Advances in neonatal care : official journal of the National Association of Neonatal Nurses最新文献

{"title":"Decreasing Complete Blood Count Clotting Rates: An Improvement Project in an Academic Neonatal Intensive Care Unit.","authors":"Emily Giddens","doi":"10.1097/ANC.0000000000000853","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000853","url":null,"abstract":"<p><strong>Background: </strong>In premature and critically ill infants, a complete blood count (CBC) is commonly collected via the heel-stick method, which is preferred because of the ongoing requirements to preserve intravenous sites. However, because of sample clotting, these specimens are often rejected, leading to unnecessary repeat heel sticks, painful stimuli, and increased costs.</p><p><strong>Purpose: </strong>The purpose of this quality improvement project was to decrease the rate of clotted CBC samples obtained from neonates admitted in the neonatal intensive care unit.</p><p><strong>Methods: </strong>The RE-AIM translation model, which stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance, was adopted to decrease the rate of clotted CBC samples through staff education, randomized audits of the staff's heel-stick technique, and the development and implementation of a standardized capillary blood sampling protocol. The primary outcome measure was the rate of clotted CBC samples, which was defined as the proportion of clotted CBC samples.</p><p><strong>Results: </strong>CBC clotted sample rates decreased by 27%, resulting in a cost saving of $1136, and overall CBC rejection rates decreased by 23%.</p><p><strong>Implications for practice: </strong>All hospital units should provide staff with an evidence-based resource, recurrent education, and evaluation of skills to avoid unnecessary repeat heel sticks and prevent increased pain sensitivity, social hypervigilance, and avoidance behavior in early infancy.</p><p><strong>Implications for research: </strong>Future efforts should focus on the long-term benefits of routine education and its effects on clotted sample rates and whether samples drawn by laboratory phlebotomy staff versus registered nurses/patient care technicians result in disproportionate rejection rates.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E171-E179"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25544491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Experiences of Infant Car Bed Use After Failure of Car Seat Tolerance Screen.","authors":"Christina M O'Connor,&nbsp;Jacqueline McGrath,&nbsp;Michele DeGrazia","doi":"10.1097/ANC.0000000000000844","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000844","url":null,"abstract":"<p><strong>Background: </strong>Failure of the car seat tolerance screen (CSTS) during hospitalization often leads to a recommendation for automobile travel within a car bed at discharge.</p><p><strong>Purpose: </strong>To describe the parental experience utilizing a car bed for infant automobile transportation.</p><p><strong>Methods: </strong>A descriptive, qualitative study design was undertaken with a purposive sample of parents recruited for a single interview in the pulmonary clinic at the time of the follow-up CSTS, approximately 1 month after hospital discharge. Interviews, guided by a semistructured interview tool, provided a holistic understanding of the parental experience utilizing car bed travel.</p><p><strong>Findings/results: </strong>Data from 15 parental interviews revealed an overarching emotional journey consisting of 5 themes: (1) an adjustment period; (2) decision-making related to the car bed purchase; (3) encounters with varied provider education and knowledge; (4) safety and security of the car bed during transit; and (5) space and mobility restrictions imposed by the car bed.</p><p><strong>Implications for practice: </strong>While recommendations exist for infant travel in a car seat, supportive recommendations for parents with an infant who needs to travel in a car bed do not exist. Based on study findings, providing parents supportive guidelines, education, and recommendations for their infant requiring travel in a car bed may be a strategy to ease the stress experienced in this situation.</p><p><strong>Implications for research: </strong>Findings indicated a need to develop policies and standards, as well as comprehensive education, for providers and parents related to car bed travel. Further research is needed to identify strategies to best support parents and infants.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"503-512"},"PeriodicalIF":1.7,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25530406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Availability of Donor Human Milk Decreases the Incidence of Necrotizing Enterocolitis in VLBW Infants.","authors":"","doi":"10.1097/ANC.0000000000000916","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000916","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E110"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39375066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Presentation and Multifactorial Pathogenesis of Necrotizing Enterocolitis in the Preterm Infant.","authors":"Rachael E Andrews,&nbsp;Kristi L Coe","doi":"10.1097/ANC.0000000000000880","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000880","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing enterocolitis (NEC) is a serious infection of the bowel wall induced by multiple pathological factors, which include inflammation and tissue invasion with bacteria known to cause severe infections. NEC is now understood to be several disease processes under one umbrella. The most common form occurs in premature infants and can exert significant impacts to preterm morbidity and mortality.</p><p><strong>Purpose: </strong>This narrative review describes current knowledge of the clinical presentation and pathophysiology of NEC in premature infants.</p><p><strong>Methods/search strategy: </strong>A review of literature was conducted using key words in PubMed and CINAHL with preference for years 2015 to 2020.</p><p><strong>Findings/results: </strong>Several converging and interrelated factors including characteristics of the premature intestinal mucosa, gut ischemia, dysregulation of the microbiome, enteral feeding, and genetics create an environment where NEC is more likely to occur.</p><p><strong>Implications for practice: </strong>To recognize and diagnose NEC in preterm infants, an understanding of underlying factors that create an optimal environment for disease acquisition in premature infants is essential.</p><p><strong>Implications for research: </strong>Prevention of NEC remains the most important strategy for decreasing morbidity and mortality. Multiple areas of potential study exist for NEC pathophysiology including those that consider how the factors discussed in this review are interrelated and how each particular pathway can be optimized to prevent the onset of NEC.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"349-355"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38967093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NANN's Thermoregulation in the Care of Infants Guideline for Practice Executive Summary.","authors":"Valerie K Moniaci,&nbsp;Bobby Bellflower","doi":"10.1097/ANC.0000000000000945","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000945","url":null,"abstract":"","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"340"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39375063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal Ultrasound Assists the Diagnosis and Management of Necrotizing Enterocolitis.","authors":"Belinda Chan,&nbsp;Sasha Gordon,&nbsp;Michelle Yang,&nbsp;Jennifer Weekes,&nbsp;Logan Dance","doi":"10.1097/ANC.0000000000000919","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000919","url":null,"abstract":"<p><strong>Background: </strong>Abdominal x-ray (KUB) routinely aids in detecting necrotizing enterocolitis (NEC), one of the most serious neonatal intestinal diseases. However, a KUB may miss up to 50% of the early signs of NEC. Recent advances in abdominal ultrasound (AUS) can expedite this diagnosis and improve clinical management.</p><p><strong>Purposes: </strong>To illustrate AUS findings that suggest NEC through 3 case examples. To review current literature regarding advantages and limitations of AUS compared with KUB.</p><p><strong>Results: </strong>The added visualization of intra-abdominal structures with AUS compared with KUB improves the diagnosis and management of NEC. Some AUS features are highly suggestive of impending bowel perforation, while others can confirm bowel perforation despite a negative radiograph.</p><p><strong>Implications for practice: </strong>AUS expedites time to diagnosis of NEC and helps to stratify patients who may fail medical management and require surgical intervention.</p><p><strong>Implications for research: </strong>More quality improvement studies are needed to validate an AUS protocol for the management of NEC. Advances in technology, such as contrast-enhanced ultrasound, may improve NEC detection with AUS in the future.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"365-370"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39375064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Assessment of and Satisfaction With Discharge Preparation From the Neonatal Intensive Care Unit.","authors":"Vincent C Smith,&nbsp;Wenyang Mao,&nbsp;Marie C McCormick","doi":"10.1097/ANC.0000000000000862","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000862","url":null,"abstract":"<p><strong>Background: </strong>A successful transition from the neonatal intensive care unit (NICU) to home is aided by a comprehensive discharge planning program that keeps families involved and engaged with the discharge preparation process.</p><p><strong>Purpose: </strong>To compare the assessment of parental NICU discharge preparedness with parental satisfaction with the NICU discharge preparation.</p><p><strong>Methods: </strong>Families were surveyed 4 to 6 weeks after NICU discharge, and those selecting \"very prepared\" were considered \"satisfied\" with their discharge preparation. On discharge day, families were considered \"prepared\" for discharge based on their overall level of preparedness and their nurse's rating of them on a discharge readiness assessment tool.</p><p><strong>Results: </strong>In total, 1104 families (60%) reported being both \"satisfied\" and \"prepared\"; 293 families (16%) were \"satisfied\" but not \"prepared\"; 297 families (16%) were not \"satisfied\" but were \"prepared\"; and 134 families (7%) were neither \"satisfied\" nor \"prepared.\" Compared with families that were both \"satisfied\" and \"prepared,\" families that were neither \"satisfied\" nor \"prepared\" were more likely to be raising the infant alone, of Black race, and to have sicker infants.</p><p><strong>Implications for practice: </strong>Some families are at a higher risk and merit more consideration during NICU discharge planning. Assess the discharge readiness of all families prior to discharge. Those at an increased risk may benefit from more discharge education and training, specifically for single mothers, those with limited resources, or others considered at high risk.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E144-E151"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25587974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Report and Biological Indexes of Work-Related Stress in Neonatal Healthcare Professionals: A Repeated-Measures Observational Study.","authors":"Monica Fumagalli,&nbsp;Livio Provenzi,&nbsp;Gabriele Sorrentino,&nbsp;Francesca Ciceri,&nbsp;Camilla Fontana,&nbsp;Sofia Passera,&nbsp;Michela Moncecchi,&nbsp;Laura Plevani,&nbsp;Dario Laquintana,&nbsp;Renato Borgatti,&nbsp;Fabio Mosca,&nbsp;Rosario Montirosso","doi":"10.1097/ANC.0000000000000848","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000848","url":null,"abstract":"<p><strong>Background: </strong>Healthcare providers working in neonatal intensive care units (NICUs) are considered at high risk for psychological work-related stress.</p><p><strong>Purpose: </strong>To evaluate both perceived and biological measures of work-related stress in neonatal healthcare professionals and to compare professionals working in the NICU with their colleagues working in less critical environments (ie, neonatal wards [NWs]).</p><p><strong>Methods: </strong>The salivary cortisol level at the beginning (CORT-B) and at the end (CORT-E) of a daily work shift was collected once a week for 6 weeks and a psychological questionnaire was submitted to NW and NICU workers of a tertiary university center.</p><p><strong>Results: </strong>No differences emerged in the overall cortisol secretion between professionals (NW 45 vs NICU 28), but the decrease in the mean cortisol values between CORT-B and CORT-E was less pronounced in NICU professionals (P < .001) who had greater psychological stress (P < .001). Lack of correlation between perceived and biological indexes was observed.</p><p><strong>Implications for practice: </strong>NICU professionals reported greater levels of self-perceived psychological stress, especially in terms of professional self-doubt and the complexity of interactions with infants and their parents.The disconnection between psychological and biological indexes raises the issue that work-related stress might be covert to the professionals themselves. Dedicated resources should be developed to address quality of life and the work environment of NICU professionals.</p><p><strong>Implications for research: </strong>The absence of a correlation between perceived and biological indexes highlights the need to incorporate multidimensional physiological and biological measurements in evaluating burnout levels in neonatal healthcare providers.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"E120-E128"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25331328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NICU Fathers: Improving the Quality of Paternal Support in the NICU.","authors":"Lawrence D LeDuff,&nbsp;Brigit M Carter,&nbsp;Craig A Cunningham,&nbsp;Lisa A Braun,&nbsp;Keith J Gallaher","doi":"10.1097/ANC.0000000000000796","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000796","url":null,"abstract":"<p><strong>Background: </strong>Parental support in the neonatal intensive care unit (NICU) is critical; yet, the nursing staff may struggle to provide optimal support to NICU fathers. Generally, fathers are not viewed as equally competent caregivers when compared with mothers, and fathers often impart these beliefs on themselves. Increasing the nursing staff's knowledge and understanding of paternal support can change attitudes and foster positive behavior changes, enhancing the perception of support received by NICU fathers.</p><p><strong>Purpose: </strong>To implement a needs assessment and educational intervention for the nursing staff designed to increase the perception of nursing support received by NICU fathers.</p><p><strong>Methods: </strong>The Nurse Parents Support Tool (NPST) was administered to the clinical nursing staff and fathers in a pre/posttest design comparing support given by nurses with the fathers' perception of received support. Data from the preintervention assessment was used to design an educational intervention on improving fathers' support. Following the intervention, a postintervention NPST was administered to fathers to determine whether there was an improvement in support perception.</p><p><strong>Findings/results: </strong>Improvement in the NICU fathers' perception of nursing staff support was noted between father groups. In addition, the NPST can be used to assess paternal support needs and develop staff education.</p><p><strong>Implications for practice: </strong>Support provided to NICU fathers can enhance the father's perception of himself as an equal and competent caregiver, leading to improved father-infant bonding as the child ages. Educational interventions targeting father support should be a routine part of nursing staff training.</p><p><strong>Implications for research: </strong>Future research should examine the long-term effects of early paternal support on psychosocial, cognitive, and developmental outcomes of NICU infants.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"387-398"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38448396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cross-sectional Survey of Enteral Feeding Tube Placement and Gastric Residual Aspiration Practices: Need for an Evidence-Based Clinical Practice Guideline.","authors":"Sheeja Perumbil Pathrose,&nbsp;Kaye Spence,&nbsp;Christine Taylor,&nbsp;Kim Psalia,&nbsp;Virginia Schmied,&nbsp;Hannah Dahlen,&nbsp;Nadia Badawi,&nbsp;Katherine Gregory,&nbsp;Karen Peters,&nbsp;Jann Foster","doi":"10.1097/ANC.0000000000000822","DOIUrl":"https://doi.org/10.1097/ANC.0000000000000822","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants routinely require enteral feeding via nasogastric or orogastric tubes as an alternative to oral feeding to meet their nutritional needs. Anecdotal evidence suggests variations in practice related to correct tube placement and assessment of feed intolerance.</p><p><strong>Purpose: </strong>To determine the current practices of enteral feeding tube placement confirmation and gastric residual (GR) aspiration of neonatal clinicians in Australia.</p><p><strong>Methods: </strong>A cross-sectional online survey comprising 24 questions was distributed to nursing and medical health professionals working in Australian neonatal care units through 2 e-mail listservs made available by professional organizations.</p><p><strong>Findings: </strong>The survey was completed by 129 clinicians. A single method was practiced by 50% of the clinicians in confirming tube placement, and most common practice was assessing the pH of GR aspirate. The majority of respondents (96%) reported that they relied on GR aspiration and clinical signs to determine feeding tolerance and subsequent decisions such as ceasing or decreasing feeds. However, the frequency of aspiration, the amount and color of aspirate considered to be normal/abnormal, and decisions on whether to replace gastric aspirate or whether aspiration should be performed during continuous tube feeding varied.</p><p><strong>Implication for practice: </strong>This study demonstrated considerable variability in clinical practice for enteral feeding tube placement confirmation and GR aspiration despite most respondents reporting using a unit-based clinical practice guideline. Our study findings highlight the need for not only developing evidence-based practice guidelines for safe and consistent clinical practice but also ensuring that these guidelines are followed by all clinicians.</p><p><strong>Implication for research: </strong>Further research is needed to establish evidence-based methods both for enteral feeding tube placement confirmation and for the assessment of feeding intolerance during tube feeding. In addition, the reasons why evidence-based methods are not followed must be investigated.</p>","PeriodicalId":520547,"journal":{"name":"Advances in neonatal care : official journal of the National Association of Neonatal Nurses","volume":" ","pages":"418-424"},"PeriodicalIF":1.7,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38807961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}