It's more than just a bond: nurses and parents are great hospital business.

A newborn's admission to the Neonatal Intensive Care Unit (NICU) can be both stress inducing and frightening for a parent or caregiver. With nursing being a constant calming presence, a trusting bond between the parents and nurses often becomes the lifeline to survive the NICU journey. This bond impacts not only the baby and family, but also promotes the institution's reputation within the community. In today's climate of healthcare professional shortages, the power of the nurses' connections to families cannot be overlooked. It is critical in all neonatal units, especially where parents are being approached to enroll their infant in clinical research.

Nurses' Knowledge, Communication Needs, and Future Directions in Neonatal Research: Results of an International Survey.

BACKGROUND: Preterm birth is a significant contributor to neonatal morbidity and mortality. Despite legislative efforts to increase pediatric drug development, neonatal clinical trials continue to be infrequent. The International Neonatal Consortium (INC) includes nurses as key stakeholders in their mission to accelerate safe and effective therapies for neonates. PURPOSE: INC developed a survey for nurses, physicians, and parents to explore communication practices and stakeholders' perceptions and knowledge regarding clinical trials in neonatal intensive care units (NICUs). METHODS: A stepwise consensus approach was used to solicit responses to an online survey. The convenience sample was drawn from INC organizations representing the stakeholder groups. Representatives from the National Association of Neonatal Nurses and the Council of International Neonatal Nurses, Inc, participated in all stages of the survey development process, results analysis, and publication of results. RESULTS: Participants included 188 nurses or nurse practitioners, mainly from the United States, Canada, the European Union, and Japan; 68% indicated some level of research involvement. Nurses expressed a lack of effective education to prepare them for participation in research. Results indicated a lack of a central information source for staff and systematic approaches to inform families of studies. The majority of nurses indicated they were not asked to provide input into clinical trials. Nurses were uncertain about research consent and result disclosure processes. IMPLICATIONS FOR PRACTICE AND RESEARCH: This study indicates the need to educate nurses in research, improve NICU research communication through standardized, systematic pathways, and leverage nurse involvement to enhance research communication.

The culture of research communication in neonatal intensive care units: key stakeholder perspectives.

OBJECTIVE: To assess the perspectives of neonatologists, neonatal nurses, and parents on research-related education and communication practices in the neonatal intensive care unit (NICU). STUDY DESIGN: Questionnaire circulated through interest groups and administered using the internet. RESULTS: 323 respondents responded to the survey. 52 were neonatologists, 188 were neonatal nurses, and 83 were parents of NICU graduates. Analysis was descriptive. Differences were noted between stakeholder groups with respect to whether current medications meet the needs of sick neonates, research as central to the mission of the NICU, availability of appropriate education/training for all members of the research team, and adequacy of information provided to parents before, during, and after a research study is completed. CONCLUSION: Engagement of nurses and parents at all stages of NICU research is currently suboptimal; relevant good practices, including education, should be shared among neonatal units.

High-Flow Nasal Cannula Practice Patterns Reported by Neonatologists and Neonatal Nurse Practitioners in the United States.

BACKGROUND: High-flow nasal cannula (HFNC) is widely used to treat neonatal respiratory conditions. Significant evidence emerged in recent years to guide practice, yet current practice patterns and their alignment with the evidence remain unknown. PURPOSE: To examine current HFNC practice patterns and availability of clinical practice guidelines used in neonatal intensive care units in the United States. METHODS/ANALYSIS: A nonexperimental, descriptive study was designed using a web-based survey to elicit a convenience sample of US neonatal providers. Quantitative data were analyzed using descriptive statistics, χ tests were used to test for differences among the categories, and post hoc comparisons among each combination of categories were conducted using a Bonferroni-corrected α of .05 to determine significance as appropriate. RESULTS: A total of 947 responses were analyzed (626 neonatologists and 321 neonatal nurse practitioners). Univariate analyses suggested wide variations in practice patterns. One-third of the respondents used clinical guidelines, the majority utilized HFNC devices in conjunction with nasal continuous positive airway pressure, more than two-thirds used HFNC as a primary respiratory support treatment, and among all respondents, significant differences related to HFNC device types were reported. IMPLICATIONS FOR PRACTICE: US providers revealed wide practice variations related to HFNC therapy. In addition, type of device used appears to impact practice patterns and approaches. Use of standardized guidelines was reported by one third of the respondents, and as such may be the contributing factor for wide practice variations. IMPLICATIONS FOR RESEARCH: Future Research is needed to target aspects of practice where practice variations exist, or practice is not supported by evidence. Significant practice differences related to the device types should be considered in future research design.

Council of International Neonatal Nurses (COINN) Global Neonatal Provider Database Initiative (CGNPD): Results From an Implementation Focus Group.

BACKGROUND: The neonatal nurses are the key component of the essential workforce necessary to address the healthcare needs of the infants globally. The paucity of the data regarding the availability and training of the neonatal workforce challenges the stakeholders at the regional, national, and global levels. The lack of these data makes strategic planning for initiatives especially in low-resourced countries difficult. Up-to-date data are critically needed to describe the role neonatal nurses play in global newborn health outcomes. PURPOSE: The purpose of the COINN Global Neonatal Provider Database Initiative (CGNPD) was to develop a workforce database by developing survey questions, conducting a focus group to determine the key reasons such a database was needed and how best to implement it, and incorporating these comments into the workforce survey and launch. Pilot testing of the draft survey instrument was done. This article reports on the findings from the focus group and the development of the survey. METHODS: A qualitative design using the focus group method was used. The focus group discussions were guided by semi-structured interview questions that had been developed prior to the focus group by neonatal experts. A convenience sample of 14 members from the international delegates and project advisory members who attended the COINN 2013 in Belfast, Northern Ireland, participated. These participants represented 10 countries. Thematic analysis was conducted using verbatim transcripts of the focus group data. RESULTS: Four main themes emerged: (1) the invisibility of neonatal nurses, (2) benchmarking needs for quality and standards, (3) need for partnership to implement the database, and (4) setting priorities for variables needed for the most salient database. IMPLICATIONS FOR PRACTICE: The questionnaire examined participants' perceptions of the significance of and the future utilization of the workforce database and elements that should be included in the survey. IMPLICATIONS FOR RESEARCH: The global neonatal workforce database is needed to describe who the neonatal nurses are in each country, what they do, how they are trained, and where they work. The data from the focus group aided in the development of the workforce survey that has been pilot tested and provides critical information to guide COINN's global implementation of the database project.

Impact on neonatal nursing globally: exemplars of how US neonatal/perinatal nurses can get involved.

Neonatal and perinatal nurses are responding to the global call by the United Nations Millennium Development Goals to decrease maternal, neonatal, and child mortality. But how does one get involved? This article describes the global needs with exemplars from Japan and Russia illustrating how nurses work globally.

[Nurse practitioners in acute care settings in the United States].

Japan is currently at a historic moment to recognize the significance of the team approach in medicine. There is a mismatch between the supply of physicians and demand for expert care that our patients expect and deserve. The acute care setting including surgery is considering adopting non-physician professionals such as nurse practitioners (NPs) in order to deliver a high quality of care. The NPs in acute care setting have evolved in the United States to meet the medical needs of the society over the last four decades. With the increased complexity of the needs of the patients in Japan, a creative innovation in the care delivery system is required. The use of the NPs in the acute care began in the neonatal intensive care unit in the early 70's as described in the author's previous article. The adult critical care realm embraced the collaborative model starting in the 90's and opened its doors widely as resident duty hours were reduced for the patient safety concerns. This article describes the wide variety of settings in which acute care NPs are found in the US today. The current model of collaborative practice owes its development and success to the committed physicians and nurses who crossed each other's boundaries for the sake of the patients decades ago.

Japan and its healthcare challenges and potential contribution of neonatal nurse practitioners.

Challenge has the potential to create opportunities for innovation. This applies to new developments aimed at enhancing existing systems of healthcare delivery. The development of the neonatal nurse practitioner's role in the United States is undoubtedly 1 such example of an innovation that was made in response to the challenge in neonatal healthcare delivery. This challenge and concomitant change was generated by a significant increase in neonatal patient needs, survival of smaller and sicker neonates, a rising acuity level, and the accompanying need to elevate the standard of healthcare for neonates. Nursing has faced such challenges more than once and been called upon to change the scope of practice not only in the United States but also globally. Japanese nursing is at a new historic moment since the end of World War II. There is an increased interest in expanding the role of nursing in collaboration with physicians to meet the complex needs of a growing neonatal intensive care population. However, for a nation where traditionally physician-led medicine was believed to maintain patient safety, nursing role advancement is met with significant opposition. This article will first describe the differences between neonatal intensive care unit workforce in Japan and in the United States and then introduce recent neonatal healthcare issues and the nation's response including an exploration of the neonatal nurse practitioner's (NNP's) role. Various barriers against nurse practitioner's role development are explained to better describe the context of NNP. This article focuses on the current status and direction of the NNP movement and efforts that are being made in Japan.