Pediatric Nursing Standards and Practices

Framework for Maternal and Child Health Nursing

• Maternal and child health nursing is evidence-based and includes a high degree of independent nursing functions, such as teaching and counseling.
• Maternal and child health nurses serve as advocates to protect the rights of all family members, including the fetus.
• The primary goal of maternal and child health nursing care is the promotion and maintenance of optimal family health.

Phases of Health Care

• Health Promotion: educating clients to be aware of good health through teaching and role modeling
  • Example: Teaching women the importance of rubella immunization before pregnancy
• Health Maintenance: intervening to maintain health when risk of illness is present
  • Example: Encouraging women to come for prenatal care; teaching parents the importance of safeguarding their home against poisoning
• Health Restoration: using conscientious assessment to identify symptoms of illness and beginning interventions to return patients to wellness
  • Example: Caring for a woman during a complication of pregnancy or a child during an acute illness
• Health Rehabilitation: preventing further complications from an illness; bringing an ill client back to an optimal state of wellness or helping a client to accept inevitable death
  • Example: Encouraging a woman with gestational trophoblastic disease to continue therapy or a child with a renal transplant to continue to take necessary medications

Nursing Process

• A form of problem-solving based on the scientific method, used to assess, make a nursing diagnosis, plan, organize, and evaluate care
• Applicable to all health care settings, from prenatal clinics to pediatric intensive care units

Philosophy of Maternal and Child Health Nursing

• Family-centered approach: considering the family as a whole and as individual members
• Community-centered approach: recognizing the influence of the community on the health of families
• Standards of care and professional performance: established by organizations such as the American Nurses Association and the Society of Pediatric Nurses

Evidence-Based Practice

• Use of evidence-based practice helps to move all health care actions to a more solid, scientific base
• The Cochrane Database of Systematic Reviews is a good source for discovering evidence-based practices
• Nursing research provides evidence for practice and justification for implementing activities for outcome achievement### Evidence-Based Practice
• Evidence-based practice is the conscientious, explicit, and judicious use of current best evidence in making decisions about patient care.
• It combines research, clinical expertise, and patient preferences.
• The worth of evidence is ranked according to its relevance and reliability.

Nursing Theory

• Nursing theories help define what nurses do and why they do it.
• They provide a framework for understanding clients and delivering care that meets their needs.
• Examples of nursing theories include Calista Roy's theory, which stresses the role of nurses in helping patients adapt to change, and Dorothea Orem's theory, which concentrates on patients' ability to perform self-care.

QSEN: Quality and Safety Education for Nurses

• The overall goal of QSEN is to prepare future nurses to continuously improve the quality and safety of healthcare systems.
• The six competencies of QSEN are:
• Patient-centered care
• Teamwork and collaboration
• Evidence-based practice
• Quality improvement
• Safety
• Informatics

Patient-Centered Care

• Patient-centered care involves treating patients as the source of control and full partners in their care.
• It is based on respect for patients' preferences, values, and needs.
• Examples of patient-centered care include taking a detailed admission history, encouraging patients to spend time with their families, and assessing family support.

Teamwork and Collaboration

• Nurses function effectively within nursing and interprofessional teams.
• They foster open communication, mutual respect, and shared decision-making to achieve quality patient care.

Quality Improvement

• Quality improvement involves using data to monitor the outcomes of care and designing and testing changes to improve quality and safety.
• Examples of quality improvement strategies include using checklists and flow sheets to provide seamless care and minimizing the risk of harm to patients and providers.

Safety

• Safety involves minimizing the risk of harm to patients and providers through system effectiveness and individual performance.
• Examples of safety strategies include learning the requirements for a safe healthcare setting, recognizing families under stress, and documenting care in an electronic health record.

Informatics

• Informatics involves using information and technology to communicate, manage knowledge, and mitigate error.
• Examples of informatics strategies include keeping records and documentation current, documenting care in an electronic health record, and recognizing the importance of complete documentation.

Maternal and Child Health Goals and Standards

• The 2020 National Health Goals aim to improve the health of women and children.
• The goals are to:
• Increase the quality and years of healthy life
• Eliminate health disparities
• The emphasis is on both preconceptual and prenatal care, as well as care during the neonatal period.

Global Health Goals

• The Global Health Goals aim to improve health worldwide.
• The goals are to:
• End poverty and hunger
• Achieve universal primary education
• Promote gender equality and empower women
• Reduce child mortality
• Improve maternal health
• Combat HIV/AIDS, malaria, and other diseases
• Ensure environmental sustainability
• Develop a global partnership for development

Measuring 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 per 1,000 live births
• Infant mortality rate: the number of deaths per 1,000 live births occurring in the first year of life
• Childhood mortality rate: the number of deaths per 1,000 population aged 1-14 years
• Perinatal death rate: the number of deaths during the perinatal time period (beginning at 20 weeks of pregnancy and ending at 4-6 weeks after birth)
• Maternal mortality rate: the number of maternal deaths per 100,000 live births

Trends in Healthcare Environment

• Initiating cost containment
• Increasing alternative settings and styles for healthcare
• Increasing use of technology
• Meeting the needs of pregnant and breastfeeding women
• Expanding maternity leave laws (e.g. Republic Act No. 11210 in the Philippines)### Regionalizing Intensive Care
• Regionalized critical care system: sickest patients are triaged en route to specialized ICUs in referral hospitals
• Close monitoring of personnel, supply use, hospital stays, patient-to-outpatient ratios, and referrals to maintain quality care while reducing healthcare costs

Changes in Health Insurance Coverage

• Changes in the healthcare industry occur at the legislative level, impacting facility operations and resource use
• PhilHealth (Philippine Health Insurance Corporation) provides health insurance coverage and ensures affordable, accessible healthcare services for all Filipino citizens

Increasing Use of Alternative Treatment Modalities

• Alternative forms of therapy, such as acupuncture and therapeutic touch, are used in addition to or instead of traditional therapy
• Increasing use of herbal remedies, such as drinking herbal teas during pregnancy to relieve morning sickness

Increasing Reliance on Home Care

• Shortened hospital stays lead to a transition from hospital to home care for many women and children before they are optimally ready for self-care
• Additional care providers are required for home care

Healthcare Concerns and Attitudes

Reproductive Development

• Begins at conception and continues through life
• Intrauterine development:
  • 5th week: mesonephric (wolffian) and paramesonephric (müllerian duct) form
  • 7th or 8th week: formation of testosterone in chromosomal males
  • 10th week: development of external genitalia
• Pubertal development:
  • Hypothalamus → GnRH → anterior pituitary → FSH and LH
  • Role of androgen: muscular development, physical growth, and increase in sebaceous gland secretions
  • Role of estrogen: development of uterus, fallopian tubes, and vagina; female fat distribution, hair patterns, and breast development

Male Reproductive System

Male External Structures

• Scrotum:
  • Thin external sac of skin divided into two compartments, each containing one testis and one epididymis
  • Temperature is several degrees below normal body temperature, essential for viable sperm production
• Testes:
  • Ovoid glands, 2-3 cm wide, located in the scrotum
  • Each testis contains interstitial cells (Leydig cells) producing testosterone and a seminiferous tubule producing spermatozoa
• Penis:
  • Glans (head) of the penis: covered with pink, moist tissue called mucosa
  • Foreskin (prepuce) covers the glans in uncircumcised men
  • Corpus cavernosum: two columns of tissue running along the sides of the penis, filling with blood to cause an erection

Female Reproductive System

Female External Structures

• Mons Veneris: pad of adipose tissue located over the pubic bone, covered by a triangle of coarse, curly hair
• Labia minora and labia majora: thin folds of skin surrounding the vaginal opening
• Fourchette: range of tissue formed by the posterior joining of the labia minora and labia majora
• Hymen: tough but elastic semicircle of tissue covering the opening to the vagina during childhood