Labor and Delivery Clinical
During my clinical experience in labor and delivery, I was able to gain some experience in the NICU (Neonatal Intensive Care Unit). I was able to see the role of the nurse play out through teamwork, communication, working as a team, safety precautions that were taken, and how to care for the client. I will discuss this and the evidence-based practice that was displayed during my clinical experience in this paper.
Teamwork and Communication
The nurses in this area worked very well together with each other and the providers taking care of the clients. The nurse I was with said that the nurses in the NICU have a great relationship with the providers they work with. He said that the providers are great at explaining to the nurses why they want certain cares or tests done for each baby so nurses understand where they are coming from. You don’t always hear that the providers do this on the other floors in the hospital, and I thought that was an important part of teamwork and communication between the interdisciplinary team.
The nurses are also great about letting the providers know how the clients are doing and updating them with any changes that occur that fluctuate from “normal” in the client. He said that the providers rely on the nurses for them to pay close attention to the babies and be their eyes, ears, and hands when they are not there. The doctor orders tests and labs to be done, but sometimes, if a client is declining, they are already showing signs of this before the test results come back, so it is important for the nurse to be aware of noting differences.
When another nurse was busy, the others were great about helping them out to keep up with work and making sure the clients were receiving medications. They were willing to help out when they were caught up with their clients to take any stress away from the busy nurse; teamwork and communication go hand in hand, and these were two things that I noticed the nurses and providers did very well at.
Professionalism and Leadership
The nurses were great at prioritizing certain tasks over others. For instance, if a client’s oxygen saturation was low and the monitoring was beeping, the nurse would go to check on the baby rather than keep on charting. A legal/ethical consideration I saw play out was the importance of providing safety through having a locked unit. When a family would call to be let in, they needed to have a code to be let in. If they couldn’t recite the code, they were not let in. This is to keep the babies safe. The last example I have would be watching the charge nurses delegate to the other nurse’s certain tasks to be done. I also saw the providers delegating tasks to the nurses. The providers would assess the babies and then let the nurses know what they needed to do and delegate these tasks to them.
Client-Centered Care
The client is under the care of the providers and nurses during their time in the NICU. Each member of the team is held to a high standard to care for each client to the best of their ability. The priority is the client and their safety, making sure to monitor each baby for any abnormalities or fluctuations from the “normal.” I did see a case where the family was from Nepal and had different cultural norms than what we see in the Midwest. One example of this was when they decided not to have their baby circumcised. The nurses were respectful of this and educated the family on how to take care of the uncircumcised penis.
Since I was in the NICU, I was not able to see a delivery or immediate post-partum care. However, I was able to see many assessments on the NICU babies and see how it can vary from one client to another. Most of the clients kept a pulse oximeter on at all times. During assessments, the nurse would change the hand or foot that it was on to prevent skin breakdown on the baby. If you leave the pulse oximeter in a specific spot for too long, this can cause skin breakdown, and babies do have thin skin, so you want to be careful about causing this. Also, during the assessment, the nurse changes diapers and weighs them. This is so the output can be added to the total daily.
Evidence-Based Practice and Judgement
Recent studies have shown that the use of music therapy can help with the negative changes that can occur in a baby after birth. There are many physiological changes that the baby goes through after being born. “In a recent review, Standley found that music therapy is used to improve feeding in hospitalized premature infants, which may have the positive benefits of decreased length of stay, decreased resting energy expenditure, and increased growth” (Allen, 2013). I found that this was very interesting since it is usually kept very quiet in the NICU. Furthermore, the article stated that, “a survey of neonatal nurses in Finland showed a majority of the nurses believed music could increase the feeling of security, improve sleep, decrease stress, and reduce pain in premature infants” (Allen, 2013). It is not easy to have a baby that is in the NICU, let alone a baby that has to stay for an extended period of time. This study it showed that music could decrease the hospital stays for some premature babies. I thought this was great because this can take a lot of stress away from the families anxious to bring their baby home healthy.
Quality Improvement and Safety
Throughout this clinical, I witnessed staff adhere to the Joint Commission’s National Patient Safety Goals. For example, I saw them prevent infection by using strict hand cleaning with each client that they worked with. Even while working with the same client, they would use hand hygiene between certain cares. I also saw the nurses adhere to the safety goal of using alarms safely. When an alarm on a piece of medical equipment went off, they would go to check it out to see what was going on in a timely manner.
Informatics and Learning Goals
I saw technology being used during this clinical in two ways specifically. The medications were stored in an electronic system that was just outside the main room in the NICU. You had to log in, find the right client, and make sure to select the right medication to take out. The other way I saw technology being used was with the use of vital sign monitors. These monitors help to keep a close eye on the clients and see how they are doing. The monitors are also connected to the computers, so every so often, the vital signs are transferred into the online medical record so the doctor or nurse can look back and see what the client’s vital signs are at a certain time. This is so helpful and a great tool to use with critical clients.
The cognitive goal I had was to really get the best experience possible and feel what it is like to work in this area of nursing. I wanted to ask as many questions as possible, and I was excited and eager to be as hands-on as possible and get the most out of this area to really understand what it is like to work here. My psychomotor goal was to start intravenous therapy. I was unable to see this, but one nurse was able to demonstrate what it was like to start one on an infant, which I found to be helpful. The effective goal I had was to be excited about any new experience I could get, even if I didn’t get to see a birth. Overall, my time in the labor and delivery and NICU was such a great experience and has solidified that this is the area that I want to work in.
References
Allen, K. A. (2013, October). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826794/ (n.d.). Retrieved from https://www.jointcommission.org/standards_information/npsgs.aspx
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Question 
Nursing is usually associated with caring for patients in a hospital bed. Nurses also use their clinical knowledge and critical thinking skills in other positions in healthcare.
Labor and Delivery Clinical
Please research and identify a nursing position (Labor and delivery). Your assignment is to create a 2–3-page document (not including title and reference page) to include information about the position and additional educational and/or certification requirements in APA format, using a minimum of 2 current, peer-reviewed, scholarly sources.