MCN 1 – M1A: Maternal & Child Health Nursing Practice PDF

MCN 1 – M1A: MATERNAL & CHILD HEALTH NURSING PRACTICE Goals and Philosophy of MCN → Obstetrics ❖ Care of women during childbirth ❖ Greek = to keep watch → Pediatrics ❖ Greek = pais – child The care of childbearing and childrearing families is a major focus of nursing practice, beca...

MCN 1 – M1A: MATERNAL & CHILD HEALTH NURSING PRACTICE Goals and Philosophy of MCN → Obstetrics ❖ Care of women during childbirth ❖ Greek = to keep watch → Pediatrics ❖ Greek = pais – child The care of childbearing and childrearing families is a major focus of nursing practice, because to have healthy adults you must have healthy children. To have healthy children, it is important to promote the health of the childbearing woman and her family from the time before children are born until they reach adulthood. That makes both preconceptual and prenatal care 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 continued health supervision and support. As children reach maturity and plan for their own families, a new cycle begins, and new support becomes necessary. The nurse’s role in all these phases focuses on promoting healthy growth and development of the child and family in both health and illness. Although the 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 rather a continuum: maternal and child health nursing THE PRIMARY GOAL OF MATERNAL AND CHILD HEALTH NURSING CARE Promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. Major philosophical assumptions about maternal and child health nursing are listed below. The health of each stage of the individual impacts the next stage and the health of the family to which the individual belongs. Healthy pregnancy will lead to healthy newborn who will grow up to become healthy children who will comprise the healthy family. THE PRIMARY GOAL OF MATERNAL AND CHILD HEALTH NURSING CARE Promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. Major philosophical assumptions about maternal and child health nursing are listed below. The health of each stage of the individual impacts the next stage and the health of the family to which the individual belongs. Healthy pregnancy will lead to healthy newborn who will grow up to become healthy children who will comprise the healthy family. MCN RANGE OF PRACTICE → Pre-conceptual health care → Care of women during three trimesters of pregnancy and the puerperium (6 weeks after childbirth (4th trimester of pregnancy)) → Care of infants (6 weeks before conception to 6 weeks after birth) → Care of child from birth to adolescence → Care in settings as varied as the birthing room, the pediatric ICU, and home PHILOSOPHY OF MCN → Family-centered Care ❖ Assessment of both family and individual → Community-centered Care ❖ Influence of the health community → Evidence-based Practice ❖ Where critical knowledge increases ROLE OF A MATERNAL AND CHILD HEALTH NURSE → Considers the family as a whole and as a partner in care → Serves as an advocate to protect the rights of all family members → Demonstrates a high degree of independent nursing functions  teaching and counseling are major interventions → Promotes health and disease prevention → Serves as an important resource for families → Respects personal, cultural and spiritual attitudes and beliefs → Encourages developmental stimulation → Assesses families for strengths as well as specific needs → Encourages family bonding rooming-in or family visiting → Encourages early hospital discharge → Encourages families to reach out to their community STANDARDS OF MCN PRACTICE Division of Maternal and Child Health Maternal and Nursing Practice of the American Nurse Child Health Association in Collaboration with the Society of Pediatric Nurses Women and Association of Women’s Health, Obstetric, Newborns and Neonatal Nurses Standards of Care 1 Assessment patient health data Diagnosis analyzes the assessment data in 2 determining diagnosis Outcome identifies the expected outcome; 3 Identification individualizes the child and the family Planning plan of care that prescribes intervention 4 to obtain expected outcomes 5 Implementation implementation of intervention 6 Evaluation Standards of Professional Performance The nurse systematically evaluates the 1 Quality Care quality and effectiveness of pediatric nursing practice. The nurse evaluates their own nursing Performance practice in relation to professional practice 2 standards and relevant statutes and Appraisal regulations. The nurse acquires and maintains current 3 Education knowledge and competency in pediatric nursing practice. The nurse interacts with and contributes to 4 Collegiality the professional development of peers, colleagues, and other health care providers. The nurse’s assessment, actions, and recommendations on behalf of children and 5 Ethics their families are determined in an ethical manner. The nurse collaborates with the child, 6 Collaboration family, and other health care providers in providing client care. The nurse contributes to nursing and 7 Research pediatric health care using research methods and findings. The nurse considers factors related to Resource 8 safety, effectiveness, and cost in planning Utilization and delivering patient care.  Framework of Maternal and Child Health Nursing Four Phases of Health Care Educating clients to be aware of good Health Promotion health through teaching and role modeling Intervening to maintain health when Health Maintenance risk of illness is present Diagnosing and treating illness using Health Restoration interventions that will return client to wellness fast Preventing further complications from Health Rehabilitation an illness, bringing client back to an optimal state of wellness THE NURSING PROCESS The nursing process serves as the basis for assessing, making a nursing diagnosis, planning, organizing, and evaluating care. The nursing process is applicable across all health care settings, from the prenatal clinic to the pediatric intensive care unit, demonstrating its broad applicability to nursing care. EVIDENCE-BASED PRACTICE Worth of Evidence Ranking Level I Evidence from at least one properly designed randomized controlled trial (RCT). Level II Evidence from well-designed controlled trials without randomization, well-designed cohort or case-control analytic studies, or multiple time series  with or without an intervention. Level III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. Use of evidence-based practice helps to move all health care actions to a more solid, and therefore safer, scientific foundation. The Cochrane Database of Systematic Reviews is a good source for discovering evidence-based practices as the organization consistently reviews, evaluates, and reports the strength of health-related research. NURSING RESEARCH Nursing research, the controlled investigation of problems that have implications for nursing practice, provides evidence for practice and justification for implementing activities to achieve outcomes, ultimately resulting in improved and cost-effective patient care. NURSING THEORY One of the requirements of a profession (together with other critical determinants, such as professionally-set standards, monitoring of practice quality, and participation in research) is that the concentration of a discipline's knowledge flows from a base of established theory. Nursing theorists offer helpful ways to view clients. For example, they help us see a pregnant woman not simply as a physical form but as a dynamic individual with important psychosocial needs, or to view children as integral members of a family as well as independent beings. Significant shifts in the scope of maternal and child health nursing have occurred as health promotion, or keeping parents and children well, has become a greater priority. Because care of women during pregnancy and of children during their developing years helps protect not only current health but also the health of the next generation, maternal-child health nurses fill these expanded roles uniquely. MCN Services/Program in the Philippines Safe Motherhood Initiatives (?) o Prenatal Care Child Health Services o Expanded Program on Immunization (EPI) o Nutrition Programs (Feeding Program) o Integrated Management of Childhood Illnesses (IMCI) Government Initiatives o Maternal, Neonatal, and Child Health Nutrition Program o Universal Health Care o Unang Yakap NATIONAL HEALTH GOALS Universal Health Care (UHC) AO 2010-0036 (DOH 2010) Achievement of the health system goals: 1. Better health outcomes 2. Sustained health financing  3. A responsive health system by ensuring that all Filipinos, especially the disadvantaged group, have equitable access to affordable health care Three Strategic Thrusts: 1. Financial risk protection through expansion in National Health Insurance Program (NHIP) enrollment and benefit delivery 2. Improved access to quality hospitals and health care facilities 3. Attainment of the health-related Millennium Development Goals Millenium Development Goals (MDGs, 2017) Eradicate extreme poverty 1 5 Improve maternal health and hunger Achieve universal primary Combat HIV/AIDS, Malaria, 2 6 education and other diseases Promote gender equality Ensure environmental 3 7 and empower women sustainability Global partnership for 4 Reduce child mortality 8 development  Sustainable Development Goals (SDGs, 2030) Affordable and 1 No poverty 7 13 Climate Action clean energy Decent work and Life Below 2 Zero hunger 8 14 economic growth Water Good health Industry, 3 and Well- 9 Innovation, and 15 Life on Land being Infrastructure Peace, Justice Quality Reduced 4 10 16 and Strong Education Inequalities Institution Gender Sustainable Cities Partnership for 5 11 17 Equality and Communities the Goals Clean Water Responsible 6 and 12 Consumption and Sanitation Production Measurement of Level of Maternal and Child Health Crude Birth Rate (CBR) → How fast people are added to the population through birth →  45/1,000 live births (high fertility) →  20/1,000 live births (low fertility) # registered life birth in a year CBR= Midyear population x 1,000  General Fertility Rate (GFR) → It is a more specific rate than CBR since births are related to the segment of the population deemed to be capable of giving birth in the reproductive age groups (155-44 yrs old). → 200/1,000 GFR (high fertility rate) → 60/1,000 GFR (low fertility rate) # registered life birth in a year GFR = x 1,000 Midyear population of women 15-44 yrs of age Maternal Mortality Ratio (MMR) → Number of deaths of females from any cause related to or aggravated by pregnancy and childbirth or within 42 days of termination → Measures obstetric risk # of deaths due to pregnancy, delivery, MMR = puerperium in a calendar year x 100 # of life births in the same year Infant Mortality Rate (IMR) → Number of deaths of infants under one year age per 1,000 live births in the same calendar year → A good index of the level of health in a community as infants are highly susceptible to adverse environmental conditions → High IMR means low levels of health standards, often linked to poor maternal health and inadequate child healthcare  → 60-50/1,000 live births commonly seen in poor population →  200/1,000 live births signifies a severe living environment Deaths under 1 year of age in a calendar year IMR = # of life births in the same year x 1,000 Neonatal Mortality Rate (NMR) → Death of infants less than 28 days, mainly due to prenatal or genetic factors # of deaths among those under 28 days of age NMR = in a calendar year x 1,000 # of life births in the same year Post Neonatal Mortality Rate (PMR) → Death among infants 28 days to less than 1 year of age in a calendar year. → Influenced by environmental and nutritional factors as well as infection # of deaths among those 28 days to less than PMR = 1 year of age in a calendar year x 1,000 # of life births in the same year  ROLES AND RESPONSIBILITIES OF MATERNAL AND CHILD NURSE Nurse provides continuous and comprehensive Health Care care to the family, group of people and Provider community and emphasizes more on promotive and preventive health care. Educates the client to develop their abilities Health and overcome barriers so they can take care of Educator their health and nursing needs, promote their health and prevent illness. Also known as nurse consultants, where they Counselor focus on ensuring delivery of quality patient care services in maternal and child’s health. Nurse who study various aspects of health, illness and health care. By designing and implementing scientific studies, they look for Researcher ways to improve health, health care services and health care outcomes in maternal and child health nursing. Manager of Nurse directly provides the care with the active Care participation of family. Advanced Practice Roles For Nurses in Maternal and Child Health Nurses prepared at the master’s or doctorate degree level who can act as Clinical Nurse consultants in their area of expertise, as Specialist well as serving as role models, researchers, and teachers of quality nursing care.  A graduate-level nurse who supervises a group of patients from the time they enter Case Manager a health care setting until they are discharged, monitoring the effectiveness, cost, and satisfaction of their health care. Nurses educated at the master’s or doctoral level who play pivotal roles in today’s health care system. Doctor of nursing Nurse practice programs are designed to prepare Practitioner nurse practitioners with the highest level of practice expertise integrated with the ability to translate scientific knowledge into complex clinical interventions. Women’s Health A women’s health nurse practitioner has Nurse advanced study in the promotion of health Practitioner and prevention of illness in women. A nurse prepared with extensive skills in Pediatric Nurse physical assessment, interviewing, and Practitioner well-child counseling and care. An advanced-practice role for nurses who Neonatal Nurse are skilled in the care of newborns, both Practitioner well and ill. Family Nurse Provides health care not only to women and Practitioner children but also to the family. An individual educated in the two Certified Nurse- disciplines of nursing and midwifery who Midwife plays an important role in assisting women with pregnancy and childbearing.  Basic Family Types Family of Procreation → family into which a person is born. Family of Orientation → family that an individual creates through marriage or partnerships Child- Couples who voluntarily choose not to have Free/Childless children. May include couples experiencing Family infertility. Couples living together unmarried. May Cohabitation include children. Offers companionship and Family financial security but lacks legal protections. Two parents and child(ren). Provides strong internal support but may lack external Nuclear Family support during crises. Binuclear Family: Post-divorce family with shared child custody. Includes multiple generations beyond Extended immediate parents and children. Offers Family abundant support but may experience resource strain. One parent raises children. Faces challenges Single-Parent like low income and exhaustion but can Family offer a strong parent-child bond and foster independence. A remarriage where both partners have children from previous relationships. Can Blended Family face child rivalry and differing parenting styles but may lessen financial difficulties and provide emotional support. Partners live together for companionship LGBTQ+ Family and support, similar to nuclear family.  Legally protected but may face health disparities. Offers strong family in crises. Cares for children whose parents cannot. Children may experience insecurity and Foster Family emotional difficulties due to frequent moves, but it prevents them from being raised in large, insecure settings. A family where the parents have chosen to adopt a child. This means they legally take Adoptive Family on the responsibility of raising a child who is not biologically their own. COMMON FAMILY TASKS physical maintenance recruitment and release socialization of family of members members placement of members allocation of resources into the larger society maintenance of order maintenance of division of labor motivation and moral reproduction Common life stages of families marriage adolescent children early childbearing launching stage families with preschool middle-years families school-aged family in retirement CHANGES IN PATTERNS OF FAMILY LIFE dual-parent reduced family size employment social problems increased divorce rates