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immunizations, screenings, health and safety education, counseling, crisis CHAPTER 1 A Framework for Maternal and Child Health Nursing 17 FIGURE 1.5 A couple, soon to be parents, share a close moment in a birthing room. intervention for teens, parenting classes, and care of the ill child and family. Community-based care can provide costeffective health promotion, disease prevention, and patient care to a large number of children and families in an environment that is familiar to them. Strengthening the Ambulatory Care System The ambulatory care system continues to broaden its base. More and more people who might otherwise have been admitted to a hospital are now being cared for in ambulatory clinics or at home. This option has proved especially important in the care of sick children and women who are experiencing a pregnancy complication or who want early discharge after childbirth. Separating a child from his or her family during an illness has been shown to be potentially harmful to the child’s development, so any effort to reduce the incidence of separation should have a positive effect (see Chapter 35). Avoiding long hospital stays for women during pregnancy is also a preferable method of care, because it helps to maintain family contact. What if... Melissa Chung has to remain in the hospital after the birth of her new baby while her baby is transported to a regional center for care? How could you help her keep in touch with her new baby? Shortening Hospital Stays More and more hospitals perform children’s surgeries such as tonsillectomy or umbilical or inguinal hernia repair without requiring an overnight stay. Early on the morning of surgery, the parent and child arrive at the hospital, and the child receives a preoperative physical examination and medication. After surgery, the child is sent to a recovery room and then to a short-term observation unit. If the child is doing well and shows no complications by about 4 hours after surgery, he or she can be discharged. Similarly, women who have begun preterm labor stay in the hospital while labor is halted and then are allowed to return home on medication with continued monitoring. The routine hospital stay for mothers and newborns after an uncomplicated birth is now 2 days or less. Short-term hospital stays require intensive health teaching by the nursing staff and follow-up by home care or community health nurses. Parents must be taught to watch for danger signs in the child without being frightened. A woman with a complication of pregnancy must be taught to watch for signs that warrant immediate attention. New parents must be taught about their newborn’s nutritional needs, umbilical cord care, bathing, and safety considerations, all before the euphoria and fatigue of childbirth have begun to wear off. This type of teaching is difficult, because it includes not only imparting the facts of self-care but also providing support and reassurance that the client or parents are capable of this level of care. Including the Family in Health Care Most hospitals have developed policies that minimize the effects of separation from parents when children must be admitted for extended stays. Open visiting hours allow parents to visit as much as possible and sleep overnight in a bed next to their child. Parents also are allowed and encouraged to do as much for the child as they wish during a hospital stay, such as feeding and bathing the child or administering oral medicine. Most of a parent’s time, however, is spent simply being close by to provide a comfortable, secure influence on the child. For the same reasons, parents on a maternity unit are encouraged to room-in and give total care to their well newborn (Box 1.8). Because parents are so important to their child’s hospital experience and overall well-being, family-centered nursing is vital. Therefore, the nurse’s client load will not be just four children, for example, but four children plus four sets of parents; not just a single newborn, but his or her two parents as well. Increase in the Number of Intensive Care Units Over the past 20 years, care of infants and children has become extremely technical. It is generally assumed that newborns with a term birthweight (more than 2,500 g or 5.5 lb) will thrive at birth. However, many infants are born each year with birthweights lower than 2,500 g or who are ill at birth and do not thrive. Such infants are regularly transferred to a neonatal intensive care unit (NICU) or in18 UNIT 1 Maternal and Child Health Nursing Practice BOX 1.8 FOCUS ON . . . EVIDENCE-BASED PRACTICE EVIDENCE-BASED PRACTICE What are the ingredients of effective family-centered care? Working on the premise that family-centered care is best achieved when a mutually beneficial partnership exists between health care providers and families, nurse researchers attempted to identify health care practices that promote or limit a family-centered philosophy. For the study, 34 women (mostly African-American) who were using maternity services at a large urban hospital were interviewed as to what they liked or didn’t like about their maternity care. The results revealed two important perceived barriers to family-centered maternity care: problems among health caregivers in coordinating services and lack of patient access to services. Factors that aided effective care were prompt response to high-risk patients and the
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