daniellerushRN

My goodness I am so glad they discovered that! Makes total sense why one would believe these babies pass from SUID. So unfortunate. And the guilt a parent must feel in that situation thinking they put their baby at risk.

It is no secret that infants love to be held. They have been snuggled close within the quiet womb for many months. The outside world is a startling and unfamiliar abyss of air. Infants do not want to be alone, untouched. Often time, we as nurses can find ourselves in a quandary. An infant needs to breastfeed, so we set the sleepy mama up with pillows and water and latch a baby to the breast. And then we leave to attend to our other patients. This is the culture, especially in Baby Friendly hospital setting where rooming-in, skin-to-skin and breastfeeding are paramount. But what happens during the time that we are not present? When we are not there to hold the hand of a new and overwhelmed parent to help make certain their baby is safe. Therefore, it is important for us to understand what Sudden Unexpected Infant Death (SUID) is, the risks involved (especially in a hospital setting) and how we can translate this information to a new parent, so they feel confident about safe sleep practices. What is SUID and Who is Most at Risk? Sudden Unexpected Infant Death (SUID) describes the sudden and unanticipated death of an infant under 1 year, often during sleep or in their sleeping area. SUID encompasses: Sudden Infant Death Syndrome (SIDS), Accidental Suffocation or Strangulation in Bed (ASSB) Unknown cause of death after investigation or found in an unsafe environment at the time of death. The designation of SUID allows for great accuracy and compilation of statistics. In the United States, 3,400 babies die each year from SUID and represents the leading cause of neonatal death. Risk factors include: Prone and side sleeping Bed sharing Soft bedding Unsafe sleep locations Tobacco smoke (secondhand smoke) Prematurity Studies have shown that infants at the greatest risk are born to mothers that are of non-Hispanic Black and Native/Alaskan American descent. Greatest-risk infants are also born to mothers who had an adolescent pregnancy, were not married, and had fewer years of education. Significant risks also include gestational hypertension, born before 37 weeks, IUGR and having a twin. The Basics of Safe Sleep Guidelines The “Back to Sleep” Campaign has been championed since 1992, but many changes have been made in recent years. I highly encourage Nurses to read the citation for the Updated 2022 Sleep Recommendations by the AAP for detailed information, including thorough reasoning for each recommendation. Summarized below are the Guidelines from 2016: Back to sleep (every sleep) Firm, flat and non-inclined sleeping surface Human milk consumption (associated with reduced risk of SUID) Room sharing (not bed sharing) for the first 6 months, if possible Elimination of objects/blankets/pillows from the sleeping space Pacifier use Avoiding smoke exposure Avoid overheating or head covering NOT using home cardiorespiratory monitors In 2022 additional changes reflect the current parental culture and available products for consumers. The following changes are listed below because of their prominence in parental behaviors today: Infant sleep products- must meet federal standards. Does NOT include inclined sleep products, hammocks, baby nest or pods, or in-bed sleepers. Bed sharing- while we must be cognizant of cultural norms and the convenience of bed-sharing for breastfeeding, under NO circumstance can the AAP recommend bed sharing including unintentional bed sharing (falling asleep while feeding infant). Weighted blankets, weighted swaddles and weighted clothing are NOT recommended. What Can Nurses do to Encourage Safe Sleep? The lengthy recommendations are overwhelming for new parents to absorb. As nurses, it is important “to set the stage” for safe sleep habits in small moments throughout their care. A 2018 study by the CDC revealed that 25% of parents left the hospital with incorrect safe sleep advice, and 20% received no teaching at all. While in the hospital, it is imperative that infants are placed supine, in the bassinet when parents need to sleep or tend to other needs. If skin-to-skin is being performed, it is important for the parent to remain awake. As nurses, we must be aware of the mode of delivery, medications received and the general well-being of the parent to ensure that we are advocating for the safest sleep practices in-hospital. These habits translate to safe sleep practices at home and should be expanded upon, with both parents if possible. It is important for nurses to understand the modifiable and nonmodifiable risk factors so that postpartum education can be customized for the parent and infant. It is vital that nurses are capable of providing safe sleep education that is up-to-date, consistent, unified, and trustworthy. Improving the Nursing Approach Nurses, it is essential to remove the sweetly slumbering baby from a sleeping parent’s arms, pray for a smooth transition and place the infant safely in the bassinet. Often, we are caught between following hospital policy and respecting a parent’s desire. We cannot predict or control the parent’s preferences or choices when they return home. It is imperative that nurses and nurse-leaders provide a synchronized and unified message. Recommendations for a cohesive approach to safe sleep education include but are not limited to: Assess all nurse's level of knowledge regarding safe sleep practices Providing education to patients that begins in labor and continues through discharge Understand the barriers that parents have regarding safe sleep practices Provide continual safe sleep messaging throughout hospital stay Providing consistent role modeling One of our most prized “hats” as postpartum nurses is that we are educators. We can feel confident that we have supported parents and their newborns with the most accurate information about safe infant sleep that will lead to positive behavior. We advised, we explained, we answered questions, and we served as advocates. FACT: We are the first line of defense in safe sleep. References/Resources Nurses Leading Safe Infant Sleep Initiatives in the Hospital Setting CDC: About SUID and SIDS Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review CDC: Safe Sleep for Babies A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model

I have just started! But articles for online magazines and some social media content so far. I just really needed something away from the bedside. Something that I could do from home, to be with my family, without forsaking all of the hard work I put in to get where I am in my nursing career. I am looking forward to this journey and I am determined to succeed. Thanks for reading!

Each shift, I feel the dam of my nursing resilience starts to crack. It leaks saltiness and frustration, indifference, and annoyance. These cracks can be deadly for a nurse; a love of nursing lost. A change is needed before the dam gives way to the flood that burn out is. The healthcare heroes of 2020 are in a crisis, and I know that I am not the only one. Chronically short staffing, overworked hours and lack of appreciation are just some of the culprits. I ask myself, what do I love most about nursing? What is my most valued role as a nurse? Is bedside nursing the only option? After all, I have worked for, would I be selling myself short as a nurse working somewhere other than the bedside? Is there really life for a nurse outside of the four walls of a hospital? To me, one of the primary tenants of nursing is acting as a patient advocate, an ally during a significant time of need, support, and counsel. An advocate's responsibility is to ensure that the patient comprehends all that surrounds them, from diagnosis to available resources. At the foundation of patient advocacy is patient education. This is one of the many, albeit the most important hats that a nurse wears. So how do I blend the value of patient education, a love of nursing, and my own personal desire to continually learn? I've discovered a surprisingly simple answer. Writing, full stop. Writing as a nurse with my valued credentials, hard-earned degree, and even harder-earned experiences. Additionally, writing satisfies a wish to move out of the large hospital system that can many times feel more like a "sickcare" industry than a healthcare industry. Writing will afford me the ability to be a true purveyor of health and not just a bystander in another patient's chronic illness story. Through writing, I can educate and inspire not just the patient sitting beside me, but a larger audience seeking advice and guidance. And then there will be the nursing love. That moment when a patient's eyes brighten with some new information or understanding, the genuine gratitude in their voice when they thank you for helping them. In writing, these satisfying moments may be over a computer screen, but I have comfort in knowing that they will be there just the same. A job well done and worth doing. My mental fortitude and resilience were forged in nursing school. My credentials are a testament to this. Nursing requires critical thinking, adaptability, attention to detail, listening, and responding. All of these characteristics do, in fact, translate into job qualifications for writing. The transition is more seamless than I could have imagined. Writing fulfills my yearning to learn and share. It allows me to continually seek knowledge in my passions, my interest areas and beyond. It cannot go without mentioning that a career as a nurse writer can result in a much-improved work-life balance. With a young family, I need this now more than ever. I am determined that gone will be the days that I return home from a night shift, ragged with the emotional and physical weight of the night, only to have to pour into my family whatever pieces are left. I am determined that gone will be the days that I need to leave the disappointed faces on Christmas or the forlorn face of my husband, children at his ankles, beckoning me not to leave. Yes, I will do this. There is, in fact, life for a nurse outside of the four walls of a hospital.

The Importance of a Self-Breast Exam Breast changes are normal throughout a woman’s lifetime. Breast morphology varies during menstrual periods, pregnancy, lactation, menopause, or hormone therapy. Self-breast exams should be an integral part of every woman’s personal routine. In fact, women have detected breast cancer themselves in 25% of cases. Those statistics are a testament to the importance of “knowing your normal” breast. There are times during the life of a breast that can present particular challenges when attempting a breast exam. The literature on breast exams during lactation has been varied and confusing. But here is what you need to know if airing on the side of caution during lactation. What Happens to Breasts During Lactation? In order to properly evaluate your breast, it is important to know what is happening inside. During pregnancy and postpartum, the breast undergoes three stages. Mammogenesis is the development of the mammary glands within the breast in preparation for milk production and actually begins during puberty. During this time, the breast is predominantly adipose (fat) tissue. During pregnancy, a rise in hormones causes the breast tissue to increase in water, electrolyte, fat content, and subsequently blood supply. Lactogenesis is the initiation of breast milk production following delivery. Hormones and the act of suckling are responsible for continued milk production from the mammary glands. Galactopoiesis is the continuation of milk production regulated by the frequent and regular removal of milk. Lactating breasts often feel nodular, heavy and sore. For this reason, it is best to do a self-evaluation with empty breasts. What Does Cancer Feel Like? Painless lumps in the breast that feel irregular in shape are the most concerning finding. Other symptoms include: skin dimpling nipple pain or discharge nipple retraction red, dry, flaking, or thickened breast/nipple skin swollen lymph nodes under the arm or near collar bone These symptoms can be caused by non-cancerous breast conditions as well. It is important to speak with your healthcare provider for further evaluation if a lump or other concerning symptoms are detected during a self-breast exam. If it is Not Cancer, Then What Could It Be? Lactation complicates breast exams because of the physical changes of the breast in the presence of milk production. Benign lumps that are identified could be: Fibroadenomas The mass is a tumor comprised of glandular tissue. The mass moves freely and has clear borders. These masses can increase in size during pregnancy. Additionally, a lactating adenoma can occur during pregnancy and breastfeeding due to hormone production. Galactoceles This is a milk-filled cyst that results from a clogged duct. It will be tender to the touch. Pain can be relieved with cool compresses and a supportive bra. Mastitis This is an infection that results in a red, inflamed and sore breast. Additional symptoms include fever, headache, nipple discharge, and possibly a pus-filled abscess. Mastitis needs to be treated with antibiotics. It is still important to speak with a healthcare provider about any of these above conditions as further evaluation and treatment may still be necessary. What is the Recommendation for Lactating Women? It is recommended by ACOG (American College of Obstetrics and Gynecology) that lactating women undergo breast exams with the same frequency as their non-lactating counterparts. Women are having children at a more advanced age, an age when more frequent breast cancer diagnostics are beginning. It is important to evaluate your individual case with your physician regarding age-related and high-risk screening. Further Testing for Patients Who Need Advanced Screening While Breastfeeding The following diagnostic tools may be recommended if the patient’s age or other high-risk criteria require further evaluation. Diagnostic mammography Breast Ultrasound MRI (Magnetic Resonance Imaging) Ductography Biopsy It is important to note that an infant does not need to be weaned prior to testing. Additionally, despite conflicting opinions, breastmilk does not need to be discarded following contrast dye imaging. This does not hold true for diagnostic tests that use radioactive materials. In this case, weaning from breastfeeding, or deferring elective tests are recommended. References NCI - Breast Changes and Conditions NIH - Self-detection remains a key method of breast cancer detection for U.S. women Breastcancer.org - Breast Self-Exam (BSE) GLOWM - The Breast During Pregnancy and Lactation Breastcancer.org - Benign Breast Changes Associated With Pregnancy and Breastfeeding The Institute for Breastfeeding and Lactation Education (IABLE)  - Breast Imaging During Lactation ACR Manual on Contrast Media