COVID-19 in babies: Knowledge for neonatal care

Infection is a leading cause of death worldwide in babies under one month of age who are more susceptible to sepsis due to immature host defence mechanisms. Usually, babies may become acutely unwell from infective pathogens due to specific differences in their respiratory and immune systems. However, with the COVID-19 virus, the focus of this paper, it appears that the neonatal population is not significantly affected in the same way as adults. That said, knowledge about this novel virus is rapidly emerging. Therefore, it is vital that neonatal nurses, midwives and other healthcare professionals are adequately informed and educated about the potential impact on neonatal practice. This review paper draws upon key findings and themes from a selection of recent literature to provide an overview of current knowledge on COVID-19 and the implications for care within the neonatal field. The discussion focuses on the nature of COVID-19, its pathophysiology and transmission relevant to maternal and neonatal care. This is followed by implications for practice; namely, maternal issues, the importance of human breast milk, neonatal care relating to parenting and specific management before a final review of the current World Health Organization guidance.     

Exploring modifiable risk-factors for premature birth in the context of COVID-19 mitigation measures: A discussion paper

During the COVID-19 pandemic, parents with sick or premature babies have faced challenges following admission to a neonatal unit due to the imposed lock-down restrictions on social contact, hospital visitation and the wearing of personal protective equipment. The negative short-term impact on neonatal care in relation to the prevention of close proximity, contact and bonding between parents and babies is potentially significant. However, an interesting finding has been reported of a reduction in premature birth admissions to the neonatal intensive care unit during the pandemic, raising important questions. Why was this? Was it related to the effect of the modifiable risk-factors for premature birth? This discussion paper focuses on an exploration of these factors in the light of the potential impact of COVID-19 restrictions on neonatal care. After contextualising both the effect of premature birth and the pandemic on neonatal and parental short-term outcomes, the discussion turns to the modifiable risk-factors for premature birth and makes recommendations relevant to the education, advice and care given to expectant mothers.     

Neonatal nursing during the COVID-19 global pandemic: A thematic analysis of personal reflections

BackgroundThe COVID-19 pandemic has resulted in significant changes and restrictions to neonatal care. The aim of this study was to explore the impact of these changes on neonatal nurses globally.MethodsWe conducted a thematic analysis on written reflections by neonatal nurses worldwide, exploring their experiences of COVID-19. Twenty-two reflections were analysed from eleven countries.ResultsThematic analysis revealed 4 main themes relating to the nurses’ role: 1) protector 2) challenges to human quality of care 3) vulnerability and 4) resilience. The measures taken as protector were described as compromising the human qualities of care fundamental to their role. This tension, together with other new challenges, heightened feelings of vulnerability. Concurrently, nurses identified role resilience, including resourcefulness and peer support, which allowed them to navigate the global pandemic.ConclusionBy identifying global challenges and strategies to overcome these, neonatal nurses may be better equipped as the pandemic continues. The reflections underscore the importance of family integrated care and the tension created when it is compromised.     

Literature Review of Mothers Diagnosed With COVID-19 and the Impact on Breastfeeding Their Newborns

In early 2020, newborns were separated from their mothers who were diagnosed with COVID-19 infection. The purpose of this literature review is to examine the current evidence to determine if the transmission of COVID-19 infection to the neonate increases if newborns are directly breastfed by mothers who are positive for COVID-19 infection. There were 28 studies conducted in seven countries, with 10 of those studies conducted in the United States. In total, 5,123 neonates were born to mothers diagnosed with COVID-19, with 3,872 neonates determined to have been breastfed or provided mixed feeding including breast milk. Overall, 2.35% (91/3,872) of the newborns tested positive, and all recovered from COVID-19 infection. As frontline health care providers, nurses are instrumental in offering support and education on the risks and benefits of breastfeeding for individuals diagnosed with COVID-19.     

The emotions of integrating breastfeeding knowledge into practice for English midwives: a qualitative study

BACKGROUND: Breastfeeding prevalence in the United Kingdom is one of the lowest in Europe. The midwife provides feeding support for new mothers but research suggests that midwives' knowledge of breastfeeding is limited. OBJECTIVE: To discover the views of English midwives in relation to their breastfeeding support role. DESIGN: Qualitative design. SETTINGS: Two maternity hospitals in Northwest England. PARTICIPANTS: Thirty midwives who cared for normal, healthy babies. Midwives were selected for interview using theoretical sampling principles from a pool of midwives who volunteered. Volunteers were accessed using a poster exhibited in relevant clinical areas. METHODS: Data were collected using audiotaped, in-depth interviews and were analysed using constant comparison techniques. RESULTS: The study highlights that differing professional knowledge and beliefs about breastfeeding support created intense, mainly negative, emotions for these midwives. Irritation and despair was experienced with the greater emphasis placed on research, rather than practice knowledge in policy and recommendations for practice. Disappointment was experienced when mothers did not conform to midwives' expectations. Conflict with differing peer-based knowledge generated feelings of intimidation and annoyance for some midwives. Some midwives demonstrated that they can sustain clinical decisions whilst based in a hostile environment, but others conformed to the practice expectations of their peers. Happiness was experienced when midwives described positive relationships with mothers, rather than their professional colleagues. CONCLUSIONS: The utilisation of professional knowledge in breastfeeding practice was a highly complex issue, and generated significant negative emotional distress, for these midwives.     

Assisting mother with preterm infant breastfeeding

It is necessary to gain nutrition for infants, especially premature. The digestive systems of premature infants are immature, so they find it hard to absorb nutrients. Mother's milk is easy for preterm infants to digest and absorb, so it is the best food for them. In reality, however, mothers always face many problems when breastfeeding preterm infants. They need support systems to establish their confidence in breastfeeding in order to improve their success rates and thus facilitate their continuation of the practice. Nurses can teach mothers how to breastfeed preterm infants. The purpose of this paper, therefore, is to describe the characteristics of the gastrointestinal systems of premature babies, the benefits of breastfeeding for premature babies, the factors influencing premature breastfeeding, the transition from gavage to oral feeding and how to assist the mothers of premature babies with breastfeeding. It also provides information on premature breastfeeding to enable nurses to provide early assistance to mothers in nursing their premature infants and in maintaining the practice of breastfeeding.     

Supporting breastfeeding mothers on children's wards: an overview

Just under half of all six-week-old babies in the U.K. are breastfed, and just under a quarter are still being breastfed at six months old so it is likely that children's nurses will frequently encounter breastfed babies on children's wards. Support for breastfeeding has traditionally been left to midwives but Department of Health guidance requires that all relevant staff have training in this practice. Children's nurses need to understand the principles and practice of breastfeeding support including correct positioning and attachment, prevention and management of breastfeeding problems, mothers' needs and safe use of breast pumps. Breastfeeding should be part of the curriculum for children's nursing courses, including practical sessions to observe breastfeeding support in the clinical setting. Children's nurses should be aware that literature and learning resources written for midwives might be appropriate for them to access to increase their understanding in this important area of practice.     

COVID-19 and Advanced Practice Registered Nurses: Frontline Update

Coronavirus disease 2019 (COVID-19) emerged in 2019 and rapidly became a global pandemic, infecting millions and killing hundreds of thousands. The disease altered the practices of hospitals, clinics, and patients. These changes have implications for advanced practice registered nurses (APRNs). APRNs must remain current on best practices for treatment and diagnosis of COVID-19 while being cognizant of changes to their scope of practice. As the pandemic continues, APRNs will remain on the front lines treating patients with COVID-19 while also caring for vulnerable populations within the community. To provide high-quality care, APRNs must use a multifaceted approach that heeds ongoing updates to evidence-based practice.     

The experiences of mothers in breastfeeding their very low birth weight infants

Title. The experiences of mothers in breastfeeding their very low birth weight infants. Aim. This paper is a report of a study of the breastfeeding experience of mothers of very low birth weight babies. Background. Very low birth weight babies, being born preterm, are at risk for feeding difficulties. Medical complications may prolong their hospital stays and further delay their progression towards oral feeding. Many studies have focused on the benefits of breastfeeding to very low birth weight babies, but very few have explored the breastfeeding experiences of their mothers. Method. Data were collected between 2005 and 2007. In‐depth interviews were conducted during home visits with 31 mothers who breastfed their very low birth weight babies. Following her baby’s discharge from hospital, each mother was interviewed twice about her breastfeeding experience. The data were analysed using qualitative content analysis. Findings. Five themes were identified from the mothers’ reports: wanting to compensate, maintaining motivation and connectedness, needing ‘extra helping hands’, controlling emotions and matching baby’s individual pace. Mothers’ self‐blaming provoked them to breastfeed their very low birth weight babies to compensate babies for the harm caused by them. These mothers learned how to express breast milk and this served as an important vehicle that gradually connected them to their babies. Conclusion. Breastfeeding a very low birth weight baby is a challenging and exhausting experience for the mother. A better teaching protocol for breastfeeding and an improved breastfeeding ethos need to be implemented in the neonatal intensive care unit and special care nursery to support families of very low birth weight infants.     

Australian and Danish nurses’ and midwives’ wellbeing during COVID-19: A comparison study

BackgroundMost investigations of nurses’ and midwives’ psychological wellbeing during the COVID-19 pandemic have been conducted in a single setting.AimTo assess and compare the psychological wellbeing of nurses and midwives in Australia and Denmark during the COVID-19 pandemic.MethodsNurses and midwives employed at four metropolitan health services in Australia and one in Denmark completed an anonymous online survey, which assessed depression, anxiety, and stress symptoms (The Depression, Anxiety and Stress Scale - 21 Items (DASS-21)), and sociodemographic and employment factors.FindingsCompleted surveys were received from 3001 nurses and midwives (1611 Australian and 1390 Danish). Overall, approximately one in seven of the nurses and midwives surveyed reported moderate to extremely severe levels of depression (n = 399, 13.5%), anxiety (n = 381, 12.9%) and stress (n = 394, 13.4%). Australian nurses’ and midwives’ scores on all DASS-21 subscales were significantly higher (representing higher levels of depression, anxiety and stress) than the scores for the Danish nurses and midwives. Fewer years of clinical experience, living in Australia and being employed on a part-time basis were significantly associated with higher levels of psychological distress.DiscussionA considerable proportion of nurses and midwives experienced distress during the COVID-19 pandemic; however, the proportion and severity varied by country. Australian nurses and midwives experienced higher levels of distress than their Danish colleagues.ConclusionNurses and midwives working in countries with relatively low numbers of COVID-19 cases and deaths are also likely to experience psychological distress. Nurses and midwives would benefit from targeted country-specific support and wellbeing initiatives.     

Cardiovascular nurses' experiences of working in the COVID-19 intensive care unit: A qualitative study

BackgroundCardiovascular nurses’ skills and experiences of cardiac critical care, management of cardiovascular emergencies, and mechanical circulatory support have been considered vital in providing nursing care for COVID-19 patients in intensive care units during the COVID-19 pandemic. To our knowledge, there are no studies have focused on the contribution and experiences of cardiovascular nurses in the critical care of COVID-19 patients.ObjectivesTo explore the experiences of cardiovascular nurses working in a COVID-19 intensive care unit during the pandemic.MethodsThe study was conducted as a qualitative study with phenomenological approach in June-December 2020. Study data were gathered from ten cardiovascular nurses through semi-structured interviews.ResultsSix themes emerged from the interview data: the duties and responsibilities in a COVID-19 intensive care unit; the differences of COVID-19 intensive care unit practices from cardiovascular practices; the transferrable skills of cardiovascular nurses in a COVID-19 intensive care unit; the difficulties encountered working in a COVID-19 intensive care unit; the difficulty of working with personal protective equipment; and the psychosocial effects of working in a COVID-19 intensive care unit.ConclusionCardiovascular nurses made an important contribution to the management of nursing services with their experiences and skills in the COVID-19 pandemic.     

A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals

BackgroundIt is widely acknowledged that the experiences of frontline primary health care professionals during COVID-19 are important to understand how they respond and act under situations of pandemic as the gatekeepers in primary health care system. School nurses are primary health care professionals who lead health care in schools and practice in a holistic manner to address the needs of schoolchildren and school personnel. There are rising mental health concerns of frontline health care professionals with anxiety and panic disorders, somatic symptoms, and feeling isolated. No studies use a qualitative study approach to document community frontline school nursing professionals’ experiences and challenges during the COVID-19 pandemic. Hence, understanding the school nurses’ experiences and challenges to fight against COVID-19 in the communities is important.PurposeThis study aims to explore the experiences of school nurses during the COVID-19 pandemic in Hong Kong.MethodsA qualitative study design adopted the principles of thematic analysis. Nineteen school nurses were recruited to participate in individual semistructured interviews and shared their roles and responsibilities during the COVID-19 pandemic.FindingsThree themes indicated the school nurses’ expand professional responsibilities to fight against COVID-19 emerged from the data analysis. These were “Managing Stress,” “Navigating the School Through the Pandemic,” and “Raising the Profile of the School Nurse Professional,”DiscussionFindings reveal the important role of school nursing professionals in minimizing the community-wide risk posed by pandemics and the need to integrate them into planning and implementation of school health policies and guidelines in the primary health care system. This essential role in schools is necessary to assess, implement, monitor, prevent, and reduce the spread of virus in school communities and to minimize the burden to and extra health care resources utilized in the acute care setting during COVID-19 pandemic.     

Australian nurses' and midwives’ perceptions of their workplace environment during the COVID-19 pandemic

BackgroundWorking as a front-line worker during a pandemic is a unique situation that requires a supportive work environment. An informed understanding of nurses' and midwives’ workplace experiences during a pandemic, such as COVID-19, may enable better preparation and targeted support for future pandemics at an individual, organisational, and policy level.AimThe aim of this study was to explore nurses' and midwives’ workplace experiences during the COVID-19 pandemic response.MethodsA cross-sectional online survey consisting of open-ended questions was conducted with a convenience sample of nurses and midwives (n = 1003) working in New South Wales Health hospital settings, in Australia. Open-ended questions were analysed using content analysis.ResultsFive themes were identified; ‘organisational communication’, ‘workplace support’, ‘availability of personal protective equipment’, ‘flexible working’, and ‘new ways of working’. Nurses' and midwives’ workplace experiences during COVID-19 were influenced by leaders who were perceived to be adaptive, authentic, responsive, transparent, and visible. While many expressed a number of workplace challenges, including access to personal protective equipment, there was opportunity to explore, develop, and evaluate new and alternate models of care and working arrangements.ConclusionIt is important that nurses and midwives are supported and well prepared to cope during pandemics in the workplace. Organisational leadership and timely dissemination of transparent pandemic plans may support nurses’ adaptive workplace experiences.     

Effective communication is key to intensive care nurses’ willingness to provide nursing care amidst the COVID-19 pandemic

BackgroundThe COVID-19 pandemic posed and continues to pose challenges for health care systems globally, particularly to Intensive Care Units (ICU). At the forefront of the ICU are highly trained nurses with a professional obligation to care for patients with COVID-19 despite the potential to become infected. The aim of this study was to explore ICU nurses’ willingness to care during the COVID-19 pandemic.MethodsA prospective cross-sectional study to explore ICU nurses’ willingness to provide care during the COVID-19 pandemic was undertaken between 25 March and 3 April 2020 at a large principal and referral teaching hospital in Sydney, NSW Australia.ResultsA total of 83 ICU nurses completed the survey. Approximately 60% reported receiving sufficient information from managers regarding COVID-19 and about caring for a patient with COVID-19. Ninety percent of nurses were concerned about spreading COVID-19 to their family. Sixty one percent of the nurses indicated that they were willing to care for patients with COVID-19. Receiving timely communication from managers was the only predictor of willingness to care among ICU nurses.ConclusionsEffective communication is a vital component during a public health emergency in order to promote nurses’ willingness to care for patients in the ICU.     

Missed nursing care before and during the COVID-19 pandemic: A comparative cross-sectional study

Aim

This study aimed to compare perception of nurses about missed care for the patients before and during the coronavirus disease 2019 (COVID-19) in Jordan. It also examined how nurses differed in terms of the type of missed care and the factors that contributed to it before and during the COVID-19 pandemic. Additionally, socio-demographic factors, including gender, educational level, length of clinical experience, work position, age, and type of shift, were examined to evaluate their association with missed nursing care.

Background

Missed nursing care refers to omission of any aspect of required patient care. Missed care lowers patient satisfaction and also leads to adverse hospital outcomes.

Methods

We adopted a cross-sectional design among 260 nurses working in medical/surgical wards and intensive care units. Views of 130 nurses before COVID-19 were compared with views of 130 nurses during the COVID-19 pandemic. We used the Arabic version of the MISSCARE survey. Data were collected between November 2019 and May 2020.

Results

During COVID-19, nurses had significantly higher satisfaction levels and lower levels of absence and intention to leave than nurses before the COVID-19 pandemic. Differences were observed between nurses’ perceptions of missed care before and during the COVID-19 pandemic. It was observed that missed nursing care increased during COVID-19. The inadequate number of staff nurses was the main reason for missed care activities among both groups. Additionally, age and shift type were significantly associated with an increased reason for missed nursing care among both groups.

Conclusion and implications for nursing

Nurses reported higher satisfaction levels and fewer absences and planned departures during this period. Nurse managers should pay attention by maintaining high satisfaction levels and formulating appropriate policies to reduce missed care levels and thus improve patient care quality.     

Experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic: A thematic meta-synthesis study

Aim

The aim of this work is to synthesize and interpret qualitative research examining the experiences of nurses providing care for patients with COVID-19 in acute care settings in the early stages of the pandemic in different countries.

Background

The prevalence of disasters, including the pandemic, is increasing globally. It is important to understand nurses' experiences in depth to effectively manage extraordinary events that may occur in the future.

Design

This is a thematic meta-synthesis study.

Methods

Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus, were searched for publications from December 2019 to October 2020. The search was updated for publications to 30 May 2022. The thematic synthesis method was used to analyse and interpret the data.

Findings

The experiences of the nurses giving care to patients with COVID-19 were grouped under four themes: (1) Difficulties encountered in the care of patients with COVID-19; (2) mixed emotions experienced in the care of patients with COVID-19; (3) coping strategies that nurses used in the management of the pandemic; (4) the benefits of the COVID-19 to nurses.

Conclusion

Nurses faced many difficulties and experienced mixed emotions while providing care for patients with coronavirus disease. Perceived social support was seen as the most important strategy for coping with these difficult situations. It is important to be aware of the difficulties and emotions experienced by nurses and support them during the COVID-19 pandemic for the management of future pandemics.     

The roles of community health nurses for older adults during the COVID-19 pandemic in Northeastern Thailand: A qualitative study

ObjectiveCommunity health nurses play an important role in primary health care service, especially during the spread of COVID-19. This study aimed to describe the work and activities of community health nurses focusing on the care of older adults during the COVID-19 pandemic in Northeastern Thailand.MethodThis was a qualitative research study. The methods, including observation, in-depth interview, secondary data, and focus group discussion, were employed to obtain data from 46 key informants. The process started from February to August 2022 in northeastern Thailand. Data were analyzed using content analysis.ResultsThe results of this study were organized into 3 main themes focusing on 1) Community health nurses’ role for older adults during the COVID-19 pandemic, which consists of 12 sub-themes; 2) Barriers of community health nurses in caring for older adults during the pandemic consisted of 2 sub-themes; and 3) Factors contributing to the success of community health nurses in managing health and providing care for older adults during the pandemic consisted of 4 sub-themes.ConclusionsThe findings showed that community health nurses had played important roles, such as educating and advocating health, providing care, promoting and empowering people in the community toward health, and giving emotional and nutritional support to older adults during the COVID-19 pandemic. This study can be used as a guideline for policymakers and health-related agencies to develop healthcare strategies and to optimize the management of community health nurses in caring for older adults during the pandemic. COVID-19 is a major public health challenge; therefore, understanding the roles and activities of community health nurses helps improve primary care cluster development, strengthens healthcare services in community, and for everyone in the community to be ready for possible challenge of future global pandemics.