Saturday September 23rd 2017

Preventing tragedies

New Mexico nurses lead initiative on shaken baby syndrome

An initiative — developed and driven by RNs to prevent shaken baby syndrome — is gaining momentum in New Mexico.  And it’s a prime example of nurses who, seeing a need, take action to make an important difference in the lives of an extremely vulnerable population.

Erika Cole demonstrates the effects of shaken baby syndrome on a specialized doll to a colleague. Erika Cole demonstrates the effects of shaken baby syndrome on a specialized doll to a colleague. Photo credit: University of New Mexico Health Sciences Center.

As many as 1,400 babies suffer from a type of abusive head trauma, shaken baby syndrome, in the United States every year, according to the University of New Mexico Hospitals Shaken Baby Syndrome Prevention and Awareness Program. One in four babies die, and the others often need medical intervention the rest of their lives.  Additionally, most injuries occur in babies under one year old.

“We have one of the highest rates of child abuse in the country,” said Maribeth Thornton, MSN, MBA, RN, NE-BC, CCM, the executive director of Children’s Services at UNMH and a New Mexico Nurses Association member. Given that troubling statistic and the fact that SBS is 100 percent preventable, former intermediate care nurseries unit director Jayme Vincent Robertson, MSN, RN, RNC, staff nurse Lorie MacIver, BSN, RNC-LRN, and nurse researcher and NMNA member Kathy Lopez-
Bushnell, EdD, MPH, APRN, teamed up to create and implement an educational program for parents and guardians to prevent SBS.

“It’s a hard topic to discuss, and many parents might think, ‘Who doesn’t know not to shake a baby,’” said Erika Cole, BSN, RN, RNC-LRN, current intermediate care nurseries unit director. “But surprisingly 1 out of 6 parents we’ve talked with say that this was the first time they heard that [shaking a baby] was dangerous.”

Now as part of routine discharge teaching, bedside nurses in the intermediate care nursery, NICU and the newborn nursery share and discuss a flyer that addresses SBS and the importance of never shaking a baby (Nurses have a script to guide them in the conversation.). Nurses use a doll that lights up to show the physical harm that occurs when a baby is shaken.

Photo credit: University of New Mexico Health Sciences Center. Photo credit: University of New Mexico Health Sciences Center.

Parents or guardians then watch a DVD, “When Babies Cry,” and can talk with nurses more about any concerns they may have.  And if they consent, nurses follow up with parents about seven months later to determine whether they have retained the preventive message and strategies. Based on the follow-up calls Cole has performed so far, they do.

“The parents really remember the video and how clearly the doll demonstrates the effects of shaking,” she said.

Cole and Thornton said that parents have told them that they are grateful for a key piece of advice: If the baby cries, and the parent is feeling frustrated or angry, it’s OK to put the baby down, shut the door and call for help.

“Parents are tired, babies cry and some babies, especially if they are colicky, often seem inconsolable,” Thornton said.  ‘This program really is about providing the coping tools parents need before they are in a situation where they are feeling out of control because they can’t console their baby,” Thornton said.

Cole explained that those babies who are in the intermediate care nursery because they are going through drug withdrawal are more likely to cry. That highly irritable state puts them at greater risk for being shaken, unless caregivers are provided the coping skills and education they need.

Since the program began in 2010, there have been no incidences of SBS-related brain injuries in babies whose parents received the patient teaching from intermediate care and NICU nurses. So far, more than 3,000 parents and guardians have participated in this learning activity. And while participation is nearly 100 percent among those whose babies are in the intermediate care nursery and NICU, the rate of patient teaching on this topic in the regular mother-baby unit is less than half – most likely because of the short length of stay, according to Thornton.

Taking the program beyond UNMH

UNMH nurses helped craft a legislative measure that would require all new parents to be educated about SBS prevention in hospitals and birthing centers statewide, and NMNA supported the initiative. Although the bill introduced by Doreen Y. Gallegos mandating parent education did not advance in the 2016 session, language was placed in the state’s general fund to ensure financial support for educational materials on SBS and for specialized dolls in hospitals and birthing centers.

Thornton said that she expects the bill mandating education to be reintroduced next year. In the meantime and with state funding in hand, UNMH nurses are visiting other facilities throughout their state to educate their colleagues about their program with the hope that others will offer it to new parents.

In addition to supporting peer-to-peer efforts, NMNA members are working with long-standing partners to determine how they can educate grandparents – many of whom are raising these children, according to NMNA Executive Director Deborah
Walker, MSN, RN.

In closing, Cole said that UNMH nurses are very passionate about preventing SBS and child abuse.

“It really comes through in their teaching,” Cole said. “We know how important this information is. It’s all about keeping babies safe.”

To learn more about the program and access the tools and video, go to: http://hospitals.unm.edu/shakenbaby/index.html.

— Susan Trossman is a writer-editor for ANA.

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