Low-Tech Care in High-Tech NICU
Monday September 18, 2000
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In the 20-bed Level III neonatal ICU (NICU) at Sarasota Memorial Health Care System (SMHCS), however, we believe in the importance of providing high-tech medical care enhanced with comprehensive "low-tech" care that supports baby, parents, and family during their stay. Two of our low-tech approaches to this comprehensive care include Kangaroo Care and the family care provided by our parent support coordinator and staff.
Kangaroo Care
For parents to feel like parents, it's important that they participate in routine care and handling of their infant during the NICU stay. At SMHCS, one way parents are able to care for their baby is through Kangaroo Care (KC), the skin-to-skin holding of infants. During KC, the diaper-clad infant is held upright, chest-to-chest and skin-to-skin, against the mother or father.
KC began in South America, when poorly equipped hospitals in Colombia were forced to place more than one infant in a single isolette, causing the spread of infection and a staggering mortality rate for premature infants. Doctors in Bogota decided to have mothers of premature babies carry them skin-to-skin, under their clothing, and let them suckle at the breast, on demand when ready. The survival rate went from 27.3% to 89% for premature infants weighing 1,001-1,500 grams and from 0% to 72.3% for premature babies 501-1,000 grams.1 Since KC became part of the plan of care in Maputo, Mozambique, the survival rate increased from 24.7% to 95% for infants born weighing less than 1,500 grams.2 These findings have not gone unnoticed, and effects of Kangaroo Care are studied extensively in the US and Europe. Kangaroo Care has been found to improve weight gain, reduce the number of days on oxygen, facilitate parent bonding, promote breastfeeding, improve digestion, and encourage better sleep/wake cycles, thereby decreasing length of stay.3 During KC, a mother's or father's body temperature will fluctuate in response to the baby's need for warmth. The infant will stay just the right temperature whether it weighs one pound or 10.4
We offer KC to all of our babies as soon as possible. Infants as small as 500 grams, babies on ventilators, and even full-term healthy babies benefit from skin-to-skin holding. During KC, a baby experiences the smell of its mother, hears her heart beat, and feels the subtle movements of her breathing.
A baby born prematurely is not just a little "big" baby. In fact, body systems haven't completely matured. KC gives the premature baby's sensory system experiences it would be having in utero if it had not been born prematurely.5 Medicine can never replace the sensory experience of Kangaroo Care.
When a baby is dying, KC provides a way for parents to bond with the child. Picture a critically ill infant covered with tangled wires and IV lines, surrounded by life support machines and monitors. The baby becomes invisible as technology sustains its life. It's hard for parents to believe that this baby is really theirs. During this unsure time, parents express feelings of helplessness. When it becomes evident that efforts to save the baby are futile, Kangaroo Care can facilitate bonding, assisting parents in the process of letting go. Giving them the opportunity to hold their baby skin-to-skin while it's alive makes the baby real to them. In most cases, they haven't had the chance to hold their infant; getting to know their baby while it's alive is an important step in the grieving process.
The Kangaroo Care program at SMHCS has been recognized nationally and internationally. The program was presented at the First International Conference of Kangaroo Care in Baltimore in 1998 and at the Physical and Developmental Environment of the High-Risk Infant meeting in Clearwater earlier this year.
We Hear You
Michael Hynan, PhD, noted author, psychologist, and parent of a premature baby, sums up the NICU family experience: "All it is - is hard."6
Though the fields of neonatology and neonatal nursing have changed dramatically over the years, the family experience for many remains, as Hynan describes it, an experience of "terror, grief, impotence, and anger."7
NICU staffs have long known the impact of a premature baby's birth on the family. Not until recently, however, have we recognized the benefits of listening to families and responding to their needs. National NICU parent groups, neonatologists, and nurses began to meet in the 1980s with a vision of something called "family-centered care." A long time coming, it's now the goal of most neonatal ICUs - a collaborative approach where parents and professionals are partners and where their roles are equally important. Professionals ask and listen, establishing relationship-based care that benefits both families and staff.
There is no single model for family-centered care. By listening to families and responding to their needs, we see a shift in philosophy that blossoms into a more family centered approach. The petals unfold uniquely in every NICU, adapting to each center and the needs of the community it serves.
At SMHCS, the NICU team consists of neonatologists, nurses, respiratory therapists, family case coordinator (discharge planning), social worker, clinical nurse specialist, developmental therapist, lactation consultants, nutritionist and parent support coordinator. The desire to listen to families is at the heart of each team member's practice.
Family satisfaction is assessed through daily communication and postdischarge parental satisfaction surveys. At SMHCS's NICU, families have told us that they have four basic needs:
1. To be equal partners in the care of their baby
2. To receive emotional support, peer and professional
3. To receive education
4. To have access to services they need
Our focus is on responding to those needs. On admission to the NICU, parents are provided with a handbook and loaner copy of Newborn Intensive Care by Jeanette Zaichkin. They're given a parent mailbox, and each parent receives a monthly calendar listing family opportunities, such as free CPR classes. Also on the calendar are family meetings that have been developed according to parental request.
The Parent Meeting is a group that meets with an RN and the parent support coordinator, providing a forum for medical questions and discussions about treatments and diagnoses. About halfway through this meeting, we facilitate transition into a support group setting.
Family Craft Nights are often held after parent meetings. Our original intent was to provide an opportunity for some family fun and, interestingly, some of our most intensive peer support sessions have evolved while hands are busy sponge-painting bibs and designing birth announcements.
Developmental Chat is a gathering with the developmental therapist and parent support coordinator as facilitators. Its focus is on preemie development and family support. Parents learn to recognize their baby's signals, follow its cues, and begin to feel good about their NICU experience. The importance of listening and responding is emphasized in family/baby and family/staff relationships.
Additional services and amenities, developed in response to family requests, include a parent sleep room, access to hospital guest rooms, a parent lending library, a biannual graduate reunion, and an extensive grief follow-up program and annual memorial service.
Our supportive community has blessed us with 30 "Cuddler" volunteers and nearly 150 women who sew and knit custom items from isolette covers to tiny hats. This overwhelming support lends a nurturing environment for both staff and the families we care for: low-tech touches in our high-tech world.
By building a foundation of family-centered care in a relationship-based practice with NICU parents, we're rewarded to see that families leaving our unit not only recognize their own strengths, but are empowered to advocate for their baby and secure for it the best possible healthcare throughout childhood.
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