Applying research in practice: parenting the premature infant

As the survival rate for premature infants increases, studies examining the interaction of parents with their premature infants have begun to appear in the literature. This review of the research can guide nurses in a variety of settings in clinical intervention strategies with these families.     

Pharmacokinetics of indomethacin in the premature infant

Indomethacin (I) pharmacokinetics was evaluated in 6 premature infants who received the drug for treatment of patent ductus arteriosus. Administered by oral or rectal route, I (0.2 mg/kg/24 h X 3) was promptly absorbed with peak plasma concentrations attained within 1 and 3 h. The elimination of I appeared to follow two compartment open model kinetics, with terminal plasma half-lives ranging from 30 to 90 h. Apparent plasma clearance values were between 0.076 and 0.335 ml/min/kg. Ductal closure was observed in 4 of the 6 infants. Data point to a possible relationship between therapeutic effects and I plasma concentrations.     

Discharge of the premature infant.

Appropriate interventions are initiated smoothly if the neonatal staff is familiarized with the new concepts of infant care and their empirical basis. It is also important that the nurses be present at all conferences to facilitate more meaningful interaction with the mother and her infant. If this is done, then it is easier to evaluate the needs of the mother and how much teaching support is necessary. The more involved the nurse becomes with the family, the more rewarding her experience will be, and she will be eager to get involved with the next family.     

Outpatient care of the premature infant

An increasing number of infants in the United States are born prematurely, with current statistics estimating about 13 percent of all births. Although survival rates and outcomes for premature infants have dramatically improved in recent decades, morbidity and mortality are still significant. Infants born prematurely are at increased risk of growth problems, developmental delays, and complex medical problems. To account for prematurity, growth and development monitoring should be done according to adjusted age (age in months from term due date). Premature infants should gain 20 to 30 g (0.71 to 1.06 oz) per day after discharge from the hospital. Growth parameters may be improved in the short term with the use of enriched preterm formula or breast milk fortifier. Each well-child examination should include developmental surveillance so that early intervention can be initiated if a developmental delay is diagnosed. Routine vaccination should proceed according to chronologic age with minor exceptions, and respiratory syncytial virus immune globulin is indicated in preterm infants who meet the criteria.     

Boston Bombings: Response to Disaster

Disasters disrupt everyone's lives, and they can disrupt the flow and function of an OR as well as affect personnel on a professional and personal level even though perioperative departments and their personnel are used to caring for trauma patients and coping with surprises. The Boston Marathon bombing was a new experience for personnel at Massachusetts General Hospital, Boston. This article discusses the incidents surrounding the bombing and how personnel at this hospital met the challenge of caring for patients and the changes we made after the experience to be better prepared in the event a response to a similar incident is needed.     

Changes in nursing identities: supporting a successful transition

This article examines the role of nurse managers in delivering the NHS modernization agenda by supporting the development of new and innovative nursing roles as proposed in recent health care policy. A study by Ewens (1998) indicates that nurses will respond positively to new short-term developments because of the ability to re-conceptualize work roles before actually undertaking them, but that long-term success will depend upon whether the workplace provides the scope and flexibility for integration of new identities into the self-concept. It is argued that when nurses find a gap between what they believe their role could be and what in reality it is allowed to be they separate their self-concept from their work role. In this situation the nurse experiences frustration and disappointment and the work role becomes 'untenable', resulting in them either leaving or retreating back into traditional professional identities. A discussion is provided on the role of nurse managers in the prevention of this negative response by supporting innovative work environments that can accommodate the new roles envisaged in the current policy. The paper concludes with consideration of the current direction of nursing and questions whether this move towards the nurse as 'assistant physician' will, in the longer term, be a good thing for patients.     

Early neuromuscular development of the premature infant.

A case study is presented which documents the neuromuscular development of a premature infant (34-35 weeks gestation) during the first eight weeks of postnatal life. The development of postural tone, spontaneous activity, and responsiveness to stimulation is described and compared with that of the full-term infant. This information is of value to physical therapists involved in evaluation and therapeutic intervention programs for high risk infants.