Neonatal Intensive Care Unit Nurses Research Articles

Implementation of Pre-/Post-Weights to Enhance Direct Breastfeeding in the NICU

IntroductionMother's own milk (MOM) is recommended as the optimal nutrition for preterm infants. Direct breastfeeding (DBF) is correlated with a longer duration of receiving MOM during hospitalization. Infants' transition to DBF may be enhanced when accurate pre-/post-weights are incorporated into nursing practice. An evidence-based practice change was introduced to promote use and increase consistency in methodology of pre-/post-weights after DBF in the neonatal intensive care unit (NICU), with the ultimate goal of increasing DBF at hospital discharge.MethodsThe practice change was introduced through an educational program, a video demonstrating pre-/post-DBF weighing techniques, and a return-demonstration. A 10-item pre-/posttest was used to evaluate nurses' knowledge gained by an educational intervention that included seven knowledge questions, three attitude questions, and three demographic descriptors.ResultsNurses' knowledge gained following the educational intervention was statistically significant (p < .001) using a paired t-test.ConclusionsThe use of pre-/post-DBF weights as an accurate assessment of MOM transfer can promote DBF during hospitalization through education of NICU nurses. Understanding nursing characteristics and attitudes can aid in promotion of DBF in the NICU by bedside nurses.

Influence of Perceptions of Death, End-of-Life Care Stress, and Emotional Intelligence on Attitudes towards End-of-Life Care among Nurses in the Neonatal Intensive Care Unit.

PurposeThe purpose of this study was to investigate the influence of perceptions of death, end-of-life (EOL) care stress, and emotional intelligence on attitudes toward EOL care among nurses in the neonatal intensive care unit (NICU).MethodsThe participants were 111 nurses working in a NICU who had experienced EOL care at least once. Data were analyzed using the t-test, Pearson correlation coefficient, and stepwise multiple regression analysis in SPSS for Windows.ResultsThe mean score for perceptions of death was 3.16 out of 5, the mean score for EOL care stress was 3.61 out of 5, the mean emotional intelligence score was 4.66 out of 7, and the average score for EOL care attitudes was 2.77 out of 4. The factors affecting attitudes towards EOL care were academic degree, anxiety regarding death, negativity towards death, experiences of patient death, and emotional intelligence. The explanatory power of these variables for attitudes towards EOL care was 24.7%.ConclusionThe results of this study are expected to serve as a basic reference for the development of nursing education programs and EOL care protocols to improve attitudes toward EOL care among NICU nurses.

Management of retinopathy of prematurity in a neonatal unit: Current approach

Retinopathy of prematurity (ROP) is a blinding morbidity affecting preterm infants. It currently represents the leading preventable cause of childhood blindness worldwide. Most data indicate an increasing incidence of ROP disease in both industrialized countries and in the developing world. There are neither symptoms of ROP nor can a specific visual behavior in a preterm infant herald a concern for ROP. Hence, an effective screening is essential for prompt diagnosis of ROP. The available evidence suggests that the majority of premature infants who go blind from ROP do so due to screening failure. Timely screening of premature infants at risk is as important as early treatment in the management of ROP. The screening protocol at each neonatal intensive care unit (NICU) should be evidence-based, should be based on preferences of neonatologists, ophthalmologists, and NICU nurses. All at-risk infants should be identified and receive adequate dilated retinal examinations at appropriate times. Appropriate screening and follow-up guidelines and timely treatment protocols need to be implemented in every NICU by pediatricians and ophthalmologists to reduce the ROP-related blindness in the community. The ultimate goals of treatment of ROP are prevention of retinal detachment or scarring and optimization of visual outcome. The standard treatment involves ablation of peripheral avascular retina preferably by indirect retinal laser photocoagulation when the ROP progresses to a stage which needs intervention since vascular endothelial growth factors (VEGF) are known to play a major role in ROP pathogenesis and its progression, injection of anti-VEGF drugs intravitreally has been found to be effective in arresting the ROP disease process. This newer emerging pharmacotherapeutic option has the potential to improve treatment outcomes.

Analysis of Learning Effect in Neonatal Practice of Nursing Students-Utilization of Evaluation Criteria in Clinical Practice Guide

Background/Objectives: The purpose of this study is to analyze the process related to the acquirement of the concept through the self - evaluation analysis that practical guidelines of the nursing student in practicing neonatal and neonatal intensive care unit.Method/Statistical Analysis: A descriptive research design was used for this study. All 109 nursing students were obtained by from neonatal and neonatal Intensive Care Unit Nursing practice in one university located in Seoul. The Data was collected for from 2014 to 2015 by the checklist of practice guideline. Collected data was analyzed on SPSS Win 21.0Findings: In the method of learning, it was confirmed that they learned the concept through most observation method. Handwashing, breastfeeding and elimination were the most frequently performed items, and pollution inspection, injection/syringe pump and TPN management were the lowest.Improvements/Applications: In order to improve the quality of clinical practice education and improve the effectiveness of practical training, it is necessary to actively review and improve the use of practical training guideline so that students can receive training in clinical practice and practical courses in the class.

Reduced Mental Workload of Neonatal Intensive Care Unit Nurses through a Self-designed Education Class: A Randomized Controlled Trial.

Background:One of the factors affecting the behavior and performance of nurses is mental workload. Training programs can improve the attitude, knowledge, and performance of nurses. However, the impact of these programs on mental workload is not clear. Therefore, the study aimed to evaluate and compare the effect of two conventional and self-designed education classes on the mental workload of neonatal intensive care unit (NICU) nurses.Materials and Methods:This study was conducted on 68 nurses, divided into two intervention and control groups. Subjects of the intervention group attended a social awareness reinforcement class, in which one of the dimensions of emotional intelligence was introduced and covered. Research tool was the mental workload questionnaire of National Aeronautics and Space Administration Task Load Index (NASA-TLX).Results:In this research, results of the paired t-test were indicative of a significant decrease in the mean score of mental workload immediately after the intervention (t = 1.48, p < 0.001) and one month later (t = 1.11, p = 0.007). Moreover, a significant difference was observed in the mean score of mental workload of the intervention group between before and after the conventional education class, and before and 1 month after the self-designed class using repeated-measures analysis of variance (F = 21.31, p < 0.001).Conclusions:According to the results of the study, the conventional education class had no impact on the mental workload, whereas the self-designed class significantly decreased mental workload. Therefore, it is suggested that education programs be conducted for NICU nurses to improve their emotional intelligence, which leads to decreased level of mental workload.

Neonatal Intensive Care Unit Nurses' Perceptions and Knowledge of Newborn Individualized Developmental Care and Assessment Program: A Multicenter Study.

Background:The newborn individualized developmental care and assessment program (NIDCAP) is a new multifaceted approach, which is developmentally and functionally supportive of health especially in premature newborns at the neonatal intensive care unit (NICU). This study is designed for assessing the knowledge and perception of nurses as the most important members of the multidisciplinary team of NIDCAP about this program.Materials and Methods:This cross-sectional study was conducted on 120 nurses working in the NICUs of Alzahra, Taleghani, and Children hospitals affiliated to the educational and treatment centers of Tabriz University of Medical Sciences as well as 29 Bahman Hospital affiliated to Tabriz Social Security Organization in 2016 using census sampling method. Three questionnaires were employed to collect demographic data and to explore the nurses' perceptions and knowledge of the NIDCAP program.Results:Findings of the study indicated that the mean (SD) nurses' knowledge and perception scores for NIDCAP were 71.83 (1.64) and 76.80 (0.79), respectively. In the terms of knowledge, significant differences were found with regard to being married (t = -2.39, p < 0.019), having an MSc degree (t = -2.14, p = 0.034), and employment experience (t = -3.38, p = 0.001). However, there was no significant relationship between perception and demographic variables (p > 0.05), nor was there any significant relationship between perception and knowledge (p = 0.275).Conclusions:The results of this study showed that the majority of nurses participating in the study had high knowledge about NIDCAP.

Drug Calculation Cards and Medication Errors in the Neonatal Intensive Care Units

Introduction: Medication administration errors are the most common medication errors. One of the most important causes of medication administration errors is a mistake in calculating the dose of medication by nurses. This study was conducted to evaluate the effects of using the Drug Calculation Cards on the amount and type of medication administration errors in the Neonatal Intensive Care Units (NICUs). Methods: This quasi-experimental study was conducted with one-group before-after design to examine the effects of using the Drug Calculation Cards on the amount and type of medication administration errors. Eligible NICU nurses in selected centers affiliated to Qazvin University of Medical Sciences were registered (n = 33) in the study within three months. Then, before intervention data were collected using “medication administration errors reporting” questionnaire. Three months later the intervention (drug calculation card) was done and the same medication administration errors reporting questionnaire was dispersed. The data were entered to the SPSS version 14 and was analyzed using descriptive statistics. Results: The mean medication administration error during the three months before and three months after the intervention were 12.41 ± 14.48 and 9.62 ± 12.72, respectively, which had a statistically significant difference (P = 0.004). Conclusions: Using the Drug Calculation Cards by nurses in

False Alarms and Overmonitoring: Major Factors in Alarm Fatigue Among Labor Nurses.

Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. Nurses were asked via focus groups about the utility of clinical alarms from medical devices. There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.

Mothers' Depression, Anxiety, and Mental Representations After Preterm Birth: A Study During the Infant's Hospitalization in a Neonatal Intensive Care Unit.

Aim: This paper aimed to explore psychological functioning and mental representations in mothers of preterm infants during the child's hospitalization in a Neonatal intensive care unit (NICU).Methods: A sample including 62 mothers of premature infants (gestational age < 37 weeks) was recruited in a NICU. According to the gestational age at the time of delivery, we considered two groups: Group A included mothers whose children were born before 32 weeks of pregnancy; Group B included mothers whose children were born at or after 32 weeks of pregnancy.Within one week of childbirth, mothers were administered two self-report questionnaires: the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). When their infants' medical conditions became stable, the Clinical Interview for Parents of High-Risk Infants (CLIP) was administered to mothers.Results: The results showed high levels of depression and anxiety in both groups of mothers, with higher state anxiety scores in Group A than Group B. Besides, a series of hierarchical regression analyses were conducted with STAI, EPDS, and gestational age as predictors on the CLIP scores. Results indicated that EPDS scores predicted CLIP scores on parental self-image, support system, and readiness for discharge (p < 0.001); moreover, the interaction among depression, anxiety, and gestational age predicted the CLIP dimension of feeling of mutual recognition (p < 0.005).Conclusions: These findings suggested that a premature birth and the child's hospitalization might exert a negative effect on the mothers' emotional state, their perception of parental self-image and, consequently, the early bond with the child—independent from the infants' gestational age at the time of the preterm delivery. The data underlined the importance of involving NICU nurses and clinicians in order to optimize the care for mothers immediately after the preterm birth and during the infant's hospitalization, taking into account psychological needs of mothers of both very preterm and moderately preterm infants.

Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit.

There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care. To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions. A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis. Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses. This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support. Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.

Associations Among Nurse Fatigue, Individual Nurse Factors, and Aspects of the Nursing Practice Environment.

This study examined the relationships among nurse fatigue, individual nurse factors, and the practice environment in the inpatient setting. Nurse fatigue affects the quality of care provision on inpatient units. Scant literature exists regarding how aspects of the practice environment relate to nurse fatigue. A cross-sectional, correlational design was used in this survey study of 175 neonatal intensive care unit nurses from multiple hospitals. Data were collected using the Checklist Individual Strength questionnaire and the Practice Environment Scale of the Nursing Work Index. Hierarchical regression analysis was performed to examine the relationships. Higher fatigue was significantly associated with more hours worked, fewer hours of sleep, a physical or mental contributor to fatigue, and a recent distressing patient event. Lower fatigue was significantly associated with better nurse manager ability, leadership, and support. Nurse fatigue may be diminished with organizational and individual strategies. Developing tactics for nurse managers to better support staff members after a recent distressing patient event is indicated.

Association of Nurse Workload With Missed Nursing Care in the Neonatal Intensive Care Unit

Quality improvement initiatives demonstrate the contribution of reliable nursing care to gains in clinical and safety outcomes in neonatal intensive care units (NICUs); when core care is missed, outcomes can worsen. To evaluate the association of NICU nurse workload with missed nursing care. A prospective design was used to evaluate associations between shift-level workload of individual nurses and missed care for assigned infants from March 1, 2013, through January 31, 2014, at a 52-bed level IV NICU in a Midwestern academic medical center. A convenience sample of registered nurses who provided direct patient care and completed unit orientation were enrolled. Nurses reported care during each shift for individual infants whose clinical data were extracted from the electronic health record. Data were analyzed from January 1, 2015, through August 13, 2018. Workload was assessed each shift with objective measures (infant-to-nurse staffing ratio and infant acuity scores) and a subjective measure (the National Aeronautics and Space Administration Task Load Index [NASA-TLX]). Missed nursing care was measured by self-report of omission of 11 essential care practices. Cross-classified, multilevel logistic regression models were used to estimate associations of workload with missed care. A total of 136 nurses provided reports of shift-level workload and missed nursing care for 418 infants during 332 shifts of 12 hours each. When workload variables were modeled independently, 7 of 12 models demonstrated a significant worsening association of increased infant-to-nurse ratio with odds of missed care (eg, nurses caring for ≥3 infants were 2.51 times more likely to report missing any care during the shift [95% credible interval, 1.81-3.47]), and all 12 models demonstrated a significant worsening association of increased NASA-TLX subjective workload ratings with odds of missed care (eg, each 5-point increase in a nurse's NASA-TLX rating during a shift was associated with a 34% increase in the likelihood of missing a nursing assessment for his or her assigned infant[s] during the same shift [95% credible interval, 1.30-1.39]). When modeling all workload variables jointly, only 4 of 12 models demonstrated significant association of staffing ratios with odds of missed care, whereas the association with NASA-TLX ratings remained significant in all models. Few associations of acuity scores were observed across modeling strategies. The workload of NICU nurses is significantly associated with missed nursing care, and subjective workload ratings are particularly important. Subjective workload represents an important aspect of nurse workload that remains largely unmeasured despite high potential for intervention.

Breastfeeding woman or lactating object? A critical philosophical discussion on the influence of Cartesian dualism on breastfeeding in the neonatal intensive care unit.

This discursive paper aims to bring to the foreground the ongoing influence of Cartesian dualism and other important contextual complexities on breastfeeding in the neonatal intensive care unit (NICU). Breastfeeding is widely supported as the optimal form of nutrition for the first 6months of life and beyond. Amidst a myriad of contextual factors, current breastfeeding rates are below globally targeted goals. For premature and/or critically ill infants, the importance of receiving breast milk is often encouraged based on its immunological and nutritive benefits as opposed to the entirety of the breastfeeding interaction, underscoring the influence of dualism in the NICU. The impact of Cartesian dualism and other sociocultural underpinnings of breastfeeding focused within the NICU environment are illustrated through a critical, philosophical discussion. Relevant historical context is provided followed by an overview of the realities of contemporary breastfeeding. These are presented as a frame of reference for the NICU breastfeeding experiences currently encountered by many mothers of preterm and critically ill neonates, further illustrated using a clinical exemplar as well as the author's own observations from neonatal nursing practice. Shifting away from a dualistic approach requires rethinking breastfeeding support interactions between NICU nurses and mothers. To address the disembodied and often mechanistic approach to care inherent in the dominant Western medical model, a relational approach to breastfeeding support in the NICU is suggested and discussed. Future research from a more critical lens is needed to examine the complex dynamics involved when nurses and mothers are negotiating decisions and processes related to infant feeding. In focusing on the relational dimensions of the breastfeeding experience, nurses can resist the dualistic influence and dominant discourses impacting infant feeding and motherhood in the 21st century.

Investigating of Moral Distress and Attitude to Euthanasia in the Intensive Care Unit Nurses

Background: Considering the religious and legal structures in Iran, the occurrence of euthanasia seems to be impossible; however, the attitude of nurses towards euthanasia and its related factors may also affect creating moral distress conditions for nurses. Therefore, this study aimed to investigate of the moral distress and attitude of Adult and Neonatal Intensive Care Units (AICU/ NICU) nurses toward euthanasia. Materials and Methods: In this descriptive-analytical study, all the nurses working in intensive care units of Educational Hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences (Ahvaz city, Iran) were selected by census. Data were collected using Corley's Moral Distress Scale and Holloway’s Euthanasia Attitude Scale. Single-variable and multivariate linear regression tests were used to analyze the data and to determine the relationships between independent and dependent variables. Analyses were done using SPSS software (version 22).Results: The attitude of all nurses towards euthanasia was negative (min score=20, max score=73, mean score= 43.78±7.99). The mean Moral distress frequency and Moral distress intensify were 47.01±12.90 and 48.42±11.62, respectively (indicates moderate ethical distress). In AICU nurses, there was a significant relationship between the frequency of moral distress and the nurses’ attitudes. However, there was no significant relationship between the intensity of moral distress and the nurses’ attitudes. In NICU nurses, there was no significant relationship between the frequency of moral distress and intensity of moral distress with nurses’ attitude toward euthanasia. Conclusion: The religious and cultural conditions of the country have caused all nurses did not consider euthanasia to be acceptable under any circumstances. Further studies are needed to better understand the attitude of nurses towards euthanasia, especially with regard to the culture of Iranian society.

Identification the best skin temperature probe attachment place in premature neonates nursed under radiant warmers in NICU: A diagnostic clinical trial study

BackgroundOptimizing thermal care is essential for premature neonates and is a major problem among researchers. Monitoring of skin temperature in premature neonates is usually done in neonatal intensive care units (NICUs). This study searched the skin temperature at 7 locations and then addressed the correlation of these locations with axillary temperature in order to identify the ideal skin temperature probe (STP) placement. MethodsThis diagnostic clinical trial was performed on 203 premature neonates cared under a radiant warmer (RW) with servo-control mode. STP was placed at different locations, including the chest, forehead, right axillary, arm, right hypochondrium of abdomen, thigh, and foot, in all the neonates. The total duration of measurement for the neonates was seven minutes. Concurrently, a digital thermometer was used at each location, recording 1428 measurements. In addition, agreement of STP with digital axillary thermometer measurements was also assessed. The significance level was P < 0.05. ResultsThe probe-measured temperature at the right hypochondrium of abdomen was consistent with the digital axillary temperature, compared to temperature measured at other sites. ConclusionIn premature neonates, proper placement of STP is necessary to monitor skin temperature safely and accurately. NICU nurses have this unique opportunity to determine the best STP placement site and to improve safe practice for optimal outcomes in neonates.

Brazilian Neonatal Nurses' Palliative Care Experiences.

The purpose of palliative care (PC) is to minimize suffering and improve quality of life. Although PC has been well studied, the experience of neonatal intensive care unit (NICU) nurses in Brazil, where little PC training is provided, requires further investigation. The objective of this study was to explore the PC experiences of Brazilian NICU nurses. An exploratory, qualitative, descriptive study was conducted using semistructured, individual interviews with NICU nurses. This study was conducted in a 30-bed NICU in a teaching hospital in Sao Paulo, Brazil. A convenience sample of registered nurses (N = 9) was recruited. Interviews were recorded and transcribed verbatim, and thematic analysis was used to analyze the data. Four themes were identified: (a) living with the grief, (b) identifying with the family, (c) providing humane care, and (d) feeling unprepared. Nurses experienced intense grief while providing PC. They closely identified with the families and aimed to provide humane care that respected the families' values and the infants as human beings. The nurses also felt they lacked adequate training in PC and expressed a need for additional education and emotional support. NICU nurses need adequate education and emotional support to ensure quality nursing care for this vulnerable population of infants and their families.

The effectiveness of Kangaroo Mother Care (KMC) on premature infant health progression in a neonatal care unit in Maternity and Children’s Hospital, Jeddah

Background: Preterm birth is considered to be the largest direct cause of neonatal mortality. Of all early neonatal deaths that have occurred within the first 7 days of life, 28% are due to preterm birth. The Kangaroo Mother Care (KMC) decreases risk of mortality, infection severity, increases infant growth, breastfeeding, and mother-infant attachment. The aim of this study is to evaluate the effectiveness of Kangaroo Mother Care on premature health progression in the neonatal care unit in the Maternity and Children’s Hospital, Jeddah. Method: Study Design: A quasi-experimental design was chosen, using data collected via the Kangaroo Mother Care Assessment Flow Sheet. Setting: Maternity and Children’s Hospital (MCH) Al-Mousaa'dya branch, a Ministry of Health (MOH) Governmental hospital, Jeddah, KSA Sample: A convenient Sample of thirty premature neonates who fulfilled the inclusion criteria who were admitted on the neonatal intensive care unit at the mentioned setting during data collection period. Permission had been obtained from all mothers of participating infants. A control group was used for comparison. Tools and instruments: The data were collected using the Kangaroo Mother Care Assessment Flow Sheet. Result: the survival rate of study group is very high as no death was noted, no statistical differences before and after KMC but the data showed that the health status of neonate was stabilized, also findings showed that weight gain increased from 1.36 kg in the first attempt to 1.48 Kg in the fifth attempt. Regarding length of stay, study group neonate had higher length of hospitalization (48±19.87) comparing to other studies Conclusion: Kangaroo Mother Care maintains all premature neonatal physiological parameters and weight gain while the neonatal length of stay in current study was high compared to other global studies. Recommendation: There is a necessity to implement KMC at all NICU in Ministry of Health Hospitals, to develop a protocol and guidelines for KMC implementation. To organize continuing nurse training and education program for neonatal intensive care units nurses. Further studies should be conducted on a larger scale in Kingdom of Saudi Arabia for generalizability and to study the factors of prolonged neonatal length of stay on NICU.

Altered CD4+ T cell immunity in nurses occupationally exposed to viral pathogens

Pathogen exposure, including but not limited to herpesviruses, moulds the shape of the immune system, both at a basal state and in response to immune challenge. However, little is known about the impact of high exposure to other viruses on baseline immune signatures and how the immune system copes with repetitive exposures to maintain a balanced functionality. Here we investigated baseline immune signatures, including detailed T cell phenotyping, antigen-specific CD4+ and CD8+ T cell responses and cytokine profile in paediatric (PED) nurses, who have high occupational exposure to viral pathogens including varicella zoster virus (VZV) and respiratory viruses, and in neonatal intensive care unit (NICU) nurses, as a control group with infrequent occupational exposure. Our results show a lower CD4+ T cell response to two VZV proteins (IE62 and gE) and to tetanus toxoid (TT) in PED nurses who are cytomegalovirus (CMV)-seronegative, compared to CMV-seronegative NICU nurses, and that the decline might be more pronounced the more sustained the exposure. This decline might be due to an attrition of VZV- and TT-specific T cells as a result of the continuous pressure on the CD4+ T cell compartment. Moreover, our data suggest that the distinct T cell phenotypes known to be associated with CMV-seropositivity might be less prominent in PED nurses compared to NICU nurses, implying a plausible attenuating effect of occupational exposure on CMV-associated immunosenescence. Overall, this pilot study reveals an impact of occupational exposure to viral pathogens on CD4+ T cell immunity and supports further investigation in a larger cohort.

Efficacy of Abdominal Massage on Feeding Intolerance of Preterm Neonates

Preterm neonates have an increased susceptibility to feeding intolerance which is one of the most significant contributors to their growth failure. Establishing and tolerating adequate enteral nutrition is difficult due to the immaturity of the gastrointestinal system; therefore it is crucial for neonatology nurses to detected this condition as early as possible and use intervention for tackling this problem to improve newborn outcome. Massage is one therapeutic nursing method that can stimulate the parasympathetic activity and induce a more effective response of the digestive system. The aim of this study was to evaluate the efficacy of abdominal massage on feeding intolerance of preterm neonates. A quasi- experimental research design was utilized to meet the aim of this study. Setting This study was conducted in Neonatal Intensive Care Unit (NICU) at Assiut University Children Hospital. Sampling: The study sample comprised all preterm neonates (60 preterm neonates) hospitalized during six months period in Neonatal Intensive Care Unit (NICU) at Assiut University Children Hospital. Three tools were used to collect the required data for this study: - Tool1- An interviewing questionnaire sheet, Tool II - Follow -up sheet and Tool III - Feeding intolerance assessment tool. Results: Highly statistically significant differences were found between the first day and 5th day related to feeding intolerance measurements parameters of the massage group (P=0.001) and the means of the abdominal circumference, the frequency of vomiting episodes, and the gastric residual volume in the massage group had decreased significantly in the 5th day of the intervention of abdominal massage, as compared with those in the first day and the frequency of defecation and daily weight gain had increased significantly. Concluded that abdominal massage has the potential effect to decrease the gastric residual volume, frequency of vomiting episodes, abdominal distension, and increase the weight and frequency of defecation in enterally fed preterm neonates. The study recommended changing the nursing practice in NICU nurses by emphasizing the importance of applying abdominal massage twice a day as a safe non-invasive intervention as standard of care in enterally fed preterm neonates'.

Going Along With It: Neonatal Intensive Care Nurses' Views of a Donor Milk Practice Change.

Donor human milk (DHM) is used when a mother's own milk is not available. Donor human milk is available as a frozen pasteurized or commercially sterilized product. An abrupt change in practice in use of donor milk products raised concerns among nurses caring for infants in the neonatal intensive care unit (NICU). The change in practice occurred without the input of nurses and without the sharing of supportive evidence with them. The purpose of this study was to explore NICU nurses' perceptions of the practice change from using frozen pasteurized DHM to using sterilized DHM in this context. A grounded theory study was conducted in a 38-bed Level III NICU. Nurse participants were interviewed using open-ended questions aimed at eliciting their perceptions of using pasteurized and sterilized DHM. There were nine nurse participants. They described their perceptions of feeling confident about pasteurized DHM to feeling uncertain about sterilized DHM. The core category of going along with it was linked to judging DHM based upon attributes, questioning benefits of sterilized DHM, and preferring past practice of using pasteurized DHM. Nurses noted that they could move from feeling uncertain about the practice change to feeling certain if they had evidence to support the practice change. Barriers to seeking evidence were time, knowledge, and waiting for someone else to do it. Practice change without interprofessional collaboration is threatened by uncertainty and lack of support for the new practice. Nurses want to give evidence-based care, but they often face barriers to seeking evidence. Removing barriers to evidence-based practice and including nurses as stakeholders in practice change decisions are suggested.