Framework for Maternal and Child Health Nursing

Standards of MCHN

1. Health Promotion: educating clients to be aware of good health through teaching and role modeling.
2. Health Maintenance: intervening to maintain health when risk of illness is present.
3. Health Restoration: promptly diagnosing and treating illness using interventions that will return the client to wellness most rapidly.
4. Health Rehabilitation: preventing further complications from an illness; bringing an ill client back to an optimal state of wellness or helping a client to accept inevitable death.

Standards of Care and Measures of Quality (WHO)

1. Every woman and newborn receives routine, evidence-based care and management of complications during labor, childbirth, and the early postnatal period
   • Women are assessed routinely and are given appropriate care.
   • Newborns receive routine care immediately after birth.
   • Mothers and newborns receive routine postnatal care.
   • Women with preeclampsia or eclampsia, or postpartum hemorrhage promptly receive appropriate interventions.
2. The health information system enables use of data to ensure early, appropriate action
   • Every woman and newborn has a complete, accurate, standardized medical record during labour, childbirth and the early postnatal period.
   • Every health facility has a mechanism for data collection, analysis, and feedback.
3. Every woman and newborn with condition(s) that cannot be dealt with effectively with the available resources is appropriately referred
   • Every woman and newborn is assessed to determine whether referral is required, and the decision to refer is made without delay. This referral follows a pre-established plan that can be implemented without delay at any time.
   • For every referral, there is appropriate information exchange and feedback to relevant health care staff.
4. Communication with women and their families is effective and responds to their needs and preferences
   • All women and their families receive information about the care and have effective interactions with staff. They experience coordinated care, with clear, accurate information exchange between relevant health and social care professionals.
5. Women and newborns receive care with respect and preservation of their dignity
   • All women and newborns have privacy around and at the time of labour and childbirth, and their confidentiality is respected.
   • No woman or newborn is subjected to mistreatment, such as physical, sexual, or verbal abuse, discrimination, neglect, detainment, extortion or denial of services.
   • All women have informed choices in the services they receive, and the reasons for interventions or outcomes are clearly explained.
6. Every woman and her family are provided with emotional support that is sensitive to their needs and strengthens the woman’s capability
   • Every woman is offered the choice to be with a companion of choice during labor and childbirth.
   • Every woman receives support to strengthen her capability during childbirth.
7. For every woman and newborn, competent, motivated staff are consistently available to provide routine care and manage complications
   • Every woman and child has access at all times to at least one skilled birth attendant and support staff for care.
   • The skilled birth attendances and support staff have appropriate competence.
   • Every health facility has managerial and clinical leadership responsible for continuous quality improvement.
8. The health facility has an appropriate physical environment, with adequate water, sanitation and energy supplies, medicines, supplies and equipment for routine maternal and newborn care and management of complications
   • Water, energy, sanitation, hand hygiene and waste disposal facilities are functional and safe.
   • Areas for labor, childbirth and postnatal care are designed, organized and maintained so that every woman and newborn can be cared for.
   • An adequate stock of medicines, supplies and equipment is available for routine care and management of complications.

Philosophy of MCHN

1. Family-centered: includes both individual and family
2. Community-centered: health depends on and influences community health
3. Evidence-based
4. Patient Advocacy: protect the rights of all family members, including the fetus
5. Teaching and Counseling are major, important nursing roles
6. Health promotion and disease prevention are vital to protect the health of the next generation
7. Personal, cultural, and religious attitudes or beliefs are meaningful and impact childbearing and childrearing
8. Circumstances such as pregnancy are meaningful only in the context of a total life

Goals of MCHN

The main goal of MCHN is the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. To this broad end, the range of practice includes:

• Pre-conceptual health care
• Care of women during three trimesters of pregnancy and the puerperium (6 weeks post childbirth)
• Care of infants during the perinatal period (6 weeks before conception to 6 weeks after birth)
• Care of children from birth through adolescence
• Care in settings as varied as the birthing room, the pediatric ICU, and at the home.

Across all practices, an essential goal of care is to remain family-centered (the family is the primary unit of care), allowing nurses to better understand individuals and their effect on others, in turn allowing for holistic care. A healthy family establishes an environment conducive to growth and health-promoting behaviors.

Advanced-Practice Roles for Nurses in MCHN

1. Clinical Nurse Specialists: master or doctorate-level nurses capable of acting as consultants in their area of expertise, as well as serving as role models, researchers, and teachers of quality nursing care.
   • Neonatal Nurse Specialists
   • Lactation Consultants
   • Genetic Nurse Counselors
2. Nurse Practitioners: master or doctorate-level nurses with advanced study in the promotion of health and prevention of illness in women. They play vital roles in educating women about their bodies and sharing with them methods to prevent illness. They also care for women with illnesses such as STIs, and offer information and counsel about reproductive life planning.
   • Pediatric Nurse Practitioner: may order necessary laboratory tests and prescribe appropriate drugs for therapy for common illnesses; consults with an associated pediatrician if a major illness is found
   • Neonatal Nurse Practitioner: skilled in the care of newborns, both well and ill. They may work in physician groups; neonatal follow-up clinics; and level 1, 2, or 3 newborn nurseries.
   • Family Nurse Practitioner: carers for the family as a whole in conjunction with a physician and provides prenatal care for a woman with an uncomplicated pregnancy.
3. Certified Nurse-Midwife: an individual educated and licensed in the two disciplines of nursing and midwifery. They play an important role in assisting women with pregnancy and childbearing, assuming full responsibility for the care and management of women with uncomplicated pregnancies either independently or in association with a physician.

Legal and Ethical Considerations in MCHN

Care is given to an “unseen” client, or clients who are not of legal age for giving consent. Nurses are legally responsible for protecting the rights of their clients, including confidentiality and are accountable for the quality of their individual nursing care. Documentation is important to ensure care is within legal parameters and protects the nurse by justifying their actions.

• Nurses need to be conscientious about obtaining informed consent for invasive procedures and determining that the pregnant woman is aware of any risk to the fetus.
• Recognition of “emancipated minors” or “mature minors” as having the right to sign for their own health care.

Some of the most difficult ethical quandaries in health care involve children and their families. Some examples include:

• Conception issues, especially in relation to in-vitro fertilization, embryo transfer, ownership of frozen oocytes or sperm, cloning, stem cell research, and surrogacy
• Abortion, particularly partial-birth abortions is still a highly controversial topic.
• Fetal rights versus Maternal rights
• Resuscitation, particularly for how long it should be continued
• Number of procedures or degree of pain a child should be asked to endure to achieve a degree of better health
• Balance between modern technology and quality of life