manners question

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    My friend had a 28 week preemie a month ago. I haven't seen my friend in person in years, she lives in another state. She shared her blog with me and I was looking through the pictures. The hospital her baby is at doesn't use developmentally appropriate positioning. In every picture with the baby on his back his arms are flailed out, his legs are froglike and there are no boundaries. I was taught that you have to keep the limbs close to the body so the muscles don't become shortened and cause the need for PT/OT.

    Here is my delicate question. Do I tell my friend and how? She is happy with the care in the NICU, I don't want to make her question everything, I also don't want her to think I am being a busy body. We used to be best friends and she is the type of mom who tries to do everything the correct way, I know she would want to know. Is it too late since he is a month old? She knows I am a NICU nurse and she hasn't asked about anything, she is one of those very involved (in a good way) moms who researches everything.

    Thanks!
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  3. 9 Comments so far...

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    Just my opinion, but.....I wouldn't do it. She sent you the blog because she's proud and happy, and your well meaning note could be a big fat downer. If she had asked your opinion, that might be different. I'm betting you're a fabulous nurse (you DID catch the positioning issue from photos), but this is not your place. It was sensitive and appropriate of you to ask for opinions.
    Last edit by SusanKathleen, RN on May 9, '08 : Reason: sp
    Imafloat likes this.
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    Thanks for the response, it was what I was thinking.
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    Also, we all know there are nurses who are great about kangaroo care and developmental positioning, and there are some who couldn't care less. I'm sure some of his nurses are the former.
    Imafloat likes this.
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    That's a tough one. Could it just be that the baby is like that during the pictures? I know it's hard sometimes when the parents are in with the baby, taking pictures, etc. The nurse is changing out the bed and mom is there snapping pictures. Maybe the nurse just hadn't gotten the babe tucked back in?

    But if it's like that in every picture, all the time ...... I don't know. I don't think I would say anything, unless she asked. And I'd just hope that some of the nurses there are more sensitive to the need for developmental care.
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    We often had infants transfer to our hospital for surgeries, etc. and I can tell you this:
    1) we did things very differently than the other hospitals (appropriate postioning, different meds, different EVERYTHING sometimes)
    2) the other hospital "saved" their baby in their eyes....they believe their "home hospital" could do no wrong (even if they consistently charted that a baby on high O2 would sat 99-100% the entire time!!!!!!!!)

    Your suggestions would not be well received even if she were a close friend, IMO. The only time she may be open to your opinion would be
    1) she asked for it
    or
    2) I think you could email some "helpful links" that you found on preemies and hopefully they include photos and information on positioning, etc. and you could present it simply as a few links for her to view at her leisure.....??? Just a thought..she could then feel it was her idea to change positioning, etc. based on reading that she has done (empower her with education!)

    Jenny
    racing-mom4 likes this.
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    Don't undermine your friend's confidence in her local health care providers and stab your colleagues in the back. That would probably cause more problems than it would solve/prevent.

    There may be a time when you can tactfully encourage better positioning ... and if that opportunity presents itself, then take advantage of it very carefully. But don't push it.
    RainDreamer likes this.
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    Ok I'm going to be different. If you were my friend I would want you to share that concern with me. That baby is only this little once and you don't want to miss any opportunities to help the baby developmentally. You don't have to point out the frog legs in the photo's but rather just bring up "I'm sure the nurses have taught you about developmentally appropriate positioning?" and explain what it is. If they are doing it she will let you know, if they aren't doing it then she should know. Be a friend and check it out. I think your friend will appreciate your concern.
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    Update, I never said a word. I believe if I have to hesitate about doing something that it isn't the right thing to do. I guess I just needed validation that I wasn't being a bad friend by keeping my mouth shut.
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    Thanks for letting us know.


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