Framework for Maternal & Child Health Nursing PDF

FRAMEWORK FOR MATERNAL & CHILD HEALTH NURSING Topic 1 Goals, Philosophies and Scope of Maternal and Child Health Nursing Topic 2 National Health Goals and the 17 Sustainable Development Goals Learning Objectives: After mastering the contents of this module, you should be able to: 1. Identify the...

FRAMEWORK FOR MATERNAL & CHILD HEALTH NURSING Topic 1 Goals, Philosophies and Scope of Maternal and Child Health Nursing Topic 2 National Health Goals and the 17 Sustainable Development Goals Learning Objectives: After mastering the contents of this module, you should be able to: 1. Identify the specific goals and philosophies of maternal and child health nursing and apply this to nursing practice. 2.Describe the scope and the professional roles for nurses in maternal and child health nursing. 3. Describe family-centered care and ways that maternal and child health nursing could be made more family centered and respectful of diversity. 4. Discuss the interplay of nursing process, evidence-based practice, and nursing theory. 5. Familiarize with the National Health Goals and Identify the SDG related to maternal and Child. Goals, Philosophies and Scope of Maternal and Child Health Nursing (MCHN) Obstetrics, or the care of women during childbirth, is derived from the Greek word obstare, which means “to keep watch.” Pediatrics is a word derived from the Greek word pais, meaning “child.” True or False Answer these questions before start our class _______ The primary goal of maternal and child health nursing is promotion and maintenance of optimal family health. _______Puerperium is also known as the fourth trimester of pregnancy. _______The health of families is both affected by and influences the health of communities. _______The nursing process is a scientific form of problem solving, serves as the basis for assessing, making a nursing diagnosis, planning, implementing, and evaluating care. _______Dorothea Orem’s theory stresses that an important role of the nurse is to help patients adapt to change caused by illness or other stressors. Primary goal of Maternal and Child Health Nursing (MCHN) is the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. The figures below show family life cycle and the scope of Maternal and child Health Nursing. Figure 1.1 shows the interrelatedness of one stage to the next stage and to the health of the families. It depicts that the health of the families largely depends on the health of the individual. A healthy woman would most likely have a healthy pregnancy. A healthy pregnancy would yield a healthy infant; this infant would become a healthy child up to adolescence and become a healthy adult. The cycle goes on. Maternal and child health nursing includes care of the pregnant woman, child, and family. (A) During a prenatal visit, a nurse assesses that a pregnant woman’s uterus is expanding normally.  (B) During a health maintenance visit, a nurse assesses a child’s growth and development. (© Barbara Proud.) The scope of practice of MCHN includes the following: ◦ Provision of preconception health care – preconception means before pregnancy ◦ Provision of nursing care of women during three trimesters of pregnancy and the puerperium ◦ 1 trimester – during the first 3 months of pregnancy st ◦ 2 trimester – 4 to 6 months nd ◦ 3 trimester – 7 to 9 months rd ◦ Puerperium - (the 6 weeks after childbirth, sometimes termed as the fourth trimester of pregnancy) ◦ Provision of nursing care of children from birth through adolescence o 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. o Provision of nursing care to families in all settings – be it in the community or in the hospital setting. Philosophy of Maternal and Child Health Nursing Maternal and child health nursing is: Family-centered; assessment should always include the family as well as an individual Community-centered; the health of families is both affected by and influences the health of communities Evidence based; this is the means whereby critical knowledge increases. A challenging role for nurses and a major factor in keeping families well and optimally functioning. Whereas, Maternal and Child Health Nurse: Considers the family as a whole and as a partner in care when planning or implementing or evaluating the effectiveness of care. Serves as an advocate to protect the rights of all family members, including the fetus. Demonstrates a high degree of independent nursing functions because teaching and counseling are major interventions.  Promotes health and disease prevention because these protect the health of the next generation. Serves as an important resource for families during childbearing and childrearing as these can be extremely stressful times in a life cycle. Respects personal, cultural, and spiritual attitudes and beliefs as these so strongly influence the meaning and impact of childbearing and childrearing.  Encourages developmental stimulation during both health and illness so children can reach their ultimate capacity in adult life. Assesses families for strengths as well as specific needs or challenges. Encourages family bonding through rooming-in and family visiting in maternal and child healthcare settings.  Encourages early hospital discharge options to reunite families as soon as possible in order to create a seamless, helpful transition process. Encourages families to reach out to their community so the family can develop a wealth of support people they can call on in a time of family crisis.  Figure 1.3 A nurse involves the mother in a physical exam to promote family-centered care. Regardless of the setting, a family-centered approach is the preferred focus of nursing care (Papp, 2012). 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 (Hedges, Nichols, & Filoteo, 2012). 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. Maternal and child health nursing can be visualized within a framework in which nurses, using nursing process, nursing theory, and evidence-based practice, care for families during childbearing and childrearing years through four phases of health care: Health promotion Health maintenance Health restoration Health rehabilitation  Term Definition Example Teaching women the importance of rubella immunization before Educating parents and children to Health pregnancy; providing preteens with follow sound health practices through promotion information about safer sex practices teaching and role modeling well before they are likely to become sexually active Encouraging women to be partners in prenatal care; teaching parents the Health Intervening to maintain health when importance of safeguarding their maintenance risk of illness is present home by childproofing against poisoning Using conscientious assessment to be Caring for a woman during a certain that symptoms of illness are Health complication of pregnancy such as identified and interventions are begun restoration gestational diabetes or a child during to return patient to wellness most an acute illness such as pneumonia rapidly Encouraging a woman with gestational Helping prevent complications from trophoblastic disease (abnormal illness; helping a patient with residual Health placenta growth) to continue therapy effects achieve an optimal state of rehabilitation or a child with a renal transplant to wellness and independence; helping a continue to take necessary patient to accept inevitable death medications Nursing Process Nursing care, at its best, is designed and implemented in a thorough manner, using an organized series of steps, to ensure quality and consistency of care (Carpenito, 2012). The nursing process, a scientific form of problem solving, serves as the basis for assessing, making a nursing diagnosis, planning, implementing, and evaluating care. It is a process broad enough to serve as the basis for modern nursing care because it is applicable to all healthcare settings, from the home to ambulatory clinics to intensive care units. Evidence-Based Practice Evidence-based practice is the conscientious, explicit, and judicious use of current best evidence to make decisions about the care of patients (Falk, Wongsa, Dang, et al., 2012). Evidence can be a combination of research, clinical expertise, and patient preferences or values. Example of Evidenced Based Practice is the Essential Intrapartum and Newborn Care (EINC) which will be discussed during the Intra-Partum Care. 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 theorists offer helpful ways to view clients so that nursing activities can best meet client needs —for example, by seeing a pregnant woman not simply as a physical form but as a dynamic force with important psychosocial needs, or by viewing children as extensions or active members of a family as well as independent beings 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) Patricia Benner’s theory describes the way nurses move from novice to expert as they become more experienced and prepared to give inter-professional care (Benner, 2011). Another issue most nursing theorist address is how nurses should be viewed or what the goals of nursing care should be. At one time, the goal of nursing care could have been stated as “Providing care and comfort to injured and ill people.” Most nurses today would perceive this view as a limited one, because they are equipped to do preventive care as well. Extensive changes 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. A third issue addressed by nurse theorists concerns the activities of nursing care: as goals become broader, so do activities. For example, when the primary goal of nursing was considered to be caring for ill people, nursing actions were limited to bathing, feeding, and providing comfort. Currently, with health promotion as a major nursing goal, teaching, counseling, supporting, and advocacy are also common roles. In addition, with new technologies available, nurses are caring for clients who are sicker than ever before. 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 to a unique and special degree. Any questions? National Health Goals and the 17 Sustainable Development Goals NATIONAL HEALTH GOALS Ambisyon Natin 2040 – Philippines development blueprint which imagines the Philippines as a prosperous nation with only one percent poverty rate in 2040. Vision: All for Health towards Health for All Three major goals that the Philippine Health Agenda aspires for: 1. Better health outcomes with no major disparity among population groups 2. A responsive health system which makes Filipinos feel respected, valued and empowered 3. Financial risk protection for all especially the poor, marginalized and vulnerable Strategic Goal 1 Better health outcomes The health sector will sustain gains and address new challenges especially in maternal, newborn and child health, nutrition, communicable disease elimination, and non-communicable diseases (NCD) prevention and treatment. Improvements in health outcomes will be measured through sentinel indicators such as life expectancy, maternal and infant mortalities, NCD mortalities, TB incidence, and stunting among under-five year-olds. Strategic Goal 2 More responsive health system The quality of health goods and services as well as the manner in which they are delivered to the population will be improved to ensure people-centered healthcare provision. This may be done through instruments that routinely monitor and evaluate client feedback on health goods used and services received. Strategic Goal 3 More equitable healthcare financing Access of Filipinos, especially the poor and underserved, to affordable and quality health goods and services will be expanded through mechanisms that provide them with adequate financial risk protection from the high and unpredictable cost of healthcare. These may include efforts to reduce catastrophic out of pocket (OOP) payments, such as through public subsidies targeted towards the poor. https://www.doh.gov.ph/sites/default/files/publications/NOH-2017- 2022-030619-1.pdf GLOBAL HEALTH GOALS – 17 SUSTAINABLE DEVELOPMENT GOALS (SDG) IN THE YEAR 2015, LEADERS FROM 193 COUNTRIES OF THE WORLD CAME TOGETHER TO FACE THE FUTURE. And what they saw was daunting. Famines. Drought. Wars. Plagues. Poverty. Not just in some faraway place, but in their own cities and towns and villages. They knew things didn’t have to be this way. They knew we had enough food to feed the world, but that it wasn’t getting shared. They knew there were medicines for HIV and other diseases, but they cost a lot. They knew that earthquakes and floods were inevitable, but that the high death tolls were not. They also knew that billions of people worldwide shared their hope for a better future. So leaders from these countries created a plan called the Sustainable Development Goals (SDGs). This set of 17 goals imagines a future just 15 years off that would be rid of poverty and hunger, and safe from the worst effects of climate change. It’s an ambitious plan. But there’s ample evidence that we can succeed. In the past 15 years, the international community cut extreme poverty in half. Now we can finish the job. The United Nations Development Programme (UNDP) is one of the leading organizations working to fulfil the SDGs by the year 2030. Present in nearly 170 countries and territories, we help nations make the Goals a reality. We also champion the Goals so that people everywhere know how to do their part. UNDP is proud to continue as a leader in this global movement Out of the 17 SDG’s, SDG 3 is related to Maternal and Child Health. SDG 3 is to, “Ensure healthy lives and promote wellbeing for all at all ages.” There are goals within the goals or shall we say Health Targets for SDG 3 which are: 1. By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births. 2. By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. 3. By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. 4. By 2030, reduce by one third premature mortality from non- communicable diseases through prevention and treatment and promote mental health and well-being. 5. Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. 6. By 2020, halve the number of global deaths and injuries from road traffic accidents. 7. By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs. 8. Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. 9. By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. 10. Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate. 11. Support the research and development of vaccines and medicines for the communicable and non-communicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade-Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for all. 12.Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States. 13.Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks. https://www.who.int/topics/sustainable-development- goals/targets/en/ KEY POINTS FOR REVIEW Maternal and Child is viewed as separate entities, however these two are interrelated and they can be well understood if they are viewed as a continuum. Maternal and child health nursing can be visualized within a framework through the use of nursing process, nursing theory, and evidence-based practice, care for families during childbearing and childrearing years through four phases of health care. Nursing research and use of evidence-based practice are methods by which maternal and child health nursing expands and improves.  Trends in maternal and child health nursing include changes in the settings of care, increased concern about health care costs, improved preventive care, and family-centered care. Practice roles in maternal and child health nursing are expanding rapidly as nurses become more versed in evidence-based practice and technologic skills. The blueprint of Philippine Health Agenda is’ “Ambisyon Natin To” with a vision of, “Health for All, All for Health 2040”. Review your lesson on NCM 103 lecture specifically the Nursing Process as you are going to use it all trough out your nursing life.