Maternal and Child Health Nursing Goals

Goals of Maternal and Child Health Nursing

• Promotion and maintenance of optimal family health ensures optimal childbearing and childrearing cycles.
• Goals are necessarily broad due to the wide scope of practice.
• Practice includes preconceptual health care.
• Care is provided during the three trimesters of pregnancy and the puerperium (6 weeks after childbirth).
• Care is provided to children during the perinatal period (6 weeks before conception to 6 weeks after birth) and through adolescence.
• Care settings vary from birthing rooms to pediatric intensive care units to homes.

Philosophy of Maternal and Child Health Nursing

• Family centered: Assessment data must include family and individual assessments.
• Community centered: Family health depends on and influences community health.
• Research-oriented: Research increases critical knowledge.
• Nursing theory and evidence-based practice is the foundation for nursing care.
• Nurses act as advocates to protect the rights of all family members, including the fetus.
• A high degree of independent nursing functions is required due to the need for teaching and counseling.
• Promoting health is an important nursing role that protects the health of the next generation.
• Pregnancy or childhood illness can alter family life in subtle and extensive ways.
• Personal, cultural, and religious attitudes/beliefs influence the meaning of illness and its impact.
• Circumstances like illness or pregnancy are meaningful in the context of a total life.
• Maternal and child health nursing is a challenging role that promotes high-level wellness in families.

Standards of Professional Performance (Association of Women's Health, Obstetric, and Neonatal Nurses. in 1998)

• Quality of Care: Nurses systematically evaluate the quality and effectiveness of their practice.
• Performance Appraisal: Nurses evaluate their own practice against professional standards, statutes, and regulations.
• Education: Nurses acquire and maintain current knowledge in nursing practice.
• Collegiality: Nurses contribute to the professional development of peers and colleagues.
• Ethics: Nurses' decisions are determined ethically.
• Collaboration: Nurses collaborate with patients, others, and providers for patient care.
• Research: Nurses use research findings in practice.
• Resource Utilization: Nurses consider safety, effectiveness, and cost in planning care.
• Practice Environment: Nurses contribute to the care environment.
• Accountability: Nurses are accountable in their ethical practice.

Framework for Maternal and Child Health Nursing

• Nurses use nursing process, theory, and evidence-based practice to care for families.
• Care occurs during childbearing and childrearing years through these four phases of health care.
• Health promotion.
• Health maintenance.
• Health restoration.
• Health rehabilitation.

Nursing Process

• Nursing care uses an organized series of steps to ensure consistent quality.
• Problem-solving is based on the scientific method, and is the basis for assessing, diagnosing, planning, organizing, and evaluating care.
• Applicable in all healthcare settings, from prenatal clinics to pediatric ICUs.

Evidenced-based Practice

• Research or investigation of a problem with clinical expertise as the base for action is implied.
• Bodies of knowledge grow and expand to the degree that people use the research skills.
• Nursing research is critical, providing evidence for practice and improving the practice.
• Justification for activities that improve outcomes is provided, ultimately improving patient care.

Nursing Theory

• Professions concentrate knowledge from an established theory base
• Nursing theorists provide ways to view clients to better meet their needs.
• Viewing clients in different ways gives greater patient care.
• Broad theoretical focus allows nurses to appreciate the effect of a child’s illness on the family.

Nurse's Roles and Functions

• Nurses provide assessment, monitoring, education, and support.
• Nurses act as patient advocates
• Nurses collaborate with other healthcare professionals
• Collaboration includes intervention and treatment.
• Collaboration includes promotion of health and safety
• Collaboration includes documentation and reporting

Key Functions of a Nurse

• Guide to prenatal care.
• Managing labor & delivery.
• Postpartum care.
• Work in neonatal intensive care.
• Work in pediatric care.
• Community health.
• Nurses do all of this while advocating, ensuring holistic care to at-risk mothers and children.

Trends in Maternal and Child Health Nursing

• Social structures, family lifestyles, and changing illness patterns are constantly evolving the maternal and child population.
• Families are smaller these days; nurses support them more in times of need.
• Single parents are increasing in number.
• Single parents need more financial resources for a child; nurses need to help find advice.
• More women are working outside of the home, influencing healthcare, child care for children, and more.
• Families are more mobile than before, requiring nurses to have increased health database access.
• Abuse is more common than before, increasing need for intervention.
• Families want increased health education, meaning health care must respect cost containment.

Roles and Responsibilities of Maternal and Child Nurse

• Assisting with labor, delivery, recovery, postpartum care, and high-risk pregnancies.
• Understand equipment through technical skills and staying up-to-date through continuing education.
• Clinical Nurse Specialist (CNS): an advanced practice registered nurse (APRN).
• Case Manager serves as patient advocates, supporting, guiding, and coordinating care
• Family Nurse Practitioner work autonomously or in collaboration to deliver family care.
• Women's Health Nurse Practitioner is an advanced practice nurse who specializes in reproductive health.
• Certified Nurse-Midwives (CNMs) fulfill women's gynecological health and provide prenatal/postnatal care.
• Neonatal Nurse is skilled in newborn care.
• Lactation Consultant teaches mothers on breastfeeding
• Sexual Assault Nurse Examiner with specialized education provides patients with medical forensic care.

Alternatives to Childbirth

• Artificial Insemination (AI) is when sperm is placed in the uterus or cervix by a doctor.
• In Vitro Fertilization fertilizes eggs removed from the ovaries with sperm outside the body.
• Gamete Intrafallopian Transfer places eggs into a catheter along with sperm to be injected elsewhere.

Ethical and Legal Problems

• Ethical issues arise around the creation and disposal of embryos
• Third-party problems include the selection and sale of reproductive material.
• Consideration toward the noncoital means of conception must be made
• Inequitable access to assisted reproductive technology must be considered

Surrogate Mother

• A surrogate mother agrees to carry a pregnancy to term for a sub-fertile couple.
• Couples must respect the attachment of the mother during the pregnancy

Adoption

• Adoption: Some individuals have genetic or health conditions that can cause high risk for pregnancy

Laws

• Intimate Partner Violence includes maltreatment by a family member against another resident.
• Despite efforts, many people have experienced violence from a partner or spouse.
• RA 9262 seeks to address the prevalence of violence against women and children (VAWC).
• RA 7877 declares that sexual harassment is unlawful in employment, education, or training.

PPT2 High-Risk Prenatal Client

• See the following PPT3, Nursing Care for clients with pregestational conditions.

PPT3 Nursing Care of Pregnant Clients with Pregestational Conditions

• Rheumatic Heart Fever (RHD)
• Gestational Diabetes Mellitus (GDM)
• Substance abuse
• HIV
• Rh incompatibility
• Anemia

Rheumatic Heart Fever (RHD)

• Disease is a result of a Beta-hemolytic streptococcal throat infection to lead to Rheumatic Fever.
• The blood increase results to create increased pressure in the heart.

Diagnostic Tests for Pregestational Clients

• Routine urinalysis and blood works
• ECG
• Echocardiograms and pulse oximetry studies.

Gestational Diabetes Mellitus (GDM)

• This has been increasing in U.S. and worldwide
• Specific risks of diabetes in pregnancy include:
  • Spontaneous abortion
  • Fetal anomalies
  • Preeclampsia
  • Fetal demise
  • Macrosomia
  • Neonatal hypoglycemia
  • Neonatal hyperbilirubinemia
  • Neonatal respiratory distress syndrome.
• The fetus uses glucose as a primary fuel, meaning the maternal is directly linked to fetal.
• Maternal glucose rises, increasing fetal glucose and resulting in fetal insulin secretion.
• Diagnostic Tests: FBS & Random blood sugar test.

Substance Abuse

• Factors that can affect those who are affected:
  • Feelings of shame
  • Denial and the stigma from drug users
  • Lack of awareness from medical workers
• Tobacco, alcohol and drugs are harmful, especially if an individual is nursing or are pregnant.

Human Immunodeficiency Virus (HIV)

• People with HIV have high white cell counts and can develop one or more infections
• HIV can be transmitted through bodily fluids
  • Blood
  • Semen
  • Pre-seminal Fluid
  • Vaginal fluids
• Risk of transmission is low when:
  • Early detection during pregnancy
  • Babies take HIV medicine in 4-6 weeks

Anemia

• A blood disorder in which the blood is in reduced ability to carry oxygen.
• Midwives help identify anemia by:
  • Reviewing history
  • Reviewing medical records
  • Reviewing social lives.

PPT4

• These are Nursing Cares for Pregnant Clients that have Gestational Conditions:
  • Hyperemesis Gravidarum
  • Ectopic Pregnancy
  • Gestational Trophoblastic Disease (GTD)
  • Incompetent Cervix
  • Spontaneous Abortion
  • Placenta Previa
  • Abruptio Placenta
  • Premature Rupture of Membranes (PROM)
  • Pregnancy Induced Hypertension
  • Gestational Diabetes Mellitus (GDM)

Hyperemesis Gravidarum

• Occurs commonly during the first pregnancy phase and conditions
• Black people are more likely to experience hyperemesis gravidarum when compared with whites.