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(those in which two adults with children from previous relationships now live together), it is important to establish who has the right to give consent for health care. Personal liability insurance is strongly recommended for all nurses, so that they do not incur great financial losses during a malpractice or professional negligence suit. If a nurse knows that the care provided by another practitioner was inappropriate or insufficient, he or she is legally responsible for reporting the incident. Failure to do so can lead to a charge of negligence or breach of duty. The specific legal ramifications of procedures or care are discussed in later chapters that describe procedures or treatment modalities. ETHICAL CONSIDERATIONS OF PRACTICE Ethical issues are increasing in frequency in health care today. Some of the most difficult decisions in health care settings are those that involve children and their families. The following are just a few of the major potential conflicts: • Conception issues, especially those related to in vitro fertilization, embryo transfer, ownership of frozen oocytes or sperm, cloning, stem cell research, and surrogate mothers • Abortion, particularly partial-birth abortions • Fetal rights versus rights of the mother • Use of fetal tissue for research • Resuscitation (for how long should it be continued?) • The number of procedures or degree of pain that a child should be asked to endure to achieve a degree of better health • The balance between modern technology and quality of life Legal and ethical aspects of issues are often intertwined, which makes the decision-making process complex. Because maternal and child health nursing is so strongly family-centered, it is common to encounter some situations in which the interests of one family member are in conflict with those of another. It is not unusual for the values of a client not to match those of a health care provider. For example, if a pregnancy causes a woman to develop a serious illness, the family must make a decision either to terminate the pregnancy and lose the child or to keep the pregnancy and work to support the mother through the crisis. If the fetus is also at risk from the illness, the decision may be easier to make; however, the circumstances usually are not clearcut, and the decisions that need to be made are difficult. These and other issues are bound to emerge during the course of practice. Nurses can help clients who are facing such difficult decisions by providing factual information and supportive listening and by helping the family clarify their values. The Pregnant Woman’s Bill of Rights and the United Nations Declaration of Rights of the Child (see Appendix A) provide guidelines for determining the rights of clients in regard to health care. 24 UNIT 1 Maternal and Child Health Nursing Practice Checkpoint Question 3 The best description of the FNP role is a. To give bedside care to critically ill family members. b. To supervise the health of children up to age 18 years. c. To provide health supervision for families. d. To supervise women during pregnancy. ✔ Key Points • Standards of maternal and child health nursing practice have been formulated by the American Nurses Association, the Society of Pediatric Nurses, and AWHONN to serve as guidelines for practice. • Nursing theory 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. It 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 27 other nations. • Trends in maternal and child health nursing include changes in the settings of care, increased concern about health care costs, improved preventive care, and family-centered care. • Advanced-practice roles in maternal and child health nursing include women’s health, family, neonatal, and pediatric nurse practitioners; nursemidwives; clinical nurse specialists; and case managers. All of these expanded roles contribute to make maternal and child health care an important area of nursing and health care. • Maternal and child health care has both legal and ethical considerations and responsibilities over and above those in other areas of practice because of the role of the fetus and child. Critical Thinking Exercises 1. How might family-centered care help the Chung family, described in the beginning of the chapter? How can you explain recent changes in health care so that Melissa might understand why her hospital stay is so much shorter this time? How can you empower the family so that they feel more in control of what is happening to them? 2. Mrs. Chung says she has trouble paying for health care. Other countries throughout the world have a health care delivery system based not on profit but on provision of care for all citizens through a taxsupported program. The infant mortality rate in many of these countries is lower than in the United States. What are some reasons that might contribute to these lower rates? 3. The age at which women are having babies is increasing. For many women such as Melissa Chung, this age is now 35 years or older. a. How do you anticipate that this trend will change health care in the future? b. Are there special services that should be provided for such women? c.
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