All children have the right to good care, both in the hospital and in their own environment. In the medical field, but also in all other areas of life.

Jan Peter Rake, pediatrician and medical director of the Amalia Children's Hospital in Nijmegen, agrees. “MKS is a vision of how to organize care for sick children through the wall of the hospital at home and vice versa. How to design care together in the best possible way.”

To draw more attention to organizing care according to the vision of the Medical Childcare Cooperation (MKS), the MKS afternoon symposium Hun life, our care will take place on 20 April. A day filled with top speakers and inspiring practical examples. One of these top speakers is pediatrician Jan Peter Rake. We talk to him about the vision behind MKS, Medical Childcare Cooperation.

Vision

Jan Peter Rake: “MKS is a vision about how you organize care through the wall of the hospital, so from the hospital to home, but just as well vice versa. In fact, it is just a vision of how to provide care in the right place. Care if needed, where needed, by whom needed. It's about organizing it in such a way that it works for both the child and the family. Without discontinuity, so independent of where the child is. With clarity about who does what and when, but also from whom, when and about what help can be requested. You would wish that for every child who needs medical nursing care outside the hospital.”

Provide care in the best possible way in the lives of children and families

“It is important to provide insight into what is needed for the specific child and his family. In the MKS working method, you do this by means of the help needs scan,” says Jan Peter. “That is a big word, but the intention is: what does this child, this family, need at the moment to ensure that the necessary care takes place properly? To which I increasingly say: complex care does not exist. Everything we do or want to do is actually not that difficult at all, including most actions that have to be done outside the hospital. But to do it day in, day out is complex. “Especially if a child's illness has an erratic course,” he explains. “And adjustments are always necessary, or because the circumstances are changing. Because a child has to go to school, and care has to continue there as well. Or because parents are divorced, do not communicate, while the child lives with both and needs care every day. Or because there are three other children at home besides a care-intensive child. But the actual care itself; whether it's feeding through a tube, flushing a bladder, taking care of a line, you can learn that. Packing care into the life of the child and family in the best possible way, that is where the challenge lies. And that, as far as I'm concerned, is what Medical Child Care Cooperation stands for. Working with each other, regardless of where you work, together with the child and the family to shape the care in the most appropriate way possible.”

“MKS is a vision of how to organize care for sick children through the wall of the hospital at home and vice versa.”

Collaboration between healthcare professional and child and family

“As a doctor you know what is medically necessary. As a nurse you know what is needed in nursing. And as a child and family you know how what is needed can best be done for you (or your child). A kind of triangle, each with its own expertise. Who strengthens each other if you only know how to find each other. For example, I think that a certain antibiotic is needed 3 times a day for 6 weeks via a blood vessel to combat a certain infection. After discharge, a pediatric nurse will then ensure that the child receives this antibiotic at home according to the usual nursing protocols. The administration times are determined together with the parents, appropriate to their family life. And where questions about the maximum time that can be between two donations, I can be called upon again. But where it is also clear at the time of discharge where the child should be if the infusion has failed, and how - for example under laughing gas in the hospital - a new one will be placed. In this way you jointly achieve child- and family-oriented appropriate care.”

Reach healthcare professionals

“It is quite difficult to reach healthcare professionals working in hospitals. The people who already know something about the MKS vision can be found at meetings such as these. They are enthusiastic and see the benefits of MKS. But for too many doctors and nurses, the world outside the hospital is an unknown world. While all hospital care has at least a beginning or a continuation outside the hospital. As far as I am concerned, transmural child care is therefore a pleonasm. In the UMC where I work, I still hear too often: that MKS, that is what the transfer nurse arranges, right? While every professional involved must contribute to MKS. And in general hospitals people still think too often: MKS, isn't that meant for those very complex children? While the child there with tube feeding also earns just MKS. I try to hold all those pediatricians to account for their responsibility for this care.”

“Packaging the care in the best possible way in the life of the child and family, that is where the challenge lies.”

On the right track

“Fortunately, we see that the MKS vision has sneaked into medical child care in recent years. Because the partners behind this vision keep highlighting the importance of continuity of care and the responsibility of intramural colleagues - also for what happens at home in terms of care - in the spotlight. Ten years ago, a mother told me that after a long hospitalization of her seriously ill baby, she was discharged home with a monitor and a bag of probes and syringes, with the message: 'this is the number of a home care organization you can call when the probe is out'. Or a pediatric nurse asked my help with a child who had come home to die, and the attending pediatrician repeatedly did not respond to her request for consultation. Fortunately, you hardly see or hear that anymore. Hardly any children go home in the Netherlands without thinking about how care should be continued at home. And yes, that can certainly be improved. And sooner too, because recordings could really be shorter, but we are definitely on the right track. And whether or not you call that child and family-oriented care from the hospital to the home and vice versa adapted to your needs or not, is irrelevant to me. The point is that every child with an illness receives the most optimal, or perhaps least burdensome, care possible for him or her, but also for the family. MKS is nothing more than the vision behind it, the way in which you organize it. We shouldn't make 'MKS' bigger than it is.”

Message to fellow pediatricians

“What I think is important is awareness. That there is medical nursing care outside the hospital. Care that often colors the life of a child with a serious chronic illness more than those few visits or admissions to hospital. And that as a professional you have something to gain from this together with the child and parents. For example, by organizing it according to the MKS vision. Fortunately, we are increasingly working according to the MKS method and we are already doing quite a lot well. However, it can be improved in a number of aspects. Children can go home even earlier. Pediatric nurses in the home setting can do everything, and sometimes even more, that the pediatric nurses can do in the hospital. As long as there is clarity about who can be reached when in case of problems. Or even better, through proactive digital visits with the child, his parents and this nurse. Just to avoid problems. As far as I'm concerned, that could be my nice message to my colleagues. Work with the extramural pediatric nurse in the same way as you do with the pediatric nurses in your hospital.

“Working according to this vision means that you organize what works for the child and family.”

Stake

“I think and believe that every sick child is entitled to care according to the MKS vision. So care if necessary, where necessary, by whom necessary. Only in the hospital if necessary. As a result, we will need fewer and fewer hospital beds in the Netherlands. By arranging care at home even better, we can really improve the quality of life of a child with an illness, but just as much for his family. By focusing on this, we add real value. And MKS is a wonderful vision in this!”

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