NICU – Page 3 – JRM Nurse Consultants

October 10 2016

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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February 02 2015

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 .

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

Written by Rosie Moore, RN, BSN, LNC

February 02 2015

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.

Written by Rosie Moore, RN, BSN, LNC

February 02 2015

Challenges that Parents of a Preemie Face

In the Neonatal Intensive Care Unit (NICU) there are challenges that parents face when they are getting ready to be discharged to the home. The parents are asked to bring a car seat to the hospital to test if the baby is able to sit in the seat and travel safely home without complications. The parent is then asked to room in one night in a different room, with equipment that they will be using in their home, for example pumps for tube feeding, oxygen monitors as well as the medications that the baby is to receive. The parents are given a brief lesson on how the equipment works, as it will be what they use at home. The nurses let the parents know that they are a call bell away and they are left there to run the NICU for their baby for one night.

The underlying assumptions of these issues are lack of confidence to be able to take care of the baby, not enough information to really understand what all the machines do and a lack of practice time. Regarding this population, parents of premature babies, the argument that is most often heard is the parents have been in the NICU watching the nurses for the last 5-7 months as they take care of their infant. The reality of the argument is that yes, the parents have been there for 5-7 months however, they have been focusing on bonding and healing from their own wounds both physically and emotionally. When they go see the baby, they only want to bond and see their baby get well so that the baby can go home. They are not focused so much on how they are going to take care of the baby when they go home because in their hopeful minds, they are hoping for the best that the baby will go home without any equipment. These arguments that the hospitals state are factual when they state that they give parents the opportunity to learn and this is enough for them, in my opinion are not factual. The truth be stated, more education is needed geared towards the parents and the home life.

An alternative to sending the parents of premature babies with pamphlets on the care of each equipment and to call the pediatrician if they have any questions, would be a personalized discharge plan that starts during the stay of the baby. A discharge teaching planner that only works with the families when they are going home would be beneficial. Every parent should receive a binder when discharge planning is being talked about. This usually happens about a month before the baby is even ready to go home. This is the time when neonatologists are deciding if the babies are ready to go home and what they will go home with. Instructions with pictures in easy to understand language should be placed in the binder with one instruction tabbed for each piece of equipment, for each treatment and for the medications. This will allow the discharge planner to start preparing the parent of the possibilities of what to expect in the home. The next step is to get the parents to practice with the NICU nurse and respiratory therapist on how to do the various treatments and care for that baby. Allowing the parents to watch the nurse and return demonstrate the treatment as they will be doing at home, referencing the instructions from the binder and allowing them to ask questions and write down notes that will help them remember something would be helpful.

There are many types of learners and we as a population of nurses have to allow people to learn in a style that they feel comfortable in order for then to be successful parents taking care of their baby. The personal connection that I have to this population is that I am one of those parents that had a premature baby. My son was born at 27 weeks, 1lb 10oz. He stayed in the NICU for 5 months. I was very involved in my son’s care and status as a nurse, but there were many times that I was a mom first. The night that my husband and I roomed in, we were overwhelmed, we did not sleep with all the monitors beeping, alarms sounding for feeding and treatments needed. I thought to myself, this is very stressful even for an experienced nurse like myself. During my NICU stay as a parent I mostly cared about bonding with my baby and having him discharged to home as soon as possible. This is one of the reasons that my husband and I started a 501c3 charity organization called The Gift of Life. “The Gift of Life offers hope, encouragement and support to parents of premature babies and neonatal intensive care units.”(The Gift of Life, n.d., p. 1)

“Knowledge is followed by comprehension, the ability to grasp the meaning of material and exceeds the knowledge level. Comprehension is the lowest level of understanding. Application is the next area in the hierarchy and refers to the ability to use learned material in new and concrete principles and theories. Application requires a higher level of understanding than comprehension.” (Robert & Petersen, 2013, p. 85)

Robert, R. R., & Petersen, S. (2013). Critical Thinking at the Bedside: Providing Safe Passage to Patients . Med Surg Nursing, 22(2), 85–93. Retrieved from http://search.proquest.com.library.capella.edu/docview/1350295511?accountid=27965

The Gift of Life. (n.d.). http://www.thegiftoflife27.org/

Facbook page https://www.facebook.com/rosiesnursecorner/timeline

Written by Rosie Moore, RN, BSN, LNC

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Years of experience in Work Comp, Case Management, Disease Management, Utilization Review and Prior Authorization.

Category Archives: NICU

The Affordable Care Act and Nursing

Feeding Readiness for Preemies

Why Do Nurses Become Complacent

Challenges that Parents of a Preemie Face