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 pose a significant barrier. OBJECTIVES: We aimed to evaluate the viability of conducting nurse-led, big-data research projects within a custom-designed computational lab 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 lab 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. Four barriers and four 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. Additionally, clinical nurse researchers require protected research time and a data science infrastructure that supports novice efforts with education, mentorship, and computational lab resources.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Lactation Experience of Mothers and Feeding Outcomes of Infants with Congenital Diaphragmatic Hernia.

Objective: This study explores the congenital diaphragmatic hernia (CDH) infant-mother dyad with regard to maternal lactation outcomes and infant exposure to a human milk diet. Study Design: This was a retrospective descriptive cohort study conducted at Children's Hospital of Philadelphia. A total of 149 infants born with CDH and admitted to the Newborn/Infant Intensive Care Unit (N/IICU) were included in the study. Results: Of 149 mothers, 141 (95%) initiated pumping for their CDH infants. At discharge from the N/IICU, 79% (n = 118) of infants were being fed human milk. Among those discharged on human milk, 55% (n = 65) were discharged being fed unfortified human milk with 9% (n = 11) being fed unfortified maternal hind milk. Conclusion: This research demonstrates that mothers of CDH infants can effectively establish and maintain a complete milk supply and that the majority of infants with CDH can receive a human milk diet for the entire hospital stay.

Nurses' Views on Using Pasteurized Donor Human Milk for Hypoglycemic Term Infants.

PURPOSE: The purpose of this study was to explore maternal child nurses' knowledge and beliefs about using pasteurized donor human milk (PDHM) to treat newborns with hypoglycemia. Pasteurized donor human milk has been used for decades in neonatal intensive care units, but its use is relatively new in the well-baby population. STUDY DESIGN AND METHODS: Focus groups of maternal child nurses were conducted to explore this topic. RESULTS: Six focus groups that included a total 20 nurses were held. Four themes were identified: 1) nurses presumed safety of PDHM but lacked knowledge, 2) nurses' role as patient-family advocate, 3) nurses' logistical concerns about implementation of PDHM, and 4) nurses lacked clarity on formal milk sharing versus PDHM. CLINICAL IMPLICATIONS: As the use of PDHM increases for well babies, nurses will need more education about PDHM, its safety profile, its use in breastfeeding support and protection of the infant microbiome, and how PDHM differs from informal milk sharing. Nurses play an important role in helping parents weigh risks and benefits of using PDHM or formula when supplementation is needed during the hospital stay. It is important that nurses feel confident in their own knowledge and ability to address parental concerns so they can advocate for their patients and support parental decision-making.

Status of Legislative Efforts to Promote and Protect Breastfeeding and the Provision of Human Milk for Women Returning to Work in the First Postpartum Year.

INTRODUCTION: Women account for over 50% of the workforce in the United States with many working women being of childbearing age. The United States does not provide long paid parental leave, thus mothers who choose to breastfeed are confronted with the reality of combining breastfeeding and returning to work. Return to work is reported to negatively impact breastfeeding exclusivity and duration. While the existing federal law protects some women, not all women have legal support to breastfeed or express milk at work. Exemptions to the federal law include limitations related to the employee's status, classification of employer, total number of employees and the employer's annual revenue. This study aimed to examine existing city-level legislation protecting the rights of women to breastfeed or express milk at their place of employment during the postpartum period. MATERIALS AND METHODS: Prospective descriptive study with survey. The national sample includes the three largest cities of each state and the capital city of the United States (Washington, DC) for a total of 151 cities. The data were collected in a tiered approach with three phases: (1) assessment of city website, (2) e-mail to city mayor's office, and (3) telephone follow-up with the city's office. RESULTS: Only 2/151 (1.3%) of cities had specific legislation outlining the protections for all breastfeeding women in the workplace. CONCLUSIONS: This research demonstrates a clear need for political action to increase the number of women who have workplace regulations to protect breastfeeding.

Best Practices to Limit Contamination of Donor Milk in a Milk Bank.

Human milk donated to a milk bank can become contaminated in a number of ways, but processes exist to eradicate pathogenic bacterial growth. Donor human milk may be cultured before or after pasteurization or both. The purpose of this article is to describe standard operations of the Mothers' Milk Bank of the Children's Hospital of Philadelphia, best practices to limit the bacterial contamination of donor human milk, and implications for future research.

Cost and Use of Pasteurized Donor Human Milk at a Children's Hospital.

OBJECTIVE: To determine the cost and use of pasteurized donor human milk (PDHM) at a children's hospital with a strong human milk culture. DESIGN: A retrospective descriptive cohort study. SETTING: A children's hospital in the northeastern region of the United States. PARTICIPANTS: Infants (N = 281) younger than 1 year of age at the time of hospitalization who received PDHM between January 2011 and November 2014. Infants older than 1 year of age at the time of hospitalization were excluded from the study sample. METHODS: For each eligible infant, the following descriptive characteristics were abstracted from the electronic health record: gestational age, birth weight, primary diagnosis, unit/floor, total volume of PDHM fed to infant, total number of days the infant received PDHM, diet order on day of discharge, and total length of stay in days. Descriptive statistics were used to analyze all data. RESULTS: Of the sample, 70% (n = 197/281) were cared for in the NICU and 30% (n = 84/281) were cared for outside of the NICU. The mean number of days an infant received PDHM was 23 days (range = 1-134 days) and the mean volume consumed daily was 195 ml (range = 6-1,335 ml). Using a purchase cost of U.S. $4.50 per ounce, the average purchase cost of PDHM per day was U.S. $29.19 (range = U.S. $0.90 to U.S. $200.23). CONCLUSION: PDHM is a low-cost intervention compared with many other interventions for the care of hospitalized infants.

Mothers of Infants With Congenital Diaphragmatic Hernia Describe "Breastfeeding" in the Neonatal Intensive Care Unit: "As Long as It's My Milk, I'm Happy".

BACKGROUND: Very little is known about the breastfeeding experience of mothers of infants born with congenital anomalies and cared for in the neonatal intensive care unit (NICU). Often, studies related to breastfeeding and lactation in the NICU setting are focused on the mothers of late preterm, preterm, low-birth-weight, and very-low-birth-weight infants. Congenital diaphragmatic hernia (CDH) is an anatomic malformation of the diaphragm and affects 1 in every 2,000 to 4,000 live births. Currently, there are no studies examining the health outcomes of infants with CDH and the effect of human milk. Research aim: This study aimed to describe the breastfeeding experience of mothers of infants with CDH cared for in the NICU. METHODS: A prospective, longitudinal qualitative descriptive design was used. Phased interviews were conducted with a purposive sample of 11 CDH infant-mother dyads from a level 3 NICU in a children's hospital. RESULTS: Six themes emerged from the data: (a) hopeful for breastfeeding, (b) latching on . . . to the pump, (c) we've already worked so hard, (d) getting the hang of it-it's getting easier, (e) a good safety net, and (f) finding a way that works for us. CONCLUSION: For this population of CDH infant-mother dyads, the term breastfeeding is not exclusive to direct feeding at the breast and the mothers emphasized the significance of providing their own mother's milk through a combination of feeding mechanisms to their infants with CDH.

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.