Neonatal Nursing

Neonatal Nursing

1. Code of Ethics (9), to value:

   • Quality of care
   • Respect and kindness
   • Diversity
   • Access to healthcare
   • Informed decision making
   • Safety
   • Ethical management of information
   • Promotion on healthcare in a sustainable environment

2. Professional Practice (8)(10)(11)

   • Therapeutic care
     • Prevent harm
       • Incubation being very likely for a baby less than 28 weeks gestation (7)
         • Wrap immediately in polyethylene bag for heat
     • Preserve Dignity
   • Acts ethically
     • Accepts the rights of others
     • Advocates for patients
       • Takes action against prejudice
     • Maintains professional boundaries
   • Collaborates
     • With families of patients
       • Uses appropriate communication
       • Allows time to build trust
         • Active listening
         • Empathy
       • Involves parents in all aspects of childs care
     • With co-workers
       • Facilitates group decision making
       • Adheres to infection control practices
   • Adhering to legislation
     • Documentation
     • Protecting Privacy
       • Confidentiality

3. Resuscitation (6)

   • Technique
     • Two fingers on lower sternum
     • 100 beats/min
     • 30 compressions:2 breaths
   • Oxygen saturation should be 60% at birth and 90% after 10 minutes of life
   • Stopping
     • If spontaneous circulation has not occurred
     • Usually after 10 minutes or with Doctor instruction
     • If stillborn parents must consent to an autopsy

4. Palliative care (5)

   • Accomodate requests of parents
     • Memory Box
       • Birth and death details
       • Lock of hair
       • Photographs
     • Private room
     • Religious Ceremonies
     • People to be present
   • Ethically obliged to give analgesia
     • And any other treatment to relieve pain
   • Documentation
     • If less then 28 days old
       • Medical Certificate of Cause of Perinatal Death including Confidential Medical Report of Perinatal Death
     • If more than 28 days old
       • Medical Certificate of Cause of Death
   • Coronial Review
     • Parents must consent to autopsy
     • if
       • Cause of death unknown
       • Death occurred in care of sibling

5. Neglect or Harm

   • Mandatory Notification made to Families SA (4)
     • Sections 6, 10 and 11 of the Children's Protection Act 1993 (SA) (3)
     • Reasonable suspicion based on reasonable grounds (2)
       • Has suffered or is likely to suffer psychological or physical injury
       • Being knowledgable about pre-existing conditions such as Mongolian Spots
   • Current legislation does not protect an unborn child (15)
     • Zoe's Law (1)
       • Mother hit by a car causing miscarriage in 2009
         • Driver not charged with death of child
       • proposed: recognise child as living person after 20 weeks gestation or weigh over 400 grams
       • Passed NSW lower house
     • Intent to harm unborn child may rise from
       • Shame
       • Guilt
       • Unplanned pregnancy

6. Making Treatment Decisions (12)(13)

   • Is it therapeutic?
     • Vitamin K given within 1 hour of birth to prevent hemorrhagic disease (14)
     • Heel prick screening test (14)
   • Is it within the scope of practise of the professional and the facility?
   • Has consent from parents been obtained?
     • For religious or personal beliefs parents may decline blood transfusion (15)
       • Medical Directive card should be completed to indicate accepted products
   • Has relevant legislation been met?
   • Example of Infants with opioid dependant mothers (17)
     • Develop Neonatal Abstinence Syndrome
       • Explain and involve parents in treatment
       • Administration of Morphine syrup
         • Qualified paediatrictian
           • License is valid for 60 days
         • Submit written application to Drugs of Dependancy Unit
     • Mandatory Notification to Families SA
       • Assessment by Child Protection Unit
     • Keep drug use confidential