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availability of health-related support outside the hospital. The authors concluded that each childbearing woman and her family should be treated, in clinical situations, as if they were extraordinary. In this way, practitioners can alter routines that cause the woman and her family to lose individualized care. Source: Gramling, L., Hickman, K., & Bennett, S. (2004). What makes a good family-centered partnership between women and their practitioners? A qualitative study. Birth, 31(1), 43–48. ? tensive care nursery (ICN). Children who are undergoing cardiac surgery or recovering from near-drownings or multiinjury accidents are cared for in a pediatric intensive care unit (PICU). Intensive care at this early point in life is one of the most costly types of hospitalization. Expenses of $1,000 a day, or $20,000 to $100,000 for a total hospital stay, are not rare for care during a high-risk pregnancy or care for a high-risk infant. As the number of these settings increases, the opportunities for advanced-practice nurses also increase. Regionalization of Intensive Care To avoid duplication of care sites, it is an accepted practice for communities to establish centralized maternal or pediatric health services. Such planning creates one site that is properly staffed and equipped for potential problems. For example, ill newborns may be transported to a central high-risk nursery for care. High-risk pregnant women and ill children may be cared for in a regional setting equipped with specialized resources for the diagnosis and treatment of specific health problems. When a newborn, older child, or parent is hospitalized in a regional center, the family members who have been left behind need a great deal of support. They may feel they have “lost” their infant, child, or parent unless health care personnel keep them abreast of the ill family member’s progress by means of phone calls and snapshots and encourage the family to visit as soon as possible. When regionalization concepts of newborn care first became accepted, transporting the ill or premature newborn to the regional care facility was the method of choice (Fig. 1.6). Today, however, if it is known in advance that a child may be born with a life-threatening condition, it may be safer to transport the mother to the regional center during pregnancy, because the uterus has advantages as a transport incubator that far exceed those of any commercial incubator yet designed. An important argument against regionalization for pediatric care is that children will feel homesick in strange settings, overwhelmed by the number of sick children they see, and frightened because they are miles from home. An important argument against regionalization of maternal care is that being away from her community and support network places a great deal of stress on the pregnant woman and her family and limits her own doctor’s participation in her care. These are important considerations. Because nurses more than any other health care group set the tone for hospitals, they are responsible for ensuring that clients and families feel as welcome in the regional centers as they would have been in a small hospital. Staffing should be adequate to allow sufficient time for nurses to comfort frightened children and prepare them for new experiences or to support the pregnant woman and her family. Documenting the importance of such actions allows them to be incorporated in critical pathways and preserves the importance of the nurse’s role. Increased Reliance on Comprehensive Care Settings Comprehensive health care is designed to meet all of a child’s needs in one setting. In the past, care of children tended to be specialized. For example, a child born with an illness (e.g., myelomeningocele, cerebral palsy) might have been followed by a team of specialists for each facet of the problem. Such a team might include a neurologist, a physical therapist, an occupational therapist, a psychologist for intelligence quotient testing, a speech therapist, an orthopedic surgeon, and finally, a special education teacher. The parents might need to find a special dentist who accepts clients with multiple disabilities. Each specialist would look at only one area of the child’s needs rather than the whole child’s development. Without extra guidance, parents would find themselves lost in a maze of visits to different health care personnel. If they were not receiving financial support for their child’s care, they might not have been able to afford all the necessary services at one time. It might have been difficult to decide which of the child’s problems needed to be treated immediately and which could be left untreated without worsening and developing into a permanent disability. Although specialists are still important to a child’s care, a trusted primary care provider to help parents coordinate these specialized services is essential in today’s managed care environment. In many settings, this primary care provider, who follows the child through all phases of care, is an advanced-practice nurse such as a family nurse practitioner, pediatric nurse practitioner, or a women’s health nurse practitioner. Nurses can be helpful in seeing that both parents and children have all their needs met by a primary health care provider in this way. The family must become empowered to seek out a family-centered setting that will be best for their health (Box 1.9).
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