Term Paper on "Neonatal Nurse Practitioner"

Term Paper 8 pages (2438 words) Sources: 3 Style: APA

[EXCERPT] . . . .

Neonatal Nurse Practitioner

Historical Background. Neonatal refers to the first six weeks after birth (Jones 2004, Nursing 2000). Neonatology or neonatal care is, thus, the medical specialty in taking care of newborns, sick and premature babies. Neonatal nurses specialize in helping these babies survive and successfully live through the first 28 days of life. This kind of care requires the artful combination of high-tech and "high-touch" skills from these nurses. It has been available in specialized nurseries and intensive care units for infants since the 60s and has been evolving. It will be recalled that the late U.S. President John F. Kennedy's son, Patrick Bouvier Kennedy, was born prematurely and underdeveloped in 1963. If the current level of neonatal were available at that time, the baby should have survived. Modern neonatal care enables prematurely born infants with as little as 22 or 23 weeks out of the normal 40 to survive (Jones, Nursing). The reported sudden death or relapse of an infant in1978 drew heightened attention to the coping needs of parents as significant stressors. This and other stressors, such as conflict about life and death, emphasized the involvement of neonatal nurses in the care of critically ill or dying infants (Engler 2004). Technological advances account for the increased capability of neonatal care to save the lives of premature infants. Statistics revealed that there are roughly 40,000 low birth weight infants born yearly in the U.S. Typical neonatal intensive care units or NICUs no longer consider most of these infants critically ill and beyond help. Most of them are doing well in most of these NICUs, the rest of these babies treated for hyperbilirunemia, a condition leading to jaundice, or for infections or recovering from surgery (Jones 2004).

The need for nurses to specialize on neonatal care in the 70s created that specialty, which combined high technology and high touch in order to help problem infants to survive (Jones 2004). Under the regionalization plan in the 80s, premature or very ill newborns would be transferred to the nearest center for this kind of care. This transport included the assessment of the infant's condition, stabilization, and the provision of continuous high-level care. The neonatal nurse was an integral member of the transport team and the role of the transport nurse evolved from it (Jones).

A neonatal staff nurse works at a level I, II or III nursery (Jones 2004). Level I nursery is for healthy newborns. Mothers and their babies at present often share the same room because they stay only briefly in hospitals. Level II nursery is an intermediate or special care nursery for premature or ill babies. These babies may need supplemental oxygen, intravenous treatment, specialized feedings, or more time to mature before they are discharged from the hospital. And Level III is a neonatal intensive care unit or NICU for newborns in the first six weeks of life who cannot be treated at either Level I or II nursery. Babies at the NICU may be too small for their age, premature, or ill but full-term infants who need high-technology care. This care may require ventilators, special equipment, incubators, or surgery. NICUs are generally found in large general hospitals or in specialized children's hospitals. Neonatal nurse practitioners directly provide that care needed by these infants (Jones).

Components of the Neonatal Nurse Practitioner

These role components in a typical hospital include practice, educator, consultancy and role modeling through professional growth and development (Creech 2005). The neonatal nurse practitioner or NNP extends direct neonatal patient care, works with six neonatalogists, attends all in-house high-risk deliveries, and provides resuscitation and stabilization management of all high-risk neonatal transports. She uses the case management model of care in her practice, manages a certain case load average on a monthly basis, manages the tiny baby population, works with advanced technology, takes charge of these special infants from admission to discharge, collaborates with the attending physician in implementing the plan o care, performs different invasive procedures, participates in family discussions, focuses on family communication and coordination, maintains an internal neonatal database, provides orientation and formal educational programs on neonatal service, and participates in fund-generating fund projects or activities (Creech).

Research Findings on the Development of the Role of NPNs recent study on the perceptions of NPNs and other nurses managing critically ill or dying infants in NICUs showed that they were comfortable with their role and involvement with the infants' family in this difficult time (Engler 2004). These NPNs perceived and placed greater weight on the family's need of them than the expectation of their peers or the administrative personnel. Those who spent more years at NICUs expressed greater capability in handling the situation, although most of them had no adequate training or preparation in bereavement or end-of-life care. Most of the respondents considered caring for the dying infant, the actual death, and cultural differences as influential or determining factors in their involvement with the infant's family. The findings, therefore, emphasized the importance of providing education and training to these nurses on bereavement or end-of-life care and cultural competence in nursing curricula (Engler).

Parents of critically ill or dying infants needed and wanted compassionate support from their infants' caregiver during very painful or stressful time (Engler 2004). The respondents filled that need by allowing the family members to hold the dying infant; by participating in grief conferences with the family and other caregivers; and by sitting and listening to family members' outpour of grief. This time of deep grief was also stressful for the NNP. She may need to discuss difficult topics, like autopsy and organ donation, with the family. The NNP at Level 3 NICU was more comfortable caring for critically ill and/or dying infants and their families than those without the policy or experience. And language or cultural barrier also significantly affected the level of the NNP's involvement with the patient's family. She needed to learn their language to explain how to use a certain device or equipment, how the infant looked like, and what her name was. Over and above, providing this care was done on a daily basis as something both necessary and desirable. This act of giving of the self was what gave the family a voice in its infant's care and where the NNP asserted great impact (Engler).

Professional Organization of NNPs

The National Organization of Neonatal Nurses or NANN is the organization of NNPs and the professional voice that shapes their practice (2006). Its vision is to improve the lives of all newborns, infants, and their families through excellence in neonatal nursing practice, education, research and professional development. It is guided by a Code of Ethics in making this contribution. Its fundamental principles bind members to recognize the worth, dignity and rights of patients and their family; use knowledge and skills for the advancement of human welfare and respect for individual differences; assume their primary responsibility towards the patient's well-being; recognize family autonomy and its right to accurate, complete and understandable information for decision-making; respect the patient's rights to privacy and confidentiality; maintain professional integrity in resolving conflicts; serve with competency and accountability; and assume responsibility for their own professional advancement (NNAN).

Ethical and Policy Issues

Nurses, NNPs in particular, confront two categories of ethical or moral diagnoses (Kopala 2005). One directly relates to the conflict, constituting an ethical dilemma. The other when a barrier stands on the way of an ethical choice. This situation is called moral distress. An ethical dilemma occurs when the decision-maker is stalled by conflicting alternatives or when one course of action seems right and wrong at the same time. Certain moral obligations require the patient to perform, or restrain him from performing, a particular course of action. He or she must carefully weigh and reflect the consequences and bases for alternatives or options. He may seek valued opinions, such a nursing diagnosis, or make the choice alone. On the other hand, barriers to a choice in ethical or moral action may be internal, external, institutional or situational. The NNP or neonatal nurse practitioner may directly help the patient or the family in appraising the situation through the "values clarification" NANDA-developed diagnosis. She may consult with other health care providers by using "multidisciplinary care conference," which will include the family. She may also invite an ethicist or form an ethics committee, which will assure the patient's rights are protected. In case of moral distress, the nurse may directly address or confront the barrier, teach or encourage the patient to take action or help the patient to remove the barrier to a decision on the course of action (Kopala).

Impact of Health Promotion and Disease Prevention on the Role of NNPs

Technological advances have been immensely enabling. Through them, healthcare professionals have been able to offer new treatment alternatives in addition or to supplement traditional ones (Kopala 2004). These technologies and wonder medicines have saved the lives of tiny babies and extended the lives of people with chronic illnesses. They have reduced prolonging life or… READ MORE

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