Highlighting Simulation Practices in the Neonatal Environment.

Simulation is an effective teaching methodology to enhance clinical thinking and reasoning skills among nursing students and practicing nurses. The opportunity to practice in a safe environment maintains a structure that promotes learning at all levels. There are various levels of fidelity as well as cost to facilitate simulation in the neonatal setting. This at times hinders the ability to incorporate simulation into educational practices. The purpose of this article is to provide a discussion on simulation practices in the neonatal setting, an overview of low-cost neonatal simulation exemplars, and implications for practice.

El método madre canguro y el niño prematuro / Kangaroo mother care and the pre-term child

OBJETIVO: analizar los beneficios del método madre canguro (MMC) y el estado actual en que se encuentra implantado en España. MÉTODO: revisión narrativa. Se realizaron búsquedas bibliográficas en Pubmed, Dialnet y Scielo; usando los términos "método madre-canguro" y "prematuro" y sus sinónimos. La búsqueda se limitó a los últimos 10 años, idiomas inglés y español. Se complementó con búsqueda secundaria a partir de la bibliografía de interés de artículos seleccionados previamente y se complementó con algunos libros y documentos especializados en la materia de organismos relevantes como la Organización Mundial de la Salud (OMS), el Ministerio de Sanidad y Política Social, la Asociación Española de Pediatría (AEP) y la web internacional de European Fundation for the Care of Newborn Infants (EFCNI). RESULTADOS: se seleccionaron en total 18 documentos: tres metanálisis, cuatro revisiones sistemáticas, dos estudios cuasiexperimentales, dos estudios de cohortes, un estudio transversal, cinco revisiones narrativas y un artículo especial. Se complementaron con tres libros y dos monografías. En la revisión se destacan los beneficios de la aplicación del método madre canguro sobre el desarrollo de los prematuros y el vínculo con sus padres. No se mencionan eventos adversos. El conocimiento sobre los beneficios a largo plazo en el ámbito del desarrollo cognitivo y emocional es escaso. La implementación del MMC en las unidades neonatales españolas es heterogéno, siendo inexistente en algunos centros. CONCLUSIONES: la utilización del MMC en las unidades neonatales ha demostrado ser eficaz en muchos aspectos relacionados con el correcto desarrollo de los prematuros. Es necesaria más investigación para determinar sus beneficios a largo plazo en relación al desarrollo cognitivo y emocional. Es fundamental desarrollar protocolos para implementar el MMC en España

OBJECTIVE: to analyze the benefits of Kangaroo Mother Care (KMC) and its current status of implementation in Spain. METHOD: a narrative review. A bibliographic search was conducted in Pubmed, Dialnet and Scielo, using the terms Kangaroo Mother Care ("método madre-canguro") and pre-term ("prematuro") and their synonyms. The search was limited to the last 10 years, in English and Spanish. This was complemented with a secondary search based on the bibliography of interest of previously selected articles, as well as with some books and documents specialized in the matter, by relevant agencies such as the World Health Organization (WHO), the Ministry of Health and Social Policy, the Spanish Association of Pediatrics (AEP), and the international website for the European Foundation for the Care of Newborn Infants (EFCNI). RESULTS: in total, 18 (eighteen) documents were selected: three meta-analyses, four systematic reviews, two quasi-experimental studies, two cohort studies, one cross-sectional study, five narrative reviews and two monographs. The review highlights the benefits of the application of Kangaroo Mother Care on the development of pre-term babies and their bond with parents. No adverse events were mentioned. There is limited knowledge about the long-term benefits at the level of cognitive and emotional development. The implementation of KMC in Spanish newborn units is heterogeneous and non-existent in some centers. CONCLUSIONS: the use of KMC in newborn units has demonstrated efficacy in many aspects associated with the adequate development of newborn babies. More research is required in order to determine its long-term benefits in terms of cognitive and emotional development. It is essential to create protocols for the implementation of KMC in Spain

Differences in Current Procedures for Handling of Expressed Mother's Milk in Danish Neonatal Care Units.

BACKGROUND: Mother's own milk (MOM) is preferred when feeding preterm infants. When expressed mother's milk is stored and handled, there is a risk of bacterial contamination, decreased immunological activity, and less nutritional potential. PURPOSE: The aim of this study was to investigate current routines when handling MOM in Danish neonatal intensive care units (NICUs). METHODS: A survey was sent to all 17 NICUs in Denmark in which current practices regarding human milk handling, storage, and preparation were evaluated. Furthermore, one question sought to establish when mother's milk was believed to be colostrum. Respondents of the survey were neonatal nurses. RESULTS: All 17 units responded to the survey. Only 5 of 17 units answered that human colostrum was defined as milk from the first week after birth. Refrigerator storage time varied between 24 and 72 hours. In 6 of 17 units, parents were in charge of mixing milk and fortifier. Heating of human milk was done by using microwave ovens in 4 of 17 of the units. IMPLICATIONS FOR PRACTICE: This national survey established that there is significant variability in the way mother's milk is handled. Some of the procedures performed may affect the quality of the milk. It is important to implement evidence-based practice regarding storage and handling of expressed mother's milk to ensure that the quality of the milk is the best possible alternative for all preterm infants. IMPLICATIONS FOR RESEARCH: Prospective studies are needed to examine the association between handling of human milk and changes in composition and nutritional potential of the milk.

Positive pressure ventilation coaching during neonatal bag-mask ventilation: A simulation-based pilot study.

BACKGROUND: Positive pressure ventilation (PPV) is the most important procedure during neonatal resuscitation. Providing effective PPV seems easy. However, performing the procedure correctly is extremely challenging. Airway obstruction and face mask large leaks are common. It is estimated that two-thirds of continued neonatal respiratory depression after the time of birth is caused by ineffective or improperly provided PPV. Finding methods to improve PPV performance are critically needed. Performance coaching is a simple and easy method of improving performing in procedural skills, and has been used previously to optimize compression technique. We performed the simulation-based pilot study to evaluate the impact of PPV coaching during neonatal bag-mask ventilation. METHODS: Randomized cross-over study of nurses performing PPV on a SMART Newborn Resuscitation Training System with, and without, coaching. The PPV coach provided real-time feedback on chest rise, mask hold, and ventilation rate. The SMART system captured data on peak inspiratory pressure (PIP), tidal volume (Vt), mask leak, and ventilation rate. Data were analyzed by a blinded reviewer. RESULTS: PPV coaching resulted in more appropriate PIPs (34 cmH2O, IQR 32-38 vs. 36 cmH2O, IQR 28-37; P < 0.001), lower Vt (4.7 ml/kg, IQR 4-8 vs. 5.5 ml/kg, IQR 4-13; P < 0.001), and less mask leak (39% leak, IQR 21-70 vs. 45%, IQR 22-98; P = 0.005). There was no difference in respiratory rate (P = 0.93). CONCLUSIONS: Coaching improved PPV performance in this simulation-based pilot study. Further research on PPV coaching during neonatal resuscitation is warranted.

Neonatal nurses' knowledge and beliefs about kangaroo mother care in neonatal intensive care units: A descriptive, cross-sectional study.

The aim of this study was to assess Jordanian neonatal nurses' knowledge and beliefs toward the application of kangaroo mother care in the neonatal intensive care unit. A cross-sectional, descriptive survey was performed using a convenience sample of 229 nurses. The findings revealed that the majority of the nurses agreed that kangaroo mother care was beneficial to both mothers and infants; however, 47.2% believed that it was not feasible for all preterm infants. The majority of nurses believed that kangaroo mother care should be restricted to infants on intravenous treatment, intubated, or with an umbilical catheter. The majority of the nurses correctly answered questions regarding kangaroo mother care. A significant relationship was found between the nurses' knowledge and their beliefs toward kangaroo mother care. The findings of this study provide insights into Jordanian nurses' knowledge and beliefs toward the kangaroo mother care approach. If addressed, these findings will help improve the practice and nursing care for preterm infants.

Neonatal nurse practitioner ethics knowledge and attitudes.

BACKGROUND: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. RESEARCH AIM: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. RESEARCH DESIGN: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. PARTICIPANTS AND RESEARCH CONTEXT: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. ETHICAL CONSIDERATIONS: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). FINDINGS: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital's legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. DISCUSSION: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. CONCLUSION: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.

Perspectives of Nurses, Nurse Leaders, and Women Regarding Anticipatory Rounds in the Postpartum Period.

OBJECTIVE: To obtain the perspectives of staff nurses, nurse leaders, and women with regard to the relevance and timing of nursing interactions during anticipatory rounds in the postpartum period. DESIGN: A qualitative descriptive design using focus groups. SETTING: A hospital with 405 beds that serves a Midwestern U.S. community of approximately 256,000 people. PARTICIPANTS: A purposive sample of 12 staff nurses, 6 nurse leaders, and 15 women attended a total of 10 focus groups. METHODS: We conducted 10 semistructured focus groups: 6 with staff nurses, 1 with nurse leaders, and 3 with women. Each participant attended one focus group. Sessions were recorded and transcribed. Investigators independently coded transcripts and identified themes collectively. RESULTS: Participants identified one overarching theme, Taking the Whole Picture Into Account, and five subthemes that were reflective of relevant nursing interactions: Help With Newborn Feeding, Managing Patient Comfort, Appreciating the Need for Safety, Being There, and Knowing Ahead of Time. Participants agreed that conducting rounds once every 2 to 3 hours was the most appropriate time frame. CONCLUSION: Participants identified important nursing interactions and their timing. Moreover, anticipatory rounding for women after birth includes more than completion of simple tasks or checklists. These findings indicate beginning evidence for what should occur during anticipatory rounds on the mother-baby unit. Timing of rounds can be flexible based on each woman's unique needs, thus reinforcing patient-centered care. However, interactions and timing should take place only when the whole picture is taken into account.

Quality Improvement Initiative for Family-Centered Care in the Neonatal Intensive Care Unit of a Tertiary Hospital in South Africa.

The introduction of family-centered care in the neonatal intensive care unit was identified as a high priority to facilitate bonding and attachment with potential positive outcomes for the parents and infants. The aim of the study was, therefore, to develop and implement a quality improvement initiative to foster family-centered care in a tertiary neonatal intensive care unit from birth onward. A pretest posttest intervention design was used using mixed methods over 3 phases to determine the perceived level of family-centered care according to healthcare professionals and parents using self-administered questionnaires; to develop and implement a quality improvement initiative to enhance family-centered care in a neonatal intensive care unit using a nominal group technique, followed by the quality improvement process; and to evaluate the outcomes of the initiative by repeating the self-administered questionnaires to parents and staff. Various activities were introduced as part of the initiative such as early breastfeeding, early introduction of parents to their infant, open visitation policy, and involvement in caring activities. The perceived level of care according to staff and parents increased. It is expected to enhance bonding and attachment between the infants and their parents, with consequential long-term positive outcomes.

Legal and ethical issues in neonatal nursing: a case study.

Neonatal nurses regularly face complex legal and ethical dilemmas. This article discusses the hypothetical case of Jack, a two-day-old infant diagnosed with trisomy 13 (syndrome), a life-limiting condition. Jack's prognosis is poor, and he is not expected to live past two weeks of age. The legal and ethical perspectives of withholding life-sustaining treatment in infants and children will be explored through the application of ethical frameworks, as well as statute and case law relevant to children and adolescent nursing. The article also discusses the neonatal nurse's role, with reference to local and national guidelines.

Care of the Family of an Infant With a Congenital Heart Defect During the NICU Hospitalization.

The family of an infant born with a congenital heart defect is challenged by both the short- and long-term implications of the diagnosis and the neonatal intensive care unit (NICU) hospitalization. Nurses are in a key position to support these families as they deal with the psychological, emotional, and financial impact of the NICU experience. Understanding how families perceive the NICU environment and their grief in losing the desired healthy baby provides the NICU nurse with the knowledge to engage in self-reflection on her or his interpersonal style and caregiving attitudes. Utilizing the concepts and principles of family-centered care and relationship-based practice, nurses can work together with the families to determine how to best meet the families' needs and to find the resources to support them. Families and colleagues appreciate nurses who demonstrate expertise in this approach to family-centered care. This appreciation leads to greater job satisfaction and decreased job-related stress.

Intraprofessional Excellence in Nursing: Collaborative Strategies for Neonatal Abstinence Syndrome.

Neonatal abstinence syndrome (NAS) is a growing public health concern, one that costs the health care system $190-$720 million each year. Recently, state-level perinatal quality collaborative groups have disseminated NAS action plans: customizable frameworks aimed to assist health care systems in identifying, evaluating, treating, and coordinating discharge services for neonates with NAS. Hospital-based neonatal nursing quality improvement teams, including neonatal nurse practitioners (NNPs), neonatal clinical nurse specialists (CNSs), and clinical neonatal nurses, by virtue of their collective academic, administrative, and practical years of experience, are ideally positioned to develop, implement, and evaluate NAS care bundles. The article's purpose is to discuss key elements of an NAS care bundle using the framework of the Perinatal Quality Collaborative of North Carolina NAS action plan as an exemplar. Discussion of evidence-based and nursing-driven metrics will be followed by a discussion of the emerging concept of an inpatient-to-outpatient transitional care NAS management model.