‘We’re here to support parents through rough and happy times’
Staff in the neonatal intensive care unit at the University Hospital of Wales look after some of the country’s most ill and premature babies. As part of a series of features for the Noah’s Ark Charity’s Tiny Lives campaign, Mark Smith speaks to one nurse
SINCE qualifying as a nurse in 2008, Hannah Joshi has worked at the University Hospital of Wales’ neonatal intensive care unit (NICU).
She applied for a graduate position at the unit and planned to move onto other fields of medicine – but never left.
“There’s something really special about being a NICU nurse,” she said.
“In a ‘normal’ situation after a baby is born, the mum and dad take their baby home a day or two after the birth.
“Part of the joy of that is introducing your new baby to family and friends so that they can get to know them too and share the experience with you.
“When your baby is on NICU there isn’t any of that. For weeks and often months the only other person who knows your baby other than you is your nurse.
“Despite the extremely difficult situation these parents find themselves in, you are part of that new family’s firsts, and that’s a real privilege.”
The condition of a premature and critically ill baby can change rapidly and often unpredictably. As each baby’s situation is different it can be difficult to provide parents with the assurances that they are desperately looking for.
It’s why mums and dads always describe the NICU experience as a “rollercoaster ride”.
Hannah believes a big part of her role as nurse is to prepare new parents for the ups and downs ahead of them and support them through it.
“There isn’t anything that can prepare you in advance for being a NICU mum or dad, so even if you know during pregnancy that your baby is going to be admitted onto the unit, parents often arrive in a state of shock.
“The first questions they’ll usually ask is when they can hold their baby, which is obviously the most instinctive thing in the world to want to do.
“It’s sometimes impossible to give a definite answer to that question, but we know it can be days and sometimes weeks.
“Initially a baby can’t wear clothes as we need clear access to them, and the bedding is ours too so even the smallest things that help a parent to connect with their baby aren’t possible.
“During that time we try to find nice little things for them to do like moisten their baby’s lips with a cotton bud or clean their faces – anything that makes them feel like they’re being a mum and dad.”
NICU nurses work in 12-hour shifts, starting at 7am and ending at 7.30pm.
Each shift begins with a safety briefing where the team are told about any critical cases, new admissions or potential concerns around infection. They are each then allocated an area to work in.
In intensive care the ratio is one nurse to one baby, while in high dependency unit (HDU) it’s one to two and in the nursery it’s one to four.
The nurse will then do a handover with the person coming off shift, which includes a top-to-toe assessment of each baby he or she will be caring for.
There is no such thing as a “normal” day on the unit, but when Hannah is working on the ward (she is also now a practice educator on NICU) she frequently works on the high dependency unit where babies are often awaiting surgery.
The NICU at the University Hospital of Wales is the only unit in the country which provides surgical care to premature or critically ill babies and many are often transferred from other areas of Wales for these procedures.
Hannah said: “The unit is open access to parents, so as there are no visiting times - they’re often here first thing.
“We usually start the day with ‘cares’ which, if it’s a surgery day, can be even more important because they want to be with their babies before they go to theatre.
“We often need to encourage parents to get involved in daily cares to begin with, not because they don’t want to but because the wires and tubes can be intimidating.
“Changing a nappy if you haven’t done it before can be daunting enough but imagine trying to do it through an incubator window on a baby that only weighs 600 grams.
“After the doctors’ ward round at 9am, I’ll do a full check on everything I need to transport the baby to theatre before the surgeon comes up to go through the consent forms with the parents.
“There’s often quite a lot of medical jargon involved at that point so I’m on hand afterwards to answer any questions.
“Being a NICU nurse, you often have to manage the balance between the need to be completely focused on the baby’s medical requirements and the desire to support parents.
“You feel that very acutely when you’re in the delivery room straight after a birth where you’re working hard to stabilise a baby, but are also very aware of the mother behind you, anxiously waiting for you to turn around and give her a sign that things are okay.
“It’s the same before taking a baby down for surgery too. You know how vital that theatre slot is and of all the