Poor nursing care or just incorrect nursing intervention?-A A +A
Tuesday, May 27, 2014
ONCE more, the nursing profession in the Philippines is drenched in hot water as three practicing nurses, according to the Commission on Human Rights (CHR), are caught in a chilling scandal of allegedly sealing the mouth of a seven-day-old newborn with a medical adhesive tape.
While there are many versions of the stories that are being presented left and right that ignited public uproar and condemnation of this alleged monstrous act, I would like to present some plausible "rationales" to the nursing interventions that these nurses allegedly rendered.
After all, I too am a nurse and maternity and newborn care are among the fields I teach in clinical practice to my midwifery students.
The tape and pacifier
According to various reports, the nurses admittedly gave the newborn pacifier to suckle on.
To hold it in place, they allegedly utilized a medical adhesive tape.
An investigator from CHR said that these nurses justified their acts by stating that the pacifier’s purpose was to prevent the baby from crying and disturbing other newborns in the nursery.
First and foremost, this nursing intervention has its roots in Sigmund Freud’s psychoanalytic theory, which informs that the most pleasurable spot for the newborn up to infancy stages is the mouth, hence, called the “Oral Stage.”
Applied to nursing, by sucking on the pacifier, it is thought that the newborn’s anxiety is reduced.
Dr. Daisy Colleen Young-Mercado, dean of a college of midwifery, shares that such an intervention is proper if the goal is to stimulate the sucking reflex.
She emphasizes, however, that the use of such should only be in a short period.
“Americans are fond of using pacifiers as it provides security blanket instead of thumb-sucking,” she adds.
However, “studies have shown that pacifier use among babies can disfigure teeth once they start erupting,” she maintains.
That ‘Breastfeeding Law’
In 2009, Republic Act (RA) 11028, which is otherwise known as the “Expanded Breastfeeding Promotion Act of 2009,” has been created to protect the newborn’s health by fostering breastfeeding.
A portion of its Section 3 states that health workers are empowered to ensure breastfeeding mothers comply with the Department of Health, World Health Organization (WHO) and United Nations Children’s Fund (Unicef) in the implementation of breastfeeding policies, the physiology of lactation, the establishment and maintenance of lactation, the proper care of the breasts and nipples, and such other matters that would contribute to successful breastfeeding.
As such, nurses are supposed to teach the parents of the newborn about the proper way of breastfeeding.
But the question is: Is pacifier use advisable for the newborn to begin with?
What research tells
According to Kramer’s research in 2011 performed in Brazil, New Zealand and the United States of America; a daily pacifier use starting before the newborn reaches four weeks of age tend to have the following effects: (1) shortened duration of breastfeeding; (2) decrease maternal confidence in breastfeeding; and (3) poor milk supply.
Furthermore, the joint statement of WHO and UNICEF in 1989 about the special role of maternity services discourages artificial teats or pacifiers to breastfeeding infants probably for the same reasons above.
Therefore, nurses are supposed to follow this joint statement as far as RA 11028 is concerned.
From the nurses’ perspective
Practicing nursing is never easy: one has to endure long hours of standing tending to the different nursing needs of diverse patients coming from different socio-economic backgrounds.
The nurse has to find ways to work with different types of physicians with different attitudes and personalities.
He or she is in constant race against time just to administer medications on time or carry out doctor’s orders.
Nurses habitually miss taking their bladder or dinner break on time because they have to be at the bedside rending medical procedures to patients whose lives are on the edge.
The wards and nursing units where nurses are stationed are usually overpopulated creating an unjust nurse-patient ratio.
And once the shift is fast approaching the eighth hour, he or she has to complete the patient’s charts.
Nurses do all these work for a few of thousands of pesos a month.
Fourteen years ago, I was taught in nursing school to explain the procedure to the patient for such reasons as to establish rapport and make the patient aware and comprehend whatever procedure is being rendered to him or her.
I wonder if these three nurses who are allegedly involved in this scam have explained the procedure and its rationale to the parents of the newborn patient.
Also, maybe the approach of responding by the nurse, when asked about the tape was fueled with sarcasm that has offended the mother.
In turn, it had been misinterpreted by the mother.
First, it is an obsolete practice to use pacifier to satisfy the newborn’s oral needs.
Second, there exists a law that requires healthcare professionals to adhere to the WHO and UNICEF’s guidelines in breastfeeding and these latter agencies discourage the use of pacifiers.
Third, practicing nurses have exploitative working environment that places them at stake for committing errors.
However, this does not excuse them from behaving professionally and rendering quality and safe nursing care, which are among the competencies expected of a Filipino professional nurse.
Fourth, nurses these days frequently miss an important step of nursing care: the explanation of the procedure of the patient.
If only these three nurses informed and explained well the rationale of the ‘pacifier’ and how long it was to stay in the mouth of the baby and that a tape would be used to anchor it, then maybe this matter has not blown out of proportion.
Published in the Sun.Star Cagayan de Oro newspaper on May 27, 2014.