Staff Perceptions and Experiences of Implementing the Baby Friendly Initiative in Neonatal Intensive Care Units in Australia

ObjectiveTo explore the perceptions, understandings, and experiences of maternity service staff toward the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Baby Friendly Hospital Initiative (BFHI) and its implementation in the Neonatal Intensive Care Unit (NICU).DesignAn exploratory study using naturalistic methods of inquiry.SettingParticipants were recruited from a total of four Australian metropolitan maternity hospitals of which two included a NICU. Focus groups and individual interviews were undertaken in the participants' choice of location, usually hospital.ParticipantsForty‐seven participants included nursing and midwifery staff and one pediatrician.MethodsData from focus groups and interviews were transcribed and thematic analysis used to identify themes related to implementation and perceptions of staff regarding BFHI.ResultsMajor themes identified focused on the differences in NICUs relative to maternity units, separate worlds of mother and infant, the hard work involved in implementing the BFHI, and the positive attitude that BFHI can be achieved. There were misconceptions by participants on the nature of the BFHI as it applied to NICUs. Factors hindering and supporting BFHI implementation were also identified.ConclusionMotivated staff, educational support, and clear guidelines are essential to support implementation of the BFHI in NICUs.     

Unintentional exposure of neonates to conventional radiography in the Neonatal Intensive Care Units.

OBJECTIVE: To evaluate the extent of unintentional exposure to X-rays performed during routine diagnostic procedures in the Neonatal Intensive Care Units (NICUs). STUDY DESIGN: During a 1-month period, 157 consecutive neonates from five level-III NICUs were recruited for this study. The mean birth weight was 1747+/-911 g (range: 564-4080 g), and gestational age was 31.6+/-3.6 weeks (range: 24-41 weeks). A total of 500 radiographs were performed including chest (68%), abdomen (17%) and combined chest and abdomen (15%). The average number of radiographs taken per infant was 4.2+/-3.6 (range: 1-21). Unintentional inclusion of body regions other than those ordered was determined by comparing the areas that should be included in the radiation field according to International recommendations, to those that appeared in the actual radiograph. RESULT: A comparison of the recommended borders to the actual boundaries of the radiographs taken show an additional exposure to radiation in all three procedures: 85% of chest radiographs also included the whole abdomen, 64% of abdomen radiographs included both thigh and upper chest and 62% of chest and abdomen radiograph included the thigh. (The range in all procedures was from ankle to upper head.) Between 2 and 20% of the relevant targeted body tissues were not included in the exposed fields resulting in missing data. The gonads of both sexes were exposed in 7% in all chest X-rays. Among male infants, the testes were exposed in 31% of plain abdomen radiographs and 34% of chest and abdomen radiographs. CONCLUSION: In the NICUs participating in the study, neonates are currently being exposed to X-ray radiation in nonrelevant body regions. Higher awareness and training of the medical teams and radiographers are required to minimize unnecessary exposure of newborns to ionizing radiation.     

Nursing Care in the Neonatal Intensive Care Unit

The field of neonatal care has evolved into a specialty brimming with technological advances, accompanied by expanded nursing roles and responsibilities. In light of this, the impact that thermoregulation, noise pollution, and disruptive care planning can have upon the progress of a sick newborn is discussed. Suggestions are made for evaluation of problem areas and for redirection of patient care plans to include attention to these vital aspects.     

Scoping Review of Baby-Friendly Hospital Initiative Compliance and Breastfeeding Initiation in Sri Lanka

ObjectiveTo synthesize the evidence for associations between Baby-Friendly Hospital Initiative (BFHI) compliance and breastfeeding initiation in Sri Lanka.Data SourcesWe searched PubMed, ProQuest, Scopus, Embase, MEDLINE, and CINAHL using various Boolean operators for multiple search terms. Studies conducted in Sri Lankan published in English from April 1, 2000, to April 30, 2020 were considered. We also searched Sri Lankan government and international organization websites and hand-searched reference lists of the included documents.Study SelectionWe screened the titles and abstracts of 99 records and retrieved 31 documents for review and assessment. We selected 24 documents, including the full texts of primary research articles, reviews, discussions, letters to the editor, and government reports if they specifically addressed breastfeeding initiation and BFHI compliance in Sri Lanka.Data ExtractionWe extracted the data for author(s), year of publication, study setting, study design, aims of the study, population and sample size, inclusion and exclusion criteria, data collection methods, participant response rate, prevalence, associated factors of breastfeeding initiation, and BFHI compliance and its contributing factors if they were available depending on the type of document.Data SynthesisWe synthesized the data narratively to address the research questions. We identified contradicting reports of the prevalence of breastfeeding initiation (23.5%–100%) across Sri Lankan hospitals. Breastfeeding initiation was significantly associated with mode of birth. We identified inconsistent compliance with the BFHI, and poor compliance was associated with inadequate staff training and ineffective monitoring systems.ConclusionWe found inadequate evidence to clarify the association between BFHI compliance and breastfeeding initiation in Sri Lanka. It is therefore not possible to conclude whether adherence to Baby-Friendly care is optimizing breastfeeding initiation in Sri Lanka.     

Facilitators and Barriers to Implementation of Safe Infant Sleep Recommendations in the Hospital Setting

ObjectiveTo identify facilitators and barriers to the implementation of safe sleep recommendations from the American Academy of Pediatrics from the perspective of hospital staff as part of a needs assessment that was used to design a successful quality improvement intervention to change clinical practice.DesignQualitative design.SettingMultiple sites of three hospitals in the northeastern and southern United States.ParticipantsWe used purposeful sampling to identify 46 participants who cared for infants on inpatient hospital units (nurses and other staff members).MethodsA qualitative researcher used grounded theory to moderate the focus groups. We constructed the initial interview guide and then changed it as needed to capture more information about new ideas as they arose. Researchers from diverse backgrounds participated in the analysis and used the constant comparative method to select important concepts and to develop codes and subsequent themes. We continued to collect data until saturation was reached.ResultsWe identified themes and subthemes, and the taxonomy fit into the Grol and Wensing framework for change in clinical practice. The six primary themes included The Innovation Itself, The Individual Health Care Professional, The Patient, The Social Context, The Organizational Context, and The Economic and Political Context.ConclusionParticipants described facilitators and barriers to the implementation of the American Academy of Pediatrics recommendations for safe infant sleep. Identification of these themes informed our quality improvement intervention to promote safe infant sleep. Findings can be used by others when faced with the need for similar change.     

Making a Good Thing Better: The Regionalization of Neonatal Intensive Care Units

Since neonatal intensive care units have reduced infant mortality and morbidity, various methods of staffing and administering the units have been implemented. To make such units as economically efficient as possible, a deliberate framework is imperative in order to avoid service duplication and enhance accessibility for high-risk neonates.     

Satisfaction With Obstetric Care: Relation to Neonatal Intensive Care

Objective: To examine the relationship between admitting children to a neonatal intensive care unit (NICU) and mothers’ satisfaction with obstetric care.Methods: Mothers of live-born infants who are now normal were interviewed about their perceptions of the interpersonal, organizational, and technical care they and their babies received during pregnancy, delivery, and the neonatal period, and their and their infants’ health. Comparisons between the responses of mothers whose babies were admitted to the normal nursery (n = 595) and those whose babies were sent to an NICU (n = 72) were made by χ² analysis (1 df) and Wilcoxon rank sum tests.Results: Mothers whose babies were admitted to an NICU were more likely to complain that their obstetricians did not explain things in terms they could understand (P < .05); did not give them the right amount of information about what to expect during pregnancy (P < .05); hid something from them before delivery (P < .001); did not explain the reasons for tests performed during delivery (P < .05); misled them about their child’s prognosis (P < .001); failed to treat properly a problem during delivery (P < .05); and did not know the latest medical developments (P < .05).Conclusion: Even when children do well, admission of newborns to an NICU is associated with greater maternal dissatisfaction with obstetric care.     

Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review

Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.     

Family Mental Health Care in the Neonatal Intensive Care Unit

The potential role of the neonatal intensive care nurse in mental health promotion is explored. The focus is upon assessment and intervention of families who are at risk for child abuse and future dysfunction. The importance of support systems during a crisis period is emphasized.