SPECIALIST NEONATAL NURSE

Specialist Neonatal Nurse

Specialist Neonatal Nurse

Introduction

The Neonatal Services practice is so highly specialized that there are no relevant Trust nursing practice policies or procedures. Consequently all nursing practice is guided by local NPG documents.

The current documents which were under review had little evidentiary support. McKenna & Hsiu-Yueh (1998) suggest that currently only 10% of nursing practice is based on sound evidence and that 50% would be the best that can be achieved. The overall aims for defining the evidence base within the documents were that research must be included and utilized if appropriate and relevant, with the judgements regarding evidence being made by those staff writing them.

Managing the change to documentation

The strategy for managing the change implicit within this project was the 'normative/re-educative approach' (Cutliffe & Bassett 1997). This method is based on the need for people to be involved in all aspects of a change if it is to be accepted by them and become part of their culture. Ownership of the outcome of the change makes it more likely to be sustained.

The criteria for recruitment of the 22 nursing staff involved in writing the new documents were based on the following principles: having a special interest in a topic (including being a member of a practice focus group), being qualified in speciality, and having undergone relevant level 2 or 3 academic study.

For any change to happen there must be a change agent. In the case of this project the author in her role as project co-ordinator acted as the change agent by having the initial vision of what may be achieved, being the instigator of the change to documentation and being in control of the process (Torrington & Weightman 1994).

The initiation and management of this process of change involved a system of education and communication including:

Co-ordination with senior nursing staff.

Introducing the concept of changes to documentation via staff education forums.

Involving staff in change.

Solving time management issues.

Ongoing identified support from Co-ordinator and Practice Development Sister.

The clinical practice environment

The NICU identified within this analysis is part of a regional referral Neonatal Service consisting of 22 cots, 18 of which are designated for intensive and high dependency care (level 1 and 2 intensive care) and four for special care (level 3). Nursing staff will be called upon, within their daily workload to care for intensive care babies who, for example, may be less than 27 weeks gestation, receiving assisted ventilation, with a birthweight of less than 1000 g; require major emergency surgery; or may be caring for a baby and his/her family on the day of his/her death (BAPM 1992).

Nurses work a 12-h shift system, with two x 30 minute overlap periods every 24 h. They give 24 h bedside care to an individual or group of babies and their families. Within the course of a shift they may also be called upon to be a team member stabilizing and retrieving a baby from another hospital ...