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organizations develop guidelines for care in their specific areas of nursing practice. In maternal-child health, standards have been developed by the Division of Maternal-Child Health Nursing Practice of the American Nurses Association in collaboration with the Society of Pediatric Nurses. These are shown in Box 1.3. The Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) has developed similar standards for the nursing care of women and newborns. These are summarized in Box 1.4. A FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING CARE Maternal and child health nursing can be visualized within a framework in which nurses, using nursing process, nursing theory, and evidence-based practice, care for families during childbearing and childrearing years through four phases of health care: • Health promotion • Health maintenance • Health restoration • Health rehabilitation Examples of these phases of health care as they relate to maternal and child health are shown in Table 1.1. The Nursing Process Nursing care, at its best, is designed and implemented in a thorough manner, using an organized series of steps, to ensure quality and consistency of care (Carpenito, 2004). The nursing process, a proven form of problem solving based on the scientific method, serves as the basis for assessing, making a nursing diagnosis, planning, organizing, and evaluating care. That the nursing process is applicable to all health care settings, from the prenatal clinic to the pediatric intensive care unit, is proof that the method is broad enough to serve as the basis for all nursing care. Because nurses rarely work in isolation, but rather as a member of a health care team or unit, Multidisciplinary Care Maps are included throughout the text to demonstrate the use of the nursing process for selected clients, provide examples of critical thinking, and clarify nursing care for specific client needs. Multidisciplinary care maps rather than nursing care plans are shown, because they not only demonstrate the nursing process but accentuate the increasingly important role of the nurse as a coordinator of client care. In addition, selected chapters also identify specific nursing outcomes using the terminology presented in the Nursing Outcomes Classification (NOC) and nursing activities using the terminology presented in the Nursing Interventions Classification (NIC) developed by the Iowa Intervention Project ( Johnson et al., 2000; McCloskey & Bulechek, 2000). Evidence-Based Practice Evidence-based practice involves the use of research or controlled investigation of a problem in conjunction with CHAPTER 1 A Framework for Maternal and Child Health Nursing 5 BOX 1.2 Common Measures to Ensure Family-Centered Maternal and Child Health Care Principle • The family is the basic unit of society. • Families represent racial, ethnic, cultural, and socioeconomic diversity. • Children grow both individually and as part of a family. Nursing Interventions • Consider the family as a whole as well as its individual members. • Encourage families to reach out to their community so that family members are not isolated from their community or from each other. • Encourage family bonding through rooming-in in both maternal and child health hospital settings. • Participate in early hospital discharge programs to reunite families as soon as possible. • Encourage family and sibling visits in the hospital to promote family contacts. • Assess families for strengths as well as specific needs or challenges. • Respect diversity in families as a unique quality of that family. • Encourage families to give care to a newborn or ill child. • Include developmental stimulation in nursing care. • Share or initiate information on health planning with family members so that care is familyoriented. clinical expertise as a foundation for action. Bodies of professional knowledge grow and expand to the extent that people in that profession plan and carry out research. Nursing research, the controlled investigation of problems that have implications for nursing practice, provides evidence for practice, upon which the foundation of nursing grows, expands, and improves. In addition, evidencebased practice provides the justification for implementing activities for outcome achievement, ultimately resulting in improved and cost-effective patient care. A classic example of how the results of nursing research can influence nursing practice is the application of the research carried out by Rubin (1963) on a mother’s approach to her newborn. Before the publication of this study, nurses assumed that a woman who did not immediately hold and cuddle her infant at birth was a “cold” or unfeeling mother. After observing a multitude of new mothers, Rubin concluded that attachment is not a spontaneous procedure; rather, it more commonly begins with only fingertip touching. Armed with Rubin’s findings and integrating these findings into practice, nurses became better able to differentiate healthy from unhealthy bonding behavior in postpartum women and their newborns. Women following this step-by-step pattern of attachment were no longer recognized as unfeeling, but normal. By documenting these normal parameters, nurses can identify women who do not follow such a pattern, and interventions can be planned and instituted to help these mothers gain a stronger attachment to their new
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