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you? • Is health education done at your learning level? • Is the facility accessible to handicapped individuals? BOX 1.9 FOCUS ON . . . FAMILY TEACHING FAMILY TEACHING Increasing Emphasis on Preventive Care A generally accepted theory is that it is better to keep individuals well than to restore health after they have become ill. Counseling parents on ways to keep their homes safe for children is an important form of illness prevention in maternal and child health nursing. Research supporting the facts that accidents are still a major cause of death in children and that women still do not receive preconceptual or prenatal care are testaments to the need for much more anticipatory guidance in this area. Increasing Emphasis on Family-Centered Care Health promotion with families during pregnancy or childrearing is a family-centered event, because teaching health awareness and good health habits is accomplished chiefly by role modeling. Illness in a child is automatically a familycentered event. Parents may need to adjust work schedules to allow one of them to stay with the ill child; siblings may have to sacrifice an activity such as a birthday party or having a parent watch their school play; and family finances may have to be readjusted to pay for hospital and medical bills. When a mother is pregnant, family roles or activities may have to change to safeguard her health. A family may feel drawn together by the fright and concern of an acute illness. On the other hand, if an illness becomes chronic, it may pull a family apart or destroy it. By adopting a view of pregnancy, childbirth, or illness as a family event, nurses are well equipped to provide family-centered care. Nurses can be instrumental in including family members in events from which they were once totally excluded, such as an unplanned cesarean birth. They can help child health care to be family-centered by consulting with family members about a plan of care and providing clear health teaching so that family members can monitor their own care (Fig. 1.7). Nurses play an active role in both teaching health promotion and sustaining families through a child’s illness. In recent years, the U.S. government has recognized that the care of individual family members is a familycentered event. The Family Medical Leave Act of 1993 is a federal law that requires employers with 50 or more employees to provide a minimum of 12 weeks of unpaid, jobprotected leave to employees under four circumstances crucial to family life: • Birth of the employee’s child • Adoption or foster placement of a child with the employee • Need for the employee to care for a parent, spouse, or child with a serious health condition • Inability of the employee to perform his or her functions because of a serious health condition A serious health condition is defined as “an illness, injury, impairment, or physical or mental condition involving such circumstances as inpatient care or incapacity requiring 3 workdays’ absence” (U.S. Department of Labor, 1995). Specifically mentioned in the law is any period of incapacity due to pregnancy or for prenatal care with or without treatment. Illness must be documented by a health care provider. Nurse practitioners and nurse-midwives are specifically listed as those who can document a health condition. Increasing Concern for the Quality of Life In the past, health care of women and children was focused on maintaining physical health. More recently, however, a growing awareness that quality of life is as important as physical health has expanded the scope of health care to include the assessment of psychosocial facets of life in such areas as self-esteem and independence. Good interviewing skills are necessary to elicit this information at health care visits. Nurses can help obtain such information and also plan ways to improve quality of life in the areas the client considers most important. One way in which quality of life is being improved for children with chronic illness is the national mandate to allow them to attend regular schools, guaranteeing entrance despite severe illness or use of medical equipment such as a ventilator (Public Law 99-452). Nurses serving as school nurses or consultants to schools play important roles in making these efforts possible. Increasing Awareness of the Individuality of Clients Maternal and child clients today do not fit readily into any set category. Varying family structures, cultural backgrounds, socioeconomic levels, and individual circumstances lead to unique and diverse clients. Some women having children are younger than ever before, and an increasing number of women are experiencing their first pregnancies after the age of 35 (Carolan, 2003). Many women are having children outside of marriage. Gay and lesbian couples are also beginning to raise families, conceiving children through artificial insemination or adoption. As a result of advances in research and therapy, women who were once unable to have children, such as those with cystic fibrosis, are now able to manage a full-term pregnancy. Individuals with cognitive and physical challenges are also establishing families and rearing children. CHAPTER 1 A Framework for Maternal and Child Health Nursing 21 FIGURE 1.7 A nurse involves the mother in a physical exam to promote family-centered care. (© Barbara Proud.) Many families who have come from foreign countries enter
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