The effects of unsupervised home-based exercise training during pregnancy: A systematic review.

BACKGROUND: Pregnant women may experience physical and emotional distress. Exercise is recommended for healthy pregnant women and is beneficial for their mental and physical health. Unsupervised home-based exercise is cost-effective for pregnant women as an occasional solution for their discomfort. However, no synthesis of randomized trials on this topic has been conducted. AIMS: The aim of this study was to evaluate the effectiveness of unsupervised home-based exercise during pregnancy. METHODS: A systematic search for randomized controlled trials was performed in electronic databases. The review extracted eligibility criteria based on unsupervised home-based exercise intervention. The quality of the included studies was performed using the Cochrane Risk of Bias Tool 2.0. This review was registered a priori in PROSPERO (CRD42023452966). RESULTS: In total, seven studies were selected for systematic review. Participant adherence rates for the three reported studies varied considerably, ranging from 33% to 75%. Two studies revealed that unsupervised home-based exercise improved symptom severity in relation to long-term adherence to exercise. Two studies suggested that maternal aerobic fitness increased due to exercise. One study revealed improved sleep quality. However, none of the studies supported the positive effects of exercise on fatigue, maternal insulin sensitivity, prenatal weight gain, postnatal weight loss, birth pain, and cesarean section. LINKING EVIDENCE TO ACTION: Unsupervised home-based exercise improves discomfort symptoms during pregnancy but requires a long intervention period. This finding suggests that the evaluation period needs to be longer to identify the effects of exercise. In addition, a theoretical-based integrity exercise plan should be considered to promote the effectiveness of unsupervised home-based exercise.

Effects of a tripartite intervention on biological stress in preterm infants during heel pricks for newborn screening: A randomized controlled trial.

This prospective randomized trial examined the effects of a tripartite intervention (behavioral state modulation + nonnutritive sucking + tucking) on stress from procedural pain during heel pricks. Blood samples for routine screening were collected by heel pricks 48 h after birth (Stage 1) and at ≥37 weeks' gestation (Stage 2); salivary cortisol levels (SCLs) pre-prick (T0) and 20 min post-prick (T1) assessed stress. Preterm infants (n = 64) sampled by convenience at Level III neonatal care units were randomly assigned to the control condition (usual care) or intervention condition (tripartite intervention). Generalized estimating equations examined differences in salivary cortisol between conditions. After adjusting for effects of gestational age, postmenstrual age, and baseline SCLs, (1) at Stage 1, the change in salivary cortisol from T0 to T1 in preterm infants who received the tripartite intervention was, on average, significantly lower by 0.431 units (log scale) than the change in preterm infants who received the control condition (p < 0.001); (2) in the tripartite intervention condition, the difference between the change in mean SCLs from T0 to T1 at Stages 1 and 2 was significantly lower by 0.287 units (log scale), on average than between the change at Stages 1 and 2 in the control condition (p = 0.026). The provision of a tripartite intervention during heel prick significantly decreased the raise of SCLs compared with infants receiving usual care, suggesting lower stress. Clinicians could easily implement the tripartite intervention for heel-stick support; however, replication is needed before recommending its incorporation into routine heel stick and other stressful procedures.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women.

DESIGN: This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES: The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND: Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS: This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS: More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS: Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE: Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

Perceived importance of competencies by nurse managers at all levels: A cross-sectional study.

AIM: To explore nurse managers' perceived importance of competencies for their current job at different levels and the associated factors. BACKGROUND: Little work to date has explored the perceived importance of competencies in nursing leadership and management or considered the related factors in the Taiwan healthcare context. METHODS: Data collected from a previous large study comprising a cross-sectional web-based survey were analysed. Kruskal-Wallis test, two-sided Fisher exact test and multiple linear regression models were used for statistics analysis. RESULTS: The mix of three skills in Katz's model indicated that human skills were equally important in all three managerial levels. Of the 23 competencies, effective communication and political astuteness were rated by nurse managers at all levels as the highest-scored (M = 4.88, SD = 0.34) and lowest-scored competency (M = 3.92, SD = 0.78), respectively. Managerial level was a significant predictor of the perceived importance of competency. CONCLUSIONS: Relationship-based competencies were prominent in the perceived importance of competencies among nurse managers at different levels. Managerial hierarchy influences the relative importance of the different managerial competencies. IMPLICATIONS FOR NURSING MANAGEMENT: This study's results provide the talent strategy framework required for improving the competencies of nurse managers at all levels.

Calling nurses to care for burn victims after color-dust explosion.

BACKGROUND: Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse-patient relationships. AIM: This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. RESEARCH DESIGN: A qualitative descriptive study using a phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT: Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi's method. ETHICAL CONSIDERATIONS: This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. FINDINGS: Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. CONCLUSIONS: Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient-nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.

Meaning of critical traumatic injury for a patient's body and self.

BACKGROUND: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient's body and self. AIM: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. RESEARCH DESIGN: A qualitative descriptive study using Giorgi's phenomenological approach. PARTICIPANTS AND RESEARCH CONTEXT: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30-60 min. Audiotaped interviews were transcribed and analyzed. ETHICAL CONSIDERATIONS: This study was approved by the Institutional Review Board of the medical center. FINDINGS: The impact of the experience of traumatic injury on participants' body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. DISCUSSION AND CONCLUSION: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient's body and self that facilitates ethical care and recovery from injury.

Psychometric properties and development of the competency inventory for Taiwanese nurse managers across all levels.

AIMS: To describe the development and psychometric testing of the competency inventory for nurse managers across all levels in Taiwan. BACKGROUND: The competency-based approach to develop nursing leadership and management competencies for the health care context is still insufficiently explored in terms of professional development in nursing administration. METHODS: This study used mixed methods, including qualitative study for generating the preliminary inventory and a cross-sectional survey of 573 nurse managers for psychometric properties of the inventory. RESULTS: Exploratory factor analysis revealed four domains with 23 items that explained 58.21% of the overall variance. The overall Cronbach's alpha coefficient was 0.93. Confirmatory factor analysis showed a well-fitting goodness-of-fit statistics. The construct validity was adequate, with an average variance extracted of 0.68 and composite reliability of 0.90. CONCLUSIONS: Across different levels, nurse managers have 23 essential competencies. The competency inventory demonstrates adequate psychometric properties with good construct validity and internal consistency, thereby reliable and valid for guiding the competency development of nurse managers. IMPLICATIONS FOR NURSING MANAGEMENT: The essential competencies of the inventory serve as a criterion-referenced measurement for competence proficiency in professional development of nursing administration and contribute to performance improvement of nurse managers in practice.

Effects of Combined Use of Mother's Breast Milk, Heartbeat Sounds, and Non-Nutritive Sucking on Preterm Infants' Behavioral Stress During Venipuncture: A Randomized Controlled Trial.

PURPOSE: Even routine procedures can cause pain and stress, and can be harmful to the fast-growing brain of preterm infants. Mitigating pain and stress with sucrose and analgesics has side effects; thus, an alternate choice is the use of natural breast milk and infants' sensory capabilities. Therefore, this study examined the effects of different integrations of sensory experiences-mother's breast milk odor and taste (BM-OT), heartbeat sounds (HBs), and non-nutritive sucking (NNS)-on preterm infant's behavioral stress during venipuncture. DESIGN: This study was a prospective, randomized controlled trial. METHODS: Infants born preterm (<37 weeks' gestational age) were enrolled in the study through convenience sampling, and randomly assigned to the following conditions: (condition 1) routine care (n = 36); (condition 2) BM-OT (n = 33); (condition 3) BM-OT + HBs (n = 33); or (condition 4) BM-OT + HBs + NNS (n = 36). Crying duration from puncture to recovery period was recorded using a voice recorder. Facial actions and body movements were measured using an infant behavioral coding scheme and transformed into frequencies during seven stages: baseline (stage 0), disinfecting (stage 1), venipuncture (stage 2), and the recovery period for 10 minutes (stages 3-6). FINDINGS: Data were analyzed for 138 preterm infants. The corresponding median times to stop crying for conditions 1, 2, 3, and 4 were 137, 79, 81, and 39 s, respectively; the instantaneous occurrence rates of stopping crying for conditions 2, 3, and 4 were 1.469, 1.574, and 2.996 times greater than for condition 1, respectively. Infants receiving conditions 3 and 4 had significantly fewer occurrences of facial actions (stage 6 and stages 4-6, respectively) and body movements (stages 3-6 for both); however, there were no significant reductions in stress behaviors for condition 2 (BM-OT). CONCLUSIONS: The combination of BM-OT, HBs, and NNS could be provided to preterm infants as interventions to prevent and reduce behavioral stress, and facilitate pain recovery during venipuncture procedures. CLINICAL RELEVANCE: Clinicians should be educated about how to recognize preterm infants' behavioral stress, and to incorporate different sensory combinations of respective mothers' BM, HBs, and NNS into painful procedures to help preterm infants recover from distress.

Integration of Different Sensory Interventions From Mother's Breast Milk for Preterm Infant Pain During Peripheral Venipuncture Procedures: A Prospective Randomized Controlled Trial.

PURPOSE: To compare the effects of integrating mother's breast milk (BM) with three different combinations of sensory stimuli on preterm infant pain during peripheral venipuncture procedures. DESIGN: A prospective, repeated-measures randomized controlled trial. METHODS: Preterm infants (gestational age between 28 and 37 weeks, and in stable condition) needing venipuncture were recruited by convenience sampling (N = 140) and randomly assigned to four treatment conditions: (a) routine care (condition 1); (b) BM odor or taste (condition 2); (c) BM odor or taste + heartbeat sounds (HBs; condition 3), and (d) BM odor or taste + HBs + non-nutritive sucking (NNS; condition 4). Pain scores were assessed based on the Premature Infant Pain Profile-Revised (PIPP-R) over nine phases: baseline (phase 0, 5 min without stimuli before venipuncture), disinfecting (phase 1), during venipuncture (phase 2), and a 10-min recovery (phases 3-8). FINDINGS: Infants who received BM odor or taste + HBs + NNS had significantly lower increases in pain scores from baseline compared with controls across phases 1 through 8. Infants treated with either condition 2 or 3 demonstrated significant reductions in mild pain during disinfecting and recovery phases, as compared with the controls. When condition 2 was used as the reference, there were no significant differences in pain scores between the infants receiving condition 3 across the nine phases, suggesting mothers' HBs have only mild analgesic effects on venipuncture pain. CONCLUSIONS: Integration of mother's BM odor or taste, HBs, and tactile NNS should be considered as an intervention for alleviation of procedural pain for preterm infants. CLINICAL RELEVANCE: Clinicians should incorporate the integrated sensory intervention into caregiving support for preterm infants undergoing short painful procedures.

Effects of a supportive care bundle on sleep variables of preterm infants during hospitalization.

Sleep is important for preterm infants' brain development, but they are frequently exposed to painful procedures in the neonatal intensive care unit (NICU) that disturb their sleep cycle and affect their growth. The purpose of this study was to examine the prolonged effects of a supportive care bundle (modulation of the infants' states, non-nutritive sucking, facilitated tucking, and oral sucrose feeding) on preterm infants' sleep variables (sleep efficiency, total sleep time, sleep latency, and frequency of wake bouts) during hospitalization. The team recruited 65 preterm infants (gestational age at birth 28-36 weeks, average birth weight 1,652 g) from a Level III NICU at a medical center in Taiwan. Infants were randomly assigned to one of two treatment conditions to be administered while receiving intrusive procedures: (1) control condition (usual care, including routine procedures, positioning, and gentle touch); or (2) intervention condition in which the supportive care bundle was added to usual care. Sleep variables were measured using actigraphy for a baseline of three continuous days on the 6th to 8th days after birth and again for 3 continuous days when infants weighed ≧1,950 g. Two forms of generalized estimating equation analyses with control of significant covariates were used for data analysis. The supportive care bundle not only significantly increased sleep efficiency and total sleep time but also significantly decreased duration of sleep latency and frequency of wake bouts. These results provide evidence to support the incorporation of the supportive care bundle into NICU clinical practice during intrusive procedures.

[Correspondence in Humanistic Care].

BACKGROUND: Intersubjectivity is a significant element of humanistic care. However, there is a lack of evidence related to the perceptions of nurses in clinical practice settings. PURPOSE: To explore the evidence of correspondence in clinical intersubjective caring activities. METHODS: The van Manen's thematic analysis approach was used to analyze the data, which was obtained from dialogues in small group learning settings. Six scenarios were identified to define the nature of correspondence in nursing care. RESULTS: In terms of reason, ethical relation, and activity, the following three items of correspondence in humanistic care were identified: coexistence through reconciling relationships with the other, cooperation through bringing out (unfolding) and not through putting in (imposition), co-transcendence from actions and reflections. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: By adopting openness in correspondence, nurses may promote coexistence through being open-minded to their opposite, promote cooperation with their opposite, and promote co-transcendence through pursuing authentic existence. The findings show that correspondence that is grounded in coexistence, cooperation, and co-transcendence promotes creativity and diversity in caring actions.

Semi-Prone Position Can Influence Variability in Respiratory Rate of Premature Infants Using Nasal CPAP.

UNLABELLED: To determine the effect of positions (supine, lateral, semiprone) on the physiological parameters (HR, RR, SpO2) of premature infants receiving NCPAP who were non-oxygen-dependent and non-BPD, and to identify significant clinical changes associated with these variables. METHODS: A crossover study design with three different positions in the assigned sequence (supine-supine, supine-lateral and supine-semiprone) was used, and each position was maintained for 1h. The subjects' vital signs were recorded 30 min after initiation of each position and measured for 30 min. RESULTS: Forty-seven infants with a median GA of 28.6 weeks (range 26-35) were studied, and their median BW was 1210g (range 776-2920). Overall, position-related effects showed significant difference in the variability in RR (OR=0.68; CI 0.51-0.89), with the variability in RR being significantly lower in the semiprone position. The lateral position was associated with increased RR (B=2.9; p=0.02). Previous use of ventilator (PUV) was associated with increased HR, whereas BW and GA were negatively associated with higher HR. Cesarean birth, use of surfactant and PUV were associated with lower SpO2, whereas BW and GA were correlated with higher SpO2. GA was identified as a protective factor, while PUV was a risk factor for the variability in both HR and SpO2. CONCLUSIONS: Premature infants receiving NCPAP sleeping in the semiprone position may have more stable RR, while the lateral position did not improve RR. Thus, the semiprone and supine positions may be considered preferable when positioning the monitored premature infants with NCPAP.

[Concept Analysis of Postpartum Depression].

Postpartum depression (PPD) affects the health of women and is an important issue that impacts negatively on the happiness of affected families. Previous studies have demonstrated that PPD impairs the mother-child attachment, impacts the marital relationship, and may cause family dysfunction. Although PPD is a common phenomenon, the concept of PPD is easily confused with other similar concepts such as postpartum blues and postpartum psychosis, which may delay proper prevention and management. This paper identifies the definitions, characteristics, antecedents, and consequences of PPD as well as provides empirical screen measurements and examples of model, borderline, and contrary cases in order to differentiate between the concepts of PPD and other disorders using Walker and Avant's (2011) concept analysis methodology. Three defining characteristics of postpartum depression were identified. First, depression begins four to six weeks after delivery and continues for at least two weeks. Second, we benchmarked over 5 depressive symptoms. Third, postpartum depression may disrupt puerperal women's lives by making it difficult for them to care for their babies and to concentrate on daily tasks. We hope that this article enhances nurses' professional competences to detect PPD as early as possible and to promote the quality of care received by postpartum women and their family members.

[Between the self and the other: the ethical attitude of providing care to others].

BACKGROUND: The need to face others is an inescapable part of the professional responsibilities of nurses. The meaning of "facing the other" is poorly addressed in nursing practice. PURPOSE: The purpose of this study was to explore the ethical attitudes of nurses related to facing others. METHODS: A qualitative approach was used to investigate the living experience of psychiatric nurses in the supervision group in terms of improved ability to handle therapeutic groups. RESULTS: The process of facing the other was for the other, by the other, and then for oneself. The presence of for the other, the sensibility from by the other, and the self-examination of for oneself were discussed in detail. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The process of for the other, by the other, and then for oneself constructed the significance of learning from the patients. The group with that used the free-floating discussion format was found to promote the ethical attitude of psychiatric nurses and may be applied in clinical practice.

Nurse-led intervention to improve oral mucosal health of intubated patients in the intensive care unit: A prospective study.

BACKGROUND: This prospective study aimed to explore the effectiveness of an oral care intervention with Tegaderm on the oral mucosal health of intubated patients. METHODS: A total of 70 intubated patients were included and randomly assigned to 1 of 3 groups, clean water brushing teeth (n = 23), brushing teeth combined with mouthwash (BTM) (n = 23), and brushing teeth combined with mouthwash and Tegaderm (BTMT) (n = 24). The Oral Mucositis Assessment Scale (OMAS) was applied to evaluate the patient's oral mucosal health before and after oral care intervention. RESULTS: The BTMT group had lower OMAS scores in almost all regions of the oral cavity, compared to the brushing teeth and BTM groups. The general linear model for repeated measurement indicated the BTMT group had the lowest total OMAS scores from Day 2 to Day 4 after the initiation of baseline OMAS evaluation. Of the 3 intervention groups, the BTMT group had the shortest length of endotracheal intubation. The BTMT group had the lowest incidence rate of ventilator-associated pneumonia; however, no significant between-group differences were found. CONCLUSIONS: BTMT effectively reduced the decline in oral mucosal health that was caused by endotracheal intubation and shortened the length of endotracheal intubation.

Effects of bradycardia, hypoxemia and early intubation on bronchopulmonary dysplasia in very preterm infants: An observational study.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is the most common pulmonary complication in preterm infants. OBJECTIVES: The study aimed to explore the effects of bradycardia, hypoxemia, and early intubation on BPD in very preterm infants. METHODS: This is a prospective observational cohort study. Preterm infants with a mean gestational age of 28.67 weeks were recruited from two level III neonatal intensive care units (NICUs) in Taiwan. Continuous electrocardiography was used to monitor heart rates and oxygen saturation (SpO2). Infants were monitored for heart rates of <100 beats per minute and SpO2 levels of <90 % lasting for 30 s. Generalized estimating equations were used to analyze the effects of bradycardia, hypoxemia, and early intubation on BPD in very preterm infants. Model fit was visually assessed using receiver operating characteristic curve analysis. RESULTS: Bradycardia, hypoxemia, and early intubation significantly increased the odds of BPD among the preterm infants (N = 39) during NICU stay; the odds ratios for bradycardia, hypoxemia, and early intubation for BPD versus non-BPD were 1.058, 1.013, and 29.631, respectively (all p < 0.05). A model combining bradycardia, hypoxemia, and early intubation accurately predicted BPD development (area under the curve = 0.919). CONCLUSIONS: Bradycardia, hypoxemia, and early intubation significantly increased the odds of BPD among very preterm infants during NICU stay. The model combining bradycardia, hypoxemia, and early intubation accurately predicted BPD development.

Women's sense of control during labour and birth with epidural analgesia: A qualitative descriptive study.

BACKGROUND: Sense of control during childbirth is a critical issue concerning the association between high-quality maternity care and infant health. This study explored the facilitators of or barriers to a sense of control and the need for interventions to raise women's experience in childbirth. METHODS: The data came from 17 participants. Data collection was conducted in the childbirth room and within three days following childbirth, respectively. For tackling the research problems, participant observation and interviewing were applied. Thematic analysis was applied to the data analyzed. RESULTS: Two themes were identified: (1) facilitators of or barriers to practice a sense of control and (2) Care needed for a sense of control. The effectiveness of a sense of control is related to energy refill, mental loading subsided, control over decisions, non-pharmacological usage, and support from the meaningful person. Care needed includes showing empathy, providing information, using complementary pain-relief strategies, and adjusting care by parturient conditions. CONCLUSION: This study highlights the influencing factors and interventions relating to women's sense of control during childbirth with epidural analgesia. The findings suggest that many approaches, such as white noise, benefit women's sense of control after an epidural. Using non-pharmacological methods, such as a birth ball, should be appropriately regulated by situations to enhance women's sense of control. Through the assessment, education, attention to maternal needs, and recognizing the barriers to a sense of control, women will benefit from the interventions designed to improve their sense of control during childbirth.

Caregiving and positioning effects on preterm infant states over 24 hours in a neonatal unit in Taiwan.

In this prospective, descriptive study, we used a repeated-measures design to explore the 24-hour effects of caregiving and positioning on preterm infants' states and the factors associated with state changes. Thirty preterm infants (gestational age 27.6-36.1 weeks) were observed for 3 days in the neonatal intensive care unit to record six states: quiet sleep (QS), active sleep, transition, active awake, quiet awake, and fussy or crying. The occurrences of QS increased when infants received no caregiving, social interaction, non-nutritive sucking (NNS), and were laterally positioned. However, QS significantly decreased and fussy or crying state increased when infants received routine and intrusive caregiving. These results suggest that caregiving, NNS, and positioning should be appropriately provided to facilitate infants' sleep, and reduce fussiness or crying.

Preterm infants' biobehavioral responses to caregiving and positioning over 24 hours in a neonatal unit in Taiwan.

This prospective, descriptive study used a repeated-measures design to explore preterm infants' biobehavioral responses to 24-hour neonatal caregiving and positioning, and the factors associated with changes in their biobehavioral responses. Thirty preterm infants (gestational age 27.6-36.1 weeks) were observed for 3 days to record biobehavioral responses. Infants' disorganized behaviors increased as caregiving intrusiveness and supine positioning increased. Social interactions did not lead to increases in infants' disorganized behaviors, but to increased regulatory behaviors. Non-nutritive sucking (NNS), and prone positioning reduced occurrences of infant disorganized behaviors. Routine caregiving increased instability of oxygen saturation, but lateral and prone positioning improved physiological stability. Clinicians can appropriately provide NNS, positioning, and social interactions to promote biobehavioral stability.