Baby Focused Nursing Care
Individualized care of babies by dividing baby beds among nursing staff on duty is the best policy. If possible, the same nurse should take care of the same baby every day. This way, the nurse gets a better orientation about diagnosis and clinical condition of the baby and have a better communication with the parents of the baby.
When it’s time for nursing care and clinical examinations, always start with babies that are awake or uncomfortable. Sleeping babies should not be disturbed if it can be avoided.
RESPONSIBILITIES OF THE NURSING STAFF
- Know the baby's medical history and clinical condition. Attend doctor’s rounds, and follow up on decisions made.
- Communication and education of family members: including guidance on routine care, breastfeeding, hand expression of breast milk, Kangaroo Mother Care and preparing for discharge.
- Routine care: Gentle sponge bathing of stable term babies. Routine sponge bathing is not recommended for care of ill premature infants. See own protocol for sponge bath. Weigh the baby and fill in the growth chart. Change linen and make nest if needed. Always handle all babies gently and carefully.
- Baby assessment: Assess clinical condition of baby and record it in nursing assessment sheet. Measure temperature of the neonate, monitor activity, color, heart rate, respiratory rate, capillary refill time, oxygen saturation, IV line patency and record it in nurses monitoring sheet every 2 hourly. Also document if the baby is on ventilator, CPAP, HFNC or nasal prongs.
- If on ventilator, record PIP, PEEP, FiO2
- If on CPAP, record PEEP and FiO2
- If on HFNC, record flow rate, and FiO2
- If on nasal prongs, record flow rate (should be < 2 LPM) and oxygen saturation (should not be > 95%)
- Ensure water is filled in humidifier chambers of ventilator, CPAP, or HFNC
- Inform the doctor on duty if baby’s condition changes and interventions need to be evaluated.
- Feed the baby as prescribed by the doctor, and make sure the baby has an orogastric or nasogastric tube in place if the baby is on gavage feed. After feeding is done, record feeding time, volume, type of milk and how it is given in monitoring sheet.
- Change the baby's position every 2 to 4 hours or if baby shows signs of distress. Change baby's diapers if needed and record passing of urine and stool in monitoring sheet.
- Administration of medications, and follow up on IV fluids given and documentation when tasks are done.
- House-keeping: Perform terminal disinfection of baby bed before each shifting. Biomedical waste generated should be discarded according to the existing protocols. Sterilization and disinfection of instruments used should be done routinely according to protocols.
- Taking blood samples and collect urine.
- Provide Kangaroo Mother Care and maintain a log book of KMC provided.
- Attend paper work: Growth charts, drug charts, ordering of equipment and medications, etc.
- Assist the doctor while intubating, suctioning, resuscitating or doing other procedures and require help.
References
- Practical Procedures for the Newborn Nursery
- A Manual for Physicians & Nurses. Deorari, Paul, Singhal
- Scotland and McMillan
- Neonatal Intensive Care by Merenstein & Gardner, 7th edition (2011)
- Bathing premature infants: physiological and behavioral consequences. Peters KL. Am J Crit Care. 1998 Mar;7(2):90-100
Document Information
Version: 2.0
Published: August 20, 2015
Revised by: Dr Chetan Meena, SMS Medical College, Jaipur and Neonatal Nurse Johanne M. E. Huurnink
Contributors: Teaching Nurses from Norway and FBNCU Nursing Staff, JK Lone Hospital, SMS Medical College, Jaipur
Previous Versions: v1.0