[likeminz]

HI..
I'm new to this forum, and fairly new to NICU nursing, having recently moved to NICU from SCN. Our unit doesnt believe in orientation (like none) so I find it hard to figure stuff out. However the point of this letter is about a situation that occurred at our unit, where a baby's parents opted to discontinue treatment. The doctor charted morphine to maintain the baby's comfort. I queried this as I didnt feel that the baby would be uncomfortable (he had been on CPAP). I felt that the morphine contributed to his speedy demise. Other staff said that hypoxia was very painful and that they required morph. i thought hypoxia was relatively painless.
opinions?...

[Tweety]

I just stumbled across this. I'm an adult med-surg nurse. In adults hypoxia can potentiate an increase in feelings of pain. In other words if an adult is uncomfortable, hypoxia makes it worse. Often when a patient reports an increase in pain that is out of proporition to what they've normally reported, I'll check their O2 sat, and sometimes it is indeed lower.

I know this doesn't help. But perhaps it's the same with neonates???

[BittyBabyGrower]

It may speed up his going, but it how it SHOULD be done. It is also a comfort to many parents to know that the baby is getting something and they won't feel or know what is going on. Some kids that have had severe hypoxic events still react to pain. I can't imagine not being able to breathe...at least the mso4 eased that.

It is part of comfort measures and being allowed to die with dignity.

[traumaRUs]

Changing units without orientation doesn't seem like a good idea to me. Do you want some orientation and it isn't provided? Are the units very similar and you don't need orientation? If you want and feel you need orientation, I would certainly contact the unit manager and staff educator. Good luck.

[Jolie]

I agree that providing morphine was appropriate and necessary. Have you ever experienced "air hunger"? It is a completely overwhelming and frightening experience. Morphine helps to suppress this awful feeling. The baby may have been too ill and weak to struggle for breath, but in all likelihood was experiencing this desperate sensation. Morphine would alleviate that and allow the baby to die peacefully.

[NiobiusSwan]

The doctor charted morphine to maintain the baby's comfort. I queried this as I didnt feel that the baby would be uncomfortable (he had been on CPAP). I felt that the morphine contributed to his speedy demise. Other staff said that hypoxia was very painful and that they required morph. i thought hypoxia was relatively painless.

If the baby was going to die regardless, isn't it better that his demise was speedy? For that child's sake, and the sake of its parents, I am glad they gave him morphine, so he could go as comfortably and with as little fear as possible.

[likeminz]

I wouldn't want to think that the baby was suffering... not at all, and would always want comfort measures where appropriate. The only reason I queried it, was that I felt that in this instance it was the morphine that killed the baby. This baby was relatively stable, had been off CPAP for a few days, went backwards a bit, was being weaned off, when a headscan was done that showed extensive PVL. Parents decided to withdraw treatment. I felt that the baby would have survived without the morphine. That worries me.

As to orientation. Our unit does very brief orientation periods... I had 2 days when I started in SCBU, to their mind changing to NICU doesnt require further orientation. I think they are wrong, but that is the way they do it, and they are not flexible. I believe it is one of the reasons we have poor staff retention.

[Mimi2RN]

What is SCBU?

[Gompers]

Originally Posted by Mimi2RN

What is SCBU?

Special Care Baby Unit, maybe?

I think it's horrible to not orient new staff, regardless of where they came from! Even if we get NICU nurses with more than a decade of experience, they still go through at least a week or so of unit orientation, since every place does things a little differently. But to go from a SCBU/SCN, or a level II to a level III...man that's a huge difference! It's like going from telemmetry to CCU with no orientation!!!

[Mimi2RN]

I think so, too. Everyone needs some orientation, it's hard to be thrown into the pond, without a little help. We have a nurse come back after several years as a SAHM. Sometimes it's just the little things that need some work. Staffing seem to forget that she is supposed to have orientation, and put her in as real!