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Turn Terry’s bed into the sunlight; provide adequate covers for warmth; leave her comfortable with electronic games to occupy her time. Assess for stressors such as loss of selfesteem and derive ways to prevent further loss such as praising her for combing her own hair. Arrange overbed table so Terry can feed herself; urge her to participate in care by doing as much for herself as she can. Ask Terry what she feels is her main need. Terry says that returning to school is what she wants most. Stress activities that allow her to maintain contact with school, such as doing homework or telephoning friends. Ask Terry what being sick means to her. Allow her to participate in care decisions based on her response. Plan care together with Terry. Encourage her to speak of school and accomplishments in Girl Scouts to retain self-esteem. Help Terry to make use of her left side as much as possible so that she returns to school and to her previous level of functioning as soon as possible. Assess Terry’s ability to use her left hand to replace her right-hand functions, which are now lost; direct nursing care toward replacing deficit with other factors, selfconcept, role function, and skills. of quality maternal and child health nursing care a continuing challenge. National Health Goals In 1979, the U.S. Public Health Service first initiated the formulation of health care objectives. Health care goals were reestablished in 2000, to be completed in 2010 (DHHS, 2000). Many of these objectives directly involve maternal and child health care, because improving the health of this young age group will have such long-term effects. The nation’s priority goals (leading health indicators) are shown in Box 1.5. Goals specific for each content area are highlighted in later chapters. National health goals are intended to help everyone more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade. Maternal and child health nurses need to be familiar with these goals, because nurses play a vital role in helping the nation achieve these objectives through both practice and research. The goals also serve as the basis for grant funding and financing of evidence-based practice. Trends in the Maternal and Child Health Nursing Population The maternal and child population is constantly changing because of changes in social structure, variations in family lifestyle, and changing patterns of illness. Table 1.3 summarizes some of the social changes that have occurred over the past 20 to 30 years that have altered health care priorities for maternal and child health nurses. Today, client advocacy, a philosophy of cost containment, an increased focus on health education, and new nursing roles are ways in which nurses have adapted to these changes. Measuring Maternal and Child Health Measuring maternal and child health is not as simple as defining a client as ill or well. Individual clients and health care practitioners may have different perspectives on illness and wellness. For example, some children with chronic but controllable asthma think of themselves as well; others with the same degree of involvement consider themselves ill. Although pregnancy is generally considered a well state, some women think of themselves as ill during this period. A more objective view of health is provided by national health statistics. A number of statistical terms are used to express the outcome of pregnancies and births and to describe maternal child health (Box 1.6). Statistics for these terms require accurate collection and analysis so that the nation’s health can be described accurately. Such statistics are useful for comparisons among states and for planning of future health care needs. Birth Rate The birth rate in the United States has gradually decreased over the past 10 years to 13.9 per 1,000 population at present (NCHS, 2005) (Fig. 1.2). Currently, the average family in the United States has 1.2 children. Boys are born more often than girls, at a rate of 1,050 boys to every 1,000 girls (NCHS, 2005). Births to teenaged mothers are steadily declining, and those to women older than 40 years of age are steadily increasing. Fertility Rate The term fertility rate reflects what proportion of women who could have babies are having them. The fertility rate is currently at 64.8%, a healthy reproductive rate for a country (NCHS, 2005). Fetal Death Rate Fetal death is defined as the death in utero of a child (fetus) weighing 500 g or more, roughly the weight of a fetus of 20 weeks’ or more gestation. Fetal deaths may occur because of maternal factors (e.g., maternal disease, premature cervical dilation, maternal malnutrition) or fetal factors (e.g., fetal disease, chromosome abnormality, poor placental attachment). Many fetal deaths occur for reasons unknown. The fetal death rate is important in evaluating the health of a nation because it reflects the overall quality of maternal health and prenatal care. The emphasis on both preconceptual and prenatal care has helped to reduce this rate from a number as high as 18% in 1950 to 6.4% at present (NCHS, 2005). Neonatal Death Rate The first 28 days of life are known as the neonatal period, and an infant during this time is known as a neonate. The neonatal death rate reflects not only the quality of care available to women during pregnancy and childbirth but also the quality of care available to
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