Nipple confusion and breastfeeding: a literature review

Among the ten steps to successful breastfeeding advocated by the WHO and UNICEF, steps six and nine clearly state that formula supplementation and pacifier use, except when medically necessary, should be avoided. Early formula supplementation may not only interfere with the mother's lactation but also result in nipple confusion on the part of the baby. To avoid nipple confusion, the encouragement of cup feeding and the non-provision of pacifiers or bottles are required nursing practice in baby-friendly hospitals. However, the relationship between nipple confusion and the duration of breastfeeding has not been well examined. The purpose of this paper is to explore the relationships between three methods of feeding (i.e. pacifier, bottle feeding, and cup feeding), nipple confusion, and duration of breastfeeding. A hypothetical framework is proposed to explain these relationships on the basis of a review of the literature.     

State of the science: use of human milk and breast-feeding for vulnerable infants

Human milk is the preferred form of nutrition for all infants including those born preterm or otherwise ill. However, without the commitment of knowledgeable healthcare providers to ensure success during mother-infant separation, many infants fail to receive their mother's own milk. Care of the mother-infant dyad during infant illness requires vigilant monitoring of the lactation experience and the commitment of healthcare providers to take a family through the step-by-step process needed to ensure positive outcomes related to the use of human milk and breast-feeding for vulnerable infants. The science tells us that human milk is the best form of nutrition for all infants. As practitioners we must be doing everything in our power to make sure the infants we care for are able to receive their mother's own milk.     

State of the science: feeding readiness in the preterm infant

Finding ways to consistently prepare preterm infants and their families for more timely discharge must continue as a focus for everyone involved in the care of these infants in the neonatal intensive care unit. The gold standards for discharge from the neonatal intensive care unit are physiologic stability (especially respiratory stability), consistent weight gain, and successful oral feeding, usually from a bottle. Successful bottle-feeding is considered the most complex task of infancy. Fostering successful oral feeding in preterm infants requires consistently high levels of skilled nursing care, which must begin with accurate assessment of feeding readiness and thoughtful progression to full oral feeding. This comprehensive review of the literature provides an overview of the state of the science related to feeding readiness and progression in the preterm infant. The theoretical foundation for feeding readiness and factors that appear to affect bottle-feeding readiness, progression, and success are presented in this article.     

State of nursing science: on the edge

Nurse scientists have had great and important successes contributing to science and to patient care. To review the state of nursing science is an enormous and complex challenge, and yet the pace of discovery constantly quickens. The purpose of this article, which was read at the 2002 State of the Science Congress, was to use the human response model to describe the domains of nursing science and note exemplary, innovative developments in the context of the model's "person" and "environmental" domains. Advances are noted in genetics, aging, development, and gender studies; also noted is work in infection care, disaster care, and identification of health disparities. Asked to predict the future, we chose instead to describe societal challenges and speculate how nursing leaders can contribute importantly by applying nursing's unique perspective. Benchmarks of our success will include reversal of the nursing shortage, patients living to their highest potential, and penetration of evidence based care into clinical practice and health policy. Furthermore, the media and the public will view nurse scientists as key informants related to clinical care. Nurse scientists will be elected to lead major interdisciplinary organizations, our training programs will prepare new scientists with the knowledge and skills to enter a competitive and ever-evolving field, our schools will have adequate infrastructure to support the advancement using cutting-edge technology, centers of excellence will provide research consultation and collaboration beyond university boundaries, and nurse scientists will assume a more visible role in translational research.     

State of the art replaces state of confusion at ED

Creative design, latest technology can improve the environment for patients and staff. Decontamination room with access from outside the hospital ensures separation from the rest of the patient population. Picture archiving communication system enables instantaneous access to test results on physician's computer screen. Wireless communications can be essential when colleagues are located a significant distance from the ED.     

State of the science: procedural pain management in the neonate

Neonates in the neonatal intensive care unit experience painful procedures. Over the last 10 years, investigators have examined several pharmacologic and nonpharmacolgic treatment strategies to decrease or eliminate the pain associated with mechanical ventilation, endotrachial intubation, insertion of percutaneous or central venous lines, heel stick, and venipuncture. These procedures and others are addressed as well as the reported severity of pain associated with these procedures. Progress has been made in the past decade to establish evidence-based treatments that will help the clinician more effectively relieve neonatal stress and pain when performing many routine procedures.     

State of the science: outcomes of acute inpatient psychiatric care

Identifying client outcomes related to nursing care is critical to establish empirical evidence that supports the effectiveness of psychiatric nursing. The purpose of this article is to conduct a methodological review of the literature that examines client outcomes after treatment in acute care inpatient psychiatric hospitals and psychiatric units of general hospitals. The databases Medline, CINAHL, HealthSTAR/Ovid HealthSTAR and psycINFO were searched for articles published between 1991and 2004. A review of literature was conducted of studies related to client outcomes after inpatient psychiatric treatment. Forty-seven studies were reviewed. There is a dearth of literature related to client outcomes after inpatient psychiatric treatment. The existing literature has conceptual and methodological limitations. The organization of psychiatric nursing care, in relation to outcomes is nonexistent in the literature. Outcomes that are sensitive to nursing care must be conceptualized theoretically and then examined empirically. The Quality Health Outcomes model is proposed to conceptualize outcomes of acute inpatient psychiatric treatment that are sensitive to nursing interventions and the organization of nursing care.     

Identifying alternative linkages among philosophy, theory and method in nursing science

The major concerns expressed in the literature regarding the development and expansion of nursing science stem from questions related to 'what sorts of science' and 'which scientific methods' are appropriate for nursing While there is a sector of nursing's scientific community that advocates a unified approach to philosophy and method, a growing sentiment for the position of philosophical and methodological pluralism is apparent This paper addresses the nature of scientific pluralism by presenting a framework for alternative linkages possible among the philosophy, theory and method appropriate for nursing science The nature of nursing knowledge that is produced within the discipline will thus depend on various forms of alternative linkages adopted by nursing scientists in addressing nursing's scientific questions In turn, such pluralism presents problems of choice to nurses in practice with respect to knowledge utilization     

State of the science for cardiovascular nursing outcomes: heart failure

The incidence of heart failure is increasing because of the progressive aging of the population and improved survival from cardiovascular disease. This article synthesizes the state of the science of nurse sensitive outcomes in heart failure treated medically or surgically and provides recommendations for building the science. Outcomes studied include mortality, morbidity, resource use, quality of life, symptoms, physical function, return to work, and self-care and compliance behavior. Gaps in the literature are identified and recommendations for future research are provided.     

The effect of prebiotic supplementation with inulin on cardiometabolic health: Rationale,design, and methods of a controlled feeding efficacy trial in adults at risk of type 2 diabetes

Prediabetes is associated with low-grade chronic inflammation that increases the risk for developing type 2 diabetes (T2D) and cardiovascular disease (CVD). An elevated lipopolysaccharide concentration, associated with dysbiosis of the intestinal microbiota, has been implicated in the development of both T2D and CVD. Selective modulation of the intestinal microbiota with prebiotics reduces intestinal permeability and endotoxin concentrations, inflammation, and metabolic dysfunction in rodents. The effect of prebiotic supplementation on cardio-metabolic function in humans at risk for T2D is not known. The primary aim of this trial is to determine the influence of prebiotic supplementation with inulin on insulin sensitivity and skeletal muscle metabolic flexibility in adults at risk for T2D. We hypothesize that prebiotic supplementation with inulin will improve insulin sensitivity and skeletal muscle metabolic flexibility. We will randomize 48 adults (40–75 yrs) with prediabetes or a score ≥ 5 on the American Diabetes Association (ADA) risk screener to 6 weeks of prebiotic supplementation with inulin (10 g/day) or placebo. Subjects will be provided with all food for the duration of the study, to avoid potential confounding through differences in dietary intake between individuals. Intestinal permeability, serum endotoxin concentrations, insulin sensitivity, skeletal muscle metabolic flexibility, endothelial function, arterial stiffness, and fecal bacterial composition will be measured at baseline and following treatment. The identification of prebiotic supplementation with inulin as an efficacious strategy for reducing cardio-metabolic risk in individuals at risk of T2D could impact clinical practice by informing dietary recommendations and increasing acceptance of prebiotics by the scientific and medical community.     

State of the science in inflammation and stroke recovery: A systematic review

Stroke is a major cause of mortality worldwide, and survivors often have major life-changing disabilities. Annually in the United States, an estimated 795,000 people experience a new or recurrent stroke. All types of stroke involve an inflammatory reaction that follows the initial phase of incidence. However, investigations into any links between inflammatory markers and recovery processes in the context of post-stroke rehabilitation are lacking. In this systematic review, we searched the literature in PubMed, SCOPUS, and CINAHL databases to gather information on inflammatory biomarkers related to stroke and their association with rehabilitation outcomes, according to PRISMA guidelines. Eleven articles (n = 1.773 stroke patients) were selected. Immune markers (interleukin 6 [IL-6], C-reactive protein, IL-1α, tumor necrosis factor α, soluble intercellular adhesion molecule 1) and functional status assessments (Modified Rankin Score, National Institutes of Health Stroke Scale, Functional Independence Measure, etc.) were the primary measures used in the reviewed studies. We found preliminary evidence for the evaluation of inflammatory biomarkers post-stroke, including the role of inflammation in functional recovery and the influence of rehabilitation on inflammation. This is the first systematic review of the topic. The review identifies several gaps in the literature that are critical for understanding the potential use of inflammatory markers to improve post-stroke outcomes.