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CHAPTER 1 A Framework for Maternal and Child Health Nursing A nurse prepares an infant transport incubator to move a premature infant to a regional hospital. Helping with safe movement of pregnant women and ill newborns to regional centers is an important nursing responsibility. (© Caroline Brown, RNC, MS, DEd.) Increased Use of Alternative Treatment Modalities There is a 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. Nurses have an increasing obligation to be aware of complementary or alternative therapies, which have the potential to either enhance or detract from the effectiveness of traditional therapy (Fletcher & Clarke, 2004; Weier & Beal, 2004). In addition, health care providers who are unaware of the existence of some alternative forms of therapy may lose an important opportunity to capitalize on the positive features of that particular therapy. For instance, it would be important to know that an adolescent who is about to undergo a painful procedure is experienced at meditation, because asking the adolescent if she wants to meditate before the procedure could help her relax. Not only could this decrease the child’s discomfort, but it could also offer her a feeling of control over a difficult situation. People are using an increasing number of herbal remedies, so asking about these at health assessment is important to prevent drug interactions. Ginger, for example, is frequently taken during pregnancy to relieve morning sickness (Senyak et al., 2005). Increased Reliance on Home Care Early hospital discharge has resulted in the return home of many women and children before they are fully ready to care for themselves. Ill children and women with complications of pregnancy may choose to remain at home for care rather than be hospitalized. This has created a “second system” of care requiring many additional care providers (Asensio et al., 2005). Nurses are instrumental in assessing women and children on hospital discharge to help plan the best type of continuing care, devise and modify procedures for home care, and sustain clients’ morale and interest in health care during such situations as home monitoring to prevent premature labor. Because home care is a unique and expanding area in maternal and child health nursing, it is discussed in relation to maternal care in Chapter 16 and in relation to children in Chapter 35. Increased Use of Technology The use of technology is increasing in all health care settings. The field of assisted reproduction (e.g., in vitro fertilization), with the possibility of stem cell research, is forging new pathways ( Jain et al., 2004). Charting by computer, seeking information on the Internet, and monitoring fetal heart rates by Doppler ultrasonography are other examples. In addition to learning these technologies, maternal and child health nurses must be able to explain their use and their advantages to clients. Otherwise, clients may find new technologies more frightening than helpful to them. Health Care Concerns and Attitudes The 1980s brought about considerable change in the health care system. As we progress through the 21st century, there are likely to be even more changes as the United States actively works toward effective health goals and improved health care for all citizens. These steps can create new concerns. Increasing Concern Regarding Health Care Costs 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 health care provider’s insensitivity to cultural values are major reasons why women do not obtain prenatal care. A woman may fear that changing jobs or not working during pregnancy may lead to loss of insurance coverage, thereby reducing her ability to pay for services. As a result, she may continue to work long hours or in unfit conditions during pregnancy. Nurses are challenged to help reduce costs while maintaining quality care so that prenatal care remains available. 20 UNIT 1 Maternal and Child Health Nursing Practice Tips for Selecting a Health Care Setting Q. Melissa Chung, the patient you met at the beginning of the chapter, asks you, “With so many health care choices and settings available, how do we know which one to choose?” A. When selecting a health care setting, use the following as a guide to help you decide what is best for your family: • Can it be reached easily? (Going for preventive care when well or for care when ill should not be a chore.) • Will the staff provide continuity of care so you’ll always see the same primary care provider if possible? • Does the physical setup of the facility provide for a sense of privacy, yet a sense that health care providers share pertinent information so you do not have to repeat your history at each visit? • Is the cost of care and the number of referrals to specialists explained clearly? • Are preventive care and health education stressed (keeping well is as important as recovering from illness)? • Do health care providers respect your opinion and ask for your input on health care decisions? • Do health care providers show a personal interest in
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