NICU Nurses Research Articles

Compassion Fatigue, Burnout, and Neonatal Abstinence Syndrome.

NICU nurses have seen a dramatic increase in cases of neonatal abstinence syndrome (NAS). The care needs of infants with NAS are highly demanding and can lead to feelings of frustration and emotional exhaustion among NICU nurses. Although studies have examined the experiences of nurses caring for NAS patients, none have specifically addressed the risk for compassion fatigue and burnout. Nurses need practical strategies to reduce their risk for compassion fatigue and burnout when caring for these patients. Improved education and implementation of self-care measures can help nurses more effectively manage stress and positively impact care of these infants and their families.

Music in the NICU: The Role of Nurses in Neuroprotection.

Early exposure to age-appropriate, meaningful auditory stimuli, such as lullaby singing, has been shown to advance various medical and developmental goals in premature infants in the NICU while reducing medical costs. A primary goal of NICU music therapists is to control auditory stimuli in the unit to help premature infants reach the greatest possible sedation. In hospitals with limited or no NICU music therapy (NICU-MT) coverage, nurses and other NICU staff can play an important role in providing neuroprotection to these premature infants while also optimizing neurodevelopment via use of recorded music. Based on current literature, this article provides a set of evidence-based guidelines for the use of recorded music with premature infants.

The Experiences of Professionals Regarding Involvement of Parents in Neonatal Pain Management

ObjectiveTo explore the experiences of health care professionals related to parent involvement during painful procedures carried out on their infants and to describe contextual facilitators and barriers that influence parent involvement during evidence-based, nonpharmacologic pain relief. DesignQualitative study with focus group interviews. SettingTwo Level III NICUs and one Level II NICU in the German-speaking part of Switzerland. ParticipantsConvenience sample of 17 NICU nurses and six neonatologists. MethodsThree interprofessional focus group interviews were conducted. Data were analyzed by thematic analysis. ResultsContextual factors among professionals, such as know-how and communication skills regarding neonatal pain management; reflective and collaborative practice; and an attitude of partnership with parents and organizational resources, such as time and staffing, promoted a working atmosphere in which it was possible to talk about neonatal pain with parents. Within this context, parents could be successfully involved in their infant's pain management. In contrast, lack of the aforementioned contextual factors, including an attitude of paternalism toward parents, resulted in a working atmosphere in which professionals “kept silent about pain” and hindered parent involvement during painful procedures. ConclusionThe work culture and organizational features of a NICU facilitate or hinder parent involvement in neonatal pain management. Facilitators and barriers should be identified from the individual, team, and system perspectives. Facilitation of parent-centered pain management in infants should be promoted by the organization.

Barriers That Impede the Provision of Pain Care to Neonates by Nurses in Jordan

ObjectiveTo describe perceived barriers to neonatal pain care and suggest strategies to overcome these barriers among NICU nurses in Jordan. DesignDescriptive study. SettingEighteen NICUs in Jordan. ParticipantsOne hundred eighty-four neonatal nurses. MethodsNurses completed a questionnaire on perceived barriers to neonatal pain care. Descriptive statistics were used to analyze the data. ResultsOne of the main issues that hindered the effective practice of neonatal pain care was the underuse of structured pain measurements, especially for painful procedures (72%). Furthermore, participants indicated minimal knowledge about pain medication for neonates (66%) and feared adverse effects (50%). The participants received inadequate training about neonatal pain care during their initial orientation (24%) and while in service (19%). Participants perceived low interprofessional appreciation of any input into pain care decisions (72%). Finally, only 39% of participants supported the involvement of parents in pain care for their neonates, and 82% were against it during painful procedures. ConclusionEfforts to improve neonatal pain care should focus on improving nurses' knowledge about neonatal pain, increasing competencies and involvement in pain management options, and improving channels of professional communication about neonatal pain.

The effectiveness of a standardised positioning tool and bedside education on the developmental positioning proficiency of NICU nurses

In order to improve the developmental proficiency of neonatal intensive care unit nurses, a standardised infant positioning assessment tool and a bedside education programme were introduced to the registered nurses in a 46 bed level III neonatal intensive care unit in the western United States. A developmental positioning team collected pre-intervention positioning scores on 54 preterm infants. This was followed by a survey of the registered nurses beliefs and attitudes, the introduction of the standardised assessment tool and an informal education programme. Post-intervention positioning scores were collected on 55 preterm infants, and analysis of the data indicated there was a statistically significant change in mean positioning scores. Additionally, the registered nurses identified several barriers to the implementation of developmental positioning. This research indicates the use of a standardised infant positioning assessment tool and bedside education may be useful strategies for improving the developmental positioning proficiency of NICU nurses.

Research trends and issues in the discharge support for mothers provided by nurses in NICU

Research trends and issues in the discharge support for mothers provided by nurses in NICU

NICU Culture of Care for Infants with Neonatal Abstinence Syndrome: A Focused Ethnography.

The purpose of this focused ethnography was to describe the culture of care and nonpharmacologic nursing interventions performed by NICU nurses for infants with neonatal abstinence syndrome (NAS). Roper and Shapira's framework for the analysis included participant observation, individual interviews, and examination of existing documents. Twelve full-time nurses were observed and interviewed. Results described the culture of care provided to infants with NAS by NICU nurses as evidenced by six themes: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer/comforter, becoming an expert), grief, making a difference (wonderful insanity, critical to them), and education and care of the mother.

Development of the Developmental Support Competency Scale for Nurses Caring for Preterm Infants

Developmental care has been recognized as a very important component for the development and health promotion of preterm infants. However, research on how to assess developmental nursing competency has not been studied as expected. This study was done to develop and evaluate a new scale to measure nursing competency for developmental support of preterm infants. Concept analysis was done with using the Hybrid model of Schwartz-Barcott and Kim (2000), from which a preliminary new scale (30 items) was developed. To test the validity and reliability of the new scale being developed, data were collected from 122 NICU nurses at 4 hospitals in 3 cities in the Republic of Korea, from December, 2014 to March, 2015. The final version of the Developmental Support Competency Scale for Nurses (DSCS-N) caring for premature infants was a 4-point Likert type scale, consisting of 19 items, and categorized as 6 factors, explaining 62.5% of the total variance. Each of the factors were named as follows; 'environmental support' (4 items), 'parental support' (3 items), 'interaction' (3 items), 'critical thinking' (3 items), 'professional development' (3 items), and 'partnership' (3 items). The Cronbach's α coefficient for the scale was .83 and the reliability of the subscales ranged from .60~.76. The psychometric evaluation of the new scale demonstrated an acceptable validity and reliability. Findings indicate that the DSCS-N can be used as the tool to test the effect of educational programs for nurses and contribute to advance developmental care for preterm infants.

The NICU Mom Who Rarely Visits and What You Can Do About It

NICU nurses often worry about NICU moms who are not able to visit their babies regularly and rightfully so. The mother is key to not only the baby's ability to survive but also thrive, and spare visits do little to help with the bonding process. This article provides solid tips on increasing the NICU mom's visits using strengths and positives instead of guilt.

GENTAMICIN PHARMACOKINETIC VARIABILITY IS INFLUENCED BY CHOICE OF ADMINISTRATION ROUTE

IntroductionA critically ill neonate may have several routes of venous access available, operating at different flow rates and with different dead-volumes, and therefore with different delivery kinetics.AimsTo determine which lumen of a double lumen umbilical venous catheter (UVC) would be used for administration of intravenous gentamicin to a premature baby and what flush volume would be used.MethodsAn individual self-administered questionnaire was completed by Dunedin Hospital NICU nurses in April-May 2014. The questionnaire consisted of two scenarios describing babies of 24 and 32 weeks gestation, and asked that the site of administration be chosen on a diagram. Secondary information regarding flush volume was also collected and free-text responses encouraged.ResultsThere were 42 nurses employed in Dunedin NICU during this period, of whom 37 (88%) responded. For a 24-week gestation baby, 34 nurses (92%) would administer into the primary lumen (20ga), containing 10% dextrose (0.5 mL/hr), compared to 3 (8%) who would use the secondary lumen (23ga), containing parenteral nutrition fluid (2.1 mL/hr). For a 32-week gestation baby 35 nurses (95%) would administer through the slow-flowing primary lumen. If a peripheral intravenous line (PIV) was present this would be used preferentially by 35 nurses (95%) to reduce the risk of infection. Smaller flush volumes were documented following administration through the UVC compared with PIV (1.17–1.35 mL vs 2.4 mL at 24 weeks and 1.42–1.74 mL vs 3.2 mL at 32 weeks).DiscussionThe variability in intravenous delivery route may be a significant contributor to variability in neonatal gentamicin pharmacokinetics.

Infant Feeding Beliefs and Day-to-Day Feeding Practices of NICU Nurses

The purpose is to examine the infant feeding beliefs and day-to-day feeding practices of NICU nurses with the goal of identifying ways to improve breastfeeding promotion. An ethnographic approach incorporated 14 months of participant observation and interviewing. General informants consisted of 114 purposively selected NICU nurses from a northeastern, level-IV NICU, pediatric hospital. From this group, 18 nurses served as key informants. There was an average of 13 interactions with each key informant and 3.5 with each general informant. Audio taped interviews and observational field notes were gathered for descriptions of beliefs and practices. Data were coded and analyzed for patterns and themes with the aid of NUD*IST. 1. The nurses identified health benefits of breastfeeding, but spoke in greater detail and with more emotion about day-to-day challenges of breastfeeding in the NICU. 2. Formula feeding evoked less emotion and most nurses viewed it as safe and convenient. 3. Despite infant feeding challenges in the NICU, nurses who had breastfeeding continuing education and/or some positive experiences with breastfeeding: identified evidence based breastfeeding benefits for mothers and babies; emphasized the health-based differences between breast milk and formula; and were more committed to working through difficulties with breastfeeding. Breastfeeding promotion interventions should include every NICU nurse and incorporate both evidence-based and affective components to overcome day-to-day feeding practice challenges. Breastfeeding promotion interventions must address conflicting and emotionally evocative infant feeding beliefs of NICU nurses. Effective interventions must be integrated within the realities of bedside feeding practices.

A pilot nursing educational intervention promoting an evidence-based transition from gavage to direct breastfeeding in a NICU

AimTo describe the development and the evaluation of a pilot nursing educational intervention aiming to promote an evidence-based transition from gavage to direct breastfeeding in preterm infants. MethodThe Iowa Model for Evidence-Based Practice to Promote Quality of Care was used as the conceptual framework guiding the development and implementation of the pilot nursing educational intervention in a NICU. Six nurses participated in all of the three workshops of the educational intervention. Their nursing practice, beliefs, and knowledge were assessed pre and post-intervention. Their satisfaction with the educational intervention was also assessed post-intervention. ResultsPost-intervention, nurses reported improved practice, beliefs, and knowledge related to the transition of preterm infants to direct breastfeeding. The educational intervention content has been well received by nurses. ConclusionA brief nursing educational intervention can improve NICU nurses' practice, beliefs and knowledge regarding the transition of preterm infants from gavage to direct breastfeeding. However, a review of the format of the educational intervention is recommended to refute more efficiently belief and facilitate nurses' recruitment.

Neonatal Intensive Care Unit Nurses’ Levels of Information Regarding Therapeutic Positions to be Applied to Preterm Newborns

Introduction: In order to provide optimal functionality of all the systems in the developmental care in the first days when they experience a great amount of stress in the neonatal intensive care unit NICU , preterm newborns should be laid down in rather special positions. The basic aims of position management in the neonatal intensive care unit NICU are to alleviate the pain/ache caused by the treatment/care interventions, minimise the effects of stressors resulting from the environmental factors and facilitate their coping with stress by preserving their postures. This study was planned to assess neonatal intensive care unit nurses’ levels of information regarding therapeutic positions to be applied to preterm newborns. Materials and Methods: The study was carried out with 52 neonatal nurses who worked in NICU in the city of Şanliurfa and who accepted to participate in the study between September and December 2012 and also is a cross-sectional and descriptive study. Results: While 57.7% of the nurses who participated in the study stated that the fetus was in physiological flexion position in intrauterine period, only 11.5% of them stated that prone, supine and sidelying position are the therapeutic positions that could be applied to preterm babies in the NICU. As for the benefits of creating the correct position for the preterm babies in NICU the nurses stated that it increased the baby’s conditions for dealing with stress 32.7% and made external line-orientation easier 28.8% . As for the damages of positioning the preterm incorrectly, they stated that it caused motor and behavioural disorders 32.7% and permanent posture disorders 26.9% . 44.2% of the Nurses stated that during their stay in the intensive care units babies should be in the prone position as recommended by the American Paediatrics Academy AAP and 25% of them stated that they should be in the supine position to prevent the risk of sudden infant mortality syndrome after being discharged from the hospital. 67.3% of NICU nurses stated that the period which preterm babies were most reactive to environmental stressors was the first days in NICU whereas 61.5% stated that their bodies should be supported for preterm babies’ development. Conclusions: Nurses working in NICU should be informed regarding the therapeutic positions to be applied in the intensive care unit and after the discharge to support the development process of the preterm neonatal.

Nursing care for the families of the dying child/infant in paediatric and neonatal ICU: Nurses’ emotional talk and sources of discomfort. A mixed methods study

BackgroundThe majority of in-hospital deaths of children occur in paediatric and neonatal intensive care units. For nurses working in these settings, this can be a source of significant anxiety, discomfort and sense of failure. ObjectivesThe objectives of this study were to explore how NICU/PICU nurses care for families before and after death; to explore the nurses’ perspectives on their preparedness/ability to provide family care; and to determine the emotional content of language used by nurse participants. MethodsFocus group and individual interviews were conducted with 22 registered nurses from neonatal and paediatric intensive care units of two major metropolitan hospitals in Australia. All data were audio recorded and transcribed verbatim. Transcripts were then analysed thematically and using Linguistic Inquiry to examine emotional content. ResultsFour core themes were identified: preparing for death; communication challenges; the nurse–family relationship and resilience of nurses. Findings suggested that continuing to provide aggressive treatment to a dying child/infant whilst simultaneously caring for the family caused discomfort and frustration for nurses. Nurses sometimes delayed death to allow families to prepare, as evidenced in the Linguistic Inquiry analysis, which enabled differentiation between types of emotional talk such as anger talk, anxiety talk and sadness talk. PICU nurses had significantly more anxiety talk (p=0.018) than NICU nurses. ConclusionThis study provided rich insights into the experiences of nurses who are caring for dying children including the nurses’ need to balance the often aggressive treatments with preparation of the family for the possibility of their child's death. There is some room for improvement in nurses’ provision of anticipatory guidance, which encompasses effective and open communication, focussed on preparing families for the child's death.

Package of local interventions for reducing in-hospital neonatal mortality using quality improvement methodology at a major hospital in India

Background: Reducing neonatal mortality has always been a challenge for the world and India. Here we provide a brief account of a pilot done at Sanjay Gandhi Memorial Hospital, New Delhi for reducing neonatal mortality . Methods: Rotation of labour room nurses to In-hospital Neonatal ICU for a specified period of 4 months for providing hands-on training on neonatal emergencies. In exchange, equal number of Nurses from NICU was posted in labour room, thus making each delivery managed by an obstetric nurse and a paediatric nurse. Ensuring breastfeeding within one hour within the labour room itself was also mandated by NICU Nurse. Results: It was observed that there was 30.2% decrease in In-hospital neonatal mortality . Conclusions: Using these interventions, there has been a dramatic decrease of neonatal mortality to 30.2% and 4.53% due to sepsis. There has also been 1% decrease in Median Referral Percentage to In-hospital Neonatal ICU due to morbidities associated with inborn neonates.

A psychologist-led educational intervention results in a sustained reduction in neonatal intensive care unit infections.

Even though in the corporate world psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU).Materials and methods: In 2007, six senior neonatal nurses underwent a training course focusing on the retrieval of evidence and knowledge of psychological principles that would allow them to share the evidence in such a way that evidence is effectively brought into practice. The course was led by a psychologist. The nurses created and delivered their own teaching modules, all focused on infection control. The rates of bacteremia, 2 years prior to intervention were analyzed and compared with the rate following the intervention for 3 years.Results: The immediate output of the course included three teaching modules: hand washing, sterile procedures, and general measures to control infection. These modules were subsequently administered to the NICU nurses in regular structured continuous nursing education sessions. The psychological techniques taught in the course were applied. Bacteremia in the NICU significantly decreased in the year of the course and the subsequent years when compared to previous years (from more than 17 in 2005 and 2006 to less than 10 per 100 admissions to the NICU in 2008 and 2009).Conclusion: This study suggests that a psychologist-led course, followed by a structured CNE can lead to a sustainable reduction in infection rates in a NICU.

Living in hope and desperate for a miracle: NICU nurses perceptions of parental anguish.

The birth of an extremely premature baby is a tragedy, and it is only natural that the parents will rely on the spiritual and religious beliefs that guide the rest of their lives. At this difficult time, parents with strong religious beliefs will hope for divine intervention and pray for a miracle. This paper outlines the difficulties experienced by neonatal nurses when caring for an extremely premature baby whose parents hold on to hope and their belief in divine intervention and a miracle. Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in NSW, Australia. A qualitative approach was used to analyse the data. The theme of "hoping for a miracle" was captured by two sub-themes "praying for a miracle" and "oscillating between hope and despair". For some families, the hope of divine intervention seemed all consuming, and the nurses were witness to the desperation and disappointment of families when a miracle was not forthcoming.

The use of neonatal palliative care: Reducing moral distress in NICU nurses

The ethical dilemmas faced by nursing professionals can lead to moral distress and the abandonment of nursing as a career. This is especially true in intensive care nursing where mortality is more prevalent. Neonatal nurses face a particularly high rate of moral distress when dealing with the treatment and loss of critical infants. This distress is compounded when nurses feel that the care they are providing is not in the best interest of the infant. Providing palliative care at the end-of-life may alleviate some of this distress, but only if palliative care is implemented consistently and effectively. Several barriers exist to implementing effective palliative care. The primary barrier is the lack of education of neonatal staff in the correct definition and application of end-of-life comfort care. This includes education in communication, assessment of needs, and implementation. A neonatal-specific palliative care team (or individual palliative care nurse) can fill this gap in education to accommodate effective care. A consistent, effective neonatal palliative care program is essential. Such a program affords the opportunity for compassionate communication with the family, a decrease in moral distress for nurses, and the provision of quality end-of-life care for the neonate.

Why NICU nurses mean so much to parents.

Parents of premature infants are grateful for their child's NICU nurse. Take a step onto the parent's side and see the top ten reasons parents are grateful for the nurses, and you might see some surprises.

Pain in the neonate: focus on nonpharmacologic interventions.

The assessment and treatment of pain in the neonate, especially preterm neonates, has been a challenge in the NICU for many years. Nurses caring for these vulnerable patients are in a key position to not only recognize when the neonate is experiencing pain but to also work collaboratively with other health care providers in determining the best method to treat and help prevent pain associated with procedures and routine caregiving activities. The American Academy of Pediatrics along with parent groups has recognized the importance of pain-prevention programs in treating pain in the neonate. Nurses, by anticipating and reducing both painful procedures and bedside interruptions, along with innovative nonpharmacologic interventions, can dramatically decrease the neonate's exposure to pain and the potential for long-term effects. An overview of nonpharmacologic interventions in the treatment of neonatal pain is provided for NICU nurses to help them effectively reduce their patient's pain and discomfort.