NR 451 Discussion The Clinical Question

The systematic review that I chose was obstetrics with a focus on skin to skin care. I currently work on a pediatric unit where NAS babies are transferred after they are stable following birth. I have seen many children sit on this unit for a month too two months going through withdrawal. These children have myoclonic tremors, increased muscle tone, inconsolable irritability, and an overall rough start in life. Most of these children don’t have a high parental involvement; but I was wondering what the affects would be on their weaning process if they had daily skin to skin. I want to know if their negative symptoms would dissipate faster, would they come off the drugs faster, and would their overall health improve quicker allowing them to either go home or be placed in foster care. I believe it is important to my current practice because we have a large population of mothers that go through the methadone clinic in town. If we found a way to improve family centered care while simultaneously shortening the weaning process for the infant and minimizing withdrawal symptoms it could mean the difference between these babies staying with us for a few weeks compared to a few months. “:Newborns with moderate to severe NAS are typically treated with oral opioids, and then weaned over days to weeks. Pharmacologically treated NAS is prolonged and costly, with lengths of stay of 2 to 12 weeks and estimated charges of $90 000 per admission (Holmes et al).” Research practice gap is when there is evidence based research supporting a specific practice but it hasn’t been implemented into actual patient care.

Holmes, A. V., Atwood, E. C., Whalen, B., Beliveau, J., Jarvis, J. D., Matulis, J. C., & Ralston, S. L. (2016). Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost. Pediatrics,137(6). doi:10.1542/peds.2015-2929

I think all of us at one time or another has certainly asked our selves…There has to be a better way of doing this. In this discussion you need to choose a systematic review from the topics provided in the class resources that is pertinent to your current or past practice. Remember you will not really be expected to implement the practice, just how you would start the process. For instance, CAUTI or catheter associated urinary tract infections are a major problem in the hospital. In surgical patients especially. When I worked on the surgical floor years ago, I was made aware of the non sterile catheter insertion procedure done in pre-op. The staff would just pour a little water over the peri area and insert. We had some raging post op UTIs needless to say even when the Foley was removed on day one.

Follow the steps above in your discussion question and tell us some of your stories of research-practice gaps. Your capstone project one is fill out the Practice Issue and Evidence Summary Worksheet on your chosen systematic review. Please review your posting requirements You should have one initial post and 2 posts to 2 different class mates.

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I encourage all of you to use one of the systematic reviews provided in the class resources section, this is a starting point and not the only reference you should use, it is just a start your research. If there is another topic you would like to use, you must have a systematic review that covers that topic. The systematic review must be used as one of your references but other references will certainly be necessary. Also, please come to the questions and answer web-ex I’m having next week. It is posted in the announcements.
Happy posting!

I’m not pediatric or OB oriented but the theory of “healing touch” is one that I am familiar with. This is such a sad situation for both baby and parents and I have heard that it is getting worse all over the country with the epidemic of inappropriate opioid use. I nursing self would say that yes skin to skin contact would help these babies recover faster and at least comfort them in their struggle to withdraw. According to Artigas, V. 2015, supportive care such as aromatherapy massage therapy, music therapy as well as skin-to-skin contact have been shown to promote weight gain and feeding tolerance, increased sleep cycles and decreased neurologic symptoms. It make sense that healing touch and providing a sense of security for the infant would decrease the affects of NAS especially considering Erickson’s stages of psychosocial development- an infant would be at the stage of Trust vs. Mistrust. Feeling safe and protected at the infant stage would promote trust.

Artigas, V. (2014). Clinical Practice: Management of Neonatal Abstinence Syndrome in the Newborn Nursery. Nursing For Women’S Health, 18509-514. doi:10.1111/1751-486X.12163

Very interesting, at our facility we manage these infants in NICU setting. I will say that our NAS taskforce have recently researched infant massage in NAS infants to use as non pharmaceutical approach for these infants. We are also looking to see if this could in conjunction with music therapy, cuddling, and possible aroma therapy may decrease the initiation of meds and aid in the weaning process to get these infants home sooner. These are actually my “niche” patients, I enjoy caring for NAS infants and their families, although as you know, it can be challenging. In addition, look into the “ESC” model. This is a new approach to care that replacing the Finnegan scoring model and simply evaluates if the infant can eat a minimal amount, sleep at least one hour at a time, and be consoled within a 15 minute period medications are withheld. Enjoy the research process! I look forward to following your progress as this is a subject of great interest to me as well.

Professor, this is true in many cases. What we are seeing is that most of these parents have not been educated on what to expect after delivery for the infant. They have no idea that a prescribed medication they are taking and the physician is aware of, leads to a 6-8 week hospitalization for the baby. They feel very uninformed and lots of guilt. Our taskforce has suggested a “referral” for these patients taking SSRI to talk with NICU personnel about the process before delivery, as well as receive brochure about NAS and what they can do to help the process. For many, rooming in would be possible if they have time to make arrangement for children, talk to close family members that may be willing to assist. When they are unprepared, and family are questioning why the infant is in hospital , it often leads to feeling that it needs to be a “secret” . These families shun their support system, instead of being able to utilize them, because of feelings of shame and guilt. This is why educating this patient population is vital.

I found your post to be interesting. When I initially decided to go into the field of nursing, my plan was to be a neonatal nurse. I thought that my love for babies would make it the perfect career for me. I would get paid to “play” with babies all day. I soon found that I was not able to handle neonatal nursing. I could not separate myself from the children when I walked out of the doors of the hospital. My heart bled for the children, especially those who had no parental involvement.

I can’t imagine working with infants who have Neonatal Abstinence Syndrome. “It is estimated that 5% to 10% of pregnant women abuse drugs during pregnancy, not including alcohol” (Maguire & Passmore, 2012). These statistics are astounding. One out of ten to one out of twenty babies are born to women abusing drugs, with most neonates beginning to showing withdrawal symptoms within the first two to three days. It is hard to imagine the ethical issues surrounding sending these infants home to known drug abusers.

Thank you for caring for these little ones.

Reference:

Maguire, D., & Passmore, D. (2012). NICU Nurses’ Lived Experience Caring for Infants With Neonatal Abstinence Syndrome. Retrieved September 8, 2017, from https://wwwLinks to an external site..researchgate.net/profile/Denise_Maguire/publication/230829215_NICU_Nurses%27_Lived_Experience_Caring_for_Infants_With_Neonatal_Abstinence_Syndrome/links/00b49533479ca8d38c000000.pdfLinks to an external site.

We actually have a huge Methadone clinic here due to the high abuse. It is extremely hard to get into the program, but if you are pregnant you go to the front of the line. After looking at a few studies it looks like this is common practice. “Women who sought out methadone maintenance treatment when they were pregnant had no difficulty enrolling in a clinic. Women who were not pregnant when seeking treatment were not so successful (Stone).” So essentially we aren’t necessarily willing to treat an addict but if they are carrying a baby why not. I guess that a huge part of me wants to believe that people can be better and we should give them the benefit of the doubt, which can be very hard when you’re watching an innocent baby seizing multiple times a day. I just think that if we try to treat the moms as moms and integrate them into the treatment of their newborns we might have a better chance of healing both of them.

Resource

Stone, R. (2015, February 12). Pregnant women and substance use: fear, stigma, and barriers to care. Retrieved September 10, 2017, from https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5

I have never experienced working in a long term care setting and am curious to see your results. Would you perceive the air mattresses to be cost effective? What are your facilities current Patient Safety Practice for preventing pressure ulcers? In an acute care facility I worked for, 500-600 beds, they bought Hill-Rom Advanta 2 Med-Surg beds for every unit except ICU. It was in response to the Joint Commission 2008 patient safety goals of preventing Pressure Ulcers. And the CMS rule that if a pressure ulcer were obtained at the acute care setting, they (hospital) would not get paid. These beds have a motor and rotate small amounts of air to relieve pressure. But they are not air mattresses. Some patients hated them and requested they be turned off and some wanted information on how to purchase one. If needed we could order a P500 air mattress if patients had been admitted with a PU or developed one at the facility. It didn’t seem to matter what mattress that some patients were on they developed a PU. “Age, immobility, incontinence, inadequate nutrition, sensory deficiency, multiple comorbidities, circulatory abnormalities, and dehydration are a handful of the more than 100 factors that have been identified as placing adults at risk for developing PUs.2,34 In addition to having many risk factors, PUs can develop very quickly. PUs have been documented as developing in just an hour.” (Sullivan, N, 2013) This is scary, especially since most residents of nursing homes have high comorbidities. I am very curious to follow your research.

Reference:

Sullivan N. Preventing In-Facility Pressure Ulcers. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. (Evidence Reports/Technology Assessments, No. 211.) Chapter 21. Available from: https://www.ncbi.nlm.nih.gov/books/NBK133388/

NR 451 Discussion The Clinical Question