Early elective, medically unnecessary deliveries gained popularity in the 20th and 21st centuries with the emergence of new technologies in the field of medicine (Gillman, Gluckman, & Rosenfeld, 2013). For the first time in the history of mankind, it was now possible for one to determine the date (earlier than what it would be if the pregnancy is carried to term) when to give birth. It was welcome news for women in the corporate society who highly value their time at work and consider carrying a pregnancy to term waste of time.
By the year 2010, the practice had become so common in the United States that medical experts had to raise alarm to get the attention of the society. Medical research had indicated that early elective deliveries have serious negative consequences on a child’s development. It was also determined, through medical research, that such processes may also affect the mother in many ways. Such medically unnecessary procedures place a massive financial burden on the parents, state, and federal governments. In this section, the researcher will focus on the analysis of the primary data collected from the sampled participants. As explained in the methodology section, the analysis took both qualitative and quantitative forms.
Prevalence of Early Elective Delivery
The first step in addressing this problem is to determine the rate of prevalence within the country. The researcher wanted to determine the magnitude of the problem to come up with effective ways of addressing it. The information could reliably be obtained from the hospitals where such procedures are undertaken. The researcher statistically analyzed the primary data obtained from the primary sources to determine the prevalence of this problem and the following figure shows the outcome.
The statistics show that there was a sharp increase in the number of early elective deliveries from 1990 to 2005. During this time, it was considered a milestone in the field of healthcare to allow pregnant mothers to choose an appropriate time to deliver their babies one or two weeks before the normal date. It explains the increase in the incidents within the United States. However, medical experts were engaged in research to help determine the impact of such procedures. When their findings came out, it became apparent that early elective deliveries have serious negative implications on the newborn.
The financial burden on the government was also huge. In 2010, the highest cases of early elective, medically unnecessary deliveries reached its peak at about 17% of all births in the country (Glasper & Rees, 2016). Through policy change and federal and state level, and public awareness campaigns, there has been a consistent decline in the number of pregnant mothers who opt for such procedures. In 2015, it was estimated that the number of early elective deliveries had dropped to about 5% of all births in the country. It is expected that there will be a further reduction of such incidents as the Americans gain more knowledge about the negative consequences of such processes.
Demographical Characteristics of the Patients Who Opt For the Procedure
According to Cutler (2014), several reasons may make a pregnant mother opt for early elective delivery instead of waiting for normal delivery. Several demographical factors may influence this choice. It is the reason why the researcher chose to determine the prevalence of this practice based on the ethnicity of the mothers. The figure below shows the outcome of that analysis. The data obtained were based on studies that were conducted in 2013 when medical experts had already issued warnings against the practice.
As shown in the graph above, the practice is more common among African Americans at 16.30% of all their births. American Indians came second at 13.10% of all their births. A common characteristic that the two ethnic groups share is that they are the minority groups in the United States that have suffered discrimination for centuries. Even in modern American society, the two groups lag behind the Whites in economic prosperity. The majority of women who opt for the procedure cite economic responsibilities as their main drive. They argue that if the time of pregnancy can be reduced, then they can get ample time to meet their financial obligations by reporting to work earlier than would have been the case if the pregnancy is carried to term. At this time, the White women registered the least incidences of early elective deliveries at 10.20%. The fact that they are more economically empowered than African American women may partly be the reason why they consider such procedures less necessary.
Challenges of Early Elective Delivery
According to Potter, Perry, Stockert, and Hall (2016), medical experts have warned against early elective, medically unnecessary deliveries. Through scientific investigations, it has now been determined that the practice exposes a child to many health risks which can be eliminated if the pregnancy is carried to term. The researcher used qualitative analysis at this stage to help describe these challenges in very clear terms. In this section, the focus was to determine the challenges to the patients (mothers and newborns) and nursing.
Challenges to the Patients
Scientific investigation has not confirmed that early elective delivery before completing 39 weeks may have both short-term and long term consequences on the newborns. One of the most common medical problems of this process is that it causes breathing problems among the newborn such as respiratory distress syndrome. One of the medical experts investigated in this study explained that this is a major problem among the newborns that may sometimes last even when they are past their infancy. Temperature problems are also common because the system of such a baby may not be capable of ensuring that the body stays warm. In many instances, such babies may have feeding difficulty, especially if it is delivered before 37 weeks. Sometimes the child may develop severe health problems such as brain damage, vision and hearing problems, learning, and behavioral disorders. The expert explained that although some of the babies born through such natural processes may be as healthy as those who were carried to term, they are more susceptible to the above medical conditions. The medical expert explained that normal deliveries are often safer than surgical procedures. As such, early elective delivery may pose a threat to the life of the mother, though the risk is significantly low.
According to Elzouki (2012), early elective deliveries have significant implications for nursing. This argument was confirmed by nurses who were interviewed in this study. According to these nurses, babies born through such procedures are more likely to require incubation than those born at the end of the term. They are also more likely to develop various medical problems that would require a longer stay at healthcare institutions. The longer they stay at the hospitals, the more attention of the nurses will be required. Sometimes the nurses get overstretched in their work as they struggle to attend to more patients. It creates a shortage of nurses, especially when such incidents are high.
Financial Burden of the Procedure
The cost of healthcare products is increasing and the federal and state governments in the United States are struggling to ensure that every American has access to affordable quality healthcare. The neonatal intensive care unit is one of the most expensive rooms in any American hospital, averaging at $76,000 (Mason, Gardner, Outlaw, & O’Grady, 2016).
Children born prematurely are more likely to end in such units than those born naturally. In most of the cases, it is the government force to meet the financial burden of such special care nursery admissions, especially if the mother is under the cover of health insurance. This practice has significantly increased the amount that the government pays to healthcare institutions every year. In case the mother is not covered, then this practice may have a significant financial burden on her and her family. One of the reasons given by interviewed mothers who have used this process before is that it allows them more time to focus on other socio-economic activities. However, the truth is that if not a success, such procedures may have serious socio-economic implications on these mothers. Such financial problems can be eliminated if the practice can be avoided unless it is medically necessary.
Policy Issues in the Fight against Early Elective Deliveries
Empirical studies have confirmed that early elective deliveries are not only financially burdening but also have serious medical implications, especially on the newborns. When not medically recommended, it is important to completely avoid such procedures because its consequences far outweigh its benefits. In this study, the primary aim was to evaluate the pattern and impact of the practice to make informed advice on the way forward. The researcher developed a primary research question that helped in gathering relevant information for the study. The following is the research question.
Which key matters of inadequate health care treatment should be considered in the nursing sector to solve the problem and eliminate the possible consequences in the United States?
The study reveals that early elective deliveries overstretch medical facilities and staff, causing unnecessary inadequacy in these institutions of healthcare. Its financial burden on the government is heavy and complications on the newborns may be long-lasting. A policy change that discourages the practice is one of the ways of addressing the problem. Awareness creation among the affected population may also help in reducing the practice within the country.
The researcher is aware that the current statistics do not show the exact prevalence of the practice in the country. Some unscrupulous doctors are willing to cite medical reasons for such procedures if they are given incentives. Others hide such statistics, especially in private clinics as long as the patient can pay. The biggest limitation of this study is that this area was not covered. Future researchers should focus on this issue to determine the exact level of prevalence of this problem.
Cutler, D. M. (2014). The quality cure: How focusing on health care quality can save your life and lower spending too. Berkeley, CA: University of California Press.
Elzouki, A. Y. (2012). Textbook of clinical pediatrics. Berlin, Germany: Springer.
Gillman, M. W., Gluckman, P. D., & Rosenfeld, R. (2013). Recent advances in growth research: Nutritional, molecular, and endocrine perspectives. Vevey, Switzerland: Nestec.
Glasper, A., & Rees, C. (2016). Nursing and healthcare research at a glance. Hoboken, NJ: John Wiley & Sons.
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and health care. St. Louis, MO: Elsevier.
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of nursing. Amsterdam, Netherlands: Elsevier Health Sciences.
Nurse Robaczynski’s Ethics Of Treatment Withdrawal
In my opinion, Ms. Robaczynski was wrong to disconnect Mr. Gessner from his respirator. I think that her actions can be interpreted as an active killing for a number of reasons. First of all, it is illegal to stop the treatment of the patients in these conditions. The hospital had already started the treatment, and the workers had no right to decide the end of the procedures independently. In this situation, it does not matter if Mr. Gessner was in a fatal condition during Ms. Robaczynski’s actions.
Secondly, her decision was unsupported by her patient because he or his representatives were not given a chance to express their opinion. While some people commented on the events of the trial, saying that they would have wanted for Ms. Robaczynski to disconnect their respirators in the given conditions, they had no authority to represent Mr. Gessner and his position. Ms. Robaczynski did not consult anyone prior to making a decision, which renders her actions as heedless and immoral.
If Mr. Gessner or the people that were allowed to speak on his behalf asked the nurse to disconnect the patient from the respirator, the situation would have different moral conditions. While Ms. Robaczynski’s actions would have been viewed as wrong from a legal point of view, the perception of her decisions would change from a moral standpoint. On the one hand, according to Fry, Veatch, Taylor, and Taylor (2010), the actions of the nurse would be illegal regardless of the patient’s consent.
The authors argue that treatment withdrawal is an action that can be classified as an active killing. On the other hand, Ms. Robaczynski would have some moral grounds to perform the withdrawal if she received permission from Mr. Gessner. All in all, her actions could be viewed differently from a moral standpoint but not from a legal one.
Fry, S. T., Veatch, R. M., Taylor, C., & Taylor, C. R. (2010). Case studies in nursing ethics. Sudbury, MA: Jones & Bartlett Learning.
Electronic Intensive Care Unit Benefits
An Electronic Intensive Care Unit (eICU) represents a type of a healthcare setting that uses the latest technologies with the purpose of providing top quality care to patients. Key goals of eICUs are making sure that care is being provided in multiple facilities, that the clinical expertise is optimized to the fullest extent, and that care is provided on a 24-hour regimen. A standard eICU consists of monitors, cameras, alarms, microphones, and other tools that offer caregivers real-time data on patients’ conditions (Rouse, 2012). Professionals who work at eICUs are called intensivists; they may also communicate with other providers to facilitate effective care. Benefits of eICUs include the following factors:
- Reduction of clinical complications among patients;
- Improvement of overall patient outcomes with the goal of reducing the length of hospitalization;
- Extension of professional expertise to as many patients as possible;
- Collection of valuable information for analysis with the goal of improving the existing care practices (Advocate Health Care, 2017).
Overall, Electronic Intensive Care Units present many opportunities for healthcare providers to extend their scope of care possibilities while making sure that patient data is under strict monitor 24 hours a day.
Bar Code Medication Administration
Since the inadequate administration of medication can lead to adverse health outcomes and put patients in danger, innovative tools targeted at the prevention of this issue have been developed. Bar code medication administration (BCMA) uses systems that aim to reduce medication errors through the verification of the “5 rights of medication administration – right patient, right dose, right drug, right time, right route – at the patient’s bedside” (Shah, Lo, Babich, Tsao, & Bansback, 2016, p. 395).
Therefore, the key benefit of BCMA implementation refers to the system’s effectiveness in reducing errors associated with the administration of medicine. The adequate administration of medicine also leads to financial benefits; it has been shown that BCMA tools a more cost-effective and require less financial coverage to pay for the aversion of a harmful error in the prescription of medication. Lastly, BCMA can contribute to significant changes in the workflow for nurses, leading to the decreased burden for healthcare professionals who can serve more patients simultaneously because an automated system plays a large role in the reduction of their workload.
Robotics in Medicine
It has been suggested that the sphere of healthcare was going to work with medical robots in the nearest future (“Robotics in healthcare – get ready!,” 2017). Despite the fears of robots becoming substitutes to the human workforce, the array of benefits of such technologies tempts healthcare professionals. Robotics in medicine can work in a variety of ways, such as offering surgical precision, generating more time for nurses to communicate with patients, assist in taking care for patients, developing telemedical networks, contributing to such innovative technologies as exoskeletons, and much more (to help paralyzed people walk) (“Robotics in healthcare – get ready!,” 2017).
To better understand how robotics in healthcare work, it is worth mentioning such successful solutions as the origami robot. Developed and tested by MIT researchers along with the Tokyo Institute of Technology and the University of Sheffield, the origami robot is a small device placed in a dissolvable capsule that patients swallow (Burns, 2016). Once swallowed, the robot unfolds itself in the patient’s body and with the control by a healthcare professional using magnetic fields can patch up a wound or remove a foreign object (Burns, 2016). Thus, robotics in medicine has had dramatic success in the last decade, and the opportunities for further development only expand.
Advocate Health Care. (2017). Benefits of eICU.
Robotics in healthcare – get ready! (2017). Web.
Rouse, M. (2012). Electronic intensive care unit (eICU).
Shah, K., Lo, C., Babich, M., Tsao, N., & Bansback, N. (2016). Bar code medication administration technology: A systematic review of impact on patient safety when used with computerized prescriber order entry and dispensing devices. The Canadian Journal of Hospital Pharmacy, 69(5), 394-402.