Neonatal Intensive Care Unit Nurses Research Articles

Comparing Neonatal Intensive Care Unit Nursing Support in Mothers With ‎Newborn Abstinence Syndrome (NAS) and Mothers of Healthy Neonates ‎

Background: The experience of having neonates in the Neonatal Intensive Care Unit (NICU) is a psychological crisis. It might cause many emotional problems for parents. Entire parental support is among the duties of the healthcare team. Therefore, this study aimed to compare the nursing support received by the mothers with Newborn Abstinence Syndrome (NAS) and the mothers of other neonates admitted to the NICU. Methods: The present cross-sectional descriptive-analytic study was conducted in the selected hospitals in Kerman Province, Iran. In total, 62 mothers with NAS and 61 non-addicted mothers with neonates admitted to the NICU were selected through convenience sampling method. The inclusion criteria were neonates under the care of parents, neonate admitted to the NICU for at least 24 hours, opiate dependence in the case group mothers, and no substance dependence in the control group mothers. The amount of nursing support for mothers having neonates with NAS was compared with that of the control mothers. The study groups were homogenized in terms of the study variables (neonate age, gender, and the duration of hospitalization). The required data were collected by the Nurse-Parent Support Tool (NPST) and analyzed in SPSS. Results: The study results revealed that among the neonates of 123 mothers, 75(60.97%) were boys, and 58(39.02%) were girls. The majority of neonates in both groups were breastfed. The mean±SD age of the mothers in the case and control group were 31.93±7.25 and 28.99±4.36 years, respectively. The nursing support level was desirable in both groups, and no significant difference was found in this regard (P>0.05). Furthermore, the level of nursing support in emotional, information-communication, self-esteem, and quality caregiving support dimensions was desirable in both groups. Conclusion: The obtained results revealed that nurses’ support was desirable in both groups. The prevalence of maternal addiction and the impact of this social harm on neonates who were admitted are essential. Furthermore, families having neonates with NAS need more support from the healthcare staff and nurses, in comparison with healthy parents; thus, the importance of this issue should be addressed in training and briefing courses for nurses.

Factors Affecting Time NICU Nurses Spend With Fathers: Results From a Larger Study.

Father involvement in the neonatal intensive care unit (NICU) is important for outcomes of children and should be encouraged. Neonatal nurses have been identified as a major source of support for fathers; yet, nurses have identified obstacles to family-centered care of the father. The purpose of this article is to present results that broaden the knowledge of factors that affect time NICU nurses spend with fathers. The information presented here is a portion of results from a larger survey that examined factors affecting NICU nurse caring beliefs of fathers. This survey study included NICU nurses and was administered anonymously online. Content analysis was completed on responses to open-ended questions. Questions asked nurses about the time they spend with fathers. Nurses described problems with workflow and encouraged family bonding. Some nurses described spending equal amounts of time with both parents, whereas others focused on either the mother or the father. Paternal attributes that affected time nurses spent with fathers included confidence, motivation, level of competence, beliefs, attitudes, and availability. Maternal factors included culture and gatekeeping. Infant factors were level of illness and tolerance to activity. Unmotivated fathers may benefit from encouragement from nurses to participate in the care of their infants. Nurses can encourage parental partnerships in caring for their infants. Factors identified in this study can help guide future studies. Understanding the relationship between NICU fathers and nurses can help improve interactions and communication.

Pharmaceutical Care in NICUs in Australia and Poland: Attitudes and Perspectives of Doctors and Nurses.

A multidisciplinary and collaborative team network is essential in ensuring positive health outcomes for critically ill neonatal patients. The objective of this study was to investigate the perceptions of neonatal intensive care unit (NICU) doctors and nurses in Australia and Poland toward pharmaceutical care services in the NICU. A cross-sectional, anonymous, electronic-based survey was distributed between January and April 2017 among a sample of NICU doctors, nurses, and midwives. A total of 77 participants from Australia and 93 from Poland completed the survey. Overall, from the perspectives of medical and nursing staff, it is apparent that clinical pharmacy practice on the NICU is more established in Australia than in Poland. Only 8.6% of Polish participants reported that a pharmacist worked directly on the NICU in comparison with 87% of Australian participants (P < .001). The main roles performed by pharmacists in Polish NICUs related to the provision of medicines, whereas Australian pharmacists were highly involved in all aspects of pharmacotherapy, particularly in the clinical and education domains. Future efforts should focus on how practice is structured in each country and what support can be implemented from educational, cultural, and legislative levels to enable better pharmacist integration into the NICU therapeutic team.

CCRN Across the Life Span.

CCRN Across the Life Span.

Validity and Reliability of Neonatal Infant Pain Scale (NIPS) in Neonatal Intensive Care Unit in Vietnam

The study aimed to culturally adapt and validate Neonatal Infant Pain Scale (NIPS) for use in Vietnamese settings. The original NIPS was translated into Vietnamese using a standard protocol. Registered nurses of Neonatal Intensive Care Unit (NICU), Tien Giang General Hospital, Vietnam used the Vietnamese NIPS for assessing neonatal pain and then provided feedback on acceptability of the scale. Five registered nurses of NICU were randomly selected and used NIPS for assessing neonatal pain while watching thirty videos at two times, two weeks apart from each other. Pulse rates per minute and oxygen saturation (SpO2) were also recorded for validity evaluation. Intraclass correlation coefficients (ICC) with two-way random effects were applied to assess intra-rater and inter-rater reliability. Multilevel linear regression was applied to assess the association between NIPS score with pulse rates and SpO2 adjusting for raters, three periods and two assessments. The Vietnamese NIPS was accepted and valued by nurses at the NICU. ICCs between the first and second assessments were from 0.53 to 1.00 for five raters before, during and after clinical procedures showing moderate to excellent intra-rater reliability. ICCs among five raters were moderate to good before and after, but poor (ICC&lt;0.4) during clinical procedures. NIPS score was not associated with SpO2, but with pulse rates per minute. The preliminary results showed that the Vietnamese version of NIPS is reliable and should be used. However, it is recommended that further research should be conducted to confirm its reliability and validity.

Hand antisepsis without decreasing efficacy by shortening the rub-in time of alcohol-based handrubs to 15 seconds

A previous study among neonatal intensive care unit (NICU) nurses showed that the antibacterial efficacy of alcohol-based handrubs (ABHR) can be achieved in 15 s instead of 30 s with a significant increase in the frequency of hand antisepsis. This study aimed to examine 15-s vs 30-s antisepsis performance by measuring microbial load on fingertips and compliance among nurses in a low-risk gynaecological ward. An independent trained observer monitored the frequency and compliance with hand antisepsis during shifts in a crossover design. Fingertips including thumbs were rinsed in soy broth before hand rubbing at the beginning of a shift and then hourly to determine the bacterial load. Performance activity was assigned to the contamination class of the Fulkerson scale. Immediately before the lunch break, volunteers cleaned their hands for a randomly determined application time of 15 or 30 s. Examination of bacterial load on fingertips revealed no difference between 15 vs 30 s application time. Controlled hand antisepsis before the lunch break also showed no difference in efficacy for either test series. Participants rubbing for 15 s were more likely to perform hand antisepsis compared with those rubbing for 30 s (P=0.2). The compliance increased from 54.7% to 69.5% in the 15-s trial. Shortening the duration for hand antisepsis did not decrease efficacy. Shortening the application time to 15 s should be considered within the critical components of a successful multimodal intervention strategy to improve hand-hygiene compliance in clinical practice.

Promoting developmental supportive care in preterm infants and families in a level III neonatal intensive care unit (NICU) setting in India

Despite evidence of short- and long-term benefits of developmental care, several studies have documented nurses' lack of knowledge and skills related to developmental care concepts. This study aims to enhance neonatal nurses' abilities to acquire care practices (knowledge and skills) regarding Developmental Supportive Care (DSC).A nonrandomized before and after intervention design was adopted to improve the knowledge and skills of staff nurses in DSC practices for preterm infants in Level III B NICU. The study included 50 level III B NICU nurses (25 in interventional group, 25 in control group) located within a tertiary care hospital in India.A significant increase in the mean knowledge score was seen among participants in the intervention group (pre-test: 16.6 ± 3.1, post-test: 29.9 ± 4.1, p = 0.01) but not in the control group (pre: 16.4 ± 2.2, post: 18.6 ± 3.6, p = 0.98). The improvement in the skills of providing DSC among neonatal nurses was also higher in the intervention group (106.4 ± 7.4) relative to the control group (65.8 ± 3.6), p < 0.01, at 0.05 level of significance.The Developmental Supportive Care Program (DSCP) had a significant impact in improving the knowledge and skills of nurses in providing care and preventing complications in preterm infants.

Dutch Neonatal Intensive Care Nurses' Perceptions of Pulse Oximeter Saturation Target Limits for Preterm Infants

PurposeTo conduct a national survey to assess practice, knowledge, barriers, and perceptions regarding oxygen saturation (SpO2) target limits among Dutch neonatal intensive care unit (NICU) nurses. Design and methodsCross-sectional, web-based survey among 667 nurses from 9 level 3 Dutch NICUs. Part of the questions were based on a clinical scenario (28-weeks preterm infant, treated with CPAP, FiO2 0.4). Results328 (53.6%) nurses responded to the survey. Of these, 281 (85.7%) reported to know the local policy of SpO2 target limits, and 261 (79.6%) and 244 (74.4%) rightly identified the lower and upper limit, respectively. Six NICUs recently increased their lower SpO2 limit and for 62.0% of their nurses this led to a significant alarm increase. For the majority of the respondents, the baby from the clinical scenario would spend <10% of the time outside the lower or upper SpO2 limits. Automated oxygen control systems were considered a good idea by 59.2% of the respondents, but 53.9% considered allowing parents to participate in FiO2 titration a bad or very bad idea. ConclusionsThe majority of the respondents identified their unit's policy-specified SpO2 target limits and reported that the increase in SpO2 target limits may have led to more alarms. Titration of FiO2 is a part of care that respondents were reluctant to share with parents. Practice implicationsA potential increase in the number of SpO2 alarms may lead to alarm fatigue. Although family-centered care philosophy is widely accepted across Dutch NICUs, there are still barriers to overcome.

Emotional Intelligence in Neonatal Intensive Care Unit Nurses: Decreasing Moral Distress in End-of-Life Care and Laying a Foundation for Improved Outcomes: An Integrative Review.

End-of-life care in the neonatal intensive care unit (NICU) is one of the most challenging practices for nurses. Negative emotions associated with moral distress often cause care to be incomplete or nurse disengagement. Emotional intelligence in nurses holds potential to address this issue, while improving patient outcomes. The purpose of this study was to critically appraise the evidence about emotional intelligence in nursing and to explore the relationship between emotional intelligence, moral distress in NICU nurses, end-of-life care, and other priority nurse and patient outcomes. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-structured integrative review was conducted, and CINAHL, Ovid, PubMed, and other databases were searched. Twelve studies were identified as relevant to this review after exclusion criteria were applied. Evidence supports the efficacy of emotional intelligence in bedside nurses as a method of improving key nurse and patient outcomes. Additionally, research suggests that emotional intelligence can be improved by training interventions. Clinical educators should integrate emotional intelligence concepts and strategies into staff training. Further research is recommended to validate previous findings in the NICU setting. Exploration of the relationship between emotional intelligence and moral distress in NICU nurses would provide a foundation for experimental designs to evaluate the effectiveness of emotional intelligence training interventions.

A Pilot Study of Oxytocin in Low-Income Women With a Low Birth-Weight Infant: Is Oxytocin Related to Posttraumatic Stress?

Negative outcomes related to prematurity may lead to maternal distress. Mothers of premature/low birth-weight infants report increased posttraumatic stress (50%) and depressive symptoms (63%) compared with mothers of full-term infants. Low-income, minority mothers with greater posttraumatic stress and depression have an increased risk for premature/low birth-weight delivery compared with their white counterparts. Variations in the neuropeptide oxytocin are implicated in lactation, perinatal depression, and maternal behavior. To examine the associations among posttraumatic stress, depressive symptoms, and oxytocin in a pilot sample of minority mothers with premature/low birth-weight infants in the neonatal intensive care unit (NICU). This study employed a descriptive, correlational pilot design of 8 minority, low-income mothers with premature/low birth-weight infants. Participants answered questionnaires pertaining to posttraumatic stress, depression, lactation, and demographics and oxytocin was measured. This is a substudy that added oxytocin values. Four participants had elevated depressive symptoms and 5 supplied their own milk. Women who provided their own milk had lower depressive (t = 3.03, P = .023) and posttraumatic stress (t = 3.39, P = .015) symptoms compared with women not supplying their own milk. Women with elevated posttraumatic stress had higher levels of depressive symptoms (r(8) = 0.8, P = .006) and lower levels of oxytocin (r(8) = 0.77, P = .026). These results are congruent with previous literature on providing human milk and maternal mental health. In addition, we found a possible relationship between postpartum posttraumatic stress and oxytocin in minority women with premature/low birth-weight infants. NICU nurses should encourage lactation and assess mothers for posttraumatic stress and depressive symptoms. Research is needed to identify the biologic milieu associated with posttraumatic stress and depression in at-risk mothers.

Emotional Intelligence in Neonatal Intensive Care Unit Nurses: Decreasing Moral Distress in End-of-Life Care and Laying a Foundation for Improved Outcomes: An Integrative Review

Journal of Hospice & Palliative Nursing 21(4):p E28, August 2019. | DOI: 10.1097/NJH.0000000000000568

Parents' and nurses' experiences of partnership in neonatal intensive care units: A qualitative review and meta-synthesis.

To explore how parents and nurses experience partnership in neonatal intensive care units and to identify existing barriers and facilitators to a successful partnership. Family-centred care is recommended as a frame of reference for treatment and care in neonatal intensive care units. A key element in family-centred care is partnership. Such partnerships are characterised by complex interpersonal relationships and interactions between nurses and parents/families. Partnerships therefore appear to present a significant challenge. A qualitative review and meta-synthesis. Comprehensive searching in ten databases: CINAHL, PubMed (MEDLINE), EMBASE, PsycINFO, Scopus and SweMed+, OpenGrey, MedNar, Google Scholar and ProQuest Dissertations & Thesis Global. A total of 1,644 studies (after removal of duplicates) were critically assessed, and 21 studies fulfilled the inclusion criteria. A meta-aggregation was used to synthesise the findings from the studies and was methodically quality assessed with QUARI/SUMARI and PRISMA. Through a meta-aggregative approach, two synthesised findings were developed: (a) co-creation of mutual knowledge and (b) developing competencies and negotiating roles. The first synthesis embraced the categories: being respected and listened to, trust and sharing knowledge, and the second synthesis embraced the categories: space to learn with guidance, encouraging and enabling, being in control. In constructing the categories, findings were identified as characteristics, barriers and facilitators to application. A successful relationship between parents and nurses can be achieved through co-creation of mutual knowledge and development of competencies and negotiation of roles. Neonatal intensive care unit nurses are in a position where they exercise power, but they can change the culture if they are aware of what seems to facilitate or create a barrier to a partnership with parents. This new evidence may inform a change in policies and guidelines which could be integrated into nurses' clinical practice in neonatal intensive care units.

Educational intervention to increase parental care of preterm neonates at district hospital in Kigali

Background: A preterm neonate usually requires specialised care in the neonatal intensive care unit (NICU). Nurses in the NICU are the primary source of parental education particularly for preterm neonates. Objective: To assess the effectiveness of a preterm infant care educational program on parental knowledge acquisition in the NICU. Methods: A quasi-experimental pre-test post-test design was used. A convenience sample of 53 parents with preterm infants was recruited at a district hospital NICU in 2017 in Kigali. The twohour evidenced-based intervention in the local language of Kinyarwanda included five Global Health Media Project videos and a power-point presentation on the knowledge and skills to improve maternal and neonatal health. Data analysis included descriptive and inferential statistics. Results: The mean correct pre-test knowledge score was 54%, and the mean correct post-test score was 92%, indicating a significant increase (38%) of correct responses after the intervention. Conclusion: An educational intervention was found to be effective in improving parental knowledge in caring for preterm infants in a district hospital NICU in Kigali. This evidenced-based intervention could become routine for neonatal nurses in NICUs throughout Rwanda. Keywords: NICU, educational program, parents, preterm birth, prematurity

Facilitating closeness between babies with congenital abnormalities and their parents in the NICU: A qualitative study of neonatal nurses' experiences

This qualitative study explored the experiences of neonatal nurses with facilitating closeness between parents and babies with congenital abnormalities in the neonatal intensive care unit (NICU). Babies with congenital abnormalities often require admission to the neonatal intensive care unit. Parents may experience emotional distancing from their baby, due to their response to their baby's congenital abnormality, as well as physical separation due to their baby's hospitalisation in the NICU. NICU nurses can help facilitate the development of closeness between babies and parents in the NICU. This qualitative interpretive description study involved face-to-face, semi-structured interviews with twelve neonatal nurses following which the data collected were thematically analysed. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in preparing this paper. Three major themes emerged from the analysis-"Everyone copes differently," "You have to focus on what is the normal thing" and "It's very much an individualised approach." Participants often felt unprepared to care for babies with congenital abnormalities and implemented coping mechanisms to overcome the emotional labour they experienced. Skin-to-skin cuddles were considered the most beneficial strategy for parents to develop closeness with their baby. Participants recognised that they sometimes "pushed" parents into engaging with their baby. Participants highlighted the importance of individualised, supportive care for these parents. Neonatal nurses require increased education about congenital abnormalities and individualised care to support them in caring for babies with congenital abnormalities. Further research is needed on parental experience of developing closeness with a baby with a congenital abnormality in the NICU.

Factors Influencing Developmental Care Practice Among Neonatal Intensive Care Unit Nurses

PurposeThis study aimed to examine factors that influence developmental care practice among neonatal intensive care unit nurses. Design and methodsThis descriptive, cross-sectional study was conducted using a questionnaire. Data were collected from 141 neonatal intensive care unit nurses from 6 hospitals in South Korea. Multiple linear regression analysis was used to examine factors influencing developmental care practice. ResultsThis study found that professional efficacy had the largest influence on developmental care practice, followed by perception of developmental care and a task-oriented organizational culture. Clinical and educational experience regarding developmental care and working environment was not associated with developmental care practice among NICU nurses. ConclusionsTo enhance nurses' practice of developmental care, enhancement of nurses' individual competency, positive perception of developmental care, and organizational efforts are required. A practical training program should be provided to nurses to promote confidence in implementing developmental care for preterm infants. ImplicationsA trained nurse should provide staff nurses with useful information on developmental care to encourage them to have a positive attitude towards developmental care. The nurse manager should create an organizational culture in which nurses perceive developmental care to be an essential nursing task in their unit.

Survey of Neonatal Intensive Care Unit Nurses' Use of a Motion/Sound Infant Seat.

Perinatal substance exposure is an increasing concern in infants being cared for in neonatal intensive care units. Current recommendations support nonpharmacologic treatments for this population of infants. Multimodal (motion, sound) seats are often employed to soothe infants. The purpose of this study was to survey neonatal intensive care unit nurses on their practices regarding the use of a motion/sound infant seat. Sixty-six nurses (52% of 126 total nurses) completed the survey about their self-disclosed practices that included (1) reasons for use; (2) rationale for choice of settings of motion and sound; (3) duration of time infants spent in seat in one session; (4) perception of positive infant response; (5) who places infants in the seat; and (6) nursing instructions dispensed prior to use. Chief reasons for use were infant state, lack of persons to hold infants, and a diagnosis of neonatal abstinence syndrome. Rationale for choice of motion and sound settings included trial and error, prior settings, personal preferences/patterns, assumptions, and random selection. Nurse responses regarding the amount of time the infant was placed in the seat in a single session ranged from 10 to 360 minutes, with determining factors of infant cues, sleeping, feeding, and someone else to hold the infant. As nonpharmacologic treatments evolve, nurses need guidelines for safe, effective interventions to care for infants. Further research is necessary to ascertain the responses of withdrawing infants and to establish guidelines and education for use of the motion/sound infant seat.

Experience of neonatal intensive care unit nurses in providing developmentally-supportive care: A qualitative study.

Many challenges have been noted in the implementation of developmentally-supportive care principles in neonatal intensive care units, despite evidence that adhering to such care principles achieves positive results for the neonate. The aim of this study was to explore and describe compliance in adhering to developmentally-supportive care principles implemented in one neonatal intensive care unit in South Africa. An exploratory design was used in this qualitative study with purposive sampling to select eligible neonatal intensive care registered nurses (n = 14) as participants. Participants all worked in a 10 bed neonatal intensive care unit at a large tertiary care public hospital. Six audio-recorded interviews were conducted, with recordings subsequently transcribed and analyzed. Three main themes were identified: value of developmentally-supportive care, nature of developmentally-supportive care, and barriers to developmentally-supportive care. One of the main themes had subthemes, which substantiated the findings, and included parent involvement, nurse engagement, and holistic care. Study outcomes offer insight into the development or revision of policies and practices, which are crucial when implementing developmentally-supportive care, particularly in resource-poor settings where challenges are magnified.

Noteworthy Professional News

Noteworthy Professional News

Performance of Neonatal Intensive Care Unit Nurses in Blood Culture Procedure in Tabriz Hospitals in 2016

Background: Blood culture is a method in neonatal intensive care unit (NICU) and a gold standard for the diagnosis of infection that is essential for proper newborn management. The aim of this study was to compare the performance of nurses in the NICUs of Tabriz University of Medical Sciences using a standard sampling method. Methods: This descriptive cross-sectional study was performed on 90 nurses working in Al-Zahra and Taleghani ‎Educational and Medical Centers, and Tabriz Children Hospital using the convenience sampling method. The study tool included a two-part questionnaire in which the first part contained demographic characteristics of the infants and nurses and the service area. The second part included a checklist of the nurses' performance before and during ‎the blood culture procedure. Data analysis was performed using SPSS statistical software (version 21), as well as descriptive and analytical statistics. Results: Most nurses did not attend training courses for blood culture. The total performance scores before and during blood ‎culture sampling were ‎13.20‎‏±‏‎2.57 and ‎12.48‎‏±‏‎2‎.14‎, respectively.‎ Conclusion: Nurses are responsible for the correct sampling of blood culture and this procedure requires sufficient skill. Therefore, organizations must adapt their system to the standards in order to determine the benefits and disadvantages of the standards.

Obstacles to Parents’ Interaction with Neonates in Neonatal Intensive Care Units from Parents’ and Nurses’ Points of View

Background: This study aimed to identify most important obstacles to proper interaction of parents with their neonates who were hospitalized in neonatal intensive care units (NICUs). Methods: This descriptive cross-sectional study was conducted on 90 NICU nurses and 400 female and male parents using census and convenience sampling methods. To collect data, in a period of three months, a researcher-made questionnaire was prepared, including factors threatening parents' interaction with their neonates in NICUs. Data analysis was performed using descriptive statistics including number, percentage and mean scores of responses in SPSS software (version 16). Results: By calculating mean scores of responses, from nurses' points of view, feeling of emotional discomfort due to being away from neonate (3.63) and nurses’ not understanding parents since they have no children (1.42) were most and least important factors, respectively. From mothers' points of view, parental stress due to neonate’s hospitalization (3.47), and the maternity wards being away from NICUs (1.37) were most and least important factors, respectively. Also, most and least important obstacles in perspectives of fathers were parental stress due to neonate’s hospitalization (3.09) and the unwanted neonate, respectively. Conclusion: The results showed that stress and tension of parents were most influencing factor on interaction of neonate-parent in NICUs. Some neonatal and organizational factors were considered less important as barriers to neonate-parent interactions in these wards.