Nursery Care
I. Rationale
The specialty of family practice is vitally interested in all aspects of pediatric health and disease. This
curriculum addresses the care of healthy newborn children in the term nursery. Pediatric health
maintenance will be addressed in the FPC curriculum and Ambulatory Pediatrics curriculum. Care of the
sick newborn and care of children of other ages will be addressed in the PEC curriculum, Peds Wards,
Ambulatory Peds, FPC, and FMS curriculum. Care of the healthy newborn will not only be addressed
during Nursery rotation, but also in the setting of OB continuity care as well as in the FPC setting, during
follow up of newborns after hospital discharge.
Family physicians must be comfortable performing a routine newborn exam in an efficient manner and
should be able to recognize symptoms and signs of congenital or acquired medical conditions. Family
physicians must be able to recognize situations which require immediate support, require hospitalization,
and/or EMS support/transportation or require referral.
II. Goals
The purpose of the Nursery rotation for Emory Family Medicine residents is to build experience in the
routine care of the healthy newborn, as dictated by current standards. The residents should become
proficient in performing a routine newborn exam in an efficient manner, and should be able to recognize
symptoms and signs of congenital or acquired medical conditions. The resident should learn to recognize
situations which require immediate support. The resident should become familiar with aspects of normal
lactation, feeding, growth, bonding, newborn physiology relative and absolute indications for hospital
admission, as well as parameters for safe and appropriate discharge from hospital care.
Medical knowledge/Patient care
A. Acquire the knowledge base and skills to provide routine medical care to newborns.
B. Learn appropriate incorporation of health promotion and disease prevention pertaining to the
newborn.
C. Understand the importance of educating the parent about environmental factors that can
adversely affect the physical and mental health, and normal development of children.
Interpersonal Skills/Communication Skills
A. Demonstrate the ability to communicate effectively with the parent(s) and develop a
therapeutic relationship with the parent(s).
B. Develop and demonstrate effective communication skills in interaction with colleagues and
other members of the team.
Practice-Based Learning and Improvement
The daily encounters with newborns and their moms (and dads if present) will trigger the graduates’
lifelong interest in maintaining and updating skills and knowledge as essential for delivering safe and high
quality care to the newborn infant. Residents must be able to investigate and evaluate their patient care
practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents
must be proactive in obtaining these skills and knowledge.
Systems Based Practice
A. Recognize personal practice limitations and understand the role of other health care
providers and resources in providing optimal care to the newborn. Understand the role of
various health care providers and disciplines in the transition of care from inpatient to
ambulatory care and vice versa.
B. An awareness of the unique vulnerabilities of infants and children that may require special
attention, consultation, referral and/or reporting to child protective services.
Last updated April 19, 2013
Professionalism, Bioethical Decision Making, Attitudes
The resident should demonstrate attitudes that encompass:
A. Empathic concern for the health of the infant in the context of the family.
B. A commitment to carrying out professional duties, in a responsible manner, and adhering to
ethical principles in order to deliver optimal patient care at all times.
III. Objectives
Medical Knowledge/Patient Care
A. The resident will be become competent in recognizing, diagnosing and treating:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
The normal newborn - routine, normal neonatal issues and their management including
Feeding and nutrition - breast and bottle
Temperature regulation
Hyperbilirubinemia and neonatal jaundice
Hypoglycemia
Neonatal sepsis
Recognition of the high-risk neonate
Respiratory distress - transient tachypnea of the newborn (TTN)
Congenital Deformities - especially cardiac and neurologic
Respiratory and Cardiac arrest
Common neonatal rashes
B. The resident will be responsible for learning procedures associated with the care of the
newborn.
1.
2.
3.
4.
5.
6.
Phototherapy
Circumcision
IV access
Umbilical catheterization
APGAR scoring
Eliciting an appropriate and sufficient prenatal and family history and presenting same to
the preceptor
Learning Activities
X
Attending Rounds
Research Conference
Multidisciplinary Rounds
Ethics/Comm Conference
Grand Rounds
Specialty Conference
Sub-Specialty
Noon Conference
Conference
X
Morning
Report
X
Faculty Supervision
Didactics
Procedures
X
NPR, PALS course during orientation month
Evaluation Methods
X Attending Evaluation
Directly Supervised Procedures
Program Director
X In-Training Exam
360 ᵒ evaluation
Videotape Review
Review
X 1) NPR, PALS exam
2) Upper level resident evaluation
Last updated April 19, 2013
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision and Feedback
Quarterly Review
Interpersonal and Communication Skills
A. Demonstrate the ability to communicate effectively with the newborn’s parents.
B. Develop skills in communicating normal and abnormal findings. Educate parents and/or
other caregivers regarding signs, symptoms, red flags; when, where and how to seek
medical care if any question arises regarding the infant’s wellbeing.
C. Develop a therapeutic relationship with the parents.
D. Develop positive and functional relationships with colleagues as well as with other disciplines
and support staff.
Learning Activities
X
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
X
Morning
Report
Didactics
Other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Evaluation Methods
X Attending Evaluation
Directly Supervised Procedures
Program Director
In-Training Exam
360 ᵒ evaluation
Videotape Review
Review
other
1) Upper level resident evaluation
Practice Based Learning
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision and Feedback
Quarterly Review
A. Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices.
B. Residents must be proactive in obtaining the skills and knowledge needed to effectively take
care of the newborn.
C. Resident must establish an attitude of lifelong learning.
Learning Activities
X
Attending Rounds
Research
Conference
Multidisciplinary
Ethics/Comm
Rounds
Conference
Grand Rounds
Specialty
Conference
Sub-Specialty
Noon
Conference
Conference
X
Morning Report
X
Faculty
Supervision
Didactics
Procedures
Evaluation Methods
X Attending
Directly
Evaluation X
Supervised Exam
Program
In-Training
X
Procedures
Director
360 ᵒ
Videotape Review
evaluation
other
Review
1) Upper level resident evaluation
Last updated April 19, 2013
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision and Feedback
Quarterly Review
Systems Based Practice
A. Recognize personal practice limitations and seek consultation with other health care providers
and resources when necessary to provide optimal patient care.
B. Develop an awareness of social, cultural and environmental factors that impact the health
and well-being of infants, and understand preventable and unpreventable factors which may
contribute to infant health problems.
C. Develop and show understanding of the importance of continuity and access to care for
prevention of illness. Facilitate smooth transition of care at time of patient discharge from
hospital.
D. Communicate verbally and document within the patient’s record clearly and completely both
to facilitate care and meet the documentation billing requirements of both Medicaid and
private health insurance.
Learning Activities
X
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
X
Morning
Report
Didactics
other
Evaluation Methods
X Attending Evaluation
Program Director
360 ᵒ evaluation
Review
other
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Videotape Review
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision and Feedback
Quarterly Review
Professionalism
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients'/parents’ culture, age, gender, and
disabilities.
D. Arrive at the Nursery on time in order to be able to perform and complete assigned duties.
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
G. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
H. Appear professionally dressed and well groomed.
I. Complete notes, referrals and other forms of communication and documentation in a timely
fashion.
J. Attend required didactics, conferences.
K. Respond to pages and clinic messages in a timely fashion.
Last updated April 19, 2013
Learning Activities
X
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
X
Morning
Report
Didactics
Evaluation Methods
X Attending Evaluation
Program Director
360 ᵒ evaluation
Review
other
X
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
Directly Supervised Procedures
In-Training Exam
Videotape Review
X
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision and Feedback
Quarterly Review
IV. Instructional methods (see above)
A.
B.
C.
D.
E.
F.
G.
H.
I.
Rotation in the newborn nursery
Attendance at high risk deliveries during Grady OB rotation
Longitudinal family practice clinic (FPC) patients
Home visits on newborns via the FPC patients
Rotations in pediatrics and on the family medicine service
PALS course and training in neonatal resuscitation
Family Medicine Didactics program
Pediatric grand rounds and conferences
Assigned reading by nursery attending, and AAFP monograph
V. Evaluation methods (see above)
A.
B.
C.
D.
Evaluations by attending faculty - pediatric and family practice attendings
Routine competency examinations/In-training exam
Attainment of the PALS certification
Chart review
VI. Implementation methods
Contact:
Susie Buchter, MD
Grady Memorial Hospital
Department of Pediatrics
69 Jesse Hill Jr. Drive
Atlanta, GA 30303
(404) 778-1440 ofc
(404) 778-1447 fax
Location: Grady Term Nursery
Supervising attending: Dr. Letitia Mobley
Last updated April 19, 2013
Family Practice Center: Half day per week.
Conferences: Pediatric grand rounds. FM didactics not required.
Call/Vacation: Call will be with the Nursery Clinic. Vacation is not permitted on this rotation.
VII. Suggested Reading List
Reading assignment by Dr. Mobley. Packet will be provided by Dr. Mobley at time of rotation
AAFP monograph #399. Care of the Newborn. (2012)
Additional reference E-books at the Emory Library:
The Harriet Lane Handbook.
http://health.library.emory.edu/search/apachesolr_search/harriet%20lane?filters=tid%3A3&retainfilters=1
Last updated April 19, 2013