familycenteredcare – JRM Nurse Consultants

April 04 2020

Religious Ethics in the NICU: Balancing Beliefs and Life-Saving Care

The ethical situation that comes to mind this week is religious ethics. This theory focuses on religion, often shaped by a parent’s upbringing and older family members. For example, Jehovah’s Witness parents do not allow blood transfusions. This becomes critical when a baby in the Neonatal Intensive Care Unit (NICU) needs a transfusion. In such cases, the treating neonatologist may need a court order to administer the transfusion. In extreme emergencies, if two doctors sign off that immediate action is necessary, the baby will receive the transfusion while the court order is pending.

As a parent of a premature baby myself, I could not imagine not doing everything possible to save my child. Yet religious ethics prioritize the parents’ beliefs, even when medical decisions are life-saving (Denisco & Barker, 2012).

The parents’ refusal can hinder care, but nurses must promote family-centered care, involving caregivers in decision-making whenever possible (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).

I recall my experience in a level 3 critical NICU, where many rooms were open due to the infants’ conditions. I watched a baby deteriorate rapidly, and the healthcare team discussed urgent transfusion needs openly. As a parent, it was heartbreaking. As a nurse, I wondered how I would handle such a situation, balancing professional responsibilities with compassion for the parents.

The nurse manager at the time criticized the parents, calling their decisions ignorant. While part of me understood her frustration, the compassionate nurse in me knew these parents faced an agonizing choice. I reminded the manager that, regardless of personal opinions, our role was to support the family, ensure the infant’s safety, and provide care—whether or not the parents agreed. By law and ethical standards, the baby would receive the transfusion if medically necessary, often by court order, but our empathy and guidance were essential for the parents during this crisis.

With religious ethics, we may not agree with the family, but as nurses, we must respect their customs and beliefs as long as the baby’s life is not in immediate danger. Compassion and empathy guide us in navigating these difficult situations.

References:
Denisco, S. M., & Barker, A. M. (2012). 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., Feudtner, C., & Matheny-Antommaria, A. H. (2010, April 13). A premature infant with necrotizing enterocolitis. Special Articles – Ethics Rounds. http://dx.doi.org/10.1542/peds.2010-0079

January 01 2020

Compassion in the NICU: Balancing Expertise, Empathy, and Family-Centered Care

One of the clinical challenges I see in the Neonatal Intensive Care Unit (NICU) is staff complacency. When nursing becomes just a job, passion can be lost, and nurses may move through the motions. We may forget that what is routine for us is a first experience for the families we care for.

Approaching every patient and parent with kindness and empathy is critical. Body language, tone of voice, and facial expressions reveal our genuineness. Even when busy, we must prioritize compassion, putting ourselves in the parents’ shoes to determine the level of care they need.

A common issue in the NICU is assessing infant readiness for oral feeding in premature babies. Opinions vary among staff about the best approach. My experience as a mother allowed me to see both sides: as a parent and as a healthcare professional.

During my son’s NICU stay, he was fed initially via NG tube and later transitioned to bottle feedings. One weekend, I was feeding him multiple times while spending the day with him, but a nurse unfamiliar with us took over, claiming I was feeding him incorrectly and causing aspiration. I was only allowed to hold him. Despite prior arrangements with management for private-room feedings due to a hospital-acquired infection, the nurse acted abruptly.

I was devastated and cried for days. When I reported the incident to the head nurse, it was documented, and the weekend nurse later apologized. Ultimately, it was discovered that the baby’s aspiration was unrelated to how I fed him, and a Mickey G-tube was inserted to facilitate safe feeding and expedite discharge.

This experience highlights the importance of patient-centered care in the NICU. The Colorado model emphasizes including patients—and in this case, parents—in decision-making, respecting their preferences, religious or cultural considerations, and personal choices (Goode, Fink, Krugman, Oman, & Traditi, 2010). Nurses may excel technically, but if parents are excluded, care is incomplete. Compassion, communication, and inclusion are as essential as clinical expertise.

Reference:
Goode, C. J., Fink, R. M., Krugman, M., Oman, K. S., & Traditi, L. K. (2010, August 10). The Colorado patient-centered interprofessional evidence-based practice model: A framework for transformation. Worldviews on Evidence-Based Nursing, 96–105.

October 10 2016

From NICU to Home: Supporting Parents of Premature Babies Through the Transition

Going home from the NICU can be one of the most stressful moments for parents of premature babies, especially without proper guidance. Families often face the challenge of caring for a baby who requires more attention than a full-term infant, and without a structured transition program, the stress can quickly become overwhelming.

The implications of current discharge practices are significant. Parents of premature babies may experience depression and anxiety due to the high level of responsibility and uncertainty. While in the NICU, families endure the emotional roller coaster of whether their baby will survive. Once the infant reaches a stable point, planning for home care begins. If the baby requires tube feedings, oxygen, a tracheostomy, or monitoring devices, major family adjustments are necessary. One parent may leave work to provide care, and missed home health visits can create unsafe situations, placing the primary caregiver under intense stress and extended hours of vigilance.

A multidisciplinary team—including nurses, doctors, occupational therapists, child life specialists, and nurse educators or consultants—should support families during this transition. The bedside nurse is particularly critical, as they develop the closest relationship with the family and understand the baby’s daily needs.

Parents benefit from clear, step-by-step instructions, demonstrations, and written reference materials that they can consult at home (Ronan et al., 2015). Current educational resources often use full-term infants, which does not realistically reflect the challenges of premature babies with medical complexities. Future research should include infants of varying gestational ages and medical conditions to better guide transition programs.

By implementing structured transition programs, NICUs can help reduce parental stress, promote family safety, and improve long-term outcomes for premature infants.

Reference:
Ronan, S., Liberatos, P., Weingarten, S., Wells, P., Garry, J., O’Brien, K., & Nevid, T. (2015, March/April). Neonatal Network, 34(2), 102. http://dx.doi.org/10.1891/0730-0832.34.2.102

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

Tag Archives: familycenteredcare

Religious Ethics in the NICU: Balancing Beliefs and Life-Saving Care

Compassion in the NICU: Balancing Expertise, Empathy, and Family-Centered Care

From NICU to Home: Supporting Parents of Premature Babies Through the Transition