Effect of the COPE Program on Self-Efficacy in Mothers of Preterm Infants: A Pretest-Posttest Quasi-Experimental Study.

The birth of a premature infant and its subsequent hospitalization in the neonatal intensive care unit are stressful experiences for mothers. Because of uncertainty concerning interactions with a premature baby, mothers often feel helpless and only hesitantly assume their maternal role. This may have a negative impact on the mother-child interaction and prevents mothers from taking an active part in E46www.jpnnjournal.com the care for their child. "Creating Opportunities for Parent Empowerment" (COPE) is a 4-phase educational intervention program aiming to systematically involve parents into caring for their premature infant. In this pretest-posttest quasi-experimental study in 2 Swiss university hospitals, we focused on maternal self-efficacy. We compared self-efficacy in mothers receiving the COPE program or standard care alone at baseline and 3 months after estimated delivery date. To measure maternal self-efficacy, we used the "Tool to measure Parenting Self-Efficacy" (TOPSE). While scores for "Emotion and Affection," "Empathy and Understanding," as well as "Learning and Knowledge" increased in both groups, only "Learning and Knowledge" scores were significantly higher in the intervention group. Given the intention of improving learning and knowledge, the COPE program might be a promising intervention contributing to enhanced maternal self-efficacy.

Translating family systems care into neonatology practice: A mixed method study of practitioners' attitudes, practice skills and implementation experience.

BACKGROUND: Family-centered care interventions are a recommended part of high-quality neonatal intensive care. Evidence suggests that engaging and supporting families improves parental and infant health outcomes. Enabling practitioners to work with families in a relational, strength-oriented way is thus vital to ensure quality care. However, implementing family-centered care remains a challenge, and its uptake is often slow and inconsistent. OBJECTIVES: To examine the impact of family systems care implementation activities on neonatal nurses' and physicians' attitudes and skills in working with families, and to explore their implementation experience. DESIGN: Mixed method design. SETTING AND PARTICIPANTS: Two neonatal intensive and one intermediate care unit in a Swiss, university-affiliated hospital. A total of 65 practitioners participated in the pre-post study, and 17 in focus group interviews. METHODS: Quantitative data was obtained before, mid-, and post-implementation through an online questionnaire. Attitudes were measured with the Families' Importance in Nursing Care - Nurses' Attitudes Scale. Skills and reciprocity in working with families was assessed with the Family Nursing Practice Scale. Four focus group interviews were conducted post-implementation. Data analysis included descriptive statistics, group comparison, and qualitative content analysis. RESULTS: A statistically significant increase in practice skills and reciprocity, but not in attitudes was found mid- and post-implementation. Practitioners reported new ways of working with families, which included enhanced awareness of the extended family, intentional relationship-building, augmented family involvement, and systemic interventions, such as therapeutic listening. They experienced implementation as a wheel that moved forward or stood still, depending on the challenges faced and the predominance of enabling versus limiting organizational factors. Practitioners felt not only challenged regarding the meaning of being-acting in family-centered ways, but also in delivering family systems care consistently and collaboratively. While practitioners experienced the educational workshop as helpful, they felt left alone during consolidation. CONCLUSIONS: Findings demonstrate that the inter-professional implementation of family systems care is highly relevant for practitioners' clinical practice. Implementation strategies yielded an increase in practice skills/reciprocity and new ways of working with families, but no quantifiable impact on attitudes. Adoption fluctuated and was ongoing, hindered by organizational constraints and lack of consolidation support. Nonetheless, practitioners gave numerous examples of family-centered practices. A combination of implementation strategies offered over time and supported by organizational structures are the most likely means to enable teams to work in partnership with families, and to promote infant and family well-being in neonatal care.

[Skin care and skin protection in preterm babies]. / Hautpflege und Hautschutz beim unreifen Frühgeborenen. Eine systematische Literaturübersicht.

UNLABELLED: The skin of preterm infants is anatomically and physiologically premature. This quality of the skin as well as the need for intensive monitoring and treatment/care represent additional stress factors for the integrity of the babies' skin. The babies have an increased vulnerability and risk of skin injuries. Therefore, during the first two to three weeks of life observation of the premature skin is of utmost importance. Ritualistic activities have to be questioned. This is particularly true for infants who are born before 28 weeks of pregnancy. This systematic literature review investigates the effectiveness of nursing interventions in the skin care and protection of the premature infants born earlier than the 32nd week of pregnancy. A systematic literature-search in different databases addressed the following topics: Skin-assessment, selection and use of adhesives, skin care with emollients, and body cleaning (wash interval). Despite certain methodological problems with some of the studies included in this review the following results can be formulated: Based on altered infant behaviour and the skin's continuously high population of germs the interval of bathing should be enhanced to four days. During the first two to four weeks of life the application of sun flower oil is recommended. It has a disinfecting effect and is relatively cheap. Potential preventive or protective dressings of the skin are recommended. Similarly both the utilisation of a valid skin assessment instrument and of preventive measures are inevitable. CONCLUSION: Evidence-based knowledge of the needs and care of premature skin could reduce complications during the neonatal phase and therefore health care costs. The implementation of a standardised, evidence-based skin care guideline could raise the health professionals' awareness in of skin care needs in this vulnerable patient group.