Nurses' beliefs and values about doing cue-based care in an NICU in Taiwan

Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU) . This study uses qualitative research methods to grasp the richness and diversity of nurses' beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses' perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.     

Use of a training program to enhance NICU nurses' cognitive abilities for assessing preterm infant behaviors and offering supportive interventions

This study tested the use of a developmentally supportive care (DSC) training program in the form of videotaped and personalized instruction to increase nurses' cognitive abilities for assessing preterm infant behavioral signals and offering supportive care. The study used a two-group pre-test post-test quasi-experimental repeated measures design. The participants were 25 NICU nurses, 13 in the intervention group, and 12 in the control group. An instrument developed for the purpose of the study was a video test that measured the effectiveness of the DSC training. The video test questionnaires were administered to the participants twice with an interval of four weeks. ANCOVA controlling the baseline scores was used for data analysis. In general, the results support the hypothesis that nurses' cognitive abilities were enhanced after the DSC training. The increase in nurses' cognitive abilities is the prerequisite for behavioral change, based on the assumptions of Bandura's Social Cognitive Learning Theory (Bandura, 1986). As nurses' cognitive abilities increased, it would be possible that nurse behaviors in taking care of these preterm infants might change. Therefore, the author recommends that in order to improve NICU care quality and the outcomes of preterm infants, the concepts of developmentally supportive care be incorporated into NICU caregiving practice by educating nurses.     

Music therapy and child care

Music therapy was shown many years ago to have positive effects in various age groups of patients in the Western world. Music can produce physiological and psychological effects, including changes in the vital signs, reductions in anxiety, improvements in the immune system, decreases in cortisol levels, the reduction of stress and the promotion of well-being. Music therapy is an inexpensive and effective intervention for nurses to apply to patients. The application of such therapy to children, however, is different from that to adults due to their limited cognitive and language development. In Taiwan, nurses' knowledge of music therapy is limited, and it is rarely used in child care. This article introduces music therapy and its effects in child care, such as in premature infants, children in emergency care, handicapped children, and children receiving surgery. Music therapy is often used as an assisted intervention for patient care in clinical settings. Health care professionals can perform some of the music therapy activities for patients appropriately even if they have not been trained in music. This article aims to improve nurses' knowledge of music therapy and to provide a useful reference for those involved in child care.     

A meta-analysis of the efficacy of music therapy for premature infants

This meta-analysis on music research with premature infants in neonatal intensive care units (NICU) showed an overall large, significant, consistent effect size of almost a standard deviation (d =.83) (Cohen, 1998). Effects were not mediated by infants' gestational age at the time of study, birthweight, or type of music delivery nor by physiologic, behavioral, or developmental measures of benefit. The homogeneity of findings suggests that music has statistically significant and clinically important benefits for premature infants in the NICU. The unique acoustic properties that differentiate music from all other sounds are discussed and clinical implications for research-based music therapy procedures cited.     

The parent–nurse relationship in the neonatal intensive care unit context – closeness and emotional involvement

Aim and background:  Family-centred care, which acknowledges parents as partners in care, is a desirable and essential part of neonatal nursing. There has been extensive research on parents' experiences of parenting in neonatal intensive care units (NICU), but there is little research on nurses' experiences of being in these enduring close relationships. The aim of this paper is to explore parents' and nurses' experiences of the close parent–nurse relationship when a premature child is hospitalized.
Method:  The design was exploratory with a hermeneutic approach. The methods used were participant observation and in-depth interviews with six mothers, six fathers and six nurses in a Norwegian 13-bed NICU. Eighteen individual interviews and 160 hours of observations were conducted over 27 weeks from 2003 to 2004. This study complies with the principles of the Declaration of Helsinki. The Regional Committee for Medical Research Ethics, the Ombudsman for Privacy in Research at the Norwegian Social Science Data Services and the hospital's research department approved the study protocol.
Results:  The NICU context is a technological environment where human interaction is a crucial issue. The character of the context and the ongoing interactions drive parents and nurses into close relationships. Closeness increases the emotional involvement and the boundary between the professional and the personal approach is threatened. The commitment of being close, combined with the emotional involvement, can be an emotional burden to both parents and nurses.
Conclusion:  Parent–nurse closeness in NICU is desirable; however, the emotional burden of this closeness seems to be seldom problematized. Awareness about the need to strike a balance between closeness and distance can positively influence parents' independence and nurses' ability to maintain professional relationships with their primary care parents.     

Nurses' attitudes and perceptions of pain assessment in neonatal intensive care

Scand J Caring Sci; 2010; 24; 49–55
Nurses' attitudes and perceptions of pain assessment in neonatal intensive care
Background:  Pain assessment of premature infants continue to be ineffective. The problem may be partly because of misconceptions or lack of knowledge in the assessment of pain in children.
Aims:  This paper reports a study to describe nurses' attitudes towards and perceptions of pain assessment in neonatal intensive care and the demographic factors related to these attitudes and perceptions of pain.
Methods:  The participants consisted of 257 Finnish nurses who were recruited from all five of the country's university hospitals caring for the premature infants receiving intensive care or monitoring. We collected data by using a Likert-type questionnaire in spring 2006. The response rate was 71% from the represented population.
Findings:  Almost all (97%) of the nurses agreed that pain assessment in premature infants is important. However, over half (60%) of the respondents agreed that they could assess the premature infants pain reliably without pain scores. The respondents' perceptions of the premature infants' ability to sense and express pain indicated rather good knowledge of the topic. Nevertheless, one-fourth of the participants was unaware that a premature infant could be more sensitive in sensing pain than a full term counterpart. Education, work experience and the working unit were the demographic factors that were significantly related to the respondents' attitudes and perceptions.
Conclusions:  On average nurses' attitudes were positive towards the pain assessment in neonatal intensive care. However, there were some gaps in the knowledge concerning the respondents' perceptions of the items, which is a challenge to nursing and nursing education.     

Parent-nurse interactions: care of hospitalized children

BACKGROUND: An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. AIM OF THE PAPER: To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. METHODS: A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. FINDINGS: Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. CONCLUSION: Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.     

A comparative study of patients' and nurses' perceptions of the quality of nursing services, satisfaction and intent to revisit the hospital: a questionnaire survey

BACKGROUND: Although it is very important to clarify the factors influencing the patients' and nurses' satisfaction with nursing services, very little research has been performed in this area. OBJECTIVES: The purpose of this study was to compare the nursing service quality, satisfaction and intent to revisit the hospital perceived by hospitalized patients and nurses in Korea. METHODS: SERVQUAL scale, an overall satisfaction and intent to revisit the hospital questionnaires were used. The sample consisted of 272 patients and 282 nurses. The data were collected using paper and pencil self-rating questionnaires and analyzed using frequency, %, mean, standard deviation, t-test and Pearson correlation coefficient. RESULTS: Overall, nurses' expectations and performance were higher than those of patients, while patients' overall satisfaction with nursing and medical care was higher than that of nurses. There was a strong positive relationship between satisfaction with nursing and medical care and intent to revisit the hospital for both groups. CONCLUSIONS: The performance was relatively lower than expectations, resulting in poor nursing care quality. Differences between expectations and performance for both patients and nurses need to be further reduced.     

Making STARs: Reaching successful transition to at-breast feeds in the premature infant

The transition to at-breast feeding in the premature infant may not occur until after discharge.PurposeTo identify factors influencing this transition to assist health care providers in providing optimal support to mothers of premature infants.DesignQualitative study based on telephone interviews with mothers 8 weeks post-discharge from the NICU regarding their lactation experiences.Sample26 mothers of 29 infants born at <37 weeks gestation who desired to feed their babies directly at-breast.ResultsPrevious breastfeeding experience appears to be a prominent factor in producing premature infant STARs (Successful Transition to At-breast feeds Reached). Additional factors that may affect the transition are: (a) whether mothers of premature infants have realistic expectations about the transition to at-breast feeds; (b) importance of adequate breastfeeding experience prior to discharge and (c) maternal confidence and patience.     

加拿大多伦多Sunnybrook Health Sciences Centre NICU护理对我国的借鉴

通过介绍Sunnybrook Health Sciences Centre NICU的护理管理和工作制度、医院感染预防、病房布局、护理业务培训和对早产儿发育的护理等内容,为我国NICU护理工作开展提供借鉴。提出我国应该加强根据国内外的最新护理进展情况规范NICU护士专科知识教材和培训方法;合理布局NICU,以改善病房环境和预防医院感染;合理安排治疗和护理时间,尽量减少对早产儿的干扰,促进其发育;鼓励父母参与患儿的护理。     

NICU护士开展发育支持护理的现况及影响因素分析

目的探讨我国NICU护士开展发育支持护理(development supporting care,DSC)行为的现况,并分析其影响因素。方法应用发育支持护理自评量表,对北京、上海、四川3省市6家实施DSC的三甲医院中的152名NICU护士进行调查,应用逐步法多元线性回归对护士实施DSC行为和7个可能的影响因素进行分析。结果护士实施DSC行为总分(73.39±11.88)分,影响护士实施DSC行为的因素依次为护患比、从事NICU护理时间、是否参加过培训及受教育程度。结论现阶段我国NICU护士实施的DSC主要凭借个人工作经验,应加强对护士的培训,尤其是护士对早产儿暗示行为的观察方面。建议由科室组建DSC小组,制订计划并实施DSC;形成以家庭为中心的NICU科室文化,促进父母的参与。     

新生儿重症监护室出院早产儿母亲育儿生活体验的质性研究

目的了解新生儿重症监护室出院早产儿母亲的育儿生活体验。方法采用质性研究法,对16例早产儿母亲在婴儿出院后1个月时进行深度访谈。结果母亲在早产儿出院后经历了"母乳喂养困难与哺乳不确定性的困惑""自我育儿能力低下的无措感""对早产儿常见症状的不安""育儿负担感""育儿信息所致的混乱与不安"等育儿体验。结论早产儿母亲存在育儿困难,在育儿过程中感受到强烈的不安,探讨这个群体母亲的护理支持方案是当前急需解决的课题之一。     

Mothers' involvement in caring for their premature infants: an historical overview

BACKGROUND: Advances in technology have resulted in increasing survival rates even for extremely premature infants. While sophisticated medical management is vital to infant survival, research has found that social factors and care giving processes are important predictors of infants' later outcome. Consequently, evidence is accumulating to demonstrate the fundamental role of mothers and families to the optimal developmental outcome of premature infants. AIM: The aim of the work reported here was to undertake an historical overview of premature infant care practices to increase neonatal nurse's knowledge of the crucial role of mothers and families in the care of their premature infants. Understanding past practice and current trends can provide neonatal nurses with critical insight which will assist in formulating current and future care. METHOD: Research and historical articles focusing on maternal involvement in preterm infant care from the development of the incubator to the present time were examined. A search of the literature between 1960 and 2002 was conducted using the MEDLINE, CINAHL and PSYCLIT databases. The search terms were premature infant, neonatal intensive care, history, and maternal care. FINDINGS: Three major themes were identified which reflect the development of neonatal care. Firstly, over the last century advances in medical and public health practice saw a decline in mortality rates for mothers and infants. Secondly, the application of this new knowledge resulted in the institutionalization and professionalization of obstetric and neonatal care which, in turn, resulted in the isolation of infants from their mothers. Finally, concurrent advances in infant research emphasized the importance of mother-infant relationships to infants' developmental outcome, resulting in greater flexibility in hospital practices regarding parental contact with their infants. CONCLUSION: As biomedical advances in technology continue to help smaller, sicker premature infants to survive, neonatal nurses are strategically placed to promote positive outcomes for infants and their families through the integration of social science and behavioural research into nursing practice.     

Human Touch Effectively and Safely Reduces Pain in the Newborn Intensive Care Unit

This was a feasibility pilot study to evaluate the efficacy of the nonpharmacologic pain management technique of gentle human touch (GHT) in reducing pain response to heel stick in premature infants in the neonatal intensive care unit (NICU). Eleven premature infants ranging from 27 to 34 weeks' gestational age, in a level III NICU in a teaching hospital, were recruited and randomized to order of treatment in this repeated-measures crossover-design experiment. Containment with GHT during heel stick was compared with traditional nursery care (side lying and “nested” in an incubator). Heart rate, respiratory rate, oxygen saturation, and cry were measured continuously beginning at baseline and continuing through heel warming, heel stick, and recovery following the heel stick. Infants who did not receive GHT had decreased respiration, increased heart rate, and increased cry time during the heel stick. In contrast, infants who received GHT did not have decreased respirations, elevated heart rates, or increased cry time during the heel stick. No significant differences were noted in oxygen saturation in either group. GHT is a simple nonpharmacologic therapy that can be used by nurses and families to reduce pain of heel stick in premature infants in the NICU.     

NICU早产儿基于行为线索的经口喂养模式的研究进展

基于行为线索的经口喂养模式指喂养者通过对早产儿所呈现的行为线索进行持续、动态的评估,来决策并提供不同的经口喂养策略.该文对NICU早产儿基于行为线索的经口喂养模式的发展背景、发展现状、理论基础、影响因素及经口喂养的准备度评估、吸吮质量评估、支持性策略等实施方法进行综述,旨在为国内NICU开展基于行为线索的早产儿经口喂养...     

家庭支持护理模式对NICU早产儿父母心理状况的影响

目的 探讨家庭支持护理模式对入住新生儿重症监护室(neonatal intensive care unit,NICU)的早产儿父母焦虑、抑郁情绪的影响。 方法 采用自身前后对照研究,选取我院NICU的192例早产儿及其父母,对其实施家庭支持护理模式。在早产儿父母参与家庭支持护理前和完成护理支持后的出院日采用焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)对其进行调查。 结果 接受家庭支持护理后,早产儿父母的焦虑、抑郁评分均低于实施家庭支持护理前(P<0.05)。 结论 家庭支持护理模式可以有效改善NICU早产儿父母的焦虑和抑郁心理状况,应将早产儿父母纳入NICU整体护理的关注范围。