AUTONOMIC NERVOUS SYSTEM organization and functions
Mdmc research project
1. Methodist Dallas
Medical Center
Neonatal Admission Nurse (NAN) Plan:
The Path to Baby-Friendly Designation
Jaclyn L. Budet RNC-OB
The University of Texas at Arlington College of Nursing
In partial fulfillment of the requirements of
N5339 Roles and Functions of the Nurse Administrator
Dorothy C. Foglia, PhD, RN, NEA-BC
November 28, 2012
2. Baby-Friendly: Ten Steps to
Successful Breastfeeding
Have a written breastfeeding policy that is routinely communicated to all health
care staff.
Train all health care staff in skills necessary to implement this policy.
Inform all pregnant women about the benefits and management of
breastfeeding.
Help mothers initiate breastfeeding within one hour of birth.
Show mothers how to breastfeed and how to maintain lactation, even if they are
separated from their infants.
Give newborn infants no food or drink other than breast-milk, unless medically
indicated.
Practice “rooming in”—allow mothers and infants to remain together 24 hours a
day.
Encourage breastfeeding on demand.
Give no pacifiers or artificial nipples to breastfeeding infants.
Foster the establishment of breastfeeding support groups and refer mothers to
them on discharge from the hospital or clinic.
3. MDMC Neonatal Admission
Nurse (NAN) Plan
Current immediate post delivery process: Eventual
separation of mother and infant.
MDMC NAN plan goal is to promote maternal bonding
with infant by providing the same level of care to the
infant in the location where the mother is.
Process plan: Understand the evidence-based research
that supports the NAN plan.
1. Define roles and responsibilities of the NAN staff member.
2. Define roles and responsibilities of the staff member present at
delivery.
3. Determine and obtain necessary equipment for NAN staff member to
complete work.
4. Evidence-Based Research
Skin-to-skin (STS): Involves a naked infant lying prone on
a mother’s bare chest, with the infant’s back covered by a
blanket (Hung and Berg, 2011).
1. Early STS improves breastfeeding and supports infant temperature stabilization and
neurobehavioral development (Hung and Berg, 2011).
2. Benefits of STS include reduced crying, improved mother-infant interaction, warmer
babies, increased sleep, decreased apnea and bradycardia, improved respiration and
oxygen saturation, and accelerated weight gain (Reeg and Lott, 2012).
3. The American Academy of Pediatrics recommends STS contact as a strategy to
increase breast milk supply and breastfeeding success (Bagby and Bowen, 2012).
Rooming-in: Allow mothers and infants to remain together
24 hours a day(www.nichq.org).
1. Rooming-in promotes skin to skin contact, adequate maternal milk supply, feeding on
demand and exclusive breastfeeding (www.nichq.org).
2. Rooming-in facilitates the infant’s transition to extrauterine life, reduces risk of hospital
acquired infection, and prepares parents to care for their infant at home (www.nichq.org).
5. Evidence-Based Research
Breastfeeding: Help mothers initiate breastfeeding within one hour of
birth (www.nichq.org).
1. Breast milk is the best source of nutrition for young children and provides both short
and long-term benefits. Infants who are breastfed are less likely to experience a variety
of infections and to develop chronic conditions later in life (Perrine, Scanlon, Li, Odom, and
Grummer-Strawn, 2012).
2. The World Health Organization and American Academy of Pediatrics recommend that
mothers breastfeed exclusively for about the first 6 months of their infant’s life (Perrine et
al., 2012).
3. Joint Commission recently recommended exclusive breast milk feeding during an
infant’s entire hospital stay (Brown and Redmon, 2012).
4. Breastfeeding within one hour of birth promotes infant’s transition to extrauterine
life, the infant is most alert within one hour after birth, and it promotes maternal
oxytocin to decrease bleeding. Early breastfeeding will facilitate effective breastfeeding
with no supplementation (www.nichq.org).
6. Evidence-Based Research
Delay of procedures: The removal of “timed” or “by the clock”
clinical practices (Penny-MacGillivray, 1996).
1. Infant Bathing: Implementation of bath delay showed that regardless of
gestational age, the incidence of newborns experiencing hypothermia and
hypoglycemia during the transitional period was reduced by changing the focus
of unnecessary interventions (Lipka and Schulz, 2012).
Delay infant baths at least 2 to 4 hours to establish thermoregulation and decrease
negative side effects of hypothermia, including increased oxygen
consumption, respiratory distress, and hypoglycemia (Lipka and Schulz, 2012).
2. Vitamin K and Erythromycin: Texas State Code requires 0.5% erythromycin
ophthalmic solution or ointment to be applied, to the infant’s eyes within 2 hours after
birth (Texas Department of State Health Services, 2012).
Vitamin K should be given to all newborns as a single, intramuscular dose of 0.5 to 1
mg soon after delivery (American Academy of Pediatrics, 2003).
3. Dubowitz Assessment: Postnatal assessment of gestational age by external Ballard
examination performed poorly compared with early ultrasound and last menstrual
period (Taylor, Denison, Beyai, and Owens, 2010).
4. Hypoglycemia Protocol: Evaluation and treatment of late-preterm infants and term
infants considered “at-risk”: those who are small for gestational age, large for
gestational age and infants of diabetic mothers. Only address the at-risk infants, not
the healthy term babies (Rucoba, 2011).
7. References
American Academy of Pediatrics, Committee on Fetus and Newborn. (2003). Controversies
concerning vitamin K and the newborn. Pediatrics, 112(1), 191-192.
Baby-Friendly USA. (2012). Baby-Friendly Hospital Initiative. Retrieved October 4, 2012
from http://www.babyfriendlyusa.org/eng/index.html
Bagby, K., and Bowen, S. (2012). Kangaroo care increases breastfeeding rates. Journal of
Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118.
Brown, T. and Redmon, M. (2012). Supporting breastfeeding in the hospital: A better start.
Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118.
Hung, K. J., and Berg, O. (2011). Early skin-to-skin after cesarean to improve
breastfeeding. The American Journal of Maternal/Child Nursing, 36(5), 318-324.
NICHQ. (2012). Best Fed Beginnings. Retrieved November 20, 2012 from
http://www.nichq.org/our_projects/cdcbreastfeeding.html
8. References
Lipka, D., and Schulz, M. (2012). “Wait for Eight”: Implementation of newborn outcomes by the
implementation of newborn bath delay. Journal of Obstetric, Gynecologic, and Neonatal
Nurses, 41, S1-S118.
Penny-MacGillivray, T. (1996). A newborn’s first bath: When? Journal of
Obstetric, Gynecologic, and Neonatal Nurses, 25, 481-487
Perrine, C. G., Scanlon, K. S., Li, R., Odom, E., Grummer-Strawn, L. M. (2012). Baby-Friendly
hospital practices and meeting exclusive breastfeeding intention. Pediatrics, 130, 54-60.
Reeg, J. L., and Lott, T. (2012). Implementing skin-to-skin care in a baby-friendly community
hospital. Journal of Obstetric, Gynecologic, and Neonatal Nurses, 41, S1-S118.
Rucoba, R. J. (2011). Algorithm is key resource on screening, management of neonatal
hypoglycemia in at-risk infants. AAP News, 32(3), 20-21.
Taylor, R. A. M., Denison, F. C., Beyai, S., and Owens, S. (2010). The external ballard
examination does not accurately assess the gestational age of infants born at home in a
rural community of the Gambia. Annals of Tropical Paediatrics, 30, 197-204.
Texas Department of State Health Services. (2012). Communicable diseases. Retrieved on
November 20, 2012 from www.texinfo.library.unt.edu