Lessons Learned from a Medical Response Team 45 Days Post-Hurricane Maria in Puerto Rico.

INTRODUCTION: Describe the lived experience of a grassroots, nongovernmental disaster medical team (DMT) through a research lens and share practical lessons learned based on the DMT's experience to support and inform future response teams. METHOD: Forty-five days after Hurricane Maria, a nongovernmental DMT provided primary medical care by means of community-based pop-up clinics and home visitations in 5 different areas of Puerto Rico. Observational data, photo images, and debriefing notes were collected and documented in the response team's daily activity log. Field notes were coded using a descriptive coding method and then categorized into 2 domains specific to public health and medical diagnosis. RESULTS: Medical aid was provided to nearly 300 (N = 296) residents. Field note observations identified exhaustion related to living conditions and the exacerbation of underlying conditions, such as reactive airway diseases, diabetes, hypertension, and depression due to the compounding effects of multiple post-disaster triggers. During home visitations, feelings of sadness and helplessness were identified secondary to natural disaster trauma and current living conditions. CONCLUSION: Our nongovernmental DMT displayed similar characteristics demonstrated by federal DMTs post-natural disaster. Several strategic lessons learned emerged from the public health intervention important to future nongovernmental DMTs.

An EBP to Promote Early Skin-to-Skin Care Intervention and Mother's Own Milk Feedings in the Extremely Low Birth Weight Population.

PURPOSE: Describe an evidence-based process (EBP) to promote early skin-to-skin care (SSC) intervention and increase mother's-own-milk (MOM) feedings at discharge among extremely low birth weight (ELBW) infants. DESIGN: This EBP aimed to address the following clinical question: Among ELBW infants, does early SSC &#ξ2264;16 days of life (DOL), compared to SSC >16 DOL, result in more infants receiving MOM feedings at discharge? SAMPLE: A retrospective chart review of 199 ELBW infants. MAIN OUTCOME VARIABLE: Early SSC intervention among ELBW infants and MOM at discharge. RESULTS: Early SSC intervention increased from 46 to 73 percent among ELBW infants over the EBP period. Frequency of SSC intervention was associated with year of EBP and MOM at discharge (p = <.05). ELBW infants in the early SSC intervention group received more MOM at discharge.

Integrating infant mental health practice models in nursing.

PROBLEM: During the first years of life, the brain is developing rapidly and is especially vulnerable to the effects of trauma and or stress. Early exposure to such early trauma or stress predisposes young children to mental health problems. The practice of infant mental health (IMH) focuses on preventing negative mental health outcomes in infancy and toddlerhood. Currently, IMH is not standard practice in nursing. To enhance IMH in nursing, this manuscript provides an overview of IMH practice models, discusses nursing implications of each model and presents a model for integrating IMH into nursing practice. METHODS: A scoping review was conducted with a literature search utilizing the keywords "infant mental health" AND "models of care" in the PubMed and CINHAL databases from 2002 to 2018. FINDINGS: Twenty of the publications retrieved met search criteria. Among the 20 articles, 10 addressed clinical-based content related to IMH practice and 10 addressed nonclinical-based content associated with IMH educational training, policy development, or system-based models of care. CONCLUSIONS: Nurses are well positioned to impact IMH. The model presented provides the nursing process as a practical framework for the integration of IMH in nursing practice that can be expanded upon as IMH evolves.

Lessons Learned from a Medical Response Team 45 Days Post Hurricane Maria in Puerto Rico.

OBJECTIVE: Describe the lived experience of a grassroots, non-governmental disaster medical team (DMT) through a research lens and share practical lessons learned, based on the DMT's experience to support and inform future response teams. METHODS: Forty-five days after Hurricane Maria, a non-governmental DMT provided primary medical care via community based pop-up clinics and home visitations in 5 different areas of Puerto Rico. Observational data, photo images, and debriefing notes were collected and documented in the response team's daily activity log. Field notes were coded using a descriptive coding method and then categorized into 2 domains specific to public health and medical diagnosis. RESULTS: Medical aid was provided to nearly 300 (N = 296) residents. Field note observations identified exhaustion related to living conditions and the exacerbation of underlying conditions such as reactive airway diseases, diabetes, hypertension, and depression due to the compounding effects of multiple post-disaster triggers. During home visitations, feelings of sadness and helplessness were identified secondary to natural disaster trauma and current living conditions. CONCLUSION: Our non-governmental DMT displayed similar characteristics demonstrated by federal DMTs post natural disaster. A number of strategic lessons learned emerged from the public health intervention important to future non-governmental DMTs.

An illustrative case for addressing infant mental health referrals.

PROBLEM: Despite knowing the importance of the early detection of adverse experiences, mental health disorders beginning or occurring during early childhood can be difficult to recognize. To address this gap, this manuscript describes the care of a parent-child dyad utilizing the nursing process in an illustrative case. METHODS: This illustrative case provides a scenario that includes the early detection of infant mental health (IMH) in primary care with referral to a psychiatric mental health advanced practice nurse (PMHNP) and highlights how integrative care with PMHNP can facilitate the use of the nursing process to promote optimal early childhood growth and development and prevent long-term mental health problems. FINDINGS: The collaboration between the primary care provider and PMHNP in addressing a common diagnosis observed in IMH (i.e., feeding disorder) where a 6-month-old infant presented with poor weight gain due to detached parenting, secondary to maternal depression, resulted in early infant-parent intervention that reduced maternal depression and normalized infant growth. CONCLUSIONS: The screening of IMH in pediatric primary care promotes early referral and collaboration with the PMHNP to address IMH problems to promote optimal growth and social-emotional development in early childhood.

A Replicable Model of Recruitment for Longitudinal Research of Preterm Infants.

BACKGROUND: Recruitment and retention in longitudinal studies can be challenging because the numbers of participants may not adequately reflect the targeted population. OBJECTIVES: The aim of the study was to present a replicable pathway model of recruitment via retrospective chart review and describe outcomes of the recruitment methods used in the model on enrollment, scheduling, and attrition. METHODS: This retrospective chart review included recruitment data from participants of a parent grant (n = 99) that met chart review inclusion criteria (n = 47) for a follow-up study measuring microbiome data of preterm infants at toddler and preschool age. RESULTS: Over a 3-year recruitment period, 25 of the 47 participants eligible for recruitment were enrolled in the follow-up study. Initial contact was more likely to be performed via mail and e-mail for first time points and via phone for subsequent contact and second time points. For scheduling, phone contact was the method utilized most frequently for both groups, with online scheduling second when introduced in the preschool group. Two participants were lost to follow-up, resulting in an attrition rate of 8%. DISCUSSION: This recruitment pathway model offers researchers multiple recruitment methods for initial contact and scheduling that may be useful in contacting more participants to positively affect enrollment and reduce attrition rates for longitudinal cohorts. The innovation of recruitment methods via Facebook for initial contact and online scheduling are new methods with promise and multiple benefits for the research staff and participants.

Longitudinal Microbiome Composition and Stability Correlate with Increased Weight and Length of Very-Low-Birth-Weight Infants.

The microbiomes of 83 preterm very-low-birth-weight (VLBW) infants and clinical covariates were analyzed weekly over the course of their initial neonatal intensive care unit (NICU) stay, with infant growth as the primary clinical outcome. Birth weight significantly correlated with increased rate of weight gain in the first 6 weeks of life, while no significant relationship was observed between rate of weight gain and feeding type. Microbial diversity increased with age and was significantly correlated with weight gain and percentage of the mother's own milk. As expected, infants who received antibiotics during their NICU stay had significantly lower alpha diversity than those who did not. Of those in the cohort, 25 were followed into childhood. Alpha diversity significantly increased between NICU discharge and age 2 years and between age 2 years and age 4 years, but the microbial alpha diversity of 4-year-old children was not significantly different from that of mothers. Infants who showed improved length over the course of their NICU stay had significantly more volatile microbial beta diversity results than and a significantly decreased microbial maturity index compared with infants who did not; interestingly, all infants who showed improved length during the NICU stay were delivered by Caesarean section. Microbial beta diversity results were significantly different between the time of the NICU stay and all other time points (for children who were 2 or 4 years old and mothers when their children were 2 or 4 years old). IMPORTANCE Preterm infants are at greater risk of microbial insult than full-term infants, including reduced exposure to maternal vaginal and enteric microbes, higher rates of formula feeding, invasive procedures, and administration of antibiotics and medications that alter gastrointestinal pH. This investigation of the VLBW infant microbiome over the course of the neonatal intensive care unit (NICU) stay, and at ages 2 and 4 years, showed that the only clinical variables associated with significant differences in taxon abundance were weight gain during NICU stay (Klebsiella and Staphylococcus) and antibiotic administration (Streptococcus and Bifidobacterium). At 2 and 4 years of age, the microbiota of these VLBW infants became similar to the mothers' microbiota. The number of microbial taxa shared between the infant or toddler and the mother varied, with least the overlap between infants and mothers. Overall, there was a significant association between the diversity and structure of the microbial community and infant weight and length gain in an at-risk childhood population.