Neonatal Intensive Care Unit Nurses Research Articles

Neonatal intensive care unit nurse training in identifying ultrasound landmarks in the neonatal mediastinum. Α training program for nurses in North-Eastern Greece

PurposeTo demonstrate methods and landmarks for mediastinum ultrasound as part of ultrasound examination of the lung for nurses. This will be the first step in their education to detect finally the tubes and lines malpositioning in order to distinguish emergency conditions of the lungs in neonates hospitalized in neonatal intensive care units. Design and methodsTheoretical and practical interventions were developed to create a 3-month training program based on similar medical courses. The study was approved by the hospital's ethics committee.The program was performed in the neonatal intensive care unit of a single academic institution. Participating nurse was supervised by a paediatric surgeon and trained in lung ultrasound (a safe method without radiation) by a paediatric radiologist. ResultsDuring the practical period (2 months), the neonatal intensive care unit nurse examined 50 neonates (25 + 6–40 + 4 weeks gestational age; 21 males) separated into two subgroups of 25 neonates each for each training month. In the first month under supervision, the nurse was trained to recognise the aortic arch, the right pulmonary artery, the esophagus, the tracheal air, and the ‘sliding lung sign’ in the anterior, lateral, and posterolateral aspects of the thoracic cage. In the second month, the nurse recorded the ultrasound examinations. The identified structures were then assessed and graded by the supervising radiologist. The overall estimated success rate (5 landmarks × 25 neonates = 125) was 90.4%. ConclusionsAlthough this is the first report of the design of a ‘hands-on’, lung ultrasound training program for neonatal intensive care unit nurses, our findings demonstrate that it is a safe and useful program for all neonatal intensive care unit nurses because theoverall success rate of the 3-month program was determined by accurate identification of basic anatomical structures (90,4%) by the nurse. Practice implicationsThis study describes the first educational training program for NICU nurses designed to recognise basic structures in the neonatal mediastinum. If the program is effective, NICU nurses will be able to identify respiratory emergencies. NICU nurses can inform doctors about emergencies according to tubes and lines malpositioning in a timely manner to avoid negative consequences.

Family and Provider Experiences With Longitudinal Care Coordination for Infants With Medical Complexity.

Parents in the neonatal intensive care unit (NICU) report low self-confidence managing their children's ongoing medical and social needs. While bedside nurses provide critical support for families throughout their NICU admission, there may be a role for nursing coordination throughout hospitalization, discharge, and in the transition to outpatient care. This program evaluation explores parent and provider experiences of a novel longitudinal care coordination program for infants with medical complexity from the NICU through their first year of life post-discharge. First, a sequential exploratory mixed-methods approach was used to evaluate parental experiences (n = 5 interviewed followed by n = 23 surveyed). Provider perspectives were elicited through semi-structured interviews (n = 8) and focus groups (n = 26 in 3 groups). Parent-reported benefits included frequent communication and personalized support that met families' and patients' evolving needs. Care coordinators, who were trained as nurses and social workers, developed longitudinal relationships with parents. This seemed to facilitate individualized support throughout the first year of life. Providers reported that smaller caseloads were central to the success of the program. This longitudinal care coordination program can be used as a translatable model in NICUs elsewhere to address the unique needs of families of infants with medical complexity throughout the first year of life. Future implementations should consider how to expand program size while maintaining individualized supports. As the care coordinators are former NICU nurses and social workers, there may be a growing role for nursing coordination of care in the neonatal population.

Assessing virtual education on nurses’ perception and knowledge of developmental care of preterm infants: a quasi-experimental study

BackgroundTo implement developmental care accurately, neonatal intensive care unit nurses should have a proper understanding and sufficient knowledge in this field. Applying new approaches in education such as offline and online education help nurses improve their skills and knowledge. This study aimed to investigate the effect of virtual education on the perception and knowledge of neonatal developmental care in nurses working in neonatal intensive care units.MethodsThis quasi-experimental study was conducted using a pretest-posttest design with two groups. The participants were 60 nurses working in neonatal intensive care units who were selected using convenience sampling (30 persons in each group). The data were collected before and 1 month after the intervention. The participants in the intervention group received developmental care training using an electronic file uploaded to Navid Learning Management System, while the members of the control group received no intervention. The instruments used to collect the data were the Demographic Information Questionnaire, the Developmental Care Knowledge Scale, and the Developmental Care Perception Scale. The collected data were analyzed using SPSS V25 software. All statistical tests were performed at the significance level of 0.05.ResultsThe Developmental Care perception scores before the intervention in the control and intervention groups were 83.40 ± 11.36 and 84.53 ± 9.48, respectively, showing no statistically significant difference (P = 0.67). Also, Developmental Care perception scores after the intervention in the control and intervention groups were 83.16 ± 13.73, and 94.70 ± 6.89, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant (P < 0.903), while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention (P < 0.001).The Developmental Care Knowledge scores before the intervention in the control and intervention groups were 52.66 ± 18.08 and 77.16 ± 17.20, respectively, showing a statistically significant difference (P = 0.001). Also, Developmental Care Knowledge scores after the intervention in the control and intervention groups were 53.66 ± 26.55and 90.33 ± 13.82, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant, while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention.ConclusionThe results of this study showed that virtual education for the developmental care of premature infants plays an effective role in the perception and knowledge of nurses working in the neonatal intensive care unit. Therefore, the development of e-learning packages for developmental care and their availability for nurses can be a step to improve the quality of nursing care for infants admitted to the NICU.

The effect of gentle human touch on pain, comfort and physiological parameters in preterm infants during heel lancing

ObjectiveThis research was conducted to evaluate the effects of gentle human touch (GHT) on pain, comfort, and physiologic parameters in preterm infants during heel lancing. MethodThis prospective, assessor-blind, randomized controlled study was performed between August 10, 2021 and September 10, 2021 in the Neonatal Intensive Care Units (NICU) of a tertiary hospital in the Central Anatolia Region of Turkey. Fifty preterm infants were randomly appointed to GHT and control groups. The researcher applied GHT to the infants in the GHT group by placing one hand on the infant's head and the other hand on the lower abdomen covering the waist and hips for 15 min. Data were collected with a Questionnaire, Physiological Parameters Observation Form, Newborn Infant Pain Scale (NIPS), The Comfort Scale (COMFORT), and Pulse Oximeter. ResultsThe NIPS and COMFORT mean scores of preterm infants in the GHT group were lower during (p < 0.001, p < 0.05, respectively) and after heel lancing (p < 0.05, p < 0.001, respectively). There was no difference between the preterm infants' peak heart rate, respiratory rate, and SPO2 values in the GHT and control groups during and after heel lancing (p > 0.05). The study found that preterm infants in the GHT group had less crying time during the heel lancing (p < 0.001). ConclusionIt could recommend using in painful procedures because GHT may positively affect preterm infants' pain, comfort, and physiologic parameters. The results of this study will contribute to NICU nurses should include non-pharmacological methods such as GHT to decrease pain of preterm infants in procedural pain. Trial registrationClinicalTrials.gov (NCT05001191).

Effectiveness of an Intervention Program on Nurses’ Practices toward Neonatal Intubation Suctioning Procedure at Neonatal Intensive Care Unit

Intubation secretion suctioning is a scientific technique carried out by intensive care nurses to keep the airway open and hence the blood oxygen saturation level within normal range. The fluid suctioning process is one of the essential procedures and priorities for nursing performance in care. Objectives: This study aimed to determine the effectiveness of an intervention program on Nurses’ practices toward neonatal intubation suctioning procedure at neonatal intensive care unit. Methodology: This is a pre-experiment design conducted on nurses working in the Intensive Care Unit at Pediatric Teaching Hospital. It started from September 30, 2021 to March 15, 2022. An observational method was adopted to collect a sample of 24 nurses to analyze the effectiveness of an intervention program on nurses' practices. A two-part checklist was developed. The validity of the instrument was determined by a committee consisting of (10) specialists from different areas. SPSS version 24.0 was used to analyze the data. Results: The results of the study showed that the neonatal intensive care unit nurses who participated in the sample numbered (24), the practices towards suctioning intubation fluids were within a low and insufficient level in the pre-test, while the post-test for all three procedures domain were within the acceptable average level. Conclusions: The study showed that there are significant differences in the impact of the program on nurses’ practices before and after implementing the program on nurses, and this indicates an improvement in the work and practices of intensive care nurses towards implementing the procedure of suctioning intubation secretion for the neonatal. Recommendation: Implementation of the interventional program for nurses’ practices and circulating to nurses in all intensive care units Designing a guidebook for the program’s steps and the steps of the procedure for withdrawing fluid from the respiratory tract of the neonatal. Keywords: Intervention Program, Nurses’ Practices, Suctioning Procedure.

Medication errors in neonatal intensive care units: a multicenter qualitative study in the Palestinian practice

BackgroundNeonatal intensive care units are high-risk settings where medication errors can occur and cause harm to this fragile segment of patients. This multicenter qualitative study was conducted to describe medication errors that occurred in neonatal intensive care units in Palestine from the perspectives of healthcare providers.MethodsThis exploratory multicenter qualitative study was conducted and reported in adherence to the consolidated criteria for reporting qualitative research checklist. Semi-structured in-depth interviews were conducted with healthcare professionals (4 pediatricians/neonatologists and 11 intensive care unit nurses) who provided care services for patients admitted to neonatal intensive care units in Palestine. An interview schedule guided the semi-structured in-depth interviews. The qualitative interpretive description approach was used to thematically analyze the data.ResultsThe total duration of the interviews was 282 min. The healthcare providers described their experiences with 41 different medication errors. These medication errors were categorized under 3 categories and 10 subcategories. Errors that occurred while preparing/diluting/storing medications were related to calculations, using a wrong solvent/diluent, dilution errors, failure to adhere to guidelines while preparing the medication, failure to adhere to storage/packaging guidelines, and failure to adhere to labeling guidelines. Errors that occurred while prescribing/administering medications were related to inappropriate medication for the neonate, using a different administration technique from the one that was intended, and administering a different dose from the one that was intended. Errors that occurred after administering the medications were related to failure to adhere to monitoring guidelines.ConclusionIn this multicenter study, pediatricians/neonatologists and neonatal intensive care unit nurses described medication errors occurring in intensive care units in Palestine. Medication errors occurred in different stages of the medication process: preparation/dilution/storage, prescription/administration, and monitoring. Further studies are still needed to quantify medication errors occurring in the neonatal intensive care units and investigate if the designed strategies could be effective in minimizing the medication errors.

Nurses’ knowledge, attitude, and practice regarding the use of physical restraints in children in the intensive care setting in China: A cross-sectional multicentre study

ObjectiveThe objectives of this study were to investigate paediatric nurses’ knowledge, attitude, and practice (KAP) regarding the use of physical restraints and to explore the factors related to the use of physical restraints. Findings will provide a reference to develop standard procedures and training. BackgroundNurses' KAP regarding the use of physical restraints affect the use of physical restraints in the paediatric intensive care unit and neonatal intensive care unit. Understanding nurses’ decision-making processes should inform strategies and methods for effectively reducing and regulating the use of physical restraints in paediatric patients in the intensive care unit (ICU) in China. MethodsWe conducted a cross-sectional survey of 823 registered ICU nurses from 12 children's hospitals in China between April and June, 2020. ICU nurses' KAP regarding the use of physical restraints in children were evaluated using a structured self-administered questionnaire that was distributed through an online platform. Descriptive and multiple linear regression analyses were used to examine the factors that influenced ICU nurses' KAP regarding the use of physical restraints in children. ResultsOverall, 49.8% of respondents were paediatric intensive care unit nurses, 25.0% of respondents were neonatal intensive care unit nurses, and 25.2% of respondents were other ICU nurses; 58.44% of nurses had received some training on the use of physical restraints in children. Mean total scores on the items addressing ICU nurses’ knowledge (range, 0 [lowest level of knowledge] −11 [highest level of knowledge]), attitude (range, 11 [least likely to use physical restraint] - 55 [most likely to use physical restraint]), and practice (range, 14 [few skills] – 42 [good skills]) regarding the use of physical restraints in children were 8.00 ± 1.46, 30.67 ± 5.31, and 37.61 ± 3.46, respectively. Multiple linear regression analysis showed a higher level of education and less work experience (years) were related to higher knowledge scores; prior training in the use of physical restraint was related to lower attitude scores; and female, prior training in the use of physical restraints, and a higher level of education were related to higher practice scores. ConclusionsNurses would like to use physical restraints without physician approval in an emergency or when they could not pay close attention to a child. There are a few standardised training and lack of clinical guidelines for paediatric nurses. We recommend establishing a standard of care for physical restraints in paediatric patients.

Evaluación del dolor neonatal y opinión de los profesionales sobre el uso de un sistema automático para su valoración

Objective: to understand the characteristics of the evaluation of neonatal pain in Neonatal Intensive Care Units (NICUs) and the opinion of professionals about the use of an automatic assessment system. Method: a cross-sectional study (2017). Population: NICU nurses and doctors from Spanish hospitals. Data collection through online questionnaire which included variables of the professional profile, frequency of pain assessment, evaluation scale used, training received, difficulties perceived to assess pain, opinion about pain evaluation and about the use of an automatic assessment system. Descriptive statistical analysis; Jamovi 1.2.7® program.Results: there were 133 answers: 83.5% were women, with a mean age of 40 (9.43) years. 88% from tertiary level hospitals; 44.1% were Nursing professionals, and 72% with >6 years’ experience at the NICU. Of these respondents, 66.9% assessed pain according to the status of the newborn, 29.3% with a scale specific to the unit, 72.6% considered that there was a subjective component in the assessment, 48.1% did not receive any training to assess pain. An automatic system was regarded as useful by 93.2%, but for 36.1% it would not be reliable, and 23.3% reckoned that an automatic system could not replace human perception. Conclusions: no protocol by consensus was applied for pain assessment in newborns, there was variability, sometimes it was not measured due to lack of time, and when it was measured, data could be subjective. The majority considered that the use of an automatic pain assessment system could be useful, although some doubted its reliability due to lack of knowledge of the technology currently applied.

Revisiting the roles of neonatal intensive care unit nurses towards vision 2030 of Saudi Arabia: A descriptive phenomenological study.

The study aimed to revisit the roles of nurses working in the neonatal intensive care unit in a specific university hospital located in the Eastern Region to pursue Saudi Vision 2030-to provide excellent quality of life and well-being for its national citizens. The neonatal intensive care unit is one of the most crucial hospital units caring for high-risk neonates with conditions like pre- and post-maturity and congenital anomalies. The nurses' experiences are vital to achieving the Saudi Vision 2030's Health Sector Transformation Strategy. Descriptive Phenomenology. Data collection utilized semi-structured individual interviews with sixteen (16) neonatal intensive care unit nurses for 10 months from March 2019 to January 2020. Colaizzi Method was used in data analysis, and the COREQ criteria list was utilized in data reporting. Three major themes emerged from the participants' narratives: (1) 'mokadem alreayah alshamela': holistic caregiver; (2) 'muzawed malomat': information provider; and (3) 'yad almusaadah': helping hand. Revisiting the various roles will align neonatal intensive care unit nurses' critical characteristics towards Saudi Vision 2030, focusing solely on improving service providers' quality and safety principles and skills. Revisiting the roles of the neonatal intensive care unit nurses would provide an alignment to the goals and objectives of the future initiatives of Saudi Arabia towards its Vision 2030.

Knowledge, Attitudes, and Practices of NICU Doctors and Nurses Toward Prevention and Control of Nosocomial Infection With Multidrug Resistant Organism

BackgroundNosocomial infection with multidrug resistant organisms (MDRO) can directly influence the curative effect and the prognosis of neonates, bringing great difficulties to clinical treatment. As direct contacts of neonates, the knowledge, attitudes, and practices (KAP) of doctors and nurses are critical for the prevention and control of MDRO infection in neonatal intensive care units (NICUs).PurposeThis study describes the KAP of doctors and nurses in NICUs toward the prevention and control of nosocomial infection with MDRO and analyzes its influencing factors.MethodsThis cross-sectional study used convenience sampling to survey 397 doctors and nurses from the NICU of 28 hospitals in 11 cities in Zhejiang Province, China. A univariate analysis and a multiple linear regression were used to analyze the data.ResultsThe median scoring rate (interquartile range) of the knowledge, attitude, and practice questionnaire was 0.86 (0.82–0.91), 0.98 (0.91–1.00), and 0.995 (0.97–1.00), respectively. However, the median scoring rate regarding “basic knowledge of MDRO” and “special prevention and control measures” was 0.50 in knowledge. The multiple linear regression showed that the influencing factors of KAP were hospital grade, professional title, gender, regular supervision, and training.ConclusionsThere was still room for improvement in the KAP of NICU doctors and nurses, especially regarding the knowledge. Men, doctors and nurses in Grade II hospitals, and doctors and nurses with primary professional titles had worse KAP. Training and supervision helped improve the KAP.Relevance to Clinical PracticeTo improve the KAP of doctors and nurses to enhance the prevention and control effect for the MDRO infection in NICUs, hospitals and departments should carry out targeted training and strengthen supervision, while Grade II hospitals, men, and doctors and nurses with primary professional titles need more attention.

Do Pediatricians and Nurses Recommend Vaccines for Preterm Infants? A Survey in Italy

To assess the level of knowledge, attitudes, and behaviors regarding vaccination in preterm infants among primary care pediatricians (PCPs) and health care workers (HCWs) in neonatal intensive care units (NICUs). Data were collected from PCPs through a confidential questionnaire distributed by email, whereas the research team distributed a self-administered anonymous questionnaire to all HCWs working in the selected NICUs. Overall, 64.1% of HCWs consider vaccines in preterm infants to be very safe. The majority of HCWs (69.8%) stated that they always recommend that preterm infants' parents vaccinate their children following the same schedule as for term infants. This behavior was significantly more likely among those who know that the vaccination schedule for preterm infants is the same as for term infants, who consider vaccines in preterm infants very effective, and who strongly agree that preterm infants should be vaccinated on the same schedule as term infants. Moreover, PCPs were more likely than NICU pediatricians to always recommend that preterm infants' parents vaccinate their children following the immunization schedule of term infants, whereas this behavior was significantly less frequent among NICU nurses. There is a need for physicians and nurses in the NICU and in the community to counteract missed or delayed immunizations. Engagement of HCWs in healthcare quality improvement initiatives focused on the promotion of timely vaccinations in preterm infants should be encouraged.

Missed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: a descriptive study.

PurposePreventing missed care is important in neonatal intensive care units (NICUs) due to neonates’ vulnerabilities. This study examined missed care and its influencing factors among NICU nurses.MethodsMissed care among 120 Korean NICU nurses was measured using a cross-culturally adapted online questionnaire. The frequency of missed care for 32 nursing activities and the significance of 23 reasons for missed care were collected.ResultsAll participants had missed at least 1 activity, missing on average 19.35 activities during a typical work-day. The most common missed item was “provide developmental care for the baby”. The most common reason for missed care was “emergency within the unit or deterioration of one of the assigned patients”. The final regression model explained 9.6% of variance in missed care. The average daily number of assigned patients receiving inotropes or sedation over the last month influenced the total number of missed care items.ConclusionMissed care was affected by nurses’ workload related to the number of patients taking medication. Frequently missed activities, especially those related to developmental care, require patience and time, conflicting with safety prioritization and inadequate working conditions. NICU nurses’ working conditions should be improved to ensure adequate time for nursing activities.

Telecoaching Improves Positive Pressure Ventilation Performance During Simulated Neonatal Resuscitations.

Introduction:Positive pressure ventilation (PPV) is a critical skill for neonatal resuscitation. We hypothesized that telecoaching would improve PPV performance in neonatal providers during simulated neonatal resuscitations.Setting:Level IV neonatal intensive care unit (NICU).Methods:This prospective crossover study included 14 experienced NICU nurses and respiratory therapists who performed PPV on a mannequin that recorded parameters of ventilation efficiency. Participants were randomized to practice independently (control) or with live feedback from a remote facilitator through audiovisual connection (intervention) and then switched to the opposite group. Participants' mask leak percentage, ventilation rates, and pressure delivery were analyzed.Results:The primary outcome of mask leak percentage was significantly increased in the telecoaching group (19% [interquartile range {IQR} 14–59.25] vs. 100% [IQR 88–100] leak, p = 0.0001). The secondary outcome of peak inspiratory pressure (PIP) delivery was also increased (median 27.6 [IQR 23.5–34.7] vs. 23.3 [IQR 19.1–32.8] cmH2O, p < 0.001). Differences in ventilation rates were not statistically significant (55 vs. 58 breaths/min, p = 0.51).Conclusion:Participants demonstrated better PPV performance during telecoaching with less mask leak. The intervention group also had higher measured peak inspiratory pressures. Telecoaching may be a feasible method to provide real-time feedback to health care providers during simulated neonatal resuscitations.Hypothesis:Neonatal providers who receive telecoaching during simulated resuscitations will perform PPV more effectively than those who do not receive telecoaching.

Safe Sleep Program for the NICU Nursing Staff: A Pilot Program.

Following an assessment of safe sleep practices (SSP) and nurses' safe sleep knowledge in a Neonatal Intensive Care Unit (NICU), an evidence-based 2-part safe sleep program including nurse education and the use of safe sleep cards was developed in an attempt to increase SSP. A quality improvement project with time-series methodology, including observational and survey data collection. To assess SSP, sleep environment audits were completed pre- (N = 48) and post- safe sleep program (N = 44). To assess nurses' safe sleep knowledge, a safe sleep questionnaire was distributed pre-education (N = 48) and post-education (N = 23). The change in SSP (ΔSSP) following safe sleep program implementation and change in nurses' safe sleep knowledge (ΔKnowledge) following education. SSP increased from 25 percent to 61 percent compliance, and nurses' knowledge scores increased from 83 percent to 97 percent.

Graphene-Based Nanomaterial Catalysis

Open visiting policy (OVP) allows the family to access the infant 24 hours a day. Nurses' beliefs can help to better plan on visiting policies. This study investigated the attitudes of nurses in Neonatal Intensive Care Units (NICUs) towards open visiting.This descriptive cross-sectional study was conducted in NICUs of the three main hospitals in Iran. All nurses with six months of work experience participated to the study. The “Beliefs and Attitudes toward Visitation in NICU Questionnaire” (BAVNIQ) was used. The data were analyzed using SPSS software version 19.The cumulative percentage of agreement and disagreement of 113 participated nurses’ towards the OVP was 46% and 66.91%, respectively. The highest scores about open visiting was in the moderate and weak rank.The study showed that NICU nurses had a moderate to poor attitude towards OVP. Improving nurses attitudes before changing visiting policies seems indispensable.

Processes for stabilizing antimony catalysts

Open visiting policy (OVP) allows the family to access the infant 24 hours a day. Nurses' beliefs can help to better plan on visiting policies. This study investigated the attitudes of nurses in Neonatal Intensive Care Units (NICUs) towards open visiting.This descriptive cross-sectional study was conducted in NICUs of the three main hospitals in Iran. All nurses with six months of work experience participated to the study. The “Beliefs and Attitudes toward Visitation in NICU Questionnaire” (BAVNIQ) was used. The data were analyzed using SPSS software version 19.The cumulative percentage of agreement and disagreement of 113 participated nurses’ towards the OVP was 46% and 66.91%, respectively. The highest scores about open visiting was in the moderate and weak rank.The study showed that NICU nurses had a moderate to poor attitude towards OVP. Improving nurses attitudes before changing visiting policies seems indispensable.

A Standardized Training Program in Ultrasound-Guided Intravenous Line Placement: Improving Nurses' Confidence and Success.

Ultrasound-guided imagery to obtain peripheral intravenous (USGIV) access is a technique that can be used to increase successful peripheral intravenous catheter insertion rates. Improving rates of USGIV use will subsequently decrease central venous catheter use and thus decrease the time to treatment initiation, reduce costs, and improve patient satisfaction. Current available programs teach nurses USGIV use for the adult population, mainly with a focus on the emergency department. To address this gap in knowledge, a USGIV program aimed at the specific needs of the neonatal intensive care unit (NICU) nurse was developed and implemented. Twelve NICU nurses were trained in USGIV access during a 4-hour combination didactic and simulation-based program. Participants took a pretest survey assessing baseline knowledge and confidence levels related to USGIV access. After didactic lecture, participants worked at stations focused on USGIV access. An 80% benchmark for each participant was set for successful USGIV attempts during simulation. Participants' knowledge and confidence levels were reassessed at the end of the program. Posttest scores increased by an average of 25%, demonstrating increased knowledge. The pre- to posttest confidence scores increased by a minimum of 1.6 points (based on a 5-point Likert scale). All participants (n = 12) successfully demonstrated proficiency by achieving at least 80% of attempted USGIV access on a mannequin. This project demonstrated that USGIV catheter can be employed in neonatal patients by training NICU nurses in USGIV techniques.

Prevention of central line-associated bloodstream infections: ICU nurses' knowledge and barriers.

Central line-associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality. The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence-based guidelines in practice. A cross-sectional study. Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020. A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence-based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU. The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence-based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.

Emotional Closeness Among NICU Fathers: A Qualitative Descriptive Study.

The unique perspective of fathers with an infant in the neonatal unit on the development of emotional closeness toward their infant is not well understood. The purpose of this study is to explore experiences and instances of emotional closeness from the perspective of fathers as well as factors influencing emotional closeness during an infant's hospitalization in the neonatal unit. This qualitative descriptive study employed one-on-one interviews with fathers recruited in a level 3 neonatal unit. The interview data were analyzed with thematic analysis, and emerging themes and subthemes were organized according to dimensional analysis. Eight fathers agreed to take part in this study. According to the participants, emotional closeness was a complex process composed of multiple dimensions. More specifically, emotional closeness was a difficult-to-describe, mixed, and growing feeling influenced by multiple factors such as the environment, co-parenting, and the father-infant relationship. It occurred in the contexts of presence and separation in the neonatal unit and was part of the development of the father-infant relationship. The results presented in this article are important for neonatal intensive care unit nurses who support fathers in the development of their fathering role. By knowing more about the process and dimensions of emotional closeness, nurses can direct their interventions with fathers to enhance emotional closeness and better understand their experience. No previous study has addressed emotional closeness as a complex process with multiple components like the current study. These findings contribute to our understanding of the process of emotional closeness for fathers.

Improving Family-Centered Care for Infants in Neonatal Intensive Care Units: Recommendations From Frontline Healthcare Professionals.

Family-centered care is a philosophy and healthcare delivery model adopted by many neonatal intensive care units (NICUs) worldwide, yet practice varies widely. The aim of this study was to synthesize recommendations from frontline NICU healthcare professionals regarding family-centered care. Data were obtained from the baseline phase of a multicenter quasi-experimental study comparing usual family-centered NICU care (baseline) with mobile-enhanced family integrated care (intervention). Members of the NICU clinical care team completed a family-centered care survey and provided free-text comments regarding practice of family-centered care in their NICU and recommendations for improvement. The comments were analyzed using a directed content analysis approach by a research team that included NICU nurses and parents. Of the 382 NICU healthcare providers from 6 NICUs who completed the survey, 68 (18%) provided 89 free-text comments/recommendations about family-centered care. Almost all comments were provided by nurses (91%). Six main themes were identified: language translation; communication between staff and families; staffing and workflow; team culture and leadership; education; and NICU environment. The need for greater resources for staffing, education, and environmental supports was prominent among the comments, as was team culture and staff-parent communications. The NICU healthcare professionals identified a range of issues that support or impede delivery of family-centered care and provided actionable recommendations for improvement. Future research should include economic analyses that will enable determination of the return on investment so that NICUs can better justify the human and capital resources needed to implement high-quality family-centered care.