Medicine and Nursing and Early Childhood Educators

Posted on | January 10, 2008 | Comments Off on Medicine and Nursing and Early Childhood Educators

Placing Natural Home-Based Allies In the Same Room

By Mike Magee, MD

If there was ever a time for Nursing and Medicine and Early Childhood Development leaders to join hands on behalf of patients, it’s now. And there is no better place to convene the gathering then in the American Home. The concepts of Home Centered Health Care Transformation, Lifespan Planning Records, and the critical role that nurturing from zero to three plays in early brain development have been featured on this site in the past. But the readiness to accept and advantage these concepts within mainstream health care is only now gaining steam. But to advantage this growing readiness for change, there must be cross-disciplinary and deliberate efforts that point toward a common vision – a challenge that can actually be built-out. Let me point specifically to three potential collaborators.

The first, Dr. Patricia Flatley Brennan, visionary health care leader who runs the HealthSystems Lab, a collaborative effort of the School of Engineering and the School of Nursing at the University of Wisconsin-Madison. As the University describes it:

"Dr. Brennan’s research focuses on designing and evaluating home care community computer systems for use by patients. Her work ranges from the development and evaluation of computer networks as a mechanism for delivering nursing care to homebound ill persons and their caregivers to assessing the impact of patient-centered computer technology on the health outcomes of persons following coronary artery bypass graft surgery. Her most current projects include exploring how individuals and families manage health information in their homes, studying the
usability of secure email use in clinics, and is developing information tools and resources to support self-care and health self-management. " Way back in 1991, seventeen years ago, Dr. Brennan published a paper called "ComputerLink: electronic support for the home caregiver." In it, she and co-authors stated that, "Computers have become ubiquitous in contemporary society, as has the demand for home care for the elderly. Caregiving is recognized as a normal experience
across the life span, and nurses must develop innovative responses to support caregivers. Computer networks offer caregivers access to a wide range of services such as communication, information, and decision support. Presented here is an interim report of a randomized field experiment demonstrating the feasibility of computer networks as a mechanism for delivering nursing services to caregivers of persons with Alzheimer’s disease. Caregivers can and do use the computer network in home care."

The second is well known medical educator and health transformer, Dr. Ralph Snyderman, Chancellor Emeritus at Duke University and head of the Duke Center for Research on Prospective Health Care. Most recently, he has teamed up with Dr. Ziggy Yoediono and published a classic article as a perfect companion to Dr. Brennan’s work. Titled "Proposal for a new health record to support personalized, predictive, preventative and participatory medicine", the paper challenges us all with these words, "Today’s approach to patient care and the medical record that directs and documents it is largely focused on identifying and treating the patients disease. This has resulted in a sporatic, reactive healthcare system. Shifting medicine’s focus to personalized strategic health planning will require a new approach to the patient ‘work-up’, a new relationship between the patient and the provider and a new medical record to support it."

Third, Dr. Edward Zigler, one of the true pioneers of Early Childhood Development, the father of Head Start and author of "The First Three Years and Beyond," recently made these observations at an event to honor parents, doctors and nurses involved in the Rocking Chair Project:

"For anyone who wants to know the literature, there is one really good book, probably the best book in human health in the past quarter of a century by Jack Shonkoff and Deborah Phillips titled "From Neurons to Neighborhoods." (The book describes among other subjects, the literature in support of early interventions that impact a baby’s brain development.) "Now this development, this recognition of brain plasticity, has not gone unnoticed by decision makers. The early brain research made clear that delaying interventions for poor children to Head Start beginning at age three was waiting too long. As a result of this knowledge, I worked with Senator Kennedy, with whom I’ve worked for many years – he’s one of the true champions of mothers and children in this country – and Senator Kennedy took the lead in establishing the Early Head Start program in this country, directed at both mothers and children from pregnancy through the second year of life. One of the interesting findings – they now have done randomized assigned outcome studies on the Early Head Start program – is that, lo and behold, the earlier you get there, particularly if you get there at pregnancy or shortly thereafter, the earlier you get to the child, the better your outcomes from the program."

Now if doctors Brennan, Snyderman and Zigler were in the same room, what would I like them to discuss? First, how might we better integrate the leadership of these three disciplines on behalf of Preventive Health Care Transformation. Second, how best might we summarize what we know for sure across these disciplines about prevention, and cross-seminate these learnings within the various professions and consumer health associations nationwide. And third, how might we take Dr. Snyderman’s insights on Prospective Health Records and infuse them with a 100 year long strategic planning spirit and functionality that begins before birth as Dr. Zigler recommends and extends out to the final years of life (to both patients and their family caregivers) as Dr. Brennan stresses.