Women’s Health and Neonatal Care – Page 2

May 05 2019

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

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April 04 2019

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

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March 03 2019

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

March 03 2019

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

February 02 2019

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

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Category Archives: Women’s Health and Neonatal Care

When a Pregnancy is not Viable

Religious Ethics

Comparison of Theories in the NICU

A Theory for Post Partum Moms

Use of a Nursing Theory