MATERNAL & CHILD NURSING (LECTURE)

NCM 107 PRELIMS

Module 1 - Maternal and Child Health Nursing

(FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING)

MATERNAL & CHILD HEALTH NURSING

b. COMMUNITY-CENTERED
➔ Includes care of the pregnant woman,
child, and family. ➔ The health of families is both affected
by and influences the health of
A. GOALS & PHILOSOPHIES OF MATERNAL & communities.
CHILD HEALTH NURSING:
c. EVIDENCE-BASED
➔ Primary goal of both maternal and
child health nursing is the promotion ➔ This is the means whereby critical
and maintenance of optimal family knowledge increases.
health. ➔ A challenging role for nurses and a
➔ Childbearing and childrearing families major factor in keeping families well
is a major focus of nursing practice in and optimally functioning.
promoting health for the next
generation. MATERNAL & CHILD HEALTH NURSE:

● Considers the family as a whole and

A. GOALS & PHILOSOPHIES
as a partner in care when planning or
OF MATERNAL & CHILD: implementing or evaluating the
effectiveness of care.
● Serves as an advocate to protect the
rights of all family members, including
the fetus.
● Demonstrates a high degree of
independent nursing functions
because teaching and counseling are
major interventions.
Maternal & Child Health Nursing Practice ● Promotes health and disease
Throughout the Childbearing‒Childrearing prevention because these protect the
Continuum health of the next generation.
1. Provision of preconception healthcare. ● Serves as an important resource for
2. Provision of nursing care of women families during childbearing and
throughout pregnancy, birth, and childrearing as these can be
postpartum period. extremely stressful times in a life cycle.
3. Provision of nursing care of children ● Respects personal, cultural, and
from birth through adolescence. spiritual attitudes and beliefs as these
4. Provision of nursing care to families in so strongly influence the meaning and
all settings. impact of childbearing and
childrearing.
A. PHILOSOPHY OF MATERNAL & CHILD HEALTH
● Encourages developmental
NURSING
stimulation during both health and
I. Maternal and child health nursing is: illness so children can reach their
A. Family-centered ultimate capacity in adult life.
B. Community-centered ● Assesses families for strengths as well
C. Evidence-based as specific needs or challenges.
● Encourages family bonding through
a. FAMILY-CENTERED rooming-in and family visiting in
maternal and child healthcare
➔ Assessment should always include the
settings.
family as well as an individual.
● Encourages early hospital discharge ➔ AmBisyon Natin 2040 represents the
options to reunite families as soon as collective aspirations of Filipinos to
possible in order to create a seamless, enjoy a "matatag, maginhawa at
helpful transition process. panatag na buhay." This was the result
● Encourages families to reach out to of various focus group discussions and
their community so the family can nationally representative surveys
develop a wealth of support people undertaken by the National Economic
they can call on in a time of family and Development Authority (NEDA) in
crisis. early 2016.
➔ AmBisyon Natin 2040 reveals the many
B. MATERNAL & CHILD HEALTH dimensions of well-being that Filipinos
value the most: strong family and
GOALS & STANDARDS
community ties, a comfortable
● 2020 NATIONAL HEALTH GOALS: lifestyle, and a secure future. It should
then be the mission of the government
THE TWO PILLARS: to steer development processes to
enable and empower every Filipino to
1. To increase quality and years of
achieve these aspirations.
healthy life.
➔ The same EO adopted the following
2. To eliminate health disparities.
vision for the Philippines:
➔ New objective recommends that all
➔ By 2040, the Philippines shall have
prelicensure programs in nursing
been a prosperous, predominantly
include core content on:
middle-class society where no one is
● Counseling for health promotion and
poor; our peoples live long and
disease prevention
healthy lives, are smart and
● Cultural diversity
innovative, and live in a high-trust
● Evaluation of health sciences literature
society.
● Environmental health
● Public health systems
● Global health

2020 NATIONAL HEALTH GOALS:

● are intended to help citizens more

easily understand the importance of
health promotion and disease
prevention and to encourage wide
participation in improving health in the
next decade.
● nurses play such a vital role in helping ➔ The strategies to achieve this
the nation achieve these objectives objective are organized under the
through both practice and research. three major pillars of "Malasakit,"
● serve as the basis for grant funding "Pagbabago," and "Patuloy na
and financing of evidence-based Pag-unlad."
practice.
a. MALASAKIT PILLAR
EMBRACING AMBISYON NATIN 2040
➔ The Malasakit pillar is about
➔ Early into his administration, President enhancing the social fabric. The
Rodrigo Roa Duterte issued Executive strategies aim to build the foundations
Order No. 5, s.2016, "approving and for a high-trust society by ensuring a
adopting the twenty five-year clean, efficient, and people-centered
long-term vision entitled AmBisyon governance; guaranteeing swift and
Natin 2040 as guide for development fair administration of justice; and
planning.” increasing awareness of the different
 cultures and values across Philippine PROVISIONS OF THE FOUR PHASES OF HEALTH
society. CARE:

1. Health Promotion
b. PAGBABAGO PILLAR
2. Health Maintenance
➔ The Pagbabago pillar is about 3. Health Restoration
effecting inequality-reducing 4. Health Rehabilitation
transformation. It consists of strategies
to expand economic opportunities, QUALITY & SAFETY EDUCATION FOR NURSES
accelerate human capital (QSEN)
development, reduce vulnerability,
➔ The overall goal is to address the
and build safe and secure
challenge of preparing future nurses
communities.
with the abilities necessary to
continuously improve the quality and
c. PATULOY NA PAG-UUNLAD PILLAR
safety of the healthcare systems in
➔ The Patuloy na Pag-unlad pillar is which they work.
about increasing potential growth. It
consists of strategies to enhance the SIX COMPETENCIES:
factors necessary to accelerate and
● Patient-centered Care
sustain growth and development
● Teamwork & Collaboration
through 2040. It is about promoting
● Evidence-Based Practice
science, technology, and innovation.
● Quality Improvement
It also covers strategies to reap the
● Safety
demographic dividend.
● Informatics

GLOBAL HEALTH GOALS

PATIENT-CENTERED CARE
● To end poverty and hunger.
➔ The patient or designee is thought of
● To achieve universal primary
as the source of control and full
education.
partner in the provision of
● To promote gender equality and
compassionate and coordinated care
empower women.
based on respect for the patient’s
● To reduce child mortality.
preferences, values, and needs.
● To improve maternal health.
● To combat HIV/AIDS, malaria, and
other diseases. TEAMWORK & COLLABORATION
● To ensure environmental sustainability. ➔ Nurses function effectively within
● To develop a global partnership for nursing and interprofessional teams,
development. fostering open communication,
mutual respect, and shared decision
C. THEORIES RELATED TO making as they achieve quality
MATERNAL & CHILD NURSING patient care.

➔ A Framework for Maternal and Child

EVIDENCE-BASED PRACTICE
Health Nursing Care
● Nurses use Nursing Process, Nursing ➔ Nurses integrate the best current
Theory, and Quality & Safety evidence with clinical expertise and
Education for Nurses (QSEN) patient/family preferences and values
competencies to care for families for delivery of optimal health care.
during childbearing and childrearing
years. QUALITY IMPROVEMENT

➔ Nurses use data to monitor the

outcomes of care and use
improvement methods to design and
 test changes to continuously improve MEASURING MATERNAL & CHILD HEALTH
the quality and safety of healthcare
➔ Statistical Terms Used to Report
systems.
Maternal and Child Health.

SAFETY
BIRTH RATE Number of births per
➔ Nurses minimize the risk of harm to
1000 population.
patients and providers through both
system effectiveness and individual FERTILITY RATE Number of
performance. pregnancies per 1000
women of
INFORMATICS childbearing age.

➔ Nurses use information and

FETAL DEATH Number of fetal deaths
technology to communicate, manage
RATE (weighing more 500 g)
knowledge, mitigate error, and
per 1000 live births.
support decision making.
NEONATAL Number of deaths per
NURSING PROCESS DEATH RATE 1000 live births
occurring at birth or in
➔ A scientific form of problem solving.
the first 28 days of life.
➔ Steps:
● Assessment PERINATAL Number of deaths of
● Nursing Diagnosis DEATH RATE fetuses weighing more
● Planning than 500 g and within
● Implementation the first 28 days of life
● Evaluation per 1000 live births.

NURSING THEORY MATERNAL Number of maternal

MORTALITY deaths per 100,000 live
➔ Designed to offer helpful ways to view
RATE births that occur as a
patients so nursing activities can be
direct result of the
created to best meet patient needs.
reproductive process.
➔ Examples of Theories Related to
Maternal and Child Nursing: INFANT Number of deaths per
● Role Attainment Theory – Becoming a MORTALITY 1000 live births
Mother RATE occurring at birth or in
● Chery Tatano Beck – Postpartum the first 12 months of
Depression Theory life.
➔ Extensive changes in the scope of
maternal and child health nursing CHILDHOOD Number of deaths per
have occurred as health promotion MORTALITY 1000 population in
has become a greater priority in care. RATE children, 1 to 14 years
- teaching, counseling, supporting, and of age.
advocacy, or keeping parents and
children well.
➔ As promoting healthy pregnancies ROLES & RESPONSIBILITIES OF A MATERNAL &
and keeping children well protects not CHILD NURSE:
only patients at present but also the
health of the next generation. a. CAREGIVERS
➔ Maternal - child health nurses fill these
expanded roles to a unique and ➔ Nurse provides direct patient-centered
special degree. care to women, infants, children, and
their families in times of childbearing,
illness, injury, recovery, and wellness.
 b. CLIENT ADVOCATES agriculture and ecosystems can
co-exist.
➔ One who speaks on behalf of another.
➔ It also means protecting the genetic
➔ As an advocate the nurse considers
diversity of the crops we grow, while
the family’s wishes and preferences
investing in research to make farming
when planning and implementing
more and more productive, especially
care.
in developing countries.

c. RESEARCHER
3. GOOD HEALTH & WELL-BEING
➔ Nurses contribute to their profession’s
➔ Ensure healthy lives and promote
knowledge base by systematically
well-being for all at all ages.
investigating theoretic or practice
➔ Aims to achieve universal health
issues in nursing.
coverage and provide access to safe
and effective medicines and vaccines
d. TEACHER for all.
➔ Education is an essential role of
today’s nurse. 4. QUALITY EDUCATION
➔ Teaching begins early, before and
➔ Ensure inclusive and equitable quality
during a woman’s prenatal care, and
education and promote lifelong
continues through her recovery from
learning opportunities for all.
childbirth and learning to care for her
➔ Cover the need for access to
newborn, and into her care in
university-level education, vocational
women’s health.
training, and entrepreneurship skills,
and they pay special attention to
e. COLLABORATOR issues of equity.
➔ Care is improved by an
interdisciplinary approach as nurses 5. GENDER EQUALITY
work together with dietitians, social
➔ Achieve gender equality and
workers, physicians, and others.
empower all women and girls.
➔ Equality and empowerment includes
WHO’S 17 SUSTAINABLE freedom from discrimination and
DEVELOPMENT GOALS violence.
➔ Ensuring universal access to sexual
and reproductive health and
1. NO POVERTY affording women equal rights to
➔ End Poverty in all Its Forms economic resources such as land and
everywhere. property, are vital targets to realizing
➔ Eradicating poverty in all its forms this goal.
remains one of the greatest
challenges facing humanity. from 1.9 6. CLEAN WATER & SANITATION
billion in 1990, to 836 million in 2015 –
➔ Ensure access to water and sanitation
too many people are still struggling to
for all.
meet the most basic human needs.
➔ Basic water scarcity affects 40% of the
global population, and nearly a billion
2. END HUNGER/ ZERO HUNGER people do not have access to that
➔ achieve food security and improved most basic of technologies: a toilet or
nutrition and promote sustainable latrine.
agriculture. ➔ Ensuring universal access to safe and
➔ Ending hunger also includes ending affordable drinking water by 2030
malnutrition, protecting small farmers, requires we invest in adequate
and changing farming itself so that infrastructure, provide sanitation
 facilities and encourage hygiene at 10. REDUCED INEQUALITIES
every level.
➔ Reduce inequality within and among
➔ Protecting and restoring water-related
countries.
ecosystems such as forests, mountains,
➔ The Goal includes a range of
wetlands and rivers is essential if we
measures, including regulation of the
are to mitigate water scarcity.
financial markets, to make the playing
field more level. Importantly, it also
7. AFFORDABLE & CLEAN ENERGY
covers the issue of migration, which
➔ Ensure access to affordable, reliable, should be “orderly, safe, regular and
sustainable and modern energy for all. responsible.”
➔ Ensuring universal access to
affordable electricity by 2030 means 11. SUSTAINABLE CITIES & COMMUNITIES
investing in clean energy sources such
➔ Make cities inclusive, safe, resilient and
as solar, wind and thermal.
sustainable.
➔ Expanding infrastructure and
➔ This Goal also covers issues like
upgrading technology to provide
transportation, disaster preparedness,
clean energy sources in all developing
and even the preservation of the
countries is a crucial goal that can
world’s cultural and natural heritage.
both encourage growth and help the
environment.
12. RESPONSIBLE CONSUMPTION, PRODUCTION
8. DECENT WORK & ➔ Ensure sustainable consumption and
ECONOMIC GROWTH production patterns.
➔ This Goal references that, but also
➔ Promote inclusive and sustainable
covers topics like reducing food
economic growth, employment and
waste, corporate sustainability
decent work for all.
practice, public procurement, and
➔ (SDGs) aim to encourage sustained
making people aware of how their
economic growth by achieving higher
lifestyle choices make a difference.
levels of productivity and through
technological innovation.
13. CLIMATE ACTION WILL
➔ Promoting policies that encourage
entrepreneurship and job creation are ➔ Take urgent action to combat climate
key to this, as are effective measures change and its impacts.
to eradicate forced labour, slavery ➔ Global warming is causing long-lasting
and human trafficking. changes to our climate system, which
➔ With these targets in mind, the goal is threatens irreversible consequences if
to achieve full and productive we do not take action now.
employment, and decent work, for all ➔ Strengthening the resilience and
women and men by 2030. adaptive capacity of more vulnerable
regions, with efforts to raise awareness
9. INDUSTRY, INNOVATION & INFRASTRUCTURE and integrate measures into national
policies and strategies.
➔ Build resilient infrastructure, promote
sustainable industrialization and foster
14. LIFE BELOW WATER
innovation.
➔ Technological progress is also key to ➔ Conserve and sustainably use the
finding lasting solutions to both oceans, seas and marine resources.
economic and environmental ➔ The world’s oceans – their
challenges, such as providing new temperature, chemistry, currents and
jobs and promoting energy efficiency. life – drive global systems that make
the Earth habitable for humankind.
How we manage this vital resource is
essential for humanity as a whole, and
 to counterbalance the effects of Module 1.2
climate change.
The Nursing Role in Reproductive and
Sexual Health
15. LIFE ON LAND

➔ Sustainably manage forests, combat

desertification, halt and reverse land THEORY OF EVOLUTION
degradation, halt biodiversity loss. ➔ Asserts that all life forms are the result
➔ The Sustainable Development Goals of procreation.
(SDGs) aim to conserve and restore ➔ It is based on the idea that all species
the use of terrestrial ecosystems such are related and gradually change
as forests, wetlands, drylands and over time.
mountains by 2020. ➔ The theory is defended on common
➔ Promoting the sustainable features and ascending complexity.
management of forests and halting
deforestations is also vital to mitigating
STORY OF CREATION IN THE BOOK OF GENESIS
the impact of climate change.
➔ Making of all thing from nothing by an
act of God.
16. PEACE, JUSTICE & STRONG INSTITUTIONS
➔ Single pair of ancestors (Adam and
➔ Promote just, peaceful and inclusive Eve)
societies. ➔ Man and woman are to be
➔ Peace, stability, human rights and “two-in-one flesh”
effective governance based on the ➔ “increase and multiply”
rule of law are important conduits for ➔ Stewards of creation.
sustainable development.
➔ The Sustainable Development Goals
INTRAUTERINE DEVELOPMENT
(SDGs) aim to significantly reduce all
forms of violence, and work with ➔ A gonad is a body organ that
governments and communities to find produces the cells necessary for
lasting solutions to conflict and reproduction (the ovary in females,
insecurity. the testis in males).
➔ At approximately week 5 of
intrauterine life, mesonephric (wolffi
17. PARTNERSHIPS FOR THE GOALS
an) and paramesonephric (mullerian)
➔ Revitalize the global partnership for ducts, the tissue that will become
sustainable development. ovaries and testes, have already
➔ The Sustainable Development Goals formed.
(SDGs) can only be realized with a ➔ By week 7 or 8, in chromosomal
strong commitment to global males, this early gonadal tissue begins
partnership and cooperation. formation of testosterone.
➔ The world today is more ➔ Under the influence of testosterone,
interconnected than ever before. the mesonephric duct develops into
➔ Improving access to technology and male reproductive organs and the
knowledge is an important way to paramesonephric duct regresses.
share ideas and foster innovation. ➔ If testosterone is not present by week
➔ “Strengthening global solidarity” 10, the paramesonephric duct
becomes dominant and develops into
female reproductive organs.
➔ When ovaries form, all of the oocytes
(cells that will develop into eggs
throughout the woman’s mature years)
are already present (Edmonds, 2012).
 PUBERTAL DEVELOPMENT years) when it rises to influence
pubertal changes in the testes,
➔ Puberty is the stage of life at which
scrotum, penis, prostate, and seminal
secondary sex changes begin.
vesicles; the appearance of male
➔ These changes in girls are stimulated
pubic, axillary, and facial hair;
when the hypothalamus synthesizes
laryngeal enlargement with its
and releases gonadotropin-releasing
accompanying voice change;
hormone (GnRH), which then triggers
maturation of spermatozoa; and
the anterior pituitary to release
closure of growth plates in long bones
follicle-stimulating hormone (FSH) and
(termed adrenarche ).
luteinizing hormone (LH).
➔ In girls, testosterone influences
➔ FSH and LH because they begin the
enlargement of the labia majora and
production of androgen and estrogen,
clitoris and formation of axillary and
which in turn initiate secondary sex
pubic hair.
characteristics, but also because they
continue to cause the production of
SECONDARY SEX CHARACTERISTICS
eggs and influence menstrual cycles
throughout women’s lives ➔ Adolescent sexual development has
(Christensen, Bentley, Cabrera, et al., been categorized into stages (Tanner,
2012). 1990).
➔ There is wide variation in the time
THE ROLE OF ESTROGEN required for adolescents to move
through these developmental stages;
➔ When triggered at puberty by FSH,
however, the sequential order is fairly
ovarian follicles in females begin to
constant.
excrete a high level of the hormone
➔ In girls, pubertal changes typically
estrogen.
occur as:
➔ This increase influences the
➔ Growth spurt
development of the uterus, fallopian
➔ Increase in the transverse diameter of
tubes, and vagina; typical female fat
the pelvis
distribution; hair patterns; and breast
➔ Breast development
development.
➔ Growth of pubic hair
➔ It also closes the epiphyses of long
➔ Onset of menstruation
bones in girls the same way
➔ Growth of axillary hair
testosterone closes the growth plate in
➔ Vaginal secretions
boys.
➔ The beginning of breast development
SECONDARY SEX CHARACTERISTICS
is termed thelarche , which usually
starts 1 to 2 years before menstruation. ➔ Secondary sex characteristics of boys
usually occur in the order of:
THE ROLE OF ANDROGEN ➔ Increase in weight
➔ Growth of testes
➔ Androgenic hormones are the
➔ Growth of face, axillary, and pubic
hormones responsible for muscular
hair
development, physical growth, and
➔ Voice changes
the increase in sebaceous gland
➔ Penile growth
secretions that cause typical acne in
➔ Increase in height
both boys and girls during
➔ Spermatogenesis (production of
adolescence.
sperm)
➔ In males, androgenic hormones are
produced by the adrenal cortex and
the testes, and, in females, by the
adrenal cortex and the ovaries.
➔ The level of the primary androgenic
hormone, testosterone, is low in males
until puberty (between ages 12 and 14
 MALE REPRODUCTIVE SYSTEM

➔ Internal structures:
➔ Ovaries
➔ Maturation of oocytes
➔ Andrology is the study of the male ➔ Fallopian tubes
reproductive organs. ➔ Uterus:
➔ The male reproductive system consists ➔ Uterine wall layers
of both external and internal divisions. ➔ Uterine blood supply
➔ External structures: ➔ Uterine nerve supply
➔ Scrotum ➔ Uterine supportive structures
➔ Testes ➔ Vagina
➔ Penis
➔ Internal structures: UTERINE DEVIATIONS
➔ Epididymis
➔ Vas deferens
➔ Seminal vesicles
➔ Ejaculatory duct
➔ Prostate gland
➔ Bulbourethral glands
➔ Urethra

FEMALE REPRODUCTIVE SYSTEM

Uterine Deviations:
A. Bicornuate Uterus
B. Anteversion
C. Retroversion
D. Anteflexion
E. Retroflexion
➔ Gynecology is the study of the female
reproductive system. ANTEVERSION the entire uterus tips
➔ External structures: far forward.
➔ Mons veneris
➔ Labia minora RETROVERSION the entire uterus tips
➔ Labia majora far back.
➔ Vestibule
➔ Clitoris ANTEFLEXION the body of the
➔ Skene glands uterus is bent
➔ Bartholin glands sharply forward at
➔ Fourchette the junction with the
➔ Hymen cervix.

RETROFLEXION the body of the

 uterus is bent sharply Increased in diameter and
back just above the (temperature, increases in length
cervix. perspiration, RR, HR Increase in size and
and BP) change in the color of
Increased muscle the labia, uterus, and
HUMAN SEXUAL RESPONSE
tension in both breasts.
➔ Masters and Johnson, 1996. smooth and skeletal Flushing of the skin
➔ The sexual experience is unique to muscle Increased in
each individual; how the body temperature,
responds to sexual arousal has perspiration, RR, HR,
common features. and ВР
Increased muscle
HUMAN SEXUAL RESPONSES CYCLE tension in both
smooth and skeletal
● Excitement muscle
● Plateau
● Orgasm
● Resolution PLATEAU PHASE

➔ Period during which sexual tension

EXCITEMENT PHASE increases to levels nearing orgasm,
➔ Begins with the onset of erotic feeling which may last from 30 seconds to 3
and sensation which occurs with minutes.
physical and psychological
stimulation (sight, sound, emotion, or PLATEAU PHASE
thought) that causes parasympathetic
nerve stimulation. Male Female
➔ Two primary physiologic changes:
➔ Vasocongestion – increased blood Vasocongestion The clitoris is drawn
supply (arterial dilation and venous leads to full forward and retracts
constriction in genital area and other distention of the under the clitoral
different body parts). penis prepuce
➔ Myotonia – an increased muscular HR (100 - 175 bpm) The lower part of the
tension (contraction). and RR (40 cpm) vagina becomes
extremely congested
(formation of
EXCITEMENT PHASE "orgasmic platform"
HR (100 - 175 bpm)
Male Female
and RR (40 cpm)
Erection of the penis Erection of the clitoris
and nipples of the and nipples of breast
ORGASMIC PHASE/ ORGASM
breast (increased size =
(parasympathetic vasocongestion); ➔ Is the involuntary climax of sexual
nerve simulation) sensitive to touch tension, accompanied by physiologic
Scrotal thickening and temperature; and psychologic release.
and elevation of the center of sexual ➔ It lasts for 3 – 10 seconds; shortest
testes (muscle arousal and orgasm stage in the sexual response cycle;
contraction) in female; increased intense pleasure affecting the whole
Presence of clear arterial blood supply body.
lubricating droplets Presence of mucoid
at the urethral fluid or lubrication of ORGASMIC PHASE/ ORGASM
meatus the vaginal walls
(bulbourethral (Bartholin's gland) Male Female
gland) Vagina widens in
 ➔ Has both biologic and cultural diversity
Muscle contractions A vigorous
components.
surrounding the contraction of
➔ It encompasses and gives direction to
seminal vessels and muscles in the pelvic
a person’s physical, emotional, social,
prostate project area - expels blood
and intellectual responses throughout
semen into the and fluid from area of
life.
proximal urethra congestion
A. Biologic Gender
Contractions are An average of 8 - 15
B. Gender Identity or Sexual Identity
followed contractions at
C. Gender Role
immediately by 3 intervals of one every
- 7 propulsive 0.8 seconds
"ejaculatory BIOLOGIC GENDER
contractions", ➔ Is the term used to denote a person’s
occurring at the chromosomal sex:
same time interval ➔ male (XY) or female (XX).
as in women which
forces semen from
GENDER IDENTITY/ SEXUAL IDENTITY
the penis
➔ Is the inner sense a person has of
being male or female, which may be
RESOLUTION PHASE the same as or different from biologic
➔ Is the 30-minute period during which gender.
the external and internal genital
organs return to unaroused state or GENDER ROLE
pre-coital stage.
➔ Is the male or female behavior a
person exhibits, which, again, may or
RESOLUTION PHASE may not be the same as biologic
gender or gender identity.
Male Female

2020 NATIONAL HEALTH GOALS RELATED TO

REFRACTORY PERIOD Women do not go
REPRODUCTIVE AND SEXUAL HEALTH
occurs during which through this period, so
further orgasm is it is possible for ➔ Increase the proportion of
impossible from a women to have adolescents who, by age 15, have
few hours or days, additional orgasms never engaged in sexual intercourse
depending on age immediately after the to 80.2% of girls and 79.2% of boys
and other factors first if properly from baselines 72.9% and 72.0%.
stimulated ➔ Increase to at least 91.3% the
proportion of sexually active 15- to
19-year-olds at risk for unintended
THE INFLUENCE OF PREGNANCY ON SEXUAL
pregnancy who used contraception
RESPONSE
at last sexual intercourse from a
➔ Following a pregnancy, many women baseline of 83.0%.
continue to experience increased ➔ Reduce deaths from cancer of the
sexual interest because the new uterine cervix to no more than 2.2 per
growth of blood vessels during 100,000 women, from a baseline rate
pregnancy lasts for some time and of 2.4 per 100,000.
continues to facilitate pelvic ➔ Reduce breast cancer deaths to no
vasocongestion. more than 20.6 per 100,000 women,
from a baseline rate of 22.9 per
SEXUALITY 100,000.
➔ Improve the health, safety, and
➔ Is a multidimensional phenomenon
well-being of lesbian, gay, bisexual,
that includes feelings, attitudes, and
and transgender (LGBT) individuals.
actions.
 ➔ The second is a hostile work
environment, in which an employer
creates an environment in which an
employee feels uncomfortable and
exploited (such as being addressed as
“honey” or “babe,” asked to wear
revealing clothing, or working where
walls are decorated with sexist
posters).

INDIVIDUAL WITH UNIQUE NEEDS AND

CONCERNS

INDIVIDUAL WITH A DISABILITY

SEXUAL HARASSMENT AND VIOLENCE ➔ Individuals who are physically
challenged have sexual desires and
needs the same as all others
SEXUAL HARASSMENT
(Meaney-Tavares & GavidiaPayne,
➔ Is unwanted, repeated sexual 2012).
advances, remarks, or behavior ➔ Manual stimulation of the penis or
toward another that is offensive to the psychological stimulation can,
recipient or interferes with job or however, achieve erection in most
school performance. men with spinal cord lesions, allowing
➔ It can involve actions as obvious as a the man a satisfying sexual relationship
job superior demanding sexual favors with his partner.
from an employee, or it could be a ➔ Most women with spinal cord injuries
man or woman sending sexist jokes by cannot experience orgasm but are
e-mail to another person in the able to conceive and have children
department. ➔ Sexuality is a facet of rehabilitation
➔ In school, it can refer to bullying that has not always received
(Marks, Mountjoy, & Marcus, 2011). attention.
➔ Rules apply to same-gender as well as ➔ If a person can accomplish activities
opposite-gender harassment. of daily living such as eating,
➔ In addition to causing occupational elimination, and mobility, then he or
disruption, sexual harassment may be she is often considered to be leading
so distressing that it can lead to short- a normal or near-normal life.
or long-term psychosocial ➔ However, establishing a satisfying
consequences for victims and their sexual relationship is an important part
families such as emotional distress of living as well and so should be
(e.g., anxiety, depression, included in assessments of clients in
posttraumatic stress disorder, rehabilitation programs.
substance abuse), interpersonal
conflict, and impaired intimacy and INDIVIDUAL WITH A HYPOACTIVE SEXUAL
sexual functioning (Stock & Tissot, DESIRE
2012).
➔ Decreased sexual desire can also be
a side effect of many medicines.
TWO TYPES OF SEXUAL HARASSMENT
➔ Chronic diseases, such as peptic
➔ One is quid pro quo (an equal ulcers or chronic pulmonary disorders
exchange), in which an employer asks that cause frequent pain or
for something in return for sexual discomfort, may interfere with a man’s
favors, such as a hiring or promotion or a woman’s overall well-being and
preference. interest in sexual activity.
➔ Obese men and women may not feel REPRODUCTIVE LIFE PLANNING
as much satisfaction from sexual
relations as others because they have
difficulty achieving deep penetration
due to the bulk of their abdomens.
➔ An individual with an STI such as
genital herpes may choose to forgo
sexual relations rather than inform a
partner of the disease. Some women
experience a decrease in sexual
desire during perimenopause.
➔ Administration of androgen
(testosterone) to both women and ➔ Includes all the decisions an individual
men may be helpful at that time, or couple make about whether and
because it can improve interest in when to have children, how many
sexual activity (Shelton & Rajfer, 2012; children to have, and how they are
White, Grady, Giudice, et al., 2012). spaced.
➔ Counseling may include the topics of
avoiding conception, increasing
RESPONSIBLE PARENTHOOD AND FAMILY
fertility, and/or what to do if
PLANNING
contraception has failed.

RESPONSIBLE PARENTHOOD CONTRACEPTIVES

➔ Is the will and ability of parents to ➔ An ideal contraceptive should be:
respond to the needs and aspirations ➔ Safe
of the family and children. ➔ Effective
➔ It is a shared responsibility of the ➔ Compatible with spiritual and cultural
husband and the wife to determine beliefs and personal preferences of
and achieve the desired number, both the user and sexual partner
spacing, and timing of their children ➔ Free of bothersome side effects
according to their own family life ➔ Convenient to use and easily
aspirations, considering psychological ➔ obtainable
preparedness, health status, ➔ Affordable and needing few
socio-cultural, and economic instructions for effective use
concerns. ➔ Free of effects (after discontinuation)
(https://doh.gov.ph/faqs/What-is-mea on future pregnancies
nt-by-Responsible-Parenthood)

ELEMENTS OF RESPONSIBLE PARENTHOOD

1. Awareness and preparedness of

duties and responsibilities of parents
2. Promotion and protection of the rights
of children
3. Nurturing parent and child relationship
and observance of effective ➔ Fertility awareness methods rely on
communication detecting when a woman is capable
4. Efffectice shared home management of impregnation and using periods of
5. Practicing family planning abstinence or contraceptive use
6. Promoting safe motherhood and child during that time.
health nutrition
7. Fostering community involvement and NATURAL FAMILY PLANNING
participation
➔ Also called “periodic abstinence
methods”
➔ No chemical or foreign material into ➔ This higher level is then maintained for
body the rest of her menstrual cycle.
➔ Failure rate ranges from 3% to 25% ➔ This pattern is the basis of the BBT
➔ Need for couple to be conscious of method of contraception.
time period when woman is most likely
to be fertile CERVICAL MUCUS (BILLINGS) METHOD

ABSTINENCE 0% failure rate

Most effective
method to prevent
sexually transmitted
infections (STIs).

PERIODIC A method to avoid

ABSTINENCE pregnancy by
avoiding sex on the
days a woman may
conceive.

COITUS 25% effective; does

INTERRUPTUS not prevent STIs. SYMPTOTHERMAL METHOD

CALENDAR (RHYTHM) METHOD

➔ This method of birth control combines

➔ The calendar method requires a
the cervical mucus and BBT methods.
couple to abstain from coitus on the
days of a menstrual cycle when the ➔ The woman takes her temperature
woman is most likely to conceive (3 or daily, watching for the rise in
4 days before until 3 or 4 days after temperature that marks ovulation.
ovulation). ➔ She also analyzes her cervical mucus
daily.
BASAL BODY TEMPERATURE

LACTATION AMENORRHEA METHOD

➔ As long as a woman is breast-feeding

an infant, there is some natural
suppression of ovulation.
➔ Because women may ovulate but not
menstruate while breast-feeding, the
woman may still be fertile even if she
➔ Just before the day of ovulation, a
has not had a period since childbirth.
woman’s basal body temperature
➔ You can use this method for the first 6
(BBT) falls about 0.5 °F.
➔ At the time of ovulation, her BBT rises a months after giving birth by only
full degree because of the influence nursing your baby from the breast (no
of progesterone. pumping).
➔ This is called continuous breastfeeding.
➔ If you use this method, you should:
➔ Breastfeed your baby at least every 4
hours during the day.
➔ Breastfeed your baby every 6 hours at
night.

BARRIER METHODS

➔ Cocoa butter and glycerin-based

vaginal suppositories filled with a
spermicide.
➔ Inserted vaginally, these dissolve and
release the spermicidal ingredients.
➔ Because it takes about 15 minutes for
a suppository to dissolve, it must be
inserted 15 minutes before coitus.
➔ Sponges are foam-impregnated
➔ Are those that place a chemical or synthetic sponges that are inserted
latex barrier between the cervix and vaginally to block sperm access to the
advancing sperm. cervix.
➔ They should remain in place for 6 hours
SPERMICIDES after intercourse to ensure sperm
destruction.
➔ The advantages of spermicides
include the following:
MALE AND FEMALE CONDOMS
➔ They may be purchased without a
prescription
➔ When used in conjunction with
another contraceptive, they increase
the other method’s effectiveness.
➔ Various preparations are available,
including gels, creams, sponges, films,
foams, and suppositories.
➔ Gels or creams are inserted into the
vagina before coitus with an
applicator.
➔ The woman should do this no more
than 1 hour before coitus for the most ➔ Male condom is a latex rubber or
effective results. synthetic sheath that is placed over
➔ Films are glycerin impregnated with a the erect penis before coitus begins.
spermicidal agent that is folded and
➔ It prevents pregnancy, because
inserted vaginally.
spermatozoa are deposited not in the
➔ On contact with vaginal secretions or
precoital penile emissions, the film vagina but in the tip of the condom.
dissolves and carbon dioxide foam ➔ To be effective, condoms must be
forms to protect the cervix against applied before any penile-vulvar
invading spermatozoa. contact, because even
pre-ejaculation fluid may contain
some sperm.
 MALE CONDOMS CERVICAL CAPS

FEMALE CONDOMS
➔ Are made of soft rubber, are shaped
like a thimble, and fit snugly over the
uterine cervix.

INTRAUTERINE DEVICES (IUDS)

➔ Female condoms are latex sheaths

made of polyurethane and
pre-lubricated with a spermicide.
➔ The inner ring (closed end) covers the ➔ A small plastic device inserted into the
cervix, and the outer ring (open end) uterus to prevent fertilization and/or
rests against the vaginal opening. decrease sperm motility.
➔ Copper T380
DIAPHRAGM
➔ Mirena IUS
➔ Originally, it was thought that the
presence of a foreign substance in the
uterus interfered with the ability of an
ovum to develop as it traversed the
fallopian tube.
➔ Today, the IUD is thought to be
preventing fertilization as well as
creating a local sterile inflammatory
condition that prevents implantation.
➔ When copper is added to the device,
sperm mobility appears to be
affected.
➔ Is a circular rubber disk that is placed
➔ This decreases the possibility that
over the cervix before intercourse; it
sperm will successfully cross the uterine
forms a barricade against the
space and reaches the ovum.
entrance of spermatozoa.
 HORMONAL METHOD remember until the second day.
Missing one pill this way should not
initiate ovulation.
2. If you miss two consecutive pills, take
two pills as soon as you remember
and two pills again the following day.
Then continue the following day your
usual schedule. You may experience
some breakthrough bleeding (vaginal
spotting) with two forgotten pills. Do
not mistake this bleeding for your
menstrual flow. Missing two pills may
allow ovulation to occur, so an added
contraceptive should be used for the
➔ Hormones that cause fluctuations in remainder of the month.
the normal menstrual cycle to prevent 3. If you miss three or more pills in a row,
ovulation or normal transport. throw out the rest of the pack and
A. Oral start a new pack of pills the following
B. Transdermal Sunday. You might not have a period
because of this routine and should use
C. Intravaginal
extra protection until 7 days after
D. Intramuscular
starting a new pack of pills.

COMBINED ORAL CONTRACEPTIVES PROGESTERONE ONLY PILL (POP)

➔ Combined Oral Contraceptive Pills ➔ Mini pills containing only
(COCs)
progesterone.
➔ Are composed of varying amounts of
➔ Without estrogen content, ovulation
synthetic estrogen combined with
small amounts of synthetic may occur but, because the
progesterone (progestin). progestins have not allowed the
➔ The estrogen acts to suppress endometrium to develop fully,
follicle-stimulating hormone (FSH) and implantation will not take place.
LH, thereby suppressing ovulation. ➔ It does not interfere with milk
➔ The progesterone action
production; it may be taken during
complements that of estrogen by
breast-feeding.
causing a decrease in the
permeability of cervical mucus,
thereby limiting sperm motility and TRANSDERMAL PATCHES
access to ova.
➔ Progesterone also interferes with tubal
transport and endometrial
proliferation to such degrees that the
possibility of implantation is
significantly decreased.

COMBINED ORAL CONTRACEPTIVES

● Management if a woman forgets to

take an oral contraceptive pill ➔ Transdermal patch that slowly but
1. If you forget to take one pill, take it as continuously release a combination of
soon as you remember. Continue the estrogen and progesterone.
following day with your usual ➔ Patches are applied once a week for
schedule. Doing so might mean taking 3 weeks.
two pills on one day, if you don’t
➔ During the week on which the woman estrogen and progesterone) given
is patch free, a menstrual flow will every 30 days inhibit ovulation, alter
occur. the endometrium and change the
➔ Patches may be applied to one of
cervical mucus.
four areas: upper outer arm, upper
➔ The effectiveness rate of these
torso (front or back, excluding the
breast), abdomen, or buttocks. methods is almost 100%, making them
an increasingly popular contraceptive
VAGINAL RINGS method.

SURGICAL METHODS

➔ Is a silicone ring that surrounds the

cervix and continually releases a
➔ Tubal Ligation
combination of estrogen and
➔ The fallopian tubes are occluded by
progesterone.
cautery, crushing, clamping or
➔ The ring is inserted by the woman and
blocking and thereby preventing
left in place for 3 weeks, then
passage of both sperm and ova.
removed for 1 week.
➔ Menstrual bleeding occurs during the
CONTRACEPTIVES: SURGICAL METHODS
ring-free week.
➔ The hormones released are absorbed ➔ The most common operation to
directly by the mucous membrane of achieve tubal ligation is laparoscopy.
the vagina, thereby avoiding a “first ➔ After a menstrual flow and before
pass” through the liver; this is an ovulation, an incision as small as 1 cm
advantage for woman with liver is made just under the woman’s
disease. umbilicus with the woman under
general or local anesthesia.

INTRAMUSCULAR INJECTIONS ➔ A lighted laparoscope is inserted

through the incision.
➔ Carbon dioxide is then pumped into
the incision to lift the abdominal wall
upward and out of the line of vision.
➔ The surgeon locates the fallopian
tubes by viewing the field through the
laparoscope.
➔ An electrical current to coagulate
➔ Is a single injection of
tissue is then passed through the
medroxyprogesterone acetate
instrument for 3 to 5 seconds, or the
(Depo-Provera) given every 12 weeks
or injections of Lunelle ( a synthetic
 tubes are clamped and cut or filled days) of unprotected coitus to
with a silicone gel to seal them. interrupt a pregnancy.

SURGICAL METHODS 2020 NATIONAL HEALTH GOALS RELATED TO

REPRODUCTIVE LIFE PLANNING

➔ Increase the proportion of

adolescents who receive formal
instruction on abstinence before 18
years of age from a baseline of 87.2%
to a target of 95.9%.
➔ Vasectomy ➔ Increase the proportion of females less
➔ A small incision is made on each side than 15 years of age who have never
of the scrotum.
had sexual intercourse from a baseline
➔ The vas deferens at that point is then
of 82.9% to a target of 91.2%; of males,
cut and tied, cauterized and plugged,
blocking the passage of spermatozoa. from 82.0% to 90.2%.
➔ Reduce the proportion of females
experiencing pregnancy despite use
of a reversible contraceptive method
from a baseline of 12.4% to a target of
9.9%.
➔ Increase the proportion of intended
pregnancies from a baseline of 51% to
a target of 56%.
➔ Decrease the proportion of births
➔ Spermatozoa that were present in the
occurring within 18 months of a
vas deferens at the time of surgery
previous birth from a baseline of 35.3%
can remain viable for as long as 6
months. to a target of 31.7%.
➔ Therefore, although the man can
resume sexual intercourse within 1 AREAS TO ASSESS IN MAKING CHOICES ABOUT
week, an additional birth control CONTRACEPTIVE METHODS
method should be used until two
negative sperm reports have been ➔ Personal values
obtained, usually requiring 10 to 20 ➔ Ability to use method correctly
ejaculations. ➔ Impact on sexual enjoyment
➔ Financial factors
REPRODUCTIVE LIFE PLANNING: EMERGENCY ➔ Length of projected relationship (short
POSTCOITAL CONTRACEPTION term versus long term)
➔ For use in emergency only (such as ➔ Past experience with contraception
rape): ➔ Future plans regarding pregnancy
➔ High-dose progestin-based pills ➔ Vital signs, Pap smear, gonococcal
➔ Insertion of copper IUD and chlamydial screening
➔ Levonorgestrel 1.5 mg are available ➔ Obstetric history, including STIs, past
over the counter without a pregnancies, previous elective
prescription by males or females abortions, failure of previously used
➔ One or two pills containing a high methods and compliance history with
dose of levonorgestrel, a progestin, past methods.
are taken anytime within 72 hours (3 ➔ Clients’ beliefs, needs, feelings, and
understanding of conception
 ➔ Current and anticipated sexual ➔ In other words, the PICOT question is
practices, number of partners, the search strategy.
feelings, and body image ➔ The search strategy leads to an
unbiased and effective search.

Module 1.3
Evidenced Based Practice in Nursing HOW IS PICOT USED IN EBP?

➔ PICO is a mnemonic device used in

nursing that helps a person remember
EVIDENCE-BASED PRACTICE (EBP)
the components of a well focused
➔ An approach to health care that
clinical question.
combines best available evidence,
➔ It is a strategy used in the first step of
healthcare professionals' expertise,
Evidence Based Practice (EBP) to
and patient preferences, yielding
assess and ask when researching to
benefits for patients, healthcare
formulate a searchable clinical
professionals, and organizations.
question by helping to develop key
➔ However, globally, EBP
terms.
implementation remains inconsistent
among nurses.
➔ Research studies show that
evidence-based practice (EBP) leads
to higher quality care, improved
patient outcomes, reduced costs, and
greater nurse satisfaction than
traditional approaches to care.

PATIENT Who are the relevant

EBP ORG. CULTURE & ENVIRONMENT
PROBLEM patients? Think about
➔ Organizational culture is the set of age, sex, geographic
shared beliefs, values, and norms that location, or specific
influence the way members think, feel, characteristics that
would be important
and behave.
to your question.
➔ Culture is created by means of
terminal and instrumental values, INTERVENTION/ What is the
heroes, rites and rituals, and INDICATOR management
communication networks. strategy,
diagnostic test, or
➔ Examples include integrity, teamwork,
exposure that you
transparency, and accountability. The
are interested in?
purpose of organizational value is to
differentiate your organization from COMPARE/ Is there a control or
others and act as a model for CONTROL alternative
decision-making processes. management
strategy you would
like to compare to
WHAT IS THE PURPOSE OF A PICOT QUESTION? the intervention or
➔ It is the mechanism to identify the indicator?

terms to be used to search for the best

OUTCOME What are the
evidence to answer a burning clinical patient-relevant
question. consequences of the
 intervention? Module 1.4A
Physiology of Menstruation
TIME/ TYPE OF What time periods
QUESTION should. Be
considered, MENSTRUAL CYCLE
What clinical domain
➔ A menstrual cycle (the female
does your question
reproductive cycle) is episodic uterine
fall under?
bleeding in response to cyclic
hormonal changes.
PURPOSE OF EBP ➔ During the menstrual cycle, the ovum
reaches its maturity, and a new
➔ Evidence-based practice provides the
uterine bed is made ready for the
foundation for safe care, leading to implantation of the fertilized ova.
increased effectiveness and
efficiency, timeliness, and more
CHARACTERISTICS
appropriate focus of research-based
data within the framework of the MENARCHE Average age of
patient's current situation and needs. onset 12 to 14 years
old; average range
of age onset is 9 – 17
STEPS OF EBP years old.

INTERVAL Average interval

CYCLES between cycles is 28
days; 23-35 days is
also normal.

DURATION OF Average is 4 – 6 days;

MENSTRUAL 2 – 9 days is also
FLOW normal.

AMOUNT OF Average amount of

MENSTRUAL menstrual flow is
FLOW 30-80 mL.

COLOR OF Dark red; a

MENSTRUAL combination of
BARRIERS OF EVIDENCE-BASED PRACTICE CYCLE blood, mucus and
endometrial cells.
1. Lack of support and supervision
2. Lack of training and education
3. Limited resources PHYSIOLOGY OF MENSTRUAL CYCLE
4. Time restriction
➔ Four body structures are involved in
the physiology of the menstrual cycle:
INDIVIDUAL BARRIER TO EBP the hypothalamus, the pituitary gland,
1. Lack of nurses' knowledge", "skills and the ovaries, and the uterus.
awareness regarding use the ➔ The First Phase of the Menstrual Cycle
Evidence-based practice", (Proliferative)
2. lack of professional characteristic ➔ The Second Phase of the Menstrual
3. Nurses' attitude and experience in Cycle (Secretory)
using" and "language barrier in using ➔ The Third Phase of the Menstrual Cycle
or implementing Evidence-based (Ischemic)
practice" ➔ The Fourth Phase of the Menstrual
Cycle (Menses)