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offering information and counseling them about reproductive life planning. They play a large role in helping women remain well so that they can enter a pregnancy in good health and maintain their health throughout life. 22 UNIT 1 Maternal and Child Health Nursing Practice ? Family Nurse Practitioner A family nurse practitioner (FNP) is an advancedpractice role that provides health care not only to women but to total families. In conjunction with a physician, an FNP can provide prenatal care for a woman with an uncomplicated pregnancy. The FNP takes the health and pregnancy history, performs physical and obstetric examinations, orders appropriate diagnostic and laboratory tests, and plans continued care throughout the pregnancy and for the family afterward. FNPs then monitor the family indefinitely to promote health and optimal family functioning. Neonatal Nurse Practitioner A neonatal nurse practitioner (NNP) is an advancedpractice role for nurses who are skilled in the care of newborns, both well and ill. NNPs may work in level 1, level 2, or level 3 newborn nurseries; neonatal follow-up clinics or physician groups. They also transport ill infants to different care settings. The NNP’s responsibilities include managing and carrying out patient care in an intensive care unit, conducting normal newborn assessments and physical examinations, and providing high-risk follow-up discharge planning (Bissell, 2004). Pediatric Nurse Practitioner A pediatric nurse practitioner (PNP) is a nurse prepared with extensive skills in physical assessment, interviewing, and well-child counseling and care. In this role, a nurse interviews parents as part of an extensive health history and performs a physical assessment of the child (Fig. 1.8). If the nurse’s diagnosis is that the child is well, he or she discusses with the parents any childrearing concerns mentioned in the interview, gives any immunizations needed, offers necessary anticipatory guidance (based on the plan of care), and arranges a return appointment for the next well-child checkup. The nurse has served as a primary health caregiver or as the sole health care person the parents and child see at that visit. If the PNP determines that a child has a common illness (e.g., iron deficiency anemia), he or she orders the necessary laboratory tests and prescribes appropriate drugs for therapy. If the PNP determines that the child has a major illness (e.g., congenital subluxated hip, kidney disease, heart disease), he or she consults with an associated pediatrician; together, they decide what further care is necessary. Nurse practitioners may also work in inpatient or specialty settings providing continuity of care to hospitalized children. As school nurse practitioners, they provide care to all children in a given community or school setting. Nurse-Midwife Throughout history, the nurse-midwife, an individual educated in the two disciplines of nursing and midwifery and licensed according to the requirements of the American College of Nurse-Midwives (ACNM), has played an important role in assisting women with pregnancy and childbearing. Either independently or in association with an obstetrician, the nurse-midwife assumes full responsibility for the care and management of women with uncomplicated pregnancies. Nurse-midwives play a large role in making birth an unforgettable family event as well as helping to ensure a healthy outcome for both mother and child (Dawley, 2003) (Fig. 1.9). LEGAL CONSIDERATIONS OF MATERNAL-CHILD PRACTICE Legal concerns arise in all areas of health care. Maternal and child health nursing carries some legal concerns that extend above and beyond other areas of nursing, because care is often given to an “unseen client”—the fetus—or to clients who are not of legal age for giving consent for medical procedures. In addition, labor and birth of a neonate are considered “normal” events, so the risks for a lawsuit are greater when problems arise. Nurses are legally responsible for protecting the rights of their clients, including confidentiality, and are accountable for the quality of their individual nursing care and that of other health care team members. In a society in which child abuse is of national concern, nurses are becoming increasingly responsible for identifying and reporting incidents of suspected abuse in children. CHAPTER 1 A Framework for Maternal and Child Health Nursing 23 FIGURE 1.8 A pediatric nurse practitioner examines a one-year-old child. (© Barbara Proud.) FIGURE 1.9 A nurse-midwife plays an important role in ensuring a safe and satisfying birth. (© Caroline Brown, RNC, MS, DEd.) Understanding the scope of practice (the range of services and care that may be provided by a nurse based on state requirements) and standards of care can help nurses practice within appropriate legal parameters. Documentation is essential in protecting a nurse and justifying his or her actions. This concern is long-lasting, because children who feel they were wronged by health care personnel can bring a lawsuit at the time they reach legal age. This means that a nursing note written today may need to be defended as many as 21 years into the future. Nurses need to be conscientious about obtaining informed consent for invasive procedures and determining that pregnant women are aware of any risk to the fetus associated with a procedure or test. In divorced or blended families
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