Unusual NICU cases require extensive education
Unusual NICU cases require extensive education
Teaching begins at admission, continues through stay
The neonatal intensive care unit at Children's Healthcare of Atlanta is not your usual NICU. It receives babies that need some sort of specialized care from hospitals throughout Georgia and neighboring states.
For example, babies are sent to Children's Healthcare when they are born with omphalocele, a protrusion of the internal organs through the umbilical cord, or gastroschisis in which the large intestine and other internal organs protrude through the abdominal wall.
"There are so many reasons why they come to us. All the babies we get are babies that other hospitals don't deal with if they are born in a regular nursery. While a lot of hospitals have what they call a NICU, they are basically for premature care," says Patricia Abernathy, RN, assistant nurse manager for neonatal services at Children's Healthcare of Atlanta.
While the health problems the children arrive with vary, the education process is the same for all the parents.
"We initiate education immediately with our families," says Abernathy.
To help orient families to the NICU who will be visiting their baby for several weeks and even months, a neonatal handbook has been written with both English and Spanish versions.
This book has generalized information about the conditions of the children being treated on the NICU, information on lab work that might be done, as well as pictures of the monitors and other machines seen on the unit and a description of the sounds that are commonly heard. Various terminology parents may hear for the first time is also included in the handbook. "This is a book they can keep going back to," says Abernathy.
Parents who are able to spend time with their baby at the hospital are encouraged to learn various techniques, such as the use of a feeding tube while the nurses administer care, if it is something the baby will need following discharge. "In that way we are not educating them at the last minute," says Abernathy.
To aid in the continuum of care the goal is to have a primary nurse assigned to every patient who will be hospitalized for 48 hours or more. Associate nurses also can ask to work with certain babies and are assigned to that child if the primary care nurse is not on duty. The only exception to the rule is when a new nurse is being oriented and it provides a good learning opportunity.
"It never happens near discharge when the primary nurse needs to be working with the family; it is more over the course of the time the baby is hospitalized," explains Abernathy.
Having a primary nurse assigned helps ensure that everything is complete by discharge, including the education that needs to be done. In addition, families become comfortable talking with the nurse and are able to ask questions and address issues they might be less likely to discuss with strangers.
Experts part of the mix
While the nurses working with the baby do a lot of the teaching, clinicians who have expertise in different areas are also brought in to educate families. If a baby is on an extra calorie formula a nutritionist does the teaching. There is a lactation specialist to consult with mothers who are breast feeding.
Experts are also called in for certain procedures. For example, a nurse specializing in tracheostomies does the discharge teaching for patients who have a tracheostomy.
To help bolster education, families are given educational materials to read and review. There are teaching sheets for each diagnosis and books on certain procedures such as an ostomy. There are also information sheets on each medicine a baby is taking.
To help track education there is a discharge list that is part of the admission packet, and as items are taught they are checked off. Abernathy says there are a lot of items on the list. For example, there needs to be a car seat test before discharge to make sure the baby can sit in a car seat without being stressed or having problems.
Also there are routine teaching sheets that are completed as the families are educated. For example, there are sheets for ostomy care, G tube care or G tube insertion. Those provide guidelines for teaching family members that help to standardize teaching as well as documentation of teaching.
"Documentation of education is vital because there is so much teaching that needs to be done," says Abernathy.
Sometimes families must attend a class to learn a procedure. For example, many parents are required to learn CPR before discharge. These classes are offered Monday, Wednesday, and Friday but if families have problems getting to a class individualized teaching must be arranged.
If a child will need a monitor at home or oxygen a representative from the home care company completes the teaching and provides a contact person to call if problems occur. This is usually done a few days before the baby is discharged.
While education for families has been carefully planned, there are many barriers to effective teaching. Often families live out of town and can only come to the hospital on weekends. Those who live in town may only be able to come to see their baby late at night once they have gotten home from work and a sitter has arrived to watch their other children.
As a result the teaching must take place in shorter periods of time. Frequently these parents don't speak English fluently, therefore language barriers further hamper the teaching. Interpreters are always used, however Abernathy says it is more difficult to teach.
"It is hard when you are not the one physically doing the talking. A lot of them shake their head but you are not sure they fully understand until they actually are physically doing the work. If they aren't at the hospital that often you are teaching when they can come and then they aren't around to keep practicing with their learning," says Abernathy.
To make sure all parents are comfortable with their baby's care before they take him or her home those who cannot spend much time at the hospital on a routine basis must stay a couple nights caring for the baby before discharge.
"It is not mandatory for parents who have been in and out and staying all along as long as they are comfortable with the care. It is really for those who have not been able to stay and do the care," says Abernathy.
Sources
For more information about situations when intensive education is required in a NICU, contact:
- Patricia Abernathy, RN, assistant nurse manager, neonatal services, Children's Healthcare of Atlanta. Phone: (404) 785-0417.
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