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/

 

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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.

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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.

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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.

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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).

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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.

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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.

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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).

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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.

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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.

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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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The Affordable Care Act and Nursing

Provisions that Will Afford Immediate Improvement for Health Care

The American Nurses Association for many years has been trying to get congress to pass a law affording health insurance for their nurses and everyone else.  When Congress passed the Affordable Care Act, more commonly known as Obamacare, they felt they had won the battle.  People in all walks of life were able to maintain health insurance based on what they could afford to pay and there was no longer the stigma of preexisting medical conditions denying coverage for anyone (American Nurses Association, n.d.).

Provisions that Will Fail to Address Deficiencies and Access

On the surface it appears that Obamacare would be a great service for premature babies that will require preventative treatment for a condition known as RSV (Respiratory Syncytial Virus).  The problem is that most recently the American Academy of Pediatrics lowered the amount of time that a premature baby can receive treatment for prevention of RSV.  Initially it was given to the babies under 2 yrs of age every month for a total of 5 months to get them through the season.  Due to the recommendations that the Obamacare made, this was drastically reduced to one every month for 3 months and some babies will only receive 1 dose.  This was due to the cost of this preventative treatment (Ertelt, 2013).

Challenges that affect Implementation of the Affordable Care Act

The most challenging aspect of implementing the Affordable Care Act in the United States is cost.  The insurance is based on a sliding scale and some folks may pay something and others do no pay anything.  The problem with this is the type of service that the patient receives.  If the patient does not have good insurance, they will be discharged sooner than later from the hospital.

Ethical Issues that Arise as a Result of Affordable Care Act

The ethical issues that will come up are always the issues of saving a life.  When the Affordable Care Act was signed in to law, it was noted that Americans would not be paying for plans that paid for abortions.  Yet it was discovered that it was documented in the plan that this would be covered.  Through lobbyists this was changed and if a person would like that part added to their policy, the client will pay 1.00 or so more per month to have that coverage added.

In the state of Florida people can have late term abortions up through 24 weeks.  Institutions or private physicians can refuse to do these abortions without any penalty.  According to statistics, Planned Parenthood received $528 million dollars in federal funding in 2013 (Ertlet, 2014).   It is unclear as to how much is being donated to preterm births.  In conclusion, maintaining a baby in the NICU is far more costly than providing what society calls today a simple abortion.  The costs of a NICU stay can be anywhere in the $2 million dollar range alone in the hospital, this does not include the cost after the infant is home for medications, homecare, therapy, doctor’s appointments with specialists and any other needs for equipment that the baby may have.  The cost of an abortion depending on the stage that the pregnancy is at can range from $300 to obtain the abortion pill, which also in some locations is administered free early on to an estimated cost of $2050 for later term abortions (All Women’s Clinic, n.d.).

 

References

All Women’s Clinic. (n.d.). http://allwomensclinic.com/fees.html

American Nurses Association. (n.d.). http://www.nursingworld.org/healthcarereform

Ertelt, S. (2013). Death panels for babies in Obamacare: Kids with RSV should beware. Retrieved from http://www.lifenews.com/2013/04/11/death-panels-for-babies-in-obamacare-kids-with-rsv-should-beware/

Ertlet, S. (2014). GAO report confirms Obama lied: 1,036 Obama care plans pay for abortions. Retrieved from http://www.lifenews.com/2014/09/16/gao-report-confirms-obama-lied-1036-obamacare-plans-pay-for-abortions/

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Feeding Readiness for Preemies

One of the most exciting moments for a parent of a NICU baby is when you can start feeding the baby from the bottle. Most are not able to do the breast feeding due to the difficulty latching on, but what a joy to feed your baby even if by bottle whether it is your breast milk or specialized formula.  There are different opinions in the medical community around feeding readiness.    My passion for the neonatal intensive care unit arose from having a premature infant myself.  My son was given breast milk initially via NG Tube until he was ready to try a bottle.  Initially the bottle feeding was started once per day and increased and they would leave the bottle feeding for when the parents were there to feed the baby to create that bonding experience.  One day  I arrived at the NICU on a weekend ready to spend the entire day with my son.  I was excited to feed him several times per day, but I was greeted by the shift nurse telling me that I was doing it wrong.  She took over the feeding entirely and when the rest of the feedings occurred that day, she took over stating that I was making the baby aspirate due to my inexperience.  I was only allowed to hold him.  When change of shift occurred she said okay time to go, I stated that we were in a private room and the nurses close the door so that we do not have to leave during change of shift.  We were in a private room because at one point the baby had developed a hospital borne infection called serratia and would remain in a private room until discharge.   Staying in the room was an arrangement that I made with upper management due to the fact that I worked full-time as did my husband and we did not have much visit time with him during the week.  She proceeded about her business and ripped the baby right out of my arms.

 

I cried for days until Monday came and I made a complaint to my head nurse who assured me that this was documented in my chart right on the front that I was allowed to stay whenever I needed to. She showed me the chart and stated that she would speak to the nurse about her abruptness.  The weekend nurse apologized to us a few days later, but by then my feelings were already crushed.   It was later discovered that the baby was aspirating even when he was fed via g-tube it had nothing to do with how I was holding or feeding him.  It was inevitable.  In the end, it was decided that the baby would have a Mickey G-tube inserted surgically for feedings to expedite his discharge to home.

As nursing professionals we need to be sensitive to the needs of our patients and their families.  We should always read the chart prior to walking in the baby’s room and talking with the family to see if there are any new changes since last you saw the baby. How could the nurse that  was in charge of my baby rip him right  out of my hands and ask us to leave.? When you look at how he was being fed here vs those those nurses that truly cared about bonding .

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These nurses were Kaleb’s primary day and night nurses…sheer joy to watch nurses caring about their patients….

 

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Written by Rosie Moore, RN, BSN, LNC

Why Do Nurses Become Complacent

A question arose from the Article called ” Challenges That Parents of a Preemie Face”

Question from Reader:

Why do you think that some nurses even myself become complacent to what is happening in our work environments and that we do not always critically think outside of the medical treatments we provide?

Answer to Reader:

Thank you for reading the article “Challenges That Parents of Preemie Face.” In answer to your question, nurses and healthcare staff become complacent in their environments because it is a job and the passion is lost allowing the nurse to move through the motions.  We are all guilty in many professions, not just nursing, of treating people matter of fact and we forget it may be our hundredth experience, but it is their first experience, no matter what the experience is. When we approach any person, especially in our nursing experience, we have to approach them with kindness and passion. We as nurses cannot continue to eat our young and continue to treat our patients as if we need to move on to our next task. Our body language, tone of voice and facial expressions, give away our genuineness.  We are all busy, but we have to put that aside and go back to compassion and empathy, thinking about how we want to be treated in this situation if we were in it.  We have to utilize our critical thinking to see what level of care that parent needs to get through this situation at hand.

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Written by Rosie Moore, RN, BSN, LNC