A pain and stress assessment and management quality improvement initiative to align with the BEST START recommendations

The aim of this quality improvement project was to improve and standardise pain and stress management practices and processes within a 34-bed Level III neonatal unit. Results demonstrated a statistically significant improvement in staff perceptions regarding education and training specific to traumatic stress as well as pain and stress assessment and management practices (p < 0.05). Building more confidence and competence with staff to utilise breastfeeding and skin-to-skin practices as primary non-pharmacologic interventions during painful and stressful procedures is a future opportunity for continued quality improvement. As NICU practice continues to evolve, clinicians must not lose sight of their role as advocates in meeting the human needs of those they serve within this highly technological environment. Pain and stress assessment and management is a first step in providing loving, compassionate, trauma informed, developmental care.     

Kangaroo care: Expanding our practice to critically ill neonates

Kangaroo Care, or the practice of skin-to-skin contact between a newborn and his or her parents, was initiated in 1983 in South America by 2 physicians and has now spread worldwide. According to a 1999 survey, 82% of neonatal intensive care units (NICUs) practice kangaroo care to varying degrees. There are numerous, well-documented physiological and emotional benefits of kangaroo care for both the infant and the parents. This report describes the process of expanding one NICU's practice of kangaroo care from treatment of stable, nonintubated patients to treatment of more critically ill infants. Copyright © 2001 by W.B. Saunders Company     

Assessing the knowledge and confidence to perform breastfeeding practices in the neonatal unit – A case study of the use of the Neonatal Unit Clinician Assessment Tool (NUCAT) in Coventry,England

The evidence that breast milk feeding reduces mortality and morbidity among premature and small babies is well established, but breastfeeding rates in neonatal units in the UK remain low. We present a case study of how a tertiary hospital unit in Coventry, England assessed staff training by interviews and undertaking the Neonatal Unit Clinician Assessment Tool (NUCAT), an on line objective knowledge test with ratings of confidence and knowledge in breastfeeding support skills. Fifty-one medical and nursing clinicians completed NUCAT. More staff scored better on the practical than knowledge domains. Doctors, those with more neonatal experience and more years since qualifying were not more knowledgeable than other clinicians overall. But senior clinicians knew more about physiology of lactation and why breastfeeding is beneficial. As prior training and experience, self assessed knowledge and confidence in practice, are not reliable predictors of knowledge, we recommend objective assessment is used to target training to individual needs.     

Experiences of parents providing kangaroo care to a premature infant: A qualitative systematic review

Parents who give birth to an unexpected preterm infant not only suffer a psychological impact, but, in addition, their roles as parent are full of uncertainty. As part of family‐centered care, kangaroo care is an important way to support premature infants and their family. This review synthesizes qualitative studies on the experiences of parents who have used kangaroo care for preterm infants in neonatal intensive care units. English and Chinese databases were searched for relevant studies from 1970 to July 2018. The findings of qualitative studies were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 731 studies were screened, and 9 were included. Five synthesized findings were identified: sense of emptiness of the parent's role, barriers in the translation of parental roles in kangaroo care, preparation enhances parental role expectations, kangaroo care enhances parental competency, and encouragement and support from family and friends. Through the implementation of kangaroo care, nurses are able to help prepare and guide parents, fit parents’ needs, and help improve their ability and self‐confidence in their parental roles.     

Design,implementation and evaluation of an education course to promote professional self-efficacy for breastfeeding care

The objective of this study was to determine the effect of an education short course on professional’ self-efficacy in the area of breastfeeding care. The intervention had a pre-post design. A total of 43 healthcare professionals attended the course. The Kirkpatrick model for the development, implementation and evaluation of education actions was used for a 4.5-h course. The aspects evaluated included professionals’ satisfaction and learning regarding confidence to support lactating mothers, perceived transfer of knowledge to the workplace and organizational changes. Data were collected using self-administered questionnaires (participants, unit managers, and education planners), before and after the intervention. Participants' satisfaction with the education action was high in all of the aspects measured (greater than 3.9 in scores of 0–5). Professionals showed a significant increase in self-efficacy levels for supporting breastfeeding (Wilcoxon test p-value = < 0.05, before intervention: median = 55, [IQR] = 11; after intervention: median = 60, [IQR] = 14). Participants, managers and organizers of the course identified changes in the way that professionals cared for breastfeeding mothers. In conclusion, this educational intervention enhanced professional self-efficacy and performance in breastfeeding care.     

Neonatal hypothermia and associated factors in preterm neonates admitted to neonatal intensive care units in southwest Ethiopia

BackgroundNeonatal hypothermia is a major risk factor for morbidity and mortality of neonates in the first 28 days since birth. However, few studies have investigated the occurrence of neonatal hypothermia in preterm newborns in southwest Ethiopia. This study aimed to determine the prevalence of and factors associated with neonatal hypothermia in preterm neonates admitted to a neonatal intensive care unit (NICU) in Southwest Ethiopia.MethodsAn institutional based prospective cross-sectional study was conducted in preterm infants admitted to the NICU at Bench Sheko, Kafa, and Sheka hospitals between March and September 2020, using systematic sampling technique. Binary logistic regression analysis was used to assess the association between neonatal hypothermia and explanatory variables. The strength of association was evaluated using an odds ratio at a 95% confidence interval, where statistical significance was considered at a threshold of p < 0.05.ResultsThe prevalence of neonatal hypothermia was 62.9% (95%CI: 58.4%–67.6%). Neonatal hypothermia was associated with their having been an antenatal care visit (AOR: 0.52; 95%CI: 0.29-0.94), obstetric complication during delivery (AOR: 4.7; 95%CI: 1.78–12.34), caesarian section delivery (AOR: 1.91; 95%CI: 0.740–4.96), non-vertex presentation (AOR: 2.59; 95%CI: 1.06–6.32), 5-min APGAR score <7 (AOR: 2.19; 95%CI: 1.148–4.17), practicing kangaroo mother care (AOR: 55; 95%CI: 0.340-0.893), and the initiation of breastfeeding between 1 and 2 h (AOR: 2.39; 95%CI: 1.29–4.415).ConclusionThe prevalence of neonatal hypothermia was high. Nearly two-thirds of neonates admitted to NICU in southwest Ethiopia had neonatal hypothermia. Healthcare professionals working in the delivery room and/or NICU must be made aware of factors associated with neonatal hypothermia to ensure the early detection and appropriate management of the condition and thus to improve outcomes in infants presenting with neonatal hypothermia.     

Breastfeeding in the context of the COVID-19 pandemic: A discussion paper

Breastfeeding offers one of the most fundamental global health benefits for babies. Breastmilk is lifesaving, providing not only nutrition but immunologic benefits and as such is strongly supported by the World Health Organization and leading healthcare associations worldwide. When the COVID-19 pandemic started in 2020, the impact of the restrictions to prevent the spread of the disease created challenges and questions about provision of safe, quality care, including breastfeeding practices, in a new ‘normal’ environment. Mothers were temporarily separated from their babies where infection was present or suspected, parents were prevented from being present on neonatal units and vital breastfeeding support was prevented. This discussion paper provides an overview of essential areas of knowledge related to practice for neonatal nurses and midwives who care for breastfeeding mothers and babies, in the context of the COVID-19 pandemic and the latest global guidance. Three areas will be discussed; the protective benefits of breastfeeding, keeping breastfeeding mothers and babies together and supporting mothers to breastfeed their babies. Finally, care recommendations are presented to serve as a summary of key points for application to practice for neonatal nurses and midwives.     

Does Kangaroo care affect the weight of preterm/low birth-weight infants in the neonatal setting of a hospital environment?

The aim of this systematic review is to ascertain if kangaroo care (KC) affects the weight of preterm/LBW infants in the neonatal setting of hospital environments. The following databases were searched: PubMed, The Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase and SCOPUS. Search terms include: kangaroo care, kangaroo mother care, kangaroo ward care, skin to skin care, skin to skin contact, skin to skin mother care, weight, neonatal infant, neonatal care and neonatal unit. 10 RCT's demonstrated that KC increases weight of preterm/LBW infants in the neonatal setting of a hospital environment. 7 quantitative studies also reported an increase in weight. Increased rates of breastfeeding were also consistently associated with regard to KC across the 17 studies. KC effects weight gain of preterm/LBW infants in the neonatal setting of a hospital environment. Exclusive breastfeeding rates were positively influenced through KC.     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.     

A digital-based follow-up program to improve maternal competence in preterm home care- A true-experimental study

ObjectiveThe purpose of this study is to evaluate how a digital-based follow-up program affects maternal competence in preterm newborn home care.MethodsA true-experimental, pretest-posttest control group study was conducted on 80 mothers of preterm infants at a tertiary-level medical college hospital in Karnataka, India, using a structured knowledge questionnaire and observation checklist. The experimental group received a multi-component, digital-based follow-up program.ResultsThe competence of mothers in the experimental group improved significantly after the intervention, as evidenced by the between-group difference in knowledge and practice score (p = 0.000).ConclusionBecause it provides mothers with continuity of support, a digital-based follow-up program can be used to improve their ability to care for preterm babies.     

Use of a Paper Checklist to Increase Clinician Adherence to Mammography Screening Guidelines

ObjectiveTo increase clinician adherence to mammography screening guidelines.DesignQuality improvement initiative.Setting/Local ProblemAt a nurse practitioner–led primary care practice, a chart audit of adherence to American Cancer Society mammography screening guidelines indicated a 12% adherence rate for clinicians writing mammography orders.ParticipantsNurse practitioners providing care to women ages 40 years and older.Intervention/MeasurementsThe intervention was a screening checklist that was completed by the woman at registration and given to the clinician during the examination. The pre- and postintervention measurement was the percentage of mammogram orders. A Fisher exact test was used to examine changes from pre- to postintervention rates of adherence.ResultsAfter the intervention, the percentage of women for whom a mammogram was recommended and ordered was 69.6%, compared to 12% from the original chart audit. This change was statistically significant (p = .01).ConclusionClinicians must find efficient approaches to improve processes within their practice settings to ensure that preventive care recommendations are made during visits. Although the screening checklist was deemed useful, improvement in adherence rates is still needed, and a paperless system should be initiated.     

Neonatal kangaroo care - What we know and how we can improve its practice: An evidence review

PurposeThe purpose of this evidence search was to review past and current kangaroo care practice and explore the Iiterature relating to improving kangaroo care for preterm infants.MethodA literature review of evidence was undertaken in order to answer pre specified questions. The literature search was undertaken on CINAHL, Google Scholar and Pubmed. Key search terms were kangaroo care, skin to skin care, kangaroo mother care, preterm infants, benefits, practices, enablers and education.ConclusionA lack of training and formal education greatly inhibits kangaroo care provision in the neonatal environment. The level of confidence a nurse has in their ability to decide whether the infant is clinically stable or not, will determine if kangaroo care is offered. Neonatal nurse education is imperative in order to improve kangaroo care practice in the clinical setting.     

A systematic review and meta-analysis of colostrum avoidance practice among breastfeeding mothers in Ethiopia,December 2021

BackgroundThe extent and causes of colostrum avoidance practices are varied widely in Ethiopia. As a result, a more conclusive study like systematic review and meta-analysis is required to take evidence-based interventional measures toward colostrum avoidance practice and its associated factors.MethodsA systematic review and meta-analysis of observational studies on colostrum avoidance practice were conducted. The online databases, other gray literature, and online repositories were searched to obtain relevant articles. The quality of each study was assessed using the Newcastle Ottawa Quality Assessment Scale for cross-sectional studies. Data were extracted using Microsoft excel 2016 spreadsheet and analysis was done by Stata 16.0 statistical package. The I² test statistic was used to test for heterogeneity whereas the funnel plot and Egger's test were used to detect publication bias. The pooled prevalence of colostrum avoidance practice and the log odds ratio with a 95% confidence interval were performed.ResultA total of 35 studies with 17, 224 breastfeeding mothers were included. The pooled prevalence of colostrum avoidance practice was 19.07% (95% CI: 14.65%–23.48%). Lack of counseling on colostrum feeding [AOR: 4.49, 95% CI: 2.74–6.25, I2 = 95.81%, p = 0.00], caesarean delivery [AOR: 3.84, 95% CI: 2.61–5.07, I2 = 77.64%, p = 0.02], delayed breastfeeding [AOR: 3.71, 95% CI: 1.07–6.35, I2 = 98.75%, p < 0.001], and poor knowledge of colostrum [AOR: 4.65, 95% CI: 3.15–6.14, I2 = 95.81%, p = 0.00] were a risk factors of colostrum avoidance practice.ConclusionColostrum avoidance is highly practiced in Ethiopia with 1 in 5 breastfeeding mothers discard colostrum. Lack of counseling on colostrum feeding and poor knowledge about colostrum were the contributing factors for colostrum avoidance practice. Maternal counseling regarding the importance of colostrum feeding to their baby should be strengthened.     

Effectiveness of a Virtual Program on Nurses’ Pain-Related Knowledge and Pain-Measurement Skills

BackgroundAim: To test whether a comprehensive virtual program for using pain scales to manage neonatal pain improved nurses’ knowledge and skill acquisition.MethodsThis non-blind randomized controlled trial included 64 participants who were randomly divided into intervention and control groups; changes in scores between pre- and posttests were compared. Certified neonatal intensive care nurses were recruited from across Japan. The learning intervention group received online training in pain measurement using structured scales, such as the Face Scale for Pain Assessment of Preterm Infants and the Japanese version of the Premature Infant Pain Profile. The control group received no training. Independent t tests and χ² tests were used to compare the baseline scores. The outcome measure was score change on a 40-point test (20 for knowledge and 20 for skill) before and after the e-learning program.ResultsNo differences in baseline data were found between the groups. Generalized linear regression models yielded a significant difference in the least squared means (95% confidence interval [CI]) for the amount of change in the total, knowledge, and skill scores between groups: 6.22 (4.18, 8.26; p < .001) for total score, 4.66 (3.37, 5.95; p < .001) for knowledge score, and 1.53 (0.06, 3.00; p = .041) for skill score.ConclusionsThe results showed that the e-learning program improved nurses’ neonatal pain knowledge and pain-measurement skills compared with no training.