Maternal Week 2 - MS. Ignacio PDF

A. Goals and Philosophers of 07 MCHN: Standard ll: Performance Appraisal The pediatric nurse evaluates his or her own nursing practice Primary goal: is the promation de mainterance af i...

A. Goals and Philosophers of 07 MCHN: Standard ll: Performance Appraisal The pediatric nurse evaluates his or her own nursing practice Primary goal: is the promation de mainterance af in relation to professional practice standards and relevant Optimal family health. statutes and regulations. Maternal and child health nursing : extends from preconcption to menopause with an expensive array health Standard Ill: Education issues and health care providers. The pediatric nurse acquires and maintains current Obstetric nursing: care of women during child birth. knowledge and competency in pediatric nursing practice. Maternal and child Health Nursing Standard IV: Collegiality >family centered The pediatric nurse interacts with and contributes to the > Evidence based professional development of peers, colleagues, and other > communty centered health care providers. - a challenging role for nurses and a major factor keeping families well a Optimally functioning. Slandard V: Ethics The pediatric nurse's assessment, actions, and THE SCOPE OF PRACTICE INCLUDES: recommendations on behalf of children and their familles are preconception heath care. determined in an ethical manner. Care of women during three trimester of pregnancy and the perception.( the 6 weeks after childbirth Standard VI: Collaboration sometimes termed the 4th trimester of pregnancy). The pediatric nurse collaborates with the child, family, and care of Infant during the perinatal period. other health care providers in providing client care. (the time span beginning of 20 weeks of pregnancy to 4 weeks ( 28 days) after birth. Standard VII: Research Care of children from birth to late adolescent. The pediatric nurse contributes to nursing and pediatric Care in a variety of hospital and home settings: health care through the use of research methods and findings. Standard VIll: Resource Utilization The pediatric nurse considers factors related to safety, B. MATERNAL AND CHILD HEALTH GOALS AND effectiveness, and cost in planning and delivering patient STANDARDS care. Standard IX: Practice Environment National Healthy People 2030 goals The nurse contributes to the environment of care delivery In 2020, the government set new goals to be achleved by within the practice settings. 2030, the Healthy People 2030 goals. are intended to help Americans more easily understand the Standard X: Accountability importance of health promotion and disease prevention and The nurse is professionally and legally accountable for to encourage wide participation in improving health for the his/her practice. next decade. The professional registered nurse may delegate to and supervise qualified personnel who provide patient care. Global Health Goals Framework for MCH Nursing Care The United Nations and WHO established millennium health goals in 2020 in an effort to improve health worldwide. Maternal and Child Health Nursing can be *Central to the goal are the targets that relate to maternal and visualized within a framework in which nurses use the child Tealth: Marsing Process, Nursing Theory and Quality and Safety 1. By 2030, reduce the global maternal mortality ratio Education for Nurses (QSEN] competencies to care for to less that 70 per 100.000 live births. families during childbearing and childrearing years and 2. By 2030, end preventable deaths of newborns and through the 4 phases of health care: children under 5 years of age, 3. By 2030, ensure universal access to sexual and Health promotion reproductive health care services. Health maintenance 4. Achieve universal health coverage. Health restoration 5. Strengthen the prevention and treatment of Health rehabilitation substance abuse. 6. By 2030, end the epidemics of AIDS tuberculosis Nursing Process and neglected tropical diseases and combat hepatitis, waterborne diseases and other Nursing care, at its best, is designed and communicable diseases. (WHO,2021) implemented in a thorough manner, using an organized series of steps, to ensure quality and Standards of Care: consistency of care. 1. Assessment Nursing Theory 2. Diagnosis 3. Outcome identification One of the requirements of a profession is that the 4. Planning concentration of a discipline's knowledge flows 5. Implementation from a base of established theory. 6. Evaluation Nursing theorists offer helpful ways to view clients Standards of Professional Performance: so that nursing activities can best meet client needs. Standard I: Quality of Care The pediatric nurse systematically evaluates the quality and effectiveness of pediatric nursing practice. QSEN: Quality and Safety Education for Nurses Stresses the importance of a nurse/patient to adapt to change cause by illness and other stressors. Improve the quality of nursing care and to build knowledge, A person is a holistic adaptive system in constant skills and attitudes necessary to help achieve that level of care with the interaction with the external and internal into prelicensure and graduate programs. environment. The main task of the human system is to maintain § Patient centered care integrity in the face of environmental stimuli. § Teamwork and collaboration § Quality improvement three central questions: § Informatics a. Who is the focus of nursing care? § Evidence based practice b. What is the target of nursing care? and When is § Safety nursing care indicated? Evidence Based Practice Under the concept of adaptation are four modes: § Evidence-based practice is the conscientious, physiological, self concept, role function, and explicit, and judicious use of current best evidence interdependence. in making decisions about the care of patients (Foxcroft & Cole, 2009). 1. Physiological - deals with the maintenance of the physical body. Nursing Research 2. Self-concept - the need for the maintenance the systematic investigation of problems that have of the mind. implications for nursing practice usually carried 3. Role function - Social integrity is out by nurses. emphasized in the role function mode. Birth rate: The number of births per 1,000 population. 4. Interdependence - Social integrity is Fertility rate: The number of pregnancies per 1,000 women of emphasized in the role function mode. childbearing age. Fetal death rate: The number of fetal deaths (over 500 g) per Dorothea Grem's Self care Deficit Theory 1,000 live births. Neonatal death rate: The number of deaths per 1,000 live The central philosophy of the Self-Care Deficit births occurring at birth or Nursing Theory is that all patients want to care for 74in the first 28 days of life. themselves, and they are able to recover more Perinatal death rate: The number of deaths during the quickly and holistically by performing their own perinatal time period self care as much as they're able. This theory is (beginning when a fetus reaches 500 g, about week 20 of particularly used in rehabilitation and primary care pregnancy, and ending or other settings in which patients are encouraged about 4 to 6 weeks after birth); it is the sum of the fetal and to be independent. neonatal rates. Maternal mortality rate: The number of maternal deaths per If a patient is unable to meet their self-care 100,000 live births that requisites, a "self-care deficit" occurs. occur as a direct result of the reproductive process. Infant mortality rate: The number of deaths per 1,000 live Patients are able to recover when they maintain births occurring at birth or some independence over their own self care. in the first 12 months of life. Childhood mortality rate: The number of deaths per 1,000 Dr Patricia Benner's Theory: From Novice to Expert population in children aged 1 to 14 years. This concept explains that nurses develop skills and an understanding of patient care over time from a combination of a strong educational THEORIES RELATED TO MATERNAL AND CHILD foundation and personal experiences. HEALTH NURSING the development of knowledge in fields such as Ramona Mercer's Maternal Role Attainment Theory nursing is made up of the extension of knowledge through research and understanding through In the process, the mother bonds with the infant, clinical experience. acquirein general caretaking tasks, and then comes to express joy and pleasure in her role as a mother. identifies five levels of nursing experience Nursing Process in the maternal Role Attainment 5 LEVELS OF NURSING EXPERIENCE: Theory: 1. Novice - a beginner with no experience. Anticipatory - the social and psychological They are taught general rules to help perform tasks adaptation to the maternal role. This includes they are told what to do and simply follow learning expectations and can involve fantasizing instruction. about the role of the mother. 2. Advanced Beginner - shows acceptable performance, and has gained prior experience in Formal - The assumption of maternal role at birth actual nursing situations. 3. Competent - nurse generally has two or three Informal - The mother develops her own methods years experience on the job in the same field. of mothering which are not conveyed by a social lack the speed and flexibility of proficient nurses system. but they have some mastery and can rely on Personal - the joy of motherhood. advance planning and organizational details. 4. Proficient - These nurses learn from experiences Sr. Cellista Roy's Adaptation Model of Nursing what to expect in certain situations, as well as how to modify plans as needed.  5. Expert - They have a deeper background of o with the highest level of practice expertise experience and an intuitive grasp of clinical integrated with the ability to translate scientific situations. Their performances are fluid, flexible, knowledge into complex clinical interventions. and highly-proficient. o Are leaders for organization and system management, quality improvement, health policy Benner's writings explain that nursing skills development, and interdisciplinary collaboration through experience are a prerequisite for becoming (Fain, Asselin, & McCurry, 2008). an expert nurse. Neonatal Nurse Practitioner ROLES AND RESPONSIBILITIES OF OF MATERNAL AND o (NNP) is an advanced-practice role for nurses who CHILD NURSE are skilled in the care of newborns, both well and ill. 1. Considers family as a whole and as a partner o The NNP's responsibilities include managing and in care when planning or implementing or caring for newborns in intensive care units, evaluating the effectiveness of care. conducting normal newborn assessments and 2. Serves as an advocate to protect the rights of physical examinations, and providing high-risk all family members including the fetus. follow-up discharge planning (Bowen, 2007). 3. Demonstrates a high degree of independent o They also are responsible for transporting ill nursing functions infants to these different care settings. 4. Promotes health and disease prevention. 5. Serves as an important resource for families during childbearing and childrearing. 6. Respects personal, cultural and spiritual attitudes and beliefs. Women's Health Nurse Practitioner 7. Encourages developmental stimulation o has advanced study in the during both health and illness so children can promotion of health and preventio of illness in reach their ultimate capacity in adult life. women. 8. assesses families for strength as well as o Such a nurse plays a vital role in educating women specific needs or challenges about their bodies and sharing with them methods 9. encourages family bonding through rooming to prevent illness in and family visiting in maternal and child o They play a large role in helping women remain health care settings. well so that they can enter a pregnancy in good stay together in the same room for health and maintain their health throughout life. 24 hours. Rooming in and Breastfeeding Act Family Nurse Practitioner of 1992 (RA 7600) o (FNP) is an advanced-practice role that provides 10. encourage early hospital discharge options to health care not only to women or children but to reunite familles as soon as possible in order to the farily as a whole. create a seamless, helpful transition process. o In conjunction with a physician, an FNP can 11. encourage families to reach out to their provide prenatal care for a women with an community so the family can develop a wealth uncomplicated pregnancy. of support people they can call on in a time of o The FNP takes the health and pregnancy history, family crisis. performs physical and obesteric examination, orders appropriate diagnostic and laboratory test, and plans continued care throughout the Clinical Nurse Specialist pregnancy and for the family afterward. o FNPS then monitor the family indefinitely to o are nurses prepared at the master's or doctorate promote health and optimal family functioning degree level who are capable of acting as during heath and illness. consultants in their area of expertise, as well as serving as role models, researchers, and teachers of Certified Nurse-Midwife quality nursing care. o (CNM) is educated in the two disciplines of nursing o Examples of areas of specialization are neonatal, and midwifery and licensed according to the maternal, child, and adolescent health care; requirements of the state genetics; childbirth education; and lactation o plays an important role in assisting women with consultation (McArthur & Flynn, 2008). pregnancy and childbearing o the nurse-midwife assumes full responsibility for Case Manager the care and management of women with uncomplicated pregnancies. o Is a graduate-level nurse who supervises a group of o Nurse-midwives play a large role in making birth an patients from the time they enter a health care unforgettable family event as well as helping to setting until they are discharged from the setting ensure a healthy outcome for both mother and or, in a seamless care system child (Declerca, 2007) o They help prevent fragmentation of care and ensure continuity of care and providing a feeling of WHO'S 17 SUSTAINABLE DEVELOPMENT GOALS "medical home" are included in care. o The Sustainable Development Goals (SDGs) are a o one that follows people both during an illness and collection of 17 global goals designed to be a on their return to the community, it involves long- "blueprint to achieve a better and more sustainable term contacts future for all". o The SDGs, set in 2015 by the United Nations Nurse Practitioner General Assembly and intended to be achieved by o are nurses educated at the master's or doctoral the year 2030 level. o The goals are categorized into 5 areas (5 P's): o indepth education for nurse practitioners as they people, planet, prosperity, peace and partnership. play pivotal roles in today's health care system. The Sustalnable Development Goals are:  1. No Poverty "emancipated minors or mature minors" 2. Zero hunger and have the right to sign for their own 3. Good health health care. 4. Education o Personal liability insurance is strongly 5. Gender equality recommended for all nurses, so that they 6. Clean water do not incur great financial losses during 7. Clean energy a malpractice or professional negligence 8. Economic growth suit. 9. Industry and infrastructure o In some states, obstetric services are 10. No inequality facing a crisis situation as more 11. Sustainabili physicians and nurse-midwives find the 12. Responsible consumption cost of malpractice insurance to guard 13. Climate action against "wrongful birth" Is making their 14. Life under water practice no longer profitable. 15. Life on land 16. Peace and justice A wrongful birth is the birth of a disabled child when the 17. Partnership for the goals, international, parents would have chosen to end the pregnancy if they had cooperation is vital. been informed about the disability during pregnancy "Wrongful life" Is a claim that negligent prenatal testing on the part of a health care provider resulted in the birth of an unperfect child. SCOPES AND STANDARDS o Because many genetic disorders can be identified prenatally, the scopes of both "wrongful birth" and 1. Scope and Standards of Maternal and Child "wrongful life" grow yearly. Philippines o If a nurse knows that the care provided by another 2. Legal considerations of maternal and child practice practitioner was inappropriate or insufficient, he or she is legally responsible for reporting the incident. o Maternal and child health nursing o Failure to do so can lead to a charge of negligence carries some legal concerns that extend or breach of duty. above and beyond other areas of nursing, because care is often given to an “unseen client”- the fetus--or to clients who are Legal considerations of maternal and child practice not of legal age for giving consent for Knowledge of laws that regulate and affect nursing practice is medical procedures. needed for two reasons: o Labor and birth of a neonate are considered "normal" events, so the risks 1. To ensure that the nurse's decisions and actions are for a lawsuit are greater when problems consistent with current legal principles. arise. 2. To protect the nurse from liability. o Nurses are legally responsible for protecting the rights of their clients, Nurses are legally responsible for protecting the rights of including confidentiality, and are their clients, including confidentiality, and are accountable accountable for the quality of their for the quality of their individual nursing care and that of individual nursing care and that of other other health care team members. health care team members. o In a society in which child abuse is of Legal Roles of Nurses: national concern, all health care providers are becoming increasingly Nurses have three separate, interdependent legal roles, each responsible for identifying and reporting with rights and associated responsibilities: incidents of suspected abuse in children. o Understanding the scope of praclice and 1. provider of service standards of care can help nurses 2. employee or contractor for service practice within appropriate legal 3. citizen. parameters. o Documentation is essential for Lability is the quality or state of being legally protecting a nurse and justilying his or responsible for one's obligations and actions and her actions Ihis concer is long-lasing, for making financial restitution for wrongful acts. because children who feel they were The standards of care by which a nurse acts or fails wronged by health care personnel can to act are legally defined by nurse practice acts and bring a lawsuit at the time they reach by the rule of reasonable and prudent action -what legal age. a reasonable and prudent professional with similar o Nurses need to be conscientious about preparation and experience would do in similar obtaining informed consent for invasive circumstances. procedures and determining that Contractual obligations refer to the nurse's duty of pregnant women are aware of any risk to care, that is, duty to render care, established by the the fetus associaled with a procedure or presence of an expressed or implied contract. test. o In divorced or blended families (those in EMPLOYEE OR CONTRACTOR FOR SERVICE which two adults with children from previous relationships now live A nurse who is employed by an agency works as a together), it is important to establish representative of the agency, and the nurse's who has the right to give consent for contract with clients is an implied one. health care. A nurse who is employed directly by a client, for o Adolescents who support themselves or example, a private nurse, may have a written who are pregnant are termed  contract with that client in which the nurse agrees o Usually, the more invasive a procedure or the to provide professional services for a certain fee. greater the potential for risk to the client, the A nurse might be prevented from carrying out the greater the need for written permission. terms of the contract because of illness or death. However, personal inconvenience and personal Implied consent exists when the individual's nonverbal problems, are not legitimate reasons for failing to behavior indicates agreement. fulfill a contract. o For example, clients who position their bodies for an injection or cooperate with the taking of vital Contractual relationships vary among practice signs infer implied consent. settings. o Consent is also implied in a medical emergency when an individual cannot provide express consent An independent nurse practitioner is a contractor because of physical condition. for service whose contractual relationship with the o Obtaining informed consent for specific medical client is an independent one. and surgical treatments is the responsibility of the The nurse employed by a hospital functions within person who is going to perform the procedure. an employer-employee relationship in which the o Generally this person is the primary care provider; nurse represents and acts for the hospital and however, it could also be a nurse practitioner, nurse therefore must function within the policies of the anesthetist, nurse midwife, clinical nurse employing agency. specialist, or physician assistant who is performing procedures in their advanced practices. This type of legal relationship creates the ancient o Informed consent also applies to nurses who are legal doctrine known as respondeat superior ("let not independent practitioners and are performing the master answer"). direct nursing care. o The nurse relies on orally expressed consent or In other words, the master (employer) assumes implied consent for most nursing interventions. responsibility for the conduct of the servant o It is imperative to remember the importance of (employee) and can also be held responsible for communicating with the client by explaining professional negligence by the employee. nursing procedures, ensuring the client By virtue of the employee role, therefore, the understands, and obtaining permission. nurse's conduct is the hospital's responsibility o The law says that a "reasonable amount" of The nurse in the role of employee or contractor for Information requited for the client to make an service has obligations to the employer, the client, informed decislon is what any other reasonable and other personnel. health care practitioner would disclose under The nursing care provided must be within the similar circumstances limitations and terms specified. The nurse has an obligation to contract only for those responsiblites General guidelines include the following that the nurse is competent to discharge. The nurse is expected to respect the rights and o The diagnosis or condition that requires treatment responalbilities of other health care participants. o The purposes of the treatment The nurse has the right to expect restonable and o What the client can expect to feel or experience prudent conduct from other health professionals. o The intended benefits of the treatment o Possible risks or negative outcomes of the treatment CITIZEN o Advantages and disadvantages of possible The rights and responsibilities of the nurse in the alternatives to the treatment (including no role of citizen are the same as those of any treatment) individual under the legal system. Rights of citizenship protect clients from harm and Informed consent has three major elements: ensure consideration for their personal property rights, rights to privacy, confidentiality, and other 1. The consent must be given voluntarily. rights, 2. The consent must be given by a client or Individual " Nurses move in and out of these roles when with the capacity and competence to understand. carrying out professional and personal 3. The client or individual must be given enough responsibilities. information to be the ultimate decision maker To give informed consent voluntarily, the client SELECTED LEGAL ASPECTS OF NURSING PRACTICE must not feel coerced Informed Consent Coercion invalidates the consent. It is important, therefore, for the person obtaining o is an agreement by a client to accept a course of the consent to invite and answer client questions. treatment or a procedure after being provided Cultural perspective also needs to be considered complete information, including the benefits and when clients are asked to make decisions about a risks of treatment, alternatives to the treatment, procedure or treatment. and prognosis if not treated by a health care Each person has the right to decide what can or provider. cannot be done to his or her person. o the goal of informed consent is *mutual decision The competent adult client is expected to have the making between both professional and patient over autonomy to make his or her own health care the treatment option that the patient wishes to decisions. receive or not to receive. It is also important for the client to understand the written material, There are two types of consent: A competent adult is a person over 18 years of age Express consent may take the form of either an oral or who is conscious and oriented written agreement A client who is confused, disoriented, or sedated is not considered functionally competent.  A legal guardian or representative can provide or The nurse advocates for the client by verifying that refuse consent for the Incompetent adult. the client received enough information to give consent. Ø EXCEPTIONS ü Therefore, it is important for the nurse to Three groups of people cannot provide assess the client's understanding and consent. identify any misconceptions. ü the nurse can ask clients to explain in The first is minors, a parent or guardian their own words what the person who is must give consent before minors can going to perform the procedure obtain treatment. The same is true of an explained to them adult who has the mental capacity of a ü If the client has questions or if the nurse child and who has an appointed has doubts about the client's guardian. understanding, the nurse must notify the health care provider. In some states, however, minors are ü Again, the nurse is not responsible for allowed to give consent for such explaining the medical or surgical procedures as blood donations, procedure In fact, the nurse could be treatment for substance abuse, liable for giving incorrect or incomplete treatment for mental health problems, information or interfering with the and treatment for reproductive health client-provider relationship concerns such as sexually transmitted ü The right of consent also involves the infections or pregnancy. right of refusal (Guido, 2014) In addition, certain groups of minors are ü Remind clients that they can change often legally permitted to provide their their minds and cancel the procedure at own consent. These include those who any time because the right to refuse are married, pregnant, parents, members continues even after signing the of the military, or emancipated (living on consent. their own). These statutes may vary by ü The nurse needs to notify the health care state. provider of the client's refusal and document the refusal in the chart The second group is individuals who ü Documentation is an important aspect of are unconscious or injured in such a Informed consent. way that they are unable to give A client's concerns or questions must be consent. documented along with the notification In these situations, consent is usually of the health care provider obtained from the closest adult relative ü Equally Important is documenting when if existing statutes permit. the client states understanding. In a life-threatening emergency, if ü Record any teaching as a result of consent cannot be obtained from the nursing related questions by the client client or a relative, then the law ü Any special circumstances, such as use of generally agrees that consent is implied an interpreter, should be documented to provide necessary care for the client's emergency condition. The Rights of Childbearing Women The third group is people with mental illnesses who have been judged by 1. Every woman has the right to health care professionals to be incompetent. before, during, and after pregnancy and State mental health acts or similar childbirth. statutes generally provide definitions of 2. Every woman and infant has the right to mental illness and specify the rights of receive care that is consistent with those who have mental illnesses under current scientific evidence about the law as well as the rights of the staff benefits and risks. caring for such clients. 3. Every woman has the right to choose a midwife or a physician as her maternity NURSE'S ROLE care provider. 4. Every woman has the right to choose her Nurses are often asked to obtain a signed birth setting from the full range of safe consent form. options available in her community, on The nurse is not responsible for the basis of complete, objective explaining the procedure but for information about benefits, risks and witnessing the client's signature on the costs of these options. form. 5. Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of The nurse's signature confirms three caregivers, with whom she can establish things: a relationship. Every woman has the right to leave her maternity caregiver ü The client gave consent and select another if she becomes voluntarily. dissatisfied with her care. ü The signature is authentic. 6. Every woman has the right to ü The client appears competent information about the professional to give consent. identity and qualifications of those involved with her care, and to know when those involved are trainees. 7. Every woman has the right to UNITED NATIONS DECLARATION OF THE RIGHTS OF communicate with caregivers and THE CHILD receive all care in privacy, which may involve excluding nonessential Principle 1 personnel. 8. Every woman has the right to receive The child shall enjoy all the rights set forth in this maternity care that identifies and Declaration. addresses social and behavioral factors that affect her health and that of her All children, without any exception whatsoever, shall be baby. entitled to these rights, without distinction or discrimination 9.. Every woman has the right to full and on account of race, color, sex, language, religion, political or clear information about benefits, risks, other opinion, national or social origin, property, birth, or and costs of the procedures, drugs, tests other status, whether of himself or of his family. and treatments offered to her, and of all other reasonable options, including no Principle 2 intervention. 10. Every woman has the right to accept or The child shall enjoy special protection, and shall be given refuse procedures, drugs, tests and opportunities and facilities, by law and by other means, to treatments, and to have her choices enable him to develop physically, mentally, morally, honored. spiritually and socially in a healthy and normal manner and 11. Every woman has the right to be in conditions of freedom and dignity. informed if her caregivers wish to enroll her or her infant in a research study. In the enactment of laws for this purpose, the best interests 12. Every woman has the right to of the child shall be the paramount consideration. unrestricted access to all available records about her pregnancy, her labor, Principle 3 and her infant; to obtain a full copy of these records; and to receive help in The child shall be entitled from his birth to a name and a understanding them, if necessary. nationality. 13. Every woman has the right to receive maternity care that is appropriate to her Principle 4 cultural and religious background, and to receive information in a language in The child shall enjoy the benefits of social security. He shall which she can communicate. be entitled to grow and develop in health; to this end special 14.. Every woman has the right to have care and protection shall be provided both to him and to his family members and friends of her choice mother, including adequate prenatal care. present during all aspects of her maternity care. The child shall have the right to adequate nutrition, housing, 15. Every woman has the right to receive recreation, and medical services. continuous social, emotional, and physical support during labor and birth Principle 5 from a caregiver who has been trained in labor support. The child who is physically, mentally, or socially handicapped 16. Every woman has the right to receive full shall be given the special treatment, education, and care advance information about risks and required by his particular condition. benefits of all reasonably available methods for relieving pain during labor Principle 6 and birth, including methods that do not require the use of drugs. The child, for the full and harmonious development of his 17. Every woman has the right to freedom of personality, needs love and understanding. movement during labor, unencumbered He shall, wherever possible, grow up in the care and under the by tubes, wires, or other apparatus. She responsibility of his parents, and in any case in an also has the right to give birth in the atmosphere of affection and of moral and maternal security; position of her choice. a child of tender years shall not, save in exceptional 18. Every woman has the right to virtually circumstances, be separated from his mother. uninterrupted contact with her newborn from the moment of birth, as long as she Society and the public authorities shall have the duty to and her baby are healthy and do not need extend particular care to children without a family and to care that requires separation. those without adequate means of support. 19. Every woman has the right to receive complete information about the benefits Payment of state and other assistance toward the of breastfeeding well in advance of labor, maintenance of children of large families is desirable. to refuse supplemental bottles and other actions that interfere with breastfeeding, Principle 7 and to have access to skilled lactation support for as long as she chooses to The child is entitled to receive education, which shall be free breastfeed. and compulsory, at least in the elementary stages. 20. Every woman has the right to decide collaboratively with caregivers when she He shall be given an education that will promote his general and her baby will leave the birth site for culture and enable him on a basis of equal opportunity to home, based on their condition and develop his abilities, his individual judgment, and his sense circumstances. of moral and social responsibility and to become a useful member of society. The best interests of the child shall be the guiding principle Philippine Reproductive Health Law of those responsible for his education and guidance; that o The Responsible Parenthood and Reproductive responsibility lies in the first place with his parents. Health Act of 2012, also known as the Reproductive Health Law or RH Law, and officially designated as The child shall have full opportunity for play and recreation, Republic Act No. 10354, is a law in the Philippines, which shall be directed to the same purposes as education; which guarantees universal access to methods on society and the public authorities shall endeavor to promote contraception, fertility control, sexual education, the employment of this right. and maternal care. o Effective January 17,2013 Principle 8 8 components of the RH The child shall in all circumstances be among the first to receive protection and relief. o Reproductive health. o Adolescent health. Principle 9 o Maternal health. o Contraception. The child shall be protected against all forms of neglect, o Sexually transmitted infection. cruelty, and exploitation. He shall not be the subject of traffic, o Abortion. in any form. o Female genital mutilation. o Child and forced marriage. The child shall not be admitted to employment before an appropriate minimum age, he shall in no case be caused or permitted to engage in any occupation or employment that DOH Programs on Maternal and Childcare would prejudice his health or education, or interfere with his physical, mental, or moral development. NATIONAL SAFE MOTHERHOOD PROGRAM Principle 10 Component A Local Delivery of the Maternal-Newborn Service Package The child shall be protected from practices that may foster racial, religious, and any other form of discrimination. o This component supports IGUs in establishing and He shall be brought up in a spirit of understanding, tolerance, mobilizing the service delivery network of public friendship among peoples, peace, and universal brotherhood and private providers to enable them to deliver the and in full consciousness that his energy and talents should integrated maternal-newborn service package be devoted to the service of his fellow men. o In each province and city, the following shall continue to be dertaken: o Establishment of critical capacities to provide Advances in genetics and genetic technology quality maternal newborn services through the organization and operation of a network of Service The goal of nursing research in clinical genetics and Delivery Teams consisting of genomics is to improve the quality of health care for patients o Barangay Health Workers and families. o BEmONC Teams composed of Doctors, o Genetics - how the characteristics of living things Nurses and Midwives are passed through the genes from parents to children Component B: National Capacity to Sustain Maternal- o Genomics - concerned with the structure, Newborn Services function, evolution, o Operational and Regulatory Guidelines and mapping of genomes. Identification and profiling of current FP Genetics nurses perform risk assessment, analyze the users and identification of potential FP genetic contribution to disease risk, and discuss the impact of clients and those with unmet need for FP risk on health care management for individuals and families. (permanent or temporary methods) They also provide genetics education, provide nursing care to patients and families and conduct research in genetics. Mainstreaming FP in the regions with high unmet need for (ISONG - International Society of Nurses in Genetics) EP Development and dissemination of Definition of Genetics/Genomics Nursing Information, Education Communication materials o Genetics/genomics nursing is the protection, Advocacy and social mobilization for F promotion, and optimization of health and abilities, prevention of illness and injury, Network of Training Providers alleviation of suffering through the diagnosis of human response, and advocacy in the care of the ü 31 Training Centers that provide BEmONC Skills genetic and genomic health of individuals, Training families, communities, and populations. o This includes health issues, genetic conditions, and Monitoring, Evaluation, Research, and Dissemination with diseases or susceptibilities to diseases caused or support from the Epidemiology Bureau and Health Policy influenced by genes in interaction with other risk Development and Planning Bureau. factors that may require nursing care ü Monitoring and Supervision of Private Midwife COMMON REPRODUCTIVE ISSUES Clinics in cooperation with PRC Board of Midwifery and Professional Midwifery Organizations Philippine Reproductive Health Law ü Maternal Death Reporting and Review System in DOH programs on maternal and childcare collaboration with Provincial and City Review Teams  ü Annual Program Implementation Reviews with language when they are stressed may be at a low point (Darby, Provincial Health Officers and Regional 2007). Coordinators Use of Conversational Space Filipino culture values and practices in relation to maternal and child care People of different cultures use the space around them differently. Culture is a view of the world and a set of traditions that a specific social group uses and transmits to the next Conversation, on the other hand, is usually held at a distance generation. of between 18 inches and 4 feet. Cultural values are preferred ways of acting based on those Business is most often conducted at a 4-foot distance, as that traditions. allows room for a desk between parties. Ethnicity refers to the cultural group into which a person was Being aware that use of space is culturally determined and born, although the term is sometimes used in a narrower can vary from person to person helps you to respect the use context to mean only race. of space for clients. Race refers to a category of people who share a socially Respect for modesty is a way to respect close space. recognized physical characteristic. Work and School Orientation o Cultural values differ from nation to nation because they often arise from environmental conditions. Other cultures do not value work in itself but see it as only a o The usual values of a group are termed mores or norms. means to an end (you work to get money or food, not o Actions that are not acceptable to a culture are called satisfaction). taboos. o Three taboos that are universal are murder, incest, and Family Orientation cannibalism. o Cultural values are formed early in life and strongly Family structure and the roles of family members are other influence the manner in which people plan for lifestyles that are culturally determined. childbearing and childrearing, as well as the way they respond to health and illness (Whitley & Kirmayer, Time Orientation 2008). o Diversity means there is a mixture or variety of "Time is money" is an often-quoted axiom. Other cultures, lifestyles and beliefs in a population. however, may not have this concern for time. They may have, instead, a concept that time is to be enjoyed. Another way that time orientation differs is in whether a SOCIOCULTURAL DIFFERENCES culture concentrates on the past, the present, or the future. AND IMPLICATIONS FOR DIVERSITY IN MCHN Male and Female Roles o Stereotyping means expecting a person to act in a In most cultures, the man is the dominant figure. characteristic way without regard to his or her The incidence of intimate partner violence may be higher in individual traits. It is generally derogatory in male-dominant cultures. nature. o Acculturation refers to the loss of ethnic In some cultures, the woman may be the dominant person in traditions in this way. the family. o Cultural assimilation means that people have The oldest woman in the home would be the one to give adopted the values of the dominant culture consent for treatment or hospital admission. o The belief that one's own culture is superior to all others is referred to as ethnocentrism. o Discrimination is the act of treating people Religion differently based on their physical or cultural traits. Religion guides a person's overall life philosophy, it Retaining ethnic traditions strengthens and enriches family influences how people feel about health and illness, what life. foods they eat, and their preferences about birth and death rituals (Miklancie, 2007). Cultural competence- the capacity to work effectively and with people, integrating the elements of their culture- Knowing what religion a family practices helps you locate a vocabulary, values, attitudes, rules. religiously important support person when needed. Cultural Sensitivity- understanding and accepting different It It also can have important implications for decision making cultural values,attitudes and behaviors during a difficult pregnancy or for childhood terminal care. Health Beliefs Communication Patterns Health beliefs are not universal. Communication patterns (not only what people say but also how they say it) are culturally determined. It is generally assumed in developed countries that illness is caused by documented factors such as bacteria, viruses, or Language barriers can be particularly significant for people trauma. who must give health histories when they or their child is ill, because their ability to cope and express themselves in any In other cultures, however, illness may be viewed primarily as This myth has many variations, with some claiming that a punishment from God or an evil spirit, or as the work of a bananas lead to regular twins while others insist on Siamese person who wishes harm to the sick person. twins, which is a serious condition wherein twins are born with part of their bodies joined together. The type of therapy people choose to restore health is also dependent on culture. However, this myth has no scientific basis, as twin development happens purely by chance or because of your Nutrition Practices genes (for non-identical twins). Foods and their methods of preparation are strongly culturally related. "Usog" is associated with feelings of physical discomfort, supposedly brought about by the innocent greeting or In many instances, people cannot find any food on a hospital admiration of a stranger. By some unexplained phenomenon, menu that appeals to them because of cultural preferences. the greeting is said to cause the baby, child, or adult gassiness, colic, dizziness or vomiting. Pain Responses To cure a child of "usog," an elderly woman in the family or a Caring for a person having pain can be problematic when the faith healer (manghihilot or albularyo) would apply her own caregiver's concept of "proper" responses to pain differs from saliva, coconut oil or chamomile oil (aceite de manzanilla) on the patient's concept. the child's abdomen. Because there are so many possible responses to pain, it is Some also place either a red marker (usually a piece of thread important to assess each person individually. or the mark of a lipstick) on the child's forehead to "absorb" the hex, or a beaded bracelet or a small pouch with an amulet Strategies to help recognize cultural influences on pain pinned on the child's clothes as a protective accessory. perception are to: a) appreciate that the meaning of pain varies among Pregnant women should not wear a necklace or wrap a cultures, towel around her neck. b) appreciate that not all people communicate or It supposedly will cause the baby to suffer from "cord coil. express their level of pain in the same way. Pregnant women should not go to funerals and the c) recognize that communication of pain may not cemetery. But if you must go, you need to tie a red scarf even be acceptable within a culture, around your tummy to ward off the ill-effects of. death? Some d) develop an awareness of your personal values and also think that spirits may follow you. Okay, perhaps the beliefs intention here is to avoid giving a pregnant woman undue e) use an assessment tool, stress. It's more of a personal decision, rather than a rule for all. FILIPINO CULTURE, VALUES AND PRACTICES o Filipino culture has been family-oriented. o Female family members, took responsibility for the When the pregnant woman steps over her husband he care of children. will experience the pregnancy discomfort. o Other adults such as aunts, uncles or grandparents have a legitimate role in the disciplining of their Husbands who feel the fatigue and get cravings is probably children. due to the pressure he feels about his impending fatherhood. He is anxious for his wife's and baby's safety. He is also POPULAR FILIPINO BELIEFS ABOUT PREGNANCY excited. o Conceiving mother is encouraged to be happy for Pregnancy is an emotional roller-coaster, so his cravings this will have an effect on the baby could be stress-eating. o Food cravings of the conceiving mother should be provided and lactating mother should be given warm bath with water previously boiled with guava Reproductive Development and other medicinal leaves. o Wearing anything around the neck of a conceiving Intrauterine Development mother like a shawl and a necklace is a restrictive Gonad- a body organ that produces the cells necessary for belief. reproduction (the ovary in females, the testis in males). week 5 of intrauterine life, primitive gonadal tissue is already formed. o Watching scary movies or ugly images by the In both sexes, two undifferentiated ducts, the conceiving mothers is prohibited because it would mesonephric (wolffian) and paramesonephric cause the baby to resemble that person or object. (müllerian) ducts, are present. week 7 or 8, in chromosomal males, this early "Paglilihi" or Pregnancy Cravings gonadal tissue differentiates into primitive testes and begins formation of testosterone. Many Filipinos, to this day, believe that what you eat and o Under the influence of testosterone, the crave for during pregnancy has a direct influence on the mesonephric duct begins to develop into the physical attributes of the baby. male reproductive organs, and the paramesonephric duct regresses. However, scientific studies prove that there is no link If testosterone is not present by week 10, the between paglilihi and the unborn baby's physical attributes. gonadal tissue differentiates into ovaries, and the paramesonephric duct develops into female As Genetics tell us, our physical attributes are inherited from reproductive organs our parents" and grandparents' set of genes and not from food week 12, the external genitals develop. craving! In males, under the influence of testosterone, penile tissue elongates and the urogenital fold on Eating twin bananas may lead to twins the ventral surface of the penis closes to form the urethra,in females, with no testosterone present, the urogenital fold remains open to form the labia  minora what would be formed as scrotal tissue in functions are to support the testes and to help the male becomes the labia majora in the female. regulate the temperature. Pubertal development Testes are two ovold glands, 2. to 3 cm wide, that lie in the scrotum. is composed of several lobules, containing interstitial cells (Leydig's cells)- responsible for production of testosterone seminiferous tubule- produce spermatozoa, Testes descend, late in intrauterine life (about the 34th to 38th week), into the scrotal sac Many male preterm infants are born with undescended testes, (Testes may not produce viable sperm and are assoclated with a 4 to 7 times higher incidence of testicular cancer (Ellsworth, 2009). Role of Androgen As the amount of testosterone increases, a feedback effect on the hypothalamus and anterior pituitary gland is created that § Androgenic hormones are the hormones slows the production of FSH and LH and ultimately decreases responsible for muscular development, physical or regulates sperm production. growth increase in sebaceous gland secretions that causes typical acne in both boys and girls. Beginning in early adolescence, boys need to learn testicular § In males, androgenic hormones are produced by self-examination the adrenal cortex and the testes; in females, by the adrenal cortex and the ovaries. Testicular self exam § In males, the level of the primary androgenic hormone, testosterone, is low in males until Normal testes feel firm, smooth, and egg shaped. puberty (approximately age 12 to 14 years). The epididymis (the tube that carries sperm away from the Testosterone levels rise to influence the further testes) can be palpated as a firm swelling on the superior development. aspect of the testes. § In females: testosterone influences enlargement of the labia majora and clitoris and formation of Penis axillary and pubic “composed of three cylindrical masses of erectile hair. tissue in the penis shaft The urethra passes through these layers of erectile Adrenarche - This development of pubic and axillary hair tissue, making the penis serve as the outlet for both due to androgen stimulation the urinary and the reproductive tracts in men. With sexual excitement, nitric oxide is released Role of Estrogen from the endothelium of blood vessels. This results in dilation of blood vessels and an increase in blood § When triggered at puberty by FSH, ovarian follicles flow to the arteries of the penis (engorgement). in females begin to excrete a high level of the hormone estrogen. Male Internal Structures § three compounds "are the epididymis, the vas deferens, the seminal § a. estrone (E1) b. estradiol (E2) c. estriol (E3) vesicles, the ejaculatory ducts, the prostate gland, § The increase in estrogen levels in the female at the urethra, bulbourethral glands puberty influences the development of the: uterus, fallopian tubes, and vagina; typical female fat Epididymis distribution and hair patterns; breast is responsible for conducting from the tubule to the development; end to growth because it closes the vas deferens, the next step in the passage to the epiphyses of long bones outside. " Some sperm are stored in the epididymis, and a Thelarche - beginning of breast development portion of the alkaline fluid that will surround maturity is produced by the cells lining. The production of ova stops at menopause (the end of the fertile period in females). Vas deferens Sperm production continues from puberty It carries sperm from the epididymis through the throughout the male's life inguinal canal into the abdominal cavity, where it ends at the seminal vesicles and the ejaculatory Anatomy and Physiology of the ducts Reproductive System Seminal vesicles External genital organs of the male include It carries sperm from the epididymis through the o the testes (which are encased in the inguinal canal into the abdominal cavity, where it scrotal sac) ends at the seminal vesicles and the ejaculatory o the penis ducts. Scrotum - rugaeted, skin-covered, muscular two convoluted pouches that lie along the lower pouch suspended from the perineum. portion of the posterior surface of the bladder and empty into the urethra by way of the ejaculatory ducts.  The release of GnRH (also called luteinizing hormone- Ejaculatory duct releasing hormone, or LHRH) by the hypothalamus initiates pass through the prostate gland and join the the menstrual cycle. seminal vesicles to the urethra. When the level of estrogen (produced by the ovaries) rises, Prostate gland release of the hormone is repressed, and menstrual cycles do The prostate gland secretes a thin, alkaline fluid. not occur When added to the secretion from the seminal vesicles and the accompanying sperm from the Pituitary Gland epididymis, this alkaline fluid further protects two hormones FSH and LH that act on the ovaries sperm from being immobilized by the naturally low to further influence the menstrual cycle: pH level of the urethra. FSH, a hormone that is active early in the cycle and is responsible for maturation of the ovum, Bulbourethral Glands LH, a hormone that is responsible for ovulation, or Two bulbourethral or Cowper's glands lie beside release of the mature egg cell from the ovary, and the prostate gland and empty via short ducts into growth of the uterine lining during the second half the urethra. of the menstrual cycle. Like the prostate gland and seminal vesicles, they secrete an alkaline fluid that helps counteract the Ovary acid secretion of the urethra and ensure the safe passage of spermatozoa. FSH and L.H are called gonadotropic hormones because they cause growth (trophy) in the gonads Semen, therefore, is derived from the prostate gland 60%, the (ovaries). seminal vesicles (30%), the epididymis (5%), and the Every month during the fertile period of a woman's bulbourethral glands (5%) life (from menarche to menopause), one of the ovary's primordial follicles is activated by FSH to Urethra begin to grow and mature. is a hollow tube leading from the base of the "As it grows, its cells produce a clear fluid (follicular bladder, which, after passing through the prostate fluid) that contains a high degree of estrogen gland, continues to the outside through the shaft (mainly estradiol) and some progesterone, and glans of the penis. It is approximately 8 in (18 As the follicle reaches its maximum size, it is to 20 cm) long. propelled toward the surface of the ovary. At full maturity, it is visible on the surface of the ovary as Like other urinary tract structures, it is lined with mucous a clear water blister approximately 0.25 to 0.5 membrane. inches across. At this stage of maturation, the small ovum ( with its surrounding follicle Menstruation membrane and fluid, is termed a graafian follicle. After an upsurge of LH from the pituitary, A menstrual cycle (a female reproductive cycle) is prostaglandins are released and the graafian episodic uterine bleeding in response to cyclic follicle ruptures. The ovum is set free from the hormonal changes. surface of the ovary, a process termed ovulation. It The purpose of a menstrual cycle is to bring an is swept into the open end of a fallopian tube. ovum to maturity and renew a uterine tissue bed After the ovum and the follicular fluid have been that will be responsible for the ova's growth should discharged from the ovary, the cells of the follicle it be fertilized. remain in the form of a hollow, empty pit. It is the process that allows for conception and The FSH has done its work at this point and now implantation of a new life. decreases in amount. LH, continues to rise in amount and acts on the Characteristics of Normal Menstrual Cycles: follicle cells of the ovary. It influences the follicle cells to produce lutein, a bright-yellow fluid. Beginning (menarche)- Average age at onset, 12.4 Lutein is high in progesterone and contains some years; average range, 9-17 years estrogen, whereas the follicular fluid was high in Interval between cycles- Average, 28 days; cycles of estrogen with some progesterone. This yellow fluid 23-35 days not unusual fills the empty follicle, which is then termed a Duration of menstrual flow- Average flow, 2-7 corpus luteum (yellow body). days; ranges of 1-9 days not abnormal Your corpus luteum is a completely norrnal cyst that forms on the ovary every single month in Amount of menstrual flow- Difficult to estimate; women of childbearing age. average 30-80 mL per menstrual period; saturating This cyst is actually a group of cells inside your pad or tampon in less than an hour is heavy ovaries that forms during each menstrual cycle. It bleeding appears right after an egg leaves your ovary Color of menstrual flow- Dark red; a combination (ovulation). of blood, mucus, and endometrial cells Although it's inside your ovaries, the corpus Odor - Similar to that of marigolds luteum's job is to make your uterus a healthy place for a fetus to grow. It releases a hormone called PHYSIOLOGY OF MENSTRUATION: progesterone that prepares your rus for pregnancy. o Four body structures are involved in of the Once it's no longer needed to make gesterone, your menstrual cycle: corpus luteum goes away. the hypothalamus, The basal body temperature of a woman drops the pituitary gland, slightly (by 0,5° to 1° F) just before the day of the ovaries, ovulation, because of the extremely low level of uterus progesterone that is present at that time. It rises by 1° F on the day after ovulation, because Hypothalamus of the concentration of progesterone (which is thermogenic) that is present at that time. The woman's temperature remains at this level until  approximately day 24 of the menstrual cycle, when Spinnbarkeit Test the progesterone level again decreases (McCance ü Spinnbarkeit Test. At the height of estrogen &Huether, 2007) secretion, cervical mucus not only becomes thin If conception (fertilization by a spermatozoon) and watery but also can be stretched into long occurs as the ovum proceeds down a fallopian tube strands. and the fertilized ovum implants on the ü Performing this test, known as spinnbarkeit, at the endometrium of the uterus, the corpus luteum midpoint of a menstrual cycle is another way to remains throughout the major portion of the demonstrate that high levels of estrogen are being pregnancy (approximately 16 to 20 weeks), produced. Uterus First phase of Menstrual cycle: Proliferative Immediately after a menstrual flow (which occurs during the first 4 or 5 days of a cycle), the endometrium, or lining of the uterus, is very thin, approximately one cell layer in depth. As the ovary begins to produce estrogen (in the follicular fluid, under the direction of the pituitary FSH), the endometrium begins to proliferate. This growth is very rapid and increases the thickness of the endometrium approximately eightfold. Second Phase of Menstrual Cycle (Secretory). After ovulation, the formation of progesterone in the corpus luteum (under the direction of LH) causes the glands of the uterine endometrium to become corkscrew or twisted in appearance and dilated with quantities of glycogen (an elementary sugar) and mucin (a protein). The capillaries of the endometrium increase in amount until the lining takes on the appearance of rich, spongy velvet. Third Phase of Menstrual Cycle (Ischemic). If fertilization does not occur, the corpus luteum in the ovary begins to regress after 8 to 10 days. As it regresses, the production of progesterone and estrogen decreases. With the withdrawal of progesterone stimulation, the endometrium of the uterus begins to degenerate (at approximately day 24 or day 25 of the cycle). The capillaries rupture, with minute hemorrhages, and the endometrium sloughs off Fourth Phase of a Menstrual Cycle (Menses), Menses, or the menstrual flow, is composed of: o Blood from the ruptured capillaries o Mucin from the glands o Fragments of endometrial tissue o The microscopic, atrophied, and unfertilized ovum o the first day of menstrual flow is used to mark the beginning day of a new menstrual cycle. o menstrual flow contains only approximately 30 to 80 ml of o blood o The iron loss in a typical menstrual flow is approximately 11 mg Cervix During the first half of the cycle, when hormone secret from the ovary is low, cervical mucus is thick and scant. Sperm survival in this type of mucus is poor. At the time of ovulation, when the estrogen level is high cervical mucus becomes thin and copious. Fern Test ü When high levels of estrogen are prosent in the body, as they are just before ovulation, the cervical mucus forms fernlike patterns caused by the crystallization of sodium chloride on mucus fibers when it is placed on a glass slide and allowed to dry. This pattern is known as arborization or ferning.