Promoting Breast Milk Nutrition in Infants With Cleft Lip and/or Palate.

BACKGROUND: The orofacial defect of cleft lip/palate (CL/P) involves an altered physiological anatomy that affects the infant's feeding ability. Infants have cleft lip (CL), cleft palate (CP), or both (CL/P). Dysfunction in the seal, as with cleft lip, or in the ability to coordinate muscle movement to generate negative pressure, as with cleft palate, leads to feeding issues that may compromise growth and affect bonding. PURPOSE: The purpose of this article is to present (1) scientific evidence that supports clinical feeding practices for the infant with CL/P and (2) teaching strategies for staff and parents. METHODS: Evidence was synthesized using a narrative review of randomized controlled trials, qualitative studies, systematic reviews, professional guidelines, and position statements. Findings were used to present specialized equipment and feeding techniques to support human milk feeding. FINDINGS: Special considerations for feeding infants with CL/P include assessing the infant's sucking ability, demonstrating proper breastfeeding positioning, supporting mothers to establish and maintain their milk supply, considering adaptive feeding equipment (ie, specialized bottles and nipples), and education about the benefits of human milk. IMPLICATIONS FOR PRACTICE AND RESEARCH: Support from healthcare professionals, particularly lactation specialists and nursing staff, is critical. Breastfeeding and the use of human milk should be prioritized and supported. Research is needed to explore environmental, genetic, and nutritional causes (eg, folic acid deficiency) of orofacial defects.

[Not Available]. / Songenent-wohnung 2.0: Was Sonden-dependente Kinder brauchen.

A dramatic increase of home enteral nutrition in pediatric population has been reported over the last decade. Inpatient units discharge more and more children with nasogastric and G- tubes. And for certain percentage the feeding and eating behavior does not improve with time. But longer tube dependency frequently results in general food aversion and refusal. The assessment and treatment, we will line out in this paper, have shown high efficiency for children with feeding tube dependency. To improve the situation of children with feeding tube dependency more treatment facilities are needed. Furthermore early prevention program and feeding tube management should be established to prevent feeding tube dependency.

[Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty]. / Dúvidas de cuidadores de crianças com fissure labiopalatina sobre os cuidados pósoperatórios de queiloplastia e palatoplastia.

OBJECTIVE: To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty. METHOD: Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes. RESULTS: Concerning cheiloplasty, the doubts were related to feeding (36%), hygiene and healing (24% each), pain and infection (8% each). With regard to palatoplasty, the doubts were related to feeding (48%), hygiene (24%), pain (16%), bleeding (8%) and infection (4%). CONCLUSION: The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound.

Positioning after feedings: what is the evidence to reduce feeding intolerances?

Nursing's goal is to be the least invasive as the patient's condition allows. As a NICU nurse, each feeding for our patients is a priority for them to grow and develop with the idea to speed discharge to home. When infants develop reflux or have increased gastric aspirates, we are concerned that their weight will taper and their length of stay will increase. Positioning provides nurses with a noninvasive option to care for these patients. The that the right-side position is best for infants to enhance digestion stems from theories of anatomy and physics. Research strengthens this supposition for those infants needing help with decreased gastric motility. Other research supports the left lateral and prone positions for those patients with GER. In practice, a patient does not necessarily have one or the other and in fact may have both GER and slowed gastric motility at any given time. The literature supports the right lateral position for enhancing gastric emptying or motility and left lateral position for GER in the uncomplicated patient with one gastrointestinal concern. The knowledge the research provides is encouraging to provide a solution, but it does not clarify the true issues of a complex patient who can have decreased gastric motility needing the right lateral position and also suffer from symptoms of GER requiring the left lateral position (see Table). For those more complicated infants, the solution might best be choosing the prone position. The prone position should not be forgotten as the findings of many studies, although not often the first choice (best results) showed it to be consistently the second best for digestive problems. In any case, the dominant positions appear to be the right or left lateral side with the prone position considered a reasonable compromise. Further research is needed to provide a clear choice for correct positioning in the NICU population. The reality for nurses is that neonatal patients are often fed every 3 hours and their lives depend on each feeding to provide nutrients for growth. It is ideal for these patients to receive every prescribed feeding and be comfortably placed in a variety of positions. Nurses' assumption that the right lateral position is best is considered, in most cases, to be a true statement for those infants with increased gastric aspirates. For those patients with GER, the left lateral position is more highly preferred. It is important for nurses to be aware of the literature but also guide their practice based on the patient assessment and presentation of symptoms. Future knowledge may provide nurses with the data needed to perfect positioning methods for infants with feeding intolerances.

An exemplar for evidence-based nursing practice using the Magnet(®) model as the framework for change: oral feeding practice in the neonatal intensive care unit.

Implementation of research evidence into practice can be challenging in areas such as the neonatal intensive care unit (NICU), where the environment is complex and rapidly changing and caregiving goals have shifted from simply infant survival to supporting positive long-term neurodevelopmental outcomes. Clinical nurse specialists (CNS) are ideally positioned to use research to obtain new knowledge, innovations, and improvements in care as part of an interdisciplinary team. The authors describe the role of the CNS in changing NICU culture around feeding infants, an important and frequent nursing activity, with the Magnet(®) model as the framework for change.

State of the science: alleviating mealtime difficulties in nursing home residents with dementia.

Three million people will reside in nursing homes (NH) in the United States, and over 50% will experience some level of dementia by 2030. People with dementia become increasingly dependent on others to manage mealtime difficulties and oral intake as the disease progresses. The purpose of this review is to explore the state of the science related to assisted hand-feeding of people with dementia in the NH, identify gaps, and inform future policy. The review was conducted in 2010 and identified sources from journal articles, websites, and other related publications. Results are presented around key themes of characteristics, measurements, related factors, and interventions for alleviating mealtime difficulties in people with dementia. Though in the early stages, international and interdisciplinary research interest exists to understand mealtime difficulties and effective intervention strategies. Health care providers must be able to identify problems and intervene appropriately to alleviate mealtime difficulties.

Using evidence to improve care for the vulnerable neonatal population.

The facilitation of evidence-based practice (EBP) in the clinical setting is important to ensure patients receive the best care possible. This article highlights changes in open visitation and feeding readiness practices that occurred in a Magnet-designated facility neonatal ICU. The examples demonstrate ways to bring evidence to the bedside within an environment that supports EBP at all levels of nursing leadership.

Analysis of the reaction and behavior of nurses after training on young child feeding.

OBJECTIVE: to assess the reaction and behavior of nurses after training on the use of educational tool to promote heathy nutrition to children. METHOD: pilot assessment study, of descriptive and quantitative approach, carried out in 2014 with eight nurses from the rural area of Ceará, Brazil, by observing a training workshop on the use of the serial album "Alimentos regionais: promovendo a segurança alimentar na promoção da alimentação infantil saudável" [Regional food: promoting food safety through child healthy feeding]. RESULTS: the analysis of the reaction of nurses to the workshop showed that all of them (100%) were satisfied with the training. In behavior analysis, more than a half of the nurses have achieved the expected performance when implementing the illustrations of the serial album, seven of them (87.5%) being considered able to use the serial album. CONCLUSION: the training was considered effective, as all the participant nurses were satisfied and most of them considered capable of using the educational tool in promoting child healthy feeding.

Impact of Cognition and Handfeeding Assistance on Nutritional Intake for Nursing Home Residents.

In nursing homes (NHs), residents are at risk for malnutrition and weight loss. The purpose of this secondary data analysis was to examine the impact of resident cognitive status and level of feeding assistance provided by NH staff on resident's daily nutritional intake and body weight. As part of a large, multisite clinical trial (N = 786), residents with and without dementia were examined according to level of feeding assistance required during mealtimes (independent, set-up only, needs help eating) over a 21-day period. Outcomes analyzed were percent of meal intake by meal type (breakfast, lunch, dinner) and overall daily intake (meals + snacks/supplements). Residents with dementia who required meal set-up assistance had significantly lower meal intake for all three meals. Residents without dementia requiring meal set-up assistance experienced significantly lower intake for breakfast and dinner, but not lunch. When snacks and supplements were offered between meals, residents with dementia consumed approximately 163 additional calories/day, and residents without dementia consumed approximately 156 additional calories/day. This study adds new evidence that residents at greatest risk for low intake are those who are only provided set-up assistance for meals and/or have cognitive impairment.

The meaning of assisted feeding for people living with spinal cord injury: a phenomenological study.

AIM: This paper is a report of a study to explore the meaning of assisted feeding through the experiences of people with high cervical spinal cord injury. Background. Eating difficulties are known to affect a person's self-image and transform social lives. Little is known about the experience of assisted feeding as a permanent situation. METHOD: Sixteen people with high cervical spinal cord injury were interviewed twice within a period of 18 months in 2005-2006. The second interview was combined with observation. Transcriptions of interviews and notes from the observations were analysed using the phenomenological guidelines by Dahlberg and colleagues. FINDINGS: The essence of the phenomenon assisted feeding was described as a constructed pattern based on coordinated attention between the person with high cervical spinal cord injury and the helper. The constituents of the essence were: paralysis as a condition of life, facing the altered meal, reconciling with diminished bodily anchoring, sensitive cooperation between self and helper, realization of own values around meals, balanced use of meal-related devices and negotiating relationship with helpers. CONCLUSION: Assisted feeding should be adjusted to each individual person. Fixed procedures or routines should be avoided and assistive devices used with care. We recommend that continuity in the cooperation between the parties involved in assisted feeding is given priority, and that personal standard and social norms around meals are acknowledged.

Applicability of Orem: training of caregiver of infant with Robin Sequence.

OBJECTIVE: to report the nurses' experience in relation to the training of caregivers of infants with Isolated Robin Sequence (IRS) for maintaining care after hospital discharge from the perspective of Self-Care Theoretical Framework. METHOD: the following categories were considered in this experience report: self-care action, self-care capacity, therapeutic self-care demand, self-care deficit, and nursing system. The nursing system was wholly compensatory and supportive-educative. RESULTS: caregivers' training by nurses results in the acquisition of technical skills and specific knowledge related to the infant's positioning in elevated ventral decubitus, nasopharyngeal intubation, feeding-facilitating techniques and care with the feeding tube. FINAL CONSIDERATIONS: the continuity of home care is guaranteed from caregivers' training for the therapeutic demand.

Effective Communication Strategies for Nurses to Discuss Infant Feeding with New Mothers During Postpartum Hospitalization.

During prenatal care and postpartum hospitalization, nurses have an important role in assisting new mothers to make informed decisions about feeding their newborn infants. There is overwhelming evidence that breastfeeding is beneficial for most new mothers and babies; therefore, perinatal nurses encourage breastfeeding. Newborn infant feeding conversations with women who have chosen to formula feed may be complicated and may cause tension in the nurse-patient relationship. Despite this potential difficulty, these conversations are essential to establish a feeding plan for the newborn infant and to promote healthy outcomes for mothers and babies. Tools are offered for nurses to guide conversations about infant feeding choices and to help to ensure that all mothers receive support and encouragement on their feeding choice.

Feeding assistance needs of long-stay nursing home residents and staff time to provide care.

OBJECTIVES: To describe the staff time requirements to provide feeding assistance to nursing home residents who require three different types of assistance to improve oral food and fluid intake (social stimulation, verbal cuing, or both; physical guidance; or full physical assistance) and to determine whether physically dependent residents require more staff time, as defined in the national Resource Utilization Group System (RUGS) used for reimbursement. DESIGN: Descriptive. SETTING: Six skilled nursing homes. PARTICIPANTS: Ninety-one long-stay residents with low oral intake who responded to improved feeding assistance. MEASURMENTS: Research staff conducted direct observations of usual nursing home care for 2 consecutive days (total of six meals) to measure oral food and fluid consumption (total percentage eaten) and staff time spent providing assistance (minutes and seconds). Research staff then implemented a standardized graduated-assistance protocol on 2 separate days (total of six meals) that enhanced residents' oral food and fluid intake. RESULTS: Staff time to provide feeding assistance that improved food and fluid consumption was comparable across different levels of eating dependency. Across all levels, residents required an average of 35 to 40 minutes of staff time per meal; thus, residents who needed only supervision and verbal cuing required just as much time as those who were physically dependent on staff for eating. CONCLUSION: The current RUGS system used for reimbursement likely underestimates the staff time required to provide feeding assistance care that improves oral intake.

Evidence for best practices in the neonatal period.

The purpose of this article is to provide a review of current nursing research that supports best practices during the newborn period. The literature review of peer-reviewed research articles published between January 2000 and October 2004 was conducted via keyword searches using the databases of the Cochrane Library, CINAHL, and MEDLINE. Key words included neonatal nursing, newborn, neonate, premature infant, preterm infant, and low birthweight. Content analysis revealed the following primary categories of studies that provide solid evidence for nursing practice: developmentally focused nursing care, neonatal skin care, feeding, skin-to-skin care, and pain management. Neonatal nurse researchers have made many important contributions to the research literature. Future research should expand the findings to date on the effective use of pain scales, the outcomes of skin-to-skin care and infant massage as standard practice for all neonates, and the effectiveness of nursing interventions to support the developmental sequelae of prematurity. Neonatal nurses should become familiar with and implement those findings from nursing research that strongly support evidence-based nursing practice.

Feeding beliefs of certified nurse assistants in the nursing home: a factor influencing practice.

In this study, the author examined the feeding beliefs of 20 certified nurse assistants (CNAs) working in nursing homes using Q methodology and semistructured interviews. Beliefs are defined as a combination of CNA feeding knowledge, experience, and values. Two groups of CNAs with contra belief systems emerged from the analysis. "Social feeders" believe feeding is a time to socialize with residents and "technical feeders" believe prroviding adequate nutrition is the main goal when feeding. CNAs felt their beliefs influenced their feeding practices. Training programs need to include all factors that may influence CNA feeding practices, such as CNAs' beliefs, resident characteristics, and institutional factors.

Early postoperative feeding and abdominal gynaecological surgery.

Since the 1990s, the traditional postoperative feeding protocol has been challenged for patients who have undergone major abdominal gynaecological surgery, and value of extended delays in commencing oral intake has been questioned. This review aims to determine whether early rather than delayed postoperative feeding following major abdominal gynaecological surgery has an impact upon recovery as measured by length of hospital stay. The Cochrane Library, Embase, CINAHL and Medline were searched for randomized controlled trials (RCTs) which compared early postoperative oral intake with delayed (traditional) postoperative oral intake for patients who had undergone major abdominal gynaecological surgery. Three RCTs were identified and available for consideration. Although study quality was variable, they suggest that early postoperative feeding appears to be safe and well tolerated after most abdominal gynaecological surgery and leads to a considerable reduction in hospital stay of approximately one day. However, patients' preference and costs remain unclear. Therefore, further well-designed studies are needed to identify the comprehensive effectiveness of early postoperative feeding protocol.

Perceptions of Pediatric Critical Care Nurses on the Initiation of a Nursing-Led Feeding Protocol.

BACKGROUND: Critically ill children frequently receive inadequate nutritional support. Feeding protocols have been shown to facilitate optimal nutritional care. PURPOSE: We aim to determine the perceptions of critical care nurses with regard to the implementation of a feeding protocol as well as to their preferred teaching methods before introducing this protocol in our pediatric intensive care unit (PICU). We hypothesize that nursing experience and educational level are factors that predict readiness to adopt this protocol. METHODS: All PICU nurses were invited to participate in an online survey to investigate their perceptions on protocol implementation and on preferred teaching methods. Statistical analysis was performed using simple logistic regression and the Fisher exact test. Statistical significance was taken as p < .05. RESULTS: Seventy-four nurses completed the survey. Fifty-four (73%) had nursing degrees. Mean duration of PICU experience was 6.2 years (5th, 95th percentile: 1, 15). Three quarters of participants (74%, n = 55) felt that they did not have sufficient knowledge regarding feeding protocols, and 86% (n = 64) expressed that they were keen to implement a feeding protocol. There was no association between readiness to adopt the feeding protocol with years of ICU experience (OR = 0.99, 95% CI [0.84, 1.18]) and educational level (OR = 1.43, 95% CI [0.31, 6.68]). The preferred teaching methods were bedside teaching (61%), didactic lectures (51%), and the distribution of protocol manuals (50%). PICU nurses felt that the advantages of a feeding protocol included standardization of practice, optimization of patient's nutritional intake, earlier initiation of feeding, increased patient safety, and the extension of nursing roles. Perceived disadvantages included inapplicability of the feeding protocol to all patients, lack of flexibility in feeding management, increased confusion, and doctors placing little value on the feeding protocol. CONCLUSIONS: This study found that nursing experience and level of education do not significantly affect the readiness of nurses to adopt a feeding protocol. Medical and nursing teams should not shy away from introducing a new protocol although their nurses have little experience or prior knowledge of that protocol. Future studies to investigate the impact of tailoring of educational needs before introduction of a new protocol are necessary to study the overall effectiveness of this teaching before introducing a new protocol in the ICU.