Part 1. My reflections as a veteran nurse on the evolution of NIDCAP Care in our NICU
I retired from work recently. I started my journey as a NICU nurse thirty years ago, when the Neonatal Intensive Care unit (NICU) just opened its doors at Meir Medical Center. After I was discharged from my service in the Army, I worked with adults in Intensive Care, and actually planned to continue in that field. When I was offered to join the new NICU, even though I was scared to make a shift from adult to newborn care, I decided to give it a try and, …. the rest is history.
I remember my first day all too well. Shortly after being guided by the pioneer Neonatologist who founded the NICU, I had to actually start to work and perform as a bedside neonatal intensive care nurse. I was scheduled for the night shift that first day, and worked with her side by side. I recall being very excited and emotional, yet my first shift went along well. During the next months I gradually got used to working with those tiny and fragile babies. I fell in love with them and with the work I did – the proof is I stayed at the NICU for 30 years!
Back then no one spoke, in our milieu, about Developmental Care, nor NIDCAP. All babies in need of assisted ventilation were cared for in open radiant beds at that time; in order to keep their body temperature stable, we partially covered them with a loose transparent polyethylene sheet. Those preterm babies used to lay untucked on their backs, often with their arms and legs away from their bodies. Fluorescent light illuminated the room and it was not possible to dim them. Everything took place in one long room – the caregiving, the numerous staff rounds and huddles, parents going in and out, … it was quite a hectic and noisy place. I recall we bathed the babies during the night shift, very quickly, as the bath “ought to be done”. Surprisingly enough, babies were weighed on a fixed schedule in the morning hours; there was no awareness, at that time, to cluster some of the caregiving according to the baby’s needs.
Some years later, a new, gentle and sensitive nurse talked about an advanced approach to preterm infant care called Developmental Care, and introduced the concept of NIDCAP to our NICU. It was certainly difficult to introduce this approach at first, and I believe it was quite a long and very quiet “revolution” that would not have thrived nor succeeded without her and without the support and vision of our managers and the openness of our staff. Initially, I thought it would be very hard for us to change our care in such a way; it was only when I delved deeper into the concept of individualized developmental care that I understood its meaning and importance.
During those years I gave birth to a 34-week-old little girl. The developmental care approach in our hospital was in its infancy and just beginning to emerge. Looking back, I feel my daughter and I had so many missed opportunities. If I knew better, I would have managed the whole experience differently. I think she lacked being held skin-to-skin, and I did not succeed in breastfeeding her.
Therefore, as a professional I gradually became very supportive of Developmental Care and found it crucial for preterm infants. The very essence of it is – in my view – to try to emulate in the NICU the womb’s conditions so as to diminish the potentially adverse neurological, physical, psychological and developmental effects the baby and family might experience. I am not able to envision today another way of caring for them, and feel deep sorrow when I hear about babies and families that are not cared for in this nurturing and supportive approach.
Persistent work was certainly necessary to implement the NIDCAP approach in our NICU’s everyday life; we had to learn and be guided, and we had to engage the whole caregiving team. I believe that our very special and sensitive team, with the support given by the NICU’s managing team, was decisive in transforming the unit into one where the NIDCAP approach to care has become second nature. We were lucky enough to have part of our staff trained by Dr. Heidelise Als and Dr. gretchen Lawhon, and to finally become the Israel NIDCAP Training Center at Meir Medical Center in October 2018. Caregivers from many other NICUs in our country participate in the Center’s courses and the NIDCAP word is now spreading in Israel.
I changed profoundly over those years. The developmental approach to care guided by NIDCAP gives support to parents in that sensitive period when the baby is in the NICU. I gradually was able to see the baby and his/her parents as a “unit”, and realized that our caregiving is meant to be for the family as a whole. It was important to me to be close and around the parents. I became more empathetic. It became important to me to really support the parents, to be a good listener, to encourage their presence at the bedside and to explain to them how their very presence diminishes the stress that their baby might experience in the NICU environment. I realized that separating the preterm baby from the mother right after birth is traumatic for them and therefore bodily contact between them is crucial. I could tell the difference between a baby whose parents were with him/her most of the time and a baby that is left alone for hours.
I like to think of our NICU as a shelter for babies and parents who go through a very difficult period. Looking into the future, I would like to see in my country more continuity of care between the NICUs and follow-up care in the community.
- Michelle Julie Meyer, RN
Retired Neonatal Nurse
Israel NIDCAP Training Center
Meir Medical Center
Kfar Saba, Israel
Please watch for the second part of the NIDCAP Care as Experienced by Two Nurses, One a Veteran, One a Novice series: Part 2. My impressions as a “young” NICU nurse, by Orna Netzer, RN.