The Bells and Whistles of a NICU

I'm pleased to welcome back Terri Forehand, NICU RN, and she explains the NICU environment. Great details for any author writing a NICU scene.

Welcome back, Terri!

Understanding the bells and whistles of a Neonatal Intensive Care Unit (NICU) is essential for the nurses and neonatologists that care for these tiny infants but it can be especially confusing for parents of a premature infant and down right mind boggling for those trying to write about a premature infant in their fiction. If you are a writer creating a plot or storyline around a NICU unit there are a few things you need to understand.

First, the NICU can be a unit where there are private rooms for each infant and where parents can spend long hours at the bedside in a more comfortable environment with the door closed. An open NICU unit is a huge room with stations or “patient areas” where there is room for the incubator for the baby, monitors, other medical equipment, and standing room around the incubator for the doctors and nurses to care for the infant. Many times you will see a rocking chair cleverly placed between the equipment so mom or dad can be only an arms length away from their baby. The overall feel of a busy unit may feel too close and crowded for many visitors.

A list of general equipment at each bedside regardless of whether it is an open unit or private rooms includes:

• Incubator or infant warmer sometimes called an island.
• Suction canister, tubing, and control gage usually attached to the wall used to assist in clearing the airway of an infant.
• Monitor and cords that attach to the infant’s chest that measure heart rate, respiratory rate, and another cord that attaches to the infant’s foot, toe, ear, or wrist that measures constant oxygen levels in the blood. The specific term for this particular probe is called oxcimetry.
• Supply cart or shelf that includes needles, blood collection supplies, extra respiratory equipment, diapers, pacifiers, and anything else the infant might need in a hurry.
• Blood pressure cords to measure the blood pressure of the infant.
• Feeding supplies.
• Many other items specific to each infant and the diagnosis including Intravenous pumps, bilirubin spot lights, and blood infusion pumps.

Advantages for the private room concept are privacy for parents and more room for staff to work on each infant. It is considered family centered and parents and grandparents seem more satisfied with these newer creative NICU units that at times can appear more like a plush hotel rather than an intensive care unit for sick babies. The biggest disadvantage for nursing staff is that you can only eyeball one baby at a time, feeling like you cannot keep the best eye on the infants in your care because of the walls between each incubator.

An advantage for the open unit style is easier management of patient care for the staff. It is easy to watch a monitor for one infant and be feeding an infant in close proximity. The nurse can see, hear, and know all about her babies because there are no barriers between patient care areas. This can also mean that private conversations between parents can be over heard by other parents making it more stressful.  The disadvantage is that it can be noisy and more overwhelming for parents not only with mixed conversations but the clanging of alarms from every direction is frightening.

A newborn between 23 and 36 weeks has no place to go but the NICU.  Gestational aged infants between 23 and 28 weeks have the additional complication of breathing issues many times requiring a ventilator. (More on that in another post) The need for extra equipment to support breathing takes up more room, adds more stress to the parents, and adds more alarms to the already frightening atmosphere. It can also be a complication in the plot of a good story.

Parents may be astonished at how complicated a NICU patient area can appear when they first see their tiny infant in that setting. Those of you writing a scene to include a NICU can appreciate how complicated the scene looks to an outsider. It also may offer the possibility for many clever or mysterious scenarios in combination with your imagined family relationships, after all babies are born to the rich, poor, good, bad, honest, and criminal characters both in real life and in the life of your imagination.

********************************************************************************

Terri Forehand is a pediatric/neonatal critical nurse and freelance writer. She writes both fiction and nonfiction, is the author of The Cancer Prayer Book released in 2011. Her picture book titled The ABC’s of Cancer According to Lilly Isabella Lane is due out in 2012. She writes from her rural home in Indiana which she shares with her husband of almost 30 years and an array of rescue animals.