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

 

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A Theory for Post Partum Moms

Betty Neuman’s theory will work well with visiting post-partum moms in their homes after they have had their babies.  One of the things that I have seen while working in labor and delivery, is that the mothers come in with preconceived ideas on what breastfeeding is or is not, based on what their mothers and grandmothers know.  The family will say that back in the day, there was not any teaching on breastfeeding, you just did it. This can cause stress with the newly delivered mother and the family.    However, I most recently read an article and it spoke about a 17-year-old girl that came in with a complicated pregnancy and she delivered early sending her baby to the Neonatal Intensive Care Unit.  She was from Mexico but spoke a language called Mixtec.  This would make explaining about breastfeeding difficult and frustrating to the family and the nurse (Peterson-Iyer, 2008).

However through Betty Neuman’s model, if the nurse takes out a book that talks about breastfeeding, even if it is not in her language, she can point to the pictures and demonstrate what she needs to do.  Initially, this mother will be pumping her milk, since the baby may be too sick to drink at the breast, however, once the discharge is planned, she will need assistance breastfeeding and bonding with the baby.  It is through home visiting nurses, that these cases of mothers that are learning and have language barriers can have support for proper breastfeeding.

Betty Neuman believes that nursing should be approached from a holistic standpoint; physical, psychological, mental, social, cultural, developmental, and spiritual well-being.  As a person, Neuman’s theory considers the patient as an individual family member, community or society. The environment that the patient lives in can be external or internal.  Stressors that Jean Watson speaks of in her theory, produces tension in a person’s life (Alligood, 2013).

 

References

Alligood, M. (2013). Systems model. In Nursing theorists and their work (8th ed., pp. 281-301). [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

When You Love Unconditionally

Do you ever wonder why people help a total stranger?  Do you ask yourself why is it that some people have babies and some who want them cannot? It is sad when these circumstances of infertility happen and a couple feels that they do not have anywhere to turn.  Rosie Moore founder of The Gift of Life a nonprofit that supports premature babies and nurse consultant for Windermere Baby and Family knows all too well the struggles that parents who cannot conceive face.  Sometimes when the parents are able to conceive, the baby may be born prematurely or the baby is miscarried, these are the heart-wrenching stories that led Rosie to start helping intended parents find a surrogate to carry a baby for them. Miracles do indeed happen, all it takes is unconditional love.

A few weeks ago Becky Kammes, a doula in Wisconsin, shared her moving story about how she gave a couple the gift of a lifetime, the gift of birth!

Read Becky’s touching story as she shares her journey

“I have two children of my own and have been a gestational surrogate twice (working on a third journey currently). Surrogacy is my heart and soul, truly.  My intended parents( IP’s) resided on the West Coast and I live in  SW Wisconsin. My IPs were quite active during my prenatal appointments through FaceTime.  When I turned 20 weeks, they traveled to WI for my 20-week appointment and ultrasound.  When it was time for the baby to be delivered, they flew back for the glorious day, the birth of their baby.   We had a doula present at the birth to support all of us during the birth process. My IP’s were elated with the idea, so my Doula and Hubby were a sensational birth duo for both of my IPs and myself. The experience went so well, that I am currently working on a sibling journey with them. They have since become our extended family and that makes my heart soar!

This was their first baby and they entrusted me with the entire pregnancy and birth; they continuously told me that I was “the birth baby professional” and they wanted me to be most at ease and comfortable. I reminded them that although I had birthed three babies prior, one of which is a surrogate delivery, THIS moment was THEIRS. This special time was THEIRS. I’m just along for the ride! Everything we discussed, every idea mentioned every suggestion made, was crucial to the process because we all had to agree on it.  The five of us were a wonderful team! There was an insatiable cohesive bond that was built without really even trying-it was innate, as silly as that sounds.

Part of the doula’s job is to learn your client’s ‘love language’ as I call it and that was done, to a T! But also, our doula managed to learn my IPs love language in such a short amount of time and didn’t overstep any support boundary in the least bit. There was a strong, energetic bond and everyone, including our nurses and OB, respected that and we ALL conquered the birth as a rockstar unit!

I would love to one day Doula for a surrogate and her IPs. It’s such a profoundly intimate moment-in every aspect of the word and to offer my own experiences and insight to help a fellow surrogate and her family have an exceptional birth experience would be a CHERRY ON MY BIRTH SUNDAE!”

 

Thank you, Becky, for sharing such a special and personal experience with Windermere Baby and Family

Visit Windermere Baby and Family to learn more about becoming a surrogate and what it entails.  We can walk you through the entire process of being someone’s miracle.

 

 

 

 

The Pain of a Child and Jean Watson’s Theory

What a difficult job it is for nurses that take care of kids that are in pain; these nurses make a difference in each child’s life that they touch.   Jean Watson’s theory of human caring is a good example of our human caring for others.  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 (Alligood, 2013).   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.  In the case of caring for a child, it creates a  natural caring environment that will help the child and the parent cope during a difficult time.

References

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

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

Dealing with Pain and Activities of Daily Living

When someone is in pain, the painful stimulation must be removed in order for them to function. In looking at the activities of daily living such as hair brushing, dressing, and many others, makes anyone in pain lack motivation to function.     When physical therapy is ordered for patients, especially in the home setting, they at times lose their motivation because of the same thing, it is too painful.  But if we as nurses write the plan of care and recommend to the physician to have medications given to the patient about 20-30 minutes before therapy, then the patient may be able to work through the therapy that may be otherwise painful.

With dependent care, it is always a difficult thing if the patient is coherent enough to know that they need help.  As home care nurse, I saw this frustration in many of my patients because their mind was intact, but with an injury or disease process that prevented them from taking care of themselves.  This is when our compassion as a nurse can show the patient that there are ways that they can still remain independent by giving them choices whenever possible.  For instance what foods they like to eat within their diet, what time of day they want their bath. Everything depends on when they have the help available, but at least whenever they can make a decision, give them that option so that way they can feel that they have some decision making power (Alligood, 2013).

References

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

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

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/