Wards of tiny charges
Coupled with medical advances she says that neonatal nursing and multidisciplinary care have also evolved to very high levels in Ireland.
For example, the neonatal individualised developmental care programme (Nidcap) used in the Coombe works to promote the in utero environment.
Lighting and noise levels are kept to a minimum and dedicated nurses know to respond to the cues of their tiny charges. For example, a rise in heart rate may mean the baby is hungry, needs a nappy change or has to be repositioned.
According to O’Sullivan, an ICU nurse needs to be very responsive, “acutely aware” and “alert always to the changing condition of their baby” so they can pick up on the minutest change.
It is also hugely important to listen to the baby’s mother, she adds.
Nurses like O’Sullivan also have a responsibility to care for and support desperately worried parents. This includes supporting parents who receive the devastating news that their baby is not going to survive.
Neonatal nurses, therefore, support parents at one of the darkest times of their lives. Parents are also offered the supports of the hospital’s chaplaincy and bereavement counselling services.
The vast majority of O’Sullivan’s tiny patients suffer from complications of prematurity and in the initial hours after birth the main focus is on helping them to breathe with the aid of ventilation. She explains that as premature babies have paper-like skin, which must be kept intact to avoid infection, handling and positioning them can be hugely challenging. The sickest babies in the NICU therefore have one-to-one nursing.
“When we have a new 24-weeker in the unit the primary nurse would be very much at the bedside . . . observing the baby all the time,” she says.
According to O’Sullivan, in an ideal world, all of the babies in intensive care would have one-to-one nursing. However, the realities of working in a downturn means this is not always possible.
“We are working in very challenging times in relation to staffing levels. We are losing staff and staff aren’t being replaced and we are actually really trying hard not to use agency staff as is directed by the HSE . . . it puts huge pressure on you. But at some point in time you have to say no, I can’t manage because it is not safe and we are well supported in this hospital when those situations arise,” she says.
The majority of the babies cared for in the neonatology centre in the Coombe do very well and for O’Sullivan the best part of her job is meeting mothers and their babies months after discharge.
She says she often has difficulty recognising parents, as their faces are no longer transfixed with anxiety.
“It is all peaks and troughs when you are looking after babies in intensive care . . . and then when you see them getting to the stage where they go home . . . it is very rewarding. It’s what makes you do what you do.”