I scampered through the hallways at Dartmouth Hospital searching for a sign to direct me towards the neonatal intensive care unit (NICU). My heart was racing knowing that I was walking into the experience completely empty handed. When I found the unit, I walked into a huddle of nurses going over the day’s census. I was assigned to a nurse who had the most severe and critical case on the unit. This was a full term baby, 40 weeks and 1 day. Though the charting from the hospital where he was born was not completely clear, it is said that the fetus was experiencing bradycardia for 17 minutes at 50bpm. This otherwise known low-risk pregnancy quickly turned into a STAT C-section. When the baby was delivered its ABGAR scores were 0, 0, and 3. The baby was intubated, put on a cardiac and brain monitor, and rushed to the Dartmouth NICU. An umbilical line and a venous line were all drawn to gain access to the circulation to hydrate and nourish. An arterial line was drawn because frequent blood gases were needed. As you can imagine, like I had, this baby looked like an experimental nursing tool.
When I first saw him he looked as though he was fake. He had lines and tubes going in and coming out of every possible place on the body. He was hooked up to the EEG monitor to record his brain waves because it had been showing signs of abscence seizures. The baby had no swallowing reflex so frequent suctioning was crucial. When I arrived I was told that the baby would be going down to get an MRI to determine if in fact there was little to no brain activity. The results of the MRI would help develop a prognosis for the baby. Doctors had mentioned to the parents at the time of birth that this baby was seriously deprived of oxygen and the outcome did not look great. By the end of the shift I had met the parents and the grandmother who were all extremely devastated about their situation and inevitable need to make a decision. The parents were told that they could take the baby off the ventilator “now” and provide comfort measures until the baby passes. The biggest issue that the nurse was concerned about was if they wait too long to exubate the baby, then his body could possibly develop the ability to breath on its own, but will most likely never be able to live a normal life. This was a tragedy and the feeling of helplessness drowned me as I watched the parents and loved ones cry in disbelief and confusion.
The predicament of my experience was figuring out how to answer a question that is never easy in the health care setting. After a series of meetings with the providers, the mother came up to me with a look of desperation and asked, “Honestly, what would you do in this situation?” She stood there staring at her son with reddened eyes and tears dripping down her face. I was in shock at what she had just asked me that I had to take a step back and think silently. Fortunately for me, the nurse intervened and answered very professionally while still being empathetic. As the mother walked away to speak to the doctor again, I couldn’t help imagine myself in the nurses’ situation having to answer a question like that. A situation like this one is not uncommon in a NICU. It raises many questions about the procedures taking place in the NICU and the support and teaching parents receive. Based on the literature, it is said that in a neonatal intensive care unit (NICU), parents rely primarily on communication with health care providers when making descions about their childs care. In general, parents want to know as much information as possible about their child’s condition. The nurses role in assisting parents surrounding decision making for their infants is as followed; provide emotional support, give information, and meet the physical care needs of mothers, infants, and fathers. It is thought that all of these behaviors help to create a caring environment that is necessary for parents surrounding descision making (Kavanaugh, Moro, Savage, 2010). Another study reported that conflicts between families and health care providers about whether to continue or withdraw life support for critcally ill infants are not uncommon and often result from inadequate communication (Kopelman, 2006). Parents face the challenge of comprehending the medical information provided to them and using the information to decide whether they should allow their child to live or die. It is evident that health-care professionals, especially nurses, play a central role in supporting the parents in descion making. A strong relationship with parents of infants in the NICU is built on good communication and trust. When health-care providers show compassion and manifest caring behaviors for the infant, parents are more likely to trust the information given to them. Trust allows parents to move forward with decisions about care for their infant, feeling condifent that they are making the right choice (Ward, 2005).
After reviewing the literature and thinking about the situation I had been in I realized how important the nurses relationship with the parents of a NICU baby is. If I were the nurse in the following case I would be sure to explain all the medical information in layman’s terms. It would be important for me to take all the time needed with the parents to answer questions and brainstorm them as well. I would hope that the parents would feel as though I was their gateway to the medical jargon and a main player on their support team. After learning more about these critical types of situations, I propose a response to the question that was asked by the mother. I would say, “Honestly Ms._________, I am not entirely sure…. You are experiencing an extremely tough situation that needs to be well thought out. I want you to know that I am here for you and your family as support in decision making so please ask me any questions about the care for you son/daughter and I would be happy to try and answer them”. The response would show some honesty to make it known that I too am human and have feelings towards the situation but would also foster a supportive and trustworthy relationship. Having gone through a descional analysis for a critical situation, it is become apparent that processing and reflecting on challenging experiences in your nursing career is a beneficial tool in learning how to become a better nurse.

Resources

Martin, Gilbert L. "The Apgar Score." Pediatrics 11.4 (2006): 1444-447. Print.
Kavanaugh K, Moro T.T. , Savage A. “How Nurses Assist Parents Regarding Life Support Decisions for Extremely Premature Infants” J Obstet Gyncol Neonatal Nurs. Author manuscript. (2010); 39(2): 147–158. [PubMed]
Kopelman A. E. “Understanding, avoiding, and resolving end-of-life conflicts in the NICU” The Mount Sinai Journal of Medicine, New York. 2006;73(3):580–586. [PubMed]
Ward F. R., “Parents and professionals in the NICU: Communication within the context of ethical decision making—An integrative review” Neonatal Network.2005;24(3):25–33. [PubMed]