Family-Centered Care of the Surgical Neonate

When infants require surgery, the family experiences a crisis. Surgical care of the infant and their family requires constant information sharing between health care providers (HCPs) and families. Parents' information needs and their readiness to learn vary along the infant's trajectory of healing. Information is acquired by parents from many sources and over time parents become an important source of information during the infant's stay in the neonatal intensive care unit (NICU). Family-centered approaches in all phases of surgical care (preoperative, postoperative and preparation for discharge) empowers and supports parents and ultimately leads to optimal outcomes.     

菲律宾St. Luke＇s Medical Centre NICU学习感悟

本文通过介绍菲律宾St. Luke＇s Medical Centre NICU的护理工作制度、服务理念、培训制度以及病房布局、母乳喂养的落实情况、对早产儿的发展性照顾等方面的情况，旨在为我国规范NICU护士专科知识的培训、优化病房环境、加强发展性护理、鼓励父母参与患儿的护理、加强患儿出院前的指导、提高NICU护理工作水平提供参考。     

Evaluating nurse staffing patterns and neonatal intensive care unit outcomes using Levine's Conservation Model of Nursing

mefford l.c. & alligood m.r. (2011) Journal of Nursing Management 19, 998–1011
Evaluating nurse staffing patterns and neonatal intensive care unit outcomes using Levine’s conservation model of nursing Aims To explore the influences of intensity of nursing care and consistency of nursing caregivers on health and economic outcomes using Levine’s Conservation Model of Nursing as the guiding theoretical framework. Background Professional nursing practice models are increasingly being used although limited research is available regarding their efficacy. Method A structural equation modelling approach tested the influence of intensity of nursing care (direct care by professional nurses and patient–nurse ratio) and consistency of nursing caregivers on morbidity and resource utilization in a neonatal intensive care unit (NICU) setting using primary nursing. Results Consistency of nursing caregivers served as a powerful mediator of length of stay and the duration of mechanical ventilation, supplemental oxygen therapy and parenteral nutrition. Analysis of nursing intensity indicators revealed that a mix of professional nurses and assistive personnel was effective. Conclusions Providing consistency of nursing caregivers may significantly improve both health and economic outcomes. New evidence was found to support the efficacy of the primary nursing model in the NICU. Implications for nursing management Designing nursing care delivery systems in acute inpatient settings with an emphasis on consistency of nursing caregivers could improve health outcomes, increase organizational effectiveness, and enhance satisfaction of nursing staff, patients, and families.     

Fathers' experiences with the skin-to-skin method in NICU: Competent parenthood and redefined gender roles

AimTo explore how fathers of premature infants experience and potentially benefit from using the skin-to-skin (STS) method during their infants' admission to the neonatal intensive care unit (NICU).Methods, participants and settingHermeneutic phenomenological qualitative study. In-depth, semi-structured interviews with five fathers of premature infants in the NICU, Copenhagen University Hospital, Hvidovre Hospital, Denmark.FindingsThree themes emerged: 1) “The competent parenthood”. 2) The paternal role and the division of roles between the parents. 3) Balance between working life and time spent with the infant.ConclusionSTS enhances the fathers' ability to play a caring role in their infant's life. Fathers consider themselves less important, as compared to the mother in relation to their infant. STS enhances an understanding of their own role as a father. Health professionals should focus on promoting the abilities of both parents and on ascribing the fathers an equal and important role in their infant's care.     

The role of fathers in supporting the development of their NICU infant

Contemporary models of NICU care emphasize the critical role of parents in supporting their infant's development. Fathers play an important, but underutilized, role throughout their infant's NICU journey. This narrative review describes the main direct and indirect mechanisms through which fathers support the development of their NICU infant, and the barriers and facilitators to this support as described in current research. Studies have identified several mechanisms through which fathers can directly enhance their infant's health and development. Several studies described the benefits of fathers providing kangaroo care, but infant-directed speech, tactile stimulation, and parent scent also appear to yield developmental benefits. However, most of the literature focused on the indirect ways that fathers support their infants through the coparenting alliance, assuming additional responsibilities that allow mothers to spend more time engaged in infant care, and by providing financial support for the family. Reduced access to the NICU setting has been identified as a key barrier to fathers' direct involvement in infant care, which has been further exacerbated due to additional restrictions imposed due to the COVID-19 pandemic. Additionally, negative perceptions held by fathers, mothers, and nursing staff regarding the role of fathers in preterm infant care may also represent a barrier to fathers' engagement. Nursing staff were identified as playing a crucial role in promoting fathers' capacity to support the development of their infants. This research can help to inform interventions and policies geared toward optimizing infant development by improving the involvement of fathers during a NICU admission, and beyond.     

Understanding the Inflammatory Response of the Neonate: Clinical Implications for Caregivers in the Neonatal Intensive Care Unit

Nurses who care for preterm infants within the neonatal intensive care unit (NICU) face a multitude of challenges. An issue of major importance is supporting the immature immune response that when left unchecked makes young and preterm infants especially vulnerable to infection. Research has shown that the neonate's inflammatory response is moderately effective yet not well differentiated, which can lead to additional tissue destruction. This article examines the pathophysiology of the inflammatory process and discusses the influence that inflammation has on the infant before and after birth. Links between neonatal sepsis and neurologic insults such as intraventricular hemorrhage and periventricular leukomalacia are discussed. These insults have been associated with poor neurodevelopmental outcomes. Nursing interventions and management strategies are provided to best support the infant during this critical process. An understanding of the infant's immune system and the inflammation process will enhance the neonatal caregiver's ability to consider and provide preventative measures in routine care practices.     

Public health nursing: the generalist in a specialized environment

In implementing a generalist model of public health nursing (the Comprehensive Multi-level Nursing Practice Model) in a rural county health department, a research team encountered critical challenges. The framework for the model was a philosophy of public health nursing practice and action research to support the public health nurse generalist role. Challenges in implementing the model stemmed from conflicts between the research team and the health department that were rooted in philosophical differences about how to implement care and the nature of nursing and the public health nursing role. Key factors were the subtle forces operating in the public health environment that constrain the public health nurse generalist role. Based on conflicts that arose in implementing the model, implications for public health nursing practice are in opportunities to influence policy at health department and other levels and responsibility for assuring professional practice.     

The nursing practice environment,staff retention,and quality of care

The effects of key factors in the nursing practice environment—management style, group cohesion, job stress, organizational job satisfaction, and professional job satisfaction—on staff nurse retention and process aspects of quality of care were examined. Hinshaw and Atwood's (1985) anticipated turnover model was modified and expanded to include relevant antecedent and outcome variables. The four-stage theoretical model was tested using data from 50 nursing units at four acute care hospitals in the southeast. The model explained 49% of the variance in staff nurse retention and 39% of the variance in process aspects of quality of nursing care. Study findings warrant careful consideration in light of recent practice environment changes: experience on the unit and professional job satisfaction were predictors of staff nurse retention; job stress and clinical service were predictors of quality of care. The variable contributing the most to indirect, and in turn, total model effects, was that of management style. These results substantiate the belief that aspects of the practice environment affect staff nurse retention, and most importantly, the quality of care delivered on hospital nursing units. © 1996 John Wiley & Sons, Inc.     

A nurse practitioner model of practice in the neonatal intensive care unit

PURPOSE: The purpose of this study was to describe the practice of the nurse practitioner (NP) in the neonatal intensive care unit (NICU) in an attempt to define an advanced practice nursing model that is unique to NP practice in the NICU. DESIGN: This qualitative research used an ethnographic case study design to answer the research question: 'What is the practice model of nurse practitioners working in the NICU?' METHODS: Seven nurse practitioners working in five level II/III NICUs in Massachusetts and Rhode Island were interviewed and observed in practice. Audiotaped interviews using open-ended questions and field notes from participant observations were analyzed for patterns of behavior. RESULTS: These nurse practitioners practiced within a model of advanced practice nursing that emphasized health, holism, and caring within the highly technological and medical NICU environment. CLINICAL IMPLICATIONS: A model of NP practice in the NICU is emerging and needs further development and testing. Nurse educators and administrators must find ways to support the nursing model in the advanced practice nursing role in the NICU. Nurse practitioners need to be more active in promoting a clearer understanding of their practice and contributions to the NICU care delivery team.     

A Pilot Randomized Controlled Trial of Outcomes Associated with Parent-Nurse Controlled Analgesia vs. Continuous Opioid Infusion in the Neonatal Intensive Care Unit

PurposeProspectively compare parent/nurse controlled analgesia (PNCA) to continuous opioid infusion (COI) in the post-operative neonatal intensive care unit (NICU) population.Design/MethodsA randomized controlled trial compared neonates treated with morphine PNCA to those treated with morphine COI. The primary outcome was average opioid consumption up to 3 post-operative days. Secondary outcomes included 1) pain intensity, 2) adverse events that may be directly related to opioid consumption, and 3) parent and nurse satisfaction.ResultsThe sample consisted of 25 post-operative neonates and young infants randomized to either morphine PNCA (n = 16) or COI (n = 9). Groups differed significantly on daily opioid consumption, with the PNCA group receiving significantly less opioid (P = .02). Groups did not differ on average pain score or frequency of adverse events (P values > .05). Parents in both groups were satisfied with their infant's pain management and parents in the PNCA group were slightly more satisfied with their level of involvement (P = .03). Groups did not differ in nursing satisfaction.ConclusionsPNCA may be an effective alternative to COI for pain management in the NICU population. This method may also substantially reduce opioid consumption, provide more individualized care, and improve parent satisfaction with their level of participation.Clinical ImplicationsPatients in the NICU represent one of our most vulnerable patient populations. As nurses strive to provide safe and effective pain management, results of this study suggest PNCA may allow nurses to maintain their patients' comfort while providing less opioid and potentially improving parental perception of involvement.Study TypeTreatment study.Level of EvidenceI.     

Ethical Considerations in the Neonatal Intensive Care Unit

Advances in treatment and technology capabilities, coupled with the ability to care for younger, smaller, and sicker neonates contribute to ethical conflicts in the neonatal intensive care unit (NICU). Although the ethical approach to care is sometimes inconsistent, it is important for clinicians to develop and adopt a framework for ethical decision-making in the NICU. Providers need to understand the four ethical principles of autonomy, beneficence, nonmaleficence, and justice and apply these principles to clinical decision-making about care in the NICU. Ethical decision-making must be family-centered and respectful of cultural differences. Providers must comply with professional ethical guidelines as well as government and legal mandates. Adopting ethical frameworks for neonatal care ensures a more holistic approach to care in the highly technical environment of the NICU.     

Recognizing and mitigating infant distress in Neonatal Intensive Care Unit (NICU)

Admission to the Neonatal Intensive Care Unit (NICU) is a psychologically and physically distressing event for infants. Preterm infants suffer from higher rates of depression and anxiety in childhood, adolescence, and adulthood, likely, at least in part, related to the experiences they have in the NICU. The parent-infant relationship is of paramount importance in determining the future trajectory of both the parent's and infant's mental health, and therefore it is critically important to both assess and support its development in the NICU. The challenges parents face in responding to their preterm, ill and fragile infants, and strategies to mitigate infant distress are outlined.     

An exemplar for evidence-based nursing practice using the Magnet(®) model as the framework for change: oral feeding practice in the neonatal intensive care unit

Implementation of research evidence into practice can be challenging in areas such as the neonatal intensive care unit (NICU), where the environment is complex and rapidly changing and caregiving goals have shifted from simply infant survival to supporting positive long-term neurodevelopmental outcomes. Clinical nurse specialists (CNS) are ideally positioned to use research to obtain new knowledge, innovations, and improvements in care as part of an interdisciplinary team. The authors describe the role of the CNS in changing NICU culture around feeding infants, an important and frequent nursing activity, with the Magnet(?) model as the framework for change.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

Mental health nursing: Daring to be different,special and leading recovery‐focused care?

How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi‐disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, “What's special about mental health nursing?” Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the ‘Ten P's of the professional profile that is mental health nursing’, which are ‘present’, ‘personal’, ‘participant partnering’, ‘professional’, ‘phenomenological’, ‘pragmatic’, ‘power‐sharing’, ‘psycho‐therapeutic’, ‘proud’ and ‘profound’. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.     

What is a nurse? The Francis report and the historic voice of nursing

Following the Francis report into shockingly deficient standards of care at an English hospital, this paper examines UK nurse education and revisits the premises on which the professional narrative of nursing was built. The UK government's response to the report is to introduce the “associate nurse” role, to be nationally trained to do fundamental care in place of the registered nurse, and a nursing apprenticeship scheme—on‐the‐job training for a nursing degree. UK nursing bodies do not address the report's recommendations in regard to registered nurse education; rather, they advocate a further perpetuation of the current system. This shows deep uncertainty about what the “true” nurse is. To those familiar with the Nightingale model that characterised nursing in England and elsewhere for a century before the introduction of Project 2000 in 1986, there is an intriguing historical echo in the Francis report. One might wonder whether Francis is really recommending a return to a virtue‐based, practice‐driven, nationally standardised version of nursing education developed by Nightingale and evidenced in nursing syllabuses in England and Wales 1860–1977. This paper supports this position, and shows from a review of historical and contemporary evidence that this Nightingale model has current relevance.     

Exploring the impact of a Dual-Occupancy NICU design on parental experience

A comparative observational study was undertaken to compare the impact of Open-Bay and Dual-Occupancy Intensive Care Unit (NICU) design on parent activities and evaluate their perceptions of both designs. Study methods included: a parent activity study, parent feedback surveys comparing physical environments, and parental involvement. Post transition parent interviews (n = 10) were conducted to gain a deeper insight into families' experiences in the Dual-Occupancy NICU. Results showed parents spent significantly more minutes per day [24 h] participating in their infant's care in the Dual-Occupancy NICU when compared to Open-Bay (359.40, 228.70, p < 0.01; respectively); similarly, increased participation was recorded in the Dual-Occupancy Special Care Nursery (SCN) when compared to the Open-Bay SCN (295.20, 231.90, p < 0.01: respectively). Parents perceived Dual-Occupancy design created “a home away from home” facilitating parental involvement in Kangaroo Care and breast feeding, where they could attend to their infant's care with minimal interruptions and privacy.