For more than 35 years, Elizabeth (Liz) Drake, RNC-NIC, MN, NNP, CNS, CHOC, Children’s at Mission Hospital in Mission Viejo, California, has worked with infants as a NICU nurse. Her time spent at the bedside of these tiny patients with families and team members have been her most meaningful—and this is one of the reasons that Drake joined Kimberly-Clark’s Huggies Nursing Advisory Council, a multidisciplinary group of experts seeking to support perinatal and neonatal nurses.
Drake took time from her schedule to answer our questions about her passion and the important work the council is doing.
Why did you become a member of Kimberly-Clark’s Huggies Nursing Advisory Council?
I am always interested in being a part of something bigger than myself and being a part of group of experts who are passionate about their specialty. I loved Kimberly-Clark’s vision for the council and was intrigued by the opportunity to share my passion for the NICU with others and to encourage care teams to strive for improved clinical practice. I love partnering with a group that is always seeking how to make things better, and I appreciate Kimberly-Clark’s desire and commitment to help babies thrive by consulting with experts in the field.
What are your tasks as a member?
The Huggies Nursing Advisory Council (HNAC) is a multidisciplinary group of experts that includes nurses, educators, a neonatal therapist, and a NICU parent advocate. Our goal is to identify opportunities to provide resources that recognize nurses’ contributions and help them perform their best—for babies, families, and communities.
Our specific tasks and engagements vary, depending on project and member. Our work ranges from speaking at conferences or webinars, to writing articles on clinical topics such as diaper dermatitis or the power of touch and hugs, to research and development of educational resources, such as Every Change Matters™: A Guide to Developmental Diapering Care, which was compiled based on the HNAC’s literature review of diapering in the context of developmental care.
Tell us about your teaching the NICU team about the power of touch and sound for premature infants.
Many of the infants in the NICU are still in the “development phase” of their lives. Their physical features are all there and complete around 6 months gestation, but the function of those organs isn’t completely developed—namely their brain development, sensory, and limbic systems. If you think about it, it’s those systems that make us human. They are part of how we will learn, feel, experience relationships, hear, and see. There is no other area of nursing/medicine where you are truly having impact in how this human being will become a relational being. I view it both as a tremendous responsibility and an incredible honor.
I have a passion for teaching others what is happening with every interaction with these very tiny—but mighty—individuals. We need to understand and learn what is happening in their bodies when they are in the NICU, including what they are saying with their movement patterns and with their silence. Though they can’t speak audibly, they have a language of their own, and when they can’t communicate we have to step in and protect them.
When drafting Every Change Matters, the HNAC wanted to communicate that preterm infants are physically taxed from the transition into the world and subsequent maternal separation, and the NICU environment contains additional stressors that could impact their development. On top of all of this, studies show that caretaking procedures that are considered standard for a full-term baby—such as diapering or tub bathing—can lead to increased pain and stress for preterm infants. Huggies, with the help of NICU nurses, developed Huggies Little Snugglers Nano Preemie Diapers, specifically for babies in the NICU weighing less than two pounds, with a narrower fit and softer fasteners to promote developmentally appropriate positioning to keep these fragile babies as comfortable as possible. They even have cute graphics to help provide parents with a sense of normalcy in a clinical environment!
The sense of touch is the first sense to develop and the last sense to fail before we die. Touch is also a powerful memory cue. The absence of loving or relational touch can result in significant growth, developmental, and behavioral deficits.
There is a gap between the womb experience and the NICU experience. The auditory system also must learn to separate meaningful versus non-relevant sound. In the intrauterine environment, noise is regulated by mom’s circadian rhythms; there are no competing noises and mom’s voice isn’t masked. In the womb, sound is non-directional and protected by the mother’s body while her voice travels inside and begins the recognition to maternal infant attachment. Purposeful sounds are needed to “prime” the brain. If we think about the small babies in our NICUs they are deprived of not only the biologic sounds from the intrauterine environment but also the low frequency tones of their mother’s voice and redundant heartbeat. When this happens during the critical period for this sense’s development, it can have a profound effect on auditory brain maturation and speech and language acquisition. Persistent background noise above 50 decibels reduces an infant’s ability to discriminate differences in pitch, intensity, tone, and pattern.
As health care teams, we need to protect REM sleep, reduce background noise levels beginning in the third trimester, provide periods of appropriate sound and of quiet, and ensure that the newborn infant hears plenty of conversational, interactive human speech from an attachment figure. Bringing parents into the NICU also provides the opportunity to bring their familiar voices closer to the baby and encourage sensory development.
Why is it important for NICU nurses to know?
The brain and limbic system is involved with many of the expressions that make us human; namely, emotions, behaviors, and feelings. That humanness also includes individuality. Infant brain development is a dynamic process dependent upon internal and external stimulation and a supportive environment. Every Change Matters describes the perfect environment as safe (providing physiologic stability and supporting optimal neuromotor development), hygienic (including ensuring hands are clean and dry before and after a diaper change), and manages stimuli (moderating bright lights and loud noises). Disruption or deprivation in the infant’s social and physical environment can create permanent deficits in the developing neurosensory and limbic system.
Educating ourselves is key. Knowledge of the experiences that play a critical role emphasizes the responsibility we have in the care we provide. The challenge is in assessing what interventions are necessary and appropriate, and if can they be performed in more protective ways. We have such a responsibility every day with every touch. With every experience as we leave a profound imprint on who they will be.
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