01	Lesson Plan for
Foundations of Maternity, Women’s Health,
and Child Health Nursing	
OBJECTIVES
1.	Describe the historical background of maternity and child health care.
2.	Compare current settings for childbirth both within and outside the hospital setting.
3.	Identify trends that led to the development of family-centered maternity and pediatric care.
4.	Describe how issues such as cost containment, outcome management, home care, and technology affect perinatal, women’s health, and child health nursing.
5.	Discuss trends in maternal, infant, and childhood mortality rates.
6.	Identify how poverty and violence on children and families affect nursing practice.
7.	Apply theories and principles of ethics to ethical dilemmas.
8.	Discuss ethical conflicts that the nurse may encounter in perinatal, women’s health, and pediatric nursing practice.
9.	Relate how major social issues, such as poverty, homelessness, and access to health care, affect nursing practice.
10.	Describe the legal basis for nursing practice.
11.	Identify measures used to defend malpractice claims.
12.	Identify current trends in health care and their implications for nursing.
KEY TERMS
•	
•	advocacy, p. 8
•	antepartum, p. 1
•	bioethics, p. 10
•	case management, p. 6
•	ethical dilemma, p. 11
•	ethics, p. 10
•	infant mortality rate, p. 9
•	intrapartum, p. 1
•	lactation, p. 7
•	malpractice, p. 3
•	morbidity, p. 10
•	negligence, p. 12
•	neonatal mortality rate, p. 9
•	nurse practice act, p. 15
•	postpartum, p. 1
•	pregnancy-related death ratio, 9
•	standard of care, p. 18
•	standardized, p. 7

Note: Audio glossary available on Evolve.
NURSING CURRICULUM STANDARDS
Quality and Safety Education for Nurses (QSEN) and National League for Nursing (NLN) Competencies
•	Patient-Centered Care
o	Nursing of Children, p. 4
o	Home Care, p. 7
o	Community Care, p. 7
o	Health Care Assistance Programs, p. 8
o	Social Issues, p. 13
o	Concerns About Early Discharge, p. 19
o	Dealing with Early Discharge, p. 20

•	Teamwork and Collaboration
o	Case Management, p. 6
o	Use of Unlicensed Assistive Personnel, p. 19
•	Evidence-Based Practice
o	Evidence-Based Nursing Care, p. 6
•	Quality Improvement
o	Current Trends in Child Healthcare, p. 5
o	Preventive Health, p. 8
•	Safety
o	Maternal and Infant Mortality, p. 8
o	Childhood Mortality, p. 10
o	Morbidity, p. 10
o	Table 1.2: Infant Mortality Data for Selected Countries (Based on 2010 Data), p. 9
o	Table 1.3: Leading Causes of Death Among Children Ages 1 to 14 Years: Death Rates per 100,000, p. 10
o	Violence, p. 15
o	Safeguards for Health Care, p. 15
o	Concerns About Early Discharge, p. 19
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2017): Concepts for nursing practice. (2nd ed.). St. Louis: Elsevier. The following specific exemplars chosen and listed for each concept have been specifically tailored to correspond to the McKinney: Maternal-Child Nursing, 5th edition, textbook.
THEME: Attributes and Resources
•	Concept: Development
o	Nursing of Children, p. 4
o	Statistics on Maternal, Infant, and Child Health, p. 8
THEME: Sexuality and Reproduction
•	Concept: Reproduction
o	Maternity Nursing, p. 1
o	Current Settings for Childbirth, p. 2
o	Table 1.1: Federal Projects for Maternal-Child Care, p. 2
o	Statistics on Maternal, Infant, and Child Health, p. 8
o	Prenatal Care in the United States, p. 14
THEME: Nursing Attributes and Roles
•	Concept: Ethics
o	Ethical Perspectives on Maternity, Women’s Health, and Child Nursing, p. 10
o	Box 1.1: Ethical Principles, p. 11
o	Box 1.2: Supreme Court Decisions on Abortion Since Roe v. Wade, p. 12
•	Concept: Health Promotion
o	Preventive Health, p. 8
THEME: Care Competencies
•	Concept: Collaboration
o	Use of Unlicensed Assistive Personnel, p. 19
•	Concept: Safety
o	Violence, p. 15
o	Concerns About Early Discharge, p. 19
•	Concept: Evidence
o	Evidence-Based Nursing Care, p. 6
THEME: Health Care Delivery
•	Concept: Caregiving
o	Case Management, p. 6
•	Concept: Health Disparities
o	Health Care Assistance Programs, p. 8
o	Poverty, p. 13
o	Homelessness, p. 14
o	Allocation of Health Care Resources, p. 14
o	Healthcare Rationing, p. 15
THEME: Health Care Infrastructure
•	Concept: Health Care Economics
o	Cost Containment, p. 5
o	Effects of Cost Containment, p. 5
•	Concept: Health Policy
o	Access to Care, p. 7
o	Public Health Insurance Programs, p. 7
o	Government Programs for Health Care: Medicaid, p. 14
•	Concept: Health Law
o	Legal Issues, p. 15
o	Unnumbered Nursing Quality Alert Box 1.1: Elements of Negligence, p. 16
o	Unnumbered Nursing Quality Alert Box 1.2: Requirements of Informed Consent, p. 17
Bachelor of Science in Nursing (BSN) Essentials
•	Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice
o	Historic Perspectives, p. 4
o	Current Trends in Child Healthcare, p. 5
o	Home Care, p. 7
o	Community Care, p. 7
o	Statistics on Maternal, Infant, and Child Health, p. 8
o	Table 1.2: Infant Mortality Data for Selected Countries (Based on 2010 Data), p. 9
o	Table 1.3: Leading Causes of Death Among Children Ages 1 to 14 Years: Death Rates per 100,000, p. 10
o	Social Issues, p. 13
•	Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety
o	Maternal and Infant Mortality, p. 8
o	Childhood Mortality, p. 10
o	Morbidity, p. 10
o	Table 1.2: Infant Mortality Data for Selected Countries (Based on 2010 Data), p. 9
o	Table 1.3: Leading Causes of Death Among Children Ages 1 to 14 Years: Death Rates per 100,000, p. 10
o	Violence, p. 15
o	Safeguards for Health Care, p. 15
o	Concerns About Early Discharge, p. 19
•	Essential III: Scholarship for Evidence-Based Practice
o	Evidence-Based Nursing Care, p. 6
•	Essential V: Health Care Policy, Finance, and Regulatory Environments
o	Table 1.1: Federal Projects for Maternal-Child Care, p. 2
o	Public Health Insurance Programs, p. 7
o	Health Care Assistance Programs, p. 8
o	Legal Issues, p. 15
o	Unnumbered Nursing Quality Alert Box 1.1: Elements of Negligence, p. 16
o	Unnumbered Nursing Quality Alert Box 1.2: Requirements of Informed Consent, p. 17
o	Current Trends and Their Legal and Ethical Implications, p. 19
•	Essential VI: Interprofessional Communication and Collaboration for Improving Patient Health Outcomes
o	Case Management, p. 6
o	Use of Unlicensed Assistive Personnel, p. 19
•	Essential VII: Clinical Prevention and Population Health
o	Preventive Health, p. 8
•	Essential VIII: Professionalism and Professional Values
o	Ethical Perspectives on Maternity, Women’s Health, and Child Nursing, p. 10
o	Box 1.1: Ethical Principles, p. 11
o	Box 1.2: Supreme Court Decisions on Abortion Since Roe v. Wade, p. 12
•	Essential IX: Baccalaureate Generalist Nursing Practice
o	Current Trends and Their Legal and Ethical Implications, p. 19

STUDENT CHAPTER RESOURCES	
Chap. 01	PREPARE FOR CLASS, CLINICAL, OR LAB
READ—Textbook (pp. 1-22)
REVIEW—Evolve Resources
•	Audio Glossary
•	Key Points
ANSWER—Evolve Resources
•	Case Study Questions
•	Chapter 1, Student Review Questions	
SG	ANSWER—Study Guide
•	Chapter 1, Foundations of Maternity, Women’s Health, and Child Health Nursing (32 Questions)	
EAQ	ANSWER—Elsevier Adaptive Quizzing
•	Chapter 1, Foundations of Maternity, Women’s Health, and Child Health Nursing	
CS	PREPARE – Clinical Skills Online
•	Clinical Skills: Maternal Newborn Collection
•	Clinical Skills: Pediatrics Collection	

INSTRUCTOR CHAPTER RESOURCES	
TB	TESTING RESOURCES—Test Bank
•	To access the ExamView format, go to the Downloads section.	
PPT	TEACHING RESOURCES—PowerPoint Presentation (Slides 1-28)	
IC	TEACHING RESOURCES—Image Collection
•	Figure 1.1. A typical labor, delivery, and recovery room.
•	Figure 1.2. Uninsured Children by Poverty Status, Household Income, Age, Race and Hispanic Origin, 2014.
•	Figure 1.3. Infant Mortality Rates, 1985-2013.
•	Figure 1.4. The cycle of poverty.	
ETC.	TEACHING RESOURCES—Conversion Guide
TEACHING RESOURCES—Curriculum Guides	

TEACHING STRATEGIES	
CONTENT FOCUS	CONTENT HIGHLIGHTS	
LEARNING ACTIVITIES	
historic perspectives
Maternity Nursing
Current Settings for Childbirth
Nursing of Children	Discuss the historical and societal changes in maternity and pediatric health care. Explain the changes in maternity care that have occurred as childbirth moved out of the home and into a hospital setting, including “granny” midwives, the emergence of medical management, government involvement in maternal-infant care, the impact of consumer demands on health care, and the development of family-centered maternity care. Describe the current settings for childbirth: hospitals, birth centers, and homes. Explain the history of pediatric nursing care, including historical perspectives, societal changes, developments in hygiene, and family-centered health care.	•	Discussion Topic: What are the advantages and disadvantages of hospital, birth center, and home births?
•	Large Group Activity: With a long sheet of rolled paper tacked to the wall or magnetized cards on the blackboard, ask a group of students to create a timeline of historical changes in maternity and pediatric health care. Ask students to consider historical perspectives of the status of children and the evolution of family-centered care.	
current trends in child health care
Cost Containment
Effects of Cost Containment	Describe the goals and objectives of Healthy People 2020. Explain how the focus of nursing care of children has changed as national attention to health promotion and disease prevention has increased. Explain prospective payments. Discuss diagnosis-related groups, managed care, and capitated care as aspects of cost containment. Describe the effects of cost containment. Discuss the case management practice model. Explain the importance of evidence-based nursing care and outcomes management, including nurse-sensitive indicators, variances, and clinical pathways.	•	Online Activity: Ask students to visit the site for Healthy People 2020 at www.healthypeople.gov, select a section of the site (topics and objectives, leading health indicators, data search, healthy people in action, tools and resources, webinars and events), and prepare a brief written summary detailing the content they found and how they can apply that content to their practice. Discuss their findings in the next class.
•	Large Group Activity: Ask students to come prepared to discuss actual and anticipated aspects of health care reform. Their ideas can come from the media or from their work situations. Direct them to think about the impact of all aspects of health care reform on pediatric care. In class, ask the students to make a list of the aspects that are identified. Discuss whether the list is complete. Ask the class to identify the aspects of health care that will have both positive and negative influences on pediatric care. Discuss differences of opinion.
•	Activity: Ask students to list the goals of managed care. Help students identify ways in which individuals and nurses can effectively work in a managed care system.
•	Activity: Review clinical pathways as they are used in the pediatric setting. Provide an incomplete pathway for a common problem for which students already know the disease process. Help them work in groups to complete the clinical pathway. Discuss its usefulness in managing nursing care.
•	Large Group Activity: Select a clinical pathway used in your clinical agency. Work with students to identify specific ways in which the pathway fosters family and patient involvement, how collaboration is used, and how nurses can determine whether the patient is on course or if a problem is developing.	
home care	Discuss the forms home care services can take.	•	Discussion Topic: Why do consumers often prefer home care? What are the benefits of home care?
•	Discussion Topic: A pregnant woman in her third trimester is seen in the emergency department for an upper respiratory infection. She tells the nurse who is interviewing her that she plans to deliver her baby at home and does not have an obstetrician. During the physical assessment, the nurse finds that the woman has hypertension. What responsibility does the nurse have to initiate further discussion of the woman’s plans for her pregnancy and birth?	
community care
Access to Care	Describe school-based health centers. Discuss factors limiting access to care and the impact of these factors on women and children. Explain public health insurance programs and preventive health.	•	Online Activity: Assign students to visit the local public health department’s Web site to explore the nurse’s role in providing care to low-income families. Have students explore community resources available to these families. Ask them to also consider barriers to accessing such resources.	
HEALTH CARE ASSISTANCE PROGRAMS	Discuss programs that assist in the case of the Women, Infants, and Children (WIC) program; Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program; Public Law 99-457; the Healthy Start program; and the March of Dimes’ Premature Birth Report Card.	•	Online Activity: Assign students to visit the March of Dimes’ Web site (http://www.marchofdimes.org/mission/prematurity-reportcard.aspx), and view the Premature Birth Report Card for your state. Ask students to summarize what they have learned and to discuss their findings in class.	
STATISTICS ON MATERNAL, INFANT, AND CHILD HEALTH
Maternal and Infant Mortality
Adolescent Births
Childhood Mortality
Morbidity	Discuss the importance of statistics as sources of information about the health of groups of people. Explain issues related to maternal and infant mortality. Describe the five leading causes of infant mortality: (1) congenital malformations, deformations, and chromosome abnormalities; (2) disorders related to low birth weight; (3) newborn problems related to maternal complications; (4) sudden infant death syndrome (SIDS); and (5) unintentional injury. Discuss racial inequality as it relates to maternal and infant mortality. Explain the issues related to adolescent births.	•	Online Activity: Assign a group of students to gather mortality and morbidity statistics on children from the local health department’s Web site. Ensure that they obtain infant statistics for the local community and its comparison with national statistics. Ask them to determine how the statistics are used.
•	Small Group Activity: Then ask students to work in small groups to identify factors in the local community that contribute to the statistics. Students can be assigned to groups using where they live or their areas of experience. Ask students to share their discussions, and assist them in drawing conclusions.	
ETHICAL PERSPECTIVES ON MATERNITY, WOMEN’S HEALTH, AND CHILD NURSING
Ethics and Bioethics
Ethical Dilemmas
Ethical Concerns in Reproduction
Ethical Concerns in Child Health Nursing	Discuss the ethical and social dilemmas that affect families. Define ethics, bioethics, and ethical dilemmas. Discuss the ethical principles in Box 1.1 and how to apply them. Explain that although using a specific approach does not guarantee a right decision, it does provide a logical, systematic method for going through the steps of decision making. Explain ethical concerns in reproduction, including elective pregnancy termination and fetal injury. Discuss ethical concerns in child health nursing, including cessation of treatment and terminating life support.	•	Large Group Activity: Present a panel discussion on current reproductive ethical issues. Include a physician, a nurse, a social worker, an ethicist, and a member of the clergy on the panel. Ask students to prepare questions ahead of time.
•	Discussion Topic: Joan and Ed are expecting their first child. Joan is 4 months pregnant, and a family history of an inherited disease is known. Laboratory studies have shown that this fetus has the disease and will be severely affected if the pregnancy is carried to term. The physician has recommended that Joan have an abortion. The couple has made a decision about the life of the fetus. The decision that they made is not the decision that you think is best for them. What is your professional responsibility to this couple? What actions would you take in providing continuing support for the decision they have made?	
SOCIAL ISSUES
Poverty
Homelessness
Prenatal Care in the United States
Government Programs for Health Care: Medicaid
Allocation of Health Care Resources
Care Versus Cure
Healthcare Rationing
Violence	Discuss the social issues that influence health care, including poverty, homelessness, access to care, and allocation of funds. Explain that poverty is a major predictor for unmet health needs in children and adults. Discuss how the homeless have the same difficulties in obtaining health care as other poor individuals because of a lack of transportation, inconvenient hours, and a lack of continuity of care. Explain the importance of prenatal care and the positive impact good prenatal care has on infant birth weight and infant mortality. Explain the purpose of Medicaid. Discuss how health care expenditures are increasing on an annual basis. Describe the issues surrounding care versus cure. Define health care rationing. Explain that violence is not only a social problem, but it is also a health problem. Discuss how nurses need to educate themselves on the issue of violence and work with schools and parents to combat the problem.	•	Small Group Activity: Divide students into small groups of four to five students. Assign each group one of the following two scenarios for discussion. Then come back together as a group to discuss student responses.
o	You are reviewing the chart of a woman for whom you are assigned to provide care during labor. You find that she has a history of substance abuse that continued during her pregnancy. How will this knowledge influence your interactions with this woman? What might you do differently with this patient?
o	You are assisting in setting up a prenatal clinic in a low-income neighborhood. What methods would you use to encourage young mothers to use the services of the clinic?
•	Discussion Topic: Ask students to discuss or debate the following questions from the textbook: Is health care a fundamental right? Should a certain level of care be guaranteed to all citizens? What is that basic level of care? Should the cost of treatment and its effectiveness be considered when one is deciding how much government or third-party payers will cover?	
LEGAL ISSUES
Safeguards for Health Care
Accountability
Malpractice	Explain that the legal foundation for the practice of nursing provides safeguards for health care and sets standards by which nurses can be evaluated. Emphasize that when nurses do not meet the expected standards, they may be held legally accountable. Discuss the purpose of a nurse practice act. Describe the function of standards of care and agency policies. Discuss accountability. Define and contrast negligence versus malpractice. Explain the four elements that must be present to prove negligence—duty, breach of duty, damage, and proximate cause. Explain that nurses can help defend themselves against malpractice judgments by following guidelines for informed consent, refusal of care, and documentation; acting as a patient advocate; working within accepted standards and the policies and procedures of their facility; and maintaining their level of expertise.	•	Discussion Topic: Review the laws governing the scope of practice for nursing personnel in maternal-newborn and pediatric nursing in your state.
•	Activity: Provide students with case examples of malpractice lawsuits from maternal-newborn and pediatric clinical settings, and ask them to assess if the four elements needed to prove negligence—duty, breach of duty, damage, and proximate cause—are present. If the cases are based on actual lawsuits, share the results. 	
CURRENT TRENDS AND THEIR LEGAL AND ETHICAL IMPLICATIONS
Use of Unlicensed Assistive Personnel
Concerns About Early Discharge
Dealing with Early Discharge	Explain the legal and ethical issues surrounding the use of unlicensed assistive personnel and early discharge. Explain that the nurse is always responsible for patient assessments and must make the critical judgments that are necessary to ensure patient safety. Explain that legal issues may be present if a patient develops a complication after early discharge. 	•	Discussion Topic: What are some nursing strategies for dealing with early discharge? Discuss new teaching tactics and careful documentation.	
in-class/ONLINE case study
Teresa is a 40-year-old gravida 1 para 0 with a history of infertility for 6 years. The pregnancy was achieved via in vitro fertilization. She is now 22 weeks and 6 days pregnant with an estimated fetal weight of 690 grams and is facing inevitable preterm birth. Her membranes have ruptured, and her cervix has quickly dilated to 6 centimeters. The neonatal team has spoken to Teresa to let her know that her baby is at the edge of viability and that the survival rate is very poor; if the baby were to survive, the team informed her, then the chance of significant disability is extremely high. Teresa and her husband are being asked to decide whether they want full neonatal resuscitation performed or only comfort measures for the infant. They have told the neonatology team that they want everything done for their newborn as doing so is possibly their only chance to have a baby.
1.	How do the ethical principles of beneficence, nonmaleficence, autonomy, and justice apply to decision making in this case?
Answer: The four ethical principles must be primarily considered from the viewpoint of the parents and the newborn. Decision making should be based on what is in the best interest of the infant. Ethical principles from the viewpoints of society and the medical staff can also be explored.
Rationale: This situation requires consideration of all ethical principles.
•	Beneficence: Will the decision to perform full resuscitation benefit the parents if it is successful and the newborn survives with a major neurologic handicap requiring life-long nursing care?
o	Will the decision benefit the newborn? Would the infant want to survive with a major handicap? Will he or she suffer during the resuscitation? Would the infant suffer if not resuscitated?
o	From the viewpoint of society: Is it beneficial to use health dollars to resuscitate and care for an infant with a poor prognosis? Does society benefit from a care philosophy that values vulnerable life at the edge of viability?
o	From the viewpoint of the medical and nursing staff: Do the members of the staff benefit by being able to apply their knowledge and technical skills to intubate and ventilate an infant with a poor prognosis? Is there a benefit to the medical and nursing staff to withholding these skills in the case of a poor prognosis?
•	Nonmalfeasance: The considerations here are similar to beneficence. Consider if less harm would be done to the parents, the newborn, society, and the medical and nursing staff if full resuscitation were performed or withheld.
•	Autonomy: Who has the autonomy to make the decision in this case? Do the parents have the right to decide? Are there laws that apply to the case? Can the medical staff be directive in counseling? In cases involving an infant, the infant has the least autonomy and is most greatly affected by the decision.
•	Justice: What decision represents justice for these parents who have arrived at this day after a difficult course to achieve pregnancy? What decision represents justice for the baby? Is withholding resuscitation ever just? Does society demonstrate consistent justice in its decisions regarding neonatal resuscitation? Is it just for the neonatology team to be forced to accept the parents’ decision and to perform procedures on the newborn that they do not support?
2.	Consider the same case if the mother were a 17-year-old gravida 3 para 2 who was homeless and abused drugs. How would the considerations change?
Answer: The prognosis of the newborn must be discussed with the parent, who must decide after counseling with the neonatal team and in accordance with law and policy. The process is no different from that in the previous case.
Rationale: The ethical principles do not change in accordance with the social situation of the parent. Counseling about prognosis should include the possible impact of the abused drugs. Aside from this, the counseling remains consistent and should consider the four ethical principles.
3.	Consider the same case if the fetus were known to have Down syndrome. Would the mother be counseled in the same way?
Answer: If the fetus were known to have Down syndrome, then the counseling should include a description of the life course and the risks of someone with Down syndrome in addition to the risks of extreme prematurity.
Rationale: The presence of a genetic disorder is one of many considerations in decision making. Some genetic disorders are incompatible with life, and the counseling should reflect this fact. Down syndrome is compatible with life. The parents must decide, based on all of the medical and social considerations.
4.	Consider the case of an infant about to be born at 34 weeks’ gestation who is known to have Down syndrome and a major cardiac anomaly. The parents have stated they do not want any treatment for their infant. The nurse is not comfortable with this decision. How can the nurse professionally handle this situation?
Answer: The nurse should seek guidance from the ethics committee at the hospital to explore whether the parents’ decision in this case is ethically acceptable. The nurse should also speak with his or her manager about the case.
Rationale: In this case, the prognosis of the infant must be discussed with the parents by the neonatal team. It is not acceptable to deny treatment, based solely on the fact that the infant has Down syndrome. If the cardiac anomaly is lethal and the treatment may further disable the infant, then an ethical case for withholding treatment may be made. However, if the anomaly can be corrected with standard neonatal medical or surgical treatment, then ethical considerations would favor treatment. This case differs from the previous case because of the gestational age of this infant. Most infants born at 34 weeks’ gestation survive. The nurse is in a difficult position in caring for a patient whose ethical thinking differs from his or her own. The nurse should seek guidance and support from an ethics committee, the law, hospital policy, and his or her manager.