Care Paths: A New Approach to High-Risk Maternal-Child Home Visitation

Abstract

Care paths for the maternal and infant populations are used to define immediate and long-term outcomes related to care received in the home. This article describes a care path developed by public health nurses for intervention with an at-risk maternal-child population in a city/county health department. A public health nursing care management model provided the framework for developing this care path to foster cost-effective use of limited resources. It is crucial that public health nurses articulate clearly the services provided in the home both for those who may seek service and for policy makers who determine funding structure. The project demonstrated that care paths for home visitation involving high-risk prenatal clients are useful tools that streamline documentation, foster consistency and continuity of care, facilitate quality improvement efforts, and provide outcome data.

Promoting Clinical Practice Knowledge in an Age of Taxonomies and Protocols

“…We do not deny that clinicians incorporate abstract knowledge into their practice, and we agree that scientific, technical guidelines facilitate record keeping, contribute to quality improvement efforts, and are one approach for studying the outcomes of nursing care (Lowry et al, 1998). Moreover, as Benner et al (1996; Benner, 1984, 2000) make clear, scientific knowledge provides a necessary cushion for the beginning nurse who lacks experience and guides the experienced nurse when she confronts clinical situations at the limits of her experience.…”

“…Standardized languages, practice guidelines, and critical pathways are increasingly championed as the way to demonstrate and advance the professional status of nursing (Johnson, Maas, & Moorhead, 2000; McCloskey & Bulechek, 2000). Although many public health nursing (PHN) educators and administrators welcome this development (Alexander & Kroposki, 1999; Hays, Kaiser, McMahon, & Kaup, 2000; Lowry, Hays, Lopez, & Hernandez, 1998; Strohschein, Schaffer, & Lia‐Hoagberg, 1999), we are less optimistic about this trend and argue that practice is misconstrued and devalued when guidelines and taxonomies are privileged over clinical know how and experiential learning. In this article, we critique the priority given to scientific, abstract reasoning and contrast this mode of knowing with the clinical and relational knowledge that resides in and develops through practice.…”