Guest guest Posted February 14, 2000 Report Share Posted February 14, 2000 In a message dated 2/14/00 9:04:27 PM Eastern Standard Time, starmom@... writes: << question for all of you.......in this building all the doors to the moms rooms automatically close.......we find this scarey, how many times you walked a new mom to the bathroom and had her faint on you and you could easily call for help....in this place no one would ever hear you, or a mom alone in trouble... or a baby choking and a mom calling for help not near the call bell.. they say that this is fire code for new construction. we are all very nervous about this, it dosent make sense. >> Our unit has both " regular " call bells (I need more pads, H2O refill, questions about something), " emergency " cal bells (My baby is choking, I feel faint, th baby is coming now!) and staff emergency buttons (help, help help!) which are located at the pt bedside, at the baby " headwall " (where we prepare for problem baby deliveries) and in the bathrooms, by the toilet and in the shower. All of our call bells go through on each nurses pager as well as audible tones int he hallways and nurses stations (we have three seperate stations in our unit) and the receptionists desk. For example a regular call bell would appear on your pager with a code " 5 " w room number following. That way, if you are unable to actually hear the bell you will still know that it is going off. All emergency calls go off on all pagers and all nurses who can are required to respond. And we do! So we mention to the Mom's if they need more pads it is probably not a good idea to use the wrong button int he bathroom or you will have 6 or 7 nurses joining you!!! Our unit receptionist desk, which is always manned 24/7, will respond to any page which rings more than five times. We can call into any pt room from anywhere in our unit, so if I am in another pt room and one of my other pt rings, I can call her from the room I am in and see what she needs, or I can choose to let another nurse, unit assistant or the receptionist answer. I have learned to call in to the room for the routine calls, it saves me many steps rather than walking to the room, then walking back to get what they needed. I really like this system, it is by Dukane. Hope that helps...BTW, I totally agree with the not using a nursery right fromt he start. We began our mother baby in our old unti before moving to the new unit. We " closed " the nursery and it was tuff! Our old unit, as you can imagine, wa snot set up to accomodate mother/baby care so when we did move, it made doing the care alot easier. Anytime you can begin a new way of caring for pts and NOT combine with that a new environment, you will help with a transition. I also can't say enough about the wonders of mothers and baby's sleeping together! It truly is amazing to see the satisafaction of both mothers and baby's when " given permission " to snuggle and sleep with their babies! Jan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2000 Report Share Posted February 15, 2000 how is your " new " staff trained? if you get a " new nurse " is there an orientation to each area? to be competent in all areas especially nicu and L & D that is a large knowlege base to have..... how sick are your nicu babies? what level are you? are your people as comfortable with deliveries as with babies on vents? are your moms generally high risk or the more non complicated variety? do you have neonatal nurse practitioners, neonatologists? how large is your unit? are all the areas in one unit? The concept for the ldrp was not to have a nursery, they ended up building a large one, half is so far stocked with empty cribs and the circs are done there, and since we are so new 2 weeks in the new place and the comfort level of the L & D people with trans is not really there that is where our new kids go, at the moment. question for all of you.......in this building all the doors to the moms rooms automatically close.......we find this scarey, how many times you walked a new mom to the bathroom and had her faint on you and you could easily call for help....in this place no one would ever hear you, or a mom alone in trouble... or a baby choking and a mom calling for help not near the call bell.. they say that this is fire code for new construction. we are all very nervous about this, it dosent make sense. if there was a fire alarm we would go around and close doors as a policy. would appreciate hearing what you have to say on these questions... thanks.....sue Fisher wrote: > > > > Ours is a completely integrated unit ie. we are all expected to be > able to > work in antenatal clinics, birth suite, ante/postnatal ward and SCN. > One > thing about it is you don't get into a rut :-). > We, too, don't have a well-baby nursery and personally I wouldn't like > to > see it any other way. At night if a baby won't settle (and we VERY > frequently use the 'in bed with mother' technique - it works like a > charm!) > we bring baby out to the desk for cuddles until he does. > I've just returned from Israel where the hospital of one of the people > I > met with has a separate nursery set-up, like many of you. The > advantages I > could see of having them integrated were that it freed up more staff > for > working with the mother/baby couplet, and the work load on the staff > was > actually reduced, because the mothers changed and bathed and rocked > and did > everything for the baby after being shown how to. > Our biggest workload in the postnatal unit would be in assisting with > breastfeeding. > I really do encourage you to view this as a positive step forward - > certainly for the mothers it's an important aspect of learning about > their > new baby, but also for the staff it really is very rewarding. > We have a compulsory rest-time for 2 hours during the day when no > medical > staff or visitors are allowed. This helps the mothers catch up on > lost > sleep, and isn't such a bad thing to encourage them to do at home. > One word of advice though - make sure the 'old' nursery is quickly > converted to another use or the 'die-hards' will continue to use it, > and > that can become really dangerous at night because it won't be > adequately > supervised. > I'm happy to answer any questions you have. > Good luck > > > **************************************************** > Fisher, BN, RM, IBCLC > BreastEd Online Lactation Studies Course > http://www.breasted.com.au > mailto:denise@... > **************************************************** > ---------------------------------------------------------------------- > [ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2000 Report Share Posted February 15, 2000 In a message dated 02/14/2000 8:14:08 PM Eastern Standard Time, denise@... writes: << We have a compulsory rest-time for 2 hours during the day when no medical staff or visitors are allowed. This helps the mothers catch up on lost sleep, and isn't such a bad thing to encourage them to do at home. >> , I think you touched on one of the important reasons why our moms want the babies in the nursery at night..our OB units have unlimited visiting hours from 9 am until 10 pm, and they never get any rest with the constant flow of visitors. We also like to tuck the babies in bed with their moms, but we do have a policy against it..so again we are stuck. Some of us " forget " the policy tho...esp when the babies are breastfeeding continuosly...Lori Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 15, 2000 Report Share Posted February 15, 2000 I wish we could let moms and babys sleep together, but in our old unit we had larger beds and a policy against it, small beds, hard floors, I will never forget the panic and fear on a moms face when kids have fallen out of the bed and hit the floor, usually they were just fine, the usual incident reports filed and x rays done to assure no damage done etc. the beds in the new place are even smaller being used for ldrp, and the rails are even smaller and shorter so you cant even really pack rolled blankets or pillows for short term safety. on the note of someone else who mentioned the " nap time for moms " or the reality of visitors being around for way too many hours, that is something i also feel very passionate about! especially the new sections and the new breastfeeding moms. they " try " to entertain their visitors, and most dont have it in them to tell them " to go, im really tired " . I always clue moms in to the fact that if they need a " nice bouncer " im always available to do that for them. I feel that the first two days Post partum, should be more for recuperation than for all day visitors, after all mom will be home in a few days, and they have the childs whole life to get to know them! I tend to feel very protective of my new moms, they will be more honest with me about how they are feeling than their visitors. what do you all think? sue Zukeeper4@... wrote: > > From: Zukeeper4@... > > In a message dated 2/14/00 9:04:27 PM Eastern Standard Time, > starmom@... > writes: > > << question for all of you.......in this building all the doors to the > moms > rooms automatically close.......we find this scarey, how many times > you > walked a new mom to the bathroom and had her faint on you and you > could > easily call for help....in this place no one would ever hear you, or a > mom alone in trouble... or a baby choking and a mom calling for help > not > near the call bell.. they say that this is fire code for new > construction. we are all very nervous about this, it dosent make > sense. >> > > Our unit has both " regular " call bells (I need more pads, H2O refill, > questions about something), " emergency " cal bells (My baby is choking, > I feel > faint, th baby is coming now!) and staff emergency buttons (help, help > help!) > which are located at the pt bedside, at the baby " headwall " (where we > prepare > for problem baby deliveries) and in the bathrooms, by the toilet and > in the > shower. All of our call bells go through on each nurses pager as well > as > audible tones int he hallways and nurses stations (we have three > seperate > stations in our unit) and the receptionists desk. > > For example a regular call bell would appear on your pager with a code > " 5 " > w room number following. That way, if you are unable to actually hear > the > bell you will still know that it is going off. All emergency calls go > off on > all pagers and all nurses who can are required to respond. And we > do! So > we mention to the Mom's if they need more pads it is probably not a > good idea > to use the wrong button int he bathroom or you will have 6 or 7 nurses > > joining you!!! > > Our unit receptionist desk, which is always manned 24/7, will respond > to any > page which rings more than five times. We can call into any pt room > from > anywhere in our unit, so if I am in another pt room and one of my > other pt > rings, I can call her from the room I am in and see what she needs, or > I can > choose to let another nurse, unit assistant or the receptionist > answer. I > have learned to call in to the room for the routine calls, it saves me > many > steps rather than walking to the room, then walking back to get what > they > needed. I really like this system, it is by Dukane. > > Hope that helps...BTW, I totally agree with the not using a nursery > right > fromt he start. We began our mother baby in our old unti before > moving to > the new unit. We " closed " the nursery and it was tuff! Our old unit, > as you > can imagine, wa snot set up to accomodate mother/baby care so when we > did > move, it made doing the care alot easier. > > Anytime you can begin a new way of caring for pts and NOT combine with > that a > new environment, you will help with a transition. > I also can't say enough about the wonders of mothers and baby's > sleeping > together! It truly is amazing to see the satisafaction of both > mothers and > baby's when " given permission " to snuggle and sleep with their babies! > > Jan > ---------------------------------------------------------------------- > [ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2000 Report Share Posted February 16, 2000 Fisher wrote: > > > > OK Sue - I did leave out a lot of crucial information in my last email > didn't I? Starting with that I'm from Australia where it's only > qualified > midwives who work in maternity care. So the staff orientation to the > whole > unit isn't a problem; though we still do get staff from other > hospitals > where they may have only worked birthsuite or postnatal or nicu for > the > last x years - nevertheless they are 'theoretically' qualified to > work all > areas. When this happens (and actually with all new staff, some more > than > others) they are assigned a preceptor from the usual staffing and they > work > together for as long as needed. ***We have a mixed bag of staff and their experiences, some were just baby nurses for years and others just mom nurses for years, one or two nicu trained came to us over the years..I came in straight from nursing school with a two year A.S. and had to do alot to prove myself worthy! (which opened the doors for others after me , but that also has it's disadvantages....when you say " theoretically qualified " that is a scarey concept, ive been a nurse for almost four year doing couplet care, get floated to nicu occasionally, we are a level three nicu so we get them as little as 27 weeks, but when floated we get the more uncomplicated growers. our moms are frequently " high risk " and we get them as antepartums and for labor and delivery and recovery. (not me as far a L & D as i have not " crosstrained as of yet " . *** > > > how is your " new " staff trained? if you get a " new nurse " is > >there an orientation to each area? to be competent in all areas > >especially nicu and L & D that is a large knowlege base to have..... > > > > >how sick are your nicu babies? what level are you? > > Level 2 I believe (I actually referred to it as a SCN, special care > nursery)- don't know whether that translates internationally. We > deliver > babies from 35 weeks and care for any baby that doesn't need > ventilation, > though we do have a ventilator and will often use it to stabilise a > baby > before it can be retrieved by the major hospital. > > >are your people as > >comfortable with deliveries as with babies on vents? > We don't keep ventilated babies. Again this is a personal thing: I'm > very > happy to work in birthsuite, but like to have an experienced person > with me > when I'm in SCN - and there are others who have different preferences, > but > we are all still expected to work in any area at any given time. > > > >are your moms generally high risk or the more non complicated > variety? > > That's difficult to define. It's more the baby that decides what we > keep > and what we ship - ie a 28wk prem labourer goes, but a 35wk severe PIH > stays (because we're not meant to deliver <35wks) > > > > >do you have neonatal nurse practitioners, neonatologists? how large > is > >your unit? are all the areas in one unit? **thank goodness we have many neonatal nurse practicioners and three neonatologists, ***> > We don't specifically employ NICU trained midwives, but have 2 or 3 on > staff (who still work all areas). Neonatologist, no - paediatricians, > yes. > We deliver about 1800 babies a year. Yes, all areas are in one unit. **we do around 3000 a year, very very busy, always.....***> > > > >The concept for the ldrp was not to have a nursery, they ended up > >building a large one, half is so far stocked with empty cribs > **this is where i wasnt clear denise, one half is stocked with empty cribs and the circs are done there, and the other half is where the new babies are being dumped quicker than ever for trans....***and yes we are getting alot of " feed in's " at night.....the physcial surrondings are really beautiful for the moms, all private rooms, big beautiful, private bathroom and shower, large enough to accomodate the bassinett, nice table and chairs, lazyboy chair that pulls out to a bed for dad.....nice as a hotel.......I just think that there will always be moms that dont want the baby at nite while they can get away with it, mind you its not all of them but still quite a few.*** > Keep filling it up with stock! Otherwise you'll end up back where you > were > and it will require staffing. > > >and the comfort level of the L & D people with trans is not really > there > >that is where our new kids go, at the moment. > > None of our well babies ever leave their mother. All their immediate > post > delivery care is done in the birthsuite beside mother and they both > come > over to the ward together and stay together. Even our c/sections stay > together in theatre and recovery and come to the ward together. > > >**what you just described is the " goal " for this unit, we have only been open for two weeks*** > >question for all of you.......in this building all the doors to the > moms > >rooms automatically close.......we find this scarey, > > Yep I agree that is scary. Also closed doors discourage you from just > wandering into a mothers room where you might find all was not well, > but > she wasn't able or didn't want to call for you. > ** this is one of the many things that troubles me most...and what you mentioned is " exactly " what we are all worried about, all of you know that you just cant be in all places all the time, besides other patients we do like to occasionally empty " our bladders " and maybe " eat something " in five minutes in an 8 hour day...*** > > All of our call bells go through on each nurses pager **this was someone else's description of what they are using in their place, at present the communications issues are far from resolved, another major concern*** > > Wow this is a concept I haven't met before - sounds brilliant. > Particularly > the bit where you can call them to find out what they want. > > Sue, what's your physical set up for the mothers doing total care of > the baby? > > Also what is the nurse:patient ration in your units? Please mention > whether you have mother and baby, or just mother. > ** denise this changes from day to day, the usual start is 3-4 mom-baby couplets and in the mix at times an antepartum, add to that having to discharge two of them that are primips, the teaching, chasing down the discharge orders, and all the other discharge paperwork, not the most fun ive ever had recently in the confusion of the new building and the lack of organization at present which im really hoping improves very very soon!**** I hope that Ive answered your questions.. sue : ) > Enjoying hearing about different places > > > **************************************************** > Fisher, BN, RM, IBCLC > BreastEd Online Lactation Studies Course > http://www.breasted.com.au > mailto:denise@... > **************************************************** > ---------------------------------------------------------------------- > [ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2000 Report Share Posted February 16, 2000 In a message dated 2/15/00 9:52:18 PM Eastern Standard Time, starmom@... writes: << * this is one of the many things that troubles me most...and what you mentioned is " exactly " what we are all worried about, all of you know that you just cant be in all places all the time, besides other patients we do like to occasionally empty " our bladders " and maybe " eat something " in five minutes in an 8 hour day...*** >> Are your nurses stations decentralized? I mean when making pt room assignments we try to put our sickest pts closest to the nurses stations. We also have the ability to transfer our sicker pts to ICU to be co-managed by OB and ICU. Thsi eliminates some of that worry factor. Also in regard to the running around thing. We found that in our unit as well. What solved the problem for us was having identically stocked supply room on each of our three halls. We still had a " main " supply room that kept a large supply on hand, but the other ones had a limited supply of all of those things. We appointed a group of nurses to be in charge of what needed to be where, whether it be a stock LDRP item, store room item, etc. Then if anyone had suggestions of ideas they would leave a note for one of that group. After only a short period of time, our running down the halls for things slowed tremendously. Now for the DC and teaching thing. One of the very best things we ever did was implement a Maternity Prepared Stay Program. This allows each pt who plans to deliver with us to meet for one hr with a RN to go over paperwork, birthplans and begin teaching. We made a video tape (very cheap to do and it costs only 3 bucks a video) with all of the necessary teaching from bathing to feeding to circ care. It is given ahead of time. We also make sure that the pt has attended any prep classes they can (and we have tons of them from breastfeeding to VBAC'ing to sibs at delivery prep). Teaching is the responsibility of every nurse. We have a concise teaching form in which the pt decided which information she feels is most important to her, which she know everything about and which she may ave questions about. We can customize all teaching that way. Byt he time the pt is discharged her teaching has more than been completed. Each shift on the clinical pathway has requirements for teaching during that time period. If it is not covered then it must be documented as to why " pt tired/not receptive at this time " etc. Then in report we tell what still needs to be done. We report by exception, we chart by exception and this saves a tremendous amt of time (however its alot of work getting it all set up). Look into ways to encourage teaching so that it is never left for the DC nurse. We all teach something most times we walk into the room, its just a matter of coming up with an easy documentation tool. Keep your chin up, it will come together for you all! Jan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2000 Report Share Posted February 17, 2000 Dear Jan, Your message is so timely for many of us! This is my first posting to the group. My name is bobbie, I am an RN in a small community hospital in a rural area of NC. Welcome to the OBnurses list Bobbie! ----Jeanine Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2000 Report Share Posted February 17, 2000 Bobbie, I live in Fayetteville, NC. Just curious if you were close by. Take care. Sincerely, Marge Please visit my webpage--Just click on: http://community.webtv.net/msollie143/Bloomwhereyouare Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2000 Report Share Posted February 17, 2000 Hi, Marge, is about 30 minutes north of Durham, NC! It's great to hear from someone kinda close by! Let's keep each other informed about conferences, etc. so maybe we will end up at one together-bobbie " Marge O. " wrote: > From: msollie143@... (Marge O.) > > Bobbie, > I live in Fayetteville, NC. Just curious if you were close by. > > Take care. > Sincerely, Marge > Please visit my webpage--Just click on: > http://community.webtv.net/msollie143/Bloomwhereyouare > > --------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2000 Report Share Posted February 17, 2000 Hi Bobbi, Welcome. I work in Raleigh. Good to have you on the list. Amy in NC Quote Link to comment Share on other sites More sharing options...
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