The Giraffe in the room

While yesterday was the official oral/written evaluation of the nursing program, today was the clinical evaluation of how the nurses were performing within the NICU.  Our program objectives, and thus our criteria to evaluate the students, are as follows:

The primary expected outcome of this program is that all enrolled nurses will graduate from the neonatal nurse certification program and will be employed in the NNU at GPHC. The secondary expected outcome of this program is that all enrolled nurses will take an active role in decreasing infant mortality through use of advanced equipment, quality improvement initiatives, and communication with physicians.  These outcomes will be assessed through the following components:

• administration of the Basic Knowledge Assessment Test (BKAT) for Neonatal Critical Care Nursing, looking for improved scores after the didactic (1^st stage) and preceptorship portion (3^rd stage) of the program
• comfort with use and troubleshooting of advanced equipment in the NICU such as EKG and oxygen saturation monitoring, thermoregulation devices, Continuous Positive Airway Pressure (CPAP), and endotracheal tube ventilation
• use of nursing process demonstrated by utilization of newborn physical assessment, assisting in patient care plan development with physicians, implementation of skills based on standards of care, and evaluation of patient care plans in light of interventions
• nursing involvement in development, maintenance, and analysis of Quality Improvement (QI) programs at GPHC, looking for positive impact on chosen outcomes (i.e. hand hygiene rates and rates of bacterial infection)

So today Kate and I did mostly observing of the nurses using equipment such as CPAP, monitors, isolettes, IVs and suction equipment, along with how they assessed, implemented, and evaluated their patients and how they communicated with physicians.  

There were many nurses doing the right thing- they were performing initial assessments on their patients (they finally have "patient assignments"!), they were performing hand hygiene and wearing gloves (most of the time) with patient care, they used alcohol when accessing vials and IVs, and were proficient in suctioning the patient (when it was recognized).  It was obvious that the student nurses have come a long way from the first day on the unit, when they were all novice nurses who didn't know how to perform an assessment let alone utilize the equipment. 

                                                      Kate assisting with resuscitation of an infant

                                          Typical infant set up with monitor, isolette, and IV pump

 

                                                              Susan starting a blood transfusion

There are many challenges, however, and most of them come from a slow adaptation to change.  While the babies were placed in the isolettes, many were not having temperatures constantly monitored, so they were cold (which causes stress, breathing problems, etc.).  While IVs were placed and alcohol used to wipe the ports before injections, they were not utilizing the IV pumps because of insufficient training and troubleshooting (the new pumps arrived the last day of my meeting madness visit in August).  And while they were assessing patients, the link to declining patient status and need to trouble shoot/reassess/call the physician was sometimes missing.  I'm not saying all of this to shoot down the amazing work the nurses/physicians are doing, or the progress that has been made with this group of students, but just to point out the obstacles that we need to overcome to get the unit functioning as was envisioned by Dr. Singh and Dr. Nelin.  

We did, however, get to witness the first portable X-ray machine in use in the NICU (which to me looks like a giraffe), and a team of Echocardiogram techs from Canada performing 4 separate ECHOs on NICU babies. Pretty cool!

                                                             Portable Giraffe (xray machine)

                                           Canadian team performing an ECHO and explaining to physician

Kate and I spent the rest of our day troubleshooting equipment, mostly IV pumps and oxygen sat probes/temperature probes in the monitors, and attending education of our new PCAs (patient care assistants) on hand hygiene and environmental management to help reduce the amount of infections in the unit.  I think the 8 new PCAs are going to help tremendously in our "housekeeping" activities which will improve the care we are able to provide our babies.  

Thompson Apkto doing a demonstration of hand hygiene with alcohol gel to the PCAs

Members of the Quality improvement/infection control team, PCAs, and Cait

Cait comforting baby with developmental positioning and containment (gotta get creative when pacifiers are not allowed)

Kate's research investigation of the IV pumps (which say they infused 8ml but there is 11mls in the syringe)

The night rounded out with our meeting of the night security guard, Fitz, who helped us navigate the path to the beer stand across the street and over the "bridge" from Project Dawn where we are staying.  Very important information to have :-)

Early morning Guyanan sun from the balcony at Project Dawn (CARRICOM secretariat center in background)