NR 452 Week 5 Bedside Heel Stick Change Proposal Example

Heel Sticks at the Mother's Bedside: A Change Proposal Built to Outlast Its Author

Student Name

College of Nursing, Chamberlain University

NR 452: Capstone Course

Instructor Name

Month Day, Year

Heel Sticks at the Mother's Bedside: A Change Proposal Built to Outlast Its Author

The Change in One Sentence

On the mother-baby unit, the newborn screening heel stick will be done at the mother's bedside while the baby is breastfeeding or held skin-to-skin, at a time agreed with the mother during the morning assessment, instead of in the nursery bassinet on the nursery's schedule.

The Evidence, at the Strength It Was Found

The appraisal completed in the previous weeks supports this change at moderate strength. Skin-to-skin contact during a painful procedure reduced newborn pain indicators across 25 trials, though the review authors rated the certainty as moderate to low (Johnston et al., 2017). Breastfeeding during a heel stick lowered measured pain and matched oral sucrose closely in a review of 20 studies (Shah et al., 2012). A small trial in healthy term newborns found that babies held skin-to-skin cried and grimaced far less during the lance than babies left in a crib (Gray et al., 2000). Oral sucrose has the strongest evidence of the three (Stevens et al., 2016), but it requires a product, a protocol and an order, which is a larger change than this project can support. The proposal therefore uses the measures that need nothing but the mother and a change in timing. None of these sources shows harm, and none claims the effect is large in every infant; the proposal claims no more than they do.

Why the Nursery Routine Persists

The current routine exists for reasons that are sensible from the unit's side. Collecting every heel stick in the nursery lets the collector work through a list in one place, with good light, a warm surface and supplies within reach, and it keeps the procedure away from mothers who might find it distressing. The routine also predates the unit's move to rooming-in; when babies spent most of the night in the nursery, collection there was simply where the babies were. Now most babies stay with their mothers, so collecting in the nursery means taking the baby away from the mother to do something painful and then bringing the baby back crying. The proposal respects the reasons behind the old routine by keeping nursery collection as a fallback and by giving the collector a set time in each room, rather than asking for collection whenever a mother happens to be feeding.

Who Holds Each Part

The writer will not be on the unit after this session, so every part of the change is assigned to someone who is staying. The day-shift nurse assigned to the mother and baby asks the mother during the 0800 assessment whether she would like to hold or feed her baby during the heel stick and agrees on a time between 24 and 48 hours of age, as the screening program requires. The nurse writes the agreed time on the whiteboard in the room. The unit's newborn screening collector, a role held by a nursing assistant trained in capillary sampling, performs the heel stick at the bedside at that time, with the nurse present if the mother is breastfeeding for the first time. The unit educator adds a five-minute segment on positioning for bedside heel sticks to the annual newborn skills day, which already exists. The nurse manager owns the change, approves it at the unit practice council and reviews it at the monthly staff meeting for the first three months.

What It Costs, in Minutes

The change costs time in two places and saves it in one. The morning question adds about thirty seconds to the nurse's assessment. The bedside heel stick takes the collector longer than a nursery heel stick, perhaps five extra minutes, because the collector must walk to the room, position the baby with the mother and wait for a feed to settle before starting. On a unit with about 12 births a day, that is roughly an hour of collector time a day. The saving is in the time spent comforting a crying newborn after a nursery heel stick and in the nurse's time returning a distressed baby to a mother who was not present, which staff estimated at five to ten minutes per baby. The change may therefore cost little net time, but it moves time from nurses to the collector, which is why the collector's schedule, not the nurse's, will decide whether the change survives.

What Mothers Are Told

Mothers are told in plain language what the heel stick is for, that it can hurt briefly, and that holding or feeding the baby during it has been shown to help babies cope. They are told that they may choose not to be present, and that the nursery remains available if they prefer. For mothers who are breastfeeding for the first time, the nurse helps with latch before the collector begins, so that the baby is feeding steadily when the lance happens. The unit's existing newborn screening pamphlet, given at admission, will gain one sentence explaining that the test is usually done in the room, so mothers are not surprised when it is offered.

Where It Could Fail

Three failure points are predictable. First, mothers who are asleep, in pain after a cesarean or away from the room at the agreed time; the proposal allows the heel stick to move to the next feed within the screening window, and to the nursery only if the window is about to close. Second, the collector's workload on high-census days, when bedside collection for twelve babies could compete with other duties; the proposal lets the charge nurse return to nursery collection for the day when census is above a threshold the unit sets, and asks that the number of such days be recorded. Third, the change could fade as new staff join; the educator's segment on newborn skills day and the whiteboard prompt are the two supports that do not depend on anyone remembering the project.

What the Unit Will Count

The unit already records the time and location of each newborn screening collection on the specimen card and in the electronic record. The measure is the percentage of heel sticks performed in the mother's room during feeding or skin-to-skin, which requires one new checkbox on the existing collection documentation. The target at three months is 70 percent of heel sticks, allowing for mothers who decline or are unavailable. Maternal satisfaction with the change will be asked in one question on the unit's existing discharge survey.

References

Gray, L., Watt, L., & Blass, E. M. (2000). Skin-to-skin contact is analgesic in healthy newborns. Pediatrics, 105(1), Article e14. https://doi.org/10.1542/peds.105.1.e14

Johnston, C., Campbell-Yeo, M., Disher, T., Benoit, B., Fernandes, A., Streiner, D., Inglis, D., & Zee, R. (2017). Skin-to-skin care for procedural pain in neonates. Cochrane Database of Systematic Reviews, 2017(2), Article CD008435. https://doi.org/10.1002/14651858.CD008435.pub3

Shah, P. S., Herbozo, C., Aliwalas, L. L., & Shah, V. S. (2012). Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database of Systematic Reviews, 2012(12), Article CD004950. https://doi.org/10.1002/14651858.CD004950.pub3

Stevens, B., Yamada, J., Ohlsson, A., Haliburton, S., & Shorkey, A. (2016). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews, 2016(7), Article CD001069. https://doi.org/10.1002/14651858.CD001069.pub5