Standard of

Performed

Performed
Not
Maternal and SOP/Policies/Programs of the Institution Specific Activities
Child Health
Nursing
1) The nurse    3 Months Probationary Training for every newly  Every newly hired nurse will work with a senior nurse as his/her
helps children and hired nurse mentor within probationary period.
parents attain and   Health Teaching/Health Information  Rotational activities by ward to conduct health information
maintain  Dissemination Program dissemination including Family Planning, Maternal and Child
optimum health. Care etc. every Monday at OPD with patients and families as
target crowd.
 Breast Feeding and Latching On Policy
 Every born child is instructed to be exclusively breastfed by the
mother per demand as prescribed by EO # 51 “The Milk Code” of
the Philippines.
 At Ward, nurses instruct mothers to latch on their babies.

 Kangaroo Mother Care Program (KMC)
 Daily OPD Prenatal & Postpartum and Newborn
Follow-up Checkup at Underfive Clinic
 Outreach Programs
 Nurses enroll all stable premature and or less than 2500 grams
newborns into KMC Program.
 Pregnant are advised to have at least one check-up in every
trimester.
 Newborn Check-up and other children under five years old is
advised to go at Underfive Clinic

 The hospital ties-up with different NGOs and other local and
 Discharge Plan Protocol international organizations to send doctors and nurses for
Medical, Dental and Surgical Missions to remote areas of the
province.
 Nurses prepare and explain well home medications and special
instructions for the clients and family members.
 Referral System  Nurses give instruction to mothers for newborns’ Immunization
at RHUs
 Nurses prepare referral papers containing client’s significant
information and medical status accompanied by an assigned
travel nurse.
2) The nurse  Family Planning Program  Every couple has to attend a Family Planning Session to promote
assists families to  Mothers’ Class Program awareness about the impact of incoming new member in the
achieve and family.
maintain a  Pregnant are advised to attend Mothers’ Class session on how to
balance between take care themselves without setting aside the care needed by
the personal their babies and the care needed by rest of the family.
growth and needs
of individual
family members
and optimum
family
functioning.
3) The nurse o Health Teaching/Health Information  OPD Nurses give Family Planning; how to mitigate future health
intervenes with Dissemination Program (High Risk Pregnancy) problems related to pregnancy.
vulnerable clients
and families at
risk to prevent
potential and
developmental
health problems
4) The nurse  Segregation of bio, non-bio, infectious etc.  Proper implementation on segregation of wastes, sharps and toxic
promotes an chemicals to prevent spread of microorganism and eradicate
environment free  Sanitary maintenance infection.
of hazards to  Maintain clean and conducive environment.
reproduction,  RA 9211, Smoke Cessation Campaign (Clinic) emphasizes strict
growth, wellness “no cigarette smoking policy” within 200 meters away from any
and recovery hospital vicinity; pregnant are advised to stop smoking it may
from illness. lead to Ectopic pregnancy.
 Promotes food and environmental sanitation; functional toilettes,
well-wrapped foods etc.
 Follows as much as possible the aseptic and/or sterile techniques
to all procedures.

 Safety Precaution Policy
 Provides client-friendly advisories, cautions, wet signs and
directory of offices, wards, significant personalities, dangerous
areas etc.
 Prevent patients from falls and other harms; safety handrails,
debris precaution.
 Safe and proper medication.
 Nurses trying to provide contextualized therapeutic environment.
  Guidelines for Patient Isolation (reverse or  Cohorting of patient base on types of diseases and classification.
protective) (Medicine, Pedia, OB, Psyche, Surgery)

5) The nurse o Baseline Physical Assessment  Nurses conduct baseline and purposive data gathering to identify
detects changes in deviation and problem of health seeking individual. Ex. “FDAR”,
health status and HGT Monitoring etc.
deviations from
optimum  NBS Program
development  The OB Nurse duty performs Newborn Screening to every
newborn child.

 Neonatal Care Standard  DR Nurses do APGAR Scoring.

 Underfive Clinic / Program (Mon-Fri)  Underfive Clinic nurse carries-out basic physical assessment to
children 5 years old and below. Do BCG to every newborn child.
6) The nurse o Standard Nursing Care Program and updates  Retraining of Updated BLS and ACLS.
carries out  Intravenous (IVT) training updates.
appropriate  Nursing independent action during emergency case. Ex.
interventions and Oxygenation (O2, Ambubaging, CPR)
treatment to
facilitate survival  Sending Nurses into seminar regarding Maternal and child
and recovery  DOH Standard Care for Maternal and Child updates, Specially NICU and OB Nurses.
from illness. updates.

7) The nurse  Health Teaching/Health Information  Nurses are task to stay at the bedside for some moments in
assists clients and Dissemination Program several times per shift to assist clients in coping or mitigating
families to  Mothers’ Class Program developing and traumatic situations.
understand and  OB Nurse at OPD is given responsibility to promote health
cope with awareness on childbearing-readiness for mothers.
developing and  During Health Education Program, Maternal and Child
traumatic Development were always tackled.
situations during
 illness,
childbearing and
childhood.
8) The nurse o Philhealth “No Balance Billing Policy” under  Nurses are responsible to facilitate clients on how to avail the
actively pursues sponsorship and non-sponsorship Programs basic services available in the hospital.
strategies to  Diabetic Club Membership
enhance access  Mothers’ Bonus
and use of  Social Services Access
adequate
healthcare
services.
9) The nurse o Integrated institutional programs and policies on o Integrated Activities in Practice and Education
improves practice and education.  Departmentalized Best Nurse Program including OB-Gynae
maternal and Department
child health  Yearly Individual Performance Commitment Review Form
nursing practice (IPCRF)
through  Sending permanent Nurses into Maternal and Child Health
evaluation of Seminars /Trainings
practice,  Updated Intravenous Therapy Trainings and Seminars
education and  Updated BLS Training
research.  Emphasis on Specialization Program
 Upgrading of knowledge and skills through sending nurses into
medical trainings and seminars.
 Mentoring

* Summary

Maternal and Child Health are domain factors in determining how healthy the community is and an important indicator showing whether the goal
is either achieved or not achieved. The Department of Health implements certain programs to improve Maternal and Child Health in the community.
They undergo thorough studies and research that suits best for the practice. Standards of Maternal and Child Health in Northern Samar Provincial
Hospital follows all the DOH updates and implements it in real life situations but there are some areas which are not well practiced and implemented.
Why? Maybe because of inadequate funds and support from the government to provide instruments, supplies, machine etc. that will be helpful in the
hospital and also some standards are fairly performed.
* Conclusion

Based on the above data, Maternal and Child Health Standards are somehow marginally performed in Northern Samar Provincial Hospital. NSPH
tries to do its best to follow the DOH updates in caring for Mother and Child. However, some standards are not properly met and implemented because of
lack of support system in maintaining the standard of care.

*Recommendation

I highly recommend that the government to provide complete and full support to every Health Care facilities in Northern Samar in order to
maintain high standard of care. The support must address to issues regarding financial matters and also trainings which are to be funded by the institution
for the personnel to gain mastery in their skills.

I. Figure of Eight Framework

The figure of eight covers caring for mother and child health, every part of figure eight was interrelated with each other, meaning the figure eight has
infinite flow. The main focused of figure eight was mother and child health, starting from below the Child health and from top the maternal health we
have the primary goal of the nurse which is health promotion, and maintaining of every mother and child’s health, and if there is pre-existing problem we
gave crisis intervention to address the problem on the other hand for continuity of care we have what we called Health rehab plus the support of family.
With addition of core competency in nursing profession that ensures quality of care we extend our caring attitude by contributing to nursing world by
continuously study, do research with evidence base practice in caring for both mother and child care with the help of basis such as theory, to support the
study, perhaps also we have the nursing process which is the foundation of nursing profession authored by Ida Jean Orlando to give appropriate nursing
care for mother and child. In my own view the figure of eight is a continuous flow with infinite extending function of its part and follows the entire
standard of care.

In relating to the result of standard of care versus to NSPH, the institution as I observed has no interest on Nursing Research but perhaps the standard
of care was observed in practice.
 II. Interpretation

The lack of strong support system in every Health Care Facilities affects the performance in providing high standard of care. This inadequacy in
return will probably increase the percentage of mortality rate in the country.

III. Evaluation
A nurse plays a significant role in providing a high standard of Maternal and Child Health Care. From assisting every patient’s needs to
maintaining a hazard free environment, nurses show that they adequately provide good healthcare services. Not only that they try to carry out appropriate
actions but also they try to enhance, improve and pursue thorough evaluation of practice to fully give their best service in the survival and recovery of
every Mother and Child.
NSPH has been consistent in providing good healthcare for every Mother and Child patient. The hospital has been trying its best in maintaining a
high standard of care despite the lack of health facilities and funds. All of the standards mentioned above are observed in the institution although some
lacks proper implementation due to inadequacy of resources.
 Every woman and newborn receives routine, evidence-based care and management of complications during labour, childbirth and the
early postnatal period, according to WHO guidelines.
1. Women are assessed routinely on admission and during labour and
childbirth and are given timely, appropriate care.
Rationale: Assessment of women and regular monitoring on admission
and during labour and birth are critical to ensure essential care that is
appropriate to the woman’s case, to prevent the onset of complications
and to identify risks or complications that require urgent action or
referral for better outcomes of pregnancy and labour for both the mother
and the newborn. On admission, women undergo a full review of their
antenatal care records, pregnancy and labour history, a vaginal
examination and confirmation of labour. Fetal heart rate, fetal lie,
position and presentation, blood pressure, pulse and temperature are
determined and recorded. Blood group and Rhesus typing, haemoglobin,
urine protein and glucose, and HIV status, if appropriate, are tested and
recorded. The progress of labour is monitored with a partograph; blood
pressure, pulse, temperature and fetal heart rate are assessed regularly
and at a 4-h action line. Pain relief is offered, and the mother’s choice is
respected. Spontaneous vaginal birth is supported and guided by the
mother’s urge to push. The third stage of labour is managed actively,
with intravenous or intramuscular oxytocin given immediately after the
birth. Any complications at admission and during labour and birth are
rapidly identified and appropriately managed.
Quality measures
Input measures
1. The health facility has the basic essential equipment and supplies for
routine care and detection of complications (thermometers,
sphygmomanometers, fetal stethoscopes, urine dipsticks) available in
sufficient quantities at all times in the areas of the maternity unit for
labour and childbirth.
2. The health facility has written, up-to-date clinical protocols for
assessing intrapartum care and action in the labour and childbirth areas of
the maternity unit that are consistent with WHO guidelines.
3. Health-care staff in the labour and childbirth areas of the maternity
unit receive in-service training and regular refresher sessions at least once
every 12 months in the identification and management of obstetric
emergencies during labour and childbirth.
4. Health-care staff in labour and childbirth areas receive at least monthly
drills or simulation exercises and supportive supervision in routine care
and detection of obstetric complications during labour and childbirth.
Output/process measures
1. The proportion of all women who gave birth in the health facility
whose blood pressure, pulse and temperature were appropriately recorded
during labour, childbirth and the early postpartum period (and acted on if
appropriate).
2. The proportion of all women who gave birth in the health facility who
received oxytocin within 1 min of the birth of their baby.
3. The proportion of all women who gave birth in the health facility
whose progress in labour was correctly monitored and documented with a
partograph and a 4-h action line.
4. The proportion of all women who gave birth in the health facility
whose urinalysis result was appropriately recorded during labour,
childbirth and the early postpartum period (and acted on if appropriate).
5. The proportion of all women who gave birth in the health facility who
received any option for pain relief during labour and childbirth.

Outcome measures
1. The health facility perinatal mortality rate [number of foetal death
(stillbirths) or early neonatal deaths / the total number of births of babies
weighing at least 1000 g or of 28 weeks’ gestation (stillbirths + live
births) x 1000].
2. Intrapartum stillbirth rate (number of stillbirths occurring during the
intrapartum period per 1000 births).
3. The proportion of all women admitted to the health facility in active
labour who gave birth within 12 h.
 * Justification

In relation to the standard of care met by NSPH versus EBP in caring for PRE-INTRA-POST Mother, they have significant relationship. Yet
NSPH and the EBP discussed above shows a slight difference since EBP exhibits a much higher quality of rendering care for every Mother and Child.
The difference is due to the inadequacy of resources in NSPH which includes the funds and instruments to be used.

2. Theory

Attachment Theory
Attachment theory is rooted in the joint work of John Bowlby and Mary Ainsworth, whose research first documented the importance of the
relationship that developed between the mother and her child. Additionally, this research helped to document the detrimental impact upon children’s
development resulting from parental separation, deprivation, or bereavement (Ainsworth & Bowlby, 1991). Attachment is thought to be developed in
phases, beginning before birth, when mothers first develop emotional feelings for their unborn babies. Attachment is believed to be a lifelong process,
involving both intimacy and independence. Newborn babies have been described as “wired for feelings and ready to learn” (National Research Council
and Institute of Medicine [NRCIM], 2000, p. 4), and advances in research about early brain development support the importance of nurturing during the
earliest years of life (NRCIM, 2000 ). In the first 2 months after birth, the baby and his or her caregivers must adjust and adapt to the changes brought on
by the baby’s first few weeks at home. During the early attachment phase, the baby learns to signal caregivers, who in return, respond to the baby’s needs
for food and comfort. Emotional regulation is a process whereby the infant learns to manage stressful situations through interactions with his or her
caregivers, which eventually helps the infant to self-sooth. The quality of early caregiving is thought to either assist or impede the infant’s ability to
regulate inner emotional states; when the caregiver responds consistently to the baby’s signals, the baby begins to develop a sense of competence and
enjoys social interactions. By 2–7 months of life, the baby’s feeding and sleeping cycles are becoming more regulated and predictable. Babies are more
interactive, easier to care for, and will smile at their caregivers. By 6 months of age, babies show differentiated emotions of joy, surprise, sadness, disgust,
and anger, respond to the emotional expressions of others, and enjoy turn-taking vocalizing. Around 7–9 months of age, the preference for familiar
caregivers and protests around separation from them emerges and is referred to as separation anxiety. When babies become “attached,” they become
increasingly wary and anxious around strangers, and it becomes even more important for the caregiver to offer comfort, nurturance, and protection.
Babies become attached to caregivers with whom they have had significant amounts of interaction. Caregivers are described as being hierarchically
arranged in terms of preference, so that the baby has a most preferred caregiver, a next most preferred caregiver, etc.; however, there is thought to be a
limit to the attachment capacity. Serious attachment disturbances become evident in settings where babies have to depend upon large numbers of
caregivers, such as in institutions, or when there are frequent disruptions of caregivers, such as in foster care placements (Smyke, Dumitrescu, & Zeanah,
2002). The concept of secure base behavior, which emerges during toddlerhood (12–20 months), describes the willingness of the child to venture out
from the caregiver to safely explore the world (Ainsworth & Bowlby, 1991). Secure base behavior develops along with the toddler’s ability to walk and
explore and the toddler’s new sense 2 Early Childhood Development Theories 23 of will. A toddler’s ability to say “no” demonstrates that he or she has
developed a solid sense of self as separate from the caregiver. The caregiver must learn to guide the child’s behavior by setting limits firmly and lovingly
to keep the toddler safe and secure. At the same time, the caregiver must reinforce and build the child’s self-confidence through positive reinforcement.
Between 20 and 24 months, the toddler’s attachment continues to evolve to others outside of the immediate family through exposure to new experiences
in community settings such as daycares. Communication and play skills become more developed and complex. Securely attached children are described
as more autonomous, socially confident, flexible in problem solving, and affectionate. By age 3, such children are described as empathetic, have better
social skills, and have become good communicators. In summary, attachment theory posits that early human relationships and experiences lay the
foundation for later development and learning.
REFERRENCES:

 World Health Organization. Strategies toward ending preventable maternal mortality. Geneva; 2015
(http://who.int/reproductivehealth/topics/maternal_perinatal/epmm/en/, accessed 22 March 2015).
 World Health Organization. Every newborn: an action plan to end preventable deaths. Geneva; 2014
(www.who.int/maternal_child_adolescent/topics/newborn/enap_ consultation/en/, accessed 19 January 2015).
 Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice. Geneva, World Health Organization, 2003
(http://whqlibdoc.who.int/publications/2003/924159084X.pdf, accessed 7 December 2004).