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Research on the benefits of early prenatal care led to the first major national effort to provide prenatal care to all pregnant women through prenatal nursing services (home visits) and clinics. Today, thanks to these and other community health measures (such as efforts to encourage breast-feeding, increased immunization, and injury prevention), as well as many technological advances, the U.S. infant mortality rate has fallen to 6.9 per 1,000 (National Center for Health Statistics [NCHS], 2005). Medical technology has contributed to a number of important advances in maternal and child health: childhood diseases such as measles and poliomyelitis are almost eradicated through immunization; specific genes responsible for many inherited diseases have been identified; stem cell therapy may make it possible in the next few years to replace diseased cells with new growth cells; new fertility drugs and techniques allow more couples than ever before to conceive; and the ability to delay preterm birth and improve life for premature infants has grown dramatically. In addition, a growing trend toward health care consumerism, or self-care, has made many childbearing and childrearing families active participants in their own health monitoring and care. Health care consumerism has also moved care from hospitals to community sites and from long-term hospital stays to overnight surgical and ambulatory settings. Even in light of these changes, much more still needs to be done. National health care goals established in 2000 for the year 2010 continue to stress the importance of maternal and child health to overall community health (Department of Health and Human Services [DHHS], 2000). Although health care may be more advanced, it is still not accessible to everyone. These and other social changes and trends have expanded the roles of nurses in maternal and child health care and, at the same time, have made the delivery CHAPTER 1 A Framework for Maternal and Child Health Nursing 9 TABLE 1.2 Summary of Nursing Theories Terry is a 7-year-old girl who is hospitalized because her right arm was severely injured in an automobile accident. There is a high probability she will never have full use of the arm again. Terry’s mother is concerned because Terry showed promise in art. Previously happy and active in Girl Scouts, Terry has spent most of every day since the accident sitting in her hospital bed silently watching television. Theorist Major Concepts of Theory Emphasis of Care Patricia Benner Dorothy Johnson Imogene King Madeleine Leininger Florence Nightingale Betty Neuman Dorothea Orem Ida Jean Orlando Rosemarie Rizzo Parse Hildegard Peplau Martha Rogers Sister Callista Roy Nursing is a caring relationship. Nurses grow from novice to expert as they practice in clinical settings. A person comprises subsystems that must remain in balance for optimal functioning. Any actual or potential threat to this system balance is a nursing concern. Nursing is a process of action, reaction, interaction, and transaction; needs are identified based on client’s social system, perceptions, and health; the role of the nurse is to help the client achieve goal attainment. The essence of nursing is care. To provide transcultural care, the nurse focuses on the study and analysis of different cultures with respect to caring behavior. The role of the nurse is viewed as changing or structuring elements of the environment such as ventilation, temperature, odors, noise, and light to put the client into the best opportunity for recovery. A person is an open system that interacts with the environment; nursing is aimed at reducing stressors through primary, secondary, and tertiary prevention. The focus of nursing is on the individual; clients are assessed in terms of ability to complete self-care. Care given may be wholly compensatory (client has no role); partly compensatory (client participates in care); or supportive-educational (client performs own care). The focus of the nurse is interaction with the client; effectiveness of care depends on the client’s behavior and the nurse’s reaction to that behavior. The client should define his or her own needs. Nursing is a human science. Health is a lived experience. Man-living-health as a single unit guides practice. The promotion of health is viewed as the forward movement of the personality; this is accomplished through an interpersonal process that includes orientation, identification, exploitation, and resolution. The purpose of nursing is to move the client toward optimal health; the nurse should view the client as whole and constantly changing and help people to interact in the best way possible with the environment. The role of the nurse is to aid clients to adapt to the change caused by illness; levels of adaptation depend on the degree of environmental change and state of coping ability; full adaptation includes physiologic interdependence. Assess Terry as a whole. An expert nurse is able to do this intuitively from knowledge gained from practice. Assess the effect of lack of arm function on Terry as a whole; modify care to maintain function to all systems, not just musculoskeletal. Discuss with Terry the way she views herself and illness. She views herself as a well child, active in Girl Scouts and school; structure care to help her meet these perceptions. Assess Terry’s family for beliefs about healing. Incorporate these into care.
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