Interview with a current Neonatal Nurse

 INTERVIEW WITH A CURRENT NEONATAL NURSE

This blog is an email interview I completed with Natalie, who is a 25-year-old Nurse, working at the Royal Darwin Hospital, Neonatal Intensive Care Unit. The intention of the line of questioning was to highlight the importance of both mathematics and measurement in health care without putting this idea into her mouth (or fingers)…

·         When did you first become a nurse?

I graduated at the end of 2014 and started working as a Registered Nurse at the start of 2015.

·         What made you want to be a nurse?

I knew I wanted a job where I could help and care for people. I knew I would enjoy it as it comes naturally to me to want to help those who are most vulnerable. 

·         Did you always want to be a nurse?

Not initially. I always pictured myself living on the land. I was in my early 20’s when I decided I wanted to study nursing but I thought I was too old for uni! I started studying when I was 24.

·         What are your daily duties in your current role?

This is a huge list really but essentially each shift I receive a patient load that I am responsible for that shift and I complete all tasks required to keep my patients safe and cared for. I receive my patient’s history at handover and I need to monitor each patient closely to pick up any signs of deterioration. I take orders from doctors and give prescribed medications, monitor fluid levels, pressure area care, general nursing care, breastfeeding support to mothers. The list goes on!

·         Have you worked in different areas?

I currently work in the Neonatal Intensive Care Unit and I couldn’t imagine working anywhere else. I have previously worked in a very busy surgical ward which was a huge challenge. On occasion, I get “sent” to a pediatric ward for a shift here and there.

·         Do you find you use mathematics in your job?

Constantly. From the minute I walk in the door.

 

·         Can you please provide a few examples of where you use mathematics in your daily activities at work?

One example is with input and output. The babies in the NICU are very sick and often very tiny (as little as 450grams) so nurses are responsible for measuring every single milliliter of fluid that goes in and comes out. Pumps deliver intravenous fluids, the rate at these are delivered is calculated on the baby’s weight and then every hour the amount infused is documented and a running total is calculated. Nappies are weighed when dry and then weighed again when wet and a calculation is used to convert grams of urine into ml/kg/hr. 

Another more simple example is the measurement of basic observations. Heart rate and respiration rate. When counted manually the nurse uses a stethoscope to count the number of heartbeats heard in 60 seconds and then the number of breaths taken in 60 seconds. Eg HR 120 beats per minute and RR 40 breaths per minute. These are then used to determine the baby’s overall clinical picture as different rates can indicate different issues. Eg if a baby has a heart rate of 130-140 over the course of the morning then it begins to dip down lower than what is normal for that baby, it is worth taking the baby’s temperature as bradycardia is a sign of hypothermia.

·         Is measurement an integral part of the mathematics used in your job?

Measurement plays a huge role in the NICU as nearly everything is measured.

·         Can you please provide some examples where measurement is vital?

The baby is weighed as soon as possible after birth. Entral feeds, IVT, urine output, and medications are all calculated based on weight. An example I can provide for measurement is the insertion of a nasogastric tube (for feeding): wtX3+13= tells you how many centimeters to insert the tube before it is taped. Eg 1.5kgX3=4.5+13= 17.5cm taped at the lip. This is checked each shift by the bedside nurse to ensure the safety of the baby. 

·         How did you develop the skills to understand measurement and mathematics to be able to care for patients?

Practice. Our unit has its policies and procedures on hand to refer to when needed however most of my learning was taught to me by senior nurses and repetition of the same tasks.

·         What are the key mathematical skills required to be a nurse?

Algebra is a huge one. General “mental maths” as we called it in primary school is necessary but it is always advised to use a calculator and when it comes to medication calculations in the NICU, two nurses are required to check the right dose together with a calculator and show each other the working out. This is the safest way.

·         Do you use these skills outside of your profession?

I do actually use algebra to calculate my own children’s paracetamol dosage! This way I can give a much smaller (but more concentrated) dose to my children that is calculated on their exact current weight. 

·         Did you learn any of these mathematical skills from your schooling?

I was terrible at algebra at school. In fact maths was my worst subject. Who knew I’d end up with a job that required so much mathematics! Repetition is the key, once you know the formulas or you have them attached to your lanyard for quick reference then it makes sense, weather you are “good” at maths or not.

·         If so, which ones do you use regularly both at work and at home?

Algebra! I use it all the time.

·         Did you find mathematics interesting at school?

Not particularly. I was just so bad at it.

·         How could I as a teacher make mathematics more enjoyable for students that may which to be a nurse or in the medical profession?

Instead of writing a whole heap of really boring maths problems on the board with no context, make a whole story with multiple problems. Eg a baby is born prematurely at 28 weeks gestation. Full term is 40 weeks. How many weeks early is this baby? Birth weight is 950g. A baby on day zero of life requires 60ml/kg/day of intravenous fluids. To work this out 60Xwt/hours

o    60X.950=57/24=2.37ml/hr. 

·         Thank you very much for your time completing these questions.

You’re welcome.

…. Upon reflection of this interview, it may have been better to complete the interview face to face to be able to go back and forth with Natalie in relation to her attitude towards maths at school and discuss different ideas on how to possibly overcome this with students today. Natalie mentioned that she learned mostly by practice and repetition in her profession, however, suggested not writing a whole heap of really boring maths problems on the board with no context when asked how to make mathematics more enjoyable.

The next two blogs will consider this further and will focus on pedagogical practices in teaching measurement in mathematics, and also provide an example of a planned lesson activity that could be completed in class, based on the responses provided from Natalie.