A Project to Implement Use of 40% Dextrose Gel for Transient Neonatal Hypoglycemia

ObjectiveTo examine the effect of oral dextrose gel and oral feedings on newborns’ blood sugar homeostasis in the first day of life in an effort to decrease transfers to the NICU.DesignEvidence-based practice project.Setting/Local ProblemObstetric service at a large hospital in northeast Ohio with approximately 5,300 births annually. Neonates who experienced hypoglycemia were often transferred to the NICU for management if treatment measures failed, thereby increasing the cost of care and separating mothers from their newborns. During 2018, there were 54 neonates transferred to the NICU for hypoglycemia.ParticipantsPediatricians, neonatologists, neonatal nurse practitioners, clinical nurse specialists, managers, educators, and registered nurses.Intervention/MeasurementsAn interdisciplinary task force created a nurse-driven protocol and associated order set and also created and provided interdisciplinary education to all involved caregivers using a multimodal approach. Neonates’ charts were audited for the time period of April 2019 to April 2020 to evaluate participants’ compliance with the prescribed practice changes.ResultsThe number of neonates who qualified for blood glucose testing per the new protocol totaled 1,369. Of these, 188 (14%) met criteria for and were treated with 40% dextrose gel. Treatment with 40% dextrose gel was unsuccessful for 25 neonates, who were then transferred to the NICU. This is 29 fewer than were transferred in 2018.ConclusionThe use of oral dextrose gel and oral feedings was associated with a decrease in the number of newborns transferred to a higher level of care for treatment of hypoglycemia.     

Relationships Among Perceived Social Support,Family Resilience,and Caregiver Burden in Lung Cancer Families: A Mediating Model

ObjectivesTo identify the factors associated with caregiver burden in Chinese lung cancer families and to detect whether family resilience mediates the effect of perceived social support on caregiver burden.Data SourcesFrom October 2021 to March 2022, a total of 213 family caregivers of patients with lung cancer from a public hospital in Sichuan Province, China, completed the Zarit Burden Interview (ZBI), the Perceived Social Support Scale (PSSS), and the Family Resilience Assessment Scale (FRAS). The Mann-Whitney U test and the Kruskal-Wallis H test were used to identify the influencing factors of family caregiver burden, and the bootstrapping method was conducted to detect the mediating role of family resilience.ConclusionIn this study, family caregiver burden could be influenced by caregiver age, caregivers’ relationships with patients, and patients’ self-care degree; family resilience was found to mediate the relationship between caregivers’ perceived social support and caregiver burden.Implication for Nursing PracticeOur study manifested that factor from both the patients’ and caregivers’ sides could influence caregiver burden of lung cancer family caregivers. The results provide further evidence that lung cancer care should be family-centered, and relevant family-supportive systems should be further developed in this field.     

Prevalencia de úlceras por presión en atención primaria en dos comarcas catalanas

ObjectiveTo determine the prevalence of and risk factors for skin breakdown due to pressure ulcers.MethodWe performed an observational, cross sectional study between April 1 and April 15, 2003 in all community nurses in the areas of Bages and Berguedà (Barcelona, Spain) and the head nurses of all nursing homes. Information (patient and caregiver characteristics and preventive measures) was gathered on all patients previously diagnosed with skin breakdown or risk of skin breakdown.ResultsA total of 810 patients were studied (209 with skin breakdown and 601 at risk for skin breakdown). The prevalence of patients with skin breakdown due to pressure ulcers was 0.11% among the adult population, 0.42% in individuals aged more than 64 years old, 7.3% in patients receiving home care, and 4.8% in nursing home residents. Each community nurse attended a mean of 3.7 patients (SD = 2.5) at risk of skin breakdown and a mean of 1.8 patients (SD = 1.1) with pressure ulcers.ConclusionsGiven the prevalence of pressure ulcers in patients receiving home care, detection of risk should be increased to prevent ulcer progression. When risk is detected, preventive measures should be increased. Health education should be improved in family caregivers, who play a major role in the process.     

Family caregivers of patients with frontotemporal dementia: An integrative review

ObjectivesThe purpose of this integrative review is to: (1) identify the characteristics of family caregivers of patients with frontotemporal dementia, (2) explore the impact of providing care on family caregivers’ health and well-being, and (3) identify coping strategies used by family caregivers.BackgroundFrontotemporal dementia is thought to be the second most common form of dementia after Alzheimer's disease. Family caregivers of patients with frontotemporal dementia face unique challenges due to its early onset, behavioral symptoms, and slow progression of decline. However, there is a dearth of research evaluating the health and wellbeing of family caregivers of patients with frontotemporal dementia.Design and data sourcesAn integrative review was conducted using the Whittemore and Knafl methodology. An electronic search of the literature was conducted using four electronic databases: PubMed, Embase, CINAHL, and Web of Science. The Crowe Critical Appraisal tool was used to evaluate the quality of the selected articles.ResultsFindings of 11 articles informed this integrative review. Family caregivers of patients with frontotemporal dementia identify behavioral disturbances as most troubling. Spouses and female caregivers experience greater caregiver burden, distress, increased rates of depression, as well as decreased sleep related to behavior disturbances. Though less explored, providing care to those with behavioral disturbances may also impact caregiver physical health. Additionally, female caregivers are most likely to employ coping strategies, most commonly, adaptation and reframing. Effective interventions to reduce family caregiver burden are poorly understood but family caregivers suggest education and internet-based support groups are most helpful.ConclusionsFamily caregivers of patients with frontotemporal dementia experience significant distress, which impacts their health and wellbeing. It is important for healthcare providers who care for patients with frontotemporal dementia to recognize the unique needs of family caregivers. Future research should focus on examining interventions and strategies to reduce caregiver burden.     

A caregiver educational program improves quality of life and burden for cancer patients and their caregivers: A randomised clinical trial

Purpose of the researchThe French setting, including laws and guidelines, advocates greater involvement of informal caregivers in the care of cancer patients to protect the caregivers from depression, distress, and a decrease in their quality of life. This study aimed to assess the efficacy of a caregiver educational programme by measuring two outcomes: patients' and caregivers' quality of life and caregivers' burden.Methods and sampleA multicentre randomised controlled trial was performed in six oncology wards in French hospitals. Eligible patients had a cancer, a main caregiver, allowed their caregivers' involvement, and received an inclusion agreement by a doctor/psychologist dyad. The experimental group participated in an educational programme performed by nurses to improve their skills in meal support, nursing care, welfare care, or symptom management. The SF36 and the Zarit burden scales were used to measure quality of life and caregivers' burden at the beginning and at the end of the study.Key results67 patients were randomised and 33 were included in the experimental group. Evolution scores, which measured the difference between baseline and final scores, showed an improvement in patients' and caregivers' quality of life and an alleviated burden for experimental group caregivers.ConclusionsAn educational programme for caregivers encourages the involvement of patients, informal caregivers and health-care providers in a triangular relationship which enhances the quality of life of patients and caregivers alike and decreases caregivers' burden. Care organisation should therefore be rethought as a triangular relationship between patients, caregivers and health-care providers, with nurses as the mainstay.     

Transition experiences of newly qualified registered graduate nurses employed in a Neonatal Intensive Care Unit

ObjectiveTo explore the experiences of newly qualified registered graduate nurses’ clinical and professional learning experiences, during their first six-months of post registration employment within a graduate nurse transition program in a Neonatal Intensive Care Unit (NICU).MethodNarrative inquiry with thematic analysis was used to explore the newly qualified registered graduate nurses’ accounts via semi-structured interviews, conducted between January 2018 – January 2019, of their clinical and professional learning during their employment in the Neonatal Intensive Care Unit.SettingIn total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited.FindingsThemes identified included: feeling unprepared; experiences of horizontal violence; the need for a supportive structural environment and seeking feedback. Participants reported overwhelming feelings of stress, emotional exhaustion, concerns for patient safety and for some, fear of early career burnout.ConclusionIn this study, newly qualified registered graduate nurses were clinically underprepared for entering a Neonatal Intensive Care Unit with all participants reporting high levels of psychosocial distress. This was further compounded by a lack of structured support, horizontal violence, and inadequate or no regular feedback from preceptors, resulting from a negative workplace culture and poor educator behaviours. Recommendations for improving the experiences of newly qualified registered graduate nurses employed in the Neonatal Intensive Care are discussed.     

Patient identification of caregivers' titles: do they know who you are?

This study investigated patients' abilities to identify licensed nurse and unlicensed assistive personnel (UAP) and whether this knowledge is related to satisfaction with care. Of 100 patients from two hospitals, 28% did not know whether caregivers were nurses or UAP on sight. Fifteen percent of patients asked to identify UAP assumed that the caregiver was a nurse. Patients could not recognize their nurse or UAP caregivers 59% of the time from a list of names. Patients were three times more likely to know the names and titles of their nurses. Older patients were less likely to remember the names and titles of their caregivers. Satisfaction with nursing care was not predicted by patients' knowledge of caregiver name or title.     

Validation of a surgical neonatal nursing workload tool

ObjectiveTo describe the development and validation of the Winnipeg Assessment of Neonatal Nursing Needs Tool-Surgical Complex (WANNNT-SC), a nursing workload tool for use in a surgical neonatal intensive care unit (NICU).MethodsThe Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) was modified to create the WANNNT-SC. Nursing staff utilized the tool over 60 consecutive shifts to determine the number of nurses needed to appropriately staff the unit. The charge nurse, based on professional judgement, also determined how many nurses were required to staff the unit on each shift.ResultsThe WANNNT-SC determined that 1.76 fewer nurses were needed for direct patient care. The tool was reliable across multiple users (mean difference 0.003, SD 0.32).ConclusionThe WANNNT-SC is valid, reliable, and can be used to determine the number of nursing staff required to provide direct patient care in a surgical NICU.     

Providing Support for Caregiver Communication Burden: Assessing the Plain Language Planner Resource As a Nursing Intervention

ObjectiveTo elicit informal caregiver feedback about an mHealth resource and it's potential as a nurse-delivered intervention for caregiver communication support.Data SourcesFour focus groups with current oncology caregivers that involved caregiver use of the resource and response to a video demonstrating the resource as a nursing intervention. A brief assessment of the resource was collected for triangulation of data.ConclusionCaregivers rated the resource as overwhelmingly positive and reported that use of the resource gave an increased sense of preparedness. Caregivers shared ideas for future expansion of the resource, highlighted the need for user-responsive design, and described the need for a caregiver-centered tool.Implications for Nursing PracticeCommunicating complex terminology relating to treatment, side effects, and symptoms requires resources to meet health literacy needs. A nursing protocol for using the resource is provided based on feedback collected from caregivers.     

Patient Education Issues and Strategies Associated With Immunotherapy

ObjectiveTo provide education strategies to health care providers caring for patients receiving immunotherapy and who are managing the various potential adverse events related to these treatments.Data Sources: Peer-reviewed literature.ConclusionDelivering patient education on immunotherapy based on a thorough educational needs assessment and identification of learning barriers may contribute to effective patient outcomes and patient safety.Implications for Nursing PracticeIt is a critical role of the nurse to educate and empower patients and caregivers with the ability to identify early signs of impending toxicities related to immunotherapy regimens. With continuous learning and clinical experience, oncology nurses are at the forefront for providing high-quality immunotherapy education to patients and caregivers.     

What Is the Experience of Babywearing a NICU Graduate?

ObjectiveTo understand the experiences of caregivers using baby carriers to hold their infant after discharge from the NICU.DesignThe qualitative research design was transcendental phenomenology.Setting/Local ProblemCaregiving of NICU graduates is associated with greater incidence of depression, anxiety, and posttraumatic stress disorder, which can impair caregivers’ abilities to form secure attachments with their infants. In addition, lack of paid parental leave, especially among those of low socioeconomic status, can result in prolonged separations between infants and caregivers in the NICU, producing toxic stressors.ParticipantsEight caregivers ages 21 to 41 years whose infants were discharged from the NICU of a regional referral academic medical center in Oklahoma City, Oklahoma. Homogenous convenience sampling was used by posting recruitment flyers in common areas of the NICU frequented by family members.Intervention/MeasurementsParticipants were educated before discharge on using baby carriers that held their infants in kangaroo position. They were asked to carry their infant in the carrier for 3 hours a day for the 2-month study period.ResultsSix total themes were identified; four were previously identified in kangaroo care and skin-to-skin care research: Decreased Stress and Anxiety, Calmness and Sleep, Attachment, and Parental Empowerment; two were independent to this study: Ease of Work and Self-Care.ConclusionThe themes identified indicate that babywearing has the potential to address harms—such as stress, fear, depression, anxiety, and posttraumatic stress disorder—that may be experienced by caregivers of infants discharged from the NICU. Babywearing can be used as an intervention to support caregivers and promote positive health outcomes after a NICU discharge.     

新生儿重症监护病房高级实践护士职能的临床作用与期望度分析

目的 探讨新生儿重症监护病房高级实践护士职能的临床作用和发展期望度,为今后培养高级实践护士提供理论依据.方法 通过自制新生儿重症监护病房高级实践护士职能问卷,对本地区238名新生儿重症监护病房医护人员进行问卷调查,并对结果进行多维尺度分析.结果 新生儿重症监护病房高级实践护士6大职能主要分布在临床作用和职能期望度两个维度上,临床作用最大和职能期望度最高的是临床实践职能.结论 发展新生儿重症监护病房高级实践护士应着重培养护士的临床实践、教育、研究和管理职能.     

Development and testing of the theory of collaborative decision-making in nursing practice for triads

BACKGROUND: Although nurses depend heavily on informal family caregivers to provide care to clients and to be involved in care planning and decision-making, no nursing theories that include the client, the caregiver, and the nurse were available to guide collaborative care planning and decision-making. AIM: The purpose of this paper is to describe the construction and initial testing of the theory of collaborative decision-making in nursing practice for a triad. The theory represents an extension of Kim's theory of collaborative decision-making in nursing practice. Kim's theory was developed to describe and explain collaborative decision-making in a dyad (client and nurse). The inclusion of a third person (family caregiver) in the theory required the addition of concepts about the caregiver, coalition formation, and nurse and caregiver outcomes. The expansion of Kim's dyadic theory to a triadic theory was achieved by means of a modified version of the theory derivation process described by Walker and Avant. CONCLUSIONS: The theory of collaborative decision-making in nursing practice for a triad can be used to guide further research and clinical practice. The theory provides a framework for researchers who are interested in studying the effects of collaboration regarding decision-making among nurses, family caregivers, and clients. The initial testing of the new theory in home health care nursing revealed variety in the nature of the client-caregiver-nurse relationships, the many processes used by the nurses in proceeding with the home visits, a multitude of decisions considered and different collaborative, noncollaborative, and coalition-forming interactions. The limited evidence of the empirical adequacy of the theory precludes development of definitive guidelines for clinical practice at this time. More studies are required before clinical practice guidelines can be developed.