Dustin Griner
Research and clinical practice has taught us that the first twenty-eight days of an infant’s life are critical. During this time, rapid growth should occur both physiologically and mentally. Retardation of growth during this critical time in the infant’s life leads to future undesirable ramifications. The main goal during this period, is to provide sufficient nutrients both parentally and enterally. These nutrients help develop vital organ and nervous system functions. Nutrients are given to prevent deficiencies as well as complete physiologic catabolism. Extensive research has been performed concerning the proper feeding guidelines for premature and very low birth weight infants. Certain guidelines must be followed and achieved in order for a premature infant to grow normally. If these feeding guidelines are not met, serious consequences result throughout the child’s life. Many technological advances have been made in the United States concerning feeding practices and sustainment of life. We are continually improving ways in which to save the lives of premature infants. In many developing countries technological advances are not available to health care professionals and they must learn to work with the resources provided. Health care professionals depend upon the knowledge of their fellow colleagues including patient progress- intervention charting. A universal concern among health care providers is the accuracy of charted nursing interventions. Many times our perceived interventions do not completely coincide to what we chart. Discrepancies among nursing interventions are crucial when dealing with life-threatening cases such as feeding of very-low birth weight infants. Many times we solely focus on our interventions throughout our shift and do not pay enough attention when charting what we have done. We sometimes forget that the staff member coming to relieve us needs a clear concise knowledge of what we have done in order to make further decisions and interventions.
In May, 2004, a group of 18 nursing students studied and worked in a Maternity hospital in a developing region of Argentina called Tucuman. During this month we were able to research and develop a greater understanding of feeding requirements of very low birth weight infants. We were also able to interview and observe both physicians and nurses in the Neonatal Intensive Care Unit, (NICU) as well as do a retrospective analysis of the charts of infants admitted to the NICU in the year 2003. All infants observed in the NICU had permission slips signed by a parent. During this month, five premature newborns were observed before, during and after feedings given by the nurses in the NICU. Three of the five newborns were within three weeks of age; the other two were within one week of age. Their weights varied between 900grams-1800 grams. As an adjunct study, two Neonatal physicians were interviewed as well as four (NICU) nurses. The questions they were asked dealt with their knowledge about feedings of premature infants, warning signs, and nursing interventions.
Discrepancies in perceived infant feedings vs. actual feedings arose in three of the five infant cases. Nurses had inadvertently documented incorrect feedings on three separate occasions. Nurses in the NICU are each assigned to six premature infants. With such a heavy work load perceived feedings are not always what actually happens. Nurses are often times unable to chart their interventions until the end of the shift, inherently leading to human error. A hospital feeding protocol for premature infants did not exist in the hospital. Feedings for premature infants were at Neonatologist discretion. During my interviews with the hospital staff I had no doubt that the physicians and nurses knew exactly what interventions they were performing, they were just unclear as to the charting recommendations for their particular feeding interventions.
Due to extreme poverty in this particular area in Argentina, funds are very limited to this hospital. Many times because of financial concerns, paper towels were used to chart the infant’s feedings and progress. I was told that form NICU sheets could not be used everyday because of the associated costs, thus limiting health care written communication. The hospital is unable to hire adequate nursing staff to ensure a safe environment for patients. Many nurses feel exhausted after caring for six very compromised patients, and charting interventions become a lower priority.
The implications of this study ideally will secure a grant ensuring funds for proper documentation of infant progress, as well as appropriate feeding protocols for neonatal health care professionals in Argentina. This should promote cost savings through earlier discharge and fewer feeding-related complication which could move the hospital toward financial sustainability of a feeding protocol for preterm infants.