Caring about Preemies' Safe Sleep (CaPSS): An Educational Program to Improve Adherence to Safe Sleep Recommendations by Mothers of Preterm Infants.

Preterm infants born before 37 weeks' gestation die of sudden infant death syndrome (SIDS) at a rate more than double that of term infants. There is a need for SIDS prevention programs tailored to the specific needs of parents of high-risk infants. The purpose of this study was to pilot test an online educational module addressing SIDS risk-reduction recommendations (RRRs) for parents of preterm infants. This study was conducted in a 44-bed transitional care unit at a level IV NICU in the Midwest. A repeated-measures design was used. Two weeks before discharge, mothers completed a survey, addressing knowledge and plans for caring for their baby at home. Mothers then viewed the 5-section Caring about Preemies' Safe Sleep (CaPSS) education module and completed the postmodule evaluation. A discharge survey was completed 4 weeks postdischarge. Fifteen mothers, mean age 26.4 years, participated; 8 (53%) returned the postdischarge survey. Module evaluation rated clarity and completeness of information high. Mothers' ratings of SIDS knowledge were significantly higher after viewing the module (P = .000) and 4 weeks after discharge home (P = .012). Mothers found the use of a pacifier at sleep times to be new information and changed their plans for caring for their infant, with 28.6% of mothers always offering a pacifier before sleep after discharge compared with the 6.7% who had planned to do this before discharge. However, only 71% of infants slept in parents' room after discharge and only 41% were receiving at least some breast milk, which are not consistent with SIDS RRRs.

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.

Implementing a Systematic Process for Consistent Nursing Care in a NICU: A Quality Improvement Project.

AIM: The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. METHODS: A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. RESULTS: Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days. CONCLUSION: Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.

Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes.

BACKGROUND: Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. PURPOSE: To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. METHODS: This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. FINDINGS: Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. IMPLICATIONS FOR PRACTICE: Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. IMPLICATIONS FOR RESEARCH: Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.

Safe Sleep Infant Care Practices Reported by Mothers of Twins.

BACKGROUND: The high prevalence of prematurity and low birth-weight places twin infants at increased risk for sudden unexpected infant death (SUID) and/or sudden infant death syndrome (SIDS). Risk for these SUID and SIDS is affected by a combination of nonmodifiable intrinsic risk factors and modifiable extrinsic stressors including infant care practices related to sleep. Although adherence to the full scope of American Academy of Pediatrics (AAP) 2011 recommendations is intended to decrease risk, these recommendations are aimed at singleton infants and may require tailoring for families with multiple infants. PURPOSE: The study describes infant care practices reported by mothers of twins in the first 6 months postpartum. METHODS: Mothers caring for twin infants (N = 35) were surveyed online both longitudinally (at 2, 8, 16, and 24 weeks after infant hospital discharge) and cross-sectionally. AAP recommendations (2011) guided survey content. RESULTS: The degree of adherence to AAP recommendations varied over time. For example, mothers of twins reported 100% adherence to placing twins supine for sleep initially, but many reported putting babies on their stomachs for naps as twins became older. Sharing a parent's bedroom decreased over time as did frequency of crib sharing. Fewer than half of mothers offered a pacifier most or all of the time for sleep. IMPLICATIONS FOR PRACTICE: Opportunities exist for development of an educational program geared specifically for postpartum parents of twins. IMPLICATIONS FOR RESEARCH: Barriers affecting adherence to AAP recommendations and effectiveness of educational programs addressing needs of this unique population need further exploration.

Neonatal nurses' beliefs, knowledge, and practices in relation to sudden infant death syndrome risk-reduction recommendations.

BACKGROUND: Sudden infant death syndrome (SIDS) remains the third leading cause of infant death in the United States and the leading cause of death beyond 1 month of age. In 2011, the American Academy of Pediatrics (AAP) released the newest SIDS risk-reduction recommendations, which address healthcare providers in neonatal intensive care units (NICUs). Little is known about neonatal nurses' SIDS prevention strategies since the release of these newest recommendations. PURPOSE: To assess neonatal nurses' beliefs, knowledge, and practices regarding SIDS prevention in both the NICU and step-down transitional care unit (TCU). METHODS: A prospective-descriptive design was used. The 33-item SIDS Risk-Reduction Questionnaire was distributed to a convenience sample of nurses in a level III NICU/TCU in the Midwest. RESULTS: Two hundred questionnaires were distributed; 96 (48%) were returned completed. Fifty-three percent of nurses strongly agreed that SIDS recommendations make a difference in preventing SIDS and 20% strongly believed that parents model SIDS prevention practices employed by staff. A majority of nurses correctly identified 2011 recommendations. Sixty-three percent of nurses often or always gave parents verbal information and 28% often or always gave parents written information regarding SIDS. Differences were seen between NICU and TCU nurses concerning beliefs and practices, suggesting that TCU nurses more consistently follow SIDS recommendations. IMPLICATIONS FOR PRACTICE: Increased neonatal nursing and parental education regarding SIDS prevention and updated hospital policies promoting safe sleep are paramount. IMPLICATIONS FOR RESEARCH: Larger multicenter studies in level II/III NICUs are needed to provide further data on SIDS attitudes and practices.

Writing for publication: perspectives of graduate nursing students and doctorally prepared faculty.

Publication is a common expectation for both faculty and graduate students in schools of nursing. Little is known about the perceptions of students and faculty regarding what supports or interferes with students' success in writing for publication. Perceptions of supports and barriers to writing for publication and the differences in perceptions between graduate nursing students and faculty were examined. A descriptive comparative design was used to sample master's (n = 62), Doctor of Nursing Practice (n = 66), and Doctor of Philosophy (n = 7) students and graduate faculty (n = 35) using two investigator-developed surveys. Students (71.1%) and faculty (57.6%) identified working with faculty and mentors as the greatest support. Students' primary barrier was finding time (64.5%). Faculty identified not knowing how to get started (63.6%) as the students' greatest barrier. Findings support that mentoring and finding sufficient time for writing are priorities for the development of a plan to support students in writing for publication.

Mothers' experiences expressing breast milk for their preterm infants: does NICU design make a difference?

PURPOSE: This study examined differences in outcomes of provision of mothers' milk before and after implementation of a single-family room (SFR) neonatal intensive care unit (NICU) and described issues related to long-term milk expression. SAMPLE: The sample included 40 mothers (15 in the original NICU and 25 in the SFR NICU). DESIGN: Descriptive comparative. METHODS: Mothers were recruited 2 months before and 3 months after opening an SFR NICU. Nutritional data were collected throughout hospitalization. Mothers used a milk expression diary during hospitalization and completed a survey, "My Experiences With Milk Expression" immediately before infant discharge. RESULTS: Seventy-five percent of mothers planned to express breast milk or breastfeed before delivery. The majority of the mothers (55%) were most comfortable pumping in their own homes because of the increased privacy. There were no statistically significant differences between the 2 groups regarding the place where they were most comfortable pumping or where they usually pumped, although more mothers pumped in their babies' rooms in the SFR NICU. The majority of the mothers reported concern about their milk supply at some time during hospitalization and 47.5% reported having breast problems. At discharge, 71.8% of the total group was providing some breast milk and 44.7% of the total group was providing breast milk exclusively. There were no significant differences between the groups in outcomes concerning the provision of breast milk. CONCLUSIONS: Individual mother's needs for privacy need to be determined and interventions to support mothers' feeding plans throughout hospitalization and at discharge need to be developed.

Reliability and validity of the Preterm Infant Feeding Survey: instrument development and testing.

No instruments have been located that examine attitudes concerning feeding decisions of mothers of preterm infants. The purpose of this study was to describe the development and psychometric testing of the Preterm Infant Feeding Survey (PIFS). The PIFS was adapted from the Breastfeeding Attrition Prediction Scale. The five-subscale, 78-item PIFS was tested with 105 mothers of preterm infants shortly after hospital admission. Individual subscale Cronbach's alpha values ranged from .75 to .82. Factor analysis demonstrated a five-factor solution. The PIFS is the first instrument to examine factors that contribute to feeding decisions of mothers of high-risk preterm infants; this knowledge will support the planning of interventions to improve breastfeeding outcomes for this population. Further psychometric testing with larger samples is recommended.

Oral Sucrose Versus Breastfeeding in Managing Infants' Immunization-Related Pain: A Randomized Controlled Trial.

BACKGROUND: Treating pain during immunization should be a part of pediatric primary healthcare around the world, as untreated pain in children has short- and long-term consequences. Few studies of pharmacologic and nonpharmacologic methods of pain relief during immunization have been conducted in low- and middle-income countries. Finding pain-mitigating interventions that are low-cost, effective, and feasible across all settings, including with low-resourced settings could improve primary healthcare. PURPOSE: To evaluate the effectiveness of oral sucrose versus breastfeeding as methods of pain management during immunization of infants through 6 months of age. METHODS: A randomized controlled experimental design was used; 120 infants were randomly assigned to control, sucrose, or breastfeeding groups. Data were collected in an Egyptian primary health center. Outcome measures including pain (as per the FLACC pain scale), crying time, and heart rate were measured at three time points. RESULTS: There were significant differences in pain scores and crying duration during and after immunization (p < .001) for the breastfeeding group compared with the sucrose and control groups. IMPLICATIONS FOR PRACTICE: Health staff and parents need education and support in use of breastfeeding for pain management during immunization. More studies are needed to evaluate effectiveness of breastfeeding versus other pain management methods for managing infants' immunization-related pain.

Incidence of infection for preterm twins cared for in cobedding in the neonatal intensive-care unit.

OBJECTIVES: To describe the incidence of infection in a group of cobedded preterm twin infants and compare it to the incidence of infection in a cohort of preterm twin infants cared for in the same institution prior to the onset of cobedding. DESIGN: Retrospective descriptive design. SETTING: Tertiary, referral neonatal intensive-care unit in the Midwest. PARTICIPANTS: Preterm twin infants between 23 and 35 weeks gestational age. METHODS: Data from 1997 to 2001 (cobedding) compared to data from 1992 to 1996 (no cobedding). MAIN OUTCOME MEASURE: Infection as evidenced by positive blood, cerebrospinal fluid, or urine culture or radiographic evidence of pneumonia or necrotizing enterocolitis. RESULTS: Independent samples t test found the cobedded and non-cobedded infants to be homogenous in demographic data. A 2-way analysis of variance demonstrated no significant effects for cobedded infants on number of sepsis evaluations or number of positive blood cultures. There was a statistically significant difference for number of positive blood cultures at discharge reflecting the increased number of positive blood cultures in the non-cobedded infants. Finally, there were no statistically significant differences found between cobedded and non-cobedded for the presence of pneumonia or necrotizing enterocolitis. CONCLUSIONS: Cobedding of preterm twins cared for in the intensive-care nursery was not associated with an increased incidence of infection. Prospective studies are needed on cobedding before a change in practice is implemented.

Supports and Barriers to Successful Progression in a DNP Program: Students' and Graduates' Perspectives.

This study examined the supports, barriers, and strategies to successful progression in a DNP program using a nationwide online survey of DNP students and graduates. Subjects (n = 172) had a mean age of 46.2 years; 83% worked full time. Major barriers were competing demands of work, family, and school. Perseverance was a key element in overcoming barriers; most students reported being overwhelmed, and 37% considered quitting. Mechanisms for programs to consider in addressing this stress are discussed.

Explanation for cessation of breastfeeding in mothers of twins.

This study used content analysis to examine reasons for cessation of breastfeeding of twins by 2 time points: 9.4 weeks and 28.3 weeks of age. From a convenience sample of 123 mothers, 110 initiated breastfeeding for their twins. Thirty women had stopped breastfeeding by time 1, with an additional 37 women stopping by time 2. Three major themes were identified regarding weaning: factors related to breastfeeding process, to mother's role and health, and to infant behavior and health. Subcategories were identified for each theme, with additional subcategories emerging at time 2. Cited reasons are similar to those given by singleton mothers; however, mothers of twins identified unique issues related to infants' behaviors, challenges presented by growth and development, and time commitments that interfered with breastfeeding continuation. Implications of the study suggest the need for continued lactation support as the twins grow and develop and new breastfeeding issues arise.

Duration of breastfeeding for mothers of twins.

OBJECTIVE: To describe the incidence and duration of breastfeeding for mothers of twins and identify factors that affected this duration. DESIGN: Secondary analysis of data from a larger longitudinal predictive study of maternal attachment in mothers of twins. SETTING: Paper and pencil questionnaires once during pregnancy and twice in the first 6 months postpartum. PARTICIPANTS: 123 women recruited from a national support group for mothers of twins. MAIN OUTCOME MEASURES: Mothers' Information Tool, Edinburgh Postnatal Depression Scale, Rosenberg Self-Esteem Scale, and the Index of Breastfeeding Status. RESULTS: 110 (89.4%) of the sample initiated breastfeeding or initiated a milk supply by pumping. Percentage of breast milk feedings at time 2 predicted whether or not a woman was still breastfeeding at time 3 (odds ratio = 3.63, p < .001). CONCLUSION: A high percentage of breastfeeding initiation was found despite the increased care burden that has been described for mothers of twins. Mothers who continued to breastfeed at time 3 provided a high percentage of the twins' milk feedings as breast milk. The results suggest that mothers who are able to persist with the difficulties of establishing a milk supply for twins and feeding two infants are able to continue providing a high percentage of the infants' feedings as breast milk.

Cup-feeding for preterm infants: mechanics and safety.

Cup-feeding is recommended for breastfed preterm infants to avoid artificial nipples. However, the oral mechanisms used in cup-feeding, or its safety and efficacy, have not been described. The authors measured sipping, breathing, SaO2, and volume of intake during 15 cup-feeding sessions for 8 infants (mean gestational age at birth was 30.6 weeks). Mean duration of sipping bursts and pauses was 3.6 seconds and 28.1 seconds, respectively. Mean breathing rate during bursts and pauses was similar (46.2 +/- 24.3 vs 45.7 +/- 17.7, respectively), with SaO2 > or = 90% during all bursts. Mean duration of cup-feedings was 15.2 +/- 3.9 minutes (range, 11.0-23.3), whereas mean volume of intake was only 4.6 +/- 2.2 mL (range, 1.5-8). For the 15 sessions, 38.5% of milk taken from the cup was recovered on the bib. Although infants remain physiologically stable, cup-feeding has questionable efficacy and efficiency. Differentiating between actual intake versus spillage of milk merits attention.

A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity.

Kangaroo care (KC) has been the intervention for preterm infants in numerous published studies. However, most well designed studies to date have used a one-group repeated measure design. This methodology is not as definitive as an experimental design. Because of the absence of a comparable control group, change between pretest and posttest may be due to any other environmental variables or normal variation of subjects (Kirk, 1995). This randomized controlled trial (RCT) was done to test the hypotheses that KC infants would have higher mean tympanic temperatures, less weight loss, more optimal behavioral states, and lower acuity (length of stay). Thirty-four eligible mother-infant dyads were randomly assigned to the KC or the control group by computerized minimization on the day following birth. Stratification variables included infant gender, birth weight, delivery method, and parity. KC infants compared to control infants had higher mean tympanic temperature (37.3 degrees C vs. 37.0 degrees C), more quiet sleep (62% vs. 22%), and less crying (2% vs. 6%) all at p=.000. No significant difference was found for weight loss and acuity (length of stay). These findings can be used for evidence-based nursing practice in Taiwan. With the knowledge attained from this RCT, nurses can educate and motivate mothers to keep their stable preterm infants warm by skin-to- skin contact inside their clothing, thereby encouraging self-regulatory feeding.

The decision-making process of workers in using sick time.

The cost of employee absenteeism in the United States is significant in terms of sick pay, overtime costs, replacement personnel compensation, and lost productivity. Little is known about what workers consider when deciding to use sick time. Previous studies have examined work absence from an array of perspectives, including resulting work strain, job satisfaction, and job security, but absenteeism in the workplace has not been examined in terms of decision making. To scrutinize workers' decisions about using sick time, a descriptive pilot study was undertaken with a convenience sample (n = 94) of working college students. The responses to the survey revealed that the majority of the workers (73.4%) used sick time because they were too ill to work. These results are in direct opposition to previous research and suggest that workers may need education about preventing and managing minor illnesses before an absence is needed. Supporting and engaging employees and their significant others in healthy worker programs, regular surveillance examinations, and illness prevention strategies are wise investments in companies' financial futures. Future research should include a comparative study of worker absenteeism between worksites with occupational health nurses and those without nurses.

Factors influencing feeding decisions of black and white mothers of preterm infants.

OBJECTIVE: To examine the factors involved in mothers' decisions to provide breast milk for their premature infants and to determine if these factors differ between Black and White mothers. DESIGN: Secondary analysis of data from 2 primary studies at 2 time points within 2 days of hospital admission (T1) and just before discharge (T2). SETTING: Urban level III Neonatal Intensive Care Unit in the eastern United States. PARTICIPANTS: Convenience sample of 80 mothers, 34 White and 46 Black, who delivered a singleton infant less than 30 weeks' gestation. OUTCOME MEASURES: Mother-focused and infant-focused factors involved in the decision to breastfeed or formula feed as measured by the Preterm Infant Feeding Survey. RESULTS: Infant-focused scores ranked higher than mother-focused scores at T1. Mother-focused scores ranked higher than infant-focused scores at T2. Between T1 and T2, the increase in mother-focused scores and the decrease in infant-focused scores were significant. There were no significant differences between the Black and White mothers' scores at either time point. CONCLUSION: Mothers' focus on factors that impact their feeding decisions change over time from their infant to themselves. Additionally, no differences were noted between the Black and White mothers.