Fifty Years of Progress in Neonatal and Maternal Transport for Specialty Care

Specialty care for preterm and critically ill infants has evolved over many years. Neonatal intensive care nurseries were developed, and physicians and nurses learned how to provide intensive care for these infants. Neonatal and maternal (in utero) transport to tertiary centers became common in regionalized systems of care to facilitate the specialized care of high-risk neonates when childbirth occurred in settings without specialized personnel or equipment. Annually, nearly 70,000 neonatal transports occur in the United States. Although specialty care helps reduce rates of neonatal mortality, racial disparities and disparities between urban and rural areas exist. The purpose of this article is to review the progress achieved in neonatal and maternal transport over the past 50 years. The knowledge developed can be used to improve the care provided to women, their fetuses, and infants.     

A Systems Model of Premature Birth Implications for Neonatal Intensive Care

The literature regarding the birth of a premature infant strongly suggests that it is a crisis-producing event for the parents of such infants. It also suggests that premature infants are poorly parented more frequently than infants born after a normal gestation. The crisis of premature birth and its effect on parent-infant interaction using a systems model of crisis theory is described. Specific intervention strategies that can be used within the neonatal intensive care unit to ameliorate the potentially detrimental effects of the crisis of premature birth on parent-infant interaction are outlined.     

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.     

Neonatal Care in Northeast Zaire

Neonatal care in rural northeast Zaire presents many challenges to nursing. The high infant mortality is a result of rampant infectious diseases, limited resources, and poor public education. Midwives use innovative nursing interventions to meet the basic needs of the neonate: warmth, respiration, nutrition, and prevention of infection. Interesting cultural beliefs also influence neonatal care in this area of Africa.     

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.     

Parental Involvement in Neonatal Comfort Care

ObjectiveTo explore how parents interact with their infants and with nurses regarding the provision of comfort care in a Neonatal Intensive Care Unit (NICU).DesignFocused ethnography.SettingA regional NICU in the United Kingdom.ParticipantsEleven families (10 mothers, 8 fathers) with infants residing in the NICU participated in the study.MethodsParents were observed during a caregiving interaction with their infants and then interviewed on up to four occasions. Twenty‐five periods of observation and 24 semistructured interviews were conducted between January and November 2008.ResultsFive stages of learning to parent in the NICU were identified. Although the length and duration of each stage differed for individual parents, movement along the learning trajectory was facilitated when parents were involved in comforting their infants. Transfer of responsibility from nurse to parents for specific aspects of care was also aided by parental involvement in pain care. Nurses’ encouragement of parental involvement in comfort care facilitated parental proximity, parent/infant reciprocity, and parental sense of responsibility.ConclusionFindings suggest that parental involvement in comfort care can aid the process of learning to parent, which is difficult in the NICU. Parental involvement in infant comfort care may also facilitate the transfer of responsibility from nurse to parent and may facilitate antecedents to parent/infant attachment.     

Bedside Musical Care: Applications in Pregnancy, Childbirth, and Neonatal Care

Although music therapy in health care settings is not new, bringing live music to the bedside is a new way of extending the caring tradition of nursing practice. Bedside musical care is consistent with a philosophy of holistic nursing practice and can be used during pregnancy, childbirth, and in neonatal care. It is defined as live music at the bedside, which is part of a treatment plan to foster integrity, well-being, and health for varied populations across the life span.     

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.     

Understanding Parenteral Nutrition A Basis for Neonatal Nursing Care

The challenge in meeting the caloric and metabolic demands of infants who are critically ill, debilitated, or neurophysically immature is discussed. Advances in nutrition that have greatly improved neonatal survival are presented. Intravenous nutrition is presented as an appropriate mode of therapy to provide or supplement nutritional support in neonates who cannot derive all the requirements from oral feedings.