TRENDS IN MATERNAL TRENDS IN MATERNAL AND CHILD CAREAND CHILD CARE

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

Managed CareManaged Care Managed Care refers to a system of Managed Care refers to a system of

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

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

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

Alternative Settings and Alternative Settings and Styles for Health CareStyles for Health Care This century has seen several major shifts in settings for This century has seen several major shifts in settings for

maternity care. At the turn of the century most births took maternity care. At the turn of the century most births took place in the home, with only the very poor or ill giving birth place in the home, with only the very poor or ill giving birth in lying in hospitals. By 1940 about 40% of live births in lying in hospitals. By 1940 about 40% of live births occurred in hospitals and by 2000 the figure had risen to occurred in hospitals and by 2000 the figure had risen to 98%. Today less dramatic but no less important trend is 98%. Today less dramatic but no less important trend is occurring as an increasing number of families are once occurring as an increasing number of families are once more choosing childbirth at home or in alternative birth more choosing childbirth at home or in alternative birth settings rather than hospitals.settings rather than hospitals.

Health care settings for children are also changing. The Health care settings for children are also changing. The home, community centers, outpatient clinics, well-baby home, community centers, outpatient clinics, well-baby clinics, schools and group homes are some settings where clinics, schools and group homes are some settings where comprehensive health care may be administered.comprehensive health care may be administered.

Including the Family in Including the Family in the Health Care Settingthe Health Care Setting

Maternal-child nursing is family centered. The Maternal-child nursing is family centered. The father of the child is as important as the mother. father of the child is as important as the mother. Many hospitals have developed policies that Many hospitals have developed policies that minimize the effects of separation from parents minimize the effects of separation from parents when children must be admitted for extended when children must be admitted for extended stays. Parents are allowed and encouraged to do stays. Parents are allowed and encouraged to do as much for the child as they wish during a as much for the child as they wish during a hospital stay. hospital stay.

For the same reasons, parents on a For the same reasons, parents on a maternity unit are encouraged to room-in and give maternity unit are encouraged to room-in and give total care to their well-newborn.total care to their well-newborn.

Increase in the Number Increase in the Number of Intensive Care Unitsof Intensive Care Units

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

NICU, ICN, PICU NICU, ICN, PICU

Most costly type of hospitalizationMost costly type of hospitalization

Increase Reliance on Increase Reliance on Comprehensive Care SettingsComprehensive Care Settings Comprehensive health care is designed to meet all Comprehensive health care is designed to meet all

of a child’s needs in one setting. In the past, care of of a child’s needs in one setting. In the past, care of children tended to be specialized e.g. cerebral palsy. children tended to be specialized e.g. cerebral palsy. Without extra guidance, parents would find Without extra guidance, parents would find themselves lost in a maze of visits to different health themselves lost in a maze of visits to different health care personnel. care personnel.

Primary care provider who follows the child Primary care provider who follows the child through all phases of care is an advanced-practice through all phases of care is an advanced-practice nurse such as Family nurse, Pediatric Nurse and nurse such as Family nurse, Pediatric Nurse and Women’s Health nurse practitioner.Women’s Health nurse practitioner.

Increased Use of Alternative Increased Use of Alternative Treatment ModalitiesTreatment Modalities There is growing tendency for families to There is growing tendency for families to

consult providers of alternative forms of consult providers of alternative forms of therapy such as acupuncture or therapeutic therapy such as acupuncture or therapeutic touch in addition to, or instead of traditional touch in addition to, or instead of traditional health care providers. health care providers.

Increased Use of Increased Use of TechnologyTechnology The use of technology is increasing in all The use of technology is increasing in all

health care settings. E.g. Charting by health care settings. E.g. Charting by computer, seeking information on the computer, seeking information on the internet and monitoring fetal heart rates by internet and monitoring fetal heart rates by Doppler.Doppler.

We must be able to explain the We must be able to explain the technology use and its advantages to clients. technology use and its advantages to clients. Otherwise clients can find new technology Otherwise clients can find new technology more frightening than helpful to them.more frightening than helpful to them.

Regionalization of Regionalization of Intensive CareIntensive Care

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

Community Community Standards of CareStandards of Care

Increasing Concern Increasing Concern Regarding Health Care Regarding Health Care Costs/Cost Containment Costs/Cost Containment

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

Shortening of Hospital Shortening of Hospital Stay/Increased reliance Stay/Increased reliance on Home Careon Home Care

Home Care: Home Care: In the past when complications occurred during In the past when complications occurred during pregnancy women were required to spend weeks pregnancy women were required to spend weeks or even months in the hospital on bed rest so their or even months in the hospital on bed rest so their condition could be closely monitored. Today, condition could be closely monitored. Today, many women can remain at home on home care.many women can remain at home on home care.

Perinatal Home Care- is care of pregnant women Perinatal Home Care- is care of pregnant women in their homes, provided by or supervised through in their homes, provided by or supervised through a home health care or community health care a home health care or community health care agency. agency.

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

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

Family-Centered Family-Centered Maternity Care Maternity Care

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

Illness in a child is a family centered event.Illness in a child is a family centered event.

4 circumstances crucial to family life:4 circumstances crucial to family life:

Birth of the employee’s childBirth of the employee’s child Adoption or foster placement of a child with Adoption or foster placement of a child with

the employeethe employee Need for the employee to care for a parent, Need for the employee to care for a parent,

spouse or child with a serious health conditionspouse or child with a serious health condition Inability of the employee to perform his or her Inability of the employee to perform his or her

functions because of a serious health functions because of a serious health condition.condition.

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

Long title:Long title: AN ACT GRANTING FAMILY AND TEMPORARY AN ACT GRANTING FAMILY AND TEMPORARY

MEDICAL LEAVE UNDER CERTAIN CIRCUMSTANCESMEDICAL LEAVE UNDER CERTAIN CIRCUMSTANCES

Scope: NationalScope: National Legislative status: Pending in the Committee (10/3/2007)Legislative status: Pending in the Committee (10/3/2007)

12 weeks of unpaid, job-protected leave to employees12 weeks of unpaid, job-protected leave to employees

DelegationDelegation is the assignment of authority and is the assignment of authority and

responsibility to another person (normally responsibility to another person (normally from a manager to a subordinate) to carry out from a manager to a subordinate) to carry out specific activities.specific activities.

However the person who delegated the work However the person who delegated the work remains accountable for the outcome of the remains accountable for the outcome of the delegated work. It empowers a subordinate to delegated work. It empowers a subordinate to make decision.make decision.

Accountability Accountability is a concept in is a concept in ethicsethics and and governancegovernance It is It is

often used synonymously with such often used synonymously with such concepts as concepts as responsibilityresponsibility,answerability, ,answerability, liabilityliability, and other terms associated with the , and other terms associated with the expectation of account-giving.expectation of account-giving.

4 Rules to follow when 4 Rules to follow when delegating:delegating:

4 Rules to follow when delegating:4 Rules to follow when delegating: Right task for the situationRight task for the situation Right person to complete the taskRight person to complete the task Right communication concerning what is Right communication concerning what is

to be doneto be done Right feedback or evaluation that the task Right feedback or evaluation that the task

was completed.was completed.

Health Care Health Care Concerns and AttitudesConcerns and Attitudes

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

Increasing Emphasis on Increasing Emphasis on Preventive CarePreventive Care

General accepted theoryGeneral accepted theory: :

It is better to keep individuals well than to It is better to keep individuals well than to restore health after they have become ill.restore health after they have become ill.

Prevention is better than Cure.Prevention is better than Cure.