The role and responsibilities of nursing

Sociology

I am a Nurse

I'm a nurse in a neonatal intensive care unit. I work with some of the most stressed out parents in history; those who have just given birth to premature infants, and are worrying their babies will survive and thrive. The scene is often chaotic and frightening. Tiny, tiny babies with tangles of tubes and monitors on every side are a terrifying sight to new parents. You can see it in the parents' faces when they visit their child, or tour the NICU for the first time.

Recently, we had a success story with a child that was especially rewarding (although all the babies that survive are rewarding)! We got a tiny premature baby boy in. His mother had gone into labor 10 weeks early, and had been airlifted by helicopter to the hospital. He was delivered just a few minutes after she arrived, and he was "blue and floppy" according to the delivery nurse. After admission to the NICU, it was discovered he also had a patent ductus arteriosus (PDA), a condition where the temporary blood vessel connecting the left pulmonary artery to the aorta in the fetal heart fails to close after birth, which is relatively common in preemies. We administered medication that caused the duct to close, and the heart murmur associated with PDA disappeared shortly thereafter. This was just the beginning of many complications the baby began to see during his eight-week stay in the NICU.

One of the things that made this child memorable was the family. The young parents were distressed, as anyone would be. The grandparents on the husband's side were also in the hospital and spent much time in the NICU with the baby. The mother, after her initial recovery suffered from severe depression (PPD), mostly as a result of her guilt feelings about doing "something" to cause the early delivery. She had been under a lot of stress at work, had been working on refurbishing a new home, and had also smoked throughout the pregnancy, and she felt all of these contributed to the situation. Working with her was difficult, because she spent literally 8 to 10 hours each day in the NICU.

I'll never forget the first time she came into the unit, while she was still a patient in the hospital. There were dark circles under her eyes, her hair was limp and dry, and her cheeks held traces of tears. Her eyes were obviously red from crying. She was in a wheelchair, with her husband pushing, and she looked like she hadn't slept in a week. Her husband headed straight for the baby, and I could tell she just longer to hold him and touch him. I let her touch him through the incubator, and reassured her that we were doing everything we could to help him. He was especially tiny and frail, and I know the sight of him frightened her. She started to cry again, and I just gave her a hug and told her everything would be OK. It was all I could do, I knew she was hurting and I could not make it go away.

The mother did not always agree with the assessments and treatments of the doctors, and would speak out when she did not agree. For example, she questioned removing the child from some of the monitors, the dosages of his medications, and his use of formula. (She had quit smoking by this time and wanted to nurse.) All of these situations were uncomfortable for the staff and the family, and at times, frankly made me want to tear my hair out! I understand how helpful the Internet can be in situations like this, but often, parents become "instant experts" and get in the way of what we are trying to accomplish.

A attempted to deal with the mother like a parent and an adult, and tried to treat her like I would want to be treated if I were ever in that situation. I tried to explain the decisions, listen to her uncertainties, and attempt to reassure her that we were really trying to do all we could to help her baby. I used my clinical knowledge of premature babies, and my experience in working in the NICU, and reassured her often that her baby's symptoms were all right in line with development and growth in the premature infant. I knew she was researching subjects on her own, so I tried not to talk down to her, but explain things in terms she would understand. I think talking down to patients and family does them a great disservice, and makes you appear untrustworthy in their eyes, so I always try to speak to them like I would speak to a colleague, but without the jargon and medical detail.

I've worked in NICUs a long time and in other areas of the hospital as well, and I know that families can be extremely stressed and frightened when their loved ones are hospitalized. I don't blame them, and I try hard to empathize with them, because they need reassurance and knowledge to feel better and understand all the things that are occurring around them. I became a nurse because I am a compassionate person, and I like to think that the way I treat families and patients gives them a little relief and makes them feel just a little better. I think that attitude is truly an important part of the healing process, and families with the best attitudes often "infect" their family members and make their recovery quicker and less draining. I could see that this mother was not allowing that to happen, and so, I tried to make friends with her, reassure her, and let her know that she could ask any question, any time.

I think this made a difference because she began to lighten up after a while, and become less demanding and second-guessing. The other members of the team noticed it, too, and began to identify a little bit better with her and her concerns. At first, they dreaded seeing her walk in the door in the morning, and so did I! We are a team in the NICU, we have to be, and we all work together to coordinate treatment, diagnosis, and wellness practices to make sure as many preemies as possible leave the NICU as healthy, viable infants.

In the United States, there are at least 508,356 premature births every year, and the number in Canada hovers around 400,000 per year. Statistics also indicate that a woman who gives birth to a premature baby has a statistically higher chance of giving birth to another preemie, about 20% higher than a woman who has not given birth prematurely. In addition, the number of premature births is increasing, and research has not yet indicated why. However, I know we see more babies in the NICU than we used to, and more concerned parents as well. So, I think it's important to understand how to work with the families and engage them in the care of the baby, so they understand what will be necessary when they take them home.