The Neonatal Integrative Developmental Care Model

After the delivery, the heat from the mom’s body can warm the baby and maintains the baby’s body temperature. For instance, when nursing students were at the operating room at Saint Peter’s Hospital during the C-section delivery, as soon as the baby was out, the doctor placed the newborn on the mother’s chest. When the mother was alert and awake during the C-section made it possible for the baby to stay on her chest on the first hours after the birth. It was one of the most beautiful moments in life. Nevertheless, there was another C-section birth of diabetic mother. She was not fully awake during the C-section and the doctor only did not promote skin-to-skin mother and the newborn. The doctors and nurses at Saint Peter’s Hospital support and encourage skin-to-skin for mother and newborn right after the birth if there is no complication on mother or baby or when the condition is possible. Saint Peter’s Hospital has policy for vaginal delivery, “all infants that meet the criteria for initiate skin-to-skin care shall have skin-to-skin care implemented as the standard of care immediately after birth and as needed thereafter regardless of feeding preference”. They promote skin-to-skin contact between mother and baby immediately after delivery. However, mothers and babies have a physiologic need to be together during the minutes, hours, and days following birth, and this time together significantly improves maternal and newborn outcomes.

Family nursing is not all about patient centered care, it is focused on the needs of the family as a whole (Nursing theory). The main goal for family nursing is to improve any health concerns by assessing the needs,problems,influences, and strentghs of the family (Journal of nursing). There are four four types of approaches to family nursing. The four types of approaches to family nursing are, family as context, family as client, family as system, and family as component of society (the book). The purpose of this paper is to define, discuss, and give examples of the four types of approaches to family nursing.

My plan and dissemination and implementation for my capstone project is to educate the nurses on the importance of teaching parents about the proper use of skin-to-skin contact. I plan on implementing this project by providing the nurses with the latest evidence based practice so that they can help implement this in their education in the NICU unit at Mount Sinai. Nurses are viewed as reliable source by the patient therefore it is important for us to implement good quality teaching. When I present this project to the unit I will make the following recommendations: to examine and reinforce the education among nurses in the unit and to encourage parents to attend a two hour hands on training course before discharge on skin-to-skin contact.

In 2002, Engler et al. conducted a descriptive study surveying nurse managers in all hospitals across the United States that were identified as providing neonatal intensive care services. Their survey found that over 80% of respondents acknowledged use of skin-to-skin contact or kangaroo care (KC) in their neonatal intensive care units (NICUs), and that these respondent felt knowledgeable about KC. However, reluctance by nurses, physicians, and families to initiate or participate in KC over perceived safety concerns for the infant was shown to be a major barrier to the regular implementation of KC in the NICU (Engler et al., 2002). As Engler et al.’s study provides the most comprehensive data on this subject to date, we conclude that safety concerns continue to be a major barrier to the use of KC in NICUs across the

For much of the earlier part of the 20th century, it was assumed that the newborn infant was a “blank slate” and the care of the newborn seemed to reflect this assumption. It is believed that one of the most important advances

“Family centered care is the delivery of safe, satisfying, high-quality health care that focuses on and adapts to the physical and psychosocial needs of the family. It is a cooperative effort between the family and their caregivers and recognizes and uses the strengths and integrity of the family” (Hammerstrand & Loewen, 2013, p. 9). According to Kuo et al. (2012), family centered care has surpassed the basic client/health care provider relationship, FCC encompasses the needs of the entire family as an entity. Benefits that have been noted include knowledge increase from the patient’s perspective, better self-care, and self-esteem of the caregivers, which lead to better outcomes for the child involved (Kuo et al., 2012). Harrison (2010) mentions that families want a partnership based relationship with health professionals, but the nurses are still finding it difficult to implement the approach in practice. Research has been done regarding FCC, but outcomes and delivery of FCC remain underdeveloped. All levels of healthcare delivery should be examined when researching FCC, but tertiary care seems to be the main level of care studied. More research needs to be done on the effects of FCC in all areas of healthcare (Harrison, 2010). FCC can be further broken down into eight core concepts, I will discuss four.

Family nursing, developed with the intent of improving children’s healthcare, is a shift from the traditional patriarchal method of delivering care to a partnership among family members (Wells, 2011). In order to implement family-centered care, the nurse must explore the dynamics in which the patient’s family operates. A major concern relating to this method of nursing was that nurses simply did not have time to speak with patients’ family members and still complete the tasks they were responsible for (Wright & Leahey, 1999). In response to this concern, Wright and Leahey developed the 15-minute Family Interview.

Play, in the NICU setting, was quite different than the general hospital floors, as the patients should not be exposed to substantial amounts of stimuli, noise, or light. The general goal of the NICU is to permit the infants to grow and develop in an appropriate environment. Despite the variances, I incorporated play into my delivery of care in four ways – therapeutic touch, toys, movement, and communication. Therapeutic touch played a major component in the NICU, as these infants still desire the security and comfort that their mother’s womb provided. With healthy infants, tapping or softly rubbing an arm would be appropriate, but these actions could overstimulate infants in the NICU, as their brains still needs time to develop. Rather, therapeutic touch entails firmly placing your hand on the infant’s body, creating a sense of security and closure.

When did children become the center of attention of medicine? Children became a big focus point of medicine in 18th century Europe. The pediatric career then came about during the early 19th century, and became taught in the mid 19th century (“Pediatrician Career Information”). So what exactly is a pediatrician? The American Academy of Pediatrics defines a pediatrician as “Pediatrics is the specialty of medical science concerned with the physical, mental, and social health of children from birth to young adulthood. Pediatric care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases” (“Definition”). A pediatrician, a very important and needed job today, treats and diagnoses children. In order to properly

The research I conducted on the subject of early skin to skin care between mother and infant states overwhelmingly that whether or not the mother is breastfeeding, early skin to skin contact has numerous benefits. The fact that this evidence based practice is not implemented for the families admitted to a facility is very concerning, however, as a nurse I’m able to understand how this practice could be shunned by staff regardless of the many benefits for mother and neonate. Time constraints, lack of training, and education, coupled with nursing shortages are the reasons that pop out to me for not implementing this time sensitive care for the patients on a birthing unit.

In my previous experience, I was used to the practice of holding neonates anytime I wanted. It was accepted to disturb their sleep in order to provide cares and do procedures. Minimal handling was only implemented for extremely premature babies. When I was exposed to the neonatal unit here in the UK, I was surprised that the practice was very different. Minimal handling is implemented on all babies, nesting is done, the room is kept quiet and the lights are dimmed to ensure that the neonates are not disturbed and are getting enough sleep. I felt uneasy not being able to touch the babies as much. It made me feel that I was not being an efficient carer. So, I kept on checking the baby that I was handling and was told by my mentor to leave the baby alone and allow him to sleep. I did not understand why the practice was different. I asked my mentor about it and she told me about developmental care. That was the first time I heard about developmental care. This led me to reading about it and wanting to learn how it affects the neonates. According to Bertelle et. al. (2005), sleep is the main behaviour of premature

Several nursing theory models are available to assist the nurse in assessing and evaluating a family, creating a care plan for a family, and determining which interventions are most applicable to the family’s needs, strengths, and weaknesses. The Neuman’s Systems Model, created in 1983 by nursing theorist/educator Betty Neuman, is a theory that encompasses the family as a whole rather than focusing on the individual patient, and offers ways in which the family can react to outside stressors and return to a whole state after the stressor is gone. Newman believes that each person is a layered, multi-dimensional being and identifies methods of coping with outside stressors that include three types of interventions that help the patient and family cope with these stressors.

Placing an infant bare on the mother, skin-to-skin, has physiologic stabilizing effects (Ludington, 2015). A randomized controlled trial of skin-to-skin versus incubator care for the first six hours of life in low-birth weight infants found that all eighteen of the skin-to-skin subjects were stable within the sixth hour (Ludington, 2015).Whereas, only six of the thirteen incubator infants were stable (Ludington, 2015)

One of the first things that struck me right away after spending a day at Nemours was their belief in providing family-centered care. I immediately realized how important family-centered care was in the pediatric population, which is why I chose that to be my “AHA” moment. The illness of a child can have a traumatic effect on both families and the child. Most pediatric care facilities have adopted the philosophy of a family-centered care approach in order to

The nursing profession has come a long way since Florence Nightingale’s pioneering of the first structured nursing education programs in the hospitals of 19th century Britain. Furthermore, the profession has grown with on-going research and education; nurses continue to receive professional, standardized education and provide holistic care for each patient that they encounter. Additionally, a specialized branch of nurses, the Neonatal Intensive Care Unit (NICU) nurses are committed to the care of the smallest and most vulnerable of patients: newborn and premature infants. These highly-trained NICU nurses care for babies suffering from critical health conditions, and they function as each baby’s comforter, primary caregiver, and advocate. Moreover, Neonatal Intensive Care