Hannah Barsam – Independent Project

Hannah Barsam – Independent Project

Class of 2017

Introduction to Topic

My independent project centered around Neonatal Abstinence Syndrome (NAS) – a syndrome infants are born with if their mother’s use opioid or other drugs while pregnant. I spent time shadowing in the University of Maryland Upper Chesapeake Health (UMUCH) Special Care Nursery (SNC) facility. This facility is specially equipped to accommodate infants who are born with various medical issues, including NAS. While shadowing here I observed several SCN nurses complete different assessments, tests, and “care times” with the infants in the nursery. The reason I chose to complete my project on this topic is because the lack of awareness on the subject. There are sources all over the world that state the incidence of NAS is increasing drastically, but most of the population remains oblivious to the drug abuse problems within their own community. Harford County, and the Upper Chesapeake Health center is a perfect example of such an area, and through this project I hope to bring a new sense of recognition and responsibility to aid in the education and prevention of this unfortunate syndrome.

Project Description

The facility where I shadowed to learn about the care and treatment of infants who had NAS was the UMUCH Special Care Nursery. I spent 70 hours of time here following various nurses on the SCN staff as they went through different assessments, tests, and “care times” with several infants that were admitted in their facility. The 3 main nurses which I communicated and collaborated with on the content of this project include Joy Daugherty (RN), Dawn Henderson (RN), and Jenn Thomas (RN). While on the unit I was taught several procedures regarding the careful treatment of infants who suffer from NAS, and was given an incredible amount of opportunities to interact with these infant’s myself – which offered me a completely new perspective on the syndrome. From the time I spent in the SCN I determined that my innovation would be two items to aid in the education of parents who have infants admitted to the nursery for NAS. The first is a one page pamphlet which outlines the most basic, and most important facts concerning the diagnosis and care of their infant as they recover from NAS. The second is a website which provides a much more extensive explanation of what exactly occurs during the treatment of their baby. This website also includes information about the discharge process, and SCN policies and procedures. Both of these are modeled from the UMUCH Special Care Nursery Parent Handbook, so the policies and some of the procedures are specific to the Upper Chesapeake Health facility and its staff. They were created to attempt and provide a more convenient and accessible formatting of the information that all the parents of NAS infants should know.

Experience Description

As stated previously my experience time consisted of 70 hours spent in the UMUCH Special Care Nursery shadowing several registered nurses. During the period I spent in the nursery there was a total of 10 infants which I got to witness some of the treatment process for. Only 7 out of these 10 were diagnosed with NAS, but I was able to learn several assessment procedures and witness various tests completed on the infants who were not admitted for NAS. I was taught the process of an assessment on an infant with NAS and was able to assist in every aspect of theses assessments for each infant with the exception of administering medication. The nurses who work in the SCN are rather eccentric, many of them play practical jokes on one another or just make sly comments to one another while on the job – while it is amusing it’s almost necessary for these nurses to be a little “crazy” as their patients are unable to really communicate with them outside of crying, the humorous environment helps in releasing the stress associated with caring for these babies. Something I found very interesting is the transformation that occurred when parents (especially ones of infants who were admitted for NAS) walked into the nursery; the RNs could be laughing it up one moment but as soon as parents come in they revert to complete professional mode. They speak carefully and politely, but there’s always a bit of tension in the air around parents. This is a subject which I spoke to my mentors about a lot, they say that being respectful and helpful to these parents is arguably the most difficult part of their job. As nurses, and many of them parents, it’s obviously very difficult for them to imagine using addictive drugs while pregnant. While they know they have to be polite and they are very respectful towards these parents, Dawn Henderson told me that there have been times she had to excuse herself from the room because she was so mad at the parents of an NAS infant she was afraid she was going to exclaim something she shouldn’t.

The work that these nurses do is admirable. When I began the process of shadowing in the SCN I thought that it might be something I wanted to pursue as a career in medicine, but after my time spent in the facility I have decided that it’s something I could never handle on a daily basis. The infants with NAS are in constant pain. They’ve been alive for only a few days or weeks, but all they have ever known is hurt and fear and pain – some of them have too many drugs in their systems to combat the symptoms of withdrawal that they can’t even open their eyes and focus on an object or a face. I myself am unable to comprehend why any mother would even risk making her baby suffer through an experience which many adults are unable to face; although I understand that each incidence of NAS has it’s own backstory and set of complex circumstances. There was one day during my shadow time where I sat in a room with a baby girl, her name was Olive, and just held her for two hours straight. That was the only way we could get her to stop crying, if someone sat there and held her (but I could not even rock her or pat her back because any movement caused her tense muscles to hurt). It was one of the most heartbreaking things I’ve ever experienced because I couldn’t fix her. There is no cure for NAS, there is no magic drug that takes away all of their pain, it’s all about doing what you can and trying to make them as comfortable as they can be. The worst part when I think about what it would be like to work with NAS infants is that you can never get closure. You stay with them and care for them until their symptoms are under enough control and they no longer need medication, but then they go home with their parents. You don’t know whether they will have mental or physical disabilities because of the NAS, you don’t know if their parents are going to start using again, or even if child protective services is actually going to monitor the family for more than a year after their discharge. Despite the fact I only spent 70 hours in this facility, and only knew these babies for a few days, I still cannot stop wondering how their lives are going to end up – if they will really be okay, and that’s not something I think I could live with as my job.

Innovation Description

The most evident issue within the SCN that I had the means to address for my innovation was the lack of education in the parents and families of the infants who were diagnosed with NAS. Most of the parents that came in knew little to none about what their child had been diagnosed with outside of the fact that it happened because the mother used/abused drugs while pregnant. This is what lead me to the idea of an educational resource for parents. However, on my last night in the nursery I requested that my mentor give me any handouts that a new parent would be given when admitting an infant with NAS. I was handed a 15 page packet, the “Parent Handbook”. Within this handbook was page after page of information on NAS – useful and helpful information. However, this booklet is completely unappealing to the eye, the formatting is difficult to follow, there are grammatical and spelling errors throughout, and there are even places in the text where it asks you to refer to another page to view a document – which is in fact no where to be found anywhere in the entire booklet. If a biomedical sciences student such as myself, who has a great interest in this topic, has difficulty sitting down and reading all the way through the packet and absorbing the information, then the likelihood that any mother who is in recovery from giving birth is going to take the time to sift through such a packet for the information she needs is very small. When I asked the nurses, and a few of the mothers, if they believed anyone actually reads the alleged packet all of them responded that they would be surprised if someone ever did.

This was my inspiration to create 2 different educational resources for the mothers of NAS infants at the UMUCH SCN facility. The first is a one page pamphlet which condensed all the most important information concerning the diagnosis and care for their infant. All information within this pamphlet comes directly from the Parent Handbook, so it is credited, accurate, and has already been approved by the Upper Chesapeake review board as certifiable. The goal of this pamphlet is to provide a way for the most essential information about NAS to be presented in an aesthetically pleasing, easy to understand format. The probability that parents will look through this short and engaging pamphlet is much higher than the probability that they will go through the extensive Parent Handbook. This pamphlet will account for 10 hours of my total project time. 4 of these hours I spent researching and verifying the information which was found in the Parent Handbook (because of the fundamental mistakes I wanted to ensure the information hadn’t been updated or was inaccurate in general). I then spent 3 hours creating a rough draft which was initially in the form of a one page flyer on which the information for the different panels was spread across the page in boxes. The remaining 3 hours were spent meeting/collaborating with Cynthia Courtney, a graphic designer who currently works for Harford Community College. She advised me that the layout of the flyer made it difficult to read the information in a logical sequence, so it was decided to change the concept into a pamphlet instead. We then went back and forth deciding what information should be put on what panels, and discussing details like color scheme and fonts. The final product allows for a smooth transition between topics and is easily read and interpreted – providing a more efficient mode of transferring information.

The second of my 2 education resources is a website which provides the entirety of the information found in the Parent Handbook. The website, found under the domain www.knowNAS.bahsbiomed.com provides a place for parents, or family/friends of parents, who want more information on the recovery process of their associated infant. I do not have high hopes that the parents will utilize this website, although it would be incredible if they did, usually the parents involved in these types of cases do not become particularly invested in the medical explanation for the events occurring in their babies lives. This website provides more of a platform for the grandparents or aunts/uncles of the infants, as these individuals are often helping the mother through her drug recovery process and therefore usually have more specific questions regarding the care of the baby. The website utilizes a basic format which is easy to use, simple text and high quality images to keep the design clean and condensed. Although there is a lot of information on the website in its entirety it is broken down into many pages and subpages to keep it from being overwhelming. This website also accounts for 10 hours of my total project time. The first 5 hours of this time I spent researching and verifying the remainder of the information in the Parent Handbook to ensure that it was all accurate and up to date. I then began the process of formatting and customizing the website domain that was given to me by Mr. Burke (it took me longer than anticipated to understand and efficiently utilize the WordPress program) which totaled 3 hours time. The remaining 2 hours was spent transferring all the information from the Parent Handbook onto the website and going through to correct all grammatical/spelling errors that existed in the original text. The final published version allows anyone associated with an infant who has NAS to gain valuable knowledge on the syndrome, but is also specific to the UMUCH SCN policies and procedures to keep the patients and their families at this particular location well – informed.

+ Project Topic

Introduction to Topic

My independent project centered around Neonatal Abstinence Syndrome (NAS) – a syndrome infants are born with if their mother’s use opioid or other drugs while pregnant. I spent time shadowing in the University of Maryland Upper Chesapeake Health (UMUCH) Special Care Nursery (SNC) facility. This facility is specially equipped to accommodate infants who are born with various medical issues, including NAS. While shadowing here I observed several SCN nurses complete different assessments, tests, and “care times” with the infants in the nursery. The reason I chose to complete my project on this topic is because the lack of awareness on the subject. There are sources all over the world that state the incidence of NAS is increasing drastically, but most of the population remains oblivious to the drug abuse problems within their own community. Harford County, and the Upper Chesapeake Health center is a perfect example of such an area, and through this project I hope to bring a new sense of recognition and responsibility to aid in the education and prevention of this unfortunate syndrome.

+ Project Overview

Project Description

The facility where I shadowed to learn about the care and treatment of infants who had NAS was the UMUCH Special Care Nursery. I spent 70 hours of time here following various nurses on the SCN staff as they went through different assessments, tests, and “care times” with several infants that were admitted in their facility. The 3 main nurses which I communicated and collaborated with on the content of this project include Joy Daugherty (RN), Dawn Henderson (RN), and Jenn Thomas (RN). While on the unit I was taught several procedures regarding the careful treatment of infants who suffer from NAS, and was given an incredible amount of opportunities to interact with these infant’s myself – which offered me a completely new perspective on the syndrome. From the time I spent in the SCN I determined that my innovation would be two items to aid in the education of parents who have infants admitted to the nursery for NAS. The first is a one page pamphlet which outlines the most basic, and most important facts concerning the diagnosis and care of their infant as they recover from NAS. The second is a website which provides a much more extensive explanation of what exactly occurs during the treatment of their baby. This website also includes information about the discharge process, and SCN policies and procedures. Both of these are modeled from the UMUCH Special Care Nursery Parent Handbook, so the policies and some of the procedures are specific to the Upper Chesapeake Health facility and its staff. They were created to attempt and provide a more convenient and accessible formatting of the information that all the parents of NAS infants should know.

+ Experience

Experience Description

As stated previously my experience time consisted of 70 hours spent in the UMUCH Special Care Nursery shadowing several registered nurses. During the period I spent in the nursery there was a total of 10 infants which I got to witness some of the treatment process for. Only 7 out of these 10 were diagnosed with NAS, but I was able to learn several assessment procedures and witness various tests completed on the infants who were not admitted for NAS. I was taught the process of an assessment on an infant with NAS and was able to assist in every aspect of theses assessments for each infant with the exception of administering medication. The nurses who work in the SCN are rather eccentric, many of them play practical jokes on one another or just make sly comments to one another while on the job – while it is amusing it’s almost necessary for these nurses to be a little “crazy” as their patients are unable to really communicate with them outside of crying, the humorous environment helps in releasing the stress associated with caring for these babies. Something I found very interesting is the transformation that occurred when parents (especially ones of infants who were admitted for NAS) walked into the nursery; the RNs could be laughing it up one moment but as soon as parents come in they revert to complete professional mode. They speak carefully and politely, but there’s always a bit of tension in the air around parents. This is a subject which I spoke to my mentors about a lot, they say that being respectful and helpful to these parents is arguably the most difficult part of their job. As nurses, and many of them parents, it’s obviously very difficult for them to imagine using addictive drugs while pregnant. While they know they have to be polite and they are very respectful towards these parents, Dawn Henderson told me that there have been times she had to excuse herself from the room because she was so mad at the parents of an NAS infant she was afraid she was going to exclaim something she shouldn’t.

The work that these nurses do is admirable. When I began the process of shadowing in the SCN I thought that it might be something I wanted to pursue as a career in medicine, but after my time spent in the facility I have decided that it’s something I could never handle on a daily basis. The infants with NAS are in constant pain. They’ve been alive for only a few days or weeks, but all they have ever known is hurt and fear and pain – some of them have too many drugs in their systems to combat the symptoms of withdrawal that they can’t even open their eyes and focus on an object or a face. I myself am unable to comprehend why any mother would even risk making her baby suffer through an experience which many adults are unable to face; although I understand that each incidence of NAS has it’s own backstory and set of complex circumstances. There was one day during my shadow time where I sat in a room with a baby girl, her name was Olive, and just held her for two hours straight. That was the only way we could get her to stop crying, if someone sat there and held her (but I could not even rock her or pat her back because any movement caused her tense muscles to hurt). It was one of the most heartbreaking things I’ve ever experienced because I couldn’t fix her. There is no cure for NAS, there is no magic drug that takes away all of their pain, it’s all about doing what you can and trying to make them as comfortable as they can be. The worst part when I think about what it would be like to work with NAS infants is that you can never get closure. You stay with them and care for them until their symptoms are under enough control and they no longer need medication, but then they go home with their parents. You don’t know whether they will have mental or physical disabilities because of the NAS, you don’t know if their parents are going to start using again, or even if child protective services is actually going to monitor the family for more than a year after their discharge. Despite the fact I only spent 70 hours in this facility, and only knew these babies for a few days, I still cannot stop wondering how their lives are going to end up – if they will really be okay, and that’s not something I think I could live with as my job.

+ Innovation

Innovation Description

The most evident issue within the SCN that I had the means to address for my innovation was the lack of education in the parents and families of the infants who were diagnosed with NAS. Most of the parents that came in knew little to none about what their child had been diagnosed with outside of the fact that it happened because the mother used/abused drugs while pregnant. This is what lead me to the idea of an educational resource for parents. However, on my last night in the nursery I requested that my mentor give me any handouts that a new parent would be given when admitting an infant with NAS. I was handed a 15 page packet, the “Parent Handbook”. Within this handbook was page after page of information on NAS – useful and helpful information. However, this booklet is completely unappealing to the eye, the formatting is difficult to follow, there are grammatical and spelling errors throughout, and there are even places in the text where it asks you to refer to another page to view a document – which is in fact no where to be found anywhere in the entire booklet. If a biomedical sciences student such as myself, who has a great interest in this topic, has difficulty sitting down and reading all the way through the packet and absorbing the information, then the likelihood that any mother who is in recovery from giving birth is going to take the time to sift through such a packet for the information she needs is very small. When I asked the nurses, and a few of the mothers, if they believed anyone actually reads the alleged packet all of them responded that they would be surprised if someone ever did.

This was my inspiration to create 2 different educational resources for the mothers of NAS infants at the UMUCH SCN facility. The first is a one page pamphlet which condensed all the most important information concerning the diagnosis and care for their infant. All information within this pamphlet comes directly from the Parent Handbook, so it is credited, accurate, and has already been approved by the Upper Chesapeake review board as certifiable. The goal of this pamphlet is to provide a way for the most essential information about NAS to be presented in an aesthetically pleasing, easy to understand format. The probability that parents will look through this short and engaging pamphlet is much higher than the probability that they will go through the extensive Parent Handbook. This pamphlet will account for 10 hours of my total project time. 4 of these hours I spent researching and verifying the information which was found in the Parent Handbook (because of the fundamental mistakes I wanted to ensure the information hadn’t been updated or was inaccurate in general). I then spent 3 hours creating a rough draft which was initially in the form of a one page flyer on which the information for the different panels was spread across the page in boxes. The remaining 3 hours were spent meeting/collaborating with Cynthia Courtney, a graphic designer who currently works for Harford Community College. She advised me that the layout of the flyer made it difficult to read the information in a logical sequence, so it was decided to change the concept into a pamphlet instead. We then went back and forth deciding what information should be put on what panels, and discussing details like color scheme and fonts. The final product allows for a smooth transition between topics and is easily read and interpreted – providing a more efficient mode of transferring information.

The second of my 2 education resources is a website which provides the entirety of the information found in the Parent Handbook. The website, found under the domain www.knowNAS.bahsbiomed.com provides a place for parents, or family/friends of parents, who want more information on the recovery process of their associated infant. I do not have high hopes that the parents will utilize this website, although it would be incredible if they did, usually the parents involved in these types of cases do not become particularly invested in the medical explanation for the events occurring in their babies lives. This website provides more of a platform for the grandparents or aunts/uncles of the infants, as these individuals are often helping the mother through her drug recovery process and therefore usually have more specific questions regarding the care of the baby. The website utilizes a basic format which is easy to use, simple text and high quality images to keep the design clean and condensed. Although there is a lot of information on the website in its entirety it is broken down into many pages and subpages to keep it from being overwhelming. This website also accounts for 10 hours of my total project time. The first 5 hours of this time I spent researching and verifying the remainder of the information in the Parent Handbook to ensure that it was all accurate and up to date. I then began the process of formatting and customizing the website domain that was given to me by Mr. Burke (it took me longer than anticipated to understand and efficiently utilize the WordPress program) which totaled 3 hours time. The remaining 2 hours was spent transferring all the information from the Parent Handbook onto the website and going through to correct all grammatical/spelling errors that existed in the original text. The final published version allows anyone associated with an infant who has NAS to gain valuable knowledge on the syndrome, but is also specific to the UMUCH SCN policies and procedures to keep the patients and their families at this particular location well – informed.

By | 2017-05-12T02:43:07+00:00 May 12th, 2017|Biomed Capstone Project 2017|0 Comments

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