Implementation of a Perinatal Hospice Program.

BACKGROUND: In 2017, the Nebraska Unicameral passed legislative bill 506, which required physicians to inform patients carrying fetuses diagnosed with a life-limiting anomaly of the option to enroll in a comprehensive perinatal hospice program. The bill also required the Department of Health & Human Services to provide information about statewide hospice programs. Families enrolled in hospice programs are better prepared for the birth and death of their child. This large academic medical center was listed on the registry but did not have a formal perinatal hospice program. PURPOSE: Implementation of a comprehensive perinatal hospice program. METHODS: The program was designed and implemented, beginning with the formation of an interdisciplinary team. Guidelines were developed for program referral, care conferences, team communication, and family follow-up. The team was educated. Electronic record documentation and order set were implemented. A data collection process was developed to track referrals and critical data points. RESULTS: The perinatal hospice program has been accepting referrals but has not had any qualifying referrals. IMPLICATIONS FOR PRACTICE: The development of an evidence-based guideline for referral that can improve referral consistency. While trisomy 13 and 18 diagnosis was historically considered life-limiting, these families now have the option of full intervention and transfer for specialists. IMPLICATIONS FOR RESEARCH: Future research will include collecting data from patients who could have benefited from hospice, including infants who were born 20 to 22 weeks, or for maternal reasons. Future research will evaluate the experience after bereavement, the hospice team's experience, and the effectiveness of the referral process.

Development and Evaluation of a Radiation Safety Program in the NICU.

PURPOSE: To develop and evaluate a radiation safety program used to educate NICU staff regarding safety procedures to minimize the effects of radiation on the newborn.
Background: Advancements in medical care have resulted in infants born at lower gestational ages and higher acuity. With increased acuity comes an increase in diagnostic testing, including radiologic imaging. Although x-rays are necessary, they do not come without risk, including the future development of cancers.
Methods: The number of x-rays completed in the NICU over a one-year period, was evaluated prior to the radiation safety program, directly after implementation, and five years postintervention.
Results: Prior to the radiation safety program, the mean number of x-rays was 4.2 per patient per NICU admission. Immediately after implementation, the mean decreased to 3.8 per patient, and five years postintervention, the mean significantly decreased to 1.9 x-rays per patient per NICU stay.

The lived experience of nurses caring for newborns with sepsis.

OBJECTIVE: To describe the lived experience of nurses who care for newborns with sepsis. DESIGN: Phenomenology, a qualitative study using open-ended, tape-recorded interviews, followed by a focus group discussion. The data were analyzed using Colaizzi's step-by-step procedure, resulting in an essential structure of the experience. SETTING: The nursery and neonatal intensive-care unit of a large community hospital in the southwestern United States. PARTICIPANTS: Eleven registered nurses who cared for newborns in both a transitional nursery and the neonatal intensive-care unit were interviewed individually or in a focus group. RESULTS: Three major themes were generated from the data: (a) "Dealing With Death and the Blessings of Life," (b) "Sepsis: The Cancer in the NICU," and (c) "Losing the Dream: Parents' Reactions." The nurses had feelings of helplessness and frustration while caring for these sick newborns. Nurses described the changes in newborns' condition as sepsis developed, the actions taken to reverse the downhill course, and the experiencing of the outcome. Nurses perceived that parents responded with overwhelming fear, guilt, and loss of control. CONCLUSIONS: The nurse caring for the infant with sepsis experiences many different emotions, reactions, and perceptions. These findings can assist nurses to have a better understanding of the role of the nurse and the emotional burden of working in the NICU.