Situation:

One day in a public place specifically in a fast food during a

busy day, a stranger verbalized “sakit akong tiyan” and
suddenly she was intensely telling nga anakon nako..
At some point you were there..
A bsn2 student…..
As a good Samaritan who happens to be taking up NCM 107
How will you react in the situation?
NCM 107 CARE OF MOTHER, CHILD AND ADOLESCENT
 NCM 107
This course deals with :
• concepts,
• principles,
• theories and
• techniques
in the nursing care
of individuals and families.
During:
• childbearing
• childrearing years
towards health promotion,
disease prevention,
restoration,
maintenance, and rehabilitation.
The learners are expected to provide:
• safe
• appropriate
• Holistic
nursing care to clients utilizing the principles
of love and peace and the nursing process
 Program Outcomes
1. Apply knowledge of the physical, social, natural and
health sciences, and humanities in the practice of
nursing.
2. Apply guidelines and principles of evidence-based
practice in the delivery of care.
3. Communicate effectively in speaking, writing, and
presenting using culturally appropriate language.
 Program Outcomes
4. Work effectively and develop love and peace in
collaboration with inter-, intra- and multidisciplinary
and multicultural teams.
5. Practice beginning management and leadership skills
in the delivery of client care using a systems approach.
6. Engage in lifelong learning with a passion to keep
current with national and global developments in
general, and nursing and health developments in
particular.
 Program Outcomes
7. Demonstrate responsible citizenship and pride of
being a Filipino embracing love and peace.
8. Apply techno-intelligent care systems and processes
in health care delivery.
9. Adopt the universal values of love and peace as well
as nursing core values in the practice of the
profession.
LESSON 1 - GOALS AND
PHILOSOPHIES OF
MATERNAL AND CHILD
HEALTH NURSING
 INTRODUCTION
• This lesson presents an overview of maternal and
child health nursing.
• The use of nursing process, nursing research, and
nursing theory in the provision of quality care is
discussed.
• The standards of maternal and child health nursing
practice, the changing discipline, and the varied
roles assumed by nurses in maternal and child
health nursing are also explored.
 LEARNING OBJECTIVES
• After mastering the contents of this chapter,
you should be able to do the following:
1. Identify the goals and philosophy of maternal
and child health nursing.
2. Describe the evolution, scope, standards, and
professional roles for nurses in maternal and
child health nursing.
 LEARNING OBJECTIVES
3. Describe family-centered care and ways that
maternal and child health nursing could be
made more family centered.
4. Identify legal and ethical issues important to
maternal and child health nursing.
 LEARNING OBJECTIVES
5. 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.
6. Integrate knowledge of trends in maternal
and child health care with the nursing
process to achieve quality maternal and child
health nursing care.
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
childbearing and childrearing”.
• The goals of maternal and child health
nursing care are necessarily broad because:

“ the scope of practice is so broad”.

 GOALS OF MATERNAL AND CHILD HEALTH NURSING

The range of practice includes:

• Preconceptual health care
• Care of women during three trimesters of pregnancy
and the puerperium (the 6weeks after childbirth,
sometimes termed the fourth trimester of pregnancy)
Care of children during the perinatal period (6 weeks
before conception to 6 weeks after birth)
Puerperium -the 6weeks after childbirth,
sometimes termed the fourth trimester of
pregnancy) Care of children during the perinatal
period (6 weeks before conception to 6 weeks
after birth)
 GOALS OF MATERNAL AND CHILD HEALTH NURSING
• The range of practice includes:
• Care of children 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 delivery is an essential goal.
PHILOSOPHIES OF MATERNAL AND CHILD HEALTH
NURSING
PHILOSOPHIES OF MATERNAL AND CHILD HEALTH NURSING

1. Maternal and child health nursing is family

centered; assessment data must include a family
and individual assessment.
2. Maternal and child health nursing is
community centered; the health of families
depends on and influences the health of
communities.
3. Maternal and child health nursing is research
oriented, because research is the means
whereby critical knowledge increases.
PHILOSOPHIES OF MATERNAL AND CHILD HEALTH NURSING
4. Both nursing theory and evidence-based practice
provide a foundation for nursing care.
5.A maternal and child health nurse serves as an
advocate to protect the rights of all family
members, including the fetus.
6. Maternal and child health nursing includes a
high degree of independent nursing functions,
because teaching and counseling are so
frequently required.
7. Promoting health is an important nursing role,
because this protects the health of the next
generation.
8. Pregnancy or childhood illness can be stressful and
can alter family life in both subtle and extensive ways
9. Personal, cultural, and religious attitudes and beliefs
influence the meaning of illness and its impact on the
family. Circumstances such as illness or pregnancy are
meaningful only in the context of a total life.
10.Maternal and child health nursing is a
challenging role for a nurse and is a major
factor in promoting high-level wellness in
families.
 Common Measures to Ensure Family-
Centered Maternal and Child Health Care
Principle
 Common Measures to Ensure Family-Centered Maternal
and Child Health Care Principle

• The family is the basic unit of society.

• Families represent racial, ethnic, cultural, and
socioeconomic diversity.
• Children grow both individually and as part of
a family.
 Common Measures to Ensure Family-Centered Maternal
and Child Health Care Principle
• Nursing Interventions
• Consider the family as a whole as well as its
individual members.
• Encourage families to reach out to their
community so that family members are not
isolated from their community or from each
other.
 Common Measures to Ensure Family-Centered Maternal
and Child Health Care Principle
• Encourage family bonding through rooming-in in
both maternal and child health hospital settings.
• Participate in early hospital discharge programs to
reunite families as soon as possible.
• Encourage family and sibling visits in the hospital
to promote family contacts.
 Common Measures to Ensure Family-Centered Maternal
and Child Health Care Principle
• Assess families for strengths as well as
specific needs or challenges.
• Respect diversity in families as a unique
quality of that family.
• Encourage families to give care to a newborn
or ill child.
 Common Measures to Ensure Family-Centered Maternal
and Child Health Care Principle
• Include developmental stimulation in nursing
care.
• Share or initiate information on health planning
with family members so that care is family-
oriented.
STANDARDS OF MATERNAL AND CHILD
HEALTH NURSING PRACTICE
 STANDARDS OF MATERNAL AND CHILD HEALTH NURSING PRACTICE

• The importance a society places on human life can

best be measured by the concern it places on its
most vulnerable members—its elderly,
disadvantaged, and youngest citizens.
• To promote consistency and ensure quality nursing
care and outcomes in these areas, specialty
organizations develop guidelines for care in their
specific areas of nursing practice.
 Association of Women’s Health, Obstetric, and Neonatal Nurses Standards and Guidelines Standards of Professional Performance

• Standard I: Quality of Care

• The nurse systematically evaluates the quality and
effectiveness of nursing practice.
• Standard II: Performance Appraisal
• The nurse evaluates his/her own nursing practice in
relation to professional practice standards and relevant
statutes and regulations.
 Association of Women’s Health, Obstetric, and Neonatal Nurses Standards and Guidelines Standards of Professional Performance

• Standard III: Education

• The nurse acquires and maintains current knowledge
in nursing practice.
• Standard IV: Collegiality
• The nurse contributes to the professional
development of peers, colleagues, and others.
 Association of Women’s Health, Obstetric, and Neonatal Nurses Standards and Guidelines Standards of Professional Performance

• Standard V: Ethics
• The nurse’s decisions and actions on behalf of
patients are determined in an ethical manner.
• Standard VI: Collaboration
• The nurse collaborates with the patient, significant
others, and health care providers in providing patient
care.
 Association of Women’s Health, Obstetric, and Neonatal Nurses Standards and Guidelines Standards of Professional Performance

• Standard VII: Research

• The nurse uses research findings in practice.
• Standard VIII: Resource Utilization
• The nurse considers factors related to safety,
effectiveness, and cost in planning and delivering
patient care.
 Association of Women’s Health, Obstetric, and Neonatal Nurses Standards and Guidelines Standards of Professional Performance

• Standard IX: Practice Environment

• The nurse contributes to the environment of care
delivery within the practice settings.
• Standard X: Accountability
• The nurse is professionally and legally accountable
for his/her practice. The professional registered
nurse may delegate to and supervise qualified
personnel who provide patient care.
A FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING CARE
• Maternal and child health nursing can be visualized
within a framework in which nurses, using nursing
process, nursing theory, and evidence-based
practice, care for families during childbearing and
childrearing years through four phases of health care:
• • Health promotion
• • Health maintenance
• • Health restoration
• • Health rehabilitation
Definitions and Examples of Phases of Health Care
Term Definition Examples
Health promotion Educating clients to be aware of good Teaching women the importance of
health through teaching and role rubella immunization before pregnancy;
modeling. teaching children the importance of safer
sex practices.

Health Intervening to maintain health when Encouraging women to come for prenatal
maintenance risk of illness is present care; teaching parents the importance of
safeguarding their home by childproofing
it against poisoning.

Health restoration Promptly diagnosing and treating Caring for a woman during a complication
illness using interventions that will of pregnancy or a child during an acute
return client to wellness most rapidly. illness.

Health Preventing further complications from Encouraging a woman with gestational

rehabilitation an illness; bringing ill client back to trophoblastic disease to continue therapy
optimal state of wellness or helping or a child with a renal transplant to
client to accept inevitable death. continue to take necessary medications.
 The Nursing Process
• Nursing care, at its best, is designed and implemented in a
thorough manner, using an organized series of steps, to ensure
quality and consistency of care (Carpenito, 2004).
• The nursing process, a proven form of problem solving based on
the scientific method, serves as the basis for assessing, making a
nursing diagnosis, planning, organizing, and evaluating care.
• That the nursing process is applicable to all health care settings,
from the prenatal clinic to the pediatric intensive care unit, is
proof that the method is broad enough to serve as the basis for
all nursing care.
 Evidence-Based Practice
• Evidence-based practice involves the use of
research or controlled investigation of a problem
in conjunction with clinical expertise as a
foundation for action. Bodies of professional
knowledge grow and expand to the extent that
people in that profession plan and carry out
research.
 Evidence-Based Practice
• Nursing research, the controlled investigation of
problems that have implications for nursing practice,
provides evidence for practice, upon which the
foundation of nursing grows, expands, and improves. In
addition, evidence-based practice provides the
justification for implementing activities for outcome
achievement, ultimately resulting in improved and cost-
effective patient care.
 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 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.
 Summary of Nursing Theories
• Terry is a 7-year-old girl who is hospitalized because
her right arm was severely injured in an automobile
accident. There is a high probability she will never
have full use of the arm again. Terry’s mother is
concerned because Terry showed promise in art.
Previously happy and active in Girl Scouts, Terry has
spent most of every day since the accident sitting in
her hospital bed silently watching television.
Theorist Major Concepts of Theory Emphasis of Care
Nursing is a caring relationship. Assess Terry as a whole. An
Patricia Benner Nurses grow from novice to expert expert nurse is able to do this
as they practice in clinical settings intuitively from knowledge
gained from practice.
A person comprises subsystems that Assess the effect of lack of arm
must remain in balance for optimal function on Terry as a whole;
Dorothy Johnson functioning. Any actual or potential modify care to maintain function
threat to this system balance is a to all systems, not just
nursing concern. musculoskeletal.

Nursing is a process of action, Discuss with Terry the way she

reaction, interaction, and views herself and illness. She
Imogene King transaction; needs are identified views herself as a well-child,
based on client’s social system, active in Girl Scouts and school;
perceptions, and health; the role of structure care to help her meet
the nurse is to help the client these perceptions.
achieve goal attainment.
Theorist Major Concepts of Theory
Madeleine The essence of nursing is care. To Assess Terry’s family for beliefs
Leininger provide transcultural care, the nurse about healing. Incorporate these
focuses on the study and analysis of into care.
different cultures with respect to
caring behavior.
The role of the nurse is viewed as Turn Terry’s bed into the sunlight;
changing or structuring elements of provide adequate covers for
Florence the environment such as ventilation, warmth; leave her comfortable
Nightingale temperature, odors, noise, and light with electronic games to occupy
to put the client into the best her time.
opportunity for recovery.
A person is an open system that Assess for stressors such as loss
interacts with the environment; of self-esteem and derive ways to
Betty Neuman nursing is aimed at reducing prevent further loss such as
stressors through primary, praising her for combing her own
secondary, and tertiary prevention. hair.
Theorist Major Concepts of Theory Emphasis of Care
The focus of nursing is on the individual; Arrange overbed table so Terry can
clients are assessed in terms of ability to feed herself; urge her to participate in
complete self-care. Care given may be care by doing as much for herself as
Dorothea Orem wholly compensatory (client has no role); she can.
partly compensatory (client participates in
care); or supportive-educational (client
performs own care).

The focus of the nurse is interaction with Ask Terry what she feels is her main
the client; effectiveness of care depends on need. Terry says that returning to
the client’s behavior and the nurse’s school is what she wants most. Stress
Ida Jean Orlando reaction to that behavior. The client should activities that allow her to maintain
define his or her own needs. contact with school, such as doing
homework or telephoning friends.

Nursing is a human science. Health is a Ask Terry what being sick means to
Rosemarie Rizzo lived experience. Man-living-health as a her. Allow her to participate in care
Parse single unit guides practice. decisions based on her response.
Theorist Major Concepts of Theory Emphasis of Care
The promotion of health is viewed as the Plan care together with Terry.
forward movement of the personality; Encourage her to speak of school and
Hildegard Peplau this is accomplished through an accomplishments in Girl Scouts to
interpersonal process that includes retain self-esteem.
orientation, identification, exploitation,
and resolution.

The purpose of nursing is to move the Help Terry to make use of her left side
client toward optimal health; the nurse as much as possible so that she
Martha Rogers should view the client as whole and returns to school and to her previous
constantly changing and help people to level of functioning as soon as
interact in the best way possible with the possible.
environment.

The role of the nurse is to aid clients to Assess Terry’s ability to use her left
adapt to the change caused by illness; hand to replace her right-hand
Sister Callista Roy levels of adaptation depend on the functions, which are now lost; direct
degree of environmental change and nursing care toward replacing deficit
state of coping ability; full adaptation with other factors, self-concept, role
includes physiologic interdependence. function, and skills.
Trends in Maternal and Child Health Care and Implications for Nurses
Trend Implications for Nursing
Families are smaller than in Fewer family members are present as support in a
previous decades. time of crisis. Nurses must fulfill this role more
than ever before.
Single parents are increasing A single parent may have fewer financial resources;
in number. this is more likely if the parent is a woman. Nurses
need to inform parents of care options and to
provide a backup opinion when needed.
An increasing number of Health care must be scheduled at times a working
women work outside the parent can bring a child for care. Problems of latch-
home. key children and the selection of child care centers
need to be discussed.
 Trends in Maternal and Child Health Care and Implications for Nurses
Families are more mobile than Good interviewing is necessary with mobile
previously; there is an increase in families so a health database can be
the number of homeless women established; education for health monitoring
and children. is important.
Abuse is more common than ever Screening for child or intimate partner abuse
before. should be included in family contacts. Be
aware of the legal responsibilities for
reporting abuse.
Families are more health-conscious Families are ripe for health education;
than previously. providing this can be a major nursing role.
Health care must respect cost Comprehensive care is necessary in primary
containment. care settings because referral to specialists
may no longer be an option.
 Statistical Terms Used to Report
Maternal and Child Health
• Birth rate: The number of births per 1,000 population.
• Fertility rate: The number of pregnancies per 1,000
women of childbearing age.
• Fetal death rate: The number of fetal deaths (over
500 g) per 1,000 live births.
• Neonatal death rate: The number of deaths per 1,000
live births occurring at birth or in the first 28 days of
life.
 Statistical Terms Used to Report
Maternal and Child Health
• Perinatal death rate: The number of deaths of
fetuses more than 500 g and in the first 28 days of
life per 1,000 live births.
• Maternal mortality rate: The number of maternal
deaths per 100,000 live births that occur as a direct
result of the reproductive process.
 Statistical Terms Used to Report
Maternal and Child Health
• Infant mortality rate: The number of deaths per
1,000 live births occurring at birth or in the first 12
months of life.
• Childhood mortality rate: The number of deaths per
1,000 population in children, 1 to 14 years of age.
ADVANCED-PRACTICE ROLES FOR NURSES IN
MATERNAL AND CHILD HEALTH
 Family Nurse Practitioner
• A family nurse practitioner (FNP) is an advanced practice role
that provides health care not only to women but to total
families. In conjunction with a physician, an FNP can provide
prenatal care for a woman with an uncomplicated pregnancy.
• The FNP takes the health and pregnancy history, performs
physical and obstetric examinations, orders appropriate
diagnostic and laboratory tests, and plans continued care
throughout the pregnancy and for the family afterward.
• FNPs then monitor the family indefinitely to promote health
and optimal family functioning.
 Neonatal Nurse Practitioner
• A neonatal nurse practitioner (NNP) 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. They
also transport ill infants to different care settings.
• The NNP’s responsibilities include managing and carrying out
patient care in an intensive care unit, conducting normal
newborn assessments and physical examinations, and
providing high-risk follow-up discharge planning (Bissell, 2004).
 Pediatric Nurse Practitioner
• A 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 nurse’s diagnosis is that the child is well, he or she discusses
with the parents any childrearing concerns mentioned in the
interview, gives any immunizations needed, offers necessary
anticipatory guidance (based on the plan of care), and arranges a
return appointment for the next well-child checkup.
 Pediatric Nurse Practitioner
• The nurse has served as a primary health caregiver or as the
sole health care person the parents and child see at that visit.
• If the PNP determines that a child has a common illness (e.g.,
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 (e.g.,
congenital subluxated hip, kidney disease, heart disease), he or
she consults with an associated pediatrician; together, they
decide what further care is necessary.
 Pediatric Nurse Practitioner
• Nurse practitioners may also work in inpatient or specialty
settings providing continuity of care to hospitalized children.
• As school nurse practitioners, they provide care to all children in
a given community or school setting.
 Nurse-Midwife
• Throughout history, the nurse-midwife, an individual educated
in the two disciplines of nursing and midwifery and licensed
according to the requirements of the American College of
Nurse-Midwives (ACNM), has played an important role in
assisting women with pregnancy and childbearing. Either
independently or in association with an obstetrician, the nurse-
midwife assumes full responsibility for the care and
management of women with uncomplicated pregnancies.
• Nurse-midwives play a large role in making birth an
unforgettable family event as well as helping to ensure a healthy
outcome for both mother and child (Dawley, 2003)
 LEGAL CONSIDERATIONS OF
MATERNAL-CHILD PRACTICE
• Legal concerns arise in all areas of health care.
• 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.
 LEGAL CONSIDERATIONS OF
MATERNAL-CHILD PRACTICE
• 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.
• In a society in which child abuse is of national
concern, nurses are becoming increasingly
responsible for identifying and reporting incidents of
suspected abuse in children.
 ETHICAL CONSIDERATIONS OF PRACTICE
• Ethical issues are increasing in frequency in health
care today. Some of the most difficult decisions in
health care settings are those that involve children
and their families. The following are just a few of the
major potential conflicts:
• Conception issues, especially those related to in
vitro fertilization, embryo transfer, ownership of
frozen oocytes or sperm, cloning, stem cell research,
and surrogate mothers
 ETHICAL CONSIDERATIONS OF PRACTICE
• 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?)
• The number of procedures or degree of pain that a
child should be asked to endure to achieve a degree
of better health
• The balance between modern technology and quality
of life.
• Do you consider your self right now as poor or
rich?
• What if you will be sick tomorrow are you
confident enough that you will be cured?
• What if you will discover today you are
pregnant? Are you ready?
• What if your home right now is on fire? Are
you ready? Is your house ensured?
•
• What if another typhoon Odette or Yolanda is
coming? Are you prepared?
• Are you sure at the age of 60’s your no longer
single?
• Are you sure that you can survive your
profession as an aspirant NURSE?
• Too many Problems…..
 
• Describe our Health Care System today base
on your own opinion and observation
shhhsssss
sssshhhh!
!!
 WHO’s 17 SUSTAINABLE
DEVELOPMENT GOALS
• 1. No Poverty
• 2. Zero Hunger
• 3. Good Health and Well-being
• 4. Quality Education
• 5. Gender Equality
• 6. Clean Water and Sanitation
• 7. Affordable and Clean Energy
 WHO’s 17 SUSTAINABLE
DEVELOPMENT GOALS
• 8. Decent Work and Economic Growth
• 9. Industry, Innovation. and Infrastructure
• 10. Reduced Inequalities
• 11. Sustainable Cities and Communities
• 12. Responsible Consumption and Production
 WHO’s 17 SUSTAINABLE
DEVELOPMENT GOALS
• 13. Climate Action
• 14. Life Below Water
• 15. Life on Land
• 16. Peace, Justice, and Strong Institutions
• 17. Partnerships
 Checkpoint Question 1
• Suppose Melissa Chung asks you whether
maternal child health nursing is a profession.
What qualifies an activity as a profession?
a. Members supervise other people.
b. Members use a distinct body of knowledge.
c. Members enjoy good working conditions.
d. Members receive relatively high pay.
 Checkpoint Question 2
• Nursing is changing because social change affects care. Which
of the following is a trend that is occurring in nursing because
of social change?
a. So many children are treated in ambulatory units that nurses
are hardly needed.
b. Immunizations are no longer needed for infectious diseases.
c. The use of skilled technology has made nursing care more
complex.
d. Pregnant women are so healthy today that they rarely need
prenatal care.
 Checkpoint Question 3
• The best description of the FNP role is
a. To give bedside care to critically ill family
members.
b. To supervise the health of children up to age
18 years.
c. To provide health supervision for families.
d. To supervise women during pregnancy.