A Gap in Practice in the NICU

Most recently I was asked to write as a contributor for a textbook called Comprehensive Neonatal Nursing 6th edition about what gaps there are in teh neonatal intensive care units.  The editors Carole Kenner, Leslie B. Altimier, and Marina V. Boykova, put together this textbook to support practice strategies and sound clinical decisions in teh neonatal intensive care unit.  My focus is on a NICU toolkit. https://www.amazon.com/Comprehensive-Neonatal-Nursing-Care-Sixth/dp/0826139094/ref=sr_1_1?keywords=9780826139146&linkCode=qs&qid=1570765494&s=books&sr=1-1

The specific gap in practice in the neonatal intensive care unit (NICU) is the challenge that parents face when they are discharged home.  The underlying assumptions of these issues include a lack of confidence to be able to take care of the baby, not enough information to understand the machines, a lack of practice time, and increased readmission rates to the hospital within 30 days of discharge from the NICU.  Regarding the population parents of premature babies, the argument that is most often heard from the nurses and the NICU team is that the parents have been in the NICU watching the nurses for the last five to seven months and they should be able to take care of their infant (Hutchinson, Spillett, & Cronin, 2012).

The parents of premature babies have a higher stress level when the babies are discharged due to not receiving specific education to ease the transition home (Busse, Stromgren, Thorngate, & Thomas, 2013).  In Miles’s (1994) study conducted via the Patient-Reported Outcomes Measurement Information System (PROMIS) following discharge from the NICU, it proved that there was a higher stress level for parents when they were discharged home.  Premature infant readmissions were analyzed and it was determined that there was a 31% readmission rate to the NICU.  The parents needed to be taught skills on how to avoid re-hospitalization (Hutchinson et al., 2012).

Premature babies were being born daily with multiple medical conditions that carried long term through the span of their lives.  When they were transitioned to their homes, they required management of their special needs in the home setting.  The transition program began 30 days before the baby was discharged to the home.  If the teaching was not done prior to the discharge home, then when they went home, the baby was susceptible to errors made at home with medications, infection control, or treatment in general.

When a baby is taken home from the regular nursery it is noted to be a scary time for parents due to the newness of being a parent.  For a parent of a premature baby, the anxiety increases especially if the baby had a long NICU stay.  The parents are accustomed to having the nurses there for support but when they go home, they feel alone.

The proposed solution for this gap in service is the implementation of a NICU navigator tool kit.  The toolkit is designed to help hospital nurses, doctors, therapists, social workers, and parents communicate more effectively towards reducing the parent’s anxiety surrounding their baby’s discharge to the home. The presentation of the NICU patient navigator toolkit contains evidence-based studies and real-life examples to demonstrate the toolkit’s necessity in the NICU.

 

 

References

Busse, M., Stromgren, K., Thorngate, L., & Thomas, K. (2013, August). Parent responses to stress: PROMIS in the NICU. Critical Care Nurse, 33(4), 1-13. http://dx.doi.org/10.4037/ccn2013715

Hutchinson, S. W., Spillett, M. A., & Cronin, M. (2012). Parents’ experiences during their infant’s transition from neonatal intensive care unit to home: A qualitative study. The Qualitative Report, 17(23), 1-20. Retrieved from http://www.nova.edu/ssss/QR/QR17/hutchinson.pdf


Source: Rosie’s Nurse Corner

Bullying is Never Okay Especially on National TV

Bullying is Never Okay Especially on National TV

Ms. Lara Spencer Good Morning America Laughs at Prince George

When I was in grammar school I was the only dark-skinned Latina in my Catholic grammar school.  My parents worked hard to provide their only daughter with the best education they could.  But I didn’t fit in.  I had two friends in grammar school that I  played with; they were both Cuban but light-skinned, blonde and brunette.  Whenever our classmates saw us they called us the black and white tv.  “Why tv”? I’m not sure. But it broke all three of our hearts. Thankfully this did not carry through high school or college; I was glad to leave this stigma behind.  I managed to graduate college and work in the real world. 

In a high-risk hospital, I encountered a professional stigma, nurses against aides and techs.  I wanted to do a good job and help my patients.  I worked with everyone, but yet, the nurses said, “you are one of us, you should not socialize at lunch/dinner with the techs or aides.” The techs/aides would say “you are a nurse but you are Latina and you need to be with your people and the African American staff.”  As for the doctors, well, they were in their own world-but I got along with them, they were too busy for stigmas.

I quickly learned life’s lessons in the business world. I took on jobs where women were in power struggles: some of the older women had no respect for younger women and vise Versa. The level of your position made a difference as to who you socialized with.  People forgot we were there to take care of the sick.

And then it happened, I was thrown into the world of Pageantry.  What me? I’m the shorts and flip flops girl!

I became a mom of a preemie, gained 50 lbs. due to the stress of a boss who said she hated people, thought there was something wrong with my learning ability, had no respect for people, and thought reading books was a waste of time let alone writing one. I cried daily at my desk as a result of the bullying and stress this woman caused me.  Until one day my doctor said “You need to lose weight, lower your blood pressure and change your eating habits or you may find yourself in an early grave.  This started a healthy journey for me.   I had to live for my son, my husband but most importantly, me.  I had to love myself because God loved me and He had a plan for my life.

Most of my close friends knew I was never a public speaker nor did I desire to share my testimony publicly.  I was actually very shy.  I used to sing as a child and through my teens until one day someone said to me, “you look silly singing in the church choir.” I allowed someone’s criticism to ruin my privilege to serve the Lord through worship.  I hid behind dance because I could express myself and not use my voice to speak to others about Jesus and what He did in my life. 

He took control of my life. I went through trial after trial until one day He inspired me to write my testimony in my very first book, titled A Story of Faith.  I thought that was sufficient, but it wasn’t.  He continued to give me test after test and each one became a testimony. He gave me divine appointments to speak to women who were going through difficult situations.  I started to seek the Lord’s guidance, asking Him to fill my mouth with the right words to empower young and older women. 

I thought to myself never will I lose 50 lbs!  But through eating properly, training with a trainer, and God’s motivation, someone noticed.   An acquaintance said, “You know if you get involved in a pageant you can reach a diverse audience that will learn about your charity and help you spread the word about the Gift of Life.”  I thought, “No one cares about pageants” (I certainly didn’t) until I tested out the theory.

I emailed a hotel the year prior to becoming a pageant queen asking for a donation to the Gift of Life and received a reply, “we don’t have any donations at this time, but try again next year”.  So the next year I sent an email, copying the same email, but signing my name as Mrs. Windermere. This was the start of a shift in favor of people.  This time around, I not only received approval for a donation, but the donation was more than I expected; a weekend getaway package to auction off at our Gala.  The pageantry gave me (“just Rosie Moore”) celebrity status almost overnight. 

My first ever competition was an eye-opener.  I felt alone amongst women who were beautiful, wealthy and eager to push any competitor out of their way.  I once again experienced exclusion because of my skin color and heritage as a Latina.  I was done with pageantry, one time was enough for me. 

Someone in the audience noticed me at the pageant with all the bad experience.  She saw something beyond my heritage; she saw that I had a platform plus a genuine love of people.  She convinced me to try again so I prepared for a year and qualified to be Mrs. Windermere International. 

This time things were different.  My peers voted me Mrs. Congeniality and I received the Community Service Award.  The following year, I went on to represent Mrs. Michigan International of which I had the opportunity to not only crown my successor but to share my testimony regarding the Gift of Life. 

Today, I am the reigning “Mrs. Southern States International I have the ability to share my testimony, the Gift of Life and my faith in Jesus!  What I learned is that there is only one winner in the eyes of man.  But, in the eyes of God, we are all winners.

It’s easy for us to fall into the same treatment we receive from others and although it hurts and we want to hurt others with the same measure, we must resist hurting others with criticism because of our own wounds. We will have a great reward as long as we believe God has us in His hands.  

This is why it pains me to hear on national television a grow woman Good Morning America” host Lara Spencer, bullying a 6-year-old boy and eliciting laughter from the audience and co-hosts because he is taking ballet. What is so funny about that? Would she have had the same sarcastic remark had it been a little girl? Prince George will be able to make that decision as an adult for himself one day when he decides what his career path should be. As a dancer who has taken ballet and danced in ballet productions, I know the importance of this being the foundation for any style of dance. I encourage Lara Spencer to google famous ballet dancers and what they have brought to the world of entertainment, Mikhail Baryshnikov is one that comes to mind. Ballet is the foundation of any style of dance, a dancer is recognized by his or her training in ballet because the way that they carry their posture stands out. Football players take ballet not only to help them be flexible in their sport but ballet improves their focus by helping them concentrate on precise movements needed in football. Ballet has been proven to boost the concentration, improve memory, and helps people to understand music and rhythm which ultimately can improve body awareness and physical control. If you have a tendency to be clumsy, ballet training can help improve that. Not everyone who takes ballet or any style of dance will become a world-famous dancer, but the opportunity to allow someone to express themselves through dance does wonder. That is why in a major study it has been proven that when you stimulate your mind by dancing, it can increase cognitive ability, therefore, decreasing the likelihood of developing Alzheimer’s or dementia.

So to Ms. Lara Spencer of Good Morning America, choose your words wisely the next time that you are sharing news or a story because your words are a double edge sword that can be hurtful to someone who is listening. I used to like watching Good Morning America and hearing the stories that were shared, but now I am appalled that Good Morning America would allow this type of bullying of a child to take place on national television.

If you missed the story, here it is https://www.youtube.com/watch?v=e27c3JmlbNM

When a Pregnancy is not Viable

I think that this is a hard decision for any mother to make when she is told that her baby may not be viable.  I can see several ethical things here that would make a decision difficult to make.  First of all, there is the termination of the pregnancy recommended because the baby will not be viable at birth, and then there is the religious aspect.  These are both ethical situations that can be very difficult for parents when they have to make a decision.  Doctors make decisions based on the viability of a baby and feel that if the baby will not make it, the pregnancy should be terminated.  In a Christian hospital, for example, these conversations may not happen, because they do not do terminations of pregnancy, so that suggestion would not be made. However, at a non-Christian hospital, that type of discussion may happen there frequently.

Each hospital should have an ethics team to explain the choices to the mother so that a mother that does not believe in termination is aware that she does have the right to keep the baby until he passes.   Allowing the parents to use their own judgment in a case like this,  provides for better healing as they cope with the impending loss.  The termination of a pregnancy before its time is devastating to any parent. A parent’s religious beliefs in the Lord keep them holding on for a possible miracle and we should not interfere in their decision making.  If the miracle does not happen, those parents will find the way to grieve the loss but at least they were offered a choice and will not have to worry that the choice was not given to them and they will not have to live with the “what ifs.”  This would be their way of coping with the death of that child (Denisco & Barker, 2012).

References

Denisco, S. M., & Barker, A. M. (2012). 25. In Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). Retrieved from https://campus.capella.edu/web/library/home

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
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Source: Rosie’s Nurse Corner

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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Source: Rosie’s Nurse Corner

Is There Still a Nursing Shortage

It seems that the nursing shortage has been an issue since I was going to school.  I remember at one point I received a one year full scholarship to go to nursing school my first year; then the 2nd year I received a letter that stated the President decided the nursing shortage was over and cut my full scholarship for the second year, forcing me to get student loans. That is enough to make you mad! But now as I practice as a nurse, I see that there is still a shortage of nurses in many fields (Moore, 2015). For instance in the hospital what I see is that they do not hire too many nurses because if they have too many on the unit and they don’t float them to another unit, they will send them home without pay because there is not sufficient work. When my son was in the Neonatal Intensive Care Unit, I had to walk past high risk antepartum, one day the lights were dim, and there was no one around. I got a bit concerned that something had happened.  There was a sign that said, “unit closed.” When I inquired, someone stated that the unit was closed because the patient census was down.  Of course two days later, it reopened.

I see that nurses are overworked because of the shortage as well.  The shortage is only getting worse as the years go by because the baby boomers are soon going to be retiring and there are no new nurses to take their place (“Focus on Education,” 2010). There are also articles that speak about new nurses graduating, but their minimal level of education required will be the bachelor’s level plus all the clinical involved with that level.  There are entrance exams to some nursing schools, making it difficult for the student to pass.  Of course, education should be taken to the next level due to the more complex illnesses and family dynamics that we have today.

In order to not continuously have a shortage, employers need to realize that yes there is a shortage and hiring more staff to help the current nurses and not over tap them will be more productive in the long run.  The medical cases are getting more complex these days for patients in the hospital, therefore making it important for nurses to have a higher level of education. The colleges have to start sending representatives to the high schools to start recruiting future nurses so that when they graduate, we can add more nurses to the profession.  Recruiters need to present the pros and cons of being a nurse and look for candidates that will be a good fit for the nursing profession.

References

Moore, M. (2015). The nursing shortage and the doctor shortage are two very different things. Retrieved from http://www.washingtonpost.com/news/to-your-health/wp/2015/06/05/the-nursing-shortage-and-the-doctor-shortage-are-two-very-different-things/

The future of nursing: Focus on education. (2010). Retrieved from http://nursejournal.org/articles/the-future-of-nursing-infographic/

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
Follow me on Facebook https://www.facebook.com/rosiesnursecorner/

 

 


Source: Rosie’s Nurse Corner

The Need for Nurses in Schools

For many families that have children in elementary through high school level with special needs for medications, it has become a question as to whether or not the school that they are zoned for has a school nurse. Many schools in Florida do not have nurses on staff (Florida Association of School Nurses website, n.d.).   In one article by the Orlando Sentinel, it notes that not all Orange County public schools have a nurse, in fact, their ratio out of 182 schools in Orange County, showed only 34 had nurses. One Orange County school mentioned that they have an RN and she helps a lot because it frees up the teacher to focus on her classroom instead of the child that is sick. The article went on to say that some tasks are delegated by the RN to non-clinical personnel, for instance, an assistant principal or secretary when the nurse is not in the school (Roth, 2011).

In my opinion, although parents of children administer injectables like epinephrine for allergic reactions or insulin, they are the parents that have been taught to watch for certain symptoms in their child that they see day in and day out.  They have a working knowledge of the situation should it arise. The school personnel, may be taught when to administer medications like epinephrine or insulin, but if they have never used it, or administered it, how can they safely administer it? Will they know what symptoms to look for if there is a reaction?

In the state of Delaware, every school is required to have a registered nurse.  Some schools that have them receive the funding through the school system grants, or in the community (Roth, 2011).  I most recently went to a school that is private with an estimated tuition rate of $14,000 per year and service preschoolers through high school. The school has a large arts program and a population of about 2000 kids, each child receives an IPad upon admission to use for homework.  They stated that they did not have a school nurse, if a child warranted medical treatment of medications or breathing treatments, this would not be the school for the child.  I found it rather sad to see that value was placed more on the material things of an IPad (which I know can help advance a student) but really the computers work just fine; having a registered nurse to help in times of kids needing treatment, or a school teacher needing treatment is much more valuable to me.

References

Florida Association of School Nurses website. (n.d.). https://fasn.nursingnetwork.com/page/18381-school-nurses-save-money-

Roth, L. (2011, September 26). A nurse in every school? Not in Florida not even close. Orlando Sentinel. Retrieved from http://articles.orlandosentinel.com/2011-09-26/business/os-fewer-school-nurses-florida-20110925_1_school-nurses-practical-nurses-students-with-chronic-illnesses

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
Follow me on Facebook https://www.facebook.com/rosiesnursecorner/


Source: Rosie’s Nurse Corner