Improving Neonatal Intensive Care Unit Practices
Organizational Structure
The infrastructure has the correct dimensions, thus allowing the adaptation of respiratory equipment, such as infusion pumps and incubators. There are even some seats to accommodate parents in the unit. Currently, the unit has 14 incubators, and it is expected that 4 more may be added in the future. Of the 14 incubators available, 2 are in isolated boxes, separate from other incubators but located within the same NICU. Within the unit, there is an office, a room stocked with pharmacy supplies, and a room for soiled materials. There is also a nursing station where monitored infants can be observed. The offices for both the supervisor and physicians are located outside the unit but adjacent to a hallway.
Features
It is worth noting that in the summer, hired nurses undergo a one-week training course. In this unit, there is no designated charge nurse, but efforts are made to keep the same nurse with the same infant(s) as much as possible. Therefore, if a nurse or an aide has been caring for infants in incubators 1 and 2, they will continue caring for the same infants the next day (on any shift).
Methods
All techniques performed on the neonates in this unit are regulated. Some examples include infant hygiene, cleaning of the incubators, and metabolic screening. Entry to the nursery is restricted to healthcare workers; family members entering must wear a green gown over their clothes and perform thorough handwashing. Notably, infant health checks are conducted at night to encourage sleep.
SWOT Analysis
Weaknesses
- Lack of communication between health professionals.
- Lack of skills in reporting on the care that families should provide to their infants.
- Time restrictions and lack of flexibility on the part of health personnel.
Threats
- Risk of losing the holistic view of the patient (focusing only on the pathology).
- Lack of coordination between health professionals from the hospital and primary care.
Strengths
- Well-trained professionals.
- Adequate physical and occupational structure.
- Nursing care focused on patient (newborn) care.
- Use of appropriate language.
Opportunities
- Promote health education.
- Enhance professional development.
- Apply modern and well-developed management methods.
- Potential for nurses to pursue a doctorate in nursing or become a pediatric nurse practitioner.
- Costs covered by society.
Proposed Improvements
Three actions are proposed to address the issues and encourage active participation and communication by the nursing staff:
- Ensure feedback to verify that parents understand the information provided.
- Conduct workshops led by the nursing staff for parents, where physical or visual contact is maintained.
- Provide a suggestion box or notebook for improvements to the unit or medical staff.
Leadership
Manager Leadership Among Nurses in the Unit
Yes, there is leadership. The leadership exercised by the supervisor is democratic, where all nurses in the unit contribute their ideas, and the most beneficial ideas are selected for implementation. It’s important to emphasize that whenever a change is proposed in the unit, the personal opinion of each nurse is considered to determine if they support the proposal. Therefore, the unit operates with a strong emphasis on teamwork.
Problem: Mother-Child Bond Disruption
The problem is the potential for disruption of the mother-child bond due to the strict visitation schedule in the unit. This problem was chosen because, from a nursing perspective, we consider the baby a biopsychosocial being with needs and the ability to feel. Parents are the main pillar of development and growth for the newborn. Therefore, we recognize that the strict visitation schedule can disrupt this crucial bond.
Proposed Interventions
Skin-to-skin contact (which improves heart rate, temperature, blood glucose, the immune system, sleep, weight gain, and neonatal brain maturation) and breastfeeding (the best food for the newborn, which also constitutes intimate contact between mother and child and significantly contributes to the bond between them, which is crucial for infant development) allow for optimal adaptation of the newborn to the extrauterine environment.
Vision for the Unit
Imagine a room for each baby, where parents could stay as long as they wanted and come and go freely, promoting privacy. Each room could be equipped with a couch and a bed. Other alternative therapies could be implemented to reduce the stress of staying in the NICU, such as music therapy, which has been shown to decrease pain, anxiety, and stress.