MODULE-1.pdf

NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) MODULE I Foundations for Maternal and Child Health Nursing...

NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) MODULE I Foundations for Maternal and Child Health Nursing This chapter discusses competencies, philosophies, challenges, Goals and new roles for nurses in maternal–child health care and how these challenges and changes mold and affect care. After studying the module, you should be able to: 1. Describe the goals, standards philosophies and professional roles of maternal- child health nursing. 2. Have a deep understanding about theories related to maternal and child nursing 3. Understand the legal issues, ethical considerations and standards of maternal and child practice HOW ARE YOU GOING TO LEARN 1. Examine carefully the module objectives 2. Read through the module test( self-test) and try to answer them to the best of your ability 3. Your answers to this self-test are to be submitted to the faculty concerned 4. Take note of the following icons presented with in this module There are three lessons in the module. Read each lesson carefully then answer the exercises/activities to find out how much you have benefited from it. Work on these exercises carefully and submit your output to your respective instructor or adviser. In case you encounter difficulty, discuss this with your instructor during the face-to- face meeting. If not contact your instructor at CCHAMS office. Good luck and happy reading!!! 1  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) Lesson 1 The area of childbearing and childrearing families is a major focus of nursing practice in promoting health for the next generation. Comprehensive preconception and prenatal care is essential in ensuring a healthy outcome for mother and child. Although childbearing and childrearing are often viewed as two separate entities, they are interrelated, and a deeper understanding is achieved when they are viewed as a continuum.  Maternal and child health nursing includes care of the pregnant woman, child, and family.  The primary goal of both maternal and child health nursing is the promotion and maintenance of optimal family health. Major philosophical assumptions about combined maternal and child health nursing are listed in the table 1-1 below. Maternal and child health nursing extends from preconception to Menopause with an expansive array of health issues and healthcare providers. Examples of scope of practice include: 1. Preconception health care 2. Care of women during three trimesters of pregnancy and the puerperium (the 6 weeks after childbirth, sometimes termed the fourth trimester of pregnancy) 3. Care of infants during the perinatal period (the time span beginning at 20 weeks of pregnancy to 4 weeks [28 days] after birth) 4. Care of children from birth through late adolescent 5. Care in a variety of hospital and home care settings Regardless of the setting, a family-centered approach is the preferred focus of nursing care.  The health of an individual and his or her ability to function as a member of a family can strongly influence and improve overall family functioning. Family-centered care enables nurses to better understand individuals and their effect on others and, in turn, to provide more holistic care.  It includes encouraging rooming-in with the mother by the mother’s partner or support person and with the child by their caregiver. Family members are encouraged to provide physical and emotional care based on the individual situation and their comfort level.  Nurses provide guidance and monitor the interaction between family members to promote the health and well-being of the family unit. 2  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS)  Listed below are tips on how to assist a family choose a healthcare setting that is Family Centered  If the setting is for child care, are personnel interested in you as well as your child?  If the setting is a maternal care site, do they ask about family concerns as well as individual ones?  Will the staff provide continuity of care so you’ll always see the same primary care provider if possible?  Does the physical setup of the facility provide for a sense of privacy, yet a sense that healthcare providers share pertinent information so you do not have to repeat your history at each visit?  Is health education done at your learning level?  Do healthcare providers respect your opinion and ask for your input on healthcare decisions?  Will the facility still be accessible if a family member becomes disabled?  Maternal and child health nursing can be visualized within a framework in which nurses use nursing process, nursing theory, and Quality & Safety Education for Nurses (QSEN) competencies to care for families during childbearing and childrearing years and through the four phases of health care: 1. Health promotion 3. Health restoration 2. Health maintenance 4. Health rehabilitation TABLE1-1 DEFINITIONS AND EXAMPLES OF PHASES OF HEALTH CARE TERMS DEFINITIONS EXAMPLES Health promotion Educating parents and Teaching women the importance children to follow sound of rubella immunization before health practices through pregnancy; providing preteens teaching and role modeling with information about safer sex practices well before they are likely to become sexually active Health maintenance Intervening to maintain health Encouraging women to be when risk of illness is present partners in prenatal care; teaching parents the importance of safeguarding their home by childproofing against poisoning 3  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) Health restoration Using conscientious Caring for a woman during a assessment to be certain that complication of pregnancy such symptoms of illness are as gestational diabetes or a child identified and interventions during an acute illness such as are begun to return patient to pneumonia wellness most rapidly Health Helping prevent complications Encouraging a woman with rehabilitation from illness; helping a patient gestational trophoblastic disease with residual effects achieve (abnormal placenta growth) to an optimal state of wellness continue therapy or a child with and independence; helping a a renal transplant to continue to patient to accept inevitable take necessary medications death Maternal and Child Health Goals and Standards Healthcare technology has contributed to a number of important advances in maternal and child health care. Through immunization, childhood diseases such as measles and poliomyelitis almost have been eradicated. New fertility drugs and fertility techniques allow more couples to conceive. The ability to prevent preterm birth and improve the quality of life for both preterm and late preterm infants has increased dramatically. As specific genes responsible for children’s health disorders are identified, stem cell therapy may make it possible to replace diseased cells with new growth cells and cure these illnesses. In addition, a growing trend toward healthcare consumerism, or self-care, has made childbearing and childrearing families active participants in their own health monitoring. Access to health care and social determinants of health, impact the role of the nurse and the health of the patient. These factors have expanded the roles of nurses in maternal and child health and, at the same time have made the delivery of quality maternal and child health nursing care a challenge. 2020 NATIONAL HEALTH GOALS The importance a society assigns to human life can best be measured by the concern a nation places on its most vulnerable members—its elderly, its disadvantaged, and its youngest citizens. In light of this, in 1979, the U.S. Public Health Service first formulated healthcare objectives for the nation. Healthcare goals are reviewed every 10 years. In 2010, new goals to be achieved by 2020 were set (U.S. Department of Health and Human Services [DHHS], 2010) 4  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) The two main overarching national health goals are: To increase quality and years of healthy life. To eliminate health disparities. The 2020 National Health Goals are intended to help citizens more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade. It’s important for maternal and child health nurses to be familiar with these goals because nurses play such a vital role in helping the nation achieve these objectives through both practice and research (see www.healthypeople.gov). The goals also serve as the basis for grant funding and financing of evidence-based practice. Each of the following sections highlights goals as they relate to that specific area of care. GLOBAL HEALTH GOALS The United Nations (UN) and the World Health Organization established millennium health goals in 2000 in an effort to improve health worldwide. As with 2020 National Health Goals, these concentrate on improving the health of women and children because increasing the health in these two populations can have such long-ranging effects on general health. These Global Health Goals are: To end poverty and hunger. To achieve universal primary education. To promote gender equality and empower women. To reduce child mortality. To improve maternal health. To combat HIV/AIDS, malaria, and other diseases. To ensure environmental sustainability. To develop a global partnership for development. WHO ’s 17 Sustainable Development goals The seventeen Sustainable Development Goals (SDGs) are our shared vision of humanity and a social contract between the world’s leaders and the people” 5  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) Lesson 2 NURSING THEORY One of the requirements of a profession (together with other critical determinants, such as members who set their own standards, self-monitor their practice quality, and participate in research) is that a discipline’s knowledge flows from a base of established theory. Nursing theories are designed to offer helpful ways to view patients so nursing activities can be created to best meet patient needs—for example, Calistra Roy’s theory stresses that an important role of the nurse is to help patients adapt to change caused by illness or other stressors (Roy, 2011); Dorothea Orem’s theory concentrates on examining patients’ ability to perform self-care (Orem & Taylor, 2011); Using a theoretical basis such as these can help you appreciate the significant effect of a child’s illness or the introduction of a new member on the total family. Family plays a vital role in health care, representing the primary target of health care delivery for maternal and newborn nurses. It is crucial that nurses assist families as they incorporate new additions into their family (see Nursing Care Plan). When treating the woman and family with respect and dignity, health care providers listen to and honor perspectives and choices of the woman and family. They share information with families in ways that the family is supported in participating in the care and decision making at the level of their choice. Because so many variables affect ways of relating, the nurse must be aware that family 6  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) members may interact and communicate with each other in ways that are distinct from those of the nurse’s own family of origin. Most families will hold some beliefs about health that are different from those of the nurse. Their beliefs can conflict with principles of health care management predominant in the Western health care system. Family Theories A family theory can be used to describe families and how the family unit responds to events both within and outside the family. Each family theory makes certain assumptions about the family and has inherent strengths and limitations. Most nurses use a combination of theories in their work with families. A brief synopsis of several theories useful in working with families is included in Table 2-1. Application of these concepts can guide assessment and interventions for the family. TABLE 1-2 THEORIES AND MODELS RELEVANT TO FAMILY NURSING PRACTICE THEORY SYNOPSIS OF THEORY Family Systems Theory (Wright The family is viewed as a unit, and interactions among and Leahy, 2009) family members are studied rather than studying individuals. A family system is part of a larger suprasystem and is composed of many subsystems. The family as a whole is greater than the sum of its individual members. A change in one family member affects all family members. The family is able to create a balance between change and stability. Family members’ behaviors are best understood from a view of circular rather than linear causality. Family Life Cycle Families move through stages. The family life cycle is (Developmental) Theory (Carter the context in which to examine the identity and and McGoldrick, development of the individual. Relationships among family members go through transitions. Although families have roles and functions, a family’s main value is in relationships that are irreplaceable. The family involves different structures and cultures organized in various ways. Developmental stresses may disrupt the life-cycle process. Family Stress Theory (Boss, How families react to stressful events is the focus. 7  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) 1996) Family stress can be studied within the internal and external contexts in which the family is living. The internal context involves elements that a family can change or control, such as family structure, psychologic defenses, and philosophic values and beliefs. The external context consists of the time and place in which a particular family finds itself and over which the family has no control, such as the culture of the larger society, the time in history, the economic state of society, maturity of the individuals involved, success of the family in coping with stressors, and genetic inheritance McGill Model of Nursing (Allen, Strength-based approach in clinical practice with 1997) families, as opposed to a deficit approach, is the focus. Identification of family strengths and resources; provision of feedback about strengths; assistance given to family to develop and elicit strengths and use resources are key interventions. Health Belief Model (Becker, The goal of the model is to reduce cultural and 1974; Janz and Becker, 1984) environmental barriers that interfere with access to health care. Key elements of the Health Belief Model include the following: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and confidence. Human Developmental Ecology Behavior is a function of interaction of traits and (Bronfenbrenner, 1979; 1989 abilities with the environment. Major concepts include ecosystem, niches (social roles), adaptive range, and ontogenetic development. Individuals are “embedded in a microsystem [role and relations], a mesosystem [interrelations between two or more settings], an ecosystem [external settings that do not include the person], and a macro system [culture]” (Klein and White, 1996). Change over time is incorporated in the chronosystem. Other issues most nursing theorists address include how nurses should be viewed or what the goals of nursing care should be. Extensive changes in the scope of maternal and child health nursing have occurred as health promotion (teaching, counseling, supporting, and advocacy, or keeping parents and children well) has become a greater priority in care (Salsman, Grunberg, Beaumont, et al., 2012). As promoting healthy pregnancies and keeping children 8  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) well protects not only patients at present but also the health of the next generation, maternal–child health nurses fill these expanded roles to a unique and special degree. QSEN: QUALITY & SAFETY EDUCATION FOR NURSES In 2007, the Robert Wood Johnson Foundation challenged nursing leaders to improve the quality of nursing care and to build the knowledge, skills, and attitudes necessary to 68 help achieve that level of care into pre licensure and graduate programs (Disch, 2012). Because of this challenge, the QSEN Learning Collaborative created six competencies deemed necessary for quality care (Cronenwett, Sherwood, & Gelmon, 2009). These competencies included five competencies that originated from a study by the Institute of Medicine The QSEN Learning Collaborative added safety as the sixth competency The overall goal is to address the challenge of preparing future nurses with the abilities necessary to continuously improve the quality and safety of the healthcare systems in which they work. Definitions for each of the six competencies along with examples of the knowledge, skills, and attitudes necessary to achieve quality maternal and child health care are shown in the table2-2 Competency Knowledge Skills Attitudes A.Patient-Centered Care The patient or designee is Take an Encourage Don’t think of thought of as the source of admission family to spend admitting Anna to the control and full partner in history as much time as neonatal care nursery the provision of detailing possible with her as a single patient but compassionate and Document the while she is rather as admitting her coordinated care based on roles of family hospitalized; family to the setting. respect for the patient’s members and assess that she 9  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) preferences, values, and who will be the will have family needs chief childcare support on provider. transition to home B.Teamwork and Collaboration Nurses function effectively Familiarize Discuss with Consider and respect within nursing and yourself with patient’s parents patient parents as interprofessional teams, how many what problems, if integrative members fostering open other any, they will of her healthcare communication, mutual healthcare have visiting so team. respect, and shared providers will other team decision making as they be interacting members can achieve quality with patient help reassure and (e.g., support them neonatologist, when they visit. nurse practitioner, nutritionist) to help appreciate how frightening having to meet so many people could be to a family. Evidence-Based Practice Nurses integrate the best Read journal Implement Value the need for current evidence with articles related evidence-based change based on new clinical expertise and to new practice so evidence so you can patient/family preferences evidence about patient’s family explain to patient’s and values for delivery of healthy families are confident family with confidence optimal health care. or neonatal that care is based any need for change in care to be on credible care better prepared research to help patient seamlessly transition from one setting to the next. 10  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) Quality Improvement (QI) Nurses use data to monitor View QI as an Use whatever Appreciate that the outcomes of care and important role aids, such as continuous QI is an use improvement methods for all checklists, flow essential part of to design and test changes healthcare sheets, or patient successful working to continuously improve the professionals information with and respecting quality and safety of beginning with forms, necessary families. healthcare systems. prelicensure in order to students provide seamless nursing care from nursery admission to home. Safety Nurses minimize the risk of Learn the Be certain Anna Recognize families harm to patients and requirements receives under stress do not providers through both for a safe developmental “hear” instructions system effectiveness and healthcare stimuli as well as well and so may need individual performance. setting for a is cared for in an these repeated or vulnerable environment that provided in a written preterm infant. promotes a sense form as well as orally. of security and is as free from pain as possible. Informatics Nurses use information and Keep records Document care in Recognize that technology to and an electronic documentation must documentation health record so be current so it various healthcare Communicate, manage Providers can Can be available Complete to be knowledge, mitigate error, keep informed to various valuable (in audit and support decision in order to healthcare reviews, what wasn’t making. provide providers. documented as being seamless care done is considered as shifts and not done). setting shifts in care. 11  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) Lesson 3 Legal concerns arise in all areas of health care. Maternal and child health nursing carries some legal concerns above and beyond other areas of nursing because care is often given to patients who are not of legal age for giving consent. Additionally, reproductive healthcare rights and laws are complex and vary from state to state. These issues require specific attention when caring for expectant families. New technologies (e.g., assisted reproduction, surrogate motherhood, umbilical cord sampling, safety of new medicines with children, and end-of-life decisions) can lead to potential legal action, especially if patients are uninformed about the reason or medical necessity for these procedures. Nurses are legally responsible for protecting the rights of their patients, including confidentiality, and are accountable for the quality of their individual nursing care and that of other healthcare team members. New regulations on patient confidentiality guarantee patients can see their medical record if they choose, but health information must be kept confidential from others (Duffy, 2011). Unfortunately, although nurses recognize the need for patient privacy, it is not practiced at the same rates. Patients are also not aware of the importance for their own medical record privacy (Kim, Han, & Kim, 2016)  Understanding the scope of practice (the range of services and care that may be provided by a nurse based on state requirements) and standards of care can help nurses practice within appropriate legal parameters.  Documentation is essential for justifying actions. it is long lasting because children who feel they were wronged by healthcare personnel can bring a lawsuit at the time they reach legal age.  Personal liability insurance is strongly recommended for all nurses, so they do not incur great financial losses during a malpractice or professional negligence lawsuit.  Nurses need to be conscientious about obtaining informed consent for invasive procedures in children and determining if pregnant women are aware of any risk to the fetus associated with a procedure or test. A parent can be contacted by phone or e-mail if not present with the child at the time the consent is needed. 12  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS)  In divorced or blended families (those in which two adults with children from 96 previous relationships now live together), it is important to establish who has the right to give consent for health care. Adolescents who support themselves or who are pregnant are frequently termed “emancipated minors” or “mature minors” and have the right to sign for their own health care.  The term “wrongful birth” is the birth of a disabled child whose pregnancy the parents would have chosen to end if they had been informed about the disability during pregnancy. “Wrongful life” is a claim that negligent prenatal testing on the part of a healthcare provider resulted in the birth of a disabled child. “Wrongful conception” denotes that a contraceptive measure failed, allowing an unwanted child to be conceived and born. As many genetic disorders can be identified prenatally, the scope of both “wrongful birth” and “wrongful life” grows yearly (Whitney & Rosenbaum, 2011). If a nurse knows the care provided by another practitioner was inappropriate or insufficient, he or she is legally responsible for reporting the incident. Failure to do so can lead to a charge of negligence or breach of duty ETHICAL AND SOCIAL ISSUES IN PERINATAL NURSING 13  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) Most difficult ethical quandaries in health care today: Those that involve children and their families Examples include: 1) Conception issues, especially those related to in vitro fertilization, embryo transfer, ownership of frozen oocytes or sperm, and surrogate motherhood 2) Pregnancy termination 3) Fetal rights versus rights of the mother 4) Stem cell research 5) Resuscitation (and length of its continuation) 6) Number of procedures or degree of pain a child should be asked to endure to achieve a degree of better health 7) Balance between modern technology and quality of life 8) Difficulty maintaining confidentiality of records when there are multiple caregivers Legal and ethical aspects of issues are often knotted, which makes the decision-making process in this area is difficult. Because maternal and child health nursing is so strongly family centered, it is common to encounter some situations in which the interests of one family member are in conflict with those of another or the goals of a healthcare provider are different from the family’s. Maintaining privacy yet sustaining problem solving in these instances can be difficult but is a central nursing role. Nurses can help patients by providing factual information and supportive listening, and helping the family and healthcare providers clarify their values. If you want to know more about the bill of rights, you may read this file for more information The Pregnant Woman’s Bill of Rights and the UN Declaration of Rights of the Child (available at http://thePoint.lww.com/Flagg8e) provide guidelines for determining the rights of women and children with regard to maternal and child health care. STANDARDS OF PRACTICE AND LEGAL ISSUES IN DELIVERY OF CARE Nursing standards of practice in perinatal and women’s health nursing have been described by several organizations, including the ANA, which publishes standards for maternal-child health nursing; AWHONN, which publishes standards of practice and education for perinatal nurses ( American College of Nurse-Midwives (ACNM), which publishes standards of practice for midwives; and the National Association of Neonatal Nurses 14  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) (NANN), which publishes standards of practice for neonatal nurses. In legal terms the standard of care is that level of practice that a reasonably prudent nurse would provide in the same or similar circumstances. In determining legal negligence, the care given is compared with the standard of care. If the standard was not met and harm resulted, negligence occurred. The number of legal suits in the perinatal area typically has been high. As a consequence, malpractice insurance costs are high for physicians, nurse-midwives, and nurses who work in labor and birth settings. STANDARDS OF CARE FOR WOMEN AND NEWBORNS A. Standards That Define the Nurse’s Responsibility to the Patient 1. Assessment Collection of health data of the woman or newborn 2. Diagnosis Analysis of data to determine nursing diagnosis 3. Outcome Identification Identification of expected outcomes that are individualized 4.Planning Development of a plan of care 4. Implementation Performance of interventions for the plan of care 5. Evaluation Evaluation of the effectiveness of interventions in relation to expected outcomes B. Standards of Professional Performance That Delineate Roles and Behaviors for Which the Professional Nurse is Accountable 1. Quality of Care Systemic evaluation of nursing practice 2. Performance Appraisal Self-evaluation in relation to professional practice standards and other regulations 3. Education Participation in ongoing educational activities to maintain knowledge for practice 4. Collegiality Contribution to the development of peers, students, and others 5.Ethics 15  NUPC 108 CARE OF MOTHER CHILD AND ADOLESCENT (WELL CLIENTS) Use of American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) to guide practice 6.Collaboration Involvement of patient, significant others, and other health care providers in the provision of patient care 7. Research Use of research findings in practice 8. Resource Utilization Consideration of factors related to safety, effectiveness, and costs in planning and delivering patient care 9. Practice Environment Contribution to the environment of care delivery 10. Accountability Legal and professional responsibility for practice LEGAL TIP: Standard of Care When you are uncertain about how to perform a procedure, consult the agency procedure book and follow the guidelines printed therein. These guidelines are the standard of care for that agency Ethical concerns have multiplied with increasing use of technology and scientific Congratulations! You have just studied Module I. now you are ready to evaluate how much you have benefited from your reading by answering the summative test. Good Luck!!! 16