Religious Ethics

The religious ethics theory focuses on religion, which is depicted by the parent’s upbringing and the older family members typically.  One particular faith, Jehovah’s Witness, does not allow for blood transfusions.  This is very important when you have a baby in the NICU (Neonatal Intensive Care Unit) that is in need of the transfusion and the parent will not consent.  The treating neonatologist will need to get a court order to do the transfusions.  In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order.  As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child.  But in this case, the religious code of ethics is based on the upbringing of the parent (Denisco & Barker, 2012).

The parent refusing to allow treatment of transfusions to their baby, would be a hindrance to the baby’s care, while at the same time as nurses we are trying to promote a  family-centered type of care involving the caregivers in the decision making and treatment  (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).  When my baby was in the level 3 critical NICU, they had open rooms, because the babies were too critical to be in closed rooms.  I watched a baby in front of us get sicker by the day and hearing the nurses and the doctors speak about the need for a blood transfusion and other treatments.  By the time they gave the baby the blood transfusion, it was too late, and the baby was terminal.  You as the parent are watching and hearing this because in this type of critical setup, there is nothing between you and the next bed except a curtain and in front of you, there is not a curtain.  As a nurse I thought to myself, how can they be having this discussion right in the open this way? As a parent I thought, how can these parents watch their baby die? I thought about how those nurses felt and if I were the nurse in that situation, what would I have done.

With the use of the religious ethics, we may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs as long as the baby is being taken care of and there is not a medical threat to the baby’s life.

References

Denisco, S. M., & Barker, A. M. (2012). 25. In Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 569-581). Retrieved from https://campus.capella.edu/web/library/home

Meadow, W., Feduter, C., & Matheny-Antomennaria, A. H. (2012, April 13, 2010). A premature infant with necrotizing enterocolitis. Special Articles-Ethics rounds. http://dx.doi.org/10.1542/peds.2010-0079

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
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Comparison of Theories in the NICU

The Roy Adaptation Model was known to focus on spiritual matters and promoting health amongst a family-centered type of care.  In the Neonatal Intensive Care Unit (NICU), this especially holds true, because of the situation of critical illness faced daily, The Roy Adaptation Model helps families adapt to a changing environment and deal with the quality of life or in some instances death.  In the NICU, Roy’s model would work well as the nurses acclimate to the parents and what is happening to their baby. With Roy’s model, she indicates that health and illness are part of a person’s everyday life, this, in turn, will cause the environment to change in which they live. If the parents are to respond in a positive way and come out of it stronger, they will need to adapt to the change (DeNisco & Barker, 2012).

People will often adapt to a change in their life when they can respond positively to the changes that are happening around them.  An example would be the early premature birth of a baby, unexpected changes in the life of a mother and those immediately around her in the family are affected.  This will include other children, spouse and anyone else part of the family’s nuclear family, which in some cultures can be a very extensive family. That mother and father will use whatever coping mechanisms they learned in life to cope with the stress and the changes that they are facing.

There are three kinds of stimuli considered in Roy’s Adaptation Model, these will all affect the subgroup of premature parents in the NICU, because of the type of unit it is, a unit of uncertainty running high with emotions that go up and down.  In a different culture, the role of the nurse will differ.  For example, think about a mother that speaks a different language and is unable to get clear communication to and from the nurse.  A translator would have to be used to explain what was happening to her as a mother and then what is happening to her baby in the NICU.  For example in one article, there was a baby born early, with a mother that did not speak the language and the family did not fully understand what was happening in the NICU.  The family asked for their “Curandero” a community healer in their culture to clean the baby with an egg (Peterson-Iyer, 2008). The nurse needs to be able to use cultural sensitivity in explaining why this cannot be done, without offending the family but still including them in the baby’s care.

Jean Watson’s theory on caring can also be applied to the NICU because it is nurturing and will be needed in a critical location like the NICU. Jean Watson’s theory of human caring focuses on giving as an extension of self.  It is about instilling faith and hope in a person.  When a person is sensitive to another person’s feelings, it helps to build a trusting relationship.  It is important to acknowledge the positive and negative feelings that a person puts out to another person.  Jean Watson believes in her theory that we experience personal growth through teaching and learning as well as spiritual and socio-cultural well-being.  Jean Watson’s theory emphasizes spiritual and nursing practice, which in turn will promote caring and love to the patient.  This will then develop into a caring relationship.  The theory allows the nurse to understand the other person’s perspectives on things and form a mutual bond.  It also promotes growth when a caring environment is formed allowing the patient to be who they are and be accepted for it (Alligood, 2013).

The role of the nurse in Jean Watson’s theory is to instill faith and hope as well as build a trusting relationship.  In the article about the Mexican Indian family, Jean Watson’s theory would apply.  The mother in this instance speaks a different language that may be unique to the translation company that the NICU uses causing a barrier.  The mother, as in the article may be young and not have received prenatal care.  Their faith is going to be different from our own, as when the father of the child, wanted to use a “Curandero”, but as nurses, we must be able to provide culturally competent care.

References

Alligood, M. (2013). Adaptation model. In Nursing theorists and their work (8th ed., pp. 303-327). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

DeNisco, S. M., & Barker, A. M. (2012). Theory-based advanced nursing practice. In Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed., pp. 361-377). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Peterson-Iyer, K. (2008). A difficult birth: Language and cultural differences. Retrieved from http://www.scu.edu/ethics/practicing/focusareas/medical/culturally-competent-care/difficult-birth.html

 

Use of a Nursing Theory

In the neonatology world, there are a lot of different cultures that come through the Neonatal Intensive Care Unit (NICU).  It is also a longer time span to work with families, than on a regular medical-surgical floor.   Florida is a  transient state with many people coming on vacation and moving from out of state; this impacts nursing with a diverse culture.  Today we will explore cultural diversity as it pertains to religious beliefs.  In neonatology, three theories come to mind King’s views, Roy’s views, and Neumann’s views.  The theorist that many Neonatal Intensive Care Units (NICU) use is the Roy Adaptation Model (DeNisco & Barker, 2013).

The Roy Adaptation Model is known to focus on spiritual matters and promoting health amongst a family-centered type of care.  In the NICU, this especially holds true, because of the critical illness faced daily by the families.  The Roy Adaptation Model helps families adapt to a changing environment and deal with the quality of life or in some instances death.   In the NICU, Roy’s model works well as the nurses acclimate the parents, to the NICU and what is happening with their baby. The nurse may find a challenge when some of the babies need blood transfusions and the parents refuse for cultural or religious reasons (Alligood, 2013).

One particular faith, Jehovah’s Witness, does not allow for blood transfusions.  This is something that is very important when you have a baby in the NICU that is in need of a blood transfusion and the parent will not consent.  In some cases, the treating neonatologist will get a court order to do the transfusions.  In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order.  As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child.  But in this case, Roy’s Adaptation Model may not be the best model to use, trying to involve the parent in a delicate situation.  The parent refusing to allow treatment of transfusions to their baby would be a hindrance to use Roy’s theory which is to promote a family-centered type of care involving the caregivers in the decision making and treatment (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).

The principle of autonomy allows the individual to make their own decision and select what is in their best interest.  Now in this instance when the baby needs a blood transfusion, there cannot be an autonomy decision, because what the parent feels is in the child’s best interest, may not be.    We may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs while at the same time being ethically correct in saving a baby’s life.  Now, as long as the baby is being taken care of and there is not a medical threat to the baby’s life some recommendations can be reviewed to try and find an alternative form of treatment.

 

References

Alligood, M. (2013). Nursing Theorists and their Work (8th ed.). Retrieved from http://online.vitalsource.com/books/9780323091947

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). Theory-Based Advanced Nursing Practice

2nd ed., pp. 6-17). [Vital Source Bookshelf].

Meadow, W., Feudtner, C., Matheny Antommaria, A. H., Sommer, D., & Lantos, J. (2010, April 13). A Premature Infant with Necrotizing Enterocolitis Whose Parents are Jehovah’s Witness. Pediatrics, 126(1), 151-155. http://dx.doi.org/10.1542/peds.2010-0079

Theoretical Models and Research

There are several theorists that can fit the neonatal population, but the one that I am selecting today is Florence Nightingale.  Although she is one of the oldest theorists, her model can still be applied to everyday nursing.  All patients are prone to getting an infection; however, the Neonatal Intensive Care Unit (NICU) is particularly at risk.  Florence Nightingale gave us some principles that would help many of our patients.  She believed in keeping the environment clean, therefore observing good infection control.  She also believed in keeping the patient in the best condition and letting nature take its course or “God.” So Florence did have a spiritual connection which made her sensitive to cultural awareness of others (DeNisco & Barker, 2013).

I believe Florence Nightingale’s research model is quantitative.  She believed that if an environment was kept clean, that the patient would not develop infections.  She believed that nurses needed to wash their hands frequently.  Back in that era, this was not a highly common practice.  Bringing it to this generation, looking at the NICU, it makes sense.  The NICU believes in keeping a sterile environment allowing only certain visitors to see the babies and frequent hand washing and scrubbing for the staff and the parents.  When parents are sick, they are asked not to come to the NICU, if a baby is sick, the parents are asked to wear a mask, gown, and even wear gloves, depending on the baby’s condition. This is an example of keeping the environment free of infections so as not to spread it to the babies (Alligood, 2010).

References

Alligood, M. (2010). Madeleine M. Leininger: Modern Nursing. In Alligood Introduction to the Nursing Theory (7th ed. (p64). Retrieved from Vital Source Bookshelf

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd ed., pp. 6-17). [Vital Source Bookshelf].

Dr. Rosie Moore https://rosiemoore27.com/

 

Critical Consciousness

My awareness of critical perspective has expanded beyond the arena  of where I work, it has involved my charity The Gift of Life  and my wedding business 27 Miracles.  I started out my nursing career working in a high risk labor and delivery unit.  In labor and delivery you meet all kinds of people from different walks of life, different religions, different ethnicities and socioeconomic status.  During a critical time such as labor when there is pain, this is when you learn about other people’s cultures and how pain is perceived by them.  As a nurse we learn about those different cultures through experience so that when we do encounter them, we can understand what level of privacy and respect they need.

parents-in-labor

My husband and I own a wedding and event planning business called 27 Miracles.  Through the years we have become well known in our town for working with ethnic weddings from different countries as well as interracial.  It has allowed me as an individual to learn many cultures and be able to show respect for other cultures and their ways of communicating.  It is a beautiful thing to see love spoken and expressed in so many different languages and cultures through music, food and traditions.

wedding

I have learned through my nursing experiences and my wedding experiences how to appreciate people more and take interest in who they are as a person.  As nurses we get  busy when we work on the floor or in an office and talk about our patients as just another number because we are  in a hurry.  Even on our busy days, we need to stop along the road and take a moment to say hello to our patients, provide a gentle touch to their hand or shoulder, and a listening ear.  These are all part of critical perspectives or as I like to call it cultural awareness.

Nurse holds elderly patient's hand

Many say that the parents of premature babies experience preterm birth  because the parent did something wrong, they smoked, drank, did drugs or a teen age pregnancy caused the premature birth.  Although some of those reasons may be true, there is another side to prematurity that people do not think about.  The mother that develops maternal illnesses like Diabetes and Hypertension, or the baby that for some reason starts developing intrauterine growth retardation and it is unsafe for him or her to be inside the womb.  It is very easy to judge when you don’t know the situation or have never experienced it, but as nurses we need to develop  ways of thinking that allows us to be aware about ourselves and those around us  (Gotzlaf & Osborne, 2010).

nicu-mom

Working with a population of parents that have premature babies, has shown me that premature birth happens all over the world. Premature birth limits no race, religion or economical status.  Our job as a nurse is to be aware of the different cultures and take the time to learn about their culture and how you can work with that person.

new-moms

References

Gotzlaf, B. A., & Osborne, M. (2010). A Journey of Critical Consciousness: An Educational Strategy for Health Care. International Journal of NursingEducation Scholarship, 7(1), 1-15. http://dx.doi.org/ 10.2202/1548-923X.2094

Updating Training in the NICU

Most recently a nurse working in the neonatal intensive care unit (NICU) approached me to ask about changing policies at her hospital regarding the updated training that they offer the new nurses on the unit.  In discussing the policy that she wanted changed in her unit, I would have to agree with her after reading about the training that they are giving the new staff.  If the new staff is watching old videos and training with different staff that have a different approach on how to do things, this will create stress in the learner.  There should be two trainers dedicated to teaching the new staff the preliminary things with several nurses trained as preceptors.  During the preceptor time, additional staff should be brought in so that the preceptor can properly train the new nurse without ignoring the learner and their needs or neglecting the patients.

nicu-nurses

The new parents coming in to the nicu to spend time with their babies are already highly stressed, this is why it is imperative that they have a nurse who is confident in the care of their infant.  The only way that this can be carried out is through the staff being properly trained.  Using a program with a check off system is good as far as having the information taught, but there needs to be a return demonstration on it.  Once the new nurse has been taught the things that are required about the unit and has completed the checklist, then the roles should be reversed.  Meaning the preceptor becomes the nurse and the nurse becomes the preceptor going through the day with what the job entails and the preceptor documenting how well the nurse mastered the information.  This will allow the preceptor to know if the new staff needs further instruction.

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In thinking about what the nurse stated that the hospital has to spend money to send staff to conferences, purchase new training videos and new computers, this is a necessity. There is not any amount of money or value that can be placed on the life of a premature baby that a large hospital can’t do to properly train staff.  There are online courses and  expert teachers that may come and do continuing education monthly at the hospital so that they can save some money on sending staff to conferences.  Also sending someone to the conference is a good idea, because they can come back with a wealth of knowledge to update the staff that did not go. Hospitals can also check if there is an option to purchase the conference material after the conference for those that could not attend. Implementation is considered the fourth step in the evidence based practice process.  The problem is identified and the solution is noted, however implementing it is what is left to do (Fineout-Overhult & Johnston, 2006).

macedonia-pediatrics-1

The preceptor NICU nurse, should make every effort to make the environment for the new nurse, conducive to learning, the focus should be on the new nurse.  The environment should be very comfortable and peaceful, allowing the new nurse to ask the necessary questions that they may have (Pilcher, 2012).  In the end, if the investment to properly train new nurses is taken and continued throughout their employment, imagine the efficiency that the unit would have decreasing the stress level of this unit and increasing the patient satisfaction.

References

Fineout-Overhult, E., & Johnston, L. (2006). Teaching EBP Implementation of Evidence: Moving from Evidence to Action. Worldviews on Evidence Based Nursing, 194-200.

Pilcher, J. (2012, January/February). Toolkit for NICU Nurse Preceptors. Neonatal Network, 31(1), 39-44.

Judging the Quality of Research Articles

In this study fifteen mothers who had babies born in to the Neonatal Intensive Care Unit (NICU) were evaluated using Spradley’s domain analysis approach.  The purpose of the study was qualitative to show how parents develop an ownership as a mother to the baby in the NICU.  The study was also quantitative because mothers in the NICU dealt with all emotions that they felt throughout different stages in their stay from stress to grief and feeling like they could not take care of their baby (Heerman, Wilson, & Wilhelm, 2005).   The researchers clearly stated their purpose in confirming their suspicion and that is that parents in the NICU do not feel like the baby is theirs until they go home with the baby. This method of study is done interview style and using different stages, meaning parents staying there from at least one week with a 24-34 week gestation baby. The study used middle class mothers that were Caucasian.

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The method of study is a valid one to obtain research, however I may have opted to use mothers of different ages, different races and more than one hospital. The factors that I feel interfered with the integrity of the research study is that the people were all of one socioeconomic class and race.  This does not give a valid study to the rest of the population, because premature birth does not make exceptions to race, economic status, geographic location, famous or not famous, it can affect anyone. A resource that would help would be other studies that used qualitative research as well with a broader subpopulation.

research

Although the study only used one socioeconomic class and one race, the study does express the issues that have been mentioned in other studies that talk about what parents feel when they are in the NICU like the study conducted by Dudek-Shriber that showed the stress of parents while in the NICU. The study that Dudek-Shriber utilized was a larger group of mothers and also a diverse population.  In comparison to the current study, Dudek-Shriber’s study was more accurate because there was variety in stages of birth, race, mother’s age and the length of stay in the NICU (Raines, 2013).

There are clear links in the subpopulation collected by the researcher to obtain the conclusion obtained, which is that mothers feel like a visitor instead of a mother when they have their baby in the NICU.  They do not feel that the baby is theirs until they go home.  Now some mothers do feel that they are a part of the baby’s life while they are in the NICU from day one and get involved to the point that they start to act like the staff according to the results.  These moms will use the same language to describe their baby but it is not really identifying them as a mother, they are still referring to the baby the same as the nurses.  The bonding has not occurred when the mothers are going through the motions that the nurse are going through.

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This study cannot be generalized as the researcher only used one race and only fifteen mothers.  It was very specific to the one NICU.  This study population is of course similar  to the population I will be working with, because as noted earlier, prematurity does not make exceptions to race, economic status or age. The researchers concluded that nurses in the NICU need to ask the mothers if they want to be involved at the different stages of the baby’s care so that they can feel connected as a family.  Nurses are sometimes very quick about their agenda and will forget to ask the mothers about being involved because they have an agenda to take care of.

nicu-research

References

Heerman, J. A., Wilson, M. E., & Wilhelm, P. A. (2005, May/June). Mothers in the NICU: Outsider to Partner. Pediatric Nursing, 31(3), 176-200.

 

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