Introduction My 27 year old nursing career began as a midwifery nurse in 1981. My career has proven rewarding and satisfying and I have gained great experience and plenty of skills and insight while serving, to the best of my ability, children, antenatal and postnatal patients, and family planning clients…
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But with the knowledge, skills and experience I had amassed, I was able to patiently navigate and resolve issues dealing with nursing responsibilities and those arising from various personality conflicts. I soon gained respect as a proven and dependable manager and after two years was made Head Nurse. At my Maternal Child Health Care Clinic (MCH) I presently manage a staff of 10 female staff nurses and two female attenders. This dissertation concerns prevailing issues that have arisen from my experience concerning home nursing during postnatal period. The study will use the methods of reflective practice to analyse the problems that nurses face during the postnatal home nursing period. The main duties provided by the maternal and child health nurse include screening of antenatal and postnatal patients; making assessments and giving immunization to children under 5 years of age; providing specific women services such as pap smears and distribution of the family planning pill; home visiting and home nursing, and providing school health services. Specific duties of the latter include giving health talks to the public school and village or community groups. The Problem I want to research the theme of home nursing due to an incident that occurred a few years ago and that has remained powerfully within me as a memory. One of our postnatal patients died because of what I thought was ultimately due, but not mainly because of, deficiencies in our home care operation. Proper nursing procedure requires that postnatal care be provided everyday for the first four days after delivery and then on day 6, 8 and 10, and lastly on day 20. After birth, this patient had somehow disappeared in the communication lines of our hospital system. She had received no follow-up or home visiting and because of this, had died. This particular patient had been diagnosed in the antenatal period as well and fit. However, she was quite obese. It was later found she had placenta praevia, a low lying placenta, and that she was experiencing bleeding antepartum haemorrhage type iii where the placenta was covering only part of the top of the cervix. She received a lower segment caesarean section (LSCS) in one of the specialist hospitals. But her birth had not been reported back to the specialist hospital. I don’t feel this patient had received the best medical attention that she could have had. I believe the system had broken down for her. UK Background Compared to other developed nations, the UK has had a good record over the years in keeping maternity and infant mortality low. Infant mortality rates per 1000 averaged 6 for 2000 and 5 for 2008 for infants under 1 (WHO, p. 55). For infants under 5, the figures were 6 for 2000 and 2008. Compared to the United States, the figures were 7 and 7, and 9 and 8 (p. 55). The lowest figures were for Japan at 3 and 3, infants under 1, and 5 and 3, for infants under 5 (p. 51). Developing countries typically display figures broaching above 50 deaths reaching to well over 200 deaths in both categories. UK maternity ratio per 100,000 live births averaged 7 between 2000-2009, with interagency figures showing 8-15 in 2005 (WHO, p. 54). The United States averaged 13 (p. 54), Sierra Leone averaged 857, showing 800 to 3,700 in 2005 (p. 54); and Canada averaged 9 and 7 to 13 in 2005 (p. 50). The infant and maternity mortality rates in developed countries have been low,
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8 Pages(2000 words)Dissertation
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