The Application of Trauma-Informed Care to Substance Use Disorder.

Trauma-informed care (TIC) has been described to apply to several groups of traumatized patient/families in the NICU. Trauma is multidimensional, including physical and psychological injuries with long-term effects on well-being and function. A newborn experiences the best outcomes when the mother also experiences the best outcomes. Thus, the TIC approach is applicable to the care of the infant with neonatal abstinence syndrome (NAS) and mother. Organizational adoption of this model is likely to provide a supportive and therapeutic environment for the infant with NAS and family.

Prácticas al momento de la ablactación en Chitré, Herrera / Practices at the time of weaning in Chitre, Herrera

Resumen Introducción: Durante los años 90 en Panamá, un programa patrocinado por los EE. UU. llevo a cabo la Iniciativa para los Hospitales Amigos de los Niños (IHAN) como guía para educar a los profesionales clínicos, al público y a las mujeres en edad reproductiva sobre los beneficios de la lactancia materna. Como resultado, Panamá tiene actualmente la mayor proporción de mujeres que ofrece el pecho materno dentro de la primera hora de vida (89.9%), pero una de las menores tasas en la región de alimentación exclusiva al pecho materno hasta los 6 meses de edad. Este estudio explora la relación entre las practicas alrededor del periodo de ablactación y la historia nutricional del lactante en mujeres panameñas con un niño de hasta 1 año de edad utilizando un diseño transversal. Materiales y Métodos: Se invito una muestra por conveniencia de 35 binomios madre-hijo en dos Centros de Salud de Chitré, Herrera. Las mujeres que consintieron participar en el estudio completaron la Escala de Autoeficacia para la Lactancia Materna, Formulario Corto (BSES-SF) y se compararon las medidas antropométricas del niño utilizando los nomogramas de los CDC. Resultados: Los puntajes del BSES-SF variaron entre 29 y 56 (media = 44.2, DE = 7.9) puntos. Siete lactantes fueron considerados a riesgo para retraso en el Desarrollo; 40% estuvieron a riesgo de talla baja y 2 estuvieron a riesgo de sobrepeso. Conclusión: A pesar de que Panamá duplicó su cantidad de IHAN a 16%, muchos lactantes continúan a riesgo nutricional.

Abstract Introduction: In the 1990's, a U.S. sponsored program ran a campaign using the Baby-Friendly Hospital Initiatives (BFHI) as a guide to educate clinical professionals, the public, and women of child-bearing age in Panama about the benefits of breastfeeding. As a result, Panama has the highest proportion of women who breastfeed in the first hour of life (89.9%), but one of the lowest rates for breastfeeding at 6 months (UNICEF, 2014). This study explores the relationship between breastfeeding practices and infant nutritional history in Panamanian women with a child up to 1 year of age using a cross-sectional design. Materials and Methods: A convenience sample of 35 mother/baby dyads was recruited from two public health centers in the Azuero region of Panamá. Women who consented completed the Breastfeeding Self-Efficacy Scale, Short Form (BSES-SF), eight items from the Baby's Feeding and Health (BFH) instrument; and infant measurements were evaluated using the Centers for Disease Control standardized growth charts. Results: Breastfeeding Self-Efficacy Scale, Short Form scores ranged from 29 to 56 (mean = 44.2, SD = 7.9). Seven infants were at risk for developmental delay; 40% were at risk for short stature; 2 were at risk for overweight. Conclusion: Even though Panama has doubled its rate of Baby Friendly Hospitals to 16%, many infants remain at nutritional risk.

Feeding Infants with Neonatal Abstinence Syndrome: Finding the Sweet Spot.

PURPOSE: The purpose of this study is to learn how caregivers who are expert in feeding infants with neonatal abstinence syndrome (NAS) successfully feed these infants during withdrawal. DESIGN/SAMPLE: Focus group methodology was used to gather information from self-identified experts from three large regional NICUs. Twelve NICU nurses and speech therapists participated in open-ended, recorded discussions. Detailed flip chart notes were taken, reviewed, and verified by the participants before the group ended. RESULTS: Four major themes emerged verified by the participants: (1) optimal medication management, (2) follow the baby's cues, (3) calm and comfortable, and (4) nurture the relationship. Participants reported using both common and creative techniques. Keeping the infant calm was crucial to being successful, as well as maintaining good control of withdrawal signs. Feeding the infant facing away from them to avoid eye contact was used, as well as vertical rocking, continuous butt patting, bundling, "shhing" sound, and a novel feeding position.

Bringing Evidence-Based Practice to Latin America: Transforming Nursing Education and Practice.

Evidence-based practice (EBP) continues to gain global attention. In the Latin American country of Panama, nursing practice has largely been guided by oral tradition and clinical experience rather than the use of best evidence. The authors used a conference-based approach in a joint effort between the University of South Florida and the University of Panama to introduce EBP to nursing leaders in Panama to bring change to the nursing curricula and, ultimately, change in nursing practice. J Contin Educ Nurs. 2017;48(11):512-516.

Long-Term Outcomes of Infants with Neonatal Abstinence Syndrome.

Parents of infants with neonatal abstinence syndrome (NAS) in the NICU may have questions about the long-term consequences of prenatal exposure to methadone, both asked and unasked. Although the signs of withdrawal will abate relatively quickly, parents should be aware of potential vision, motor, and behavioral/cognitive problems, as well as sleeping disturbances and ear infections so their infants can be followed closely and monitored by their pediatrician with appropriate referrals made. Furthermore, this knowledge may inspire parents to enroll their infants in an early intervention program to help optimize their outcomes. There are still many unanswered questions about epigenetic consequences, risk for child abuse/neglect, and risk of future substance abuse in this population.

Characteristics of Maternal-Infant Interaction During Treatment for Opioid Withdrawal.

PURPOSE: The purpose of this study was to describe the interactions between mothers in a methadone treatment program and their infants during a bottle feeding and compare the findings with normed data. DESIGN: A comparative-descriptive design was used. SAMPLE: Data from 12 opiate-exposed mother-infant dyads were compared with normed data. MAIN OUTCOME VARIABLE: Nursing Child Assessment Satellite-Training Scale scores. RESULTS: The opiate-exposed dyads scored significantly lower than the normed dyads in the infant subscales of clarity of cues (p < .001, 95% confidence interval [CI], 1.56-4.08) and responsiveness to caregiver (p < .01, 95% CI, 0.27-2.5), as well as the total score (p < .001, 95% CI, 2.42-6.15). Parent sensitivity to infant cues subscale (p < .01, 95% CI, 0.42-2.37) and parent contingency score (p < .01, 95% CI, 0.55-3.81) were also significantly lower. The cognitive growth fostering subscale scores were significantly higher in the neonatal abstinence syndrome (NAS) group (p < .01, 95% CI,- 2.94 to- 0.7).

Patterns of Disruptive Feeding Behaviors in Infants With Neonatal Abstinence Syndrome.

BACKGROUND: Severe irritability in infants with neonatal abstinence syndrome often impacts their ability to feed successfully, which challenges a mother's ability to demonstrate this most basic parenting skill. There is little empiric evidence to guide recommendations for practice in this population. PURPOSE: Describe the infant behaviors that disrupt feeding in infants with neonatal abstinence syndrome. METHODS: A mixed-method approach was used to describe digitally recorded infant feeding behaviors. Qualitative methodology was first used to identify categories of behaviors during the feeding. The categories were used as a coding scheme to identify the temporal sequence, duration, and frequency of behaviors observed during a feeding. RESULTS: The behavior categories that disrupted feeding were identified as fussing, resting, crying, and sleeping/sedated. Infants spent almost twice as much time in fussing as in feeding. The majority of the infants were fussing between 1 and 11 minutes during the feeding, and fussing disrupted feeding in every subject at least once. Feeding behavior occurred only 24% of the time, while fussing and crying occurred 51%. Fussing was the primary transitional behavior from one category to another. Infants who did not complete their feeding had nearly twice the mean number of fussing episodes as those who completed their feeding. IMPLICATIONS FOR PRACTICE: Fussing is a transitional state and appears to provide an opportunity to test interventions that help the mothers re-engage their infants in feeding. The frequency of the behavioral transitions provides a measure of irritability that has not been previously described in this population. IMPLICATIONS FOR RESEARCH: Additional study is needed to evaluate the impact and contributions of maternal behaviors and external variables on infant behavioral transition.

Mothers on methadone: care in the NICU.

When women addicted to opioids seek prenatal care, the treatment of choice is methadone. Methadone mediates the addiction by reducing fluctuations in maternal serum opioid levels and protecting the fetus from repeated withdrawal episodes. Methadone maintenance is associated with increased maternal weight gain, decreased illegal drug use, and improved compliance with prenatal care. Although the risks are less when compared with street drugs, the risk to the fetus is physical dependence. Despite the magnitude of this national problem, there is a dearth of literature to guide NICU nurses on how to best support mothers of infants with neonatal abstinence syndrome (NAS) in the care of their infants. The purposes of this article are to review what is known about women in methadone treatment who have a history of opioid addiction and apply that evidence to guide neonatal nurses to support mothers of infants with NAS in the NICU.

Clinician perceptions of a changing hospital environment.

OBJECTIVE: The purposes of this study were to describe how a move into a new hospital influenced the work environment, how long it takes clinicians to adjust to such a significant change, and how much a new hospital work environment helps the practice shift toward patient- and family-centered care (PFCC). BACKGROUND: Creating a healthy work environment to keep patients safe and staff engaged in the mission of the organization is perhaps one of the most important roles of hospital administrators and nursing leaders. METHODS: A descriptive and comparative design was used to investigate how clinicians perceive, evaluate, and adjust to a new hospital environment, and how much a healthy work environment helps the practice shift toward patient- and family-centered care. RESULTS: Perceived stress was significantly higher than baseline 15 months after the move into the new hospital (p < 0.0000), and employees with 3 or more years of service had significantly higher stress than others (p < 0.000). Nurses had the second lowest mean stress score (x = 12.5). The PFCC score increased significantly (p < 0.007). CONCLUSIONS: The single-patient room model increased the workload of many clinicians, and their stress increased after 15 months. There were additional burdens not measured that also may have added to the stress of the participants. The new hospital enabled a significant practice shift toward PFCC. KEYWORDS: Healing environments, organizational transformation, patient-centered care, pediatric, satisfaction.

Using a clinical collaborative model for nursing education: application for clinical teaching.

The promise of a clinical collaborative model (CCM) is that it engages hospital partners in a mutually beneficial partnership by providing the entire student clinical experience in one institution. The CCM prepares students for the day-to-day reality of patient care through the use of individual staff nurse preceptors, enhancing the relationship between the student and hospital upon graduation. The authors describe a successful paradigm for student nurse clinical education across the baccalaureate program.