“I am going to the sea to fetch a new baby…the journey is dangerous and I may not return . . .”

- Saying of Tanzanian women near the time of delivery

Identify the goals and philosophy of maternal and child health nursing

Discuss the implications of the common standards of maternal and child health nursing and the health goals for the nation for maternal and child health.

Increase awareness of health educators regarding their crucial role in improving status of women and children’s health and welfare.

Discuss the ethico-legal-moral basis of Maternal and Child Health Nursing

ASSOCIATION OF WOMEN’S HEALTH, OBSTETRIC AND NEONATAL NURSES STANDARDS AND GUIDELINES

Standards of Professional Performance Association of Women’s Health, Obstetric and Neonatal

Nurses (1998), Standards for the nursing care of women and

newborns (5th ed.). Washington, DC

Standard I: Quality of Care The nurse systematically evaluates

the quality and effectiveness of nursing practice.

Standard II: Performance Appraisal

The nurse evaluates

his/her own nursing practice in relation to professional practice standards and relevant statutes and regulations.

Standard III: EducationThe nurse acquires and maintains current knowledge in nursing practice

Standard IV: CollegialityThe nurse contributes to the professional development of peers, colleagues and others

Standard V: EthicsThe nurse’s decisions and actions on behalf of patients are determined in an ethical manner.

Standard VI: CollaborationThe nurse collaborates with the patient, significant others, and health care providers in providing patient care.

Standard VII: ResearchThe nurse uses research findings in practice

Standard VIII: Resource Utilization

The nurse considers factors related to safety, effectiveness and cost in planning and delivering patient care.

Standard IX: Practice Environment

The nurse contributes

to the environment of care delivery within the practice settings.

Standard X: Accountability

The nurse is professionally and legally accountable for his/practice. The professional registered nurse may delegate to and supervise qualified personnel who provide patient care.

Standards of Care Comprehensive pediatric

nursing care focuses on helping children and their families and communities achieve their optimum health potentials. This is best achieved within the framework of family-centered care and the nursing process, including, secondary and tertiary care coordinated across health care and community settings.

Standard I: Assessment

The pediatric nurse collects health data.

Standard II: Diagnosis

The pediatric nurse analyzes the assessment data in determining diagnoses.

Standard III: Outcome Identification

The pediatric nurse identifies expected outcomes individualized to the client.

Standard IV: Planning The pediatric nurse

develops a plan of care that prescribes interventions to obtain expected outcomes.

Standard V: Implementation The pediatric nurse

implements the interventions identified in the plan of care.

Standard VI: Evaluation The pediatric nurse evaluates

the child’s and family’s progress toward attainment of outcomes.

Standard I: Quality of Care The pediatric nurse

systematically evaluates the quality and effectiveness of pediatric nursing practice.

Standard II: Performance Appraisal

The pediatric nurse evaluates his or her own nursing practice in relation to professional practice standards and relevant statutes and regulations.

Standard III: Education The pediatric nurse acquires and

maintains current knowledge.

Standard IV: Collegiality The pediatric nurse contributes to

the professional development of peers, colleagues and others.

Standard V: Ethics The pediatric nurse’s decisions

and actions on behalf of children and their families are determined in an ethical manner.

Standard VI: Collaboration The pediatric nurse

collaborates with the child, family and health care provider in providing client care.

Standard VII: Research The pediatric nurse uses research

findings in practice.

Standard VIII: Resource Utilization The pediatric nurse considers factors

related to safety, effectiveness and cost in planning and delivering care.

American Nurses Association and the Society of Pediatric Nurses (1996) Statement on the Scope and Standards of Pediatric Clinical Practice. Washington, DC: American Nurses Publishing House

Primary goal of maternal and child health nursing:

Promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing.

Range of practice:

Preconceptual health care

Care of women during three trimesters of pregnancy and the puerperium

Care of children during the perinatal period

Care of children from infancy through adolescence

Care in settings as varied as the birthing room, pediatric intensive care unit and the home

1. Maternal and child health nursing is family-centered; assessment data must include a family and individual assessment.

2. Maternal and child health nursing is community-centered; the health of families depends on and influences the health of communities.

3. Maternal and child health nursing is research-oriented because research is the means whereby critical knowledge increases.

4. Nursing theory and evidence-based practice provide a foundation for nursing care.

5. A maternal and child health nurse serves as an advocate to protect the rights of all family members, including the fetus.

6. Maternal and child health nursing uses a high degree of independent nursing functions because teaching and counseling are so frequently required.

7. Promoting health is an important nursing role because this protects the health of the next generation.

8. Pregnancy or childhood illnesses can be stressful and can alter family life in both subtle and extensive ways.

9. Personal, cultural, and religious attitudes and beliefs influence the meaning of illness and its impact on the family. Circumstances such as illness or pregnancy are meaningful only in the context of total life.

10. Maternal and child health nursing is a challenging role for the nurse and is a major factor in promoting high-level wellness in families.

I. Legal Basis of Maternal and Child Nursing:› Scope of Nursing Practice› Standards of Nursing Care › Client/Patients Safety› Informed Consent› Right to Privacy

Section 28. Scope of Nursing. A person shall be deemed to be practicing

nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age. As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. As member of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death.

(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;

(b) establish linkages with community resources and coordination with the health team;

(c) Provide health education to individuals, families and communities;

These establish the minimum criteria for competent and proficient delivery of nursing care. Such standard are designed to protect the public and are use to judge the quality of care provided.› Examples

Standards of Practice for Maternal- Child Health by ANA

Standards for Pediatric Clinical Nursing Practice by ANA and Society of Pediatric Nurses (2003)

Scopes and Standards of Practice for Neonatal Nursing by ANA and National Association of Neonatal Nurses (2004)

JCAHO (Joint Commission on Accreditation of Healthcare Organization) has identified patient safety as an important responsibility of healthcare providers and established seven goals as requirements for accreditation last 2005.

1. Improve the accuracy of patients identification

2. Improve the effectiveness of communication among caregivers

3. Improve the safety of using medications4. Improve the safety of using infusion

pumps5. Reduce the risk of healthcare-associated

infections6. Accurately and completely reconcile

medications across the continuum of care7. Reduce the risk of patient harm resulting

from fall

This is a legal concept that protects a person’s right to autonomy and self-determination by specifying that no action may be taken without that individual’s prior understanding and freely given consent.

When they are minor parents of the child client

When they are emancipated minors(self-supporting adolescents under 18 y.o.)

When they are adolescents between 16-18 seeking birth control, mental health counseling or substance abuse treatment

When the child and the parents do not agree on major treatment options.

When the parents’ choice of treatment does not permit lifesaving treatment for the child.

When there is a potential conflict of interest between the child and parents (e.g. Suspected child abuse or neglect) .

When parents are incapacitated and cannot make a decision (e.g. critically injured in the same motor accident).

The right of a person to protect his or her person or property free from public scrutiny.

Autonomy – the right/freedom to decide (the patient has the right to refuse despite the explanation of the nurse) Example:  surgery, or any procedure

Nonmaleficence – the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social)

Beneficence- for the goodness and welfare of the clients

Justice – equality/fairness in terms of resources/personnel

Veracity – the act of truthfulness Fidelity – faithfulness/loyalty to clients

Golden Rule The principle of Totality – The whole is greater than its

parts Epikia One who acts through as agent is herself responsible –

(instrument to the crime) No one is obliged to betray herself The end does not justify the means Defects of nature maybe corrected If one is willing to cooperate in the act, no justice is done

to him A little more or a little less does not change the

substance of an act. No one is held to impossible