Congenital Cytomegalovirus-History, Current Practice, and Future Opportunities.

Cytomegalovirus (CMV) was first identified in the 1950s and noted to cause newborn disease in the 1960s. It is now known to be the most common cause of congenital infection in the world, leading to various central nervous system sequelae, the most common being hearing loss. Cytomegalovirus is a ubiquitous pathogen that affects nearly 30,000 infants annually in the United States, leading to 3,000-4,000 cases of hearing loss. Prevention through vaccination has proved unreliable, as has the use of immune globulin. Prevention through education has been shown to be the most effective method of minimizing infection. Antiviral therapy is effective at reducing the impact of infection on newborns. Continued global efforts will hopefully provide more solutions for this opportunistic infection.

The History and State of Neonatal Nursing Quality Improvement Practice and Education.

Quality improvement has evolved rapidly in neonatal nursing. This review outlines the history and current state of quality improvement practice and education in neonatal nursing. The future of neonatal nursing includes a stronger emphasis on quality improvement in advanced practice education that promotes doctoral projects that result in clinical improvements. A collective focus will ensure that neonatal nurses not only deliver evidence-based care, but also continually improve the care they deliver.

Hospital Magnet® Designation and Missed Nursing Care in Neonatal Intensive Care Units.

Missed nursing care is an emerging measure of front-line nursing care effectiveness in neonatal intensive care units (NICUs). Given Magnet® hospitals' reputations for nursing care quality, missed care comparisons with non-Magnet® hospitals may yield insights about how Magnet® designation influences patient outcomes. The purpose of this secondary analysis was to evaluate the relationship between hospital Magnet® designation and 1) the occurrence of nurse-reported missed care and 2) reasons for missed nursing care between NICU nurses employed in Magnet® and non-Magnet® hospitals. A random sample of certified neonatal intensive care unit nurses was invited to participate in a cross-sectional survey in 2012; data were analyzed from nurses who provided direct patient care (n=230). Logistic regression was used to model relationships between Magnet® designation and reports of the occurrence of and reasons for missed care while controlling for nurse and shift characteristics. There was no relationship between Magnet® designation and missed care occurrence for 34 of 35 types of care. Nurses in Magnet® hospitals were significantly less likely to report tensions and communication breakdowns with other staff, lack of familiarity with policies/procedures, and lack of back-up support from team members as reasons for missed care. Missed nursing care in NICUs occurs regardless of hospital Magnet® recognition. However, nurses' reasons for missed care systematically differ in Magnet® and non-Magnet® hospitals and these differences merit further exploration.

The Future of Neonatal Advanced Practice Registered Nurse Practice: White Paper.

In recent years, the National Association of Neonatal Nurses and the National Association of Neonatal Nurse Practitioners have been monitoring aspects of neonatal advanced practice nursing and providing leadership and advocacy to address concerns related to workforce, education, competency, fatigue, safety, and scope of practice. This white paper discusses current barriers within neonatal advanced practice registered nurse practice as well as strategies to promote the longevity of the neonatal advanced practice registered nurse roles.

The Influence of Neonatal Nursery Design on Mothers' Interactions in the Nursery.

UNLABELLED: This study examined the influence of neonatal nursery design on interactions between nurses and mothers of infants in the nursery. DESIGN AND METHODS: We used a natural quasi-experimental design, using semi-structured interviews and a structured measure of mothers' and nurses' perceptions of nursing care, to compare mothers (n=26 and n=40) and nurses (n=22 and n=29) in an open-bay (OB) nursery and a single family room (SFR) nursery. Thematic analysis was used to generate key themes from the interviews. RESULTS: Mothers and nurses in both nursery designs talked about Valuing interactions; the importance of interactions between mothers and nurses. Mothers and nurses described SFRs as providing a space, My/their room, which enhanced mothers' sense of control and connection with the infant. SFRs were also associated with Changing the norms of interactions with nurses and other mothers, which created challenges in the desired quantity and quality of interactions for mothers and nurses. Nurses in the SFR nursery also reported Enhanced interactions, including improved confidentiality and personalized communication. Mothers in the OB nursery reported more supportive mothering actions from nurses than mothers in the SFR nursery. Both mothers and nurses in the OB nursery also talked about Our nursery community, which captured the value of having other nurses and mothers in the rooms. CONCLUSION: Mothers and nurses perceived that the SFR nursery enhanced privacy and maternal closeness for mothers compared to the OB nursery. However, the SFR nursery design presented challenges to some interactions of value to nurses and mothers.

Interprofessional Education in Neonatal Care.

Interprofessional education is not a new concept. Yet, the operationalization of interprofessional education with related competencies for collaborative team-based practice in neonatal units is often difficult. Changes in healthcare with an emphasis on patient-focused care and the concern for patient safety and quality care are accelerating the need for more interprofessional education. This article briefly outlines the evolution of interprofessional education to support collaborative team-based practice and how that facilitates safety and quality care in neonatal units.

Historical Trends in Neonatal Nursing: Developmental Care and NIDCAP.

The focus of neonatal nursing has shifted from a highly technical approach to one of supportive interventions and a more individualized developmental approach. Developmental care is described as a philosophy of care that requires rethinking the relationships between infants, families, and healthcare professionals. Various models of developmental care exist; however, they all include a variety of activities designed to manage the environment and individualize the care provided to premature and/or sick infants.

State of the state: NNP program update 2013.

Findings from a spring 2013 survey of neonatal nurse practitioner (NNP) program directors are presented and concerning trends identified. Implications of these findings, in combination with other external factors influencing the supply/demand ratio on the stability of the NNP workforce nationwide, are explored. Present and future NNP workforce demands in relation to the educational programs available to prepare nurses for NNP practice are examined. Finally, discussion focuses on the politics and pragmatics of sustaining the NNP role for posterity.

Online Neonatal Training and Orientation Programme in India (ONTOP-IN)--the way forward for distance education in developing countries.

BACKGROUND: Internet-based distance learning combined with local hands-on skill enhancement can provide high-quality standardized education to in-service healthcare professionals in a wide geographical area. OBJECTIVE: Primary objective of this study was to evaluate the efficacy of internet-based distance learning in conjunction with local hands-on skill enhancement in improving knowledge and skills of essential newborn care among in-service nursing health professionals. METHODS: A total of 98 participants from seven health facilities in India and Maldives were enrolled in the study. Delivery of course material staggered over 5 weeks in the form of two lessons every week was moderated by two to three online tutors at each site. Participants managed actual case scenarios, participated in discussion forums and synchronous chat sessions within a closed group. Skill learning was administered by local tutor at the partnering health facilities. Knowledge and skill enhancement were evaluated by administering online multiple-choice questions (MCQs) test and on-site objective structured clinical evaluation (OSCE) stations before and after completion of the course. Participants' satisfaction was evaluated on a five-point Likert scale. RESULTS: Among 98 participants enrolled in the study, 78 (79%) completed the post-test assessment. There was significant increase in knowledge and skills scores (MCQ test: mean difference: 6.4 (95% CI: 5.6-7.17), OSCE: mean difference: 15.4 (95% CI: 12.7-18.1). All the participants expressed satisfaction with content and delivery of the learning module. CONCLUSION: To conclude, online training and teaching in essential newborn care is feasible and acceptable for in-service nursing professionals and serves as a useful tool for professional development of their practical skills and knowledge.

Neonatal Resuscitation Program (NRP) 2011: new science, new strategies.

In spring 2011, the American Academy of Pediatrics (AAP) will release sixth edition materials for the Neonatal Resuscitation Program (NRP). This edition brings changes in resuscitation practice and a new education methodology that shifts the instructor from "teacher" to "learning facilitator" and requires the NRP course participant to assume more responsibility for learning. The change from a lecture format to simulation-based learning requires instructors to learn new skills and meet new requirements to maintain instructor status.The sixth edition of the Textbook of Neonatal Resuscitation and the fifth edition of the Instructor's Manual for Neonatal Resuscitation are currently in press. The AAP granted permission to use material from these forthcoming publications in this article.

Global and cultural perinatal nursing research: improving clinical practice.

High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.

Balancing the scale: directions for future research for perinatal advanced practice nurses.

Advanced practice nurses, including midwives, are well positioned to conduct, participate, or both in both basic and translational research to improve the outcomes and processes of perinatal care. This article contains suggestions for future research by perinatal advanced practice nurses, conceptualized around a scale to promote balance in outcomes. More research is needed in a number of areas, examples include collaborative practice, normal birth, and translation of the evidence concerning skin-to-skin practice. Health disparities; maternal, neonatal, and infant morbidity and mortality; formula feeding; and other vulnerabilities need more research to decrease these problematic outcomes. Advanced practice nurses are encouraged to be actively involved in perinatal research, to help confront and reduce health disparities, and to apply evidence in practice, broadly promoting wellness for women and their families.

Routine obstetrical interventions: research agenda for the next decade.

There are many interventions performed as a part of the active management of labor and birth that have remained unchanged over the years. Separating ritual from beneficial nursing care can guide the development of a research agenda. The agenda for the next 10 years can address some of the gaps remaining in the evidence-based foundation for routine interventions used during labor and birth. The gaps identify areas where unanswered questions prevent optimal care from occurring. These unanswered questions include optimal time for epidural administration; management of maternal movement during labor when routine interventions make this difficult; changing the practice of immediate, closed glottis coached pushing at 10 cm; continuous electronic fetal monitoring; routine administration of intravenous fluids; and finally, the use of oxytocin as augmentation or induction of labor.

Staff perception one year after implementation of the the newborn individualized developmental care and assessment program (NIDCAP).

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) was piloted at one NICU. Staff perception of impact and the feasibility of applying the program was explored in a survey and a focus group interview. NIDCAP was perceived to impact positively on infant well-being and parents' way of caring. Although the influence of NIDCAP on staff working conditions and job perfomance was overall positive, their perceptions varied. Presence of the NIDCAP observer and empowerment of parents was challenging to some nurses, especially in terms of decision making in care. Conflicts of interest occurred between staff member need of light and infant need of light reduction.