Part II
And Finally, Maguire and colleagues also reported on the care of NAS infants and found three areas somewhat similar to the last two reports. The team reported concern that the NICU nurses had about caring for the infants, working with families, and sending the infants back with the families.
The NICU nurses were especially frustrated about not being able to console the uncontrollable crying of the NAS infants. They often suggested feeling useless and unable to cope. The nurses did not appreciate the degree of skill needed to calm the NAS infants. They were under the impression that sleep would ease the withdrawal cycle.
This particular issue, sleep, became the focus of a complaint by one of the mothers upon her visit to see her baby.
The nurse, Karen, was assigned to care for NAS patient baby Jack in the NICU unit. Jack had been receiving clonidine and morphine at four-hour intervals until it was decided that he should be weaned off the medication.
Jack’s body began to react immediately. His NAS scores started to increase. He became irritable and cried uncontrollably. Karen tried every method in her arsenal but was unable to stop his crying. She fed him before he started crying. Then she swaddled him, gave him a pacifier, and rocked him but to no avail. Finally, Jack, completely exhausted, fell asleep.
When Karen entered another room to check on a patient she again heard Jack’s frantic crying. She immediately notified the neonatologist that Jack’s score was up to 12 (1-5 is a normal range). After describing Jack’s symptoms she was ordered to give Jack an increased dose of morphine.
Even with the morphine, Karen was unable to calm Jack. This time she described feelings of frustration and that the sound of his crying gave her a feeling of being useless. She said it sounded painful. She thought of the NAS wards that seemed to be filling up with more patients each day.
She thought that for some reason she seemed to be assigned to more and more NAS cases. She resented being a “baby rocker” when she had been trained to care for infants on high-frequency ventilation.
Finally, Jack fell asleep just as his mother came to visit. Karen gave her an update on Jack’s NAS scores and his need for an increased morphine dose. Then Karen suggested to his mother that after his traumatic afternoon he should be allowed to sleep.
Karen’s Suggestion Was Not Well Received
Jack’s mother took offense at Karen’s suggestion saying that she did not come all this way and not be able to hold her baby. She went ahead and held him briefly then, just before she left, complained that he must be hungry because he is crying. Jack, of course, was unable to eat as he was so distraught.
Karen’s mood turned from frustration to anger at her disbelief that babies are sent home to their parents who are obviously unable to care for them.
She tried to get help, but none was available. At the same time, the nurse in charge told Karen that a new patient was being assigned to her. Karen was told that her patients were considered very stable, even though the nurse in charge failed to recognize his intense needs or the stress Karen has been experiencing.
Just as Karen’s new patient arrives, Karen can hear Jack’s unrelenting crying. Then she learns that another mother has complained that Karen has been inattentive to her child. At that moment Karen left work emotionally drained and exhausted only to begin again the next morning.
Yet Nurses Are Still Dedicated
The authors show that nurses still have a strong attachment to these infants despite having to cope with their families. Discharging the infants to their homes was particularly disturbing to the nurses. They expressed their concerns about abuse, mothers seemingly unable to care for the infant, and the long-term issues that may arise.
Check out the original story here.
