Maternal and Infant Health Scope and Standards PDF

Scope and Standards Ethical, Social and Legal Issues Culture, Values And Practices Maternal and Child Health  Impetus for Maternal Health Maternal and infant deaths are preventable, yet the current infant mortality rate for Philippines in 2020 i...

Scope and Standards Ethical, Social and Legal Issues Culture, Values And Practices Maternal and Child Health  Impetus for Maternal Health Maternal and infant deaths are preventable, yet the current infant mortality rate for Philippines in 2020 is 18.815 deaths per 1000 live births, a 2.2% decline from 2019. The infant mortality rate for Philippines in 2019 was 19.239 deaths per 1000 live births, a 2.16% decline from 2018 (Macro Trends, 2020).  According to CIA World Factbook (Nov. 2020), Phil. IMR accounts to a total of 20 deaths/1,000 live births. Philippines’ maternal mortality rate for 2017 was 121.00 per 100,000live birth, a 2.42% decline from 2016. Sustainable Development Goal (SDG) target 3.1 aims to reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030.  Health Status objectives (Phil) Infant 0 – 1 year - 17 deaths per 1000 livebirths Children 1 -4 y. o. to 33.6 % per 1000 live births Adolescence and youths by 50% Goal of Child Health Program The Child Health Program aims that every child grow up in a family with love and security, lives in healthy surroundings, receives adequate nourishment, health supervision and medical attention, and is taught the elements of healthy living. DOH Programs Garantisadong Pambata Newborn Screening Immunization Program Oral Health Program Adolescent Youth Health Program  Causes of MMR Delays in seeking care, making referral and providing appropriate medical management or treatment Closely spaced births Frequent pregnancies Causes of MMR Poor detection and management of high-risk pregnancies Poor health access to facilities Lack of competence in managing obstetrical emergencies Goals of Maternal Health (Phil) The goal of an effective maternal health program is to ensure that every expectant and nursing mother maintains good health; learn the art of child care; undergoes normal delivery; and bears healthy children. Overall Aim of Maternal Health (Phil.) To improve survival as well as promote and maintain the optimal health of women and their fetuses and/ or newborn through a package of services throughout the pre- pregnancy, prenatal, natal and postnatal stages.  Philosophy of Maternal Health (Phil.) Pregnancy, labor, delivery and puerperium are part of the total life cycle; it is family- centered. Maternal and Child Health is based on the philosophy of mother and child relationship in consideration of the entire family, culture and socioeconomic environment.  Philippine Strategic Thrust: – BEMOC Strategy – Improve quality of care – Reduce women’s health risk DOH Programs Antenatal and Postnatal Care Labor and Delivery Reproductive Health Program and Services  Scope and Standards The scope of nursing practice is the range of roles, functions, responsibilities and activities which a registered nurse is educated, competent and has authority to perform. Standards of practice are safeguards for health care.  Republic Act 7164, introduced by Senator Heherson Alvarez, codified and revised all the laws regulating the practice of nursing in the Philippines. It was known as the Philippine Nursing Act of 1991. In October 21, 2002, Republic Act No. 9173 otherwise known as “The Philippine Nursing Act of 2002” replaced R.A. 7164. Functions of Law in Nursing -provides a framework for establishing what nursing actions in the care of patients are legal -delineates the nurse’s responsibilities from those of other professionals -helps to establish the boundaries of independent nursing actions -assists in maintaining a standard of nursing practice bymaking nurses accountable to the law Summary of RA 9173 or Phil. Nursing Act of 2002 A comprehensive legislation regulating various aspects of nursing profession. Its main objective is to provide for protection and improvement of nursing profession by instituting measures that shall result in relevant nursing education, humane working conditions, better career prospects and dignified existence for nurses. It also provides for organization of board of nursing, examination and registration of nurses, nursing education, nursing practice, as well as several related matters.  Legal Basis (Phil.) 1987 Constitution of the Philippines The state shall accept an integrated and comprehensive approach to health development … there shall be priority for the needs of the underprivileged, elderly, disabled, women and children.  Magna Carta of Women (RA 9710) (March 2010) supersedes all laws, acts and guidelines which are prejudicial or detrimental to the welfare of women and government is mandated to fully address the issue which are related to health of women. Magna Carta of Women (RA 9710) Rights of Women : 1. Protection from all forms of violence 2. Participation and Representation 3. Equal treatment before the law 4. Equal access in education, scholarship and training Laws, acts, guidelines RA 3753 – Civil Registry Law PD 651 – Birth Registration Law – Immediate registration of birth within 30 days PD 996 – Compulsory Immunization for Infants and Children Laws, acts, guidelines EO 51 – Milk Code of the Philippines EO 199 – National Family Planning Policy RA 10354 –Responsible Parenthood and reproductive Health Act of 2012 -guarantees universal access to methods on contraception, fertility control, sexual education, and maternal care  Reproductive Health Concepts RA 7610 – Anti-Child Abuse Act RA 7658 – An act prohibiting employment of children below 15 years old RA 6809 – Emancipation law lowered majority age from 21 to 18 years old Reproductive Health Concepts A married couple has the capability to reproduce or procreate RH is the exercise of reproductive right with responsibility RH includes sexual health for the enhancement of life and personal relations Reproductive Health Concepts  RH means safe pregnancy and delivery RH includes protection from harmful reproductive practices and violence RH assures access to information on sexuality to achieve sexual enjoyment  Reproductive Health Concepts Nurses must be knowledgeable about the laws related to health care of women and their families in the state/ country here they practice, as well as the specific policies of their healthcare institutions.  Standards of Practice 1. Legal Standards Nurses must be aware in their scope of practice. 2. Organizational Standards Organizational guidelines provide broader guides that are nationally recognized specific for maternal and child health. Standards of Practice 3. Agency Standards Healthcare agencies required to have policies, procedures and protocols to define and guide all elements of care; updated and periodically reviewed.  Safeguards for Healthcare Nursing Practice Act Standards of Procedures and Protocols – WHO, DOH, CDC, etc. Standards of Care – Set by professional organizations – ANA, AWHONN, etc. Agency Policies – Each health care agency set specific policies, procedures, and protocols that govern nursing care.  Malpractice Negligence is the failure to perform as a reasonable, prudent, careful person of similar background would act in similar situation. -Doing something that should not be done or failing to do something that should be done.  Elements of Negligence Duty – The nurse must have a duty to act or give care to the client. It must be part of the nurse’s responsibility. Breach of duty – A violation of that duty must occur. The nurse fails to conform to established standards in performing that duty.  Elements of Negligence Damage – An actual injury or harm to the client as a result of the nurse’s breach of duty must occur. Proximate cause – The nurse’s breach of duty must be proved to e the cause of harm to the client.  Example: Nurse’s must be careful to include detailed data on charts.  Documentation Is the best evidence that standards of care is maintained. Example: Nurse’s notes Fetal monitoring strips Electronic data Flow sheets Consent  Ethical Framework 4 Basic principles to solve ethical dilemma 1. Beneficence - means acting for the patient’s benefit 2. Nonmaleficence - is known best by the saying that is credited to Hippocrates “First, do no harm”.  Ethical Framework 3. Respect for autonomy Means that patients have the right to make decisions about themselves as well as, the right to have the information that is needed to make certain decisions.  Ethical Framework 4. Justice or fairness – Means that all patients should be treated equally. – Discrimination should not occur based on social or economic status or type of illness.  Ethical Principle Other important ethical principles: Accountability – accept responsibility for actions as healthcare professionals Confidentiality – keep information private Cont. Ethical Principle Truth (veracity) – tell the truth - To maximize the efficiency of healthcare the patient and the healthcare providers are bound to tell the truth Fidelity – keep promises and do not make promises that cannot be kept  Benevolent Deception It is very important that healthcare workers be very discreet in providing information. While telling the truth increases their credibility, it is oftentimes how they say this information that makes it acceptable or not.  Example A caesarian birth may prevent permanent harm to a fetus in jeopardy. However, the surgery that saves the fetus also harms the mother, causing pain, temporary disability, and possible financial hardship. There are also basic surgical risk to the mother. Both mother and health care providers may decide that the principle of beneficence outweighs the principle of nonmaleficence. If the mother does not want surgery, the principle of autonomy and justice also must be considered. If the mother’s right to determine what happens to her body more or less important than the right of the fetus to fair and equal treatment?  Example of Nonmaleficence Not assisting or performing abortion Not performing euthanasia or mercy killing Not willfully subjecting patient to experimental drugs Not harming the patient's reputation by revealing confidential information  Applying Nursing Process to Solve the Dilemmas Assessment – Gather data to clearly identify the problem and the decisions necessary. Obtain viewpoints from all who will be affected by the decision and applicable legal, agency policy, and common practice standards.  Applying Nursing Process to Solve the Dilemmas Analysis – Decide whether an ethical dilemma exists. Analyze the situation using ethical theories and principles. Determine whether and how these conflict.  Applying Nursing Process to Solve the Dilemmas Planning – Identify as many options as possible, determine their advantages and disadvantages, and conclude which options are more realistic. Predict what is likely to happen if each option is followed. Include the option of doing nothing. Choose the solution. Applying Nursing Process to Solve the Dilemmas Implementation – Carry out the solution. Determine who will implement the solution and how. Identify all interventions necessary and what support is needed. Evaluation – Analyze the results. Determine whether further interventions are necessary.  Legal and Ethical Issues Laws and ethics are interrelated and affect all of nursing. Professional nurses must understand their scope of practice, standards of care, institutional or agency policies, and state laws. Nurses must be responsible for knowing current information regarding ethics and laws related to their practice.  Issues Fetal therapy New procedure or experiential procedure Poverty Disparities in health care/ Access to health care Perinatal health Teenage pregnancy Health prioritization Abortion (Pregnancy termination) Contraception  Issues Informed Consent – Refusal of medical treatment Confidentiality Advancing technology Surrogate parenting  Brief discussion on some issues Abortion Abortion was a volatile, legal, social and political issue even before. It has become a hotly debated political issue that separate people into two camps: pro-choice and pro- life. The pro-choice group supports the right of any woman to make decisions about her reproductive functions based on her own moral and ethical beliefs. The pro-life group feels strongly that abortion is murder and deprive the fetus of the basic right to life.  Informed Consent Informed consent has four key elements: Disclosure, Comprehension, Competency and Voluntariness The physician or advanced practice nurse is responsible for informing the client about the procedure and obtaining consent. Cont. Nurse’s Responsibility Ensure that consent form is completed with signature  Serves as witness  Determine whether the client understands Cont. Treating clients without obtaining proper consent may result in charges of assault, and the health care provider or facility may be held liable for any damages. Cont. All clients have the right to refuse medical treatment. Client’s may refuse treatment if it conflicts with their religious and cultural issues. Confidentiality In maternal and newborn care, information is shared only with the client, legal partner, legal guardians or individual’s established in writing by the client or child’s parents.  Exceptions to confidentiality Suspicion of physical or sexual abuse and injuries caused by a weapon or criminal act must be reported to proper authorities. Abuse case are reported to welfare authorities, whereas, criminal acts are reported to the police.  Cont. Exceptions to confidentiality The healthcare provider must also follow public health laws like reporting of notifiable diseases.  The Human Genome Project The HGP was13-year project completed by the US Department of Energy Human Genome Project (HGP), an international collaboration that successfully determined, stored, and rendered publicly available the sequences of almost all the genetic content of the chromosomes of the human organism, otherwise known as the human genome. The Human Genome Project The goal of HGP is to determine the base pairs that make up human DNA, and of identifying and mapping all of the genes of the human genome from both a physical and a functional standpoint. The Human Genome Project Fast, large-scale, low-cost DNA sequencing has propelled genomics into mainstream medicine, driving a revolutionary shift toward precision medicine. Early diagnosis of a disease can significantly increase the chances of successful treatment, and genomics can detect a disease long before symptoms The Human Genome Project HGP has a great impact to health and medicine but it also brings to surface some ethical, social and health concerns like the possibility of using cloning techniques to create embryos and possibly human beings; and, technologies developed for more sophisticated fetal testing. Advance technology Nurse’s play and important role in caring and advocating for clients and their families. As the use of technology grows, situation will surface more frequently to test the nurse’s belief system.  It is crucial for nurses to be able to understand the science of genetics, and appreciate implications of recent developments or advancements.  Nurse’s Role (Contemporary/ Current Health Issues) Know how to access current accurate knowledge Be aware of the alternatives of healthcare delivery systems Develop an ethical framework of practice  Professional Obligations Nurses have no obligation to support a position with which they disagree. The nursing practice act allow nurses to refuse to assist with the procedure if it violates the ethical, moral or religious belief.  Alternative Location/ Setting of Birth Home-like institutional birth setting – Maternity units designed for family-centered care Labor, Delivery and Recovery Room (LDR) Labor, Delivery, Recovery and Postpartum Birthing Centers close proximity to hospital in case of complication Alternative Location/ Setting of Birth Alternative birth centers have sprung up throughout the country and are providing one-room, homelike environments for labor, delivery and recovery. Whether at home, in a birth center or even at a hospital, these alternative methods of birth can help make labor and delivery more tolerable. Example: water birth, Lamaze, etc.  Culture is the sum of the beliefs and values that are learned, shared, and transmitted from generation to generation by a particular group. Ethnicity is the condition of belonging to a particular group that shares race, language and dialect, religious faiths, traditions, values, and symbols, as well as food preferences, literature and folklore.  Cultural Health Beliefs 1. Traditional Methods to prevent illness Ex. Wearing of amulets African origin consume nonfood substances (pica) such as starch to facilitate labor.  Cultural Health Beliefs 2. Traditional practices to maintain health Ex. Wearing of scarves by pregnant client and avoiding cool air draft thus maintaining health of a pregnant woman. Belief that illness is a punishment of breaking a religious code Asians protect woman from cold forces for 30 days after birth of newborn by not taking a bath or cold bath. Cultural Health Beliefs 3. Traditional practice to restore health Ex. Use of herbs and plants Culturally Competent Nursing Care Cultural competence is defined as the knowledge, willingness, and ability to adapt health care to enhance its acceptability to and effectiveness with clients from diverse culture (Clark, 2007). Culturally Competent Nursing Care Nurses must develop nonjudgmental and be accepting of client’s cultural differences. Using diversity as strength empowers nurses and clients to achieve a mutually acceptable health care goal. Steps to developing Cultural Competence  1. Cultural self-awareness  Becoming aware  2. Cultural knowledge  Learning about culture  3. Cultural skills Learn how to perform on point cultural assessment and care 4. Cultural encounter Engage or participate in as many cultural happenstances or chances