baby – JRM Nurse Consultants

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

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

October 10 2018

What is a Father’s Role When the Doula is There?

The doula never takes the father’s role in the birthing process. The doula enhances and compliments the father’s role during the entire birth. In this generation, more fathers are becoming involved in the process of birth. However many fathers still want to be there for their partner, but maybe not in the coaching aspect for fear that they may do something wrong. Have no fear dads, you cannot do anything wrong. When the doula is there, she will guide you through the process of being your partner’s support system. With the doula there it gives the father flexibility to rest, has a bathroom break, eat, and most importantly learn the techniques that will be needed during the difficult time of labor.

www.windermerebabyandfamily.com

February 02 2017

Quality and Safety at Well Baby Clinics

Recently, I was speaking with a health nurse at a clinic about the increase in babies being sick due to a lack of well baby check ups and vaccinations. In speaking with the health nurse and in review of her concerns about her well-baby clinic, one of the critical dimensions that came to mind was inquisitiveness to determine whether offering immunizations at her clinic was working or not working to get the parents to come to the clinic. If it is a well baby care clinic, are the parents bringing in the babies for any other check ups? For instance are they coming in when a shot is not needed?

After our conversation, the health nurse decided to seek information about the mothers that were not coming and noticed that there was a drop in the amount of people who came because they did not have public transportation available for them, due to the distance that they lived from the clinic (she is in a rural area). I suggested that there should be some creativity on the clinic’s part to establish a new way for the immunizations to get to the parents.

Creativity and inquisitiveness were two critical thinking dimensions that I identified in this well baby clinic scenario as I was speaking to the health nurse. The structure is the routine immunizations that they provide to the parents at the clinic. The process is based on the age of the infant and that will determine when they come in for their routine immunizations. The outcomes are the hopes of reducing childhood illness, for instance measles (Rubenfeld & Scheffer, 2005).

In thinking, there are a few alternative ways that I think would help the well baby clinic and also help these families. First of all, finding out where the majority of the families that were affected by the lack of transportation live. Once that is determined, locate a school, church or shopping center that will allow once per week or once per month depending on the amount of babies that need immunization, to set up an immunization clinic for those families affected by the bus system. The schools, church and shopping centers are places that parents will need to go to if they have school age children or if they have to buy groceries or attend a church. Even if they don’t attend the church, if it is in the community they have easy access to bring the baby for the immunizations.

Another alternative, is working with the resources available in the community. Perhaps the clinic can find out if the transportation available to take people to doctor’s appointments would be available to bring the parents on a specified appointment day. If the bus can pick up the parents where they used to take the city bus and bring them in to the clinic to get the shots, then go back to the bus stop once the group was done.

When the clinic presents these alternatives to the stakeholders making the decisions on what they will pay to make the clinic a success, it is important to share the benefits for doing the immunizations. If presented in a narrative format, explaining first, the subpopulation that uses the clinic, then the treatment and frequency that they come as well as the consequences of the parents not coming. Presenting the stakeholders with realistic facts if the babies are not immunized and that they can get a childhood illness like the measles, and how an epidemic can spread in the community, is an eye opener. If there are complications from the illness without having proper care to the child or even an adult who was never immunized as a child, there can be an inpatient hospital stay. The inpatient hospital stay would cost the tax payers and stake holders more money when simpler solutions could have been implemented.

In conclusion, education and preventative care is the basis of the well-baby clinic, but when the parent does not have the means to get to the one and only clinic, then an alternative to provide the same service has to be sought to keep the community healthy and avoid unnecessary inpatient hospital stays.

References

Rubenfeld, M. G., & Scheffer, B. K. (2015). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

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/

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Written by Rosie Moore, RN, BSN, LNC

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

Tag Archives: baby

When a Pregnancy is not Viable

Religious Ethics

What is a Father’s Role When the Doula is There?

Quality and Safety at Well Baby Clinics

Challenges that Parents of a Preemie Face