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.
I'm so excited to have JoAnn Spears back. She will be lending her nursing prowess to a discussion of the mental capabilities of Queen Elizabeth and Mary Queen of Scots. She did a very popular series on her take on the medical illnesses of Henry the VIII which you can find below.
