NCM 107 LEC Framework PDF

HI HOW ARE YOU TODAY? Framework for Maternal and Child Health Nursing Obstetrics – Care of woman during childbirth; derived from Greek word “obstare” (to keep watch) Pediatrics – derived from Greek word, “pais” (child)  Focus of MCN Care of childbearing and childrearing families. P...

HI HOW ARE YOU TODAY? Framework for Maternal and Child Health Nursing Obstetrics – Care of woman during childbirth; derived from Greek word “obstare” (to keep watch) Pediatrics – derived from Greek word, “pais” (child)  Focus of MCN Care of childbearing and childrearing families. Primary Goal of MCN Promotion and maintenance of Optimal Family Health.  Goals of MCN/ Scope of Nursing Practice 1. Preconceptual Health Care 2. Care of the women during the 3 trimesters of pregnancy > 1 st Trimester – 1 st to 3 rd months > 2 nd Trimester – 4 th to 6 th months > 3 rd trimester – 7 th to 9 th months 3. Care of the women during the puerperium or 4 th trimester - 6 weeks after childbirth  Goals of MCN/ Scope of Nursing Practice 4. Care of the infants during the perinatal period - 6 weeks before conception and 6 weeks after birth 5. Care of children from birth to adolescence - Neonatal ( 28 days of life) - Infancy ( 1 to 12 months) - Adolescence ( after 18 years old) 6. Care in the settings varied from birthing rooms, to PICU, to home  Philosophies of MCN 1. MCN is Family Centered; assessment must include both family and individual assessment. 2. MCN is Community Centered; health of families depends on & influences the health of communities. 3. MCN is Evidence Based because critical knowledge increases  Philosophies of MCN 4. MCN includes independent nursing functions because teaching & counselling are major interventions. 5. MCN Nurse, Advocate (protects the rights of family members, including fetus) 6. Health Promotion and Disease Prevention to protect health of new generation. 7. MCN is a challenging role for nurses ** In all settings and types of care, keeping the family at the center of care or considering family asthe primary unit of care is an essential goal because the level of a family’s functioning affects the health status of its members. A family centered approach enables nurses to better understand individuals and their effect on others, and in turn, to provide holistic care ***  Framework for MCN 1. Nursing Process (ADPIE) 2. Evidence Based Practice 3. Nursing Research 4. Nursing Theory  4 Phases of Health Care 1. Health Promotion Educating clients to be aware of good health through teaching and role modelling Ex. Family planning, teach the importance of safe sex practice, importance of immunizations.  4 Phases of Health Care 2. Health Maintenance Intervening to maintain health when risk of illness is present Ex. Encourage prenatal care, importance of safeguarding homes by childproofing it against poisoning  4 Phases of Health Care 3. Health Restoration Diagnosing and treating illness using interventions that will return client to wellness fast Ex. Care of child during illness, care of woman during pregnancy complications  4 Phases of Health Care 4. Health Rehabilitation Preventing further complications from an illness Bringing client back to an optimal state of wellness Helping client accept inevitable death Ex. Encourage continuous therapies and medications Measuring Maternal & Child/Statistical Terms Used to Report Maternal & Child Health Birth Rate - number of births per 1000 population Fertility rate - number of pregnancies per 1000 women of childbearing age Fetal Death Rate - number of fetal deaths weighing more than 500g or more per 1000 live births Neonatal Death Rate - number of deaths per 1000 live births occurring in the 1st 28 days of life Perinatal Death Rate Perinatal Period - 6 weeks before conception & 6 weeks after childbirth Number of deaths of fetuses weighing >500g and within the 1st 28 days of life per 1000 birth Infant Mortality Rate - number of deaths per 1000 live births occurring in the 1st 12 months of life Childhood Mortality Rate - number of deaths per 1000 population in children; 1 - 14 y/o Maternal Mortality Rate - number of maternal deaths per 100,000 live births that occur as direct result of reproductive process  Trends in Healthcare Environment 1. Cost containment - reducing the cost of health by closely monitoring the cost of personnel, use and brands of supplies, length of hospital stays, no. of procedures carried out, and no. of referrals while maintaining quality care  Trends in Healthcare Environment 2. Increasing Alternative Settings & Styles for Healthcare LDRP Rooms (Labor–Delivery–Recovery–Postpart um) A more natural childbirth environment as a birthing room. Family members are invited to stay to be a part of childbirth.  Trends in Healthcare Environment 2. Increasing Alternative Settings & Styles for Healthcare Retail Clinics or Emergent Care Clinics located in shopping malls Ambulatory Clinics or at home to avoid long hospital stays for women and children  Trends in Healthcare Environment 3. Including Family in Healthcare 4. Increasing Intensive Care Units NICU or ICN PICU 5. Regionalizing Intensive Care - ex. Premature infant transferred to regional hospital  Trends in Healthcare Environment 6. Increasing the Use of Alternative Treatment Modalities - alternative method of therapies such as acupuncture and therapeutic touch; herbal remedies 7. Increasing Reliance on Home Care - decreased hospital stay  Trends in Healthcare Environment 8. Increasing Use of Technology - use of internet, charting in computer, using Doppler 9. Free Birthing - women giving birth without healthcare provider supervision; unassisted birth 10. LAMAZE - breathing techniques  Legal Considerations of MCN Practice 1. Identifying and Reporting Child Abuse 2. Child can bring a lawsuit when they reach legal age 3. Informed Consent for invasive procedure and any risk that may harm the fetus 4. In divorced or blended families, nurse has the right to sign consent.  Legal Considerations of MCN Practice Note: Nurses are legally responsible to protect the rights of their client and documentation is essential to protect the nurse and justify his or her actions  Ethical Considerations of Practice 1. Conception Issues a. In Vitro Fertilization b. Embryo Transfer c. Cloning d. Stem Cell Research e. Surrogate Mothers 2. Abortion 3. Fetal Rights vs Rights of the Mother  Ethical Considerations of Practice 4. Use of Fetal Tissue for Research 5. Resuscitation 6. No. of procedures or degree of pain that a child should asked to achieve better health 7. Balance between modern technology and quality of life  National Health Situation on MCHN Jan 2020 – WHO declared Covid-19 as a public health emergency of international concern and eventually as a global pandemic in March 2020 Results: Pandemic Response > lockdowns > curfew/ restrictions > regulated non essential travel > disrupted delivery services especially non covid essentials health services > disrupted routine health care system including relief and from gender- based violence  Survey of WHO (2020) Family Planning and Contraception – most disrupted Access to sexual and reproductive health services Threats to accessibility Lack of finances Lack of transportation Closure of clinics Restricted movements Fear of infection  In the Philippines 1. Insufficient human resource for full implementation of essential health services secondary to re assignment of health staff to covid-19 response 2. Limited access to basic health services - Due to limited operating hours - Conversion to Covid facilities - Limitations in transportations  In the Philippines 3. Misconceptions and fears on immunization, FP side effects, HIV stigma among users due to lack or poor counseling 4.Increase barriers to health care seeking behavior - due to mobility restrictions - fear of contracting the disease 5. Record keeping, surveillance, and reporting measures were hampered - existing resources were tapped to prefer Covid 19 related tasks  Policy and Guidelines that would enable the continuous provision of information and services to people in need of most support Department memorandums ○ 2020-167 – continuous provision of essential health services ○ 2022-022 – continuous provision of family planning services during enhanced community quarantine following the covid 19 pandemic ○ 2022-262 – continuous provision of maternal health services Department memorandums ○ 2022-319 – guidelines on Covid 19 management of pregnant women, women to give birth and newborns ○ 2022-341 – provision of health services for adolescents ○ 2022-351 – guidelines on the implementation of HPV vaccination  Strategies ○ Strengthening health response within the health care provider network ○ Shifting capacity building, health promotion and provision of technical assistance to online platforms ○ Ensuring continuous provision of health services through teleconsulting, client centered approach for delivery of medicines ○ Reducing stocks out of FP and HIV commodities ○ Fund provision for personal protective equipment  Republic Act # 11223 or the Universal Health Care Act ○ Guarantees that every filipino is given equitable access to high quality and affordable health care goods and services, including protection against financial risk due to illness  Republic Act # 10354 or the Reproductive Health Act of 2012 ○ Also known as Responsible Parenthood Reproductive Health (RPRH) ○ The main objective is improving reproductive health outcomes in the country  KRA1: Maternal, Newborn, Child Health, Nutrition Antenatal care visit – to 53 % Postpartum care - by 5 points from 62% in 2019 Facility based deliveries and skilled health attendance - Though still 90% of pregnant women delivered in health facilities Immunization Coverage > fully immunized infants - of 7.6% > beyond one year - 13.69% > antigen coverage - > pneumococcal vaccine - by 13% Immunization at birth - 7% to 6% ( BCG and Hepa B) Postpartum breastfeeding woman - by 15% Coverage for exclusive breastfeeding - to 52% in 2020 from 59% in 2019  Maternal Health Outcomes Women are still dying due to pregnancy related complications every year Maternal Mortality Ratio (MMR) – # of maternal deaths per 100,000 live births. Maternal Death – death of a woman while pregnant or within 42 days of pregnancy, irrespective of duration and site of pregnancy, from any causes related to or aggravated by the pregnancy or its management but not from accidental or incidental causes ( WHO 2016) Neonatal, Infant and Child Health Outcome Nutrition Outcomes Nutrition Outcome Key Intervention: Maternal Health Services Telemedicine – introduced by DOH and UP  KRA2: Family Planning From 8.1M FP users in 2020 - of 6 % users - of 43% new acceptant - of 28 % dropouts The rate of facility consumption For short acting methods - by 67% - POP by 26% - male condoms by 6 % - COP by 2% - injections For long acting methods - by 18% - implants by 3% - IUD KRA3: Adolescent Sexual and Reproductive Health Adolescent birth rate – age 15-19 remains exceeds the average of 35 15 – 19 1.8% from 2018-2019 10 – 14 7% ( due to abuse) Exposure to HIV/AIDS – 4% (3562) of all diagnosed from 1984 to Dec 2020 were 19 years old and younger ○ 6 % were children less than 10 years old  KRA4: Sexually Transmitted Infections and HIV/AIDS Based on AIDS Epidemic Model- Spectrum Estimated # of PLHIV reached to 111,400 ○ 82,865 – reported ○ 4,574 – deaths ○ 78,791 – alive ○ 47,979 – PLHIV on antiretroviral therapy ○ HIV Care Cascade for 202 has been adversely affected by Covid-19 pandemic with reduced coverage for testing, treatment and viral load testing  KRA5: Eliminating Violence Against Women and Children PNP reported ○ 14,835 cases of violence for women ○ 10,429 incidents of violence against women and children ○ 1,850 cases of rape ○ 1,408 cases of acts of lasciviousness