Relationship between Antenatal Care and Hemolytic Disease of Newborns - Example

Table of contents Table of contents 1 Relationship between antenatal care and Hemolytic disease of newborns 2 1.Introduction 2 2 Aspect: rhesus antigen and hemolytic disease of newborns 2 3.1 Internal drivers 3 3.2 External drivers 3 4 Tools that will be used 3 4.1 Balanced scorecard 4 4.1.1 The balanced score card for the local community centre (ADAPTED FROM KAPLAN AND NORTON) 5 4.2 strategic mapping 6 4.2.1 The development of the strategic dichotomous key towards strategic mapping 6 4.2.1.1 Antenatal care strategic map 7 4.3 Customized questionnaires 8 A questionnaire for the husbands 9 5 Expected outcomes from analysis 10 5.1 Expected outcome of using balanced scorecard 10 5.2 Expected outcome from Strategic mapping 10 5.3 Expected outcome from customized questionnaires 11 6 The summary 11 7 Recommendations 12 8 References 13 Relationship between antenatal care and Hemolytic disease of newborns 1. Introduction Antenatal care is an intervention measure meant to equip the expectant mothers with knowledge on pregnancy (UNICEF, 1997), problems that are associated with pregnancy in order to facilitate healthy growth and development of a child during its embryonic life. One aim of antenatal care in the local community centre is in the determination of the rhesus antigens (UNICEF, 1997) of the mother and that of the child to determine if the child is likely to suffer from hemolytic disease of the newborn (UNICEF, 1997). 2 Aspect: rhesus antigen and hemolytic disease of newborns The rhesus antigens factor is a matter of concern and occurs when a rhesus negative mother marries a rhesus positive husband and carries a rhesus positive fetus. During labor, fragments of the fetal red blood cells containing the rhesus antigens pass across the placenta into the mother’s bloodstream (Grace Monger). The mother responds by producing anti-rhesus antibodies that pass back across the placenta into the fetal blood circulation. Generally, the rhesus antibodies are not formed immediately enough or in sufficient quantities to affect the first child, but subsequent rhesus positive child will suffer from a massive destruction of the red blood cells, a condition termed as hemolytic disease of the new born (Grace Monger). The new born suffers from acute anemia and is very breathless, as a result of shortage of oxygen required for aerobic respiration that causes oxygen debt and forces intervention procedures are in place because in most cases the mother may not suspect the disease or the newborn may not be born. Hemolytic disease is associated with many miscarriages. The hemolytic disease of a newborn is medically attended to by complete blood transfusion (UNICEF, 1997) of the rhesus negative blood which is very expensive for some families but the best way is to inject the mother with anti-rhesus antibodies (Grace monger) that coat any fetal red anaerobic respiration to occur and is characterized by accumulation of lactic acid and leads into muscle cramps and muscle orgasm. The child dies if no medical blood cell that leak out into the mother’s blood stream and are destroyed before the mother’s immune system (Grace Monger) has time to respond. The injected anti-rhesus antibodies last in the mother’s blood for a few weeks and don’t affect subsequent pregnancies. Hemolytic disease is associated with deaths of many children (UNICEF, 1997) and has made many families to have only one child or none at all. They husband may never understand that the problem was initially caused by his rhesus antigens that were dominant over the mothers (UNICEF, 1997). 3.1 Internal drivers Internal drivers (Fitzsimmons and Fitzsimmons, 2000) will include the pregnant women attending antenatal care and their tutors and revolves around the need for them to know the importance and impact of antenatal care in management of rhesus antigen factor (Grace monger), the need for the tutor to understand the expectations of the pregnant mothers (Grace monger) by educating them on the effects of the rhesus antigens, and taking part in providing viable solutions by creating husbands antenatal care class (Kamau, G.N et al, 1984) 3.2 External drivers External drivers (Fitzsimmons and Fitzsimmons, 2000) are mainly the NHs and the community staff who will be supposed to formulate strategies that are supposed to determine the antenatal care initiatives and planning training programs for the nurses and the pregnant mothers, evaluating any deficits in the current antenatal care program, motivating the nurses to reduce the staff turnover, and projecting on the costs of training. 4 Tools that will be used These are balanced scorecard, strategic mapping and customized questionnaires. The strategic goals (John Bicheko PICSIE Books) will meet and reflect the future achievements of the local community centre. These include: Strategic goal Measure of progress towards aims and objectives Initiatives to help in goal realization The centre delivers excellent quality antenatal care *Reduces incidence rates of infection *Decreasing mothers complaints *Increasing complements on antenatal ca *Improving on the standards of antenatal care *Formation of database for complaints analysis and feedback *Implementing policies that could lead into improved antenatal care Pregnant women understand their roles and responsibilities in managing rhesus antigen *Through nurse or staff survey studies *Implementing agendas for change *Analysis of flow charts performance management process Proper risk management associated with rhesus factor *Greater reporting of incidents of risks *Presence of up-to-date data on shrinking risk register *Involving external feedback e.g. CNST *Presence of functional systematic measures for risk identification *Staff training on root cause analysis of risks *Improved communication Presence of excellent leadership in rhesus antigen management *Product of staff survey on rhesus factor *Leadership qualities at the point of antenatal care training *Identification of leadership qualities *Presence of RCN and national leadership training Staff understand occurrences through efficient communication system *A function of staff survey *Evaluation of people downloading newsletters from the website *Presence of downloadable newsletters *Implementing agenda for change *Importance of antenatal care benchmark 4.1 Balanced scorecard Balanced score card (BSC) according to Kaplan, R. S. and Norton, D.P. (1996) is performance measurement technique that helps management in strategy formulation and implementation. In the local community centre, BSC integrates concerns of nurses, patient satisfaction with antenatal care, processes, innovations and finance, aspects that give the local community centre a structure a competitive cutting edge in adding value to its antenatal services. 4.1.1 The balanced score card for the local community centre (ADAPTED FROM KAPLAN AND NORTON) Level of measure Patient perspective Financial perspective Internal hospital perspective Learning/ growth perspective Nurses scorecard *Pregnant mother’s antenatal care service (internal) 95% *Reduce wastes in antenatal care * antenatal care costs *Reduce number of mortality to zero *Attend 2 relevant courses a year *Make 2 suggestions a year *Be a team player Plan scorecard *Pregnant mothers medical satisfaction, 95% on time *Quality antenatal care at all times *Be a leader in diagnosis and treatment *Improve cost structure by 20% *Cost reduction of antenatal care by 10% *Improving Antenatal care asset utilization by 80% *Improve on antenatal medical intervention *Involve pregnant mother s and their husbands in decision making Ward scorecard *High speed in attending to expectant mothers *Improved antenatal care quality *Zero complaints of pregnant mothers *Zero nurse turnover *Improve on cost structure by 20% *Leader in antenatal care satisfaction *10% antenatal care cost reduction *Improvement on antenatal care diagnostic processes *Vitality: 25% increase in pregnant mothers seeking antenatal care. Community nurse supervisor *Happy satisfied nurses *95% nurse availability *Reduce antenatal material costs *Reduce wastage in antenatal care Reduce overtime *Schedule Training of nurses *Increase links with similar community setups to share knowledge on antenatal care. 4.2 strategic mapping 4.2.1 The development of the strategic dichotomous key towards strategic mapping 1a. mothers are facing miscarriages. Go to 2 1b. mothers are giving birth into children with hemolytic disease of the newborn. Go to 3 2a. the cause of the miscarriage may be genetic. Go to 4 2b. the cause of the miscarriage is not genetic. Go to 5 3a. mother didn’t get efficient antenatal care. Go to 6 3b. mother got adequate antenatal care. Go to 7 4a. the fetus could lack genes that are required to form necessary organs like brain, lung, liver, pancreas etc. Go to 8 4b. the mother does hard work that predisposes miscarriage. Go to 9 5a. the cause of miscarriage is related with ABO blood group. Go to 10 5b. the cause of miscarriage is not related to ABO blood group. Go to 1b. 6a. the mother has financial difficulties that prevent her from attending antenatal care clinic. Go to 11 6b. the mother has no financial difficulties. Go to 1a. 7a. the mother didn’t follow guidelines given in the antenatal care clinic. Go to 11 7b. the mother experiences household conflicts that don’t facilitate fulfillment of the antenatal guidelines. Go to 11 8a. the genetic problem is with the gamete or sperm of the husband. Go to 11 8b. the pituitary gland of the mother may be failing to produce progesterone that is required to maintain the pregnancy. Between 3-4 months, the ovary copius luteum degenerates and stops producing progesterone that maintains pregnancy and the role is taken over by the pituitary gland. Go to 12 9a. batter leads to the miscarriage. Got to 11 9b. batter may predispose a brain stem malignant tumour that might be affecting hormone co-ordination. Go to 13 10a. the cause lies in the rhesus antigen. Go to 14 10b. the cause is not related with rhesus antigen. Go to 1b. 11a. there is a need to call the husband to the antenatal care. 11b. there is a need to talk to the couples about the problem. 12a. the mother needs to spend her gestation period in the hospital. 12b. the mother doesn’t need to spend her gestation period in the hospital. Go to 14 13a. a neurosurgery is required to remove malignant tumour 14a. the mother can have injections of rhesus antibodies 14b. surrogacy can be a remedy 4.2.1.1 Antenatal care strategic map 4.3 Customized questionnaires The questionnaire (Fitzsimmons and Fitzsimmons, 2000) should be targeted to prepare the mother for the outcome of their pregnancy. The sample size will be 50. 1. Do you know your rhesus antigen status and what do the value mean to you? 2. In terms of rhesus antigen status, are you entitled to have married your wife? 3. In many families, children have poor learning development, what is the likely suspect to the scenario? 4. In many instances, a woman is not likely to carry a baby to full term, what is the relationship between her condition and the rhesus antigen factor? 5. Are you saving for the medical expenses that are incurred following incidences of hemolytic disease? 6. What is the financial implication of Rhesus factor if it is not understood as likely cause of deaths in children? 7. What does serial miscarriage do to relationship between the couples and other relatives? 8. Do the other family members side with the man or the woman in the event of serial miscarriage or deaths of the children? 9. Is the mother’s lifestyle likely to affect the healing process in case caesarian delivery is recommended? 10. Is the family ready for surrogate option where the mother and father may opt to have their gametes fertilized and transferred to another woman’s womb where pregnancy is likely to run full term? 11. What social factors influence the surrogacy parenthood? 12. Are there legal procedures that may prevent the surrogate mother from surrendering the child to the ‘real parents’ genetically?’ 13. Are you likely to engage in extra-marital affairs to determine if you are able to produce a healthy baby? A questionnaire for the husbands 1. Do you know your rhesus antigen status and what do the value mean to you? 2. In terms of rhesus antigen status, are you entitled to have married your wife? 3. What would you do if your wife constantly delivered children suffering from hemolytic disease that later died? 4. Would you accept her condition or your condition as natural and opt to live with her or him? 5. Are you saving for the medical expenses that are incurred following incidences of hemolytic disease? 6. What is the financial implication of Rhesus factor if it is not understood as likely cause of deaths in children? 7. What does serial miscarriage do to relationship between the couples and other relatives? 8. Do the other family members side with you or the woman in the event of serial miscarriage or deaths of the children? 9. Is the mother’s lifestyle likely to affect the healing process in case caesarian delivery is recommended? 10. Is the family ready for surrogate option where the mother and father may opt to have their gametes fertilized and transferred to another woman’s womb where pregnancy is likely to run full term? 11. What social factors influence the surrogacy parenthood? 12. Are there legal procedures that may prevent the surrogate mother from surrendering the child to the ‘real parents’ genetically?’ 13. Are you likely to engage in extra-marital affairs to determine if you are able to produce a healthy baby? 5 Expected outcomes from analysis 5.1 Expected outcome of using balanced scorecard The BSC will help the local community centre to map its strategic intentions of effectively servicing the pregnant mothers, involving value prepositions for the pregnant mothers through making the community centre a compelling place for efficient and competent antenatal care The BSC will facilitate establishment of antenatal care focus, build a culture of antenatal excellence based on performance measurements and help the local community centre focus on core issues of antenatal care and help in continuous planning and implementation of strategies that can improve the antenatal care. 5.2 Expected outcome from Strategic mapping Strategic mapping (Kaplan, R. S. and Norton, D.P. 1996) helps in determination of areas of interests that are not adequately provided or covered in the antenatal care. It involves laying down strategies (Fitzsimmons and Fitzsimmons, 2000) that lead into the improvement of the antenatal care by incorporating other factors that indirectly affect the antenatal care. The development of the strategic mapping involves development of a strategic dichotomous key. This helps to determine areas in the antenatal care that need to be addressed and measures to be taken to ensure they are provided for timely and efficiently. It is also a diagnostic tool. 5.3 Expected outcome from customized questionnaires The analysis of the data developed from the customized questionnaires will provide a quantitative data on the opinion of wives towards the problem of hemolytic disease of the newborn. The data will quantitatively show women who are ready to try other methods of getting a child and qualitatively show variables that reflect women’s concerns on hemolytic disease. The data will quantitatively show the opinion of men towards hemolytic disease of newborns and its cultural and social impacts. 6 The summary The service chosen for detailed analysis is ‘antenatal care and pregnancy education classes with respect to rhesus antigen factor’ whose aims is to help husbands and wives To know their rhesus antigen status To know how to manage pregnancy problems related to rhesus antigen factors including hemolytic disease of the new born To prepare the mother to save enough money to cater for any emergency situation that need complete blood transfusion of the new born or the fetus To advise the mothers on the challenges associated with rhesus antigen factor like divorce and separation due to serial miscarriages or deaths of the newborns that is related to anemia. To provide mothers with alternative medical intervention of rhesus antigen problem through injection of the expectant mother with rhesus antigen antibodies To help the husbands and wives evaluate the risks involved in the event of rhesus antigen problems and home birth in case an emergency caesarian section delivery has to be recommended To help the pregnant mother understand other methods of having a baby in case she cannot carry her fetus full term like surrogacy To advise the mother that failure of a woman to carry a baby full term is not associated with her own genetic disorders but as a result of an immune reaction that arise when she bears a child whose rhesus antigens are positive while her rhesus antigens are negative. To analyze the results and findings from questionnaires A customized interview (John Bicheko. PICSIE Books) will be carried out with full participation of the husbands, the pregnant wives, tutors of the pregnant women, NHS staff and registered community nurses and community staff with an aim of streamlining the culture associated with hemolytic disease of the newborns and. Strategic tools like balanced score card, strategic mapping and customized questionnaires will be used to evaluate the effect of antenatal care and pregnancy education classes and help to pave way for a feasible way forward. From the analysis, efforts will be made to incorporate the findings and proposals achieved from the session and improve the quality of services that is offered to reflect what the mother feel as the best suitable way or method to handle the scenario. Recommendation will be made to improve the services to better serve the interests of the pregnant women in the event of a problem associated with rhesus antigen factor. 7 Recommendations Although the genetic test cross could be done, this produce is only a theoretical component of the aspect but does not predict with certainty if that will be the outcome. It is not possible to determine the genetic outcome of a fetus before actual fertilization has occurred. Therefore there is need for rhesus antigen properties of a fetus to be determined because this will help to prepare the pregnant mother psychologically for the risks involved. This can only be done when the woman is pregnant. Couples who have suffered from hemolytic disease of the newborn should seek guidance on how they can manage the problem and have healthy children. 8 References 1. UNICEF: the state of world’s children. 1997. New York. Oxford university press. 2. Grace monger, advanced biology, longman. 3. Kamau, G.N., Kariuki, J. T. and Njuguna, A.K: 1984, rhesus antigens and haemolytic disease of the newborns. Parents and parenting, pages: 19-24 4. Kaplan, R. S. and Norton, D.P. 1996: the balanced scorecard: translating strategy into action. 5. Kaplan, R. S. and Norton, D.P.2000: the balanced scorecard: how balanced scorecard companies thrive in the new business environment. 6. Fitzsimmons and Fitzsimmons, 2000. service management: operations, strategy and information technology, 3rd ed. Irwin/McGraw-Hill 7. John Bicheko. PICSIE Books. The quality 75: Towards six sigma performance in service and manufacturing. Read More