After spending a semester in the Newborn Intensive Care Unit (NICU) as a student nurse in training, I can report that I have learned a great deal about the vital issues and practices that are involved in the intensive care unit for newborns, and about the duties and responsibilities of a nurse in that area of healthcare. Part of my training involved treating wounds and the therapeutic communication that is involved in wound care; also, I became well familiarized with the family centric care that is part and parcel of the NICU.
Family Centered Care at the NICU
What can be more important for a family that has just been on the emotional roller coaster of giving birth prematurely to a new member of the family than being made to feel welcomed and to be treated with a great deal of professionalism and respect? There are a number of resources available for families in the NICU, including the fact that parents are "…always welcomed at your baby's bedside"; the hospital offers to involve families in the care of the new baby because this relationship is seen as a "partnership" (Newborn Services). I was very impressed with the openness and thoughtfulness of the hospital in that regard and it is one of the highlights of my semester of learning in the NICU.
Any time night or day parents may visit the NICU, and they are welcome to bring their other children (providing those children are healthy) for brief visits as well. Even friends of the family that have no biological relationship with the family are welcomed (when accompanied by the baby's family) but the children of family friends are not permitted to come and visit the new baby and its mother.
The rule to be strictly enforced is that all visitors (including family members) must be "…free from infections and colds…as babies (especially premature infants) are susceptible to these illnesses and need protection from them" (Newborn Services). It is generally true that while a family with a brand new baby is thrilled and excited, it is also true that a significant amount of stress is part of the birthing experience when a baby is born prematurely, and I saw stress and deep concern in the faces of the families that were in the unit as I was doing my part as a student nurse.
I of course never claimed that I was an expert and had all the answers for the families; but I was very comfortable in conversing with mothers and fathers and their siblings. I learned that a nurse (or doctor) speaking in clear, calm tones to family members, is an ideal way to keep people calm and to have them feel confident that everything is being done professionally and competently to make sure the baby's and mother's good health is the number one priority.
Learning the specific tasks that a nurse is responsible for when it comes to premature babies was an important part of my semester of learning. Premature and "unhealthy" babies need to have their temperature taken regularly and they need to have their nappy changed frequently as well as having their mouths clean. Mothers who wish to come and visit their babies often are asked to phone the nurse first, so that the visit can be timed well; that is, the baby sleeps for a certain amount of time and then is awakened so the attention mentioned in this paragraph can be provided, and hence, mothers like to be on hand to take the baby's temperature and to do the other things necessary in caring for the infant.
The NICU embraces the philosophy of "Developmental Supportive Care," which means lighting around the baby should be "low," and there should be constant quiet in the baby's environment. Also Developmental Supportive Care includes "optimal positioning" of the infant and part of the family centered unit's practice is to promote "kangaroo cuddles" and "baby bonding" (Newborn Services). According to an article in the Australian publication, The Age (Cauchi, 2002), kangaroo care involves parents cuddling up to premature infants each day for up to two to three hours." Even if the baby is still attached to an oxygen tube, the baby is placed on one parent's chest and is kept warm that way plus the obvious human bonding that takes place is a benefit to both parent and child, Cauchi explains.
Discussing kangaroo cuddling with parents was one of my more interesting experiences during my semester in the NICU. I pointed out that empirical studies conducted by three Israel universities showed that skin-to-skin contact between premature babies and their parents brings benefits to both, as Cauchi indicated in the article mentioned in the paragraph above. In those studies mothers who bonded with their premature infants through kangaroo cuddling were less depressed over the situation and tended to see their babies as more normal than abnormal.
Moreover, I pointed out, the studies showed that the 73 pre-term infants who bonded with their mothers using the kangaroo cuddling enjoyed a more stimulating home environment following the cuddling. Also, the mothers of those 73 pre-term babies were more sensitive to their baby's needs and more resourceful at six months than the mothers of 73 infants born in the normal time frame (9 months) that were also part of the study in Israel.
One question I would get occasionally revolved around the idea that kangaroos are native to Australia, not New Zealand, but I started a new concept by suggesting that New Zealanders with premature babies could call it "Kuala Cuddling" if they wanted to. I got some smiles from that, and it brought me closer to the parents, who in many instances were justifiably afraid for the health of their babies and it showed in their eyes and in their body language.
My duties included being an important part of the family-centric policies of the hospital and explaining to the mother that she must express her milk eight to a dozen times in a 24-hour period because the more milk she expressed the more her body will produce. The hospital provides mothers with pumps for her vis-a-vis the breast milk. When she brings the milk to the hospital for her baby, it should be refrigerated; in fact as soon as she produces the milk, she needs to get it into the refrigerator and if it is in the fridge for a few days it should be frozen (Newborn Services).
Among the more unpleasant ramifications for a premature baby is the first bowl movement a baby passes; if it is a black-green kind of color, it can indicate that the baby is passing meconium, which, if not passed, can get into the baby's lungs and cause serious problems with breathing for the child (Newborn Services). If the infant does indeed have breathing problems due to meconium, I learned that the child needs to be very closely monitored and will need blood tests, even intravenous drip (IV) and possibly a ventilator (Newborn Services).
Among the questions nurses in any maternity ward are asked -- especially in an intensive care unit for premature babies -- is, when can the baby come home? There is a checklist provided by the hospital which includes bullet points that explain when the baby is ready to be released to the family. The conditions that must be present include: a) the baby is sucking all his or her feeds from a bottle or the mother's breast; b) the baby can maintain temperature in a cot; and c) there is not a specific weight or gestation for release, but doctors must be assured that the child is strong enough to be sent home (Newborn Services). When taking the child home parents must be aware of New Zealand's legal requirements for car seats and child restraints. All children under the age of 5 years are required to be securely restrained during travel by car (Newborn Services).
I was also instructed in the care of wounds during my semester at the hospital, and among the more common wounds in hospitals are "pressure ulcers." In doing further research on pressure ulcers I downloaded an article in the peer-reviewed Critical Care Nurse (Estilo, et al., 2012) that explained when patients are confined to bed for long periods, the pressure on areas where "…bony prominences are located disposes these patients to pressure ulcers." Patients that are critically ill don't have the ability to turn themselves over, and hence if nurses and other caregivers don't reposition these patients, pressure ulcers are apt to appear (Estilo, 65).
Another important topic that I have studied previously and came into contact again was the concept of ethical issues for nurses -- in particular, nurses in intensive care units. An article in the peer-reviewed Nursing Ethics points to the complexity of decision-making when caring for a person in ICU. For example, physicians sometimes have to make decisions "in short period of time and with limited knowledge of…