Neonatal Musings

 

I attended the National Association of Neonatal Nurses’ conference in Phoenix a month or so ago.  There were several topics that were presented.  I thought I would review a few of those in my blog this month.  As I am just now reviewing the topics, it was remarkable how many were about supporting the nurse and family.

As we all know, supporting the nurse is important so that we can give proper support to families.  The opening session was presented by Patti Bondurant. She is currently from Texas Children’s, but has an impressive past.  She talked about nursing in general and our responsibility to keep learning.  With the changes we are seeing in health care now, the time for nurses to step up and take a more active role has come.  However, we must be properly educated to do that.  She pointed out that every other profession, both in health care and in other areas, requires at least a Master’s degree for entry into practice.  I have been a nurse for over 30 years and remember the debate about entry into practice being a Bachelor’s degree 30 years ago.  She warns that unless we make improvements in basic nursing education, nurses may not be prepared to take the position of leadership that is required of them in the new health care model.  Besides formal education, though, the ongoing continuing education is equally  important.  Many of us will be able to identify someone who, in spite of an advanced degree, is not keeping up with current knowledge and research.  Keeping up with changes in the field is very important as we see changes coming about faster and faster.  If we don’t read professional journals and attend professional conferences, these changes don’t make it into our patient care.

Several clinical topics offered good information and I’ll pick a couple to include here.  There were two projects presented, one as a poster and another as a paper presentation regarding limiting skin punctures related to IV starts.  This was also part of our project for the California Collaborative to Decrease Blood Stream Infections.  After reviewing all sources of nosocomial infection, we found an association between skin breakdown and blood stream infections.  Most of these were related to central line dressings that had lost their integrity but some occurred in infants who did not have central lines, no other obvious source for infection and did have a peripheral IV (PIV).  There are a couple of papers that demonstrate that the risk of infection related to a PIV may be as high, if not higher than infections related to a central catheter (PICC).1, 2  One of the projects presented at NANN from Pennsylvania Hospital showed a decrease in non-central line related blood stream infections, although the numbers were small before the project.  The point of the other project from a hospital in Illinois was to decrease the number of skin punctures but outcomes such as infection were not followed, simply decreasing the sticks.  This may indeed decrease infection, it would undoubtedly decrease painful experiences for the infant!  This group also mentioned efforts to decrease IV days in such ways as evaluating the continued need for intravenous therapy when it is difficult to restart an IV with formal criteria to ensure this happened.

Another area that was addressed more than once in the conference was neonatal abstinence syndrome (NAS).  There were several posters and at least one or two presentations about this topic.  It is obviously a huge issue for all of us in our clinical practice.  One of the posters states that infants diagnosed with NAS has tripled since 2000.  Some focused on recognition of the infant in withdrawal, general care, including medical management of the symptoms as well as assisting mothers who ultimately, in many cases will be caring for these infants after discharge.  The care we provide while the infants are with us, although sometimes prolonged due to the withdrawal, has little impact in their overall outcome.  The support and encouragement we can provide to whoever will be caring for the infant after discharge has more long-reaching effects.  Many studies, although difficult to do and therefore not large studies, have shown that in spite of drug exposure in utero, the environment of care (nurturing) has more impact on long term outcome.

These are just a few of the topics that were presented.  But the most encouraging topic was the last one, as it should be!  Cindy Clarke presents motivational topics often. She was asked to offer an uplifting presentation to encourage and fortify the audience to go back to their units renewed and ready to provide the support needed for families in the biggest crisis of their lives.  In one session, the audience was asked what they did to take care of themselves.  This was a session about compassion fatigue and horizontal aggression.  One nurse said getting away to the NANN conference every year is her time for rejuvenation.  She takes an extra day and comes alone to spend time at a spa then attends the conference.  This gives her time away to consider only her own needs and meet those needs before going back home, undoubtedly to family, work and other responsibilities that can suck your energy if you don’t carve out time for yourself!  And I put this in with the discussion about Ms. Clarke’s presentation because she had so many wonderful things to say about neonatal nurses, it will motivate you to face any difficult shift.  She also writes a blog and I cannot say it as good as she does because she lived the experience of having an infant in the NICU!  Read it for yourself at http://musingofthegreatblue.blogspot.com and you remember why you are in this work!  It is really about the babies and creating a family environment that supports them into productive, happy, healthy adults!

References:

1. Ainsworth SB, Clerihew L, McGuire W.  Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.  Cochrane Database Systematic Review.  2007;18(3):CD004219.

2. Parellada JA, Moise AA, Hegemeir S, Gest AL.  Percutaneous central catheters and peripheral intravenous catheters have similar infection rates in very low birth weight infants.  J Perinatol. 1999; 19(4):251-254.

 

Looking for additional reading from Sandy Beauman’s professional perspective?
View her blog entry, Believing it is Possible, about how nursing motivation for success
can impact patients in a large way:
Click here to read the full blog entry.