Tag Archives: Rosie Moore

Updating Training in the NICU

Most recently a nurse working in the neonatal intensive care unit (NICU) approached me to ask about changing policies at her hospital regarding the updated training that they offer the new nurses on the unit.  In discussing the policy that she wanted changed in her unit, I would have to agree with her after reading about the training that they are giving the new staff.  If the new staff is watching old videos and training with different staff that have a different approach on how to do things, this will create stress in the learner.  There should be two trainers dedicated to teaching the new staff the preliminary things with several nurses trained as preceptors.  During the preceptor time, additional staff should be brought in so that the preceptor can properly train the new nurse without ignoring the learner and their needs or neglecting the patients.

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The new parents coming in to the nicu to spend time with their babies are already highly stressed, this is why it is imperative that they have a nurse who is confident in the care of their infant.  The only way that this can be carried out is through the staff being properly trained.  Using a program with a check off system is good as far as having the information taught, but there needs to be a return demonstration on it.  Once the new nurse has been taught the things that are required about the unit and has completed the checklist, then the roles should be reversed.  Meaning the preceptor becomes the nurse and the nurse becomes the preceptor going through the day with what the job entails and the preceptor documenting how well the nurse mastered the information.  This will allow the preceptor to know if the new staff needs further instruction.

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In thinking about what the nurse stated that the hospital has to spend money to send staff to conferences, purchase new training videos and new computers, this is a necessity. There is not any amount of money or value that can be placed on the life of a premature baby that a large hospital can’t do to properly train staff.  There are online courses and  expert teachers that may come and do continuing education monthly at the hospital so that they can save some money on sending staff to conferences.  Also sending someone to the conference is a good idea, because they can come back with a wealth of knowledge to update the staff that did not go. Hospitals can also check if there is an option to purchase the conference material after the conference for those that could not attend. Implementation is considered the fourth step in the evidence based practice process.  The problem is identified and the solution is noted, however implementing it is what is left to do (Fineout-Overhult & Johnston, 2006).

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The preceptor NICU nurse, should make every effort to make the environment for the new nurse, conducive to learning, the focus should be on the new nurse.  The environment should be very comfortable and peaceful, allowing the new nurse to ask the necessary questions that they may have (Pilcher, 2012).  In the end, if the investment to properly train new nurses is taken and continued throughout their employment, imagine the efficiency that the unit would have decreasing the stress level of this unit and increasing the patient satisfaction.

References

Fineout-Overhult, E., & Johnston, L. (2006). Teaching EBP Implementation of Evidence: Moving from Evidence to Action. Worldviews on Evidence Based Nursing, 194-200.

Pilcher, J. (2012, January/February). Toolkit for NICU Nurse Preceptors. Neonatal Network, 31(1), 39-44.

Using Evidence to Change Policies

Rules are sometimes implemented by people who may not actually be a staff nurse to observe and see what a family’s needs are.  In most hospitals these days there are more times that can be spent with families in intensive care units, however they are probably limited to 1-2 people.  As a staff nurse, changing a policy that is not implemented is not a good thing, because if something were to happen while the family is there, the nurse may be reprimanded for not following protocol.  What the staff nurse can do is collect information by asking a foreground question that is more specific (Rubenfeld & Schaeffer, 2014).

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An example of a foreground question can be which visiting hours work best for families that have patients in the hospital?   The nurse should look for the answers by recording the hours that the families are able to come in to see their loved one.  Once this is determined, then the nurse can speak with the manager and bring the evidence that was collected, specifically how many families were questioned, what hours they were visiting, what is the majority of the time that families selected.  Once the manager has had a chance to review the statistics provided, then this information can be taken to the decision makers of policies to review and come up with a better outcome. Making changes in the workplace can only take place when the staff genuinely cares about work place practices that will benefit their patient and the staff (Mitchell, 2013).

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References

Mitchell, G. (2013, April). Selecting the Best Theory to Implement Planned Change. Nursing Management, 20(1), 32-37. Retrieved from http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?sid=4ba42c53-9a6d-4ec5-b6bb-2f078e04b7c7%40sessionmgr4001&vid=1&hid=4204

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from http://online.vitalsource.com/books/9781284059571

Judging the Quality of Research Articles

In this study fifteen mothers who had babies born in to the Neonatal Intensive Care Unit (NICU) were evaluated using Spradley’s domain analysis approach.  The purpose of the study was qualitative to show how parents develop an ownership as a mother to the baby in the NICU.  The study was also quantitative because mothers in the NICU dealt with all emotions that they felt throughout different stages in their stay from stress to grief and feeling like they could not take care of their baby (Heerman, Wilson, & Wilhelm, 2005).   The researchers clearly stated their purpose in confirming their suspicion and that is that parents in the NICU do not feel like the baby is theirs until they go home with the baby. This method of study is done interview style and using different stages, meaning parents staying there from at least one week with a 24-34 week gestation baby. The study used middle class mothers that were Caucasian.

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The method of study is a valid one to obtain research, however I may have opted to use mothers of different ages, different races and more than one hospital. The factors that I feel interfered with the integrity of the research study is that the people were all of one socioeconomic class and race.  This does not give a valid study to the rest of the population, because premature birth does not make exceptions to race, economic status, geographic location, famous or not famous, it can affect anyone. A resource that would help would be other studies that used qualitative research as well with a broader subpopulation.

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Although the study only used one socioeconomic class and one race, the study does express the issues that have been mentioned in other studies that talk about what parents feel when they are in the NICU like the study conducted by Dudek-Shriber that showed the stress of parents while in the NICU. The study that Dudek-Shriber utilized was a larger group of mothers and also a diverse population.  In comparison to the current study, Dudek-Shriber’s study was more accurate because there was variety in stages of birth, race, mother’s age and the length of stay in the NICU (Raines, 2013).

There are clear links in the subpopulation collected by the researcher to obtain the conclusion obtained, which is that mothers feel like a visitor instead of a mother when they have their baby in the NICU.  They do not feel that the baby is theirs until they go home.  Now some mothers do feel that they are a part of the baby’s life while they are in the NICU from day one and get involved to the point that they start to act like the staff according to the results.  These moms will use the same language to describe their baby but it is not really identifying them as a mother, they are still referring to the baby the same as the nurses.  The bonding has not occurred when the mothers are going through the motions that the nurse are going through.

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This study cannot be generalized as the researcher only used one race and only fifteen mothers.  It was very specific to the one NICU.  This study population is of course similar  to the population I will be working with, because as noted earlier, prematurity does not make exceptions to race, economic status or age. The researchers concluded that nurses in the NICU need to ask the mothers if they want to be involved at the different stages of the baby’s care so that they can feel connected as a family.  Nurses are sometimes very quick about their agenda and will forget to ask the mothers about being involved because they have an agenda to take care of.

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References

Heerman, J. A., Wilson, M. E., & Wilhelm, P. A. (2005, May/June). Mothers in the NICU: Outsider to Partner. Pediatric Nursing, 31(3), 176-200.

 

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How Nursing Has Evolved Through the Years

Nursing has evolved throughout the years thank goodness to a different level of respect.  Although I do believe that some doctors and even nurses still carry the old way of practicing where the doctor is the lead and nothing else matters.  This is I believe even differs from the North to the South.  I remember graduating from nursing school and working with the doctors in labor and delivery who are now looking at me not as the kid in school, but as the professional on their team.  The doctors would say call me Mike, or John when we were not around the patients and it was a comfortable working relationship (not to the extent of the TV show dramas, that is not realistic!) making everyone’s job easier, especially for a new grad that had questions.

When I moved to Florida I noticed that the nurses and staff would say Dr. Smith or Dr. Jones and he would say whatever it is he needed and the nurse would say yes sir, is there anything else that I can do for you.  It was the politeness of the South or the servant of the South one or the other.  I thought to myself,  okay this is  certainly going to take some getting used to if I am going to live in Florida.  In no time at all, I had to conform since I wanted to be gainfully employed.

When I think of being on an interprofessional team, I think of the team that I was in up North, where it was a comfortable open ended relationship between nurses and doctors to discuss what was happening with the patient and come up with a plan.  When I think of being on the interprofessioal team in Florida when I first moved here, that to me was not a team.  It was a nurse and a doctor, with the doctor stating what needed to be done, the nurse saying yes sir and doing what she was asked.  It should be a partnership collaborating together (Sommerfeldt, 2013).

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Many years have evolved since I first moved to Florida and I have seen the change happen where nurses can have a more involved relationship with doctors as a team player and include nutritionists, therapists and discharge planners. There are still some rigid single minded doctors out there that will not work on an interprofessional team; however our job is not to change them.  We can spend a long time trying to make changes and getting our point of views heard, but if we can make an impact with what we can control in our scope of practice, this will go a long way to improving healthcare.

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References

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014

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