Neonatal Intensive Care Unit Nurses Research Articles

Simulation-Based Empathy Training Improves the Communication Skills of Neonatal Nurses

BackgroundEmpathy is a fundamental component of all relationships between health care workers and patients, but very little is known about how best to teach empathy to neonatal intensive care unit (NICU) nurses—particularly with respect to their ability to recognize and respond empathically to parents. This study describes the development and implementation of simulation-based empathic communication training and the evaluation of training efficacy. MethodA quasi-experimental, single-group design was used which was evaluated with a pretest and posttest. Thirty-two NICU nurses from a Chinese hospital participated in simulation-based training for empathic communication skills. Nurses completed an observer-reported assessment at both before and after training, as well as a survey on their self-reported attitude, confidence, and understanding of empathy. ResultsThe majority of nurses (>90%) were satisfied with the training. Their self-reported attitude and confidence concerning their empathy skills as well as their understanding of empathic communication reflected significant improvement. The behaviors of nurses toward communicating empathetically improved significantly after undergoing the simulation training (p < .001). ConclusionsThe training was effective for improving the ability of NICU nurses to communicate empathically with parents.

Neonatal intensive care nurses’ knowledge and beliefs regarding kangaroo care in China: a national survey

ObjectiveKangaroo care (KC), a well-established parent-based intervention in neonatal intensive care units (NICUs), with documented benefits for infants and their parents. However, in China there remains a lack of knowledge...

Introduction of Continuous Video EEG Monitoring into 2 Different NICU Models by Training Neonatal Nurses.

Continuous video electroencephalographic (EEG) (cvEEG) monitoring is emerging as the standard of care for diagnosis and management of neonatal seizures. However, cvEEG is labor-intensive and the need to initiate and interpret studies on a 24-hour basis is a major limitation. This study aims at establishing consistency in monitoring of newborns admitted to 2 different neonatal intensive care units (NICUs) managed by the same neurocritical care team. Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues, and identify amplitude-integrated EEG abnormalities. Guidelines, checklists, and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. A cohort of 100 infants with moderate to severe hypoxic-ischemic encephalopathy before and after the training program was compared. During the study period, 192 cvEEGs were obtained. The time to initiate brain monitoring decreased by 31.5 hours posttraining; this, in turn, led to an increase in electrographic seizure detection (20% before vs 34% after), decrease in seizure clinical misdiagnosis (65% before and 36% after), and reduction in antiseizure medication burden. Training experienced NICU nurses to set up, start, and monitor cvEEGs can decrease the time to initiate cvEEGs, which may lead to better seizure diagnosis and management. Further understanding of practice bundles for best supporting infants at risk and being treated for seizures needs to be evaluated for integration into practice.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Factors affecting Korean neonatal nurses' pain care: Psychometric evaluation of three instruments.

The purpose of this study was to evaluate the psychometric properties of the Korean-language versions of Pain Knowledge and Use (PKU-K), Collaboration and Satisfaction About Care Decisions (CSACD-K), and Environmental Complexity Scale (ECS-K). A cross-sectional design was used with a convenience sample of 159 Korean nurses in seven neonatal intensive care units (NICUs). The data were collected by surveying the nurses with the PKU-K, CSACD-K, and ECS-K. Internal consistency reliability was assessed and Horn's parallel analysis, a confirmatory factor analysis, and a convergent construct validity test were conducted in order to evaluate the psychometric properties of the instruments. The PKU-K, CSACD-K, and ECS-K exhibited strong internal consistency reliability. Horn's parallel analysis showed four factor structures for the PKU-K, one for the CSACD-K, and three for the ECS-K. The confirmatory factor analysis showed a good model fit for the PKU-K and CSACD-K, but the ECS-K model showed a poor fit. Most factor loadings were statistically significant. The CSACD-K's convergent validity was supported by significant correlations for collegial nurse-physician relations with a validated instrument. The findings support the reliability and validity of the PKU-K, CSACD-K, and ECS-K for measuring nurses' knowledge about neonatal pain care, nurse-physician collaboration, and the work environment in NICUs. However, the ECS-K needs further refinement before it is applied to Korean NICU nurses.

Targeted educational program improves infant positioning practice in the NICU

Infant positioning may interfere with neuromotor development. Bedside education and Infant Positioning Assessment Tool (IPAT) improve nurses' and doctors' proficiency in applying proper infant positioning. Nursing compliance with proper positioning is suboptimal due to many factors. One factor was the inadequate knowledge and practice of infant positioning, since the baseline mean IPAT score was 3.4. Three experienced neonatal intensive care unit (NICU) nurses were chosen as position champions to help other NICU nurses apply proper positioning and monitor IPAT scores. Education and hands-on demonstration sessions were developed based on the observed baseline practice. Periodic education with hands-on demonstration was given to NICU nurses and residents. Infants' positions were objectively scored using IPAT. Two Plan, Do, Study and Act cycles were completed and adjustments were made based on each cycle's achieved results. Mean IPAT scores increased from 3.4 at baseline and 6.3 in the second cycle to 7.3 in the third cycle of intervention. A systematic approach targeting infants' positioning succeeded in improving nurses' and residents' clinical performance. Not reaching significant change until after 18 months highlights the difficulty and complexity in changing behaviors.

Impact of family integrated care on infants\u2019 clinical outcomes in two children\u2019s hospitals in China: a pre-post intervention study

BackgroundMost Neonatal Intensive Care Units (NICUs) in China have restricted visiting policies for parents. This also implicates that parents are not involved in the care of their infant. Family Integrated Care (FIC), empowering parents in direct care delivery and decisions, is becoming the standard in NICUs in many countries and can improve quality-of-life and health outcomes of preterm infants. The aim of this study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Dysplasia (BPD).MethodsA pre-post intervention study was conducted at NICUs in two Chinese children’s hospitals. Infants with BPD were included: pre-intervention group (n = 134) from December 2015 to September 2016, post-intervention (FIC) group (n = 115) and their parents from October 2016 to June 2017. NICU nurses were trained between July and September 2016 to deliver the FIC intervention, including parent education and support. Parents had to be present and care for their infant minimal three hours a day. The infants’ outcome measures were length-of-stay, breastfeeding, weight gain, respiratory and oxygen support, and parent hospital expenses.ResultsCompared with control group (n = 134), the FIC group (n = 115) had significantly increased breastfeeding rates (83% versus 71%, p = 0.030), breastfeeding time (31 days versus 19 days, p < 0.001), enteral nutrition time (50 days versus 34 days, p < 0.001), weight gain (29 g/day versus 23 g/day, p = 0.002), and significantly lower respiratory support time (16 days versus 25 days, p < 0.001). Oxygen Exposure Time decreased but not significant (39 days versus 41 days p = 0.393). Parents hospital expenses in local Chinese RMB currency was not significant (84 K versus 88 K, p = 0.391).ConclusionThe results of our study suggests that FIC is feasible in two Chinese NICUs and might improve clinical outcomes of preterm infants with BPD. Further research is needed to include all infants admitted to NICUs and should include parent reported outcome measures. Our study may help other NICUs with limited parental access to implement FIC to enhance parental empowerment and involvement in the care of their infant.

Impact of Instructions on the Developmental Status of Premature Infants on the Clinical Practice of Neonatal Intensive Care Unit (NICU) Nurses

Background: Stabilization of the conditions of infants is essential to the neurodevelopmental interventions in neonatal intensive care units (NICUs). Premature infants are born before the third trimester of pregnancy is completed, which disrupts the evolutionary process associated with brain development in neonates. Given the importance of the position of preterm infants and limited findings on nursing education in NICUs, the present study aimed to conduct a training intervention to improve the performance of nurses to properly implement the evolutionary positions of premature infants in the NICU. We also investigated the impact of instructions on the evolutionary status of preterm infants on the clinical practices in the NICUs of the hospitals affiliated to Iran University of Medical Sciences.Methods: This quasi-experimental study was conducted on 85 NICU nurses selected via convenience sampling. Performance of the nurses in implementing the evolutionary supportive status on the preterm infants admitted to the NICU was assessed and compared using a neonatal assessment tool before, one week, and two months after the intervention.Results: Analysis of the demographic data indicated that the majority of the NICU nurses had a master’s degree (98.8%), most of whom were aged more than 30 years (48.2%). Nurses constituted the majority of the participants (97.6%), who had the highest work experience (5-10 years) (42.4%). A significant difference was observed in the performance scores of nurses in the evolutionary support status of premature infants before, one week, and two months after the training (P>0.001).Conclusion: According to the results, training on the emergency support status of premature infants had a positive effect on the nursing performance in NICUs.

Experiences of the Iranian Neonatal Intensive Care Unit Nurses in Implementing Family-Centered Care: Walking on an Insecure Foundation

Background: Most of the nurses have accepted family-centered care (FCC) as a standard model of care; however, they meet difficulties using this model. The aim of this study was to explore the perception of Neonatal Intensive Care Unit (NICU) nurses about the implementation of FCC.Methods: This qualitative study was carried out on 11 in-service NICU nurses with at least three years of work experience using an interpretative phenomenological approach. The study setting was three separate NICUs of three teaching hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran. Data collection was performed through semi-structured interviews and field notes. The data were analyzed using the seven-stage Diekelmann, Allen, and Tanner approach.Results: One of the important themes emerging in this study was “Walking on an insecure foundation” that included three subthemes of “Inappropriate base”, “A pathway with no lines” and “Unequal encounter”. The nurses described a lack of facilities, inadequate space, and staff’s specific instruction in encouraging parents’ engagement, as well as high work pressure due to short staffing as factors that affected their ability to provide an ideal FCC.Conclusion: As the findings indicated, the lack of essential substructures and absence of a systematic program to engage parents in the care process of their infants have resulted in different operations by the nurses and discontinuous FCC implementation in NICUs. Officials and policy-makers should consider basic requirements, adequate workforce, and explicit guidelines to contextualize and guarantee the continuity of FCC.

Abstract PD-033: A PRE-POST INTERVENTION STUDY TO ASSES THE IMPACT OF FAMILY INTEGRATED CARE ON INFANTS’ CLINICAL OUTCOMES IN TWO CHINESE NEONATAL INTENSIVE CARE UNITS

Aims & Objectives: In China, parents have limited access to Neonatal Intensive Care Units (NICUs) and are not integrated in the care of their preterm infant during hospitalization. Family Integrated Care (FIC) is a model where parents become the primary caretaker to improve quality-of-life and health outcomes of preterm infants. The aim of the study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Disease (BPD). Methods A pre-post intervention study at NICUs in two Chines children’s hospitals. The pre-intervention group included infants (n=134) hospitalized from December 2015 to September 2016; FIC group were infants (n=115) admitted between October 2016 to June 2017. NICU nurses were trained, July to September 2016, to deliver the FIC intervention; parent education and support. Parents needed to take care for their infant for minimal three hours a day. Outcome measures were length-of-stay, breastfeeding, weight gain, respiratory and oxygen support. Results Compared with control group (n=134), FIC group (n=115) had significantly higher breastfeeding rate (χ2 = 4.696, p=0.030), breastfeeding time (t = 4.501, p<0.001), enteral nutrition time (t = 7.195, p<0.001), weight gain (t=3.180,p=0.002), and significantly lower respiratory support time (t = -5.388, p<0.001). Oxygen Exposure Time decreased but not significant (39.38 ± 14.918 VS 40.94 ± 13.786; p=0.393) (Table 1).Conclusions Our study suggests that educating and involving parents in the care might improve clinical outcomes of preterm infants with BPD and provides a reference for further implementation of FIC to enhance parental involvement in those NICU with limited parental participation.

Reducing the Burden of Discharge Training & Education for Neonatal Intensive Care Unit (NICU) Nurses and Families

Background: NICU discharges are prone to miscommunications particularly after prolonged length of stay (LOS). Early two-way communication between parents and the team provides emotional support and a timely method of addressing concerns (Purdy et al, 2015). Our satisfaction surveys showed that parents were unfamiliar with discharge requirements and had little time to learn skills in preparation for independent care. Moreover, nurses and families alike were dissatisfied with the burden of being rushed to teach and learn new caregiving skills on day of discharge. Objective: To increase the percent of staff-led discharge education and training tasks initiated with caregivers >24 hours before discharge to home …

Reducing the Burden of Discharge Training &amp; Education for Neonatal Intensive Care Unit (NICU) Nurses and Families

Reducing the Burden of Discharge Training &amp; Education for Neonatal Intensive Care Unit (NICU) Nurses and Families

Knowledge and Performance of Developmentally Supportive Positioning for Premature Infants among Neonatal Intensive Care Unit Nurses

Purpose This study was conducted to assess the knowledge and performance of developmentally supportive positioning for premature infants (DSPP) among neonatal intensive care unit (NICU) nurses. Methods The participants in this study were 131 nurses working in the NICU at five university hospitals in Daejeon and the city of Cheong-ju. The collected data were analyzed with descriptive statistics, the t-test, analysis of variance, and Pearson correlation coefficients using SPSS for Windows version 22.0. Results NICU nurses’ average DSPP knowledge score was 24.7 out of 33.0, and their average DSPP performance score was 3.2 out of 4.0. A statistically significant positive correlation was observed between knowledge and performance of DSPP (r=.32, p<.001). Conclusion To improve the level of NICU nurses’ knowledge and performance of DSPP, educational programs should be developed and their effectiveness should be verified. Key words: 지식; 간호사; ì‹ ìƒì•„ì§‘ì¤‘ì¹˜ë£Œì‹¤; 환자 ì²´ìœ„ìœ ì§€; 미숙아 Key words: Knowledge; Nurses; Neonatal intensive care units; Patient positioning; Premature infants

Factors Associated with the Method of Feeding Preterm Infants after Hospital Discharge

Purpose To investigate factors that may affect the method of feeding among preterm infants at 4 weeks after discharge. Methods This study included 222 mother-infant dyads born before a gestational age of 37 weeks. The feeding method and general medical characteristics of the participants were assessed at 4 weeks after discharge using a structured questionnaire. Multinomial logistic regression analysis was used to examine which factors were associated with breastfeeding at home. Results Of the 222 infants who qualified for the study, 71 (32.9%) continued to receive breastmilk at 4 weeks post-discharge. Multinomial logistic regression analysis showed that breastfeeding at 4 weeks post-discharge was associated with higher breastfeeding self-efficacy, vaginal delivery (experience), direct breastfeeding in the neonatal intensive care unit (NICU), gestational age between 30 and 34 weeks, and breastmilk consumption in the NICU. The following factors were associated with mixed feeding at 4 weeks post-discharge: being employed, having higher breastfeeding self-efficacy, and direct breastfeeding in the NICU. Conclusion NICU nurses should provide opportunities for direct breastfeeding during hospitalization and support breastfeeding to enhance breastfeeding self-efficacy. These factors may help to ensure the continuation of breastfeeding after discharge. Moreover, factors that affect breastfeeding should be considered when providing interventions. Key words: ëª¨ìœ ìˆ˜ìœ ; ë¶„ìœ ; ìˆ˜ìœ ë°©ë²•; 미숙아; 퇴원 Key words: Breastfeeding; Infant formula; Feeding method; Preterm birth; Patient discharge

The relationship between social support and the quality of working life of neonatal intensive care unit nurses in selected hospitals of Ahwaz University of Medical Sciences-2016

Abstract Background and Objectives : Social supports have a key role in nurses’ quality of life. The present study aimed to measure the quality of and social support and examine their relationship in neonatal intensive care unit nurses. Materials and Methods : In the present descriptive-correlational study, statistical population consisted of nurses in neonatal intensive care units of selected hospitals affiliated to Ahwaz University of Medical Sciences, selected by census. Tools used included Zimet et al. Social Support Scale and Brooks' Quality of Working Life of Nurses questionnaire. Validity of this questionnaire was confirmed by 12 experts, and its reliability was confirmed by Cronbach's alpha coefficient. Data were analyzed in SPSS-20. Results The highest mean value in social support pertained to family dimension (5.190) and the lowest to friends (4.505), and overall mean social support value was 4.785. The quality of had the highest mean value in working life dimension (3.672) and the lowest in personal life (3.350), and overall mean value of quality of was 3.550 in nurses. The results obtained showed a significant relationship and a positive correlation between social support and the quality of in nurses (P=0.012, r=0.251). Discussion and conclusion : The results obtained showed a significant and positive relationship between social support and the quality of in nurses. But, the relationship between subscales of these two variables was mildly confirmed. Generally, the present study results concur with the results of previous studies.

Changing Neonatal Nurses' Perceptions of Caring for Infants Experiencing Neonatal Abstinence Syndrome and Their Mothers

Neonatal intensive care units (NICUs) are caring for an increasing number of infants born with neonatal abstinence syndrome (NAS). The literature identifies the need for education for NICU nurses on NAS including skills for interacting with the mother with substance use disorder. An evidence-based practice project was developed to offer an educational presentation targeting these topics to 206 NICU participants (93% registered nurses, 1% licensed vocational nurses, and 6% nursing assistants) at a level IV NICU. A pretest/posttest was developed to assess knowledge of the participants prior to and after completion of the educational presentation. A posteducational questionnaire was developed to evaluate the skills learned for interacting with the mother with substance use disorder and the participant's professional readiness. The posttest demonstrated a statistically significant (P < .001) increase in knowledge of NAS. On the post-educational questionnaire, 96% of participants correctly identified 3 skills they would use clinically with mothers with substance use disorder and 84% of participants identified 2 personal strengths and 2 weaknesses that influence their care of infants with NAS and their families (professional readiness). These results demonstrate that this educational presentation was effective and should be replicated at other facilities to improve the knowledge and skills of NICU nurses to promote improved care for infants with NAS. Future studies should examine the impact on patient outcomes by preforming post-discharge interviews with the mothers of infants with NAS in the NICU pre- and post-educational intervention. Expanding the presentation into an interprofessional educational opportunity would promote increased knowledge and care by the entire multidisciplinary team.

The Effect of Educating the Use of Developmental Positions of Premature Infants on the Clinical Performance of Neonatal Intensive Care Unit Nurses

The Effect of Educating the Use of Developmental Positions of Premature Infants on the Clinical Performance of Neonatal Intensive Care Unit Nurses

Collaboration challenges faced by nurses when premature infants are discharged.

To explore the collaboration challenges faced by neonatal intensive care unit (NICU) nurses and public health nurses when preparing premature infants for transition home and to explore the culture of cooperation between the two professional groups. Qualitative individual interviews were undertaken with two NICU nurses and two public health nurses. A qualitative content analysis was used to analyse the data. Three main themes were identified: different expectations and lack of communication between NICU nurses and public health nurses; responsibilities and interactions between the two professional groups were not clearly defined; and the public health nurses' competence was not recognised by the NICU nurses and parents. There is a need of clear guidelines about the discharge process from the NICU. This issue must be given further attention.

The five-factor model of personality, work stress and professional quality of life in neonatal intensive care unit nurses.

The study aim was to determine the direct and indirect relations of the five-factor model of personality traits and work stress with professional quality of life in neonatal nurses. Neonatal intensive care nursing has positive and negative effects on neonatal nurses' psychological well-being. Although individual and situational factors interact to influence professional quality of life, there have been few studies of these relationships in neonatal nurses. A cross-sectional study conducted in 2016. Self-report questionnaires were used to measure professional quality of life (burnout, secondary traumatic stress and compassion satisfaction), five-factor model of personality traits (neuroticism, agreeableness, extraversion, conscientiousness and openness) and work stress (role ambiguity, role conflict and role overload). One hundred and forty (34%) of 405 eligible neonatal nurses provided the data. After controlling for work stress, neuroticism and agreeableness were related to burnout, neuroticism was related to secondary traumatic stress, and extraversion was related to compassion satisfaction. Work stress controlled for personality traits was related to burnout and secondary traumatic stress, but not to compassion satisfaction. Neuroticism moderated the effect of work stress on secondary traumatic stress and agreeableness and openness moderated the effect of work stress on compassion satisfaction. Work stress mediated the effect of neuroticism and extraversion on burnout and the effects of extraversion and conscientiousness on compassion satisfaction. Strategies to reduce work stress may not lessen burnout and secondary traumatic stress or increase compassion satisfaction in neonatal nurses who are prone to high neuroticism, low agreeableness and low extraversion.

Decision-making at the limit of viability: differing perceptions and opinions between neonatal physicians and nurses

BackgroundIn the last 20 years, the chances for intact survival for extremely preterm infants have increased in high income countries. Decisions about withholding or withdrawing intensive care remain a major challenge in infants born at the limits of viability. Shared decision-making regarding these fragile infants between health care professionals and parents has become the preferred model today. However, there is an ongoing ethical debate on how decisions regarding life-sustaining treatment should be reached and who should have the final word when health care professionals and parents do not agree. We designed a survey among neonatologists and neonatal nurses to analyze practices, difficulties and parental involvement in end-of-life decisions for extremely preterm infants.MethodsAll 552 physicians and nurses with at least 12 months work experience in level III neonatal intensive care units (NICU) in Switzerland were invited to participate in an online survey with 50 questions. Differences between neonatologists and NICU nurses and between language regions were explored.ResultsNinety six of 121 (79%) physicians and 302 of 431(70%) nurses completed the online questionnaire. The following difficulties with end-of-life decision-making were reported more frequently by nurses than physicians: insufficient time for decision-making, legal constraints and lack of consistent unit policies. Nurses also mentioned a lack of solidarity in our society and shortage of services for disabled more often than physicians. In the context of limiting intensive care in selected circumstances, nurses considered withholding tube feedings and respiratory support less acceptable than physicians. Nurses were more reluctant to give parents full authority to decide on the course of action for their infant. In contrast to professional category (nurse or physician), language region, professional experience and religion had little influence if any on the answers given.ConclusionsPhysicians and nurses differ in many aspects of how and by whom end-of-life decisions should be made in extremely preterm infants. The divergencies between nurses and physicians may be due to differences in ethics education, varying focus in patient care and direct exposure to the patients. Acknowledging these differences is important to avoid potential conflicts within the neonatal team but also with parents in the process of end-of-life decision-making in preterm infants born at the limits of viability.

Dark and Bright-Two Sides of Family-Centered Care in the NICU: A Qualitative Study.

Nurses in the Neonatal Intensive Care Unit (NICU) have an important role in implementing family-centered care (FCC). The aim of the study was to explore the lived experiences of NICU nurses on implementing FCC. An interpretative phenomenological study was conducted and 11 employed nurses were interviewed from April 2015 to February 2016. The data were analyzed through the Diekelmann, Allen, and Tanner approach. Four main themes of "strain to achieve stability," "bewildered by taking multiple roles," "accepting the family," and "reaching bright horizon" were extracted. This study provided deeper understanding about nurses' perceptions of FCC implementation. In Muslim developing countries, FCC implementation is challenging and nurses are under extra pressure because of a shortage in nursing workforce; however, having positive experiences with family participation and valuing theism beliefs allowed them to support family involvement. Support of nurses to take FCC strategies in the NICU is needed by officials overseeing the health care system.