delay a family and raised in large orphanage settings
who then may experience infertility issue ● Possible negative aspects: insecurity and
inability to establish meaningful relationships
2. The Nuclear Family – traditional structure that is because of frequent moves
composed of a husband, wife and children.
● Positive aspects: support for family members; Adopted Family
sense of security ● Positive aspects: Children grow up well cared
● Possible negative aspects: may lack support for and experiencing a sense of love; a woman
people in a crisis situation who relinquishes her child for adoption can feel
a sense of relief her baby will have a lifestyle
3. The Cohabitation Family – composed of better than what she could provide.
heterosexual couples who live together like a nuclear ● Possible negative aspects: Divorce of the
family but remain unmarried. adopting parents can be devastating if the child
views himself as the cause of the separation or
4. The Extended (Multigenerational) Family – as a child unable to find a secure family for a
includes not only the nuclear family but also other second time.
family members such as grandparents, aunts, uncles,
cousins and grandchildren. Family Functions and Roles
● Positive aspects: support for family members; ● The family roles that people view as appropriate
sense of security are the ones they saw their own parents
● Possible negative aspects: may lack support fulfilling.
people in a crisis situation ● As new generations takes on the values of the
previous generation, traditions and culture pass
5. The Single-Parent Family from generation to generation.
● Positive aspects: support for family members; ● As nurse, it is important to identify the roles that
sense of security 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: ● Abiding familiarity with others. Can know
The family welds an environment which ourselves and others well.
surrounds, trains and educates the child. It shapes the ● Economic benefits.
personality and moulds the character of its members. It
emotionally conditions the child. CHARACTERISTICS OF HEALTHY FAMILIES
● Appreciation – notice the less obvious things,
E. Nuclear position in the social structure: express appreciation often.
The family is the nucleus of all other social ● Kindness –tends to be catching.
organizations. The whole social structure is built of ● Communication – listen so others will talk, talk
family units. so others will listen.
● Time Together – plan it, don’t wait to find it,
F. Responsibility of the members: need quantity to have quality.
The members of the family has certain ● Values and Standards – communicate them
responsibilities, duties and obligations. Maclver points clearly, follow them consistently.
out that in times of crisis men may work and fight and ● Strictness & Permissiveness – firm, fair, and
die for their country but they toil for their families all friendly.
their lives. ● Problem Solving – look for solutions, not for
blame.
G. Social regulation: ● Traditions –give a sense of identity.
The family is guarded both by social taboos and ● Fun & laughter – plan it, use props, bring home
by legal regulations. The society takes precaution to jokes.
safeguard this organization from any possible
breakdown.

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 - Using short, easy sentence

Diversity in a population means there is b. Nonverbal Communication

a mixture or variety of
sociodemographic groups, experiences,
and beliefs in the population. • Eye to eye contact
Culture is a view of the world and a set
of traditions a specific social group uses
• Touch
and transmits to the next generation.
Transcultural nursing is care guided
• Shaking hands

by cultural aspects and respects • Tattoos

individual differences (Darnell &
Hickson, 2015) 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
Techniques of Sociocultural
Assessment
- Family and structure and roles may
be culturally determined.
Communication Pattern/Language - Identifying the family decision-
- (not only what people say but also
maker is important.
how they say it) are determined by
e. Male and Female Roles
culture and are increasingly
important during times of stress. - In most culture, man is the
- Confirm it to the patient
dominant figure.

- Written Information or Interpreter

- In contrast, in some culture, the
woman may be the dominant
- Cultural variations are respected person in the family, esp. the oldest
woman.
 information of the particular ovum
g. Religion and sperm that joined.
– because religion guides a person’s
overall life philosophy, it influences - Week 5 of intrauterine life-
how he or she feels about health primitive gonad is formed.
and illness. Mesonephric (wolffian) &
Paramesonephric (műllerian)
h. Health Belief undifferentiated ducts are
- Health beliefs are not universal present.

- Week 7 or 8 – in chromosomal
I.Nutrition Practices males, early gonadal tissues
- Food and methods of preparation are differentiates into primitive testes
strongly culturally related. and begins formation of
testosterone.
j. Pain Responses
- Week 10 – if testosterone is not
- A person’s response to pain is both present, the gonadal tissue
differentiates into ovaries.
individually and culturally
determined.
2. Pubertal Development
- Threshold sensation-amount of - The Hypothalamus, under the direction
of the Central Nervous System
stimulus that results in pain
may serve as a gonadostat or
- Pain Threshold-individual reports regulation mechanism set to
that a stimulus is painful “turn on” gonad functioning.

- Pain Tolerance-individual - The theory that the girl must reach

withdraws from a stimulus a critical weight of approximately
95 lbs (43 kg) or develop a critical
Chapter 5: Reproductive and Sexual mass of fat before the
Health hypothalamus is triggered to send
initial stimulation to APG to begin
Reproductive Development gonadotropic hormone formation.

• Physiologic readiness for Pubertal Development

childbearing begins during
intrauterine life • Role of Androgen

• Puberty - Responsible for muscular

developement, physical growth and
Reproductive Development increase in sebaceous gland
1. Intrauterine Development secretions.

- The sex of an individual is - Males- produced by the adrenal

determined at the moment of cortex and testes
conception by the chromosome
- 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