Welcome to my blog!

Hello!

My name is Urmi Mota and I’m a senior at BASIS Scottsdale. Instead of attending school for the last trimester, seniors at our school are given the unique opportunity to conduct a research study of their choice. I will be pursuing my Senior Project, “Within the NICU: It’s a Family Matter” at Banner Desert Medical Center, specifically in the NICU (Neonatal Intensive Care Unit) of the connected Cardon Children's Medical Center.

Ever since I was little, I’ve had an interest in medicine. No one in my immediate or extended family ever had a career in the medical field which is probably one of the main reasons that my curiosity for the field grew. Over the years, I have volunteered at multiple hospitals and participated in numerous classes both in and out of school that have helped me gain perspective about this field. Therefore, when the chance arrived where I could pursue a project of my choice, I knew that I wanted to explore this field, but I didn’t know what exactly I wanted to research. That is, until I started volunteering at Banner Desert Medical Center (BDMC).

Banner Desert Medical Center

I became a hospital volunteer for BDMC in the fall of 2016, supervising those who enter and exit the NICU facility. Over the few months that I volunteered there, I wanted to learn more about what was going on within the NICU facility rather than just from the conversations I’ve had with people from the outside.

Family Centered Care, an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families, is the idea that the patient's family plays a vital role in a patient recovery by being informed and involved every step of the treatment. Before the 1970's, pediatric patients were often separated from their parents for diagnosis or treatment because of the belief that the hospital institution, treatment, and medication were the most important factors to improve a child’s health. In the 1970s and 1980s, the importance of family in pediatric health became more widely recognized and implemented. However, the implementation of family involvement in a child’s health progression was slower in the NICU compared to other medical services. While virtually all hospitals emphasize the importance of family interaction within pediatric patients’ road to recovery, some still restrict family involvement within the NICU with rules such as visiting hours or limits on external visitors other than immediate family members.

My research aims to look at to what extent Family Centered Care is implemented within the NICU at Banner Desert Medical Center. For a more detailed explanation of my project, please feel free to check out Senior Project Proposal on the right sidebar.

Along with shadowing neonatal professionals, neonatal nurses, and nurse practitioners here in Arizona, I hope that sometime in the next ten weeks that we spend pursuing this Senior Project I will be able to travel to India to observe to what extent Family Centered Care is implemented at the Shrimad Rajchandra Hospital in Dharampur, India. As this hospital is located in rural India, it would be very interesting to see to what extent the core ideas of Family Centered Care are implemented there, as the culture is completely different.

Over the next few months, I will update this blog regularly with my experiences and interesting findings I have while at the hospital. With only another week of school left, I am eager to start on this journey and hope that you come back to see where it takes me!

The Presentation

Hey everyone,

The past couple of weeks I've been working on my project presentation. I can't believe 10 weeks full of on-site experience has culminated to this! Tomorrow is presentation day, so I hope to see you all there, but if you aren't able to make it, here's a link to my presentation: Senior Project Final Presentation 

Once again, thank you all for your amazing support in the past three months and I hope you have an amazing summer! :)

The End!

Hey everyone! I can’t believe that this was the final week of the senior project. It feels like it just started a couple weeks ago, but 10 weeks flew by so quickly! I want to say a massive thank you to both Ms. Rothlisberger, my NICU on-site mentor, and Dr. Vegunta, my Pediatric Surgery on-site mentor, for taking time out of their insanely busy schedules to not only let me observe within the units but also to guide me along the way. Also, a huge thank you to Ms. Conner for being there since the beginning and helping in every single situation and aspect related to the senior project, and to Ms. Mitrovich for helping me connect me find a second site placement and for dealing with all of my late messages (sorry!). Lastly, thanks to all of you for your questions, comments, and support for my project and for taking the time to read my posts every week, even if a few of them got too long. :)

Anyways, back to the project itself. Since it was the last week on-site, I spent a majority of my time analyzing the results from the surveys. I conducted a total of 43 survey interviews that I used for the sake of my project. There were a couple that I couldn’t use as either a question was left unanswered or the profession wasn’t specified, which would’ve ruined my result accuracy. Although I would’ve liked to have more, I’m glad I was able to conduct 43 as my original goal was 40. If you don’t recall from a few weeks ago what my survey looked like, here it is again: Within Pediatrics: It's a Family Matter Survey

Over the course of the 10 weeks, my question changed slightly as I became more focused on the awareness and opinions that the healthcare personnel had regarding family centered care rather that to what extent it was implemented. Originally, I expected that healthcare personnel that spent more time with patients such as nurses would have had a more positive reaction to family centered care. I also expected healthcare personnel that spend less time with the patients and the families such as the administrative staff or PCA’s would have less awareness about the subject. However, turns out that I was completely wrong.

The results came out with not significant different in between the different professions that I shadowing within the two facilities. In contrast, nurses were actually the most open about the drawbacks and negative aspects of family centered care. Another thing that was unexpected was the surveys that I conducted at the PACU, where the healthcare personnel attend to adult patients. That also led to interesting results, as a high proportion of nurses who cared for adults knew less about family centered care compared to those in pediatric care.

Once again, thank you so much for reading my journey with the senior project. I hope you enjoyed reading about it as much I did writing about it :)

Surveys, Getting Lost, and the PACU!

Hey everyone! Welcome to the second to last post!

Anyways, this week at the NICU I spent a majority of my time getting more surveys done. For that reason, instead of observing at CCN units, I observed in a bedside ICU pod, where there were about 10 babies and at least 6 nurses. It was a pretty regular day at the NICU, with continuous feeds and cares going on every few hours, the ophthalmologist (specialist in the forms and diseases of the eye) taking eye exams of the babies, and family members coming in and out to visit their child.  After I finished interviewing the majority of the nurses who weren’t busy in that pod, I went over to another pod to interview more. Also, for those of you asking about the patient who had a loss of breath last week, the baby is fine and now in a better condition than before.

At the Pediatric Surgery Clinic this week, I went early to conduct more surveys with people who work there but I don’t normally see, meaning the physician assistants who work with the other surgeons or the clinic staff who I hadn’t met before. Along with that, I actually interviewed another surgeon of the clinic while he walked from the clinic to the OR unit, which was slightly stressful because I had to look at the questions off my phone and memorize his answers while trying to remember the halls that we were passing and turning through. Although I did manage to remember his answers and write them down before I forgot, I did forget the way that we walked, so I spent about the next half hour trying to navigate myself back to the clinic. Banner Desert Medical Center is HUGE, so it’s not easy to try and find your way once you get lost in those dozens of hallways. I felt like I was in a maze of white painted hallways with confusing signs and repeating walkways.

The most interesting day of the week was definitely the last one where I got taken to the PACU and the pediatric OR. In order to get a new perspective on the surveys, Dr. Vegunta suggested that I interview healthcare personnel who care for adults, because everyone I had interviewed so far with the survey worked within pediatrics. A lovely nurse at the Pediatric Surgery Post-OP area led me down those dozen hallways once again to the PACU, the post-anesthesia care unit, an area where patients come to recover and wake up directing after a surgery or other type of procedure requiring anesthesia. It surprised me how different the environment was of the adult care area in comparison to the pediatric care. The pediatric care area is so much brighter, colorful, and relaxing in comparison to the adult recovery area. The PACU was huge but it was also packed, as it was a busy day in the operating room.  Although I didn’t want to disturb anyone who was with patients or blatantly very occupied, I managed to get about 7 surveys from nurses there.

This is a picture that I found similar to what the PACU looked like, but without the beds. 

After I came back to the pediatric OR, I scrubbed up into appropriate attire and observed a appendectomy (surgery to remove the appendix). The appendectomy was actually a lot larger than I imagined, I was surprised at its length when they removed from the patient’s body and put it in the container.

In total, this week was highly concentrated in getting as many more surveys done as I could possible. I’m currently working on compiling the results and finding more patterns, which I will show you all next week, in the last week of the SRP!
Thanks for reading :)

Slow yet Intense Day!

Hey there! Welcome to this week’s post! This week has been a lot more inactive in comparison to the past couple weeks.

In the NICU this week, it was slightly difficult finding someone or a group for me to observe because it was a very hectic day where there were many families around. To maintain their privacy and to make sure that I wasn’t invading their personal time and space, I decided to shadow CCN (Continued Care Nursing) once again. I watched two babies have baths, get changed, fed, and wrapped up in the blankets. The patients get baths about every three days to ensure that excessive bathing and exposure doesn’t affect their health. Apparently, in the past, premature babies in the NICU used to be given baths on the daily, which isn’t always the best thing to do for some situations where the patient is extremely premature and skin isn't as strong.

One of the patients that day actually stopped breathing momentarily, not because of any heart or lack of oxygen problems, but rather because the baby had a lot of fluid build-up in the lungs and breathing pipes. The alarm for the system went off repeatedly and nurses rushed to the room. It was slightly intense and crowded, so I mainly watched from afar as the physicians, RT's, and nurses handled the situation within a few minutes. They ended up setting up a machine that would regulate the patient’s breathing so that the baby doesn’t have to forcefully attempt to breathe, as it gets tiring for its tiny body. Basically, it controls the breathing for the baby.

Later on, one of the nurses showed me how a Pyxis station works. The Pyxis MedStation system is an automated medication dispensing system. It helps healthcare providers safely and efficiently dispense medications while offering enterprise-ready integration. The nurse was removing morphine to give to a baby whose parent was a person that took drugs while pregnant.

An example Pyxis Machine

Besides that, this week I also conducted and collected responses to a few more interviews, and so far I have about 25. From a quick glance, I can see a few obvious patterns already in the answers and a few interesting differences as well. I’m starting to compile them all together for the results so that I can show different factors such as occupation, age, place of work, or gender to explain why the results of the survey came out in the way that they are.

Anyways, there's only two more weeks are left of the senior project; it’s insane how fast two months have gone by. Thanks for reading the post!

Shadowing RT's & Surgery Clinic's Front Desk!

Hey everyone!

This week at the NICU facility I got the chance to shadow an RT (respiratory therapist), a specialized healthcare practitioner trained in pulmonary medicine in order to work therapeutically with patients suffering from various pulmonary issues. In the NICU, the RTs mainly monitor the infants’ breathing or the patterns of the ventilators the babies could be put on. Newborns born prematurely often have breathing problems due to undeveloped lungs but even full-term babies can also develop respiratory issues from a difficult labor and delivery, birth defects, or infection. The RT that I was observing for the day was in charge of the care of multiple babies who were on ventilators for various reasons.

Jet Oscillator Machine (a type of ventilator)

One of the patients had a bone development abnormality that caused the bones in the body to disjointed at points and not in proper shape. I watched as the RT carefully re-positioned and re-taped a breathing tube to the patient’s face as it had been causing minor bruising near the baby’s mouth.

A newborn with a breathing tube

Another baby that the RT who I was observing was in charge of was a baby born at almost 24 weeks gestation. In other words, the baby was born by emergency cesarean section 16 weeks (4 months) prior to full term! Often, babies that born at 22 to 23 weeks do not survive after birth, so it was a remarkable sight to see this baby. Many of the nurses came and went to look at this baby because it's not often that a baby so small is seen. So tiny that the baby could completely fit in one hand, it had to rely on a breathing tube as the lungs were too undeveloped to support the body.

A size comparison of a baby at 24 weeks gestation and a hand

As the infant’s eyes were still fused shut, hair covered the head from the back of the scalp down to the eyes, skin was so delicate that touching it normally would leave a mark or bruise, the nurses handled the baby with extreme delicacy. The RT spent about a half hour changing the breathing tube to ensure that the tape or weight of the tube doesn’t significantly affect the baby’s skin. In one of my earlier posts I mentioned a baby that was born 14 weeks premature; however this baby was so much more smaller than one I saw earlier. In the time that the breathing tube was being replaced, the baby also had an x-ray done so that the doctor could see how much of the chest and abdomen had developed internally.

In Pediatric Surgery this week, I spent most of the time observing at the clinic. I sat at the front desk for a few hours observing what it’s like to be part of PFS, patient financial services. When you go to a doctor’s appointment, these are the people that check you in, answer phone calls, manage all the paperwork and insurance information, etc. I also observed clinic appointments for a few hours as I had in previous weeks and interacted with patient families.

I managed to also get more survey interviews done this week, and I’m hoping that by the time this project ends I have more than enough to make an accurate analysis!

Anyways, I hope you enjoyed the post and I'll see you next week! :)

Surveys and Child Life!

Hi there!

This week was slightly different than because I started interviewing various healthcare professionals with a short survey. In order to learn more about the NICU’s and Pediatric Surgery’s opinions on Family Centered Care, I had created a short survey from which I will later analyze to see to what extent it is implemented and to what extent it affects the care. I'm hoping that over the course of the next few weeks, I can interview as many people as possible from both departments.

So this week in the NICU, I shadowed CCN (Continued Care Nursing) again. Coincidentally, the time that I arrived was the same time that the ophthalmologists had come again to perform eye exams. As the doctor himself wasn’t able to come but his assistants were, they took pictures of the eye and retina rather than the doctor looking directly in the infant’s eyes. I could see a close up image of the eye on the monitor, and it was very interesting to see the difference between babies with completely healthy eyes and babies that show slight Retinopathy of Immaturity. If you don’t remember from my post from two weeks ago, ROP is a common disease that can occur in premature babies. It causes abnormal blood vessels to grow in the retina (the layer of nerve tissue in the eye that enables us to see) which can cause it to detach from the back of the eye, leading to blindness. In the past, oxygen saturation levels weren’t as regulated for preterm newborns in comparison to today.

The retina detached back of the eye due to ROP

Besides observing the eye exams and the care for the babies for the day, I also got the chance to interview three of the nurses and PCA’s with the survey,.

At Pediatric Surgery this week, I was introduced to a very nice lady who was the department’s child life specialist. A child life specialist is pediatric health care professional who works with children and their families in hospitals and other healthcare settings to help them cope with the challenges of hospitalization, illness, and disability. For this department specifically, she helps children and families to understand and cope with the various aspects related to surgery. Her entire work is surrounded by the concept of Family Centered Care, so I was very excited to spent a few hours with her as she showed me around the various rooms and explained to me the different experiences they try to give to the children and the family.

She showed me the various items that they give to children to relax them such as toys, customized pillow cases, cartoon blankets, stickers, or colored medical equipment. Along with that, she showed me around the post-operation floor where patients recover after surgery. The entire floor was painted with colorful colors, each room seeming like a “house”. There were also three or four “quiet rooms” on the floor where families could go and relax or do extra research. Additionally, she showed me the “school rooms”, where kids could go to catch up on homework, learn something new or just play as they would in school in elementary school, and a huge auditorium like room with a stage, a TV, a mini basketball hoop, and video games. This room was an event room where they hosts play and performances weekly and plan events so that children can escape the boredom and fear that they have in the hospital. These are just few of the many areas and aspects of what she covers on a daily basis. It was very enlightening to get to talk with her about not only the positive aspects of family centered care and how from the conversations to just a simple sticker can make a difference in the patients’ and families’ emotional state, but also about the difficulties that come along. Whether it be cultural differences, families with internal or personal issues, or a new topic of LGBTQ+ that wasn't always something that was considered in the past, the time I spent with her was definitely very informative in regards to my project, and I’m glad I got the chance to see and hear what it’s actually like having family centered care in action.

Besides that, I also witnessed a Laparoscopic Pyloromyotomy procedure, which is a surgical approach in which a cleft is made in the longitudinal and disk shaped muscles of the pylorus (the opening from the stomach into the small intestines). This technique is used to cure pyloric stenosis, a condition in which the opening between the stomach and small intestine thickens. In the course of surgery, a slit is made in the pylorus, which will loosen the tightness of the muscle so as the stomach can vacant and food will be capable to move conveniently into the small intestine. Here's a picture I found that summarizes the process of the procedure in four steps:

An incision being made into the pylorus

Anyways, I hope everyone is having a great start to Spring!