The concept of Synergy can be applied to the practice of nursing by means of education and service. To obtain Synergy in nursing the nurse’s knowledge and skills are able to meet the individual needs of the patient population that is presented. Currently in Western Pennsylvania, there is a rising number maternal substance abuse during pregnancy. This epidemic in turn creates a different type of population in infants than other areas of the Neonatal Intensive Care Unit (NICU), with specific healthcare needs.
One area that is lacking synergy is the care of this rising patient population of infants suffering from Neonatal Abstinence Syndrome (NAS). This creates a gap between nursing education and clinical application. Due to the rise in NAS infants it is important for nurses to be educated in proper care for an infant presenting with this diagnosis, symptom management, communication skills, and the fundamental knowledge Neonatal Abstinence Syndrome. Poor patient outcomes can be caused by a lack of understanding addiction.
The Vermont Oxford Network states, “Fear of stigmatization, discrimination, child removal, poor treatment, and criminal prosecution has deterred women from seeking care. However, the research suggests that providing substance dependent women with comprehensive healthcare, drug and alcohol abuse treatment, and social support improves pregnancy, birth, and child development outcomes. ” (Horbar, Soll & Buus-Frank, 2013) When the infant is admitted into the acute care setting, the care needs of these patients should focus less on the immediate outcome, and more on what will create the greatest good for each patient as an individual.
There is an essential need for the development of collaborative solutions for care and education in the healthcare setting for the care of this rising population. Often this would be to provide care with a realistic goal of maintaining optimal levels of comfort with minimal side effects of withdraw. “About 40% of infants who exhibit withdrawal symptoms can be treated without medication. ” (White, 2013) Nurses who take time to ensure a level of comfort will help to alleviate symptoms of NAS withdraw and also help support the family in their infant’s care.
In addition to providing comfort will help decrease the need to be medicated for withdraw and ultimately will lead to a shorter hospitalization. The manager of a Neonatal Intensive Care Unit will need to address this issue and implement change in order to improve patient outcomes. The competencies that make up the Synergy model are clinical judgment, advocacy and moral agency, caring practices, facilitation of learning, collaboration, systems thinking, response to diversity, and clinical inquiry.
For the NAS population advocacy, clinical judgment, caring practices and facilitation of learning are most important. Advocacy proposes the nurse to serve as a moral agent to work on the infant’s behalf in order to provide the greatest good to help resolve concerns that are both clinical and ethical. Clinical judgment is the ability for the nurse to take on the leadership role to care for their patient. Infants are unable to make healthcare decisions; the nurse must consider the parent’s wishes and what the result the nurses’ actions will yield for this infant.
These actions must positively contribute to their plan of care overall. Caring practices creates a compassionate and therapeutic environment for each the patients, recognizing the unique needs of each infant. The nurse acts as a facilitator of learning when he/she incorporates the understanding of the infant’s family into the care. The Synergy mode includes patient characteristics, which are, resiliency, vulnerability, stability, complexity, resource availability, participation in care and decision-making and predictability.
For the NAS population the patient characteristics would immediately associate complexity, vulnerability, and participation in care and decision-making. Complexity as referred to as to the multitude of symptoms that are to be considered for proper care of the patient. These infants are unable communicate pain, symptoms needs, and what their desire’s are. For example, these infant’s cry and are inconsolable until the nurse goes through a trial and error until he/she figures out the needs of the child. They do not understand what is happening to them.
Vulnerability includes the stressors that these patients will be exposed to that may affect outcomes. The infants depend on the decisions their families and healthcare professionals. Increased length of hospital stay can lead to problems that may decline in their already compromised condition, for example, infection. Lastly, the NAS patients are vulnerable due to the fact that they are unable to make their own healthcare decisions and have to depend on parents and healthcare providers to be speak on their behalf.
The parents participate in care as they receive information and help assist in the care for their child. Analyze the Case Nursing education places emphasis on clinical presentation, physical stressors and conditions that affect the patient and their associated treatments. Increased education is needed for nurses on the postpartum and NICU units about the treatment for this specific patient population. With the increase in drug dependent mothers there seems to be little nursing education provided on postpartum and NICU nursing units about the care for these infants, and this issue needs to be addressed.
“Infants with NAS have higher rates of neonatal complications, prolonged lengths of stay and consume substantial NICU and hospital resources. Further, they impose a growing burden on already strained healthcare resources because state Medicaid expenditures are disproportionately impacted. ” (Horbar, Soll & Buus-Frank, 2013) The administration and education team needs to identify this problem and incorporate teaching and updated research on these units. One competency that lacks synergy in the nursing care of the NAS population is collaboration.
“Collaboration enhances the capacity of a group and increases the potential for success. ” (Hardin & Kaplow, p. 75, 2005) It is not uncommon when different discipline areas such as the nurse, doctor, social worker etc. identify different goals for the patient. Poor communication causes the team to not work in unison to collaborate and work towards a common goal. “A key to collaboration is the communication that must exist between the patient, family, and health care team members as well as among members of the health care team.
Another synergy lacking competency would be caring practices, which is the unique nursing care provided to the patient and families. Within the NAS population nurses have to recognize the differences and incorporated them into the infants care. Having compassion and creating a calming environment help provide comfort in a therapeutic environment. Often times the NAS population is considered as level II care, this allows for the nurses to take on a multiple patient assignment of three to five infants at a time.
The NAS population is unique; they require much coddling and almost constant attention from the nurse. Having greater than three patients causes a great disadvantage to these children due to the nurse having to spread herself thin to meet the basic needs of feeding, changing and medicating, the nurse does not have adequate time to rock and soothe the infants causing greater withdraw symptoms. The rational decision-making model will help identify and implement the appropriate changes that are essential in optimizing care for the NAS population.
Improvement in the education of the healthcare staff will create better patient outcomes. This decision making process includes three steps to achieve this objective: identify possible outcomes, determine probability of each outcome, and take action with the highest probability to achieve a positive outcome. The considered actions are increased in-person training, mandatory review of printed materials, or an on-line training course. The greatest positive outcome would come from increased in-person training. Create a Change Proposal
Part of the nursing orientation for staff will be to participate in a class specified for the training related to care of the NAS infant prior to working in the NICU. Written material as well as a presentation will be provided. The attending physician will make a statement about services provided to the NAS infant, medications and important facts that the physician would like in report. For the staff nurses’ senior nursing projects are assigned yearly and are presented to maintain their status on the unit. Assigning NAS care to a few nurses each year will keep the most up to date research on the unit.
These nurses will participate in Internet presentations that focus on quality, safety and care for infants and families of and NAS infant. Finally, a staff member from the social work team will join and present his/her role in the case of a NAS infant. The unit will provide CEU’s for this training. This proposal will affect the unit internally by involving the management team and multiple staff disciplines. The management team will help aid in this proposal by providing a day that is designated this additional training and appoint the appropriate nursing, physician and social work staff to participate in running the program.
Finally obtaining CEU’s approved by the state board of nurses to offer education credits for after the completion of training. The designated nurses assigned to NAS as a senior project must keep up to date with the training information prior to the class of new staff, doing so will ensure they are prepared for questions that may arise. With this proposal the staff has the potential to increase the patient stability, outcome and satisfaction. Also this proposal will be aimed to help the nurses caring for NAS infants to promote patient care through evidenced based research.
A change model that applies to this proposal would be the Lewin’s change model. This model is based on unfreezing, moving, and refreezing. First the unfreezing stage, the current beliefs and ideas will change with the desired outcome. The health care team will sufficiently identify the epidemic and need for changes in care for the NAS infant, inspiring the education and treatments needed to move the staff towards bettering practices. Lastly, refreezing, the nursing staff will have a new outlook or attitude towards NAS infants.
Changes in the treatment process will be instituted based on the staff’s new outlook. Having the knowledge and resources for the care of the NAS infant will allow the care team to handle each unique case with evidenced based approach. Along with any type of change there will always be positive and negative outcomes on the environment. Positive outcomes will include an influx in nursing knowledge, better patient outcomes and an increased amount of resources for the staff.
Negative outcomes may include not having the adequate amount of staff to run this program and the biases formed by individuals prior to participating in this class. A way to follow up with the care provided to these patients and their families would be an optional survey completed by the families allowing the unit to see their strengths and weaknesses. The survey will allow for improvement of care. “Nurses who have confidence in their ability to positively impact maternal parenting behaviors through education and skill building may impact patient care outcomes.
It is imperative that the management and supervisors recognize the issues that nurse’s experience when caring for NAS infants. Educating staff will allow for a balance of practice and the nurses actions. Instituting this educational program will provide synergy to the NICU units and the epidemic of withdraw infants. The unit directors will be able to see that the changes to the unit and education instituted has worked when NAS infants have a shorter hospital stay, a decrease in the use of morphine and phenobarbital and finally patient/parental and nurse satisfaction.
In conclusion, with the epidemic of substance abuse mothers on the rise it is imperative that neonatal nursing units properly educate their staff about the treatment and care of NAS infants. With the changes proposed in this case the care of this specific population will be enhanced. These infants are very fragile and require a lot of special attention. The proper care and education could make the world of a difference in a baby’s life.