Jet Fernandez, RN

FRAMEWORKS:
Maternal & Child Health Nursing
 LEARNING OUTCOMES:

• State the goal of Maternal and Child Health.

• Identify and explain the Scope of Practice of a Maternal

and Child Health Nurse.

• Integrate concepts, nursing theories, and principles of

sciences and humanities in the formation of appropriate
nursing care during childbearing and childrearing years.

• Identify and Explain the National Health Goals.

 MCHN TERMINOLOGIES:

• OBSTETRICS- care of women during childbirth (Greek: “obstare”-to keep watch)

• PEDIATRICS- specialty of medical science concerned with the physical, mental,
and social health of children from birth to young adulthood (Greek: “pais”-child)
• NEONATE/NEONATAL- 28 days of life
• INFANT/INFANCY- 1-12 months
• FETAL-relating to a fetus/position
• MORTALITY-number of deaths
• MORBIDITY- suffering from a disease or medical condition
• PRENATAL-existing before birth
• ANTEPARTUM- before childbirth
• INTRAPARTUM-during the act of birth
• POSTPARTUM-time after birth
• PUERPERIUM- period of about six weeks after the childbirth and delivery of the
placenta
 U.N. STATISTICS:

• Nearly 830 women die every day due to

complications during pregnancy and childbirth.

• 94% of all maternal deaths occur in low and

lower middle-income countries.
• In developing countries, conditions related to
pregnancy and childbirth constitute the second
leading causes (after HIV/AIDS) of death among
women of reproductive age.
• Complications during pregnancy and childbirth
are the leading cause of death for girls ages 15
to 19 globally.
• More than 500 women and girls in emergency
situations die every day from complications due
to pregnancy and childbirth.
 MATERNAL AND CHILD HEALTH
NURSING (MCHN)

FRAMEWORK

• Childbearing is the process of giving birth; pregnancy and parturition.

• Childrearing is the raising of children; parenting.
 PHASES OF DEFINITION CONCRETE EXAMPLES
HEALTHCARE
Health Promotion Educating parents and the Teaching women the
children to follow sound importance of immunization
health practices through before pregnancy; teaching
teaching and role modeling. children the importance of
safer sex practice.

Health Maintenance Intervening to maintain Encouraging women to come

health when risk of illness is for prenatal care; teaching
present. parents to safeguard their
homes by childproofing it
against poisoning.

Health Restoration Using conscientious Caring for a woman during a

assessment to be certain complication of pregnancy or a
that symptoms of illness are child during an acute illness.
identified and interventions
are begun to return patient
to wellness most rapidly.

Health Helping prevent Encouraging a woman with

Rehabilitation complications from illness; gestational trophoblastic
helping a patient with disease to continue therapy or
residual effects achieve an a child with a renal transplant
optimal state of wellness to continue to take necessary
and independence; accept medications.
inevitable death.
 The Primary Goal of Maternal and
Child Health Nursing
To promote and maintain optimal family
health to ensure cycles of optimal
childbearing woman and her family from the
time before children are born until they
reach adulthood.

The area of childbearing and childrearing families is a

major focus of nursing practice in promoting health for
the next generation.
Did you know?
• Both preconceptual and prenatal cares are essential
contributions to the health of a woman and fetus and to a
family’s emotional preparation for childbearing and
childrearing.

• As children grow, families need to continued health supervision

and support. As children reach maturity and plan for their
families, a new cycle begins and new support becomes
necessary.

• Although this field of nursing typically divides its concerns for

families during childbearing and childrearing into two separate
entities, maternity care and child health care, the full scope of
nursing practice in this area is not two separate entities, but
one: maternal and child health nursing.

• The goals of maternal and child health nursing care are

necessarily broad because the scope of practice is so broad. In
all settings and types of care, keeping the family at the center
of care delivery is an essential goal.
 RANGE OF PRACTICE
(Services and care that may be
provided by the nurse based on
state requirements):
1. Preconceptual Health Care
2. Care of women during 3 trimesters of pregnancy
 1st trimester (1st – 3rd month)
 2nd trimester (4th – 6th month)
 3rd trimester (7th – 9th month)

3. Care of women during Puerperium or 4th Trimester (6 weeks after

childbirth)

4. Care of infants during Perinatal Period (6 weeks before conception

and 6 weeks after birth)

5. Care of children from birth to adolescence

 Neonatal (28 days of life);
 Infancy (1 – 12 months);
 Adolescence (after 18 y/o)

6. Care in settings as varied as the birthing room, the pediatric

intensive care unit, and the home.
PHILOSOPHIES OF MATERNAL
AND CHILD HEALTH

A nursing concept is
always guided by
Philosophies and
Principles that makes it
more comprehensive and
effective when it is put
into practice.
Maternal and child health nursing is:
 Always family- centered
 Community-centered
 Research-oriented
 Grounded in nursing theory and evidence-
based practice
 MCHN nurses serve as advocate to protect the
rights of all family members.
 Inclusive of a high degree of independent
nursing functions.
 Promoting Health is an important nursing role
 Pregnancy or childhood illness can be stressful
and can alter family life in both subtle and
extensive ways.
 Personal, cultural, and religious attitudes and
beliefs influence the meaning of illness on the
family. Circumstances such as illness or
pregnancy are meaningful only in the context
of a total life.
 A challenging role for a nurse and is a major
factor in promoting high-level wellness in
families.
 PRINCIPLES IN MATERNAL AND CHILD
HEALTH NURSING

• The family is the basic unit of society.

• Families represent racial, ethnic, cultural and social
diversity.
• Children grow both individually and as part of a family
COMMON MEASURES HOW WE CAN ENSURE
A FAMILY-CENTERED MCH CARE:

1. Consider the family as a whole as well as its individual

members.
2. Encourage families to reach out to their community so that
family members are not isolated from their community or from
each other.
3. Encourage family bonding through rooming-in in both maternal
and child health hospital settings.
4. Participate in early hospital discharge programs to reunite
families as soon as possible.
5. Encourage family and sibling visits in the hospital to promote
family contacts.
6. Assess families for strengths as well as specific needs or
challenges.
7. Respect diversity in families as a unique quality of that family.
8. Encourage families to give care to a newborn or ill child.
9. Include developmental stimulation in nursing care.
10. Share or initiate information on health planning with family
members so that care is family- oriented.
MATERNAL AND CHILD HEALTH
GOALS AND STANDARDS

Access to health care and social

determinants of health impact the role of
the nurse and the health of the patient.
These factors have expanded the roles of
nurses in maternal and child health and, at
the same time, have made the delivery of
quality maternal and child health nursing
care a challenge.
 2020 NATIONAL HEALTH GOALS

• It is intended to help citizens to easily understand the

importance of health promotion and disease prevention and to
encourage wide participation in improving health in the next
decade.

• The United Nations and the World Health Organization

established millennium health goals in 2000 in an effort to
improve health worldwide. As with 2020 National Health
Goals, these concentrate on improving the health of women
and children because increasing the health in these two
populations can have such long-ranging effects on general
health.
These Global Health Goals are:

1. To end poverty and hunger.

2. To achieve universal primary education.
3. To promote gender equality and empower women.
4. To reduce child mortality.
5. To improve maternal health.
6. To combat HIV/AIDS, malaria, and other diseases.
7. To ensure environmental sustainability.
8. To develop a global partnership for development.
PRIORITY GOALS (leading health indicators)

1. PHYSICAL ACTIVITY: Regular physical activity throughout

life is important for maintaining a healthy body, enhancing
psychologic well-being, and preventing premature death.

The objectives selected to measure

progress in this area are:

a. Increase the proportion of

adolescents who engage in various
physical activity that promote cardio
respiratory fitness 3 or more days
per week for 20 or more minutes
per occasion.

b. Increase the proportion of adults

who engage regularly, preferably
daily, in moderate physical activity
for at least 30 minutes per day.
2. OVERWEIGHT AND OBESITY. Overweight and obesity
are contributors to many preventable causes of death.
The objectives selected to measure
progress in this area:

a. Reduce the proportion of children and

adolescents who are overweight or
obese.

b. Reduce the proportion of adults who are

obese.

3. TOBACCO USE. Cigarette smoking is the single most

preventable cause of disease and death.

The objectives selected to measure

progress in this area:

a. Reduce cigarette smoking by

adolescents.
b. Reduce cigarette smoking by adults.
4. SUBSTANCE ABUSE. Alcohol and illicit drug use are associated
with many of the country’s most serious problems, violence, injury,
and HIV infection.
The objectives selected to measure progress
in this area:
a. Increase the proportion of adolescents not
using alcohol or any illicit drugs.
b. Reduce the proportion of adults using any
illicit drugs.
c. Reduce the proportion of adults engaging
in binge drinking of alcoholic beverages.

5. RESPONSIBLE SEXUAL BEHAVIOR. Unintended pregnancies

and sexually transmitted diseases, including infection with human
immunodeficiency virus that causes AIDS, can result from
unprotected sexual behavior.
The objectives selected to measure
progress in this area are:
a. Increase the proportion of adolescents
who abstain from sexual intercourse or
use condoms if sexually active.
b. Increase the proportion of sexually
active persons who use condoms.
6. MENTAL HEALTH. Approximately 20% of the US population
is affected by mental illness during a given year. Of all mental
illnesses, depression is the most common disorder. Major
depression is the leading cause of disability and is the cause of
more than two thirds of suicides each year.
The objective selected to measure
progress in this area:
a. increase the proportion of adults
who recognize depression who
receive treatment.

7. INJURY AND VIOLENCE. A lot of Filipinos die each day from

injuries, due primarily to motor vehicular crashes, firearms,
poisonings, falls, fires, and drowning. The risk of injury is so great
that most persons sustain a significant injury at some time during
their lives.

The objectives selected to measure

progress in this area:
a. Reduce deaths caused by motor
vehicular accidents.
b. Reduce homicides.
 8. ENVIRONMENTAL INJURY. An estimated 25% of preventable
illnesses worldwide can be attributed to poor environmental
quality. Air pollution alone is estimated to be associated with
premature deaths.
The objectives selected to measure progress
in this area are:
a. Reduce the proportion of persons exposed
to air that does not meet the DENR’s
health-based standards for ozone
b. Reduce the proportion of non-smokers
exposed to environmental tobacco smoke.

9. IMMUNIZATION. Vaccines are among the greatest public health

achievements of the 20th Century. It prevents disability and death from
infectious diseases and can help control the spread of infections. The
objectives selected to measure progress in this area are:
a. Increase the proportion of young children who
receive all vaccines that have been
recommended for universal administration for
at least 5 years.
b. Increase the proportion of noninstitutionalized
adults who are vaccinated annually against
influenza and pneumococcal disease.
10. ACCESS TO HEALTH CARE. Strong predictors of access to
quality health care include having a health insurance, a higher
income level, and a regular primary care provider or other source
of ongoing health care. Use of clinical preventive health care
services, such as prenatal care, can serve as indicators of access
to quality health care services.

The objectives selected to

measure progress in this area are:

a. Increase the proportion of

persons with health insurance.
b. Increase the proportion of
persons who have a specific
ongoing care.
c. Increase the proportion of
pregnant women who begin
prenatal care in the first
trimester of pregnancy.
NURSING
THEORIES
Patricia Nursing is a caring
Benner relationship. Nurses grow
from novice to expert as
they practice in clinical
settings.

Dorothy A person comprises

Johnson subsystems that must remain
in balance for optimum
functioning. Any actual or
potential threat to this system
balance is a nursing concern.

Imogene Nursing is a process of action,

King reaction, interaction, and
transaction; needs are identified
based on client’s social system,
perceptions, and health; the role of
the nurse is to help the client
achieve goal attainment.
Florence The role of the nurse is viewed
Nightingale as changing or structuring
elements of the environment
such as ventilation,
temperature, odors, noise, and
light to put the patient into the
best opportunity for recovery.

Madeleine The essence of nursing is care. To

Leininger provide transcultural care, the
nurse focuses on the study and
analysis of different cultures with
respect to caring behavior.

Betty A person is an open system

Newman that interacts with the
environment; nursing is aimed
at reducing stressors through
primary, secondary, and
tertiary prevention.
Dorothea The focus of nursing is on the
Orem individual; clients are assessed
in terms of ability to complete
care. Care given may be wholly
compensatory (client has no
role); partly compensatory
(client participates in care); or
supportive- educational (client
performs own care).

Ida Jean The focus of the nurse us

Orlando interaction with the client;
effectiveness of care depends
on the client’s behavior and
the nurse’s reaction to that
behavior. The client should
define his or her own need.

Rosemarie Nursing is a human science.

Rizzo Parse Health is a lived experience. Man-
living-health as a single unit
guides practice.
Hildegard The promotion of health is viewed
Peplau as the forward movement of the
personality; this is accomplished
through an interpersonal process
that includes orientation,
identification, exploitation, and
resolution.

Martha The purpose of nursing is to move

Rogers the client toward optimal health;
the nurse should view the client as
whole and constantly changing and
help people to interact in the best
way possible with the environment.

Sister The role of the nurse is to aid

Callista Roy clients to adapt to the change on
the degree of environment change
and state of coping ability; full
adaptation includes physiologic
interdependence.
 ROLES AND RESPONSIBILITIES OF A
MATERNAL AND CHILD NURSE
1. Considers the family as a whole and as a partner in care when planning or
implementing or evaluating the effectiveness of care.
2. Serves as an advocate to protect the rights of all family members, including
the fetus.
3. Demonstrates a high degree of independent nursing functions because
teaching and counseling are major interventions.
4. Promotes health and disease prevention because these protect the health
of the next generation.
5. Serves as an important resource for families during childbearing and
childrearing as these can be extremely stressful times in a life cycle.
6. Respects personal, cultural, and spiritual attitudes and beliefs as these so
strongly influence the meaning and impact of childbearing and childrearing.
7. Encourages developmental stimulation during both health and illness so
children can reach their ultimate capacity in adult life.
8. Assesses families for strengths as well as specific capacity in adult life.
9. Encourages family bonding through rooming-in and family visiting in
maternal and child healthcare settings.
10. Encourages early hospital discharge options to reunite families as soon as
possible in order to create a seamless, helpful transition process.
11. Encourages families to reach out to their community so the family can
develop a wealth of support people they can call on in a time of family
crisis.
 QSEN: QUALITY & SAFETY
EDUCATION FOR NURSES

1. Patient-centered care
2. Teamwork and collaboration
3. Quality improvement
4. Safety
5. Informatics
6. Evidence-based practice – is the conscientious, explicit, and judicious use of
current best evidence to make decisions about the care of patients.
 STATISTICAL TERMS USED TO REPORT
MATERNAL AND CHILD HEALTH

1. Birth Rate – no. of births per 1000 population

2. Fertility Rate – no. of pregnancies per 1000 women of childbearing age
3. Fetal Death Rate –no. of fetal deaths weighing more than 500 g or more
per 1000 live births
4. Neonatal Death Rate
 Neonatal Period – 1st 28 days of life; Infant is called Neonate
 No. of deaths per 1000 live births occurring in the 1st 28 days of
life.
5. Perinatal Death Rate
 Perinatal Period – 6 weeks before conception and 6 weeks after
childbirth
 No. of deaths of fetuses weighing > 500g and within the first 28
days of life per 1000 birth.
6. Infant Mortality Rate – no. of deaths per 1000 live births in the first
12 months of life.
7. Childhood Mortality rate – no. of deaths per 1000 population in
children; 1 – 14 y/o
8. Maternal Mortality Rate – no. of maternal deaths per 100,000 live
births that occur as direct result of reproductive process.
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LISTENING!