The Nursing and Medical Management of Infants and Families - Essay Example

The Nursing and Medical Management of Infants and Families Introduction Neonatal nursing refers to a sub-speciality of nursing that works with newborn infants born with diverse problems ranging from birth defects, prematurity, cardiac malformations, surgical problems, and infections. The term developmental care describes broadly those interventions that support and facilitate the stabilization, recovery, and development of infants and families undergoing intensive care in an effort to facilitate optimal outcome. #1The nursing and medical management of infants and families within the intensive care environment Theoretical approaches to developmentally focused care encompass interventions that counteracts sensory-overload or deprivation such as minimizing stress responses or facilitating positive sensory experiences; interventions that pursue to help parents to resolve the emotional crisis of the pre-term birth and facilitate maternal-infant attachment; interventions that aid parents to be sensitive and responsive to their infant’s behaviour and enhance social interactions, confidence, and practical care giving; interventions directed at infants and families with diagnosed developmental delay or chronic illness (Shelton1999, p.118). In terms of limiting sensory overload/deprivation, NICU is perceived as overly stimulating relative to natural uterine environment. Minimizing the effects of the NICU, advocates of this approach suggest minimal handling and reduction of sensory input. The protection from possible hazard such as bright lighting is perceived to minimize the stress response and subsequently promote enhanced stability and tolerance of handling (Phillips 2003, p.84) The stress signals of the autonomic system entail aspects such as bowel strain, cough, sneeze, or yawn, tremor, twitch, or startle, respiratory pause, gasping, or sighing. Stress signals of the motor system encompass aspects such as hyper-flexion, protective manoeuvres, gape face, and fixed and stereotypical postures. Newborn developmental care yield significant outcome improvements indicated by fewer days on the ventilator, shorter hospital stay, early feeding success, a reduction within the number of complications, enhanced neuro-developmental outcomes during the initial eighteen months of life, and enhanced parent/infant bonding (Ricci and Kyle 2009, p.720). Advancements registered in neonatal intensive care have largely enhanced the survival rates of premature infants within the last two decades. It is essential to highlight the non-verbal language of the premature infant signs of stress such as colour changes, change in heart rate, yawning, open and gaping mouth, change in breathing rate and pattern, hiccupping, extended limbs, and squirming. The signs of stability encompass: stable colour, consistent heart rate, regular breathing pattern, hand on face, sucking, smiling, hand to mouth, relaxed tone and posture, and clear sleep states. The newborn period remain distinctively distinguished by the inseparable relationship between a mother and her infant. To facilitate the formation of an attachment to built, infants need to be close to their mothers to prompt their needs and mothers need to be close to respond to them. The process of reciprocity is adaptive as the mother discovers to recognize her infants’ cues, adapt to her behaviours and responses and satisfy the needs of her infant. Parents with an infant in the newborn intensive care unit (NICU) experience numerous feelings of anxiety, depression, stress, and loss of control and they fluctuate between feelings of inclusion and exclusion relayed to the provision of healthcare (Ricci and Kyle 2009, p.721). Nursing interventions that facilitate positive psychosocial outcomes are necessary to minimize parental feelings of stress, loss of control, and anxiety. Mothers of infants requiring exceptional care start their experience parenthood in the unusual and intimidating environment of the environment of the newborn intensive care unit (NICU) that may yield in delayed maternal attachment. Studies indicate that newborns that are born ill and separated from their mothers, and separated from their mothers are predisposed to disturbances within the development of maternal newborn attachment (Carpenito-Moyet 2007, p.10). Early separation of the infant from parent heightens strain on the infant-parent relationship, especially in cases of lengthy stays within the NICU since parents need to be capable to see, hold, and touch their newborn so as to facilitate early attachment and bonding. The hospitalization and infant ill health usually interrupt the natural bonding between a mother and the newborn. This can lead to significant stress and influence the mother-infant relationship and their capability to bond reciprocally. In the arena of mother-infant interaction, breastfeeding and participation within routine care has been found to enhance mother’s maternal role, inclusion and confidence, and feelings of closeness (Shelton1999, p.117). In the arena of nurse mother interaction, nurses who avail psychosocial support and actively communicated and engaged with mothers have been found to assist in the development of positive and trustful relationships. Intrinsic within the practice of paediatric critical care nursing centres on aiding families to endure the stressful and unspeakable experience of an infant’s or child’s critical illness. This humanistic facet of practice is critical to guarantee that families can continue to function in vitally significant roles that are therapeutic to families, as well as their critically ill children (Timby 2009, p.916). Family-centred care remains presently conceived as “best practice” within paediatric healthcare settings. The critical tenet of family-centred care details that the family remain constantly in the child’s life and eventually holds the responsibility for guaranteeing that the child’s physical, social, and emotional needs are satisfied. Some of the beliefs and behaviours critical for parent-professional partnerships encompass a presumption of and respect for the intrinsic capabilities and strengths of families; a commitment to and valuing of diversity; a capability to communicate and share information in ways that are affirming and functional; treating others with dignity and respect; capability to build on family strengths to improve feelings of control and independence; and, a capability to avail assistance in a manner that match family priorities (Timby 2009, p.917). #2 The nature, causation, consequences and management of diseases and conditions associated with intensive care All expectant parents anticipate that their babies will be healthy; however, sometimes problems arise that demand that a newborn to be hospitalized. Babies may be sent to NICU in the event that: the babies are born prematurely, experience of difficulties during the delivery of the babies, and in cases where the babies show signs of a problem within the first few days of life (Boxwell 2010, p.16). In most cases, only young babies (babies with a condition associated with premature births) who have not gone home from the hospital after their birth are treated in the NICU. The length of the period in which the babies remain within the NICU hinges on the acuteness of the condition. Some of the common diseases and conditions associated with intensive care include: Anaemia Babies who are anaemic may manifest symptoms such as high heart rate, low blood pressure, have apnea and appear sleepy. Premature infants may develop anaemia for diverse reasons: failure to make many fresh blood cells. Moreover, their red blood cells usually manifest a shorter life compared to adults. In full-term or pre-term babies, haemolytic disease of the newborn incorporating the incompatibility between the blood forms of the mother and the baby can also yield to anaemia (Roberton and South 2006, p.323). A physician can diagnose anaemia with a blood count or blood test. The treatment of anaemia for premature babies who weigh less than 2.2 pounds may require re blood transfusions. The doctors may also seek to treat the underpinning cause of the anaemia. Apnoea Although, is normal for an individual to experience occasional pauses during breathing, newborns who do not take at least one breath in 20 minutes manifest a condition referred to as apnoea. Amid an apnoea spell: the baby stops breathing, the heart rate may slow down, and the skin may turn pale, blue, or purplish owing to lack of oxygen(Roberton and South 2006, p.700) . Apnoea mainly caused by immaturity within the area of the brain that controls the drive to breathe (whereby the brain does not “remember” to take a breath). In the NICU, every premature baby remains closely monitored for apnoea spells. The first mode of treatment for apnoea entails stimulating the baby to aid remembers to breathe. This can entail rubbing the baby’s back or tapping feet. Nevertheless, when apnoea manifest frequently, the baby may necessitate medication (usually caffeine) or the utilization of a nasal device that blows a gradual stream of air into the airways to maintain them open. Bradycardia Bradycardia refers to an abnormal slowing of the heart rate, which emanates from other problems such as low oxygen levels within the blood or apnoea (Roberton and South 2006, p.517). Bradycardia remains diagnosed by taking the baby’s pulse and monitoring within the NICU. Bradycardia is treated by dealing with the underpinning cause such as apnoea. In some infrequent cases, a heart defect may be responsible for the slowed heart rate. For the suitable care, babies born with a heart defect should be taken to a paediatric cardiologist. Bronchopulmonary Dysplasia (BPD) Babies requiring oxygen prior to their original due date conceived to have bronchopulmonary dysplasia, a chronic lung disease in infants. BDP occurs in various infants for diverse reasons. The blend of the premature baby’s immature lungs and utilization of the treatments (inclusive of oxygen and machines) to aid the infant’s breathing may render damage (or scarring) to the lungs (Roberton and South 2006, p.476). Infections and pneumonia can also yield to the condition; however, as babies mature, they are able to grow more lung tissue that can enhance their breathing over time. The diagnosis of BDP mainly does not occur till 2-4 weeks into the infant’s life. Bronchopulmonary dysplasia is occasionally treated with steroids to minimize the amount of scarring; nevertheless, based on the fact that steroid can yield side effects, physicians usually mainly wait as long as possible to start steroid treatment. Other commonly utilized medicines entail diuretics that aid in eliminating excess fluid that can build up within the damaged lungs and bronchodilators that relax the muscles enveloping the airways and allow them to open up. Hydrocephalus Hydrocephalus refers to the build up of cerebral spinal fluid that envelops the brain and the spinal cord. Hydrocephalus manifests when something (bleeding from an intraventricular hemorrhage or a deformity of the brain or skull) obstructs the flow of the fluid (Roberton and South 2006, p.575). The buildup of the fluid can create pressure that can render damage to the brain. Hydrocephalus is suspected is an infant manifests a large head or if the head size grows rapidly. A magnetic resonance imaging can be employed to establish a suspicion of hydrocephalus. Less serious cases of hydrocephalus are mainly treated by simply monitoring, although, severe cases may require the placement of a tube within the brain that drains the fluid. Intraventrical Hemorrhage (IVH) Intraventricular hemorrhage refers to the bleeding within the brain. Severe cases of IVH may lead to a drop in blood pressure or even seizures. Other symptoms of IVH encompass a weak suck, high-pitched cry, anaemia, apnoea, and bradycardia. IVH mainly manifests in premature babies based on the fact that their vessels within their developing brains are essentially fragile and can easily bleed (Feigin 2004, p.880). There is no distinct treatment for intraventricular haemorrhage, and NICU attempt to prevent it by controlling the infant’s blood pressure. The other common conditions entail jaundice representing yellowing of the skin and whitening of the eyes in a newborn. The yellow colour emanates from the presence of bilirubin produced when red blood cells age and are broken down by the body by the liver. Jaundice is common in premature babies with immature organs and babies with different blood type from their mothers (Boxwell 2010, p.23). High levels of jaundice can be harmful given that they can lead to brain damage. The treatment of Jaundice encompasses phototherapy to breakdown the bilirubin within the skin and exchange transfusion in case of harmful levels of bilirubin. #3 Appropriate Practice Developments in the light of Current Research findings Nursing Care and Management of Newborn There are a number of challenges that have been highlighted as impacting significantly on nursing practice, especially for nurses working within the maternal-newborn arena: integration and expansion of midwifery and family-centred models of care, decrease in the utilization of unnecessary or questionable-benefit technology, integration of research into practice, patient and family teaching, employment of technology as an adjunct to developmental care, the urge for comprehensive breastfeeding education and support, developmental care as continuum incorporating women’s health promotion, and culturally competence care (Daniels 2004, p.408). Three prominent areas of research have been identified in neonatal care in availing necessary care for premature babies, namely: parent’s experiences of having their premature baby; services and facilities presently accessible to parents by neonatal units; and, effective interventions for communication, support, and information (Daniels 2004, p.407). The transition from foetus to newborn demands intervention by a skilled healthcare provider in close to 10% of the deliveries. Perinatal asphyxia and severe prematurity form complications of pregnancy that often necessitate complex resuscitation by skilled personnel. The establishment and maintenance of respirations forms a critical need that must be satisfied immediately (Kenner and Lott 2007, p.489). Establishing and maintaining the newborn’s airway based on the common characteristics of newborn respirations such as irregular rate, breathing altered by external stimuli, and periods of apnoea that are less than 15 second is normal. The second nursing care and management of newborns within the first 6 hours after birth entail maintenance of body temperature since an infant is extremely vulnerable to heat loss based on the fact that the body surface area is substantial relative to body weight, and the infant has comparatively little subcutaneous weight. It is also essential to identify the infant after delivery prior to leaving the delivery room. It is also critical to establish parent-infant bonding process as the first step within the process of attraction between the parents and the newborn (Coughlin, Gibbins and Hoath 2009, p.2239). Postnatal care for all newborns should entail immediate and exclusive breastfeeding, warming of the infant, timely identification of danger signs with referral and treatment, and hygienic care of the umbilical cord. Since most of the newborn deaths occur among low birth weight babies, the care of the baby after six hours should also encompass extra care of low birth weight newborns for breastfeeding, warmth, and early highlighting of danger signs. Nevertheless, less consistent attention has been awarded to the non-clinical issues and the manner in which they affect a family’s journey via neonatal care and their experience of the transfer from hospital to home. Family-centred care within a neonatal unit entails healthcare professionals actively taking into account parental feelings to have a pre-term or sick child, and working within a policy environment in enhancing the family’s experience (Curley and Moloney-Harmon 2001, p.8). It is essential to keep mothers and babies together after birth. Mothers and babies usually share a natural instinct to be close at birth after birth. Holding the baby skin-to-skin bear numerous benefits as it makes breastfeeding easy and enhances bonding. This is also critical in enabling the baby to stay warm and cry less. Babies cared for within the hospital nursery usually cry more and may have more trouble breastfeeding. Systematic reviews have established that interventions to enhance information provision, and support for parents and enhance parent’s involvement within their babies’ care can have a significant impact on a parent’s confidence, parenting behaviour, and wellbeing of the family (Kenner and Lott 2007, p.489). A number of interventions have been established to have a positive influence, namely: skin-to-skin care (kangaroo care), support for breastfeeding, provision of concise information regarding their baby’s condition, and education centring on the baby’s developmental needs and behavioural cues. Findings from research outline a range of interventions that can contribute to family-centred care: an educational behavioural intervention program can enhance parent’s mental health outcomes, minimize mean length of stay in NICU (-3.9days), and overall hospital length of stay (-3.8 days) (Melnyk, et al, 2001, p.273). Kangaroo care can minimize maternal anxiety, and enhance a mother’s sense of competence and sensitivity toward her infant (Tessier, et al, 1998, p17). #4 The Legal, Professional and Ethical Responsibilities with Current Practice on the Nursing Care and Management within the first 6 hours After Birth Newborns may experience life-threatening conditions such as brain injury or congenital brain abnormalities can arise. These conditions demand careful individual assessment prior to any decision making. Delivering care that matches to the standards of practice for nursing safeguards both the patient and the nurses. Legally, nurses are held accountable to deliver care in a way that any reasonable nurse would render in the same or equivalent circumstances (Obeidat, Bond and Callister 2009, p.23). Nursing standards are grounded in nursing practice acts, court decisions, and nursing organizations that avail specialty certifications. Majority of legal actions against nurses arises because a patient or patient advocate asserts that the nurse contravened a standard of care and the said breach yielded in harm to the patient (Timby 2009, p.915). The primary concern centres on adhering to seven key principles, namely: administer medications properly; monitor for and report deterioration; communicate effectively; delegate responsibly; document in an accurate, timely manner; knowing and following facility policies and procedures; and, proper utilization of equipment (Sally 2008, p.34). The nurse, in all professional relationships, is expected to practice with compassion and respect for the intrinsic dignity, distinctiveness of each person, and respect for the worth of every person. The nurse’s central commitment centres on the patient by respecting the primacy of the patient’s interest, maintain professional boundaries, avoid conflict of interests, and the right to self determination (Roussel, Swansburg and Swansburg 2006, p.10). Similarly, the nurse is expected to promote, advocate for, and strive to safeguard the health, liberties, and safety of the patient. In doing so, nurses are expected to respect the patient’s privacy and confidentiality. The nurse is responsible and accountable for individual nursing practice and outlines the suitable delegation of tasks consistent with the nurse’s obligation of tasks consistent with the nurse’s responsibility to avail optimum patient care (Montgomery 2001, p.31). The nurse is expected to establish, maintain, and enhance health care environments and conditions of employment beneficial to the provision of quality healthcare. A critical question that confront those engaged in critical care decision making centres on addressing concerns the value they place on the life of foetus or a newborn baby. The other ethical issue centres on withholding and withdrawing treatment and deliberate action to terminate life. This also centres on the extent to which parents are consulted in advance regarding the initiation of intensive care. The present practice in the majority of neonatal units’ centres on resuscitating a baby if the result is uncertain and to launch intensive care till the outlook is apparent. The legal obligation centres of availing suitable care that does not necessarily encompass admission to a neonatal intensive care unit (Murray and Huelsmann 2009, p.10). Newborns should not be subjected to intensive interventions that are unlikely to yield any benefit, and that may cause suffering. The complex reality of decision making for newborns in their first six hours details that there may be ethical issues. The assessment of best interests is highly dependent on the certain situations of each case that should be conveyed in the decision-making process (Crenshaw 2007, p.39). The other ethical issue centres on the sanctity of life in which the core question does not centre on whether the child’s life is worth living, but how best the newborn’s life should be respected. For instance, nurses would be required to make a decision of resuscitation with a possibility of survival and disability. The initial assessment of whether a baby may survive, minimal attention is awarded to the potential pain and distress for the newborn caused by a period of unsuccessful intensive care. Conclusion The key elements incorporated into policy and practice entail the recognition that the family remains the constant bedrock within the child’s life. This makes it critical to facilitate family-professional collaboration at all facets of hospital, home, and community care: care of the individual child, policy formulations, and program development, evaluation, implementation, and evolution. The other key elements encompass exchanging complete and unbiased information between professionals and families in a supportive manner at all times. This should be guided by incorporation of policy into practice based on appreciation and honouring of cultural diversity, strengths, and individuality across families. References List Boxwell, G. (2010). Neonatal intensive care nursing, Oxon, Routledge. pp.16-19. Carpenito-Moyet, L. J. (2007). Nursing diagnosis: application to clinical practice, Philadelphia, Lippincott Williams & Wilkins.pp.10-11. Coughlin, M., Gibbins, S. & Hoath, S. (2009). Core measures for developmentally supportive care neonatal intensive care units: Theory, precedence and practice, J Adv Nurs. 65 (10), pp.2239-2248. Crenshaw, J. (2007). Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding, The Journal of Perinatal Education 16 (3), pp.39-43. Curley, M. & Moloney-Harmon, P. (2001). Critical nursing of infants and children, New York, W. B. Saunders Company. pp.8-14. Daniels, R. (2004). Nursing fundamentals caring & clinical decision making,Australia, Delmar Learning. pp.407-408. Feigin, R. D. (2004). Textbook of pediatric infectious diseases, Philadelphia, Saunders. pp.880 Kenner, C., & Lott, J. W. (2007). Comprehensive neonatal nursing: an interdisciplinary approach,St. Louis, MO, Saunders Elsevier. pp.489. Melnyk, B. M., et al., (2001). Improving cognitive development of low-birth-weight premature infants with the COPE program: a pilot study of the benefit of early NICU intervention with mothers, Research in Nursing & Health 24 (1), pp.373-89. Montgomery, K. S. (2001). Maternal-newborn nursing: Thirteen challenges that influence excellence in practice, The Journal of Perinatal Education 10 (1), pp.31-40. Murray, M., & Huelsmann, G. (2009). Labor and delivery nursing: a guide to evidence-based practice, New York, Springer. pp.10-13. Obeidat, H. M., Bond, E. A. & Callister, L. C. (2009). The parental experience of having an infant in the newborn intensive care unit, J. Perinat Educ. 18 (3), pp.23-29. Phillips, C. R. (2003). Family-centered maternity care, Boston, Jones and Bartlett Pub. pp.84. Ricci, S. S., & Kyle, T. (2009). Maternity and pediatric nursing, Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. pp.720. Roberton, D. M., & South, M. J. (2006). Practical paediatrics, Edinburgh, Churchill Livingstone/Elsevier. pp.320-702. Roussel, L., Swansburg, R. J., & Swansburg, R. C. (2006). Management and leadership for nurse administrators, Sudbury, Jones and Bartlett. pp.338. Sally, A. (2008). Seven legal tips for nursing practice, Nursing 38 (3), pp.34-39. Shelton, T. L. (1999). Family-centered care in pediatric practice: when and how? J Dev Behav Pediatr 20 (1), pp.117-118. Tessier, R., et al., (1998). Kangaroo mother care and the bonding hypothesis, Pediatrics 102 (1), pp.17. Timby, B. K. (2009). Fundamental nursing skills and concepts, Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. pp.915. Read More