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Implementing the Neonatal Assessment Nurse Role in the LDR: Improving Neonatal Outcomes While Supporting Family-Centered Care
Title: Implementing the Neonatal Assessment Nurse Role in the LDR: Improving Neonatal Outcomes While Supporting Family-Centered Care
- Identify three improvements in neonatal outcomes that are evidence-based and support non-separation of infant and mother following delivery.
- Describe a curriculum that supports competent bedside assessment and care of the neonate.
- Review pre- and post- Neonatal Assessment Nurse role implementation data related to nurse's attitudes towards infant care at the mother's bedside and change in neonatal outcomes.
Knowing the stabilization and bonding benefits of minimizing the separation of the mother-infant dyad at delivery, a nurse driven taskforce integrated the role of a Neonatal Assessment Nurse (NAN) into the care delivery process. The taskforce discovered that inconsistent care practices, anecdotally reported by the medical providers, impacted the quality of neonatal care and maternal satisfaction. The purpose of this project was to establish an innovative role designed to consistently provide transitional care at the mother’s bedside for eligible newborns. Without funding to hire additional nurses into this position, a core group of nurses from all Maternal Child Health units volunteered.
Proposed change:
Introduction of the NAN, as a dedicated clinical assignment, would positively facilitate fetal to neonatal transition; decrease separation; increase percentage of skin-to-skin experiences; improve nurses’ perspective of neonatal care; decrease NICU admissions, and improve maternal satisfaction. The NAN provides transitional care at the mother’s bedside, thus changing the current practice of conveniently transferring infants to where the work can be accomplished.
Implementation, outcomes and evaluation:
Hospital IRB approval was obtained. Strategies for NAN success included detailed role description; patient care priorities; expectations when LDR had no neonatal patients; and a decisive evaluation plan for those infants requiring non-intensive, yet supportive care and monitoring. A comprehensive process of didactic education and clinical orientation was individualized based on the nurse’s expertise along the spectrum of neonatal care. Simulation scenarios served as teaching adjuncts and reinforced evidence-based practices.
The enthusiasm of the NAN-identified nurses and creative staffing models developed by the MCH units’ charge nurses assured coverage for every shift, seven days a week.
The Caring Behaviors Inventory by Wu, Larrabee, and Putman (2006) was used pre/post NAN to gain clinical nurses’ perspective about care delivered to neonates < 4 hours of age. This tool and the survey focusing on maternal perspective were chosen because both aligned with the hospital's choice of Watson Caring Theory as the framework that currently guides nursing practice.
Implications for nursing practice:
The NAN role in LDR presents an extended benefit of having a dedicated nurse to provide neonatal care in situations when transition time requires pulse oximeter monitoring and/or additional post-stabilization assessments. With no literature available on this topic, publication of the positive results of this implementation plan will help others adopt similar roles specific to their settings.
Keywords:
neonatal assessment nurse, newborn transitional care, family-centered care