The Arcus Experience: Bridging the Data Science Gap for Nurse Researchers.

BACKGROUND: For years, nurse researchers have been called upon to engage with "big data" in the electronic health record (EHR) by leading studies focusing on nurse-centric patient outcomes and providing clinical analysis of potential outcome indicators. However, the current gap in nurses' data science education and training poses a significant barrier. OBJECTIVES: We aimed to evaluate the viability of conducting nurse-led, big-data research projects within a custom-designed computational laboratory and examine the support required by a team of researchers with little to no big-data experience. METHODS: Four nurse-led research teams developed a research question reliant on existing EHR data. Each team was given its own virtual computational laboratory populated with raw data. A data science education team provided instruction in coding languages-primarily structured query language and R-and data science techniques to organize and analyze the data. RESULTS: Three research teams have completed studies, resulting in one manuscript currently undergoing peer review and two manuscripts in progress. The final team is performing data analysis. Five barriers and five facilitators to big-data projects were identified. DISCUSSION: As the data science learning curve is steep, organizations need to help bridge the gap between what is currently taught in doctoral nursing programs and what is required of clinical nurse researchers to successfully engage in big-data methods. In addition, clinical nurse researchers require protected research time and a data science infrastructure that supports novice efforts with education, mentorship, and computational laboratory resources.

Creation and implementation of a REDCap database demonstrates engagement and impact for a hospital-based center for nursing research and evidence-based practice.

Demonstrating impact is essential for hospital-based centers for pediatric nursing research and evidence-based practice. To meet this aim, the Center for Pediatric Nursing Research & Evidence-Based Practice at Children's Hospital of Philadelphia created a Research Electronic Data Capture (REDCap) database as a project engagement tracker to (1) capture all requests for consultation, and (2) summarize the Center's multi-professional consultants' engagement in diverse projects across our large pediatric health system. We implemented our REDCap project engagement tracker six years ago and continue to utilize it as a living database. Customized reports allow us to effectively manage our daily operations and communicate our reach and value to stakeholders internal and external to our organization. With REDCap's flexibility and ease of use, this project engagement tracker can be easily shared with like organizations. And with strong partnerships, we hope to see the development of common metrics to communicate the impact of centers of nursing inquiry on a national scale.

National collaborative maximizes pediatric hospital-based nurse scientist impact and resources through strategic networking.

This paper describes how a national collaborative of pediatric nurse scientists has leveraged the expertise of their membership and strategic networking to guide the development of the evolving hospital-based nurse scientist role and influence centers of nursing research. Members' narratives illustrate how their networking across the collaborative has resulted in increased clarity and understanding of the hospital-based nurse scientist role, consistency in job responsibilities and expectations, title changes that more accurately reflect the nature of the role, establishment or expansion of centers of nursing research, success in talent recruitment, diversification of center team members, reporting structure alterations, and dedicated nursing research funding mechanisms. These tangible outcomes enable pediatric nurse scientists to become more effective in their roles and transform the care of pediatric patients and their families.

Evidence in Hand: Optimizing the Unique Skill Set of a Hospital-Based Center for Nursing Research and Evidence-Based Practice.

This paper describes how, as the COVID-19 pandemic emerged, one hospital-based center for nursing research and evidence-based practice capitalized on its unique skill mix to quickly pivot to provide hospital administrators and staff with timely, relevant evidence regarding the care of patients and families, as well as the protection of direct care providers and all support staff. The products produced by this center, both proactive and in direct response, contributed to clinical operations decision-making and thus, tangibly impacted practice. The positive outcomes described speak not only to the clinical environment, but also to the presence and specialized contributions of a multiprofessional center for nursing research and evidence-based practice in such a way that was not possible prior to COVID-19.

Advancing Opportunities for Clinical Inquiry and Professional Development During a Pandemic.

A notable challenge faced by pediatric hospitals during the COVID-19 pandemic included the need to decrease inpatient census and socially distant non-clinical hospital employees to alternative work arrangements. In doing so, nurses and other clinical care services employees were reassigned to new roles, while others continue to work from home. This paper aims to describe how during the COVID-19 pandemic, a pediatric hospital-based center for nursing research and evidence-based practice used this opportunity to virtually engage staff across the department in topics of clinical inquiry through education sessions, office hours, and individualized/team consultation. Therefore, elevating and increasing the presence of nursing research and evidence-based practice while providing opportunities for the continued professional development of nurses, respiratory therapists, clinical dietitians, child life specialists and employees in neurodiagnostics.

Human Milk and Breastfeeding Outcomes in Infants With Myelomeningocele.

BACKGROUND: In 2015, the study setting instituted an enteral feeding pathway, "PO Ad Lib Feeding to Support Breastfeeding." Many infants admitted to the study setting's newborn/infant intensive care unit with a primary diagnosis of myelomeningocele fall within the setting's enteral feeding pathway's inclusion criteria. PURPOSE: The primary objective of this study is to describe the enteral feeding exposure and trends, by type and method, among infants with myelomeningocele. METHODS: Retrospective descriptive cohort design. Participants were infants with a primary diagnosis of myelomeningocele between 2013 and 2016. The electronic health record was used to collect descriptive data (demographics and daily enteral feeding exposure). Data were analyzed using descriptive statistics. FINDINGS/RESULTS: More than 80% (n = 148, 81.3%) of the participants' mothers had a personalized prenatal nutrition consultation and the majority of those mothers (n = 102/118, 86.4%) had a goal to breastfeed for more than 6 months. The majority (n = 144/182, 79.1%) of the study cohort was exposed to mothers' own human milk as their first feed. It is also notable that 80.8% (n = 147) fed at least once directly at the breast; however, infants were also fed by bottle or by feeding tube. IMPLICATIONS FOR PRACTICE: It demonstrates that with appropriate evidence-based breastfeeding interventions, mothers having infants with myelomeningocele can expect to feed their infants human milk as well as direct breastfeed. IMPLICATIONS FOR RESEARCH: Future research should focus on human milk/breastfeeding outcomes of infants with myelomeningocele post-hospital discharge. Long-term breastfeeding may have an important role in the development of infants with myelomeningocele.

Human milk and breastfeeding: An intervention to mitigate toxic stress.

The American Academy of Nursing has identified toxic stress in childhood as a health policy concern of high priority. Adult diseases (e.g., obesity, diabetes, hypertension and cardiovascular disease) should be viewed as developmental disorders that begin early in life that could be reduced with the alleviation of toxic stress in childhood. The provision of human milk/breastfeeding is an evidence-based intervention that may hold the greatest potential to mitigate the effects of toxic stress from the moment of birth. Assisting families to make an informed choice to initiate and continue breastfeeding from birth has the potential to address both the disparity in the quality of nutrition provided infants and the economic stress experienced by families who purchase formula. The Expert Panel on Breastfeeding endorses initiatives to improve the initiation, duration, and exclusivity of breastfeeding to mitigate the effects of toxic stress in this call to action for research to build the evidence to support these critical relationships.

The use of technologies to support human milk & breastfeeding.

The application of lactation technologies is not limited to the NICU or the hospital setting. These technologies can be implemented within the home or hospital setting to promote the use of human milk and protect the breastfeeding relationship. Through the use of breast pumps, scales, and nipple shields, women can be supported to achieve their personal breastfeeding and lactation goals.

An ethical case for the provision of human milk in the NICU.

Despite recommendations from the World Health Organization, the United Nations Children's Fund, the American Academy of Pediatrics Section on Breastfeeding, and others, only a small percentage of infants in the United States receive exclusive human milk for the first 6 months of life. In the United States, decisions related to infant feeding are determined by surrogate or proxy in place of the neonatal voice, using the "best interest principle" as the guiding ethical focus. Given the established research on the benefits of an exclusive human milk diet compared with artificial nutrition (infant formula), infant feeding decisions made for the critically ill neonate should rest entirely in the infant's best interest, not solely in parental authority. If the mother's own milk is not available or its use is contraindicated, the American Academy of Pediatrics recommends donor human milk. However, the preverbal voice of the neonate makes it difficult to isolate the best interest of the infant separated from the family unit. Using a case exemplar, it is proposed that the means in which infant feeding decisions are made for the critically ill infant should rest entirely in the infant's best interest, not parental authority, during the course of care in the hospital setting. The best interest principle, surrogate decision making, parental authority, and proxy consent are reviewed. Furthermore, a case for the best interest principle to further illustrate the importance of the infant's voice in relationship to enteral feeding decisions is provided. Finally, implications for clinical practice are offered.

Associated morbidities to congenital diaphragmatic hernia and a relationship to human milk.

The majority of what is known in the recent literature regarding human milk studies in the neonatal intensive care setting is specific to term and/or preterm infants (including very-low-birth-weight preterm infants). However, there is a lack of human milk and breastfeeding literature concerning infants with congenital anomalies, specifically infants diagnosed with congenital diaphragmatic hernia (CDH). By applying human milk research conducted among other populations of infants, this article highlights how human milk may have a significant impact on infants with CDH. Recent human milk studies are reviewed and then applied to the CDH population in regard to respiratory and gastrointestinal morbidities, as well as infection and length of stay. In addition, clinical implications of these relationships are discussed and suggestions for future research are presented.

Breastfeeding the infant with congenital diaphragmatic hernia post extracorporeal membrane oxygenation.

Infants born with congenital diaphragmatic hernia (CDH) often require extracorporeal membrane oxygenation (ECMO). Infants on ECMO may experience a long period of being nothing by mouth (NPO) while receiving parenteral nutrition. Once the infant with CDH is repaired and off ECMO, human milk should be used to initiate enteral feedings. Human milk provides immunologic, developmental, and nutritional protection for these highrisk infants and may be crucial in decreasing morbidities commonly associated with post-ECMO survivors. These mother-infant dyads require extensive lactation support to ensure maintenance of milk supply and successful transition to direct breastfeeding. Three case studies are presented as exemplars to demonstrate how breastfeeding success can be achieved even in the most vulnerable infants.

Lactation Outcomes After Participation in a Tailored Prenatal Nutrition Consultation Among Women With Infants With Congenital Anomalies.

OBJECTIVE: To describe lactation outcomes among of a cohort of mother-infant dyads in which the women had an individualized prenatal nutrition consultation intervention. DESIGN: Descriptive cohort study. SETTING: A free-standing children's hospital with a center for fetal diagnosis and treatment and a specialized maternity unit. PARTICIPANTS: A total of 160 women who had prenatal nutrition consultations in 2014 to 2017 and gave birth to infants with known congenital anomalies and required intensive care after birth. METHODS: We surveyed women regarding their lactation outcomes after the Breastfeeding Report Card metrics of the Centers for Disease Control and Prevention and obtained permission to abstract demographic and clinical information from the setting's electronic health record. We analyzed data with standard descriptive statistics. RESULTS: Among the cohort, 86.9% (n = 139) of participants intended to provide human milk or combination feeding in the prenatal period. A total of 128 (92.1%) infants were first exposed to human milk enterally. At the time of discharge, 92.1% (n = 128) of the infants received human milk. The breastfeeding outcomes of the cohort significantly surpassed national data: initiation (98.1% vs. 84.1% national), breastfeeding at 3 months (89.4%), exclusive breastfeeding at 3 months (60% vs. 46.9% national), breastfeeding at 6 months (76.9% vs. 58.3% national), exclusive breastfeeding at 6 months (45% vs. 25.6% national), breastfeeding at 12 months (50.6% vs. 35.3% national), and breastfeeding beyond 12 months (34.4%). CONCLUSIONS: Lactation outcomes among women who had prenatal nutrition consultations far surpassed national data, and this intervention has implications for family-centered prenatal care, informed decision making, and improved breastfeeding outcomes in the hospital setting and postdischarge.

Parental Perceptions of Adolescent Connectedness and the Role of the Primary Care Provider.

INTRODUCTION: Adolescent connectedness to adults, schools, and peers is a protective factor for development. This study aimed to describe parental perceptions of opportunities for youth connectedness and the potential role of the primary care provider in supporting these opportunities. METHOD: Eleven parents or caregivers of youth aged 11-18 years participated in semistructured interviews for a prospective qualitative descriptive study. Interview transcripts were analyzed using constant comparison and deductive and inductive coding. RESULTS: Findings suggest that parents and caregivers view adolescent participation in activities as positive, and nonparental adults play a large role in influencing adolescent involvement in activities. Parents and caregivers did not recall discussing connectedness with their adolescent's primary care provider but would find this helpful. DISCUSSION: Conversations about connectedness are missing from the well adolescent visit, and more research is needed to explore the most effective ways to have these discussions with adolescents and their parents or caregivers.

Birth and Breastfeeding in the Hospital Setting during the COVID-19 Pandemic.

For new families giving birth in a hospital setting, the COVID-19 pandemic has presented numerous challenges to their birth, breastfeeding, and postpartum experiences. We present experiences of three first-time, healthy mothers and their babies, as they gave birth in the hospital and were breastfeeding during the start of the pandemic in Philadelphia, PA. Each case is framed in the mother's prenatal goals, infant feeding intentions, birth, breastfeeding, and postpartum experiences. Shared concerns and experiences among the three participants are described in five key areas: 1) Recommendations changing every day, 2) Guilt, concern, and stress, 3) In-person versus telehealth visits, 4) Missing time with family and friends, and 5) Silver linings. Through these mothers' experiences, nurses and other health care providers can learn from their perceptions and events and proactively work to ensure we provide sound anticipatory guidance, enhance our communication, and improve provision of evidence-based lactation care and support.

Case Report of Recurrent Bilateral Mastitis in a Woman Who Is Exclusively Pumping Breast Milk for an Infant in the NICU.

In this report, we describe a case of bilateral lactational mastitis in a primigravid, Spanish-speaking woman who exclusively pumped breast milk for a hospitalized, critically ill infant in the NICU within a free-standing children's hospital. The case follows her clinical presentation, assessments, diagnostics, and therapeutic interventions during the 45-day postpartum period. This case report highlights the situational and environmental context of the woman's experiences and emphasizes potential disconnections of care. Regarding her mastitis, the maternity care providers relied on the woman to provide all relevant information without knowledge of her hospitalized infant's health status. Traditionally during the postpartum period, infants hospitalized in the NICU and their mothers are cared for by separate provider teams. Clinicians must acknowledge that when women transition from recent patients to parent visitors after birth, they will likely have ongoing medical, obstetric, and psychosocial care needs.

The Critical Window of Opportunity: Lactation Initiation Following Cesarean Birth.

Introduction: Cesarean birth is reported to be risk factor for the delayed onset of maternal lactation. The purpose of this study was to describe the timing of lactation initiation, subsequent feeding/milk expression patterns, and daily milk volumes among women who had a cesarean birth of an infant with a known congenital anomaly during the 3-day postpartum hospital stay. Materials and Methods: Retrospective descriptive cohort study. The electronic medical records of dyads, between 2014 and 2017 at the study setting, were abstracted for demographic and clinical data. Milk expression and milk volume data were abstracted from maternal lactation logs. Data were analyzed using descriptive statistics. Results: Among the cohort (n = 468 dyads), the mean time from infant delivery by cesarean to lactation initiation was 257.5 minutes. The cohort was divided into three groups by the timing of lactation initiation: EARLY (≤60 minutes; n = 112), MID (>60 minutes to ≤360 minutes; n = 309), and LATE (>360 minutes; n = 47). Statistically significant differences are seen between groups for the daily means: number of feeds/pumps and maternal milk volumes (irrespective of the presence of lactation risk factors). Discussion: This is the first study to explore the relationship of lactation initiation among women postcesarean birth whose infants have a known congenital anomaly. The time between the infant's birth and the first feed/milk expression, and the patterns of feeding/milk expression during the postpartum hospital stay, are key drivers for maternal milk supply.

Experience of burnout among pediatric inpatient nurse preceptors.

BACKGROUND: There is a paucity of research describing burnout among nurses who work in the role of a preceptor, in the inpatient setting. In 2017, precepting nurses at an academic children's hospital were surveyed using the Oldenburg Burnout Inventory (OBI). Results of the survey inspired leadership to further explore this phenomenon using key informant interviews. METHODS: Prospective qualitative description with individual interviews analyzed using conventional content analysis. RESULTS: In regard to burnout, five themes illustrated the experiences of precepting nurses. "Feeling the Responsibility" reflected the cognitive stain of precepting. "An Obligation to the Role," reflected the dimensions of the OBI that addressed distancing and decreased interest in the work. However, preceptors described positive experiences "It Challenges Me Every Day," awareness of resources "Nursing Response," and insights for improving the preceptor program, "Future Strategies." CONCLUSIONS: While elements of the OBI were salient in the data, three inductive themes highlighted the balance of positive challenges and learning opportunities that inspire preceptors.

Lactation Outcomes Among Dyads Following Participation in a Model of Group Prenatal Care for Patients with Prenatally Diagnosed Fetal Anomalies.

Introduction: MamaCare is an adaptation of the CenteringPregnancy group prenatal care model designed to support women when the pregnancy has been complicated by the presence of known congenital anomalies. The lactation-related outcomes of participants were unknown. Materials and Methods: This is a retrospective descriptive cohort study describing the lactation-related outcomes of participants of MamaCare over 43 months. Data collection included abstraction of maternal demographic data, maternal group prenatal care session participation data, maternal pregnancy and delivery data, as well as documented lactation and breastfeeding data. Results: The total cohort consisted of 92 dyads. Of the 81 women who received an individualized prenatal nutrition consultation, 65 (80.2%) voiced a prenatal feeding goal of human milk and breastfeeding only, while the remaining 16 (19.8%) expressed goals of combination feeding (human milk and infant formula). For the surviving 85 infants, 91.8% of the mothers initiated lactation on the delivery day and the remaining 7 women initiated lactation on postpartum day 1. Also at the time of discharge from the initial intensive care unit stay, 87.1% of infants were receiving maternal human milk. Discussion: For families who participate in MamaCare, not only do they form a sense of community and learn about human milk and breastfeeding before delivery, the MamaCare facilitators and presenters normalize their experience to help MamaCare participants best meet their personal breastfeeding goals as well.