TRENDS IN MATERNAL AND CHILD CARE

The settings for maternal and child health care are changing to better meet the needs of increasingly well-informed and vocal consumers

Managed Care
Managed Care refers to a system of health care delivery that focuses on reducing the cost of health care by closely monitoring the cost of personnel, use and brands of supplies, length of hospital stays, number of referrals requested.

 - Limiting the number of hospital days. Before managed care, women stayed 3 or 4 days after childbirth; today they rarely stay over 48 hours.

- Distribution of personnel. Before nurses completed al care procedures for patients, no matter how small or unskilled the task. Today with managed care ancillary personnel such as unlicensed assistive personnel, perform many tasks under the supervision of the nurse.

Alternative Settings and Styles for Health Care

This century has seen several major shifts in settings for maternity care. At the turn of the century most births took place in the home, with only the very poor or ill giving birth in lying in hospitals. By 1940 about 40% of live births occurred in hospitals and by 2000 the figure had risen to 98%. Today less dramatic but no less important trend is occurring as an increasing number of families are once more choosing childbirth at home or in alternative birth settings rather than hospitals. Health care settings for children are also changing. The home, community centers, outpatient clinics, well-baby clinics, schools and group homes are some settings where comprehensive health care may be administered.

Including the Family in the Health Care Setting

Maternal-child nursing is family centered. The father of the child is as important as the mother. Many hospitals have developed policies that minimize the effects of separation from parents when children must be admitted for extended stays. Parents are allowed and encouraged to do as much for the child as they wish during a hospital stay. For the same reasons, parents on a maternity unit are encouraged to room-in and give total care to their well-newborn.

Increase in the Number of Intensive Care Units

Over the past 20 years, care of infants and children has become more intensive. It is generally assumed that newborns with a term birth weight (more than 2,500g or 5.5 lb) will thrive at birth. However many infants are born each year with birth weights lower than 2,500 or who are ill at birth and do not thrive.

 NICU, ICN, PICU Most costly type of hospitalization

Increase Reliance on Comprehensive Care Settings

Comprehensive health care is designed to meet all of a childs needs in one setting. In the past, care of children tended to be specialized e.g. cerebral palsy. Without extra guidance, parents would find themselves lost in a maze of visits to different health care personnel. Primary care provider who follows the child through all phases of care is an advanced-practice nurse such as Family nurse, Pediatric Nurse and Womens Health nurse practitioner.

Increased Use of Alternative Treatment Modalities

There is growing tendency for families to consult providers of alternative forms of therapy such as acupuncture or therapeutic touch in addition to, or instead of traditional health care providers.

Increased Use of Technology

The use of technology is increasing in all health care settings. E.g. Charting by computer, seeking information on the internet and monitoring fetal heart rates by Doppler. We must be able to explain the technology use and its advantages to clients. Otherwise clients can find new technology more frightening than helpful to them.

Regionalization of Intensive Care

To avoid the duplication of care sites, it is an accepted practice for a community to establish centralized maternal or pediatric health services. Ill newborns may be transported to a central high risk nursery when necessary. Likewise, high risk women and children may be cared for in a regional setting with specialized resources for the diagnosis and treatment of their specific health problem

Community Standards of Care

Increasing Concern Regarding Health Care Costs/Cost Containment

The advent of managed care has concentrated efforts on reducing the cost of health care. This has direct implications for maternal and child health nursing because nurses must become more cost-conscious about supplies and services. Lack of financial ability to pay and insensitivity to cultural values are major reasons that women do not obtain prenatal care.

Shortening of Hospital Stay/Increased reliance on Home Care

Home Care: In the past when complications occurred during pregnancy women were required to spend weeks or even months in the hospital on bed rest so their condition could be closely monitored. Today, many women can remain at home on home care. Perinatal Home Care- is care of pregnant women in their homes, provided by or supervised through a home health care or community health care agency.

 e.g. preterm labor that has been halted, hyperemesis gravidarum and hypertension.

They are allowed to return home on medication with continued monitoring. The routine hospital stay for mothers and newborns after an uncomplicated delivery is now 2 days or less.

Family-Centered Maternity Care

Health Promotion with families during pregnancy or childrearing is a familycentered event because teaching health awareness and good health habits is accomplished chiefly by role modeling. Illness in a child is a family centered event.

 4 circumstances crucial to family life:

Birth of the employees child Adoption or foster placement of a child with the employee Need for the employee to care for a parent, spouse or child with a serious health condition Inability of the employee to perform his or her functions because of a serious health condition.

 FAMILY AND MEDICAL LEAVE ACT OF 2007 Filed on October 2, 2007 by Defensor Santiago, Miriam

Long title: AN ACT GRANTING FAMILY AND TEMPORARY MEDICAL LEAVE UNDER CERTAIN CIRCUMSTANCES
Scope: National Legislative status: Pending in the Committee (10/3/2007)

12 weeks of unpaid, job-protected leave to employees

Delegation
is the assignment of authority and responsibility to another person (normally from a manager to a subordinate) to carry out specific activities.
However the person who delegated the work remains accountable for the outcome of the delegated work. It empowers a subordinate to make decision.

Accountability
is a concept in ethics and governance It is often used synonymously with such concepts as responsibility,answerability, liability, and other terms associated with the expectation of account-giving.

4 Rules to follow when delegating:

4 Rules to follow when delegating: Right task for the situation Right person to complete the task Right communication concerning what is to be done Right feedback or evaluation that the task was completed.

Health Care Concerns and Attitudes

The 1980s brought about considerable change in the health care system and particularly in maternal and child health. At this time 21st century there are likely even more changes to come toward effective health goals and guaranteed health care for all citizens.

Increasing Emphasis on Preventive Care

General accepted theory:
It is better to keep individuals well than to restore health after they have become ill. Prevention is better than Cure.