NCM107 PRELIMS Lecture Notes

A Framework for Maternal and Child Health Nursing

I. Goals and Philosophies
▪ major focus in promoting health for the next generation is the area of
childbearing and childrearing families
▪ comprehensive preconception and prenatal care → healthy outcome for
mother and child
▪ childbearing and childrearing are two separate entities but interrelated in a
continuum
▪ Primary Goal: promotion and maintenance of optimal family health
▪ Scope of practice includes:
– Preconception health care
– Care of women during three trimesters of pregnancy and the puerperium
– Care of infants during the perinatal period
– Care of children from birth through late adolescent
– Care in a variety of hospital and home care settings

A. Maternal and Child Health Nursing is:

▪ Family-centered; include family with the individual
▪ Community-centered; community affects and influences family
▪ Evidence-based

B. The nurse should:

▪ Consider family as a whole and partner in care
▪ Serve as an advocate for the family including the fetus
▪ Demonstrate a high degree of independent nursing functions because
teaching and counseling are major interventions
▪ Promote health and disease prevention
▪ Serve as an important resource
▪ Respect personal, cultural, and spiritual attitudes and beliefs
▪ Encourage development stimulation during health and illness
▪ Assess for strength, needs and challenges
▪ Encourage family bonding
▪ Encourage early hospital discharge options to reunite families as soon as
possible in order to create a seamless and helpful transition process
▪ Encourage families to reach out to their community

II. Maternal and Child Health Goals and Standards

A. Global Health Goals
▪ Two main health goals: to increase quality and years of healthy life and to
eliminate health disparities
▪ United Nations (UN) and WHO
▪ Major step forward in improving the health of all people
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B. Health Setting Magnet Status

▪ Magnet Status: credential given by the American Nurses Credentialing
Center (ANCC)
▪ Criteria:
– Transformational leadership: convert their organization’s values, beliefs,
and behaviors in order to create a high professional level of nursing care
– Structural empowerment: innovative environment where strong
professional practice can flourish with regard to the hospital’s mission,
vision, and values
– Exemplary professional practice: comprehensive understanding of the
role of nursing
– New knowledge, innovation, improvements: strong nursing leadership,
empowered professionals, and exemplary practice while contributing to
patient care
– Empirical quality results: solid structure and processes where strong
professional practice can flourish and where the mission, vision, and
values come to life as the organization achieves the outcomes believed to
be important for the organization
▪ “Magnet hospitals attract and maintain top talent; improve patient care,
safety and satisfaction; foster a collaborative culture; advance nursing
standards and practice; and grow business and financial success”

III.Framework
▪ Use of nursing process, nursing theory, and Quality & Safety Education for
Nurses (QSEN)
NCM107 PRELIMS Lecture Notes

▪ Four phases of health care:

– Health Promotion: educate on sound health practices through teaching
and role modeling
– Health Maintenance: intervening to maintain health when risk of illness is
present
– Health Restoration: Using conscientious assessment to be certain that
symptoms of illness are identified and interventions are begun to return
patient to wellness most rapidly
– Health Rehabilitation: Helping prevent complications from illness; helping
a patient with residual effects achieve an optimal state of wellness and
independence; helping a patient to accept inevitable death
A. QSEN
▪ Six competencies (five from a study by the Institute of Medicine)
– Patient-centered care
– Teamwork and collaboration
– Quality improvement
– Informatics
– EBP
– Safety
B. Measuring Maternal and Child Health
▪ Birth rate: number of births per 1,000 population; births/1,000
▪ Fertility rate: number of pregnancies per 1,000 women of childbearing age;
pregnancies/1,000
– Reflects nutritional resources
▪ Fetal death rate: number of fetal deaths (over 500g in weight) per 1,000 live
births; fetal deaths/1,000
– Reflects overall quality of maternal health and available services
▪ Neonatal death rate: number of deaths at birth or in the first 28 days of life
per 1,000 live births; neonatal deaths/1,000
– Reflects quality of care of pregnant women and infants during first month
of life
▪ Perinatal death rate: number of deaths during perinatal time period (fetus is
at least 500g about 20 weeks to 4-6 weeks after birth); sum of fetal and
neonatal rates
▪ Maternal mortality rate: maternal deaths due to pregnancy per 100,000 live
births; maternal deaths/100,000
– Although some of the causes for maternal mortality remain unclear,
known causes include: noncardiovascular disease, cardiovascular disease,
infection or sepsis, hemorrhage, cardiomyopathy, pulmonary embolism,
hypertensive disorders of pregnancy, stroke, amniotic fluid embolism,
anesthesia complications
▪ Infant mortality rate: deaths at birth to 12 months of life per 1,000 live
births; infant deaths/1,000
– Good index of general health
NCM107 PRELIMS Lecture Notes

– Reflects the quality of pregnancy care, overall nutrition, sanitation, infant

health and available care
– This rate is the traditional standard used to compare the health of a
nation with previous years or with other countries.
▪ Childhood mortality rate: deaths per 1,000 children 1-14 years; child
deaths/1,000
▪ Issues to consider: teenage pregnancy, poor nutrition, poor quality of care to
women and infants, poor sanitation
▪ Fetal deaths before birth and after 20 weeks gestation are due to maternal
factors (ex. premature cervical dilation and maternal hypertension) and fetal
factors (ex. chromosomal abnormalities and poor placental attachment)

IV. Healthcare Concerns and Attitudes

▪ Increasing concern for the quality of life
– scope of health care has expanded to include the assessment of
psychosocial facets of life in such areas as self-esteem and independence
– required good interviewing skills and plan ways to improve quality of life
according to the patient’s needs
▪ Increasing awareness of the individuality and diversity of patients
▪ Empowerment of healthcare consumers
– Nurses can promote empowerment of parents and children by respecting
their views and concerns, regarding parents as important participants in
their own or in their child’s health, keeping them informed, and helping
and supporting them to make decisions about care
*Emancipated minors or mature minors: adolescents who support themselves or
who are pregnant and have the right to sign for their own health care
*Wrongful birth: 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: a claim that negligent prenatal testing on the part of a healthcare
provider resulted in the birth of a disabled child
*Wrongful conception: contraceptive measure failed, allowing an unwanted child to
be conceived and born
*Standards of maternal and child health nursing practice have been formulated by
the American Nurses Association to serve as guidelines for practice
*QSEN competencies, combined with the nursing process, provide a sound method
of care for expanding areas of practice
*Nursing research and use of evidence-based practice are methods by which
maternal and child health nursing expands and improves
*The most meaningful and important measure of maternal and child health is the
infant mortality rate, which is the number of deaths among infants from birth to 1
year of age per 1,000 live births. This rate is declining steadily, but in the United
States, it is still higher than in 25 European countries
*Trends in maternal and child health nursing include changes in the settings of care,
increased concern about healthcare 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
NCM107 PRELIMS Lecture Notes

*Maternal and child health care have both legal and ethical considerations and
responsibilities over and above those in other areas of practice because of the role
of 98 the fetus and child

Childbearing and Childrearing Family in the Community

I. The Family as Part of a Community

 Community: group of individuals interaction within a limited geographic area

A. Family Structures
 Family: a householder and one or more other people living in the same
household who are related by birth, marriage, or adoption
 two or more people who live in the same household, share a common
emotional bond, and perform certain interrelated social tasks (Allender,
2013)
 Types:
– Family of Orientation: born into
– Family of Procreation: established
 Childfree or Childless
 Cohabitation
 Nuclear
 Extended (multigenerational)
 Single-parent
 Blended
 LGBT
 Foster
 Adoptive
B. Family Functions and Roles
 Wage earner, financial manager, problem solver, decision maker, nurturer,
health manager, environmentalist, culture bearer, gatekeeper
C. Family Tasks
 Physical maintenance
 Socialization of family members
 Allocation of resources
 Maintenance of order
 Division of labor
 Reproduction, recruitment, and release of family members
 Placement of members into the larger society
 maintenance of motivation and morale

wa nako kasabot

 Concept of Unitive and Procreative Health

NCM107 PRELIMS Lecture Notes

 Marriage: companionship and procreation; Sex: emotional bonding and

conception
 Unitive: becoming one flesh, uniting into one
 Procreative/Procreation: increase and multiply, harbor new life

D. Sexual Health
Sexuality is a multidimensional phenomenon that includes feelings, attitudes, and
actions. It has both biologic and cultural diversity components. It encompasses and
gives direction to a person’s physical, emotional, social, and intellectual responses
throughout life. Sexuality has always been a part of human life, but only in the past
few decades has it been studied scientifically. One common finding of researchers
has been that feelings and attitudes about sex vary widely across cultures and
individuals. Although the sexual experience is unique to each individual, sexual
physiology (how the body responds to sexual arousal) has common features

 Human Sexuality
 Major Components: biological sex, sexual orientation, sexual attitude,
values, sexual preference/gender ???
 Sexual Response Cycle

E. Sexual Response Cycle

Four discrete stages:
Excitement
Plateau
Orgasm
resolution

*Republic Act 10354 or the Responsible Parenthood and Reproductive Health Law of
2012 (RH Law) is a national policy that mandates the Philippine government to
comprehensively address the needs of Filipino citizens when it comes to responsible
parenthood and reproductive health

*Families exist within communities; assessment of the community and the family’s
place in the community yields important information on family functioning and
abilities
*A family is a group of people who share a common emotional bond and perform
certain interrelated social tasks
*Because families work as a unit, the unmet needs of any member can spread to
become the unmet needs of all family members
*Common types of families include nuclear, extended, single-parent, blended,
cohabitation, LGBT, foster, and adopted families
NCM107 PRELIMS Lecture Notes

*Common family tasks are physical maintenance, socialization of family members,

allocation of resources, maintenance of order, division of labor, reproduction,
recruitment and release of members, placement of members into the larger society,
and maintenance of motivation and morale
*Common life stages of families are marriage; early childbearing; families with
preschool, school-age, and adolescent children; launching stage; middle-years
families; and the family in retirement
*Changes in patterns of family life that are occurring include dual-parent
employment, increased divorce rates, reduced family size, and social problems such
as intimate partner violence
*Considering a family as a unit (a single patient) helps in planning nursing care that
not only meets QSEN competencies but also best meets the family’s total needs
*Because families exist within communities, assessment of the community and the
family’s place in the community yields further information on family functioning and
abilities.
Male and Female Reproductive System

I. Reproductive Development
Gonad: body organ that produces cells necessary for reproduction
 Female: ovaries → oocytes (cells that become eggs)
 Male: testicles/testes → spermatocytes (cells that become sperm)

Puberty: stage of life at which secondary sex changes begin

 Release of Gonadotropin-releasing hormone (GnRH)

Androgen
 Muscular development, physical growth, increase in sebaceous gland
secretions that cause acne
 Adrenal cortex and (male) testes or (female) ovaries

Estrogen
 Triggered at puberty by FSH
 Development of uterus, fallopian tubes, vagina, breast, typical fat
distribution, hair patterns
*adrenarche: onset of adrenal androgen production
*thelarche: development of breasts (usually 1-2 years after menstruation)
*pubarche: development of pubic hair
*menarche: first menstruation
*precocious puberty: early puberty

 Male reproductive system

 Andrology = study of male reproductive organs
 External Structures:
– Scrotum: support testes, regulate temperature of sperm
– Testes: encased by protective white fibrous capsule with numerous
lobules where each contain Leydig cells (interstitial cells on the testes
that produce testosterone) and a seminiferous tubule (produce
NCM107 PRELIMS Lecture Notes

spermatozoa/sperm); maturity of sperm: GnRH → FSH (releases

androgen-binding protein/ABP) and LS (release of testosterone from
testes) → ABP and testosterone = sperm, regulated through negative
feedback
– Penis: serves as an outlet for both male urinary and reproductive tracts;
prepuce: foreskin
 Internal Structures:
– Epididymis: passage of sperm from tubule to vas deferens
– Vas deferens (ductus deferens): passage of sperm to seminal vesicles and
ejaculatory duct; where sperm matures (65 to 75 days sperms mature
during passage through ductus deferens)
– Seminal vesicles: secrete viscous alkaline liquid high in sugar, protein,
and prostaglandin content; provide liquid with preferred pH of sperm
increasing motility
– Ejaculatory ducts: sperm to urethra
– Prostate gland: secrete thin alkaline fluid increases pH protects sperm
– Urethra: to outside
– Bulbourethral glands or Cowper’s glands: more alkaline fluid; semen →
60% prostate 30% seminal 5% epididymis 5% Cowper’s or bulbourethral
*aspermia/azoospermia: absence of sperm
*oligospermia: low sperm count; less than 20 million sperm per milliliter

 Female Reproductive System

 Gynecology
 External Structures (vulva):
– Mons veneris/mons pubis: pad of fat
– Labia minora: connective tissue for enclosure and protection
– Labia majora: protection
– Vestibule: flattened smooth surface inside labia
– Clitoris: rounded organ of erectile tissue covered by a fold of skin
(prepuce)
– Skene glands (paraurethral glands): beside urethra probably for
lubrication
– Bartholin glands (vulvovaginal glands): beside vaginal opening,
lubrication – helps sperm survival
– Fourchette: ridge of tissue formed by the posterior joining of the minora
and majora; area where an episiotomy is usually done
– Perineal muscle (perineal body): posterior to fourchette
– Hymen: elastic semicircle of tissue covering the vaginal opening
 Internal Structure:
– Ovaries: ova in utero 5-7M, 2M birth, 500k 7yrs old, 300k 22yrs old
– Fallopian tubes: isthmus – usually cut during tubal ligation; ampulla –
usually where fertilization occurs
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– Uterus: isthmus – short segment between body and cervix usually cut
during cesarean

*Hematocolpometra: retained blood and endometrial tissue in uterus and

vagina (mens blood cannot pass)
 Uterine deviations:

– Vagina
– Breasts

 Menstruation
 Purpose is to bring an ovum to maturity and renew uterine tissue bed
 Average length: 28 days; normal range 23-35 days
 Average menstrual flow (menses): 4-6 days; normal range 2-9 days
NCM107 PRELIMS Lecture Notes

 Hypothalamus → Gonadotropin hormone-releasing hormone/ Luteinizing

hormone-releasing hormone (initiates menstrual cycle so no GnRH no period);
lessens when estrogen increases
 Pituitary gland (anterior/adenohypophysis) → Follicle Stimulating Hormone
(FSH-maturation of ovum) and Luteinizing Hormone (LH-most active at
midpoint of cycle, releases mature egg from ovary, stimulates growth of
uterine lining during second half of cycle)
 Ovaries: estrogen (helps maintain pregnancy and stimulates fetal maturation)
estradiol (form of estrogen, development of secondary sexual characteristics;
usually used during HRT)
NCM107 PRELIMS Lecture Notes
NCM107 PRELIMS Lecture Notes