New Program Provides Consistent Infant Care, Familiar Facese

Nurses at Texas Children's Newborn Center have embarked upon a method of care specifically designed to provide the nursery's most fragile babies with consistent care.

Texas Children's Consistency of Care for Infants and Families program involves nurses in the hospital's Level II and III nurseries working in teams of nine to 12. Less critically ill infants are cared for in the Level II nursery, while the Newborn Center's sickest babies are cared for in Level III. Nurses are assigned to the same babies for an eight-week period, to provide a level of consistency and familiarity among the babies, their families and the caregivers.

"What we're hoping is that the better the nurses know the baby, the more coordinated the patient's stay will be," says Carol Turnage Carrier, a neonatal clinical nurse specialist at Texas Children's. "We're also really trying to help reduce families' anxiety and facilitate their adaptation to parenting their babies."

In a traditional hospital setting, a baby easily could see as many as 57 nurses during a one-month hospital stay. The Consistency of Care program allows nurses time to learn babies' silent cues of distress, and build intimate bonds with them and trust with their families. Ultimately, this fosters the babies' development, decreases the number of complications and shortens the length of their hospital stays.

A 30 member task force spent six months designing the Consistency of Care program at Texas Children's Newborn Center.

The Center's Level II and Level III nurseries compose the nation's largest neonatal intensive care unit, where more than 2,500 babies are treated annually by a staff of nearly 300 caregivers.

Elements of the consistency of care model include:

• The Level II and III nurseries are divided into five geographic areas.
• A team of nine to 12 nurses covers each area.
• Each team cares for 12 to 18 babies in Level II and 10 to 12 babies in Level III.
• Team leaders begin each shift with team members reporting on the status of their patients.
• Respiratory therapists and other clinicians are dedicated to teams, as needed.
• The teams are grouped together for a year but rotate to different areas every eight weeks, a time period based upon babies' average length of stay.

This consistency model is the second phase of Texas Children's Developmental Support program. This program centers on treatment that takes into account newborns' nonverbal cues, such as frowning or stiffly outstretched limbs and fingers. These might be cues that the baby needs a protected environment of dim lights or decreased noise.

"It's important to be supportive of the babies with everything we do," says Turnage Carrier. "We also want to bring families into parenting roles while the babies are in the hospital."

Nurses who care for the same babies over an extended period of time become familiar with these babies' cues, needs and habits, while the babies learn the nurses' voices, their scents and even their touches. The same nurses teach families how to care for their babies at every stage of growth, allowing families to continue their education rather than starting over with a new nurse every time they come to the hospital.

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©2006 Texas Medical Center

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