Implementing the Role of Neonatal Assessment Nurse to Improve Skin-to-Skin Care and Breastfeeding Exclusivity.

OBJECTIVE: To improve rates of exclusive breastfeeding during the postpartum hospital stay by implementing a new role of dedicated neonatal assessment nurse (NAN), whose primary function was neonatal care beginning immediately after birth. DESIGN: Quality improvement project with plan-do-study-act using evidence-based guidelines for implementing the NAN role. SETTING/LOCAL PROBLEM: Labor and delivery department of a tertiary care teaching hospital in the southeastern United States; breastfeeding exclusivity rates at this hospital were in the range of 50%. PARTICIPANTS: Registered nurses employed in the labor-delivery-recovery unit, mother-baby unit, and NICU. INTERVENTION/MEASUREMENTS: The NAN role was implemented to promote immediate skin-to-skin care (SSC) for stable newborns after vaginal and cesarean birth. Each NAN's competency was evaluated at the beginning and end of the education session through a pretest/posttest, and a skills validation was used to affirm their readiness for the new role. The outcome measure was breastfeeding exclusivity at the time of discharge from the hospital. SSC initiation and duration immediately after birth were the process measures. RESULTS: Twenty-five bedside registered nurses participated in this quality improvement project. There was a statistically significant difference between the pretest and posttest scores (p < .001), indicating a knowledge increase. All nurses met the skills validation criteria. The rate of SSC immediately after vaginal birth increased from 49% to 82% and after cesarean birth from 33% to 63%. Breastfeeding exclusivity rate at the time of discharge from the hospital increased from 50% to 86%. CONCLUSION: The NAN role provided transitional care at the bedside without the separation of mothers and newborns. This was an innovative role, without the need to hire new staff, that provided evidence-based care, resulting in improved SSC and exclusivity of breastfeeding before discharge.

Association of Nurse Staffing With Nosocomial Infections of Very Low-Birth-Weight Infants.

Prior studies have reported inconsistent findings regarding the relationship between nurse staffing and nosocomial infections in very low-birth-weight (VLBW) infants. Little is known about whether similar associations occur in Korea. The purpose of this study was to identify the nurse staffing of neonatal intensive care units (NICUs) in Korea and to verify the association between nurse staffing and nosocomial infections among VLBW infants in NICUs. We selected 4654 VLBW infants admitted to 52 hospitals. Nosocomial infections were defined as incidence of bloodstream infection, urinary tract infection (UTI), or rotavirus infection. The average number of NICU patients per nurse was 4.51(minimum-maximum: 2.38-8.16). Hospitals with a higher number of patients per nurse exhibited a significant increased UTI rate (P = .005) and rotavirus infection rate (P = .025) in the univariate analysis. After adjusting for all patient and hospital characteristics, UTI significantly increased with increasing number of patients per nurse (odds ratio [OR] = 1.79; 95% confidence interval, 1.29-2.47), while bloodstream infection (OR = 0.93; 95% confidence interval, 0.79-1.09) and rotavirus infection (OR = 1.14; 95% confidence interval, 0.92-1.41) were not significant. These findings revealed that a nurse staffing in NICUs is an important factor for preventing UTI among VLBW infants.

Los pediatras frente a la educación para la salud comunitaria; valoración de la utilidad de una intervención durante el periodo perinatal / Paediatricians facing community health education; assessment of the usefulness of an intervention during the perinatal period

INTRODUCCIÓN: el objetivo general de este trabajo es describir la situación actual de la educación para la salud (EPS) comunitaria en la Pediatría de Atención Primaria (PAP) española y analizar la utilidad de una intervención de EPS perinatal. MATERIAL Y MÉTODOS: estudio descriptivo observacional, realizado en marzo de 2019, a partir de los datos recogidos a través de una encuesta para profesionales difundida en una lista de distribución (PEDIAP) que cuenta con 1139 suscriptores, en su mayoría pediatras de Atención Primaria (AP). RESULTADOS: se recogieron 353 respuestas (83,9% mujeres). El 42,8% de las respuestas procede de la Comunidad de Madrid, seguida de Andalucía (12,2%) y Asturias (10,5%). El 84,1% de los profesionales trabaja en centros que imparten EPS comunitaria pero solo el 38% de ellos participa en alguna actividad. Las matronas realizan EPS en el 79,5% de los casos, seguidas por enfermería (77,8%). Pese a no ofertarse actividades en sus centros, al 82,1% le gustaría poder participar en algún proyecto de EPS, pero el 71,4% argumenta como impedimentos la falta de tiempo, el 48,2% la ausencia de compañeros dispuestos a participar y el 39,3% el déficit de formación en el manejo de grupos. El 21,4% reconocía falta de motivación y el 12,5% experiencias previas negativas. CONCLUSIONES: la inmensa mayoría de los profesionales consideraron útil la EPS perinatal, destacando la posibilidad de empoderar a las familias. Enfermería pediátrica fue el perfil mejor valorado por los profesionales para impartir EPS comunitaria infantil

INTRODUCTION: the main aim of the study was to describe the current situation of Health Education (HE) programmes in primary care (PC) in Spain, and to assess the usefulness of a perinatal educational intervention in the community. MATERIAL AND METHODS: We conducted an observational and descriptive study in March 2019 by analysing data collected from a a survey of health care professionals. The questionnaire was distributed through a health care professional mailing list that has 1139 subscribers, most of who are primary care paediatricians. RESULTS: we collected 353 responses, 83.9% from female responders; 42.8% were submitted from the Community of Madrid, followed in frequency by Andalusia (12.2%) and Asturias (10.5%). Of all respondents, 84.1% reported working in sites that offered community HE, but only 38% participated in any such activities; 79.5% of midwives reported delivering HE, followed in frequency by nurses (77.8%). Of the respondents whose centres did not offer HE, 82.1% expressed a desire to participate in community HE projects, but many cited barriers to do so, including a lack of time (71.4%), a lack of co-workers willing to participate in these activities (48.2%) and inadequate training on how to lead group activities (39.3%). Also, 21.4% reported feeling unmotivated and 12.5% having negative experiences in the past. CONCLUSION: the vast majority of surveyed providers considered that perinatal health education was useful, highlighting that it could empower families. Respondents considered that paediatric nurses were the health professionals best suited to deliver community health education interventions

A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S.

BACKGROUND: The benefits of family-centered care for the health and well-being of preterm infants and their families include increased parent-infant closeness, improved lactation, and positive mental health outcomes; however, it is known that the extent to which family-centered care is adopted varies by unit. This study aimed to understand how differences in neonatal care culture in two units in Finland and the U.S. were translated to parents' infant feeding experiences in the hope of improving relationally focused feeding practices in both locations. METHODS: This qualitative, cross-sectional study utilized narrative methodologies to understand the lived experiences of 15 families hospitalized in a tertiary neonatal intensive care unit in Finland (n = 8) and the U. S (n = 7). RESULTS: A global theme of lactation as a means or an end showed that lactation and infant feeding were framed differently in each location. The three supporting themes that explain families' perceptions of their transition to parenthood, support as a family unit, and experience with lactation include: universal early postnatal challenges; culture and space-dependent nursing support; and controlled or empowering breastfeeding experiences. CONCLUSIONS: Care culture plays a large role in framing all infant caring activities, including lactation and infant feeding. This study found that in the unit in Finland, breastfeeding was one method to achieve closeness with an infant, while in the unit in the U.S., pumping was only an end to promote infant nutritional health. Therefore, breastfeeding coupled with closeness was found to be supportive of a salutogenic, or health-promoting, care approach for the whole family.

Blogs y redes sociales como herramienta de difusión de cuidados basados en la evidencia: el caso de Cuidando neonatos / Blogs and social networks as evidence-based care dissemination tools: Cuidando neonatos case

Introducción: diversos estudios identifican la falta de conocimientos y tiempo como una de las barreras para la implementación de los resultados de la investigación en la práctica clínica. El uso de la tecnología de la información y comunicación puede ser una solución a estos problemas. Objetivo: evaluar el alcance y la difusión de los contenidos publicados en el blog Cuidando neonatos relacionados con el consumo de evidencia en cuidados. Material y método: estudio descriptivo transversal. Los instrumentos utilizados fueron Google Analytics y el directorio Blogger. Resultados: el número de páginas vistas en el periodo de revisión (12 de noviembre de 2014 hasta fecha 12 de septiembre de 2018) fue 645 249 durante 155 874 sesiones. La mayoría de las visitas procedían de España y México. De los 144 posts publicados, 26 estaban relacionados con el consumo de evidencia en cuidados. La entrada más vista fue: "RCP neonatal. ¿Repasamos conceptos claves?", con 13 649 visitas. Conclusiones: el alcance de los contenidos publicados en Cuidando neonatos y difundidos a través de sus redes sociales, constatan que el blog puede ser una herramienta que facilite la implementación de cuidados de salud basados en la evidencia en el ámbito de la neonatología

Introduction: several studies have identified the lack of knowledge and time as one of the barriers for the application of research findings to clinical practice. The use of information and communication technologies may offer a solution to these problems. Objective: to asses the reach and diffusion of contents published in the Cuidando neonatos blog related to the consumption of evidence in health care. Material and method: we conducted a cross-sectional descriptive study using Google Analytics and the Directorio Blogger. Results: there were a total of 645 249 page views in the period under study (November 12, 2014 to September 12, 2018) in the course of 155 874 sessions. Most visits came from Spain and Mexico. Of the 144 published posts, 26 had to do with evidence-based care. The most-viewed post was "RCP neonatal. ¿Repasamos conceptos claves?", which received 13 649 visits. Conclusions: the reach of the contents published in the Cuidando neonatos blog and disseminated through its social network profiles demonstrates that blogging can be a powerful tool to facilitate the implementation of evidence-based health care practices in the field of neonatology

Adaptation of the MISSCARE Survey to the Maternity Care Setting.

Missed nursing care is an important measure of nursing care quality that is sensitive to nurse staffing and is associated with patient outcomes in medical-surgical and pediatric inpatient settings. Missed nursing care during labor and birth has not been studied, yet childbirth represents the most common reason for hospitalization in the United States. The Missed Nursing Care (MISSCARE) Survey, a measure of medical-surgical nursing quality with substantial evidence for validity and reliability, was adapted to maternity nursing care using data from focus groups of labor nurses, physicians, and new mothers and an online survey of labor nurses. Content validity was evaluated via participant feedback, and exploratory factor analysis was performed to identify the factor structure of the instrument. The modified version, the Perinatal Missed Care Survey, appears to be a feasible and promising instrument with which to evaluate missed nursing care of women during labor and birth in hospitals.

The Ethics of Perinatal Care for Black Women: Dismantling the Structural Racism in "Mother Blame" Narratives.

Perinatal and neonatal nurses have a critical role to play in effectively addressing the disproportionate prevalence of adverse pregnancy outcomes experienced by black childbearing families. Upstream inequities in maternal health must be better understood and addressed to achieve this goal. The importance of maternal health before, during, and after pregnancy is illustrated with the growing and inequitable prevalence of 2 common illnesses, pregestational diabetes and chronic hypertension, and 2 common conditions during and after pregnancy, gestational diabetes and preterm birth. New care models are needed and must be structured on appropriate ethical principles for serving black families in partnership with nurses. The overarching purpose of this article is to describe the ethics of perinatal care for black women; to discuss how social determinants of health, health disparities, and health inequities affecting women contribute to poor outcomes among their children; and to provide tools to dismantle structural racism specific to "mother blame" narratives." Finally, strategies are presented to enhance the provision of ethical perinatal care for black women by nurses.

Factors Influencing Developmental Care Practice Among Neonatal Intensive Care Unit Nurses.

PURPOSE: This study aimed to examine factors that influence developmental care practice among neonatal intensive care unit nurses. DESIGN AND METHODS: This descriptive, cross-sectional study was conducted using a questionnaire. Data were collected from 141 neonatal intensive care unit nurses from 6 hospitals in South Korea. Multiple linear regression analysis was used to examine factors influencing developmental care practice. RESULTS: This study found that professional efficacy had the largest influence on developmental care practice, followed by perception of developmental care and a task-oriented organizational culture. Clinical and educational experience regarding developmental care and working environment was not associated with developmental care practice among NICU nurses. CONCLUSIONS: To enhance nurses' practice of developmental care, enhancement of nurses' individual competency, positive perception of developmental care, and organizational efforts are required. A practical training program should be provided to nurses to promote confidence in implementing developmental care for preterm infants. IMPLICATIONS: A trained nurse should provide staff nurses with useful information on developmental care to encourage them to have a positive attitude towards developmental care. The nurse manager should create an organizational culture in which nurses perceive developmental care to be an essential nursing task in their unit.

Description of the use of integrative mixed method in neonatal nursing.

To describe the application of the integrative mixed method and its steps. Descriptive methodological study. The integrative mixed method approach was exemplified in a study conducted in neonatal nursing on maternal stress throughout the experience of premature newborns' care. Data on maternal stress level (quantitative approach) and maternal perception of care (qualitative approach) were grouped after analyzes made separately according to the analysis technique of each approach. Subsequently, quantitative and qualitative data were integrated, which originated a new set of data to be interpreted, and consequently enabled a greater understanding of the phenomenon under study and emphasized the importance of the integrative mixed method. The integration of the two approaches, qualitative and quantitative, is a denser theoretical framework with strong scientific evidence for a better understanding of the phenomenon under study than the use of a single approach, since, at the same time, it identifies the frequency of the phenomenon and the reason for its occurrence.

Association of Nurse Workload With Missed Nursing Care in the Neonatal Intensive Care Unit.

Importance: Quality improvement initiatives demonstrate the contribution of reliable nursing care to gains in clinical and safety outcomes in neonatal intensive care units (NICUs); when core care is missed, outcomes can worsen. Objective: To evaluate the association of NICU nurse workload with missed nursing care. Design, Setting, and Participants: A prospective design was used to evaluate associations between shift-level workload of individual nurses and missed care for assigned infants from March 1, 2013, through January 31, 2014, at a 52-bed level IV NICU in a Midwestern academic medical center. A convenience sample of registered nurses who provided direct patient care and completed unit orientation were enrolled. Nurses reported care during each shift for individual infants whose clinical data were extracted from the electronic health record. Data were analyzed from January 1, 2015, through August 13, 2018. Exposures: Workload was assessed each shift with objective measures (infant-to-nurse staffing ratio and infant acuity scores) and a subjective measure (the National Aeronautics and Space Administration Task Load Index [NASA-TLX]). Main Outcomes and Measures: Missed nursing care was measured by self-report of omission of 11 essential care practices. Cross-classified, multilevel logistic regression models were used to estimate associations of workload with missed care. Results: A total of 136 nurses provided reports of shift-level workload and missed nursing care for 418 infants during 332 shifts of 12 hours each. When workload variables were modeled independently, 7 of 12 models demonstrated a significant worsening association of increased infant-to-nurse ratio with odds of missed care (eg, nurses caring for ≥3 infants were 2.51 times more likely to report missing any care during the shift [95% credible interval, 1.81-3.47]), and all 12 models demonstrated a significant worsening association of increased NASA-TLX subjective workload ratings with odds of missed care (eg, each 5-point increase in a nurse's NASA-TLX rating during a shift was associated with a 34% increase in the likelihood of missing a nursing assessment for his or her assigned infant[s] during the same shift [95% credible interval, 1.30-1.39]). When modeling all workload variables jointly, only 4 of 12 models demonstrated significant association of staffing ratios with odds of missed care, whereas the association with NASA-TLX ratings remained significant in all models. Few associations of acuity scores were observed across modeling strategies. Conclusions and Relevance: The workload of NICU nurses is significantly associated with missed nursing care, and subjective workload ratings are particularly important. Subjective workload represents an important aspect of nurse workload that remains largely unmeasured despite high potential for intervention.

Evaluation of Key Factors Impacting Feeding Safety in the Neonatal Intensive Care Unit: A Systematic Review.

BACKGROUND: Individualized feeding care plans and safe handling of milk (human or formula) are critical in promoting growth, immune function, and neurodevelopment in the preterm infant. Feeding errors and disruptions or limitations to feeding processes in the neonatal intensive care unit (NICU) are associated with negative safety events. Feeding errors include contamination of milk and delivery of incorrect or expired milk and may result in adverse gastrointestinal illnesses. PURPOSE: The purpose of this review was to evaluate the effect(s) of centralized milk preparation, use of trained technicians, use of bar code-scanning software, and collaboration between registered dietitians and registered nurses on feeding safety in the NICU. METHODS/SEARCH STRATEGY: A systematic review of the literature was completed, and 12 articles were selected as relevant to search criteria. Study quality was evaluated using the Downs and Black scoring tool. FINDINGS/RESULTS: An evaluation of human studies indicated that the use of centralized milk preparation, trained technicians, bar code-scanning software, and possible registered dietitian involvement decreased feeding-associated error in the NICU. IMPLICATIONS FOR PRACTICE: A state-of-the-art NICU includes a centralized milk preparation area staffed by trained technicians, care supported by bar code-scanning software, and utilization of a registered dietitian to improve patient safety. These resources will provide nurses more time to focus on nursing-specific neonatal care. IMPLICATIONS FOR RESEARCH: Further research is needed to evaluate the impact of factors related to feeding safety in the NICU as well as potential financial benefits of these quality improvement opportunities.

NICU Nurses and Families Partnering to Provide Neuroprotective, Family-Centered, Developmental Care.

The aim of this project was to determine how implementing neuroprotective, family-centered, developmental care interventions would impact the satisfaction of nurses and families compared with traditional care in a NICU. Neuroprotective, family-centered, developmental care is grounded in the principle that optimal health outcomes are accomplished when patients' family members play an active role in contributing emotional, social, and developmental support for their babies. To accomplish this, nurses needed an understanding of the developmental problems associated with high-risk premature infants, fundamentals of neurosensory growth, and how the intrauterine environment protects the infant from the fluctuation of an unstable extrauterine environment. The model we chose to use was the Neonatal Integrative Developmental Care Model. Pre- and post-surveys showing an increase in knowledge and benefits of these interventions were collected from nurses. Pre- and post-Press Ganey reports showed families had a strong satisfaction with neuroprotective, family-centered, developmental care in our NICU.