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Chapter 01 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 are broad b/c the scope of practice or range of practice includes the ff: 1. 2. Preconceptual Health Care Care of women during 3 trimesters of pregnancy 1st trimester (1st 3rd month) 2nd trimester (4th 6th month) 3rd trimester (7th 9th month) Care of women during Puerperium or 4th Trimester (6 weeks after childbirth) Care of infants during Perinatal Period (6 weeks before conception and 6 weeks after birth) Care of children from birth to adolescence Neonatal (28 days of life); Infancy (1 12 months); Adolescence (after 18 y/o) Care in settings as varied as the birthing room, the PICU, and the home.

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Philosophies of MCN 1. 2. 3. 4. 5. 6. 7. MCN is Family Centered; assessment must include both family and individual assessment. MCN is Community Centered; health of families depends on & influences the health of communities. MCN is Evidence Based because critical knowledge increases MCN includes independent nursing functions because teaching & counselling are major interventions. MCN Nurse, Advocate (protects the rights of family members, including fetus) Health Promotion and Disease Prevention to protect health of new generation. 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 as the primary unit of care is an essential goal because the level of a familys 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 *** Family basic unit of society Framework for MCN 1. 2. 3. 4. Nursing Process (ADPIE) Evidence Based Practice Nursing Research 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 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

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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

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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

Trends in Maternal and Child Health Nursing Population Client Advocacy safeguarding and advancing the interests of clients and their families. Trends Families are smaller in size Increased Single Parents (most common type of parent in US) Increased mothers working outside home at least part time (90%) Families are more mobile; Increased no. of homeless women & children Child and Intimate Partner Abuse Families are more health conscious Health care should respect cost containment Nursing Implications Fewer family members are present as support people in times of crisis Role of Nurse: Fullfill the role Fewer financial resources esp. woman Role of Nurse: Inform parents of care options and back up opinion Healthcare must be scheduled at times a working parent can care for her own self or bring a child for care. Role of Nurse: Discuss selection of child care centers Good interviewing & health monitoring are necessary so health database can be established and continuity of care. Screening for child or intimate partner abuse; Nurses must be aware of legal responsibilities for reporting abuse. Provide Health Education Comprehensive care is necessary in primary care settings because referral to specialists may no longer be an option; Health insurance is not available in all families.

Measuring Maternal and Child Health / Statistical Terms Used to Report Maternal and Child Health 1. 2. 3. 4. 5. 6. 7. 8. Birth Rate no. of births per 1000 population Fertility Rate no. of pregnancies per 1000 women of childbearing age Fetal Death Rate no. of fetal deaths weighing more than 500 g or more per 1000 live births Neonatal Death Rate Neonatal Period 1st 28 days of life; Infant is called Neonate No. of deaths per 1000 live births occurring in the 1st 28 days of life. Perinatal Death Rate Perinatal Period 6 weeks before conception and 6 weeks after childbirth No. of deaths of fetuses weighing > 500g and within the first 28 days of life per 1000 birth. Infant Mortality Rate no. of deaths per 1000 live births in the first 12 months of life. Childhood Mortality rate no. of deaths per 1000 population in children; 1 14 y/o Maternal Mortality Rate no. of maternal deaths per 100,000 live births that occur as direct result of reproductive process.

Trends in Health Care 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.

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Increasing Alternative Settings and Styles for Health Care LDRP Rooms (Labor Delivery Recovery Postpartum) a more natural childbirth environment as a birthing room. Family members are invited to stay to be a part of childbirth. Retail Clinics or Emergent Care Clinics located in shopping malls Ambulatory Clinics or at home to avoid long hospital stays for women and children. 3. Including Family in Health Care 4. Increasing Intensive Care Units NICU (Neonatal Intensive Care Unit) or ICN (Intensive Care Nursery) PICU (Pediatric Intensive Care Unit) 5. Regionalizing Intensive Care ex. Premature infant transferred to regional hospital 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 8. Increasing Use of Technology use of internet, charting in computer, using Doppler 9. Free birthing women giving birth without health care provider supervision; unassisted birth 10. LAMAS breathing techniques Legal Considerations of MCN Practice 1. 2. 3. 4. Identifying and Reporting Child Abuse Child can bring a lawsuit when they reach legal age Informed Consent for invasive procedure and any risk that may harm the fetus In divorced or blended families, nurse has the right to give consent.

Note: Nurses are legally responsible to protect the rights of their client and documentation is essential to protect nurse and justify his or her actions. Ethical Considerations of Practice 1. Conception Issues In Vitro Fertilization Stem Cell Research Embryo Transfer Surrogate Mothers Cloning Abortion Fetal Rights vs Rights of the Mother Use of Fetal Tissue for Research Resuscitation No. of procedures or degree of pain that a child should asked to achieve better health Balance between modern technology and quality of life.

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