Neonatal Intensive Care Unit Nurses Research Articles

Relief and care in the shade: A concept extracted from practices of neonatal nurses during pain management

Background & Aim: Nowadays, despite the improvements in the knowledge and attitude of healthcare professionals, there are still obstacles against pain management in neonatal intensive care units. Hence, it is necessary to know about the problems of pain management in neonatal intensive care units. This research aimed to explore the pain management experiences of neonatal intensive care unit nurses and neonatologists. Methods & Materials: This content analysis study was conducted on six experienced neonatal intensive care units nurses and two neonatologists in one hospital affiliated to Shiraz University of Medical Sciences who were selected through purposive sampling which continued until saturation. The data were collected through semi-structured interviews and field notes. The data were simultaneously analyzed using inductive content analysis. Results: Analysis of the data generated one theme and three categories and seven subcategories. The theme was “pain relief in the shade”. The categories were “responsibility versus ignorance”, “family caregiver as a barrier or facilitator”, and “newborn, sacrificed due to imbalanced context”. This study showed that professional caregivers managed pain on the margin of other cares. The effects of family care were identified as paradox, helping, or disturbing. The participants also emphasized the impact of environmental disruptions on pain management. Conclusion: The experiences of pain management in neonatal intensive care units were identified at three levels of professional caregivers, family caregivers, and organizational atmosphere. Exploring this experience could help improve pain management and reduce its side effects in susceptible neonates. Hence, healthcare workers are recommended to ensure effective pain management in neonatal intensive care units by ongoing monitoring and audit.

Early Inflammatory Measures and Neurodevelopmental Outcomes in Preterm Infants.

Inflammation may be an important predictor of long-term neurodevelopment in preterm infants. The identification of specific inflammatory biomarkers that predict outcomes is an important research goal. The purpose of this analysis was to identify associations between an early measure of inflammation and neurodevelopment in very preterm infants and to identify differences in the relationship between inflammation and neurodevelopment based on infant gender and race. We conducted a secondary analysis of data from a randomized controlled trial of a caregiving intervention for preterm infants born less than 33 weeks postmenstrual age. Plasma was collected with a clinically indicated laboratory draw by neonatal intensive care unit nurses and analyzed by multiplex assay for cytokines, chemokines, and growth factors. Neurobehavior was assessed by research nurses at the time of discharge from the neonatal intensive care unit using the motor development and vigor and alertness/orientation clusters from the Neurobehavioral Assessment of the Preterm Infant. Neurodevelopment was assessed at 6 months corrected age by the developmental specialist in the hospital's neonatal follow-up clinic using the Bayley Scales of Infant Development, Third Edition. We used linear regressions to estimate the effect of cytokine levels on neurodevelopment and allowed the effects to differ by infant gender and race. In a sample of 62 preterm infants with discharge neurobehavioral assessments and a sample of 40 preterm infants with 6-month neurodevelopmental assessments, we found inconsistent associations between single-time point inflammatory measures and neurobehavior or neurodevelopment in analyses of the total sample. However, regressions with interactions revealed effects for multiple inflammatory measures on early neurobehavior and neurodevelopment that differed by infant gender and race. Although early single-time point measures of inflammation may be insufficient to predict neurodevelopment for all preterm infants, the effect of inflammation appears to differ by infant gender and race. These demographic factors may be important considerations for future studies of inflammation and neurodevelopment as well was the development of future interventions to optimize outcomes.

Effect of a Computer-Based Learning Module on Nurses' Performance Regarding Safety Arterial Blood Gases Sampling for High Risk Neonates

Arterial blood gases analysis considered a method for monitoring high-risk neonate's condition as it provides the basic information for determining the adequacy of alveolar ventilation, acid-base status and oxygenation. Nurses' attention should be given to the following factors; infection control or universal precautions as the neonates are at high risk of infection. Aim: The study aimed to evaluate the effect of a computer-based learning module on nurses' performance regarding safety arterial blood gases sampling for high risk neonates. Methods: A quasi-experimental research design conducted at Neonatal Intensive Care Units (NICUs) and Surgical Neonatal Intensive Care Unit SNICU of Benha Specialized Pediatric Hospital. A purposive sample of available nurses (62) and high-risk neonates (74). Researchers used three tools as Online nurses' self-administered questionnaire designed to assess nurses’ personal characteristics and nurses' knowledge regarding safe blood sampling for high-risk neonates. The second tool was nursing practice observation checklists. The third tool was High-risk Neonates' Medical Assessment Record. Results: Findings of the current study revealed a statistically significant difference pre and post computerized-based learning module implementation regarding safety arterial blood gases for high-risk neonates. The results also revealed a highly statistically significant difference in nursing knowledge and practices (p < 0.001). Conclusion: It can be concluded that the research hypothesis is accepted, the implemented computerized-based learning module improved nurses' knowledge and practices towards safety arterial blood gases sampling for high-risk neonates. The study recommended conducting periodical online programs for nurses in NICUs with continuous regular updating of knowledge and practice regarding safe arterial blood gases sampling for high-risk neonates.

The Problems of Nurses Working in the Newborn Intensive Care Unit: A Qualitative Research

Amaç: Yenidoğan yoğun bakım ünitesinde (YYBÜ) çalışan hemşirelerin yaşadığı sorunları belirlemektir.Yöntem: Çalışma niteliksel, fenomenolojik bir çalışmadır. Ocak-Ekim 2019 tarihleri arasında yapılmıştır. Çalışmaya farklı hastanelerde çalışan 17 YYBÜ hemşiresi katılmıştır. Çalışmada araştırmacılar tarafından oluşturulan veri toplama formunda; sosyo-demografik verilerden oluşan birinci bölüm sekiz sorudan ve araştırma sorularının bulunduğu ikinci bölüm 12 açık uçlu sorudan oluşmaktadır. Veriler araştırmacılar tarafından kodlanmış, tematik analiz yapılmıştır. Bulgular: Çalışmaya katılan hemşirelerin yaş ortalaması 29.13’ yıl ve YYBÜ’de çalışma süre ortalaması 5,73 yıldır. Hemşirelerin, 15’i üniversite mezunu, ikisi lise mezunu ve yedisi evlidir. Çalışma sonucunda dört tema belirlenmiştir: Sağlık sorunları, psikososyal sorunlar, mesleki sorunlar ve etik-manevi sorunlarSonuç: Hemşireler YYBÜ’de çalışmaktan dolayı varis gibi sağlık sorunları yaşamaktadır. Psikolojik, sosyal ve ekonomik olarak negatif etkilenmektedir. Mesleki hastalıklar açısından riskler taşımaktadırlar. Sağlık çalışanlarının sayı ve niteliğindeki yetersizlikler, cihaz ve malzeme sıkıntısı, hemşire başına düşen hasta sayısının standartları aşması ve buna bağlı bakım kalitesinde düşmeler gibi hasta bakımını etkileyen sorunlar yaşanmaktadır. Ekip arkadaşları, aileler ve amirlerle iletişim sorunları yaşadıkları saptanmıştır. Etik olarak; yararlılık, özerklik, adalet ve eşitlik ilkesinin ihlalinden duyulan rahatsızlıklar belirlenmiştir.

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

Abstracts of the 29th Annual Pediatric Pharmacy Association (PPA) Meeting April 29 to May 3, 2020

NICU Parent Preferences for Stakeholder Engagement in Research.

Engagement of parents as stakeholders in the research process can help ensure that interventions are aligned with their needs and experiences, but little is known about their preferences for research collaboration. The purpose of this qualitative, exploratory study was to explore former neonatal intensive care unit (NICU) parents' attitudes toward engagement as parent collaborators and identify potential barriers and facilitators to parent collaboration in research. Three focus groups and 3 interviews were conducted. Participants completed a demographic survey including information about their child's hospitalization. Parents were asked to discuss their NICU story, involvement in the parent community, experience with research, and factors influencing their decision to collaborate on a research study. Nine parents completed the study. Participation was motivated by a desire to help other families. Recruitment suggestions included using parent organizations, social media networks, and advertising in the NICU. Facilitators to research engagement were passion about research topic, distance participation, affecting change, helping other parents, and compensation. Barriers included time constraints and unresolved trauma. NICU nurses can leverage their relationships with parents to act as liaisons between research teams and parents, helping recruit and encouraging them to form research partnerships. Parents are interested in collaborating with neonatal research teams when they can improve experiences for other families and can see or help implement change. Researchers should be conscious of constraints on parents' ability to meet frequently or in person and offer accommodations such as conference calls and online training.

Factors Influencing Developmental Care Performance among Neonatal Intensive Care Units Nurses

This study was conducted to identify factors related to developmental care performance among neonatal intensive care units (NICU) nurses. The participants were 139 nurses who had provided care to premature infants for more than 6 months and were recruited from the NICU of 8 hospitals. Data were collected from September 1 to December 1, 2017 through questionnaires that encompassed developmental care performance, developmental care perceptions, and the nursing work environment. More than half (51.8%) of the participants responded that they had never received developmental care education, and for 89.6% of those who had received developmental care education, it was a one-time event. The average developmental care performance of NICU nurses was 0.81, with a range of 0.5~1 point. Multiple regression analysis, demonstrated that the nursing work environment (β=.27, p=.001) and developmental care perceptions (β=.23, p=.004) influenced developmental care performance, with a total explanatory power of 14%. Based on these results, developmental care education for the NICU nurses must be provided systematically. In addition, strategies to improve nurses' perceptions of developmental care and to provide appropriate support for the nursing work environment can promote developmental care performance.

Preparing Nurses for Palliative Care in the NICU.

Neonatal intensive care unit (NICU) nurses require knowledge and skill to meet the unique needs of infants and families. Increasingly, principles of palliative care are being integrated into the NICU setting to improve the quality of care. The purpose of this article is to describe the efforts of the End-of-Life Nursing Education Consortium (ELNEC) project and its Pediatric Curriculum, which began in 2003 to provide this education, and to also describe efforts by nurses to implement the training into their practice settings. The ELNEC Pediatric Palliative Care (ELNEC-PPC) project is a train-the-trainer educational program and evidence-based curriculum. Participants attend a course or receive online training and then apply the education to implement improved practices in areas such as symptom management, care at the time of death, and bereavement support for families. Experiences with ELNEC-PPC have demonstrated that nurses can implement the curriculum to improve care. Continued attention to palliative care in this setting is needed, and future research is needed to evaluate the outcomes of this education and practice change.

The Effects of a Continuous Olfactory Stimulation Using Breast Milk (COSB) on Behavioral State and Physiological Responses in Korean Premature Infants

PurposeThis study aimed to evaluate the effects of continuous olfactory stimulation with breast milk (COSB) on behavioral and physiologic states of Korean premature infants. Design and methodsWe examined the COSB effects on the behavioral states and physiological responses, including heart rate and oxygen saturation, in 30 premature infants using a non-equivalent control group pre- and post-test design. Sterile 2 cm × 2 cm gauzes wet with 2 cc breast milk were placed 10 cm away from the infants' nostrils 8 times per day for 3 consecutive days. We obtained five measurements each of the behavioral state, heart rate, and oxygen saturation of the premature infants in the neonatal intensive care unit (NICU). Statistical analysis was conducted using descriptive statistics and two-way repeated-measures ANOVA. ResultsThe experiment group presented significantly reduced heart rate variations (p = .039). There were significant differences in the heart rate at all time-points in the control group (p < .001) but not in the experimental group, indicating more stable (p > .089) heart rates in the latter group. There were positive COSB effects on the behavioral states of premature infants at some time points. ConclusionsCOSB can be a useful intervention program for high-risk infants for partial behavioral state stabilization and significant heart rate stabilization. Practice implicationsCOSB might enable NICU nurses to provide a useful and safe developmental care plan for the premature infants hospitalized in the NICU to improve their physiologic and behavioral condition.

Burnout in neonatal intensive care unit nurses: relationships with moral distress, adult attachment insecurities, and proneness to guilt and shame.

Background Informed by the person-environment transactional model of stress, the purpose of the study was to explore the relationships of environment-related moral distress and person-related anxious and avoidant adult attachment insecurities, and personality proneness to guilt and shame with burnout in neonatal intensive care unit (NICU) nurses. Methods This was a multicenter cross-sectional self-report questionnaire cohort study comprising 142 NICU nurses currently working on six Level 3-4 NICUs in New South Wales, Australia. Results Burnout was reported by 37% of NICU nurses. Moral distress, anxious and avoidant attachment, and guilt- and shame-proneness had moderate-large zero-order correlations with burnout. Overall, these predictor variables explained 40% of the variance in burnout. Moral distress (β = 0.40, P < 0.001), anxious attachment (β = 0.18, P < 0.05) and shame-proneness (β = 0.22, P < 0.01) were unique predictors of burnout. Shame-proneness partially mediated the effect of anxious attachment on burnout [indirect effect, B = 0.12, confidence interval (CI) (0.051-0.201)]. Conclusion The management of burnout in NICU nurses requires attention not only to environment-related moral distress but also to person-related anxious and avoidant adult attachment insecurities and personality proneness to guilt and shame.

The Role of the NICU in Father Involvement, Beliefs, and Confidence: A Follow-up Qualitative Study.

Fathers are important to infant outcomes. Infants of involved fathers have improved weight gain, sleep, and psychosocial behaviors. Father involvement with neonatal intensive care unit (NICU) infants reduces the length of stay. The purpose of this study was to explore and describe involvement, confidence, and beliefs of fathers of infants who were hospitalized in the NICU and discharged home in order to begin to investigate NICU father involvement from a longitudinal perspective. This exploratory qualitative study was conducted 4 to 5 years after the initial NICU stay using telephone interviews. Fathers who participated in this study were selected from participants of a previous NICU study. Qualitative analysis was conducted using standard procedures for grounded theory. Nineteen fathers participated in the study. The major themes were "It was scary," "Just be there," "It was rough," "It's not about yourself," "A special bond," and "Almost a treat." The fathers reported that the NICU providers, nurses, and staff helped them to overcome uncertainty and lack of knowledge, which helped them improve their confidence and involvement during the NICU stay. Fathers see nurses as a source of support. Nurses can encourage fathers to visit regularly and participate in infant care activities. NICU presence aids fathers in developing confidence and knowledge in parenting during their child's infancy, which can set the stage for ongoing involvement. Future work should continue to focus on longitudinal studies of fathering and the role of the NICU in encouraging involvement and parenting readiness.

Neonatal Nurses' Self-reported Practices, Knowledge, and Attitudes Toward Use of Maternal Voice for Preterm Infants.

Infants born extremely premature (<1500 g) often experience lengthy stays in the challenging environment of the neonatal intensive care unit (NICU) separated from their parents. The purpose of this study was to explore nurses' knowledge, attitude, and use of maternal voice as a therapeutic intervention for preterm infants in the NICU. Neonatal nurses (n = 117) completed an online survey about the use of maternal voice in their individual units. Questions included: (1) previous knowledge surrounding use of maternal voice in the NICU; (2) their attitudes about using maternal voice recordings and/or live maternal speech as an intervention; (3) whether their unit had the necessary equipment and environment conducive to using the therapy; (4) average amount of time parents were in the NICU with their neonate; and (5) in what situations they would personally encourage the use of maternal recordings (during procedures, rounds, etc). Of those responding, 73.3% of nurse (n = 117) respondents agreed they were willing to incorporate maternal recordings into caregiving, with 80.8% indicating they were open to learning and employing different therapies to improve parental involvement in infant care. When the appropriate equipment is available, neonatal nurses are interested and willing to use alternative therapies that incorporate parental participation into direct caregiving as well as utilizing maternal voice recordings. Further research with larger, more diverse samples is needed to determine the current knowledge, attitudes, and practices of maternal voice recordings by NICU nurses. Future research can also focus on barriers to utilization of the therapy during daily care.

Nurses' Perceptions of the Palliative Care Needs of Neonates With Multiple Congenital Anomalies.

This study was conducted to determine neonatal intensive care unit (NICU) nurses' opinions about the palliative care needs of neonates with multiple congenital anomalies. The study sample consisted of the 20 nurses who agreed to participate in the study and worked in the NICU between November and December 2017. A one-to-one interview method was utilized using a semistructured interview form. Written consent was obtained from participants and reconfirmed verbally prior to data collection. In the study, most of the nurses stated that the therapeutic medical treatment should not be started for dying neonates with multiple congenital anomalies. It was also found that nurses did not have enough palliative care knowledge for neonates. The palliative care needs of the neonates with multiple congenital anomalies in NICUs were found to be pain management, infection care, enhancing quality of life by avoiding unnecessary medical practices, skin care, the care of the baby in the ventilator, timely application of the treatment of neonates, and supporting family.

Perceived Infant Well-Being and Self-Reported Distress in Neonatal Nurses.

Infants who are admitted to a neonatal intensive care unit (NICU) may experience significant symptom burden. Parents are often distressed by these symptoms, which can affect their long-term coping and distress. There is limited research examining nurse perceptions of infant well-being (symptoms, suffering, and quality of life [QOL]) and associations with nurse distress. The objective of this descriptive study was to explore associations between nurse perceptions of infant well-being and self-reported distress. Nurses caring for infants with potentially life-threatening/life-limiting conditions were recruited from a Level IV NICU in the Midwestern United States as a part of a study on infant symptom burden. Nurses reported their perceptions of infant well-being and their own distress on a 5-point Likert scale. Surveys were administered at the bedside weekly for up to 12 weeks, depending on length of stay. Infant suffering and QOL were examined in relation to nurse distress. A cross-classified multilevel model was used to account for dependence within nurse and within patient. A total of 593 surveys were collected from nurses. Using a cross-classified multilevel model with variables entered simultaneously, nurse perceptions of greater infant suffering and lower infant QOL were significantly associated with greater nurse distress. Preliminary evidence shows that greater perceived infant suffering and lower perceived infant QOL may be associated with greater levels of self-reported distress in NICU nurses. Further work is needed to better understand factors related to symptom management in the NICU and the potential role of caregiver distress and compassion fatigue in NICU nurses.

Translation, Cultural, and Age-Related Adaptation and Psychometric Properties of Persian Version of "Quality of Dying and Death" in Nurses Working in Neonatal Intensive Care Units.

Background:Death and dying care is an area with less attention in nursing. This even is evidenced as more challenging in some populations such as neonates. Neonatal intensive care unit (NICU) nurses should be aware of the quality of care they provide for dying neonates and their families to find the areas which need attention.Objective:The aim of this study was to assess the psychometric features of the Quality of Dying and Death (QODD) questionnaire in NICU nurses in Tehran, the capital city of Iran.Methods:This methodological study was conducted in 2017. For this purpose, using census method, 130 NICU nurses working in selected hospitals participated. After the backward–forward translation, based on the method proposed by the International Test Commission, the psychometric properties of the Persian QODD were examined through the assessment of the face, content and construct validity, internal consistency, and stability.Results:Final Persian QODD's content and face validity were accepted through a qualitative method. In the confirmatory factor analysis, the original version of QODD was not confirmed. Subsequently, an exploratory factor analysis was carried out in which phrases were included in three dimensions (symptom control, preparation for death of neonate, and professional attention) that explained 75% of the variance. Cronbach's alpha values ranged from 0.82 to 0.88 for these three dimensions. The intraclass correlation coefficient (ICC) was ICC = 0.94 between two tests performed with a 2-week interval on twenty eligible nurses.Conclusions:The Persian version of QODD has acceptable psychometric properties in nurses working with the neonatal population and can be used to investigate the NICU nurses' opinion on the QODD provided in NICU patients.

THE EFFECT OF APPLYING NURSING CARE BUNDLE ON CONTROLLING CENTRAL VENOUS LINE INFECTION IN NEONATAL INTENSIVE CARE UNITS

Central venous line (CVL) is a necessary device used frequently in neonatal intensive care units (NICUs) for critically ill neonates who need continuous monitoring and resuscitation treatment. Significant evidence has accumulated indicating that CVL nursing care bundle is considered as an essential component of CVL infection prevention practice to combat the incidence of CVL infection. Aim: This study aimed to examine the effect of applying nursing care bundle on controlling central venous line infection in neonatal intensive care units. Subject and method: A quasi-experimental design was used. The study was conducted at NICU at Kafr El Sheikh General Hospital. The study included a convenience sample of all available bedside/ working nurses (n= 30), 79 preterm infant (recruited for 3 months’ period). Tools: Three tools were used to collect data. Tool 1: An interview questionnaire for nurse's knowledge. Tool 2: Observational checklist used to assess nurses’ performance regarding CVL care bundle. Tool 3: Laboratory investigations tool for preterm infants. Results: More than half of studied nurses (56.7%) didn't receive any training program about CVL care bundle for controlling CVL infection in NICU and the majority of the studied nurses had insufficient knowledge, as well as the majority of the studied nurses, had an unsatisfactory practice regarding CVL care bundle preprogram. The sufficient knowledge level and satisfactory practices had improved immediately post and 3 months post program implementation. About half (51,9%) had negative CRP post-program implementation, while (54,4%) of neonates had negative blood culture post-program. Conclusion: The program had a positive effect on the NICU nurses’ knowledge & practices immediately post& post 3 months of the program implementation. Recommendation: Including CVL nursing care bundle practices into nurses’ routine care and developing regular and continuous educational programs for the nurses in NICU according to their needs aiming to upgrading their knowledge and improving their practice for critically ill neonates.

A Study of the Relationship between Job Satisfaction and Burnout among Neonatal Intensive Care Unit Staff

Background: Considering the importance of job satisfaction and occupational burnout among nurses, the present study aimed to determine the prevalence of occupational burnout and the degree of job satisfaction among neonatal intensive care unit (NICU) nurses.Methods: The current research was a cross-sectional study in which the Job Descriptive Index and Maslach Burnout Inventory were distributed among the NICU nurses. The collected data were analyzed using SPSS software.Results: A total of 30 NICU nurses working in two public and private hospitals participated in the present study. The mean age of the participants was measured at 37.46±6.93 years, most of them (73.3%) held a Bachelor’s degree and more than 60% were married. No significant relationship between job satisfaction and burnout was observed among the nurses. Both variables were moderate among the NICU nurses as representatives of the staff working in special units.Conclusion: It is widely believed that people who are exposed to extreme stress for a long time are more likely to suffer from occupational burnout. Moreover, considering the importance of this issue in healthcare environments for the provision of services that physically and mentally affect patients, it is recommended to pay greater attention to employee satisfaction and burnout process in hospital settings.

Vicarious Posttraumatic Growth in NICU Nurses.

When posttraumatic growth occurs in clinicians as a result of their caring for patients and families who are traumatized, it is termed vicarious posttraumatic growth. (1) To determine the level of vicarious posttraumatic growth and the disruption of core beliefs in neonatal intensive care unit (NICU) nurses who have cared for critically ill infants and their families. (2) To explore those quantitative findings through nurses' qualitative descriptions of their growth. A mixed method with a convergent parallel design was used to address the study aims. A targeted sample of neonatal nurses was recruited from the National Association of Neonatal Nurses (NANN) through the MyNANN Community message board. The sample consisted of 109 NICU nurses who completed the quantitative strand and 61 (55%) who completed the qualitative strand. Nurses completed the Posttraumatic Growth Inventory, the Core Beliefs Inventory, and described their experiences of any positive changes in their beliefs or life as a result of caring for critically ill infants. IBM SPSS 25.0 and Krippendorff's content analysis were used to analyze the quantitative and qualitative data, respectively. NICU nurses reported a moderate degree of vicarious posttraumatic growth and disruption of their assumptive world. Appreciation of Life was the Posttraumatic Growth Inventory dimension that reflected the highest growth and Spiritual Change the lowest. Providing posttraumatic growth interventions has the potential to help NICU nurses find meaning through their experience. Future surveys need to include a higher response rate to generalize the findings. A video abstract is available.Video Abstract available at: https://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=36.

Kangaroo mother care practice, knowledge, and perception among NICU nurses in Riyadh, Saudi Arabia.

BackgroundThe imapct of Kangaroo Mother Care (KMC) in neonates is positively reported in the literature. However,several challenges hindered the wide-scale application of this practice.ObjectivesTo assess the levels of knowledge and competency of kangaroo mother care (KMC) among nurses and to identify the potential barriers to practice.MethodologyStructured web-based questionnaires were submitted to nurses working at neonatal intensive care units (NICUs) located in Riyadh, Saudi Arabia. The participants were asked to answer 23 questions distributed in four main domains, namely, demographic data, knowledge about KMC, practice levels, and barriers to KMC practice. For answers to the knowledge and barriers to practice domains, the mean scores (standard deviations) were calculated to present participants’ perceptions and beliefs from 1 (strongly disagree) to 5 (strongly agree).ResultsTwo hundred nine NICU nurses responded (95.2% females, 89.5% working in a government hospital, 69.9% obtained a Bachelor’s degree). The majority of respondents perceived KMC as promoting maternal-infant bonding (4.47 ± 1.3) and enhancing successful breastfeeding (4.44 ± 0.9), while there were considerable uncertainties about KMC application in infants weighing < 1000 g (2.21 ± 1.2). Most of the nurses encouraged parents to perform KMC (92.8%) and provided sufficient information to optimize practice (90%). However, several barriers were apparent, including fear of accidental extubation, lack of time due to workload, familial reluctance to initiate KMC, and lack of privacy during KMC practice.ConclusionThere is reasonable knowledge among NICU nurses, and most of them are actively engaged in practice. There is an urgent need to address the reported barriers through the implementation of clear practice guidelines, provision of suitable educational programs, optimization of staff numbers, and financial support for the development of areas conducive to KMC.

Secondary Traumatic Stress in Maternal-Newborn Nurses: Secondary Qualitative Analysis.

BACKGROUND: Secondary traumatic stress can be the cost for clinicians when caring for persons who have been traumatized. Secondary traumatic stress is a syndrome of symptoms similar to posttraumatic stress disorder (PTSD). AIMS: To conduct a secondary qualitative data analysis of three primary data sets of secondary traumatic stress in nurses. METHODS: Cross validation was the type of qualitative secondary analysis used to compare qualitative findings across these multiple data sets. In the three primary studies, the data were analyzed for themes. In this secondary qualitative analysis, a different defining unit was chosen. This time, the four categories of PTSD symptoms (intrusions, avoidance, arousal, and negative alterations in cognitions and mood) were used to analyze the data sets using content analysis. RESULTS: For all three groups of maternal-newborn nurses, the intrusions category was ranked first and the negative cognitions and mood category was ranked second. The remaining two symptom categories were where their rankings differed. The labor and delivery and neonatal intensive care unit nurses ranked arousal symptoms third and avoidance symptoms fourth. For the nurse-midwives, the rankings for these two categories were reversed. The neonatal intensive care unit nurses comprised the one group that did not report any avoidance symptoms. CONCLUSIONS: This secondary qualitative analysis confirmed the presence of PTSD symptoms that maternal-newborn nurses struggled with as a result of caring for either critically ill infants or women during traumatic births. Hospital preventive strategies and interventions for secondary traumatic stress in nurses are discussed.