Models of maternity care: a continuity of midwifery care

Pregnancy and birth are significant life events for women and their families and midwife supports a woman throughout pregnancy, birth and the postnatal period. So, the demand for services that are family friendly, women focused, safe and accessible is increasing. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. Because pregnancy and childbirth involve every part of feelings, physical and practical needs, hopes, religious and spiritual beliefs can all affect pregnancy and birth. So, model of maternity care addresses all these aspects to help give birth safely, naturally and confidently. The aim of this review is how midwives working in different model care constructed their midwifery role in order to maintain a positive work-life balance. Evidence from high income countries found such models to be a cost-efficient way to improve health outcomes, reducing medical interventions and increasing satisfaction with care.

Evolving locally appropriate models of care for Indian sickle cell disease.

The sickle cell gene in India represents a separate occurrence of the HbS mutations from those in Africa. Sickle cell disease in India occurs against different genetic and environmental backgrounds from those seen in African patients and there is evidence of clinical differences between the populations. Knowledge of the clinical features of African disease was drawn from the Jamaican Cohort Study, based on prospective follow up of all cases of sickle cell disease detected by the screening of 100,000 consecutive newborns in Kingston, Jamaica, and supplemented by observations from the Cooperative Study of Sickle Cell Disease in the US. Defining the principal causes of early morbidity in African sickle cell disease led to successful interventions including pneumococcal prophylaxis, parental education in the early diagnosis of acute splenic sequestration, and the early detection by trans-cranial Doppler of cerebral vessel stenosis predictive of stroke but their success depended on early diagnosis, ideally at birth. Although reducing mortality among patients with African forms of SS disease, the question remains whether these interventions are appropriate or justified in Indian patients. This dilemma is approached by comparing the available data in African and Indian forms of SS disease seeking to highlight the similarities and differences and to identify the deficiencies in knowledge of Indian disease. These deficiencies could be most readily addressed by cohort studies based on newborn screening and since much of the morbidity of African disease occurs in the first five years of life, these need not be a daunting prospect for Indian health care personnel. Newborn screening programmes for sickle cell disease are already underway in India and appropriate protocols and therapeutic trials could quickly answer many of these questions. Without this knowledge, Indian physicians may continue to use possibly unnecessary and expensive models of care.

Changing models of care for emergency surgical and trauma patients in Singapore

The last 15 years have seen changing patterns of injury in emergency surgery and trauma patients. The ability to diagnose, treat and manage these patients nonoperatively has led to a decline in interest in trauma surgery as a career. In addition, healthcare systems face multiple challenges, including limited resources, an ageing population and increasing subspecialisation of medical care, while maintaining government-directed standards and managing public expectations. In the West, these challenges have led to the emergence of a new subspecialty, 'acute care surgery', with some models of care providing dedicated acute surgical units or separating acute and elective streams with the existing manpower resources. The outcomes for emergency surgery patients and efficiency gains are promising. In Singapore, Khoo Teck Puat Hospital has implemented its first dedicated acute surgical unit. This article outlines the evolution of acute care surgery and its relevance to Asia.

Cuidado humanístico y transpersonal: esencia de la enfermería en el siglo XXI. Fundamentos disciplinares / Humanistic professional care

Los cuidados representan la esencia de la función enfermera, no obstante, por la cotidianeidad de los mismos, a menudo no se les da la importancia que suponen unos cuidados profesionales que sean acordes en el momento histórico y cultural. Este artículo pretende argumentar la importancia de unos cuidados profesionales humanísticos para el siglo XXI, en los diferentes ámbitos de cuidado, sea crónicos o críticos, en los diferentes espacios: comunidad o institucional, en las diferentes funciones enfermeras o campos de actividad: formación, asistencia, gestión, investigación y política, y con la utilización de los diferentes saberes: modo personal, estético, ético, empírico y sociopolítico o emancipatorio. Para ello se desarrolla, con un lenguaje científico y a la vez claro y comprensible, conceptos relevantes del cuidado de los siglos XX-XXI. Como marco teórico se describe una perspectiva de los orígenes de los cuidados a lo largo de la historia de la humanidad; los paradigmas enfermeros a partir del siglo XIX; los saberes para una educación del siglo XXI de Morin, para concretar en los saberes enfermeros según Pepin. A partir de esta perspectiva, nos situamos en el paradigma de la transformación, para puntualizar conceptos y especificidades de los modelos de Watson, Mishel y Boykin/Schonhofer, con la intencionalidad de dar valor a sus postulados, que recogen la historia de la humanidad y los saberes asumidos, nos permiten dar respuesta a los fenómenos del siglo XXI, y se deben plasmar en el cuidado profesional, en los currículos académicos y en la investigación y la gestión.

Care or cares are at the heart of the nursing function. However, due to their ordinariness, they are often not given the importance posed by some professional cares consistent with the historical and cultural moment we live in. The aim of this article is to argue the importance of humanistic professional care for the 21st century in the different scopes of care, both chronic or critical, in the different areas: community or institutional; in the different nursing functions or activity fields: training, support, management, investigation and policy; and using the different knowledge: personal, aesthetical, ethical, empirical and sociopolitical or emancipatory mode. To this end, with a scientific but at the same time clear and comprehensible language, relevant concepts of care in the 20th-21st centuries are developed. As a theoretical framework, a broad perspective of the origins of care throughout the history of mankind is described; the nursing paradigms since the 19th century; Morin’s knowledge for an education in the 21st century, to give concrete shape in the nursing knowledge according to Pepin.From this general and global perspective, we are in the paradigm of transformation, to make clear concepts and particularities of Watson, Mishel and Boykin/Schonhofer models, with the aim of giving value to their tenets, which gather the history of mankind and the assumed knowledge, which allow us to answer the questions and issues in the 21st century, and must be translated to the current professional care, in academic curricula and ongoing training, in investigation and management.

Vínculo longitudinal na atenção primária: avaliando os modelos assistenciais do SUS / Longitudinal bond in primary care: evaluating models of care SUS

O vínculo longitudinal pode ser definido como relação terapêutica entre paciente e profissionais da equipe de Atenção Primária em Saúde (APS) ao longo do tempo, que se traduz na utilização da unidade básica de saúde (UBS) como fonte regular de cuidado para os vários episódios de doença e cuidados preventivos. O vínculo longitudinal contribui para diagnósticos e tratamentos mais precisos, diminuição dos custos da atenção e maior satisfação do paciente. O presente estudo teve por objetivo investigar o atendimento a tal atributo na experimentação de diferentes modelos assistenciais organizativos da APS no contexto do SUS. O estudo, que está estruturado em três artigos / capítulos, teve início com a identificação do vínculo longitudinal como característica central da APS. Revisão conceitual possibilitou definir o termo, identificar três dimensões para análise do atributo (identificação da UBS como fonte regular de cuidados; relação interpessoal entre profissional e paciente; e continuidade informacional), e construir roteiro para investigar o vínculo longitudinal no âmbito da APS municipal. Revisão bibliográfica sobre os modelos assistenciais no Brasil identificou propostas atuais com experiências consolidadas de estruturação da APS. Esses municípios / modelos foram: Camaragibe – que aderiu à Estratégia Saúde da Família; e Belo Horizonte – que segue os princípios orientadores do modelo Em Defesa da Vida/Acolhimento, embora tenha aderido à Estratégia Saúde da Família posteriormente. A presença de elementos favorecedores do vínculo longitudinal na abordagem teórica desses modelos foi averiguada, bem como a reprodução desses elementos nas concepções vigentes no âmbito da gestão da APS municipal. A terceira parte da tese consiste em estudos de caso, com trabalho de campo nesses dois municípios...

The longitudinal relationship can be described as a ‘therapeutic relationship between patient and Primary Health Care (PHC) staff over time, expressed as use of the basic health care center (Unidade Básica de Saúde, UBS) as the regular source of care for the variousepisodes of disease and for preventive care’. A longitudinal relationship contributes towards more accurate diagnoses and treatments, lower health care costs and greater patientsatisfaction. The purpose of this study was to investigate this attribute in the experimentation with different PHC organization models in Brazil’s national health system, the Sistema Únicode Saúde (SUS). The study, which is divided into three papers/chapters, began by identifying the longitudinal relationship as a key characteristic of PHC. By conceptual review it waspossible to define the term, to identify three dimensions for analysis of the attribute (identification of the UBS as the regular source of care; the interpersonal relationship betweenhealth care professional and patient; and informational continuity) and to construct an investigational path for researching the longitudinal relationship in municipal PHC. A bibliographical review of health care models in Brazil identified current setups withestablished experience in structuring PHC. These municipalities/models were Camaragibe, which applied Brazil’s Family Health Strategy, and Belo Horizonte, which followed theguiding principles of the Em Defesa da Vida/Acolhimento (in defence of life/humane reception) model, although it later adhered to the Family Health Strategy. The models’ theoretical approaches were examined for elements likely to favour the longitudinalrelationship, and whether such elements were reproduced in conceptions current in the municipal PHC managements. The third part of the thesis comprises case studies involving field work in these two municipalities...