How NICU design and infant and family-centered developmental care act synergistically to support babies and families.

Recommended NICU Design Standards and Infant and Family Centered Developmental Care standards have complementary goals. Design standards focus on environmental modifications necessary to enhance NICU baby and family experiences and outcomes. Infant and Family Developmental Care Standards focus on the functional aspects of babies' and families' experience, including the caregiving environment. When applied in the NICU environment of care, both complementary evidence-based standards can function synergistically to promote better outcomes for babies and families.

Establishing a tutoring and academic support center: Collaborating with nurse educator students.

Academic demands challenge many nursing students as they embark on their professional journey to become competent nurses or further their education. Challenges with incorporating successful retention strategies were problematic during the worldwide COVID-19 public health emergency. Academic student support services were urgently needed. This article describes the successful development of a funded college campus's academic support service center using virtual nurse educator tutoring services for undergraduate and graduate nursing students. The mission of the center is to assist nursing students to become independent, self-confident, and efficient learners who successfully fulfill all academic nursing program requirements. Evidence-based education was provided to train tutors and refine their technology competencies. Tutoring was provided for graduate students to fulfill the need for similar types of academic support services. Metrics were collected to evaluate the relationship between tutoring and academic success indicators. Initial evaluations of tutoring sessions by tutees suggest that peer tutoring as an adjunctive teaching and learning strategy can positively impact academic performance. Findings included improved student quantitative measures including higher exam scores and GPAs along with qualitative outcomes suggesting increased critical thinking skills, self-direction, and self-confidence. Nurse educator student tutors gained valuable teaching experience that promoted their overall academic role development.

Executive summary: standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit.

OBJECTIVE: Developmental family-centered care is evolving as an essential intensive care practice component for newborns and families. Research supports developmental care and the resulting positive outcomes for infants and families. STUDY DESIGN: An interprofessional and parent committee utilized a systematic review and consensus process to evaluate the evidence for intensive care practice. Infant- and family-centered developmental care was described, practice components identified, and evidence-based standards and competencies articulated. RESULTS: Consensus process results included articulation of Standards, Competencies and Recommended Best Practices for Infant and Family Centered Developmental Care (IFCDC), including components of systems thinking, positioning and touch, sleep and arousal, skin-to-skin contact, reduction of pain and stress for infants and families, and feeding. CONCLUSIONS: Successful IFCDC-recommended practices provide opportunities to integrate the family with the interprofessional team, standardize practice, and improve outcomes.

The Welch Emotional Connection Screen: validation of a brief mother-infant relational health screen.

AIM: The Welch Emotional Connection Screen (WECS), assesses mother-infant Emotional Connection in clinical settings. It includes: Attraction, Vocal Communication, Facial Communication, Sensitivity/Reciprocity and clinical decision of Emotional Connection (yes/no). We tested concurrent and construct validity of the WECS and associations with behavioural and physiological measures in preterm infants. METHODS: Videos from 76 mothers-infants (gestational age 36 weeks) during an in-NICU caregiving paradigm were coded for maternal caregiving behaviour. Videos of mothers-infants were also obtained at 4 months during 10 minutes of face-to-face play (coded with WECS and for maternal positivity and infant social engagement) and the still-face paradigm (coded for infant behavioural approach towards mother; infant electrocardiogram acquired in vivo). RESULTS: WECS maternal scores were positively associated with maternal sensitivity and quality of vocal contact at 36 weeks (caregiving) and maternal positivity at 4 months (face-to-face). WECS infant scores positively correlated with infant social engagement and maternal positivity during face-to-face interactions at 4 months. Infants from emotionally not connected dyads (vs. emotionally connected dyads) displayed autonomic dysregulation and less approach-seeking behaviour towards mother during interactive/play sessions of the still-face paradigm. CONCLUSION: This preliminary evidence supports the WECS as a valid screen for rating mother-preterm infant emotional connection associated with healthier infant biobehavioural stress responding.

Lack of Emotional Awareness is Associated with Thwarted Belongingness and Acquired Capability for Suicide in a Military Psychiatric Inpatient Sample.

OBJECTIVE: To examine potential links between facets of impulsivity and emotion dysregulation to components of the Interpersonal-Psychological Theory of Suicide (thwarted belongingness, perceived burdensomeness, and acquired capability) among U.S. military personnel. METHOD: The current study performed secondary data analysis from a randomized control trial testing the efficacy of a cognitive therapy for 134 service members (71.64% male, 68.66% Caucasian; mean age: 30.14) admitted to a psychiatric inpatient unit for a suicide-related crisis. We utilized the Difficulties in Emotion Regulation Scale, the Barratt Impulsivity Scale, the Acquired Capability for Suicide Scale, and the Interpersonal Needs Questionnaire. RESULTS: All emotion dysregulation dimensions and one impulsivity facet (attentional) were positively correlated with perceived burdensomeness and thwarted belongingness. Lack of emotional awareness was positively associated with acquired capability. After controlling for depression, hopelessness, and demographic covariates, lack of emotional awareness was significantly associated with both thwarted belongingness and acquired capability, but not perceived burdensomeness, and impulsivity dimensions did not link to any variable of interest. CONCLUSIONS: Findings imply that individuals with reduced emotional awareness may have difficulty cultivating interpersonal bonds and be more vulnerable to elevated acquired capability. Lack of emotional awareness may be a potential contributor to both suicidal desire and capability.

Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework.

Pediatric feeding disorders (PFDs) lack a universally accepted definition. Feeding disorders require comprehensive assessment and treatment of 4 closely related, complementary domains (medical, psychosocial, and feeding skill-based systems and associated nutritional complications). Previous diagnostic paradigms have, however, typically defined feeding disorders using the lens of a single professional discipline and fail to characterize associated functional limitations that are critical to plan appropriate interventions and improve quality of life. Using the framework of the World Health Organization International Classification of Functioning, Disability, and Health, a unifying diagnostic term is proposed: "Pediatric Feeding Disorder" (PFD), defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable practitioners and researchers to better characterize the needs of heterogeneous patient populations, facilitate inclusion of all relevant disciplines in treatment planning, and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy.

Impulse control difficulties while distressed: A facet of emotion dysregulation links to Non-Suicidal Self-Injury among psychiatric inpatients at military treatment facilities.

Links between emotion dysregulation, suicide ideation, and suicidal versus non-suicidal self-injury (NSSI) are poorly understood within military samples. United States service members and beneficiaries (N = 186), psychiatrically hospitalized following a suicidal crisis, completed the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and reported lifetime suicide ideation, attempts, and NSSI. We expected that emotion dysregulation would positively associate with worst lifetime suicide ideation, multiple suicide attempt status, and lifetime NSSI. Suicide ideation severity and multiple suicide attempts did not associate with DERS components. Notably, difficulties with impulse control (feeling out of control while distressed) was positively associated with NSSI history. Theoretical models that clearly describe the role of emotion dysregulation in suicidal thoughts, its progression to suicidal actions, and NSSI are needed to advance clinical care for this highly vulnerable group. Longitudinal and micro-longitudinal study designs require further investigation.

Non-Suicidal Self-Injury Elevates Suicide Risk among United States Military Personnel with Lifetime Attempted Suicide.

Military psychiatric inpatients with and without a lifetime history of non-suicidal self-injury (NSSI), combined with a history of at least one suicide attempt, were compared on suicide ideation severity, number of suicide attempts, and Interpersonal-Psychological Theory of Suicide variables. Data were derived from baseline assessments performed in a psychotherapy randomized controlled trial. Lifetime history of NSSI and lifetime number of suicide attempts were assessed using the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011 ). Individuals with versus without a combined lifetime history of attempted suicide and NSSI showed significant elevations on thwarted belongingness and acquired capability for suicide. No significant between-group differences were found on perceived burdensomeness, frequency, duration, and controllability of suicide ideation, or number of lifetime suicide attempts. A history of NSSI, above and beyond attempted suicide, appears to increase service members' social alienation and acquired capability for suicide.

Developmental care for high-risk newborns: emerging science, clinical application, and continuity from newborn intensive care unit to community.

Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed.

Eating as a neurodevelopmental process for high-risk newborns.

Many high-risk and preterm infants have difficulty with successful feeding and subsequent optimal growth during their stay in the neonatal intensive care unit as well as in the months after discharge. Environmental, procedural, and medical issues necessary for treatment of the hospitalized infant present challenges for the development of successful eating skills. Emerging data describe eating as a predictable neurodevelopmental process that depends on the infant's organization of physiologic processes, motor tone and movement, level of arousal, and ability to simultaneously regulate these processes.

Family-based intervention to enhance infant-parent relationships in the neonatal intensive care unit.

OBJECTIVE: To examine how family-based interventions in the neonatal intensive care unit (NICU) may change parental knowledge and behaviors and decrease stress. METHODS: Eighty-four high-risk mother-infant dyads were randomly assigned to two intervention and one control groups. Group 1 (n = 28) participated in a demonstration of infant reflexes, attention, motor skills, and sleep-wake states. Group 2 (n = 31) viewed educational materials. Group 3 (n = 25), controls, participated in an informal discussion. Parent-infant interactions (Nursing Child Assessment Feeding Scale) were videotaped. Mothers completed measures of stress (Parenting Stress Index) and knowledge of infant cues (Knowledge of Preterm Infant Behavior Scale). RESULTS: Mothers in both intervention groups evidenced greater knowledge and more contingent and sensitive interactions with their infants than did the control group. Stress also differed across groups, and all mothers reported scores above norms. CONCLUSIONS: In a high-risk sample, short-term, family-based NICU interventions may enhance mothers' knowledge, sensitivity, contingency, and stress.

Early relationship environments: physiology of skin-to-skin contact for parents and their preterm infants.

Skin-to-skin care involves the mother placing her diaper-clad infant upright between her breasts in direct skin contact. The practice has evolved worldwide to be an intervention strategy in neonatal intensive care units for premature infants and their mothers. Few adverse outcomes have been noted in thermoregulation, cardiovascular changes, or behavioral organization. Findings have been positively related to better infant physiologic and neurobehavioral outcomes, maternal breastfeeding success, and positive attachment relationships. The early, intimate, and physiologically stabilizing benefits of skin-to-skin care provide for a new conceptualization of the optimal environment for preterm infants in intensive care.

Mean noise amounts in level II vs level III neonatal intensive care units.

PURPOSE: To compare mean noise amounts in Level II NICUs with those in Level III NICUs after controlling statistically for the number of infants per unit. STUDY DESIGN: A between-group design was used in measuring noise amounts. SAMPLE: Noise amounts were sampled using a central site procedure during two time periods of approximately 25 minutes each (total time approximately 50 minutes) in five Level II NICUs and seven Level III NICUs in Colorado. MAIN OUTCOME VARIABLE: Average noise amounts (in dB) from two time periods of approximately 25 minutes each (total time approximately 50 minutes). RESULTS: Mean noise amounts were significantly higher in Level III NICUs (mean = 54.89 dB) than in Level II NICUs (mean = 49.07 dB). This result remained statistically significant even after correcting statistically for total number of babies present in each NICU during noise measurements.

Developmental progression of feeding skills: an approach to supporting feeding in preterm infants.

Infants born prematurely, with congenital or acquired medical conditions, or who have extended stays in the neonatal intensive care unit (NICU) are at higher risk of developing feeding and nutritional problems than are full-term, healthy newborns. Because of the complex nature of feeding, it is necessary to have a thorough understanding of the developmental nature of this skill. The importance of recognizing stability in the physiologic, motor and state systems and using stability to determine both readiness to begin nipple feeding and progress in feeding, is discussed. Intervention strategies to promote stability leading to successful feeding are also described. Viewing infant feeding from a developmental skill acquisition perspective can guide the caregiver in determining how challenging it is for the infant, and therefore is useful in supporting the progression of feeding.

Developmental care decreases physiologic and behavioral pain expression in preterm neonates.

Pain expression in the neonate (NN) is affected by intrinsic and extrinsic factors (gestational and postconceptional age, states, and painful experiences). The impact of developmental care is discussed in relation to defined pain expression. The aim of this randomized crossover study was to determine the impact of developmental care on pain expression during a nursing intervention in preterm NNs. Nineteen preterm NNs (gestational age, 29 +/- 1.8 weeks body weight, 1212 +/- 255 g) were included. Each NN experienced 2 randomly ordered diaper changes (with and without developmental support). Physiologic responses (heart rate, oxygen saturation, hypoxic events with SaO(2) less than 80%, bradycardia less than 80 beats/min) were studied during 3 periods: baseline, diaper change (time 0), and recovery period. Pain expression was evaluated with 2 pain scales: chronic pain with Echelle Douleur et Inconfort ([EDIN] or Pain and discomfort scale for newborns) at time B60 minutes, 0, +30 minutes, and +60 minutes and procedural pain with the Preterm Infant Pain Profile (PIPP) at time 0. Statistical analysis was conducted with a Wilcoxon nonparametric test. PIPP, EDIN 0, EDIN + 30 minutes, and EDIN + 60 minutes scores were significantly decreased with developmental care versus without developmental care: 8.7 +/- 1.9 v 11.1 +/- 2.36 (P < .01) 0.6 +/- 0.5 v 3.2 +/- 2.9 (P < .01);0.33 +/- 0.5 v 3.9 +/- 2.5 (P < .001);0.3 +/- 3.4 v 3.4 +/- 3 (P < .001), respectively. Hypoxic events rate was decreased with developmental care during the baseline and diaper change periods. The lowest oxygen saturation observed during the PIPP measure was significantly higher with developmental care (88.8% +/- 3% v 81.8% +/- 4% P < .01). Developmental care significantly decreased the PIPP and EDIN pain scores and hypoxic events during a routine nursing intervention.