A Nurse/Intern Partnership Program Accelerates Positive Relationship Formation Between Pediatric Interns and Pediatric Nurses.

BACKGROUND: The relationship between nurses and interns affects the quality of patient care; efforts to improve this relationship are necessary for optimal care. Previously, relationship formation was found to depend on mutual trust, respect, effective communication, and undergoing the process of role formation, all of which require time. This led to the hypothesis that instituting a Nurse/Intern Partnership Program (NIPP) would accelerate relationship formation. METHODS: Using a semi-structured interview guide, prior to NIPP implementation, one nurse (n = 5) and 2 second-year resident (total n = 6) focus groups were held. After implementation, one nurse (n = 6) and one intern (n = 9) focus group were held. The focus group data were analyzed using the 5 stages of qualitative research framework. RESULTS: Thematic data analysis with 3 independent coders supported the previously developed model of relationship formation; the NIPP accelerated relationship formation between nurses and interns through creating an early ally, improving communication, and increasing role understanding. The program may have improved the culture of the pediatric unit. The interns reported more of a positive impact of the NIPP on nurse/intern relationship than the nurses. CONCLUSIONS: The NIPP was positively received by pediatric residents and nurses and successfully accelerated relationship formation between the 2 groups.

Care Through the Newborn's Eyes.

Separation of mothers and infants after birth is standard practice for many hospitals, yet not evidence-based. Nonseparation clearly has numerous benefits. However, newborns lack a voice to make choices to direct their course of care. The evidence supports nonseparation strategies for mothers and infants that promote attachment, physiologic regulation, nutrition, sleep, communication, and management of stress/pain. Moreover, the evidence is compelling that nonseparation is essential. The time has come to act on the evidence and begin seeing the care we provide through the newborn's eyes.

Does Music Positively Impact Preterm Infant Outcomes?

BACKGROUND: The hospital environment leaves preterm infants (PTIs) exposed to various stressors that can disrupt their growth and development. Developmental interventions such as music may be an important strategy to mitigate PTI's stress. This brief evaluates current evidence regarding the impact of music therapy on outcomes for PTIs. PURPOSE: The question guiding this brief is "Do various types of music therapy positively affect physiologic indicators, feeding behaviors/length of stay (LOS) and pain management outcomes for PTIs?" SEARCH STRATEGY: CINAHL/MEDLINE Complete and PubMed databases were searched using keywords preterm infants, premature infants, preterm baby, premature baby, NICU baby, music, and music therapy. The search was limited to 5 years for English studies evaluating the effects of music therapy on physiological indicators, feeding, pain outcomes, and length of stay. The search yielded 12 studies addressing these concerns. FINDINGS: Music therapy was shown to positively affect physiologic indicators, feeding, length of stay, and pain outcomes for PTIs. In addition, music decreased parental stress. IMPLICATIONS FOR PRACTICE: Thoughtful consideration should be given regarding the value of diverse types of music and parental involvement when incorporating music into an individualized plan of care. Furthermore, the development of guidelines with a focus on ambient sound reduction is an important strategy when adding music as an intervention. IMPLICATIONS FOR RESEARCH: Further research is needed to investigate ambient sound levels in conjunction with musical interventions. In addition, the impact of various types of music, differences in gender, reduction of stress, pain for infants, and parental role in music requires further evaluation.

Elevated upper body position improves pregnancy-related OSA without impairing sleep quality or sleep architecture early after delivery.

BACKGROUND: During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early after delivery. METHODS: Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h after delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position. RESULTS: Fifty-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position (P = .031) during sleep. Moderate to severe OSA (AHI > 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm2 to 1.54 ± 0.1 cm2 during wakefulness. Position-dependent increase in CSA and decrease in AHI were correlated (r = 0.42, P = .022). CONCLUSIONS: Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early after delivery. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01719224; URL: www.clinicaltrials.gov.