Practice developments supporting change implementation in Wellington,New Zealand (NZ) for ‘continuity of care when transitioning complex preterm infants from NICU to home’

The discussion paper will focus on continuity of care relating to previous NZ research, specifically to transitioning complex preterm infants from NICU to home based on parent experiences, and on the practice developments that have occurred, to ensure optimal health outcomes. Previous NZ research discovered parent desire a consistent service delivery for the entire transition journey from NICU and at home.An informative and comprehensive opportunity has occurred for reflective professional practice, evaluation, development and implementation which have transpired in positive change through innovative practice developments and support change implementation in Wellington, NZ. This has resulted in the articulation of a model of care that has both embraced and integrated parental desires for a continuity of care process for complex preterm infants. This has been achieved by having the same Discharge Facilitator/Key Case Manager present within the NICU and external to the NICU for Home-based infants for the entire transition journey.The paper will focus and emphasis additional practice development changes and furthermore, will present a real purpose, for other countries to learn of such practice developments that have exemplified a celebratory success for families of Wellington, NZ.     

Facilitators and barriers to developmentally supportive care for preterm infants in low and middle-income countries: A scoping review

BackgroundPreterm birth and its associated complications are a major cause of neonatal mortality worldwide. Approximately 15 million preterm infants are born annually, most births occurring in Sub-Saharan Africa and South Asia. However, Developmentally Supportive Care—an evidence-based intervention reported to improve the survival of preterm infants, is under utilized in Low and Middle-Income Countries. This review focuses on examining the barriers to, and facilitators of, Kangaroo Mother Care, positioning (nesting and swaddling), and control of the external neonatal intensive care environment in low- and middle-income countries.MethodsSix databases were systematically searched between January 2000 to April 2020. A search of the grey literature was also conducted. Two independent reviewers screened the citations of the retrieved papers and abstracted data for included studies based on predetermined inclusion/exclusion criteria.ResultsA total of 15853 articles were retrieved from the search. A full-text review was conducted on 155 articles. Thirty-two papers were identified and included in the review. Thirty papers focussed on KMC, two papers focused on noise control. No studies were identified on positioning and light control in the NICU. Barriers identified included lack of knowledge of DSC practices in both health care workers and family caregivers, existing cultural norms, and the absence of protocols and guidelines for practice. Facilitators included; healthcare worker training, leadership and support from health care facility managers to family caregivers, and available infrastructure.ConclusionFurther studies that comprehensively examine DSC implementation in Low-Middle-Income countries are required in order to improve sustained DSC practices.     

Neonatal nurses’ perceptions of using live streaming video cameras to view infants in a regional NICU

Tertiary hospital services have introduced live streaming video cameras into Neonatal units with the aim of reducing distress and enhancing bonding and attachment between infants and parents during hospitalisation. However, there is a paucity of research exploring the impact of using live streaming video cameras in the neonatal unit. The aim of this study was to describe staff perceptions of using a live streaming video camera in a neonatal context. Quantitative and qualitative data were collected via an online questionnaire. While staff reported benefits for parents, concerns regarding increased workload and difficulties in using the technology were also reported. For this technology to be implemented as standard care, and to ensure nurses confidence in using it, it will be important to address these concerns. Working in collaboration with nurses who have daily and ongoing experience with the cameras in clinical practice is key to finding effective solutions for implementing live web streaming cameras into standard care.     

A service evaluation of the fathers’ peer support group on a neonatal intensive care unit (NICU)

The following study evaluates a fathers' peer support group facilitated on a tertiary neonatal intensive care unit (NICU). Within the group, the experiences of fathers with an infant on the NICU was explored. Data was collected from eight fathers and analysed using thematic analysis. Four key themes emerged: (1) the “ups and downs” of the NICU journey, (2) the “balance between two worlds”; juggling NICU and life outside, (3) being “an important member of the family”; feeling seen, included and cared for and (4) “I'm not alone”; the benefits of the shared experience. The study concluded that the peer group was a valued form of support during which fathers were facilitated to meet other NICU dads, share their NICU journey and learn from the experiences of others. Recommendations for setting up a NICU fathers' peer support group are provided.     

Assessment and characterization of sound pressure levels in Portuguese neonatal intensive care units

In the NICU, systematic exposure to sound-pressure above the recommended level can affect both neonates and staff. This study aimed to evaluate the sound pressure levels in three Portuguese NICUs and the noise perceptions of staff. The measurements were performed with a sound-level meter, considering the location of the main sources of noise and the layout of the units. A questionnaire was applied to assess noise perceptions of professionals. Among the staff, 41.1% classified the environment (regarding noise) as “slightly uncomfortable”; 48.4% considered it as “acceptable.” The majority (55.5%) considered “equipment” the most annoying source of noise. The results showed that noise levels were excessive in all the evaluated areas of the NICUs, exceeding international guidelines, with levels ranging between 48.7 dBA to 71.7 dBA. Overall, there is a need for more research to verify the effectiveness of some actions and strategies to reduce the effect of noise in the NICU.     

NICU患者耐药金黄色葡萄球菌感染的监测与控制

总结了2004年7月～2005年12月NICU患者耐药金黄色葡萄球菌(MRSA)感染的控制经过.预防和治疗措施落实后耐药金黄色葡萄球菌(MRSA)感染流行得到控制,感染率明显下降.通过改进消毒隔离的措施,使交叉感染得到有效控制,减少患者的并发症,降低医疗费用,提高了医疗护理的质量.     

新生儿重症监护病房护理人员疼痛知识培训的效果分析

目的探讨疼痛知识培训对新生儿重症监护病房(neonatal intensive care unit,NICU)护理人员疼痛管理知识和态度的影响。方法便利抽样选取某三级综合性教学医院的临床NICU护理人员42人,采用自身前后对照的研究设计,使用护理人员疼痛知识和态度(2008)中文版问卷(knowledge and attitudes survey regarding pain,KASRP)评价疼痛知识培训对护理人员疼痛管理知识和态度的影响。结果接受疼痛知识培训后,护理人员KASRP的平均得分从培训前的(16.88±3.05)分增加到(34.68±5.74)分,应用疼痛评估工具的频率显著增加,与培训前比较差异均有统计学意义(均P0.05)。结论疼痛知识培训能显著提高NICU护理人员的疼痛知识水平,改善对疼痛管理的认识,促进其对新生儿疼痛的管理,对及时评估、预防和降低新生儿疼痛具有积极的意义。     

The effect of gestational age on clinical and radiological presentation of necrotizing enterocolitis

Background/purpose

To test the hypothesis that clinical and radiological features of necrotizing enterocolitis vary with gestational age in all neonates with NEC and in subgroup of surgically treated patients.