Introduction
The current NICU at Ruby Memorial Hospital in West Virginia has a bed capacity of 150; however, it sees an average of 875 births each year by a certified midwife nurse or a physician, with an unacceptably high mortality rate. Any measure of hospital improvement initiatives is insufficient to minimize the considerable burden of infection because of equipment and space limits in the NICU. The goal of this Proposal, as the CEO of the hospital’s Board of Directors, suggests setting up a newborn critical care unit (NICU). The newly developing urgent care unit will minimize infection, increase service quality, and decrease infant death.
The Objective of the Proposal
The goal is to create a cutting-edge facility that is well-built and well-equipped, utilizing the latest commercially available technology and processes. Its development will be after the present NICU and will offer the hospital personnel the external surroundings required to reduce infant mortality (Chandra, 2019). Following the project’s previous start meeting, the clinical specialists devoted two weeks to completing a clinical evaluation to learn about current operations, difficulties, and the need for an enhanced facility. It involved data collection, shadowing medical practitioners in the NICU and units that refer newborns, and intensive interactions with NICU personnel and other essential stakeholders.
Project Description
The current Proposal is to develop a three-story structure with high-acuity NICU facilities on the first story adjacent to the maternity room and an empty area on the ground as well as the second floor. Extra space exists in the current NICU that will be linked to the first story of the new facility for support programs and possible low-acuity beds. However, reusing the existing NICU facility is not included in this concept. The new building’s NICU support space will consist of high-acuity beds, clinical assistance, and a modest location for point-of-care diagnostics (Chandra, 2019). The ultimate quantity of a number of beds will fluctuate as the design advances.
Staffing of the Current NICU Operation
The current staff at NICU is two to three chief house officers, one neonatologist, and three to four trainee residents. One chief house officer, one to two resident doctors, one nurse for every 20 stable infants, and one physician per 10 acute medical babies typically staff each shift. The optimum nurse ratios for the NICU are 1:2 in elevated units and 1:4-6 in limited care units, although realistic increased staffing will be 1:8-10 in restricted care units (Holdren et al., 2019). Staffing for nursing and biological and medical engineering should be enhanced. More nurses are needed to increase the nurse-to-patient proportion, a 24-hour administrative officer to assist with admissions, and a biometric device to ensure safe admittance into the unit.
Limited Space
The existing NICU space is insufficient for care provision, resulting in early morbidity and death of newborns. There is a critical need for facilities for moms since the number is rising daily. The hospital needs three to four in-patient units for level one operations and two to three for level two treatments. It will enable minimally invasive interventions like short-term recovery from more severe disease and delivery. 92-122 total beds are required to handle the NICU’s current daily newborns (Dolezel, 2020). Ruby Memorial Hospital’s position as a teaching hospital should be considered while designing the healthcare area required to sustain a NICU of the stated size. The creation of the new NICU unit should include adequate teaching space and extra rooms.
Nutrition
Mothers with neonates in the unit are expected to stay at a neighboring mother’s shelter and go to the NICU each 2 to 3 hours for feeding because of insufficient nurse staffing. Although breast milk is favored over formula, it is accessible since it is made in an adjacent preparation room by a nutritional staff member before each feed (Holdren et al., 2019). The nutritionist is also in charge of teaching moms how to breastfeed correctly. Experienced nurses and support workers should ideally perform all feeding. Even women who are used to feeding their newborns using a nasogastric tube have mistakenly caused colostrum or formula aspiration in the tube, resulting in oxygen deprivation, infection, and death.
Environment considerations
The planned NICU will consist of a three-story structure with 1,250 square meters of space on each floor. As a general rule, USAID considers the development of structures less than 10,000 square feet to be small-scale and improbable to have significant adverse environmental consequences. The project’s Initial Environmental Examination (IEE) also states that building up to a few times bigger may still be comparatively small, although detrimental consequences require careful assessment and mitigation. The IEE further stated that the facility is being built on the premises of the current health facilities rather than in a new location. Ultimately, the project will likely remain in the position of a negative assessment, given the conditions indicated in the IEE.
Health Personnel Concern
There are now 12 experts working on site, with some aid from professionals from many of the university’s other independent facilities. Their responsibilities include managing garbage and waste carrier contracts, developing and disseminating environmental policy, and overseeing the campus mosquito and pest spraying program (Hill et al., 2018). As a guideline, the team must be directly involved in the project’s execution to ensure that environmental standards are incorporated into the design and building requirements. Incoming contractor workers require training to grasp unique campus challenges and to supervise contractors for conformity while the new structure is being built. The group should assist in the management of ongoing waste handler education.
Cross-cultural Relevance
Families from many cultures are affected by a newborn’s admittance to the NICU. The ethnicity of a child’s family can influence the mother’s prenatal treatment and the possibility that the kid will be admitted to the NICU. Given that newborn children from diverse cultures will be referred to the NICU, a social worker must be sensitive to cultural differences and comprehend how culture might influence a family’s readiness to seek and accept care. The NICU does provide some challenges to connecting with the newborn. They are separated from their parents and may not be at home with them. Acute stress condition is widespread among parents whose children are in the NICU.
Parent Involvement
Many parents noted their heartfelt thanks for the competent treatment that saved their children’s lives. Others worry about how they and their infants were handled in the NICU. The family felt it was wrong for them not to be involved in the care of their infant and decision-making as they may have wanted (Walani, 2020). It becomes a significant difficulty when parents feel entitled to comment about simple parts of the care of their child. The new facility considers these previous issues and strives to integrate remedies into its operations. As the CEO, it aims to guarantee that parents are satisfied with their services.
Certificate of Need
Certificates of Need are not required in West Virginia because they damage persons needing medical treatment while discouraging new employment and health care expenditure in the state. While authorities claim that the CON program’s goal is to manage expenses, enhance quality, assure access, and facilitate collaboration, it does not accomplish any of these goals (Adams, 2022). In West Virginia, entrepreneurs in health care confront significant hurdles to entry, including countless dollars in application costs, potential lawsuits from rivals, moratoriums on particular industries, and the stress of navigating the authorization process (Njoroge, 2020). These restrictions raise patient prices and reduce treatment quality which impedes the primary purpose that this new hospital wants to achieve.
Pros of NICU
Most expecting mothers do not anticipate their baby ending up in the Neonatal Intensive Care Unit. However, if an issue arises during or after the pregnancy, they must be prepared. The benefits of a NICU facility include avoiding uncomfortable transfers in the event that the infant requires more care, providing around-the-clock services, and having trained employees (Hammond, 2020). These medical professionals have acquired specialized training and possess the necessary equipment and technology to handle the unique demands of newborns that require NICU care. The disadvantages are that it comes with a lot of pressure to service the demanding patients, that it needs mental flexibility, and that it is emotionally challenging. NICU nurses are subjected to a great deal of mental trauma during their assignments.
Cons of NICU
The NICU is a very demanding institution. The NICU nursing team is in charge of the lives of tiny, fragile newborns that might go into emergency mode at any time. Even healthy newborns can become severely ill at any time, and newborns in the NICU can slip into a coma unknowingly (Dolezel, 2020). Parents of NICU newborns carry a lot of worry with them each time they visit the unit, and a number of them would like to stay there all the time. Caregivers may feel that those families are the second group of patients because they have unrealistic demands and are prone to pass their frustration to the nurses.
Recommendations
At the health facility level, we advocate for the hospital advisory committee because of their possible role in training workers and standardizing policies about infant care and relationships with their families. Medical training courses with a long-term approach to mother and child health are critical (Bird, 2021). There must be the unification of obstetrical, postnatal, and neonatal care for baby patients and education for physicians and families. Hospital management should support research that reduces the ambiguity in the care of high-risk babies. In terms of government policy, every law governing the medical care of infants must recognize their vulnerability to overtreatment and neglect. Newborn babies should be subject to rules that protect human participants from the unknown hazards of studies.
Conclusion
The NICU situation is complicated, evoking intense emotions among families who must rely on experts who were acquaintances before the infant’s entrance. The trust experts create with parents because their kids are the foundation of their relationship. It takes time, knowledge, honesty, and compassion. Everything was done to help families in crisis influence the connection with their infants and the functionality of their family. The aim of the new NICU facility is the infant’s best interests. The infant’s well-being and quality of life are more important than survival. However, there is no need for a Certificate of Need because it does not serve the facility’s best interests.
References
Adams, S. (2022). The debate over Certificate of Need Gaining Traction in West Virginia Legislature.The intelligence.
Berger, M. (2017). A 10-step model for improving breastfeeding in NICU babies. Penntoday.
Bird, C. (2021). Capabilities of a Special Care Nursery. Verywellfamily.
Chandra, P. (2019). We need more advanced neonatal intensive care facilities. Indianexpress.
Dolezel, J. (2020). How to Read the NICU Monitors. Verywellfamily.
Hammond, M. (2020). The Pros and Cons of a Career in NICU Nursing. Latinamericanpost.
Hill, C., Knafl, K. A., & Santacroce, S. J. (2018). An integrative review of family-centered care from the perspective of parents of children cared for in a pediatric intensive care unit. Journal of pediatric nursing, 41, 22-33. DOI: 10.1016/j.pedn.2017.11.007
Holdren, S., Fair, C. & Lehtonen, L. (2019). A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S. BMC Pregnancy Childbirth 19, 345.
Njoroge, W. (2020). Racially/Ethnically Diverse Parents Experience the NICU Differently. How Can We Offer Better Support? Policylab.
Norman, M. (2021). COVID during pregnancy poses a low risk to newborns, new research shows. Theconversation.
Taylor, M. (2021). The Newborn Heel Stick Test. Whattoexpect.
Vitale, F. M., Chirico, G., & Lentini, C. (2021). Sensory stimulation in the nicu environment: Devices, systems, and procedures to protect and stimulate premature babies.Children, 8(5), 334.
Walani, S. R. (2020). Global burden of preterm birth. International Journal of Gynecology & Obstetrics, 150(1), 31-33.