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Tue, 6 Feb 1996 06:38:12 -0500 |
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Hi Sandy:
I was hired & began a lactation program for a home health agency in 6/95.
Due to the nature of their incorporation/affiliation, we have a home
visiting program, rather than a follow up clinic. I can briefly tell you
what it entails:
1. 10 steps from BFHI in place but revised a bit to suit home health needs.
2. Policies in place that are based on the 10 steps
3. All OB/ped nurses are completing the UNICEF 18 hr course & following me
for pt. visits until we are comfortable. They refer to me as needed.
4. Lactation visits that are appropriate for each of our OB/ped programs - #
of visits depends on the program & mother's needs & 3rd party payors:
-early maternal discharge: follow up in mother's home 24-48 hrs after
their discharge - all OB/ped nurses are covering these visits - they try
to schedule me for bfing clients, but it doesn't always work. A mom
discharged with bfing problems is given priority for me to see her.
-Regular prenatal/pp visits as referred by HCP - some specifically
request LC visit, some don't but schedulers are alert to mom's feeding
plans and plan appropriately
-Healthy Beginnings plus - I case manage any bfing moms in this program.
It involves 4 prenatal visits & pp follow up that is more detailed
than other programs but varies. One prenatal visit is entirely
devoted to bfing in this program.
-Babies First program - A 2 yr. low income infant follow up program
alloting 8 visits per baby - state grant. If mom is bfing, I case
manage for the duration or until weaning.
I personally like the in-home follow up for many reasons. I can honestly
see what her "nursing nest" looks like. I get a real feel for the social
issues around her. I can better guess what may or may not work and plan my
suggestions appropriately. I also feel there are moms who really love the
decreased hassle of staying home as opposed to packing up to head out to a
clinic/office. There are also those moms who are very worried about what
you might see - ranging from she and the house are a *wreck* to something
more scary like she has no heat. Hence another reason I like the home visit
- getting a mom more help than she may have dreamed possible. Re: the house
being a wreck (or mom!), I always include as part of my call to schedule
with mom directions to *NOT* make these issues a concern. I remind her that
dust and pajamas are a part of normal pp! I tell her that an immaculate
house will scare me - I have 4 kids! I suggest that I hope I find her just
out of bed when I get there. Often moms begin the visits offering yummies -
I take that as the golden moment to remind her of her pp roles - rest,
recover, get to know her baby, & bf! Then we discuss who can provide HER
with yummies over the next few days/weeks.
One thing I have learned in this role - 3rd world conditions exist a might
close to home. Sometimes we fall into the trap of thinking not in my
backyard but it is!!! I have woven this into the 18 hr course - bfing &
survival isn't just a 3rd world issue. Thankfully I found that experienced
home health nurses take this quite seriously - newer ones soon learn too!
This is by far the easiest LC position (save the dealings with 3rd party
payors!) I have ever had from the standpoint of dealing with staff.
I am still learning a great deal but this is where I am for now. Hope this
is helpful to you.
Debbie Shinskie RN CES IBCLC
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