Pebbles of Hope speaks with Cheryl Major, a retired neonatal nurse from Monroe Carell Jr. Children’s Hospital at Vanderbilt, in the latest episode of the Bridging the Gap podcast
Pebbles of Hope releases today the fifth episode of its podcast series, Bridging the Gap, in which we explore the issues affecting NICU families in underserved communities. This latest episode features Cheryl Major, a retired neonatal nurse from Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee. In this episode, Cheryl Chotrani, Executive Director of Pebbles of Hope, speaks with Cheryl to discuss the ways in which nurses and other NICU staff can provide better support to disadvantaged NICU families. A condensed version of our conversation is below.
Please share with us your career path and what led you to become a neonatal nurse.
Cheryl: I have served as a neonatal nurse my entire career. I started in 1968 in Nashville at Vanderbilt in the very early days of high-risk neonatal care. I was attracted to that because I always liked working with babies. It turned out that my career took me to Vanderbilt at a time when they were beginning to develop a special care nursery to help babies that were being born prematurely and I had an opportunity to work with a physician who was on the cutting edge of some of the therapies to help these premature babies. From that exposure, I have continued to maintain interest, even post-retirement, in trying to address the challenges we have with high-risk newborn care. One of them is that even as we’ve made progress in caring for these babies, we still find that the incidence of prematurity is increasing. Although mortality rates are going down, there are more and more babies that may have special needs and these families and communities need more support.
What are some of the unique challenges that lower-income or otherwise disadvantaged families face when they have a baby in the NICU?
Cheryl: What we find is that many times these families are faced with distance, which can make it challenging for them to get the services they need. I started my career in the early days when we began to provide ambulance transport for premature babies, and there were often many miles between where the family lives and the NICU where the baby is being treated. Even going across town for some families can be difficult, so there is that element of separation that must be overcome. This is why outreach activities are so important to establish the connection between the families and the NICU staff so that they can find ways to keep the parents involved in the baby’s care.
What effect do issues like the challenge of distance have on a baby’s expected outcome?
Cheryl: Of course, the duration of the NICU stay will be a factor. But, we all know that babies definitely respond to voice, and studies have shown that even premature babies can recognize their mother’s voice. There also is the importance of touch and for parents to just get to know their baby as early as possible. Technology can be a great help here. Many NICUs have begun installing cameras so that parents can see and interact with their babies from a distance. Many excellent studies have shown that it really does make a difference, even with the sensory development of the baby, when parents can establish this early interaction through voice and touch.
What are some of the things that nurses can do to provide more support to parents whose babies will have an extended NICU stay or otherwise need extra help?
Cheryl: The nurses generally have more interaction with the families than perhaps the other members of the medical team. Nurses are the ones that get to know the parents the best, and hopefully a relationship of trust develops and that parents feel safe to ask questions anytime. Many NICUs promote primary nursing so that the same nurse is with the baby for the majority of their NICU stay. So, even when the attending neonatologist or nurse practitioners change, the nurse is the one that is the most consistent in the baby’s care. If there is a family that has been identified by a social worker on staff as needing extra support, the nurse is really the gateway to ensure that communication is happening effectively and that the proper steps are being taken to get the family access to the resources they need.
What are some of the strategies that hospitals and NICU staff use to provide discharge support to families that have less than ideal situations at home?
Cheryl: The approach we use in the NICU is that discharge planning starts the day of admission. It’s a plan that begins early and includes a thorough assessment of the social and environmental situation at the family’s home. The earlier we identify challenges, the sooner we can help the family access resources and services. Almost every state in the US has a system of care that is geared to support higher risk families. All of the team members at the NICU involved in the baby’s care should have a thorough understanding of what the family’s needs are and immediately begin to link them to services. For some programs, there is processing time that needs to be taken into consideration, so in the meantime, even just reassuring the mother that help is on the way is important.
How do you advise families with limited financial means on the essential supplies they need to prepare for bringing their baby home, or how do you get them access to these supplies?
Cheryl: Many state or community programs provide families with access to the essential supplies. For example, one of the things we know is that premature babies are at higher risk of SIDS or sleep-related death. Most of the programs across the country have recognized this and have campaigns to try to promote safe sleep practices. Not only do families get introduced to that information in the hospital, but they also see nurses demonstrate those safe sleep practices. If there is, during the investigation with the family, a finding that they don’t have a crib, an environment that is smoke-free, or don’t otherwise have an environment that allows them to practice safe sleep, there are resources in the health department to address this. In Tennessee we even have a grant to get pack n’ plays that we can give to families free of charge if there is confirmation of a need. That’s an example of how we can assess a family’s situation and provide them with the proper support. Our health department also has something called the “Incredible Baby Shower” at least three times a year where families are able to get supplies.
How can hospitals, governments and community organizations work better together to provide support and improve outcomes for NICU families?
Cheryl: As more organizations and initiatives are formed, there is always a risk of duplication of effort. But there may be even more of a challenge of these organizations not collaborating or communicating with each other as well as they could. So, that is where I think it is up to each community to have a central resource, which may be the state health department or it could be at the county or district level. The main thing is to ensure that there is a plan in place to ensure that there is no pregnant woman or new mother that does not have access to the services she needs. It’s also a matter of establishing effective lines of communication with care providers to share knowledge and resources. So, we all really need to communicate, collaborate and do our best not to duplicate services and make sure that they are accessible to all families when needed, irrespective of their ability to pay.
The full audio copy of this episode as well as all other episodes of the Bridging the Gap podcast is available on iTunes, Google Play or wherever you get your podcasts.