Again, that is judging the entire system, by personal experience.
The further problem, is who defines what is best? We all want what is
'best'? What is 'best'?
There is no such thing as 'best' in clinical governance. There is a
minimum competency level. That is not decided by the individual
standing at the bedside. It is decided by the organisation in charge of
the care and treatment of the patient. Individuals within that scope,
work to ensure they never fall below a minimum standard of care. That
some individual units and professionals, far exceed those minimum
requirements, is to be encouraged and congratulated.
I know many caring and compassionate people who try to do their 'best',
and as they are ill-trained, ill supported and badly managed, and often
have out of date training, and in doing 'their best' they wreck the
chances of breastfeeding for many babies. Equally, I know of some who
have, in other fields, killed patients with 'doing their best'. On
this, medical negligence claims are made.
"Doing their best" isn't an issue. Making sure they hit minimum
competency standards, is. And it is useful to point out that this is
about a real baby, who died from a real e-sak infection - his name was
Connor - and that his parents did not give informed consent for the
powdered milk fortifier that was given to their healthy baby. No doubt
the nurse who gave it, thought she was 'doing her best'. But her unit
wasn't meeting the minimum competency standards required, if the
reported events are subsequently upheld as factually correct.
I find the idea that NICU units throughout the entire globe, 24/7, are
staffed only by the very best, the very competent, the exceptionally
well trained, the wonderfully dedicated and the uber-qualified, all
doing the absolute right 'best' decision all the time... a warm and
comforting myth. Thankfully, some individual pockets of them do attain
these standards, and can be held up as such.
The WHO, UNICEF, and the USA-FDA caution against the use of powdered
milk fortifier and powdered formula with preemies and young babies,
specifically because of the risk of e-sak infection. That's not to
state that every such use is the wrong treatment choice for that child.
There are loads of warnings we all disagree with, about treatment.
Treatment guidelines are often political, as well as evidence based,
sadly. I doubt many in here have NOT witnessed two doctors arguing
ferociously about 'what is the best' treatment for an patient. What is
'the best' is open to interpretation and personal experience - hence the
safety net of minimum standards of competency. But it is to state that
discussion of the use of such powdered supplements in neo-natal care is
fair game for discussion, opinion and debate. Not to mention, that the
duty to increase awareness if those risks, to parents, is absolute.
Morgan Gallagher
[log in to unmask] wrote:
> "Simply, not everyone does want the best
> outcome for the babies in their care. Some just want the shift to end
> so they can crawl home and contemplate how they ended up in a job they
> hate, and which they aren't actually that well cut out for."
>
> Nurses, physicians and other health care professionals have lots of easier
> options than work in the NICU if they really don't want to be there. I agree
> that some health care practitioners are better informed than others. They may
> not all be a conscientious as I, personally, would like, but I cannot believe
> that anyone I have ever worked with does not want the best outcome for
> infants under their care.
>
>
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