Caring Practice


Caringis considered the basis that offers a framework for nursing practice.The ability of a nurse to care for patients is influenced by variousfactors. For instance, the relationship between the care providers,patients, and their family members is very significant in impactingthe care provided to patients since once an excellent relationship isestablished nurses become inspired to provide the much-needed care(Sitzman &amp Watson, 2014). However, if there is no cooperationamid patients and care providers, it would be hard for nurses to havethe drive to provide care effectively. There is a need for nurses tocomprehend the art of caring and what caring is not so as to providethe best atmosphere in the caring practice (Sitzman &amp Watson,2014). Proper and satisfactory care is the desire of every humanbecause it supports the survival of individuals. Therefore,appropriate care emerges as the need of every person. It is essentialfor patients to show their commitment in receiving care throughcollaborating with caregivers. However, it is the role ofpractitioners to ensure that they are dedicated to providing the bestto their patients (Sitzman &amp Watson, 2014). The caregiver shouldalways engage with patients in a compassionate manner. The purpose ofthis report is to provide an exemplar of my nursing practice thatshows the provision of care to a patient. Furthermore, the HarrisHealth NPPM components will also be highlighted.

Thecaring practice has a role in promoting comfort, healing, as well aspreventing unnecessary suffering for patients and their families.Harris Health Nursing has an excellent history, a vibrant present, aswell as a promising future emanating from its caring practices. It isthe mission of Harris Health Nursing to offer high-quality health andhealing services to its patients, their households, and the communityat large. Harris Health Nursing Practice Models (NPPM) has threedomains, which include care delivery system, professionalenvironment, and knowledge structure. According to Harris Health NPPM(2014), “Applying a systematic knowledge structure facilitates aprofessional level of practice characterized by evidence-baseddecisions.” The organization strives to offer a healing environmentto its patients. The professional environment domains for HarrisHealth System are envisioned in shared governance, professionaldevelopment, differentiated practice, and professional enculturation.The care delivery system “reflects the nurse’s authority andaccountability in making clinical decision and obtaining targetedoutcomes. It promotes continuous, consistent, efficient, andaccountable nursing care” (Harris Health NPPM, 2014). The practicemodel enables nurses in providing a standardized care for patientsand their families, which is chiefly relationship-based andpatient-centered. The relationship-based care assists nurses ingetting to know the patients and their families. This is perceived ascritical in meeting the individualized needs of patients. Theleadership of Harris Health Nursing invests in its people as itsprimary resources in supporting and promoting nursing at thedifferent levels of the organization. Harris Health nurses have thebenefit and support of working with leaders and colleagues within anenvironment which values team learning, mental modeling, personalmastery, as well as the capacity to approach work within a framework.Harris Health Nurses have depicted nursing excellence in theorganization since they are passionate about caring for patients anddesire to excel as clinical nurse leaders at the bedside.

Someof the newborn babies require special attention when they are bornprematurely. In the case of the patient to be considered in thisreport, it is a baby who was born prematurely. A baby having agestational period of 30 weeks became admitted to the NeonatalIntensive Care Unit (NICU) for prematurity and respiratory distresssyndrome. Newborn babies who require intensive medical unit need tobe admitted into a unique area of a hospital that is known as NICU.The baby was placed on bubble CPAP, PEEP 6, and FIO2 23-25 %.{ BubbleCPAP: “Thebubble CPAP delivery system comprises of a humidified gas source, aninterface that connects the CPAP circuit to the infant’s airwaythrough short nasal prongs, and a tube submerged in a bottle ofwater. As the gas exits the tube, it creates bubbles that producesmall airway pressure oscillations. When these oscillations reach theneonate’s lungs, the result is improved gas exchange and lungfunction” (Hanlon, 2014)}. Alternatively, UVCline is inserted for total parenteral nutrition (TPN) and medication,and the Baby tolerated bubble CPAP 6 and FIO2 is weaned to 21%. Inproviding care to the baby, I was assigned as the primary nurse forthe shift lasting from 7 PM to 7 AM. The moment I was positioning thebaby in the dandle roo, the mother came. [DandleRoo: “The Dandle Roo was developed by NICU professionals to supportthe neurodevelopment of the pre-term and ill infants. The Dandle Roois the first three-dimensional system that supports prone, supine andside-lying positions all in one device” (Dandle.Lion Medical, n.d).I introduced myself, arranged a private place and offered her arecliner. I explained the infant’s condition briefly and called thedoctor to explain in detail about the medical condition of the baby.The doctor clarified her questions and explained in detail about theimmature lungs and digestive system. In order to alleviate heranxiety, I explained to her about the cardiac monitor, alarm setting,bubble CPAP set up, umbilical line, TPN, and feeding by theorogastric tube. I encouraged her to touch the baby, explained aboutbreast feeding and pumping. Then I taught her how to pump, store andtransport breast milk as she was separated from the baby. At thisjuncture, I offered her the breast pump and she pumped at thebedside. According to Woten &amp Hurst (2016), “post-natalattachment is facilitated by a positive birth experience and byseeing, touching, and providing care for the infant. The birth of apremature or critically ill infant and hospitalization in theneonatal intensive care unit can interfere with mother-infantattachment” (Woten &amp Hurst, 2016, p.1). Also, I explained toher that since the baby was premature, the condition could change atany time. The mother was happy when she left the NICU on the firstday.

Duringthe consecutive visits, I updated the mother about the infant’scondition. I explained to the mother about the protected sleep, painassessment, and management, positioning the baby, feeding, and skincare. With respect to the family-centered care, I involved andassisted the mother to do kangaroo care, change diaper, and positionthe baby. I explained to her about the importance of providing aquiet environment to promote the baby’s rest and sleep. Within aweek, the mother of the baby had developed confidence with me, whichwas evident from her words. I remember her saying “I feel like, inmy absence, you are taking care of my baby the way I want it to be. Iam going to refer Ben Taub hospital to my family and friends for theexcellent care”. This was clear that I had already established anattachment to the mother, which was necessary for the provision ofcare.

Thebaby’s condition was improving gradually, but on the 10thday of life, he vomited three times during the day shift, and thevomiting was not associated with feeding. During my time, the babyvomited again one time approximately 2 hours after feeding. On myassessment, the baby’s abdomen was distended, mild erythema aroundthe umbilicus and no bowel sounds heard on auscultation. I informedthe doctor regarding the change in the condition of the baby.Furthermore, the baby developed multiple episodes of apnea andbradycardia with desaturations and hypotension. The doctor assessedthe baby and ordered for abdominal X-ray. The X-ray result revealedfree air in the intestine. Since Ben Taub Hospital does not have aneonatal surgical team, the medical team decided to transfer the babyto Texas Children’s Hospital (TCH) for further management. Icalled the mother and briefly explained the change in the conditionof the baby and asked her to come to the unit to sign the Memorandumof Transfer (MOT). In this situation, I had to initiate and directthe doctors on how to do the MOT, as the Neo fellow and residentdoctors were new to the NICU and this was their first timetransferring a baby to another hospital.

Whenthe mother arrived at NICU, I arranged a private place and offered arecliner. From her interactions and behavior, she was very upset andsad and asked several questions regarding the condition of the baby.I explained to the mother about the baby’s condition and need totransfer it to TCH. I called the fellow doctor to explain about themedical facts. From my previous experience, I knew that the suddendrastic change in the condition of the baby made her more upset andchange in her behavior. In an attempt to help her calm down, I calledthe chaplain to talk to her. Even though the chaplain talked to her,she remained upset and anxious. I involved the social service toinform her about a local support group. I involved the charge nursein talking to her. I updated the fellow doctor regarding the behaviorstate of the mother and requested him to make an opportunity for themother to talk to the attending doctor. The attending doctor alsoexplained to the mother about the baby’s condition over the phone.I explained to her ways of calming down the mind, includingmeditation and prayer and provided the handouts for tips for reducingstress and meditation. I explained to her about the kangaroo teamfrom Texas Children’s Hospital (kangaroo team is a transport team,and it consists of a Neonatal nurse practitioner, RN and respiratorytherapist from TCH). I handed over the baby’s clothes, one ID band,umbilical cord, and footprint sheet to the mother. I sat with herexplaining these facts nearly for half an hour. She said that shewould practice meditation according to her cultural and spiritualheritage. When the kangaroo team arrived at the unit, I vividlyexplained about the mother’s reaction to the change in thecondition of the baby. I requested them to allow the mother toaccompany them because that could assist in lessening her anxiety andworry. The team agreed to do as I had requested. I knew very wellthat this was not an established practice for the kangaroo team,which made me share with them about the situation. The kangaroo teamhad a detailed discussion with the mother, and she slowly becamerelaxed as evidenced by her soft words, touching of the baby, andsmiling. She expressed gratitude to me for giving support and help inher difficult time.

Tomeet the caring needs of the baby, I integrated the caring practicesinherent in the Neonatal Intensive Care Unit (NICU) cultures that theunit values most to meet the nursing mission of providinghigh-quality care and vision for optimal health outcomes. Iincorporated the Neonatal Intensive Care Unit’s core measures whiletaking care of the baby.

Thefirst core measure was protected sleep. I assessed the baby’ssleep-wake states and clustered all care activities when the baby wasawake. The NICU lights and sound were maintained within therecommended range to provide infant to have uninterrupted periods ofsleep. The NICU practice is soft talk where everyone kept theirvoices at low levels. Another NICU culture is to attend cardiacmonitor and ventilator alarms without waiting this was critical toprevent the deleterious effects of noise on the babies. According toCaple &amp Hurst (2016), “Continuous exposure to excessivebackground noise increases a newborn’s physiological requirements,diminishes peripheral oxygen saturation, slows weight gain,diminishes perfusion to critical brain tissues, interrupts the normalsleep-wake cycle essential for healing and immune system development,and can prolong the patient stay in the NICU” (Caple &amp Hurst,2016). This being the case, I educated the mother concerning theimportance of providing uninterrupted sleep and avoiding excessivenoise.

Thesecond core measure that I emphasized was pain and stress assessmentand management. I assessed pain every 4 hours before, during, andafter all procedures with subsequent documentation. According toPasek &amp Huber (2016), “painful procedures place a newborn atrisk for brain damage. Moreover, brain damage and the generation offree radicals are associated with hypoxia” (Pasek &amp Huber,2012 p 61). I used non-pharmacological measures such as swaddling,offering a pacifier, and administering sucrose prior to all painfulprocedures on the baby. According to Pasek &amp Huber (2012), themechanism of action of sucrose “is thought to involve activation ofthe endogenous opioid system (the release of beta-endorphins) throughgustatory pathways or taste” (2012, p. 61). I encouraged the motherto do skin-to-skin care (kangaroo care) which has a positive outcomeon the stress of the NICU setting on the premature babies. I alsoinvolved and shared with the parent regarding pain and stressmanagement plan of care.

Thethird core measure involved the developmental activities of dailyliving these entailed positioning, feeding, and skin care. I ensuredproper postural support by placing the baby in a dandle roo. Thedandle roo keeps the baby in flexion containment and alignment.According to Caple &amp Hurst (2016), “Developmental Care (DC) ofthe newborn involves reading and responding for instance, holdingthe infant, gently touching, and placing the infant in a fetalposition to its behavior in an effort to identify its needs. DC alsoinvolves altering the environment such as decreasing light and noiselevels to decrease stimulation and limit exposure to stimuli that aregreater than the infant’s premature brain can tolerate” (Caple &ampHurst, 2016). I provided pacifier for non-nutritive sucking duringgavage feeding. I educated and supported the mother for breastfeedingand pumping every two hours while being separated from the baby.Finally, I ensured that the skin integrity was assessed anddocumented every 3 hours, and applied aloe vesta (skin care productused in NICU to prevent skin breakdown) after each diaper change.

Thefourth core measure was family-centered care. The parents of the babyhad unrestricted access for 24 hours to their infant in the NeonatalIntensive Care Unit. I assessed the mother’s emotional and physicalwell-being, ability and confidence in taking care of her baby. Theparents were offered and encouraged to participate in medical rounds(the team included neo fellow, resident, charge nurse, bedside nurse,and respiratory therapist) at 9 pm every day. I involved the motherduring caregiving activities such as bathing, diapering, and feedingof the baby. I explained and encouraged the mother to do kangaroocare, which has been recommended by NICU. Furthermore, I involvedsocial service for access to resources and supports that assisted themother for her short and long-term parenting needs.

Thefifth core measure was the healing environment. A quiet environmentwas provided by dimming lights and lowering noise levels. I ensuredphysical and auditory privacy for the mother during each visit byproviding curtains around the baby’s bed and less interruption bythe health care team. In the NICU, nurse-doctor-respiratory therapistcollaboration was always practiced to provide high-qualitycomprehensive care to the infants. I practiced evidence-basedpolicies, procedures, and resources to sustain the healingenvironment in NICU. I communicated effectively and timely with theneonatal team, and the baby’s mother to prevent any delay intreatment. Jean Watson’s theory of caring practice was veryrelevant in this context. The theory explains the interpersonalrelationship between two or more people. “Care must be especiallyfocused on interpersonal relations since the care moments areexpressions of the interaction that can happen in a transpersonalmanner. Analysis of the transpersonal care concept focuses on theestablishment of a relation that goes beyond caring for physiologicalnecessities, aiming at a higher level, and resulting in thetransformation of both individuals (Santos et al., 2014). A loving,trusting and caring relationship between the mother and health careteam brought a positive impact on the mother since it helped increating an environment where the team could offer care tosatisfactory levels.


Inthe provision of care, it is vital for caregivers to treat patientsas unique individuals through providing care in a compassionatemanner. Also, the practitioners should be in a position todomesticate the environment of patients in order to provide asupportive healing setting. Collaboration plays a critical part inthe caring practice since it helps in understanding the needs ofpatients. Harris Health Nursing has an excellent history, a vibrantpresent, as well as a promising future emanating from its caringpractices. It is the mission of Harris Health Nursing to offerhigh-quality health and healing services to its patients, theirhouseholds, and the community at large. Harris Health NursingPractice Models (NPPM) has three domains, which include care deliverysystem, professional environment, and knowledge structure. Accordingto Harris Health NPPM (2014), “Applying a systematic knowledgestructure facilitates a professional level of practice characterizedby evidence-based decisions.” The organization strives to offer ahealing environment to its patients. The professional environmentdomains for Harris Health System are envisioned in shared governance,professional development, differentiated practice, and professionalenculturation. Proper and satisfactory care is the desire of everyhuman because it supports the survival of individuals. Therefore,appropriate care emerges as the need of every person. It is essentialfor patients to show their commitment in receiving care throughcollaborating with caregivers.


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