Since neonatal nursing is my special interest and field, I chose to write about the health care options which are available to parents having children in different hospitals throughout the world.  With the state of the art technological advances in the neonatal units, there are so many options available for the care of newborn babies.  I reviewed the neonatal units in Australia, Saudi Arabia, New York, Tokyo, Ireland, and California, and I have learned what I takes to run a neonatal intensive care unit all around the world.

 There were several National Standards that apply to my research.  Knows and understands that people define regions and use them to interpret the world’s changing complexity.  This applies to the hospitals because where the majority of people live, determines how the world changes and grows.  Knows and understands that culture and experience influence people’s perceptions of places and experiences.  This applies to the way that different cultures view different procedures in a hospital setting, as well as a worldly setting.

 The first hospital that I reviewed was the Kirwan Hospital for Women.  The KHW is located in Townsville, North Queensland, Australia.  Townsville is the largest city in Queensland, with a population of more than 150,000 people.  KHW is a hospital dedicated solely to the needs of women.  It has maternity, gynecology, and neonatal units, whose goals are to provide the best quality care for women and their newborns.

 Kirwan Hospital for Women has the only Level III neonatal unit outside of Brisbane.  KHW serves a diverse community in a sparsely populated area one-tenth the size of the United States, so the staff must go out and retrieve the infants that require Level III neonatal care.  They care for every infant admitted except for those requiring treatment for cardiac abnormalities.  KHW also provides ultrasound facilities that include CT and MRI scanning.  They have a very qualified pediatric surgeon that repairs all congenital anomalies, and other problems requiring surgery, except for cardiac lesions.

 Since KHW is in such an unpopulated area, the distance required for patients retrievals are enormous.  In 1997 alone, they traveled 13,000 km doing retrievals.  They transfer eight babies a month back to a Level II hospital.  One of KHW’s biggest challenges is the nursery staff coordinating the retrievals.  They average four per month.  The retrieval team consists of one medical doctor and one registered nurse from the Level III staff, utilizing a Royal Flying Service twin engine King airplane (1).

 At Kirwan Hospital for Women, the neonatal unit is composed of a 6-cot Level III nursery and a 12-cot Level I and II nursery.  They will soon be expanding to 10 Level III cots, 20 Level II cots, and 6 to 10 Level I cots.  They are in desperate need of expansion because they regularly have eight babies requiring Level III care and eighteen requiring Level II and Level I care.  They are having trouble taking care of these babies in their limited space.

 The staff in the Level III unit are adaptable and considerate toward many cultures.  The babies include those from remote Aboriginal missions on the tip of Cape York, as well as to those of newly arrived immigrants who know so little English that the use of interpreters is very necessary.  With an interpreter, they can minimize the trauma to families with sick babies by helping them to understand what is wrong with their child and what treatment he needs (1).

 In the NICU, it is very important that the environment be appropriate for the premature and ill neonates.  All of the incubators have padded covers, and each cot has a light with dimmer switch directly overhead.  There are rest periods when the lights are dimmed and the handling is minimized.  They occur for two hours each afternoon and from 10:00 pm to 7:00 am in all three nurseries.  KHW actively promotes breastfeeding in their nurseries.  There is one member of the staff that is a lactation consultant.  Mothers are supported in their decision as to how they will feed their babies.  Supply lines and finger feeding have been useful in helping mothers to establish breastfeeding.  Infants are put to the breast when they show signs of hunger, regardless of their age or degree of prematurity (1).  The KHW have a committed multidisciplinary team who feels that the care the babies receive in their regional neonatal unit is world class.

 In Saudi Arabia, intermarrying is very common, so many babies are born with congenital abnormalities.  Educating people about this is very important.  Another problem is that time is perceived differently in Saudi Arabia.  Set routines, such as feeding times, are not controlled by the clock.  Arabs believe that when it is God’s will things will happen (2).  Most people in Saudi Arabia are Muslims.  They must pray five times per day, so their schedule is made around prayer time.  Nurses have to be flexible with their nursing routines, in order to meet the needs of their patients.

 There is a language barrier that must be overcome in Saudi Arabia, in which the majority speak Arabic.  Hospitals in the west are becoming more family centered.  Being a male-dominated society, men control the lines of communication, and doctors discuss treatment with the men first and then the men make all of the decisions for all the care of the women in the hospitals, including breastfeeding.

 Even though hospitals in the larger cities in Saudi Arabia are equipped with the finest technological equipment and research is advanced, their culture and traditions create obstacles that make their health care system seem almost backward.

 The Jo Carole and Ronald S. Lauder Newborn Intensive Care Unit is located at the Mount Sinai Hospital in New York.  The Division of Newborn Medicine is a state of the art facility, whose focus is primarily to care for the well-being of high-risk newborns.

 The NICU at Mount Sinai has over seven hundred admissions a year, including one hundred transports that are transported with their own transport system from other hospitals.  The NICU is equipped with a thirty-five bed unit.  During 1993, there was nearly 5,500 deliveries at the Mount Sinai Medical Center.  There were 720 admissions to the Newborn Intensive Care Unit; approximately one hundred of these were transported from other institutions (3).  The Lauder NICU has a strong emphasis on family-oriented care.  They have two full-time social workers, a team of rehabilitation specialists, two home care coordinators, and two developmental pediatricians.  The NICU has two private rooms devoted to breastfeeding and a "nesting" room where families can spend the night with their infant before they are released.  This allows the parents to adjust to caring for their child and allows the staff to observe their parenting skills.

 In Japan, medical technology surpasses most countries in the world.  The Aiiku Hospital located in Tokyo is known for their Department of Neonatology directed by Kazukiko Kabe M.D..  The department consists of a nine bed, Level III intensive care unit and a nineteen bed growing care unit, which just opened on April 1st.
 High-risk babies are cared for with multidisciplinary treatment.  The staff is well qualified with thirty-six neonatal nurses, three neonatologists, and two resident physicians.  Babies are given 24-hour care by these competent well trained medical specialists.  Research plays a big part in the program at Aiiku Hospital, developing new ways to provide neonatal care for future generations.

 Dublin, Ireland is a city that is well advanced in medical technology.  The Coombe Women’s Hospital is the busiest women’s hospital in Ireland.  Established in 1826 as a maternity service, it now offers a wide variety of options available to mothers in labor and delivery.

 In 1995, 6,301 women gave birth to 6,388 babies, with a continuing low perinatal mortality rate of 7.2 per thousand (4).  They advertised that their staff is dedicated and competent, caring for women and babies, as well as their husbands in one of their fourteen clinics.  The hospital also houses four modern theaters and a new delivery suite, and a state of the art Special Care Baby Unit.  Coombe also provides a large team of social workers, an ultrasound department, and contemporary laboratories, which help to provide services for the hospital.

 With the building of the new delivery suite, the hospital has one of the most modern and homelike settings for delivering babies in the country.  Specializing in the care of women, babies, and their external families, much research is being done and specialized clinics and support services have been developed to meet everyone’s needs.  Just a few of these services include adolescent gynecology, family planning service, infertility, menopause, miscarriage, and urogynaecology clinics.

 Realizing that there is a growing need for more education and information for expectant mothers, an annual public lecture-series has been developed as well as an ongoing proactive education awareness program.  Simple fact sheets are distributed for women and health care professionals as a further means of educating the people in Dublin.  The final important fact about Coombe is that the facility is attached to three medical schools, University College Dublin, Trinity College, and the Royal College of Surgeons in Ireland.  The campus also houses a School of Midwifery which trains many in the area of interest.

 The Long Beach Community Medical Center in Long Beach, California has a Neonatal Intensive Care Unit that is equipped with very advanced, state of the art equipment.  The 20-bed, Level III intensive care unit has been designed by the state of California specifically to take care of the critical medical needs of babies (5).  The Long Beach NICU is staffed with specially-trained physicians, nurses, and health professionals who are experts in the treatment of ill and premature newborns.  The NICU was designed to foster parental involvement in the care and treatment of the babies.

 The Level III unit is equipped with state of the art equipment, including advanced soundproofing technology, a regulated-lighting system to minimize the glare, special isolettes and warming tables, and other equipment designed to monitor the temperature, heart rate, blood pressure, and breathing rate of the babies.  The NICU is also equipped with a private family waiting room that also serves as an overnight room, and also open visiting hours that provide an opportunity for the parents to be close to their baby.

 The Long Beach NICU has a team of neonatologists who are specially-trained in the care of newborn babies.  They provide 24-hour on site coverage to the NICU.  There are several special services that the Long Beach NICU provides for the babies and parents.  One of these special services provided is social workers who are trained to help the parents through their difficult time.  Another special service is the Infant Cuddler Program.  This program has very special volunteers who have unique training in infant stimulation and provide comfort to the babies.  Another special service is the Infant Training Classes that the NICU provides so that the parents can learn to care for their child.  They learn how to perform infant resuscitation (CPR) in case of emergencies.  All of these special services provide the love and care that the parents expect for their special child.

 The National Association of Neonatal Nurses was created over the last ten years to bring the world together.  This forum provides an opportunity for neonatal nurses and midwives everywhere to network, exchange ideas and experiences about neonatal care throughout the world (6).  The purposes of the Neonatal Nurses Association include the promotion of good standards of neonatal nursing for the benefit of babies, their families and the nurses involved in their care.  The Neonatal Nurses Association has developed regular links with other national organizations representing neonatal nurses both in Europe and elsewhere in the world.  It is therefore with real pleasure that the NNA has agreed to host the Third International Neonatal Nurses Conference in the United Kingdom, April 22-24, 1999 (6).

 Paula Hale, a nurse from the United Kingdom said, "The aim of nursing is to develop nurses able to provide a progressive environment, a high quality care and to work collaboratively in strategic planning with other health care mentors."  Paula tells us about her experiences while she was a nurse in India.  Maternal and child health are given a very high priority with the Government of India.  The government is trying to reduce the infant mortality by making a wider provision of neonatal services in special care of the  newborn.  In 1986, a link between the Nottingham Neonatal Service and the State of Maharastra was established to develop international fellowship and the sharing of good practice in neonatal nursing.  This resulted in a wide variety of initiatives in education and training, including exchange of neonatal nurses between India and the United Kingdom, management workshops, local in-service programs in individual hospitals, short courses, and update and refresher workshops (6).

 These advancements in neonatal nursing with the development of the National Association of Neonatal Nurses has brought the medical world together.  This association has made people from different countries come together and share their different nursing techniques.  Neonatal nursing has advances dramatically in the past few years, and it will continue to grow and help the neonates through out the many years to come.  I have learned many things about neonatal nursing and I intend on using this information to better myself as a neonatal nurse.

 Works Cited
(1)  Carson, Vicki,  "Letter From Townsville:  Neonatal Nursing Tropical Style."
           http://www.nann.org/ctrlline/twnsvill.htm
(2)  Braden, Sandra,  "Neonatal Nursing in Saudi Arabia."
           http://www.nann.org/ctrlline/nnsaudi.htm
(3)  "The Jo Carole and Ronald S. Lauder Newborn Intensive Care Unit."
           http://www.mssm.edu/peds/newborn.html
(4)  "Coombe Women’s Hospital."
           http://www.coombe.ie/intro/facts.html
(5)  "Long Beach Neonatal Intensive Care Unit."
           http://www.lbcommunity.com/medical/mdmcsneo.html
(6)  "International Neonatal Nurses Broadsheet."
           http://www.bizjet.com/jnn/conference.html

Other Works
 "Aiiku Hospital:  Department of Neonatology."
           http://www.path.or.jp/~kkabe/NICU.html