INTRODUCTION

NEONATAL INTENSIVE CARE UNIT is a specially staffed and equipped hospital NICU dedicated
to the management of neonates with life threatening illness, injuries and complications.
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 healthcare professionals to provide specialized care for the tiniest
neonates. NICUs may also have intermediate or continuing care areas for babies who are not
as sick but do need specialized nursing care. Some hospitals do not have the personnel or a
NICU and babies must be transferred to another hospital.
The organization of good quality special care neonatal unit is essential for reducing the
neonate mortality and providing the quality of care among the survivors. The paediatrician
and the nurse incharge of should be taken into confidence during the planning stage so that
the NICU is based on their opinions for meeting the special needs of the neonates.

Which babies are admitted in NICU?

Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have
low birthweight (less than 5.5 pounds), or have a medical condition that requires special care
of your baby.

Following factors effect the wellbeing of a neonate and thus result in the need of specialized
care in specialized intensive care unit:

 maternal factors:

o age younger than 16 or older than 40 years

o drug or alcohol exposure

o diabetes

o hypertension (high blood pressure)

o bleeding

o sexually transmitted diseases

o multiple pregnancy (twins, triplets, or more)

o too little or too much amniotic fluid

o premature rupture of membranes (also called the amniotic sac or bag of waters)
  delivery factors:

o fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)

o breech delivery presentation (buttocks delivered first) or other abnormal

presentation

o meconium (the baby's first stool passed during pregnancy into the amniotic fluid)

o nuchal cord (cord around the baby's neck)

o forceps or cesarean delivery

 baby factors:

o birth at gestational age less than 37 weeks or more than 42 weeks

o birthweight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8
pounds, 13 ounces)

o small for gestational age

o medication or resuscitation in the delivery room

o birth defects

o respiratory distress including rapid breathing, grunting, or apnea (stopping

breathing)

o infection such as herpes, group B streptococcus, chlamydia

o seizures

o hypoglycemia (low blood sugar)

o need for extra oxygen or monitoring, intravenous (IV) therapy, or medications

o need for special treatment or procedures such as a blood transfusion

PHYSICAL FACILITIES

Space
The size of the unit is related to the expected population intended to be served. In India,
about 15 to 20 percent of newborn babies need special care, depending upon the criteria for
antenatal booking for confinement.

In addition, if the center is to serve as a referral unit for the neonates born outside the
hospital, allowance should be made for additional physical facilities and space. In a maternity
unit having 2,000 deliveries per year, facilities for special care of 8 high risk neonates should
be available.

Each neonate should be provided with a minimum area of 100 sq. ft. or 10 m 2. There should
be no compromise on space and its adequacy is crucial for reduction of nosocomial infections.

Space should be allocated within the nursery complex for promotion of breast feeding,
expression of breast milk and its storage.

A separate bay in the lying-in NICU should be earmarked for transitional care of high risk
babies by their mother before they are discharged from the hospital. The entry of visitors to
this area should be restricted and it should be kept adequately warm. Facilities for maintaining
asepsis and weighing the babies should be available in the transitional care room (TCR).

Location
The neonatal unit should be located as close as possible to the labor rooms and obstetric
operation theatre, to facilitate prompt transfer of sick and high risk neonates.

The presence of an elevator in close proximity is desirable for transport of outborn neonates.

The nursery should not be located on the top floor of the hospital but there should feasibility
for the sunlight to peep into the nursery enhance brightness and provide ultraviolet rays
augment asepsis.

Floor plan
The unit facility should preferably be in a square space so that abundant open unencumbered
space available.

A split unit i.e. on either side of the hospital should be avoided for ease of mobility and
prevention of infections.

The walls should be made of washable glazed tiles.

 The windows should have two layers of glass panes to ensure some measure of heat and
sound insulation.

Adequate number of deep wash basins with elbow or foot operated taps, having constant
round-the-clock water supply should be provided.

Built-in wall en cabinets with foldable covers are useful for stacking purposes.

The doors should be provided with automatic door closers. In addition to the special care
minimal care and isolation rooms, the unit should closely linked with formula room, x-ray
room, laboratory and a procedure room.

The cleaning area is used for sterilization of equipment and for fumigation of incubators in a
specially designed vapour proof chamber.

Ventilation
Effective air ventilation of nursery is essential reduce nosocomial infections. The most
satisfactory ventilation is achieved with laminar air flow system which is rather expensive.

When centralized air conditioning is used, minimum of 12 changes of room air per hour are
recommended. The air-conditioning ducts must be provided with millipore filters (0.5 u) to
restrict the passage of microbes.

A simple method to achieve satisfactory ventilation consists of provision of exhaust fan in a

reverse direction near the ceiling for input of fresh uncontaminated air and fixation of another
exhaust fan in the conventional manner near the floor for air exit.

A constant positive air pressure should be maintained in the nursery so that contaminated air
from the corridors does not gain access into the nursery. The use of chemical air disinfection
and ultraviolet lamps are no more recommended.

Lighting
The nursery must be well illuminated and painted white or slightly off white to permit prompt
and early detection of jaundice and cyanosis. It is best achieved by cool white fluorescent
tubes to provide at least 100 foot candle, shadow-free illumination at the neonatal's level.

The number and exact location of fixtures can be worked out taking into account size of the
nursery, height of the ceiling, and availability or otherwise of sunlight.

Spot illumination for various procedures can be provided by a portable angle-poise lamp
having two 15 watt fluorescent bulbs which when held at a distance of about one foot from
the neonate, produce about 100 foot candle intensity of light. In places where electrical failure
is frequent and prolonged, the electrical system of the nursery complex must be attached to a
generator.

Exposure of preterm babies to strong light has been incriminated as a risk factor for the
development of retinopathy of prematurity. The nursery light should be dimmed at night to
simulate day-night pattern to promote hormonal surge and growth of babies. Bed side lights
with dimmer switches should be provided to create specialized microenvironment for each
baby.

Environmental temperature and humidity

The temperature of the nursery complex must be maintained around 26 ± 2°C in order to
minimize effects of thermal stress on the babies. This is best achieved by centralized air
conditioning having temperature control knobs in the nursery. The air movement should be so
designed that drought is minimized.

In places where air conditioning is not feasible, room temperature can be reasonably well
maintained in winter by use of radiant heaters and hot air blowers. Portable radiant heater,
infra red lamp or bakery bulb can be used to provide additional source of heat to an individual
neonate.

Acoustic characteristics
The ventilation system, incubators, air compressors, suction pumps and many other devices
used in the nursery produce noise. Sound intensity in the nursery should not exceed 75 db to
protect hearing of nursery personnel and neonates. Excessive noise may lead to hearing loss,
physiological and behavioral disturbances such as sleep disturbances, startles and crying
episodes, hypoxia, tachycardia and increased intracranial pressure.

The fabrication and redesigning of nursery equipment should take into account the
desirability of minimizing noise by dampening the sounds by acoustic or other means. It is
desirable to have effective sound proofing of ceilings, walls, doors and floor when a new
nursery is designed.
Telephone rings and equipment alarms should be replaced by blinking lights. Instead of air
compressors, centralized sources of compressed air, oxygen and suction should be provided.
Decibel meters should be installed to monitor sound levels in the nursery.

The beneficial and soothing effects of meaningful sounds such as gentle music or recordings
of parent voice should be harnessed to provide physiologic stability to the babies.

Handling and social contacts

Excessive and rough handling of delicate newborn babies is associated with several adverse
physiological consequences such as excessive crying, sleep disturbances, tachycardia or
bradycardia, hypoxia and rise in blood pressure and intracranial pressure.

Handling should be gentle and kept to the barest minimum without compromising care
Soothing words, gentle stroking and rocking should be practised after a painful procedure.
Gentle caressing, cuddling and touching by the mother are desirable to provide comfort and
confidence to the baby and aid the process of healing.

Neonates should be exposed to gentle and soothing tactile, kinesthetic, vestibular, motor,
auditory and visual experiences to provide opportunities for early learning and improvement
in behavior. Parents should be allowed unrestricted entry to the nursery to provide these
useful sensorimotor stimuli. It enhances the process of bonding between the baby and the
family.

Communication system
The nursery complex should be provided with an intercom system so that additional person
can be called for help in case of emergency without leaving the sick neonate. Mobile phones
should not be used near the vicinity of the nursery because the electromagnetic waves are
likely to interfere with the functioning of the electronic equipment.

Electrical outlets
There should be adequate number (8-12 electrical points at the height of 4-5 feet) of light and
power electrical points attached to a common ground. Each neonates must be provided with
at least eight electrical outlets. The use of adapters and extension boards should be
discouraged.

The electrical equipment used in the nursery must be checked at least once a month for
leakage of current and adequacy of grounding. If possible special fittings with safety devices
should be installed.

The voltage supply to the nursery should be stabilized with the help of a voltage servo-
stabilizer. There should be round-the clock power back up including provision of UPS system
for the sensitive equipments.

LABORATORY FACILITIES
Satisfactory facilities for routine radiological examination should be available in the nursery
round the-clock. A good portable 3- phase generator x- ray machine of at least 200
milliamperes with extremely short exposure time (11120 seconds) should preferably be
housed in a small room adjacent to the NICU.

A side laboratory for routine analysis of blood, urine, amniotic fluid, gastric aspirate for shake
test and cytology, glucose, bilirubin, hematocrit and blood gases and acid-base parameters
etc. should be available. Centralized facilities for microbiochemical techniques especially for
estimation of total and direct serum bilirubin, blood glucose, arterial p0 2, pC02, pH and base
deficit are desirable. Facilities for analysis of serum sodium, potassium, calcium, total serum
proteins and albumin should be at hand.

The collection of venous blood is often difficult and hazardous in sick preterm babies. These
babies often require frequent biochemical estimations. It is generally not appreciated that
removal of 10 ml of blood from a 1,500 g neonate amounts to about 8 percent of his total
blood volume. This is equivalent to removal of about 400 ml of blood in an adult. Thus a micro
chemical laboratory which can carry out investigations on very small samples of blood
obtained in heparinised capillary tubes or microcentrifuge tubes from heel puncture, should
be considered as an essential facility for NICU.
 EQUIPMENTS

A large number of monitoring devices for diagnostic and therapeutic application for the high
risk newborn neonates have been developed. These have considerably improved their intact
survival. Several basic prerequisites must be fulfilled before any center invests in purchase of
expensive equipment involving foreign exchange. The fundamental needs of the unit are
availability of adequate space, freedom from congestion and presence of a sufficient number
of adequately trained nurses. A reasonable level of asepsis must be achieved and facilities for
maintaining thermoneutral environment should be established. The feeding of babies should
be associated with minimal risk of aspiration.

The equipments listed below are by and large arranged in the order of their usefulness and
priority.the maintenance of existing equipment in proper working condition is more important
than acquiring additional gadgets.

1. Resuscitation Equipment
2. Oxygen and suction facilities
3. Catheters, syringes and needles
4. Feeding equipment
5. Laminar flow system
6. Weighing machine
7. Incubators\
8. Radiant heat warmers
9. Phototherapy unit
10. Heat rate monitor
11. Blood pressure monitor
12. Multi- channel vital sign monitor
13. Infusion pump
14. Bilirubin analyzer
15. Transcutaneous bilirubinometer
16. Transcutaneous blood gas monitor
17. Pulse Oximeter
18. Neonatal pulmonary function tests
19. Cranial ultrasonography
20. Intracranial pressure monitor
 PERSONNEL

Acquisition of new equipment does not necessarily ensure better services and outcome.
Machines do not replace men. The best monitors with us are dedicated nurses and resident
doctors involved in the care of newborn babies with their observational skills sharpened by
experience. Therefore, they need continued in-service training, teaching and encouragement
for obtaining the best results.

Who will care for baby in the NICU?

The following are some of the specially trained healthcare professionals who will be involved
in the care of your baby:

 neonatologist - a pediatrician with additional training in the care of sick and premature
babies. The neonatologist supervises pediatric fellows and residents.

 nurse practitioners who care for babies in the NICU.

 respiratory therapists

 occupational therapists

 dietitians

 lactation consultants

 pharmacists

 social workers

 hospital chaplains

The members of the NICU team work together with parents to develop a plan of care for high-
risk newborns.

The survival of newborn babies depends mainly upon the availability of specially doctors and
trained nurses. The Nursing Council of India has not outlined any special guidelines for this
purpose. It has been recommended b y the American Academy of Pediatrics that one nurse is
needed to offer special or intermediate nursing care to 3 babies or intensive care to one
neonate.
In countries, where monitoring devices are not routinely available, relatively larger number of
nurses are necessary for undertaking manual monitoring.

It is generally not appreciated by the hospital administrators that a considerable time of the
nurse is spent on rigorous housekeeping rituals to maintain asepsis in the nursery. The
frequent toilet care, expression of breast milk, formula preparation and feeding are time
consuming and unassisted by any attendant. Whenever adequate number of nurses are not
available, these rituals are compromised resulting in outbreak of epidemic of infection in the
nursery. The nursery complex must, therefore, be considered as an independent nursing unit
under the charge of a fully qualified nursing sister.

The National Neonatology Forum of India has recommended that at least one trained nurse
should be allocated to provide coverage to four babies in the neonatal intensive care unit.
The allowance should be kept for additional 25 percent staff to provide for the exigencies of
day off and leave. Therefore, for a 8-bedded NICU, eight nurses should be sanctioned to
ensure availability of two nurses in each shift along with one additional sister incharge in the
morning shift. The continuity of service can be maintained if at least 50 percent of the nurses
are rather permanent and not transferred frequently as is the usual practice in general
hospitals. There must be equal distribution of nurses in the three duty shifts during 24 hours.

It is desirable to have services of public health nurses and social workers for follow up and
home care of low birth weight babies after their discharge from the hospital.

A pediatrician specially interested in the care of newborn babies should devote his full time to
improve the existing standards of neonatal special care services. The unit must also have an
independent senior resident doctor and one junior resident round the-clock for every 8 babies
requiring special care. The resident doctors must work in these units for at least 3 months to
maintain continuity of medical care. All deliveries in the hospital should preferably be
attended by a physician trained in the care of newborn.

A laboratory technician should be available to operate bilirubinometer, glucometer,

microcentrifuge, and blood gas analyzer. A biomedical technician or a link person is essential
to maintain a liaison with suppliers of equipment to ensure their smooth functioning, prevent
breakdowns and reduce the uptime.

When ventilatory facilities are established respiratory therapist is a useful member of the
neonatal team to monitor ventilatory settings, provide tracheal suctioning and chest
physiotherapy.

The resident staff and nurses working in the NICU must be trained to properly handle and use
the equipment. The nurses must be imparted continuing in-service training in the art of
neonatal nursing and preventive maintenance of a variety of electronic equipments used in
the NICU. They should participate in the monthly perinatal morbidity and mortality
conferences.

TRANSPORT OF SICK NEONATES

Satisfactory transportation facilities are needed, whether a baby is being transported from
one hospital to an intensive care unit or simply within the hospital from NICU to the operation
theatre, x-ray department etc. The short distapce transport within the hospital can be
accomplished in a prewarmed Armstrong incubator. The use of a plastic basket with
perforated sides coupled with careful placing of hot water bottles is recommended for use in
the rural setting. The baby can be wrapped in tin foil or covered with several layers of cotton
and carried next to skin. Thermocole (polystyrene) box is an effective insulator and can be
used in the community for transport of babies.

In a busy NICU or a regional neonatal center, availability of a transport incubator is

mandatory. The transport incubator should be sturdy but light weight and run both on mains
and batteries. The incubator should maintain air temperature in the desired range and must
have the facility of providing oxygen and suction. The baby in the incubator should be visible
through the incubator canopy. The transport ambulance should be equipped like a mini-NICU
and should have a vital sign monitor, portable ventilator, resuscitation bags, oxygen, life
saving drugs and disposables.

If a sick or a high-risk neonate is to be transferred to a NICU, a well defined plan should be

adopted. The uterus is an ideal 'transport incubator'. Thus delivery of the high-risk mother
should preferably be conducted in a center having NICU in order to circumvent the need for
subsequent transfer of a sick newborn with all its attendant hazards. Availability of an
ambulance equipped with transport incubator and facilities for suction, bag and mask
ventilation and services of a physician and nurse for care of babies during transit are
essential.Transport facilities with good infrastructure should be available at the receiving
NICU.

The condition of the baby should be assessed before transfer. The goal of every transport is to
bring a sick neonate to a specialized neonatal center in a stable condition. To avoid
complications during transport, the neonate should be as stable as possible before leaving the
referring hospital. Hypothermia, hypovolemia, hypoglycemia, acidosis and seizures should be
treated before baby is transferred. Oral feeding should be stopped and an IV line established
at a peripheral site or through umbilical vein for administration of 10% dextrose. Add 1 unit of
heparin per ml of fluid if fluids are given via an umbilical catheter.

The neonate with history of frequent apneic spells or severe respiratory distress syndrome
should be decompressed and intubated before the start of journey. The baby should be placed
in a prewarmed transport incubator and administered oxygen. The portable incubator
provides an ideal microenvironment during transport. It is battery operated and has built-in
system for oxygen supply. The transport incubator should be light in weight but sturdy and
should allow sufficient access to manage a critically ill baby.

The transport team should estimate the amount of oxygen and air required during transport
by assessing the distance, time and needs of the neonate. The ambulance should be warm and
well illuminated for observation of the baby. Temperature and color of the baby should
receive due attention. Early transfer of a mildly ill baby is preferable to the transfer of a baby,
whose condition has deteriorated to a state, when there is little hope for survival.

The principles of safe transport of sick babies are expressed by a mnemonic STABLE where
each alphabet stands for Sugar, Temperature, Airway, Blood pressure, Lab work and
Emotional support or communication with family.

MANAGEMENT OF NURSING SERVICES

Management of nursing services is one of the prerequisites for good nursing care.
There are many factors involved in good nursing services management, which the nurse
manager/supervisor needs to understand thoroughly for good management of the NICU as
follows.

1. KNOWLEDGE of the NICU means that knowledge of all the duties and activities to be
performed in NICU.
2. PLANNING THE SCHEDULE of the NICU refers to a planned programme for each
day's work to save time and use available time in a useful way for nursing the clients.
3. STARTING THE WORK ON TIME: Proper arrangements are made so that all nurses
do their job in right time as assigned promptly.
4. PREVENTING INTERRUPTIONS: Good management requires avoidance of
interruption whenever possible, for e.g. changing assignments are anticipated.
Establishment of NICU routine provide a plan for delegation of duties and getting the
work done in an efficient way. Policy manuals of the institution help to establish NICU
 routines which include handling orders, writing and giving reports, checking medicine
cards, summarising charts, handling telephone calls, checking and ordering, supplies,
keeping cupboards stocked, distributing linen, collecting specimens, there is more time
left for individualised nursing, supervision and teaching.
5. USE OF DEMOCRATIC METHOD IN ESTABLISHING NICU POLICY : When NICU
objectives are to be determined and a policy to be established or changed, better co-
operation is achieved if participation of the entire staff is encouraged.
6. ORIENTATION OF NEW PERSONNEL: Well developed orientation programme helps
good NICU management. When new staff have entered the hospital, they must be
oriented to hospital as well as the NICU, which helps new nurses develop desirable
understanding and attitudes.

Orientation of hospital will include the type of hospital, organisation of hospital, aim of
nursing service, relationship of hospital with medical/nursing schools or colleges,
doctors, different departments in relation to nursing services, health services for nurses,
meal hours, plans for periodical conferences and staff development.

Orientation of NICU will include the introduction of new nurses to NICU personnel,
services represented on the NICU, methods of assignment, working schedule of the day
(neonates time of awakening, taking TPR, meal timings etc) resting hours, visiting hours
etc, duties of non-professional workers, methods of obtaining daily assignments
(handling orders, charting etc), NICU tour/ rounds, location of equipment, location of
existing and emergency equipments, and other sources of information such as
procedures, routines, and NICU policy book etc and also introduction of required special
experiences.

7. MAINTENANCE OF SUITABLE ENVIRONMENT: Elements which help maintain suitable

environment in the NICU include prevention of noise, good ventilation, cleanliness of
NICU, well functioning equipments, good housekeeping etc. Because, noise hampers
relaxation and rest; improper ventilation is harmful to health. A sanitary, safe, restful
environment is necessary to the neonates welfare and comfort as well as that of all
members of the NICU personnel. Cleanliness and order improve morale and tend to
make workers careful and neat in their habits. Maintenance of building and equipment
in good repair is economical as well as safe and efficient.
8. PROVIDING SUPPLIES AND EQUIPMENT IN NICU : There should be provision for
proper supplies and equipment for efficient work supplies are expendable items or
those articles which are used up and must be recorded periodically such as soap, and
detergents, paper towels, stationery, sterile goods, etc. Equipments include more
permanent articles and may be classified as fixed or movable. Fixed equipment is not a
part of the structure of the building but is attached to its walls or floor such as
 sterilisers and sinks. Movable equipments include furniture, instruments, syringes,
dishes etc. For good management, all materials (supplies and equipment) should be
adequate free from repair, accessible, and conveniently located and should maintain
the standard, in the materials, according to their use, maintain good exchange system,
inventory and requisition.
9. CLEAR CUT, SPECIFIC ORDERS FOR MEDICAL THERAPY AND NURSING: Good
NICU management needs a clear cut doctors orders and nursing orders, which are very
essential to safeguard the neonate welfare. They help prevent errors and thus they
protect the doctor, the nurse and the hospital. It is always better that orders be written
and Signed by the doctor. There are some standing orders that also should be written
in the policy book of the hospital, then only the nurses are able to carry out the
standing orders. Nursing orders, given by the nurse supervisor, should be specific and
easily communicated to the concernes nurses to carry out and the same which avoid
confusion and other odd events.
10. RECORD KEEPING, MAINTAINING ACCURATE RECORDS IS ESSENTIAL FOR
GOOD MANAGEMENT: They might be a neonate clinical records, administrative
records, all have legal and scientific value, so that recording competence should be
maintained. Records will include, administrative records, doctor's orders, nursing
orders, nurses notes, record of treatment etc. While using records proper instruction to
be followed by proper use of clinical records. In addition proper maintenance of
records of equipments lossess and replacements, records of personnel performance
are also a part of good management.
11. REPORTING: Reports are of prime importance both to good NICU management and
to a well-functioning hospital. Many reports are oral and are concerned mainly with the
immediate functioning of the NICU such as reports between nurses and reports to
doctors and supervisors. Reports are written as they may be needed for legal purposes,
when they are to serve as a source of reference, or to be used by several people.
Written reports include day, evening and night reports and those relating to accidents
and unusual condition which may reflect the quality of care the neonate has received.
Reports to other departments in the hospital and to agencies outside the institution are
usually written. A report to be of the greatest use and to save time and duplication of
efforts must be prompt, complete, accurate and objective. Reports which have legal
significance, especially those describing accidents and mistakes, are written by the
individuals involved and should include all identifying information, which in any way
may have contributed to the situation.
12. ESTABLISHMENT OF GOOD RELATIONSHIP: Establishing good working
relationship within the NICU and with other associates is an essential factor in good
work management. In the hospital where every individual and every department exists
for its contribution to the neonate and his well-being, there are interdependencies and
 interrelationships which must be understood and respected. When good relationship
exists, people are enthusiastic about their work. They feel themselves to be a part of
the institution. A warm, friendly atmosphere prevails the hospital.
13. DELEGATING RESPONSIBILITY: Whenever an individual is responsible to another
person, delegation of duties is essential. In a hospital NICU the bedside care of the
neonates is delegated to the staff and student nurses, housekeeping duties are
assigned to other personnel. The delegation of responsibility will be made in
accordance with the ability of individuals within the frame of policy of the hospital.
14. ASSIGNING DUTIES AND RESPONSIBILITY: Well-planned assignments of duties
and responsibilities have following objectives.
i. To provide the neonate with the best possible nursing care.
ii. To plan assignment which are interesting and stimulating to professional growth.
iii. To provide a well rounded educational experience for student nurses.
iv. To achieve good NICU management.
15. TO ACHIEVE GOOD NICU MANAGEMENT , seven principles should be kept in
mind when planning assignments which include:
• Activities are better performed when each is made the responsibility of a single
person.
• If nurses are to use their time to good advantage they must be able to plan it.
• If there are not enough nurses on any duty to carry the nursing load it is better to
use students and non-professional worker according to their ability.
• Assignments of neonates and duties should not be charged untill or unless they are
absolutely essential.
• The care required by all neonates in the group assigned to one nurse must be
considered when making assignment.
• Assignment planning is closely related to time planning.
• The best use will be made of the nurses time if the neonates assigned to one nurse
are geographically close together.
16. There are three METHODS OF ASSIGNMENT namely neonate method, functional
method and team method.

 In the neonate method, a nurse is expected to give complete nursing care to one or
more neonates including general nursing measures, treatments, medications, taking
TPR, serving nourishments, giving health education. If she goes off some may
handed over promptly to another nurse to carry out the same round the clock.
 In the functional method, the nurses are assigned to specific functions in the NICU
such as giving medication or treatment to all neonates, taking TPR giving nursing
care to a group of individuals.
 In the team method of assignment several staff members under the leadership of a
 professional nurse are assigned a group of neonates. Ideally the team continued to
care for neonates throughout their entire hospitalisation. The team leaders assign
the neonates to team members daily in accordance with the needs of the neonates
and the ability of the members to meet their needs.

17. TIME PLANNING refers to well arrangement of time for personnel who are working
in the NICU. For providing adequate care to the neonates in the NICU, time planning is
very essential. Time planning may affect the health and morale of the staff. The
objectives of time planning includes:
• To provide adequate staff for good nursing care for 24 hours.
• To provide the best possible experience for nursing students.
• To comply with good personnel practices and keep nurses happy and
contented.
18. GOOD TEACHING: The education of the nurse is markedly influenced by the
assignment which are planned for nurse on the hospital NICUs. To plan assignments of
educational value the nurse supervisor must know the experiences the NICU has to
offer especially those which are not available elsewhere. The abilities of the student are
expected to develop on the NICU, and the experiences which will help to do so. Nurse
supervisor also needs to be familiar with the experience background of the students
and to be informed of the length of the students assignments to the floor. Clinical
experience for students includes neonate care, nursing procedures and general NICU
activities. Nurse supervisor has to plan these experience for the benefit of students to
get good education. Technique of NICU teaching will include incidental teaching
besides, clinic demonstration, individual conference, group conference, nursing care
conference, teaching round out etc.
19. GOOD SUPERVISION: supervision is a teaching learning process which helps the
nurse and nursing students to think and act for themselves, set-up their own objectives
which have meaning to them and it helps them to attain objectives through approval,
commendation, self analysis and by physical assistance when it is indicated. It respects
the personality of nurse, it inspires nurses to grow in effectiveness.
 SEMINAR
SUBJECT: OBSTETRICAL AND GYNAECOLOGICAL NURSING

TOPIC: NEONATAL INTENSIVE CARE UNIT- its organization

AND

MANAGEMENT OF NURSING SERVICES IN NICU.

SUBMITTED TO:

MRS SHIVANI SHARMA,

LECTURER, GSCON

SUBMITTED BY:
JAGDEEP KAUR

M. Sc nursing 1st year

Roll no. 8