Neonatal Intensive Care Nursing

Glenys Boxwell (Connolly), Julia Petty, Lisa Kaiser, Glenys Boxwell (Connolly), Julia Petty, Lisa Kaiser

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351367486
• Edition: 3
• Topic: Médecine
• Subtopic: Prestation de soins de santé

Thoroughly revised and updated, this new edition of Neonatal Intensive Care Nursing is a comprehensive, evidence-based text for nurses and allied health professionals caring for sick newborn infants.

This user-friendly text focuses on the common problems and related care occurring within the neonatal specialty. All previous chapters have been thoroughly updated and new content includes chapters on, for example, organisation of neonatal care, assessment of the neonate, the premature and low birth weight neonate as well as palliative care. In addition, the book now includes a broad and in-depth web-based companion comprising online resources, case studies with answer guides and learning activities. This accessible and interactive approach enables nurses to recognise, rationalise and understand clinical problems using an evidence-based approach. Divided into four parts, the book provides an overview of neonatal care, and a detailed look at the physical and emotional wellbeing of neonate and family, a range of clinical aspects of neonatal care, and key practices and procedures.

Neonatal Intensive Care Nursing will be essential reading for both new and experienced nurses, allied health professionals and students learning about neonatal care including those undertaking qualifications in the neonatal specialism and pre-registration students taking relevant modules or placements.

PART 1

AN OVERVIEW OF NEONATAL CARE

An overview of neonatal care: The parent voice

Going into neonatal care was like entering another world. The highs and lows and hurdles along the way. We went from intensive care to high dependency and then to special care but then had to go back again to intensive care when he got an infection. Everything seemed to start all over again … the uncertainty and another bumpy ride.

He then got transferred to another hospital for his heart which was very different, and we returned three days later.

Eventually, we were transferred back to our home unit, another new experience, but it was still weeks before we could finally go home.

Going home was a like a miracle almost – we couldn’t believe the day had finally arrived. It was difficult and so daunting, but we knew it had to happen and we had to cope without the pillars of the neonatal staff supporting us.

Of all the different transitions though the different parts of the neonatal unit and the different hospitals, going home was the hardest step for the first couple of years. He needed to be re-admitted a couple of times with infections and breathing problems.

But we got there and can look back at the challenges, knowing that he overcame them all.

Voice of a mother of a 24-week gestation baby, Tom (pseudonym), who spent four months in neonatal care within three different hospitals.

Adapted from Petty et al., 2019a; 2019b
See chapter 4 reference list for full citations.

1Organisation of neonatal care

Heather Maxwell and Katie O’Connell-Binns

Contents

Guidance on how to enhance personal learning from this chapter

Introduction and background

Categories of neonatal care

Transitional care

Special care

High dependency care

Intensive care

Levels of service provision

Neonatal transport

The role of operational delivery networks

Staffing of neonatal units

The neonatal nurse

Education and continuous professional development

Career progression

Extended nursing roles

Neonatal outreach nurse

Enhanced Neonatal Nurse Practitioner (ENNP)

Advanced Neonatal Nurse Practitioner (ANNP)

Neonatal Nurse Consultant

The multidisciplinary team

Pharmacy

Dietetics

Radiography

Occupational therapy

Physiotherapy

Speech and language therapy

Psychological support

Conclusion

Case studies

Web-based resources

References

Guidance on how to enhance personal learning from this chapter

Key points covered in this chapter

■Definitions of the different care categories infants fall under within neonatal services, and the structure of neonatal care in the United Kingdom (UK).

■Neonatal nursing education, continuous professional development and career progression.

■Various roles of the multidisciplinary team and their contribution to a baby’s journey through the neonatal unit.

Reflection

Reading through the chapter, you are encouraged to engage with the key points and related literature in an enquiring way. Ask these questions:

■Why are categories of care important and how do they impact on the planning and delivery of neonatal care?

■What are the advantages of extended and enhanced nursing roles? Do they form part of your unit’s structure?

■Which specialities of the multidisciplinary team are available for your unit, and how can they benefit your patients?

Implications for nursing care

■Finally: this chapter should facilitate your understanding of how neonatal care is organised in the UK. Consider how you can contribute towards the effectiveness of your own neonatal network, and what this means for the individual babies you look after on a day-to-day basis.

Introduction and background

Approximately 750,000 babies are born in England, Scotland and Wales each year. Of these, 95,000, or 1 in 8 of these infants, will be admitted to a neonatal unit (Royal College of Paediatrics and Child Heath (RCPCH), 2018a), while in Northern Ireland 1,800 babies are born prematurely or sick, requiring care in one of NIs’ seven neonatal units (TinyLife and Bliss, 2018). Neonatology is a relatively small speciality but, owing to continual medical advancements, the survival rates of small, sick and extremely premature babies have improved. Numerous stakeholders from national organisations and government bodies, such as the National Institute for Health and Care Excellence (NICE), Department of Health (DH), British Association of Perinatal Medicine (BAPM), Neonatal Nurses Association (NNA), Royal College of Nursing (RCN), Scottish Neonatal Nurses Group (SNNG), Bliss and TinyLife among others, help shape neonatal care and provide guidance and support for staff and families. Recently, the new National Health Service (NHS) plan (NHS, 2019) lays out recommendations for neonatal and maternity care moving forward for the next ten years. This chapter will explore how neonatal services are structured and coordinated in the UK by outlining the BAPM Categories of Care and levels of service provision, describing the function of operational delivery networks (ODN), and finally examining the role of the neonatal nurse and the multidisciplinary team.

Categories of neonatal care

Newborn infants are admitted to the neonatal unit (NNU) for a variety of clinical conditions and treatment, including having been born too early, having a low birth weight or a medical or surgical condition that needs specialist treatment (RCPCH, 2018a). These will determine the levels of care different infants require, and thus the staff who may safely look after them. In 2011 BAPM defined criteria for four categories of care for neonatal patients to ensure every baby is assigned appropriate care levels. These are transitional care, special care, high dependency care and intensive care. Throughout an infant’s stay within neonatal services, the category of care may vary due to changes in their condition, e.g. clinical improvement or deterioration (NHS Improvement, 2018).

Transitional care

The concept of transitional care (TC) was originally developed by Whitby (1983) and has proven its value by preventing unnecessary separation of mother and baby (Duddridge, 2001; Miah, 2013; Battersby et al., 2017). It serves infants who require support but do not require NNU admission (see p. 6 for criteria), until they may be discharged home. This model confers benefits such as reduced length of stay on the NNU, allowing for optimised use of neonatal cots, improved parental confidence, bonding, establishment of breastfeeding with higher success rates and an overall improvement of the family experience including promotion of sibling bonds (Duddridge, 2001; BAPM, 2017). As reported by Boyle et al. (2015) in a paper on late and moderately preterm infants, a substantial amount of specialist input is provided in postnatal wards, beyond normal newborn care. Therefore, appropriate expertise and early planning are essential if such infants are managed away from specialised neonatal settings.

TC can be delivered in two service models: on a dedicated TC ward, or within a postnatal ward and is facilitated via close cooperation of neonatal and midwifery staff. This may include maternity care assistants, nursery nurses and other nursing support roles. In either case, the mother must be resident and caring for her baby as the primary caregiver. The mother is supported with care activities above those required normally (BAPM, 2017).

Criteria for TC could include:

■Prematurity (≥34 weeks or ≥33 weeks if discharged from the neonatal unit)

■Low birth weight (but >1600 grams)

■Nasogastric tube feeding (≥3 hourly)

■Babies on IV antibiotics, if otherwi...