NICU CONCEPTS, STAFFING,PROTOCOLS, PHYSICAL LAYOUT

WELCOME TO THE
NEONATAL INTENSIVE CARE UNIT
(NICU)

#CUTEST NURSING BRANCH
CONGRATULATIONS TO PARENTS
YOU ARE HERE TO LEARN MORE ABOUT NICU
AFTER BIRTH
CHILDREN REQUIRE TO SOLVE SOME OF THE DIFFICULT TASK SO
WE ARE HERE TO HELP THEM.

1. CONCEPT OF NICU ( STAFFING, EQUIPMENTS)
2. PHYSICAL LAYOUT OF NICU FOR EFFECTIVE MGT.
3. NICU NURSE PROTOCOL WITH EXAMPLES
4. TRENDS IN NICU
5. ENDOTRACHEAL SUCTIONING PROCEDURE

Neonatal care, as known as specialized nurseries or
intensive care, has been around since the 1960s.
The first American newborn intensive care unit,
designed by Louis Gluck, was opened in October
1960 at Yale–New Haven Hospital. ... The term
neonatal comes from neo, "new", and natal,
"pertaining to birth or origin"

NICU centers to babies up to 28 days of age, that is preterm as well as term are
cared for in an NICU up to 28 days of age. So that is the upper limit for
admission.
Newborn babies who need intensive medical attention are often admitted into a
special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU
combines advanced technology and trained health care professionals to provide
specialized care for the tiniest patients.

Demand for NICU Services Has
Increased
Escalating rates of preterm birth and low-birth weight infants
•Climbing cesarean delivery rate
•Rising number of multiples
•Increasing maternal age
•Decreased infant mortality
•Exponential increase in number of NICU beds

BEFORE ENTERING NICU,
YOU MUST REMOVE YOUR RINGS, CHANGE CLOTHES OR COVERING
GOWNS.
 YOU MUST WASH YOUR HANDS WITH SCRUBBING TECHNIQUE FOR
ATLEAST TWO MINUTES.

NEONATOLOGIST(1 per Shift for 8-12 baby NICU): Neonatologists are pediatricians with
advanced training in caring for babies in the NICU. They provide comprehensive care for
critically ill newborns and infants.
Advanced Practice Nurses( 1 per Shift for 8-12 )
The advanced practice nurses, also known as Neonatal Nurse Practitioners (NNP), in the Rush NICU
are a vital part of your baby's health care team. They specialize in providing medical care for infants in
the NICU and are dedicated to improving your baby’s health.
NNPs are in the unit 24 hours a day, providing frequent monitoring of your baby. They give
comprehensive medical care tailored to meet the needs of your baby and your family.

NICU TEAM
Nurses
The NICU nursing team provides extraordinary care with knowledge, skill and
compassion.
Nutrition Specialists
Good nutrition is an essential component in every baby's health. For babies facing
additional medical challenges, it is especially important.
Social Workers
A clinical social worker is a professional counselor who helps to assess and alleviate
problems related to personal, family or social situations. Clinical social workers are a vital
part of the rehabilitation multidisciplinary team.
Discharge Planners
Taking a new baby home is exciting, but it can also be stressful. This can be more true
when you take home a baby who has been in the NICU, whether it has been for a day or a
few months.

NICU TEAM
Respiratory therapists
Respiratory therapists are on site in the NICU 24 hours a day to care for your baby. The
therapists are neonatal-trained therapists and are assigned to the NICU.
Lactation consultants and peer counselors
The Milk Club is the lactation and human milk feeding program in the NICU . The clinical
program is based on the most up-to-date research about lactation and human milk all
NICU infants.
Chaplains
Chaplains at NICU come from a variety of backgrounds. The staff includes a Roman
Catholic priest, a Muslim imam, a Jewish rabbi, Hindu Priest and clergy representing a
variety of other denominations.
Physical therapists
A developmental assessment and intervention by a pediatric physical therapist is available
for babies in the NICU. Parents of babies cared for by physical therapists are instructed in a
home exercise program to promote normal patterns of movement.

NICU TEAM
Transport Team
If your baby requires advanced neonatal care, your infant's primary care provider may
arrange transport to NICU. A specialized neonatal transport team is extremely important,
as newborn infants have special needs and require unique care.
Palliative Care Medicine Specialists
The Children's Hospital palliative care program provides care to children with complex,
chronic medical problems that are potentially life-limiting or life-threatening.

ACCORDING TO NEONATAL ACQUITY- STAFFING CAN BE
DESIGN AS PER AMERICAN ACADEMY OF PEDIATRICS
INFANT
ACUITY
LEVEL
ORIGINAL
DESCRIPTION
OPERATIONAL DEFINITION
1 Continuing care Infant only requiring PO or NG feedings, occasional enteral
medications, basic monitoring. May or may not have a heparin
lock for meds.
2 Requiring
intermediate care
Stable infant on established management plan, not requiring
significant support. Examples would include: Room air,
supplemental oxygen or low flow nasal cannula, several meds.
3 Requiring intensive
care
Infant is stabilized, though requires frequent treatment and
monitoring to assure maintenance of stability. Examples would
include: Ventilator, CPAP, high-flow nasal cannula, multiple IV
meds via central or peripheral line.
4 Requiring multi-
system support
Infant requires continuous monitoring and interventions.
Examples would include: Conventional ventilation, stable on
HFV, continuous drug infusions, several IV fluid changes via
central line.
5 Unstable, requiring
complex critical care
Infant is medically unstable and vulnerable, requiring many
simultaneous interventions. Examples would include: ECMO,
HFV, nitric oxide, frequent administration of fluids, medication

LETS UNDERSTAND NICU EQUIPMENTS
BECAUSE
IF YOU ARE NOT FAMILIAR WITH IT, IT MAY BE PRODUCING……..

Apnea Monitor — A machine that detects when your baby stops breathing for a
few seconds. An alarm goes off to let NICU staff know your baby has stopped
breathing.

Bililights( Phototherapy Machine) — Bright lights over a baby’s incubator that
treat jaundice. Jaundice is when a baby's eyes and skin look yellow. A baby has
jaundice when his liver isn't fully developed or isn't working. Treatment with
bililights is also called phototherapy. Babies can have this treatment for 3 to 7
days. Phototherapy with a 20 cm distance between the light source and the
neonate is more effective than a 40 cm distance for decreasing bilirubin levels at
24 hours in newborns with hyperbilirubinemia.

Continuous Positive Airway Pressure
(Also Called CPAP) — A machine that
sends air and oxygen to your baby’s
lungs through small tubes in his nose or
windpipe (also called trachea).
Cooling Blanket Or Cap — A cap used to lower your baby’s
body temperature. They may help reduce or prevent problems
that can happen if your baby’s brain doesn’t get enough
oxygen. The cap can cool your baby’s brain and body to about
92 F (33.5 C). Your baby may get a cooling blanket or cap
within about 6 hours of birth and can use it for up to 3 days.
After that, your baby is slowly warmed to a normal body
temperature of 98.6 F (37 C) by increasing the temperature in
the incubator. The aim is to cool infants with moderate or
severe Hypoxic-Ischemic Encephalopathy(HIE) within 6 h of
birth to a body temperature between 33.5°C and 34.5°C and
maintain this degree of cooling without interruption for 72 h.

Incubator — A clear plastic bed that helps keep your baby
warm. You can touch your baby through holes (also called
ports) in the sides of the incubator. Kinds of incubators are
Giraffe® and Isolette®.
Mechanical Ventilator — A machine that helps your baby
breathe or breathes for him when he’s not breathing on his
own. It works by pushing warm air and oxygen into the
lungs through a breathing tube called an endotracheal
tube. The provider sets the amount of oxygen, air pressure
and number of breaths per minute for your baby.

Oxygen Hood — A clear plastic box that fits over
a baby’s head and gives him oxygen. Providers
use it with babies who can breathe on their own
but still need some extra oxygen. Three round
oxygen hoods/head boxes (large, medium and
small) of sizes 24cm, 21.5cm and 20.5cm internal
diameter and a height of 16cm, 18.5cm and
20.5cm.
Radiant Warmer — An open bed with
overhead heating to help keep your baby
warm. Providers may use a warmer instead of
an incubator if your baby needs to be handled
a lot. An incubator is a clear plastic bed that
helps keep your baby warm.

Extracorporeal Membrane Oxygenation
(Also Called ECMO) Also known as
Extracorporeal Life Support (ECLS) is an
extracorporeal technique of providing
prolonged cardiac and respiratory support
to persons whose heart and lungs are
unable to provide an adequate amount of
gas exchange or perfusion to sustain life.
The technology for ECMO is largely
derived from Cardiopulmonary Bypass,
which provides shorter-term support with
arrested native circulation.

BABY SIDE MONITOR OR MULTIPARA MONITOR
• Heart or cardio respiratory monitor. This monitor displays a
baby's heart and breathing rates and patterns on a screen. Wires
from the monitor are attached to adhesive patches on the skin of
the baby's chest, abdomen, and leg.
• Blood pressure monitor. Blood pressure is measured using a
small cuff placed around the baby's upper arm or leg. Periodically,
a blood pressure monitor pumps up the cuff and measures the
level of blood pressure.
• Temperature. A temperature probe is placed on the baby's skin
with an adhesive patch. A wire connects the temperature probe to
the overhead warmer (or isolette) to help regulate the heat
needed to keep the baby warm.
• Pulse oximeter. This machine measures the amount of oxygen in
the baby's blood through the skin. A tiny light is taped to the
baby's finger or toe, or in very tiny babies, a foot or hand. A wire
connects the light to the monitor where it displays the amount of
oxygen in the baby's red blood cells.
• Transcutaneous oxygen/carbon dioxide monitor. This machine
measures the amount of oxygen and carbon dioxide in the baby's
skin.

NOW, FRIENDS LET UNDERSTAND THE PHYSICAL LAYOUT AND
STANDARDS OF THE NICU FOR ITS EFFICIENT MANAGMENT

STANDARD-I UNIT CONFIGURATION
The NICU design shall be driven by systematically developed program goals and
objectives that define the purpose of the unit, service provision, space utilization,
projected bed space demand, staffing requirements and other basic information
related to the mission of the unit. The neonatologist and the nurse in charge must
be involved while planning the unit.
INTERPRETATION
Program goals and objectives congruent(harmony) with the philosophy of care and
the unit’s definition of quality should be developed by a planning team. This team
should include, among others, health-care professionals, families whose primary
experience with the hospital is as consumers of health care, administrators and
design professionals.

STANDARD 2: NICU LOCATION WITHIN THE HOSPITAL
The NICU shall be located within space designed for that purpose. It shall
provide effective circulation of staff, family and equipment. Traffic to other
services shall not pass through the unit. The NICU shall be in close and
controlled proximity to the area of the hospital where births occur. When
obstetric and neonatal services must be on separate floors of the hospital, an
elevator located adjacent to the units with priority call and controlled access by
keyed operation shall be provided for service between the
birthing unit and the NICU.
INTERPRETATION
The purpose of this standard is to provide safe and efficient transport of infants
while respecting their privacy. Transport of infants within the hospital should be
possible without using public corridors.

STANDARD 3: FAMILY ENTRY AND RECEPTION AREA
The NICU shall have a clearly identified entrance and reception area for families.
Families shall have immediate and direct contact with staff when they arrive at
this entrance and reception area. NICU should have single entry and exit point.
INTERPRETATION
The design of this area should contribute to positive first impressions for families
and foster the concept that families are important members of their infant’s
health-care team, not visitors.

STANDARD 4: SAFETY/INFANT SECURITY
The NICU shall be designed as part of an overall security program
to protect the physical safety of infants, families and staff in the NICU. The NICU
shall be designed to minimize the risk of infant Abduction.
INTERPRETATION
Because facility design significantly affects security, it should be a priority in the
planning for renovation of an existing unit or a new unit. Care should be taken to
limit the number of exits and entrances to the unit.

STANDARD 6: PRIVATE (SINGLE-FAMILY) ROOMS
Rooms intended for the use of a single infant and his/her family shall confirm to
the requirements for infant spaces designated elsewhere in these standards, with
the following exceptions:
• Minimum size shall be no less than 165 ft2 (15.3m2) of clear floor area.
•The requirement for wireless monitor and communication devices shall be
identical to that described for isolation rooms .
• Each room shall be designed to allow visual and speech privacy for the infant and
family.
• Family space shall be designated and be able to include, at a minimum:
A comfortable reclining chair suitable for kangaroo care , A recumbent sleep
surface for at least one parent ,A desk or surface suitable for writing and/or use of
a laptop,computer
• At least four electrical outlets for use and charging of electronic devices.
•No less than 6 ft3 (0.2m3) of storage space

STANDARD 6: PRIVATE (SINGLE-FAMILY) ROOMS (CONT.)
Staff space shall be designated and include, at a minimum:
•A work surface of no less than 6 ft2 (0.6m2),A charting surface of no
less than 3 ft2 (0.3m2)
•Supply storage of no less than 30 ft3 (0.85m3).
NOTE: The above requirements can be met by any combination of
fixed and portable casework desired, but all storage must be
designed for quiet operation.

INTERPRETATION
Private (single-family) rooms allow improved ability to provide individualized and
private environments for each baby and family when compared with multi-
patient rooms. In order to provide adequate space at the bedside for both
caregivers and families, however, these rooms need to be somewhat larger than
an infant space in an open multi-bed room design, and they must have additional
bedside storage and communication capabilities in order to avoid isolation or
excessive walking of caregivers.

STANDARD 7: AIRBORNE INFECTION ISOLATION ROOM(S)
An airborne infection isolation room shall be available for NICU infants, and shall
provide a minimum of 150 ft2 (14m2) of clear floor space, excluding the entry
work area. A hands-free hand washing station for hand hygiene and areas for
gowning and storage of clean and soiled materials shall be provided near the
entrance to the room. Ventilation systems for isolation rooms shall be engineered
to have negative air pressure with air 100% exhausted to the outside, and shall
meet acoustic standards for infant rooms.
Airborne infection isolation rooms shall have self-closing devices on all room exit
doors.
INTERPRETATION
An airborne infection isolation room adequately designed to care for ill newborns
should be available in any hospital with an NICU.

STANDARD 8: OPERATING ROOMS INTENDED FOR USE BY NICU PATIENTS
Operating rooms in health-care facilities where infant procedures may be
performed shall be constructed to operating room specifications except for the
following modifications:
•Assuming infant’s eyes are shielded (eye patches) while in the operating room,
no changes to the IES (Illuminating Engineering Society) guidelines for operating
rooms.
•Each procedure area must be physically separated from other areas so that
during surgery or procedures patient and staff flow may be strictly controlled.
INTERPRETATION
Standard operating room environments may be temporarily modified to better
accommodate term infants requiring surgery, but cannot be made optimal for
some term and preterm infants, nor can the problems associated with
transporting less stable infants away from the intensive resources of the NICU be
avoided.

STANDARD 9: ELECTRICAL, GAS SUPPLY AND MECHANICAL NEEDS
Mechanical requirements at each infant bed, such as electrical and gas outlets,
shall be organized to ensure safety, easy access and maintenance. There shall be a
minimum of 20 simultaneously accessible electrical outlets. The minimum
number of simultaneously accessible gas outlets is:
Oxygen 3 and
Vacuum 3.
There shall be a mixture of emergency and normal power for all electrical outlets
per current National Fire Protection Association recommendations.
INTERPRETATION
A system that includes easily accessible raceways for electrical conduit and gas
piping, work space and equipment placement is recommended because it
permits flexibility to modify or upgrade mechanical, electrical or equipment
features.

STANDARD 10: AMBIENT TEMPERATURE AND VENTILATION
The NICU shall be designed to provide an air temperature of 72 F to 78 F (22–26
1C) and a relative humidity of 30 to 60%, while avoiding condensation on wall and
window surfaces.
For Ventilation,
A minimum of six air changes per hour is required, with a minimum of two
changes being outside air. The ventilation pattern shall inhibit particulate matter
from moving freely in the space, and intake and exhaust vents shall be situated to
minimize drafts on or near the infant beds.
INTERPRETATION
Heat sources near the exterior wall, if applicable, should be considered to
ameliorate the ‘cold wall’ condition, which in turn can be a source of convection
drafts.

STANDARD 11: HAND WASHING
STANDARD 12: GENERAL SUPPORT SPACE( FOR CLEAN AND SOILED UTILITIES)
STANDARD 13: STAFF SUPPORT SPACE( FOR LOCKERS,CHANGING CLOTHES, REST)
STANDARD 14: ADMINISTRATIVE SPACE
STANDARD 15: FAMILY SUPPORT SPACE( FAMILY LOUNGE,REST, LOCKABLE
STORAGE)
STANDARD 16: CEILING SURFACES, FLOOR SURFACES, WALL
SURFACES,FURNISHING,LIGHTINGS- DAY AND NIGHT LIGHTING, PROCEDURE
LIGHTS
STANDARD 17: ACOUSTIC ENVIRONMENT( DESIGN SHOULD BE MINIMAL
BACKGROUND NOISE- less than 40 decibles )

1. Every infant bed, whether in a single or multiple-bed room, shall be within
20 feet (6 meters) of a hands-free HANDWASHING station. Hand washing
stations shall be no closer than 3 feet (0.9 meter) from an infant bed, clean
supply storage, or counter/work surface unless a splashguard is provided.
2. An airborne infection ISOLATION room shall be available for NICU infants,
and shall provide a minimum of 150 square feet (14 square meters) of
clear floor space, excluding the entry work area.
3. Each infant SPACE shall contain a minimum of 120 square feet (11.2
square meters) of clear floor space, excluding hand washing stations,
columns, and aisles.
4. Acoustical ceiling tile, heavily insulated walls, carpeted corridors and other
features are designed to keep sounds under 40 decibels.

Nurse Protocol means a written document mutually agreed upon
and signed by a nurse and a licensed physician, by which the
physician delegates to that nurse the authority to perform certain
medical acts. These acts shall include, without being limited to, the
administering and ordering of any drug.
“Protocol” means a series of actions( which may include a number
of medications) that may be implemented to manage a patient’s
clinical status. A protocol allows the application of specific
interventions to be decided by the Nurse bases on the Patient
meeting certain criteria outlined in the care.

WHAT IS THE DIFFERENCE BETWEEN STANDING ORDERS AND PROTOCOLS?
Protocol: protocols allow the Nursing Professional, paramedic to perform
medical procedures that are normally in the domain of a physician. Standing
orders are more like temporary rules or methods, while protocols are more
definitive and usually follow a series of algorithms.
WHAT ARE NURSE DRIVEN PROTOCOLS?
Nurse-driven protocols (NDPs), which provide a medically approved rubric for
professional nurses to make autonomous care decisions, can facilitate
appropriate catheter use and timely removal, as advised in the Centers for
Disease Control and Prevention's 2009 CAUTI prevention guidelines

REQUIREMENT OF NURSE WHO USES NURSE PROTOCOL
• Hold a current license to practice as a registered professional nurse (RN)
• Adhere to the written nurse protocol.
REQUIREMENT FOR NURSE PROTOCOL
• Be reviewed, revised or updated annually.
• Be available and accessible in each of the specific settings where RNs function
under nurse protocols and be available upon request.
•Include the specific terms/conditions under which delegated medical acts may
be performed.
Why are protocols important in healthcare?
Standardization of practice to improve quality outcomes is an important tool in
achieving the inspired shared vision of patients and their health care providers.
Checklists and protocols should be incorporated into systems as a way to help
practitioners provide the best evidence-based care to their patients.

1ST EXAMPLE NURSE PROTOCOL FOR ADMINISTERING VACCINES
NURSE PROTOCOL FOR ADMINISTERING VACCINES
SIGNATURE PAGE
NOTE: This type of signature page would be used by RN or APRNs
when the vaccine must be transported to non-county Health
Department sites such as school-based clinics.
The signatures below indicate an agreement between the
delegating physician(s) and the registered professional nurse(s)
RN(s) who are authorized to administer the following vaccines:
• Seasonal Influenza Vaccine
• Meningococcal Vaccine
• Pneumococcal Vaccine
• Tetanus-containing Vaccine

Record reviews by the delegating physician(s) will be completed at
least once annually. Ideally, it is preferred that record reviews be
completed on a quarterly basis throughout each year to identify
strengths and opportunities for improvement in a timely manner.
___________________________
Signature of Delegating Physician Date
___________________________
Signature of RN Date

2ND EXAMPLE OF STANDARD NURSE PROTOCOL FOR DIAPER
DERMATITIS
(DIAPER RASH)
DEFINITION
Inflammation of the skin within the area usually covered by the diaper.
ETIOLOGY
It can be caused, and aggravated by, many factors acting separately or in
combination. Contact irritants such as urine, stool and chemicals may be
involved. Bacterial, fungal or viral infections may also cause diaper dermatitis.
Other causes include seborrheic dermatitis or atopic dermatitis.
SUBJECTIVE Patient (caregiver) may complain of:
a. Pruritus
b. Irritability
c. Erythema

OBJECTIVE Physical examination:
a. Irritant contact diaper dermatitis will show mild erythema,
especially on the buttocks, genitalia and lower abdomen with
sparing in the creases.
b. Bacterial infection will show vesicles and/or pustules in the
diaper area.
c. Monilial (candidal) infection will show smooth, shining, “fire-
engine” red, papular and nummular rash, with well-circumscribed
borders, that extends into creases, and satellite lesions that are
outside the margin of the erythema. Oral thrush may also be
present. Small pustules are often present on the periphery.
Antibiotic use is a predisposing factor.
d. Affected area may be moist and exudative.
e. During healing of moderate to severe dermatitis, skin may be dry
and scaly.

ASSESSMENT
Diaper dermatitis.
PLAN
THERAPEUTIC PHARMACOLOGIC
1. For cases of diaper dermatitis that have the typical appearance of monilial
infection (satellite lesions, etc.) or for cases of diaper dermatitis that have been
present for more than 3 days without improvement.
a. Apply nystatin 100,000 units/gm (e.g., Mycostatin©) cream lightly to
affected area under a barrier ointment 3 times a day for 7-10 days. (May
repeat cycle once).
b. Treat for oral thrush, if evident. (See Thrush - Oral Candidiasis protocol).
NOTE: Topical hydrocortisone and fixed-combination medications, Mycolog II and
Lotrisone, should NOT be used. (Adverse systemic effects may occur due to use in
an occlusive diaper area).

PATIENT EDUCATION/COUNSELING
1. Assure that parent/caregiver knows how to treat, as above.
2. Teach parent to promptly change diapers as needed.
3. Teach parent to gently wash area (do not scrub). If rash is severe and to avoid
rubbing – to clean and rinse, use a water bottle to squirt warm water gently and
pat dry.
4. Teach parent to use mineral oil on a cotton ball to remove dried feces.
Nurse Protocols for Registered Professional Nurses 2018,type of diaper used is a
reasonable consideration. Diaper rash is less common with use of super
absorbent disposable diapers.
5. Contact clinic if any problems obtaining medications.
FOLLOW-UP
1. No follow-up needed if symptoms resolve within 2 weeks.
2. Reevaluate if symptoms persist or worsen beyond 2 weeks.

NON-PHARMACOLOGIC MEASURES
1. General Treatment and Prevention
a. Keep diaper area dry and free from urine and stool:
1) Change diapers frequently.
2) Cleanse diaper area with warm water with each diaper change. Avoid use of
soap which can be irritating to skin, and use mild, non-perfumed, non-medicated
soap only if necessary.
3) Air drying is useful.
4) Avoid starch, other powders and petroleum jelly.
b. Apply bland ointment (e.g., A&D ointment) or a barrier cream (e.g., zinc oxide
or Desitin©) after each diaper change.
c. Avoid the use of commercial diaper wipes, which are often perfumed and
irritating. Recommend using plain water and soft, non-abrasive towel for
cleaning.
d. Infants using super absorbent disposable diapers have a significantly lower
frequency and severity of diaper rash when compared with infants using cloth
diapers. These should be recommended if the dermatitis is recurrent or severe.

CONSULTATION/REFERRAL
NOTE: Refer patient to primary care provider OR consult with APRN or
delegating physician for care management if the following conditions are
present.
(When a patient is REFERRED to the primary care physician, the Public Health
RN may no longer care for the patient under this nurse protocol):
1. Failure to respond to treatment.
2. Signs of bacterial infection are present.
3. Any rash that is unusual or severe.

TRENDS IN FAMILY-CENTERED CARE IN NEONATAL INTENSIVE CARE
Family-centered care in neonatal intensive care changed over the last decades. Initially,
parents and infants were separated and parents were even being blamed for cau-sing
infections in their infants. Facilitation of family-centered care includes involving the
parents in daily care activities, kangaroo care, developmental care, interaction and
communication with the infant, as well as involving grandparents and siblings.
Implementation of family-centered care requires appropriate policies, facilities and
resources, education of all involved, and a positive attitude.
MATERIALS FOR A HEALTHY ENVIRONMENT
As designers, we advocate for sensitivity in maintaining a healthy built environment.
Sustainable practices are a focus for the NICU for the finishes selection and supplies that
are used to support infant care. Materials should be selected that reduce exposure to
toxins when looking at anything from IV administration, cleaning products used in the
NICU and composition of building materials.

ROLE OF NURSE HAS CHANGED A LOT
These roles are beyond the traditional boundaries of nursing. Today pediatric nurses are
involved and performing a great job independently, and /or with the collaboration of
pediatrician. The care given by the pediatric nurse is greatly admired by the children,
parents and relatives. This is because of the 24 hours availability of the pediatric nurses
and ready to care approach implemented by them. Today’s roles can be categorized into
extended and expanded roles along with the traditional roles performed by them.
NEONATAL NURSING TOMORROW
Neonatal nurses can work and are working at their best for the pediatric population.
There will be more roles that they will be serving in future. In the developed countries
neonatal nurses are performing these roles but because of lack of prominent leaders in
this field, in developing countries these roles are lacking. Some of the roles are; Nurse
entrepreneur, Tele nurse, Forensic nurse, Peace Corps nurse, independent neonatal nurse
practitioner and independent neonatal nurse consultant

PROBLEM INTERVENTION COMPARISON OUTCOMES
Improving Knowledge
And Promoting Learning
With Simulation
Technique
(Special focus on
simulation: educational
strategies in the NICU)
Hands-On Learning Has
Been Incorporated Into
NRP And Similar
Training For Some Time,
Simulation-Based
Learning Is Increasingly
Being Utilized In New
And Varied Situations
Comparison was made
with other Learning
Techniques to find out
the effectiveness of
teaching method
The article concludes
with a look at the
potential future of
simulation-based
education. It is
considered that
simulation technique is
one of the best teaching
& learning method.

1. Robert M. Kliegman, et al., Nelson Textbook of Pediatrics, 19th ed., Elsevier,
Saunders, Philadelphia, PA, 2011,
http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-1-4377-0755-
7&eid=4-u1.0-B978-1-4377-0755-7..00226-8--s0040 , accessed on /April 28, 2013.
2. Paul S. Auerbach, Wilderness Medicine, 6th ed., Elsevier Mosby, Philadelphia,
PA, 2012, http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-1-
4377-1678-8&eid=4-u1.0-B978-1-4377-1678-8..00099-4--s0420 accessed on April
28, 2013.
3. American Academy of Pediatrics, “Diaper Rash,” Patient Education Online, June
2010, http://www.patiented.aap.org/content.aspx aid=5297 (April 28, 2013).
(Current)
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972584

9408429635
RINIL MACWAN
9408429635/8849290742
jonilsmacwan2017@gmail.com
JONILS MACWAN
7/8/2019 58

NICU CONCEPTS, STAFFING,PROTOCOLS, PHYSICAL LAYOUT

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