超低出生体重儿的临床救治

目的：探讨超低出生体重儿的临床救治方法。方法：对3例超低出生体重儿（ELBWI）的临床诊治进行综合分析。结果：3例超低出生体重儿经过10～14周的治疗，1例于生后103d，体重达1400g时死于感染。2例救治成功，出院后的随访追踪1例生后1．6岁（纠正胎龄15月）跟踪体格检查及智力检查发育同正常同龄儿。另一于生后5月（纠正胎龄2月）时出现神经运动发育落后，经过及时的康复治疗，生后9月（纠正胎龄6月）跟踪体格检查及智力检查发育同正常同龄儿。结论：成功救治超低出生体重儿关键是：从入院后的保暖、监护、防治各种并发症、维持内环境稳定和保证营养需求等，制定系统化整体救治方案并实施。而出院后的随访可减少后遗症的发生，提高生命质量。     

股静脉留置针在超低出生体重儿输液中的应用

目的探讨股静脉留置针在早产超低出生体重儿输液中的应用效果。方法将60例超低出生体重儿随机分为观察组和对照组,观察组采用24G美国BD公司的静脉留置针进行股静脉穿刺置管,对照组进行头皮静脉、四肢浅静脉和腋静脉穿刺置管,分别观察2组静脉留置针置管的效果。结果与对照组相比,观察组留置针留置时间长（P〈0．05）,不良事件（外渗、静脉炎、脱管、堵塞）发生率低（P〈0．05）。结论应用股静脉留置针留置时间长,并发症发生率低,适合于输注高渗透压,高刺激性的药物,解决了超低出生体重儿长期静脉输液穿刺置管难的问题,可用于抢救四肢静脉穿刺困难的患儿。     

母乳系统化管理提高超低出生体重儿住院期间母乳喂养率的实践研究

[目的]提高住院期间超低出生体重儿母乳喂养率.[方法]将2011年1月-2012年12月符合入选条件的63例超低出生体重儿作为对照组,实施超低出生体重儿母乳喂养的常规宣教及护理,将2013年1月-2014年12月符合入选条件的70例超低出生体重儿作为观察组,对母乳喂养给予系统化管理,包括设立母乳专管护士,开放家长课堂,培训超低出生体重儿家长熟知母乳喂养对超低出生体重儿的重要性以及如何进行母乳的收集、保存、运送、解冻和加温等,建立母乳支持方案,比较两组超低出生体重儿的母乳喂养情况、并发症发生率及住院时间.[结果]观察组首次母乳喂养日龄低于对照组,14 d内及住院期间纯母乳喂养率高于对照组,坏死性小肠结肠炎发生率低于对照组,经比较差异均有统计学意义(P＜0.05).[结论]科学有效的母乳管理是提高住院超低出生体重儿母乳喂养率的有效方法.     

新生儿个体化发育支持护理及评估在极低出生体重儿中的应用

新生儿个体化发育支持护理及评估（Neonatal Individualized Developmental Care and Assessment Program ，NIDCAP）自1986［1］年Dr ．Als 推广以来，已在国外很多医院实施于新生儿监护病房内的早产儿及高危新生儿。该项目以神经发育和心理发育为基础，强调对患儿的行为反应进行观察评估，采用个体化干预方案。我院2012年5月始，在新生儿重症监护病房设立了特殊照护（Special Care Nursery ， SCN）病房，对极低出生体重儿运用NIDACP模式进行护理，取得一定效果，现报告如下。     

经外周中心静脉置管在早产儿及危重新生儿中的应用及护理

目的探索PICC插管技术在早产儿及危重新生儿中的应用。方法对在新生儿科住院的早产儿及危重新生儿130例,使用PICC插管技术,经贵要静脉穿刺80例,腋静脉40例,肘正中静脉5例,头静脉3例,窝静脉2例。结果置管成功129例,失败1例。平均留置时间为18 d。发生机械性静脉炎5例,堵管13例,因堵管拔管1例。意外拔管1例,导管尖端异位5例。结论 PICC置管为危重新生儿尤其是早产儿及极低出生体重儿提供了可靠安全的中长期静脉通道,保证药物及营养的供给,减轻了护理工作量,减少因反复穿刺给患儿带来的疼痛刺激,是有效抢救极低体重儿、超低体重儿不可缺少的技术。     

脐静脉置管在极低或超低出生体重儿中的应用与护理进展

综述脐静脉置管在极低或超低出生体重儿中的应用与护理进展,指出脐静脉置管术本身优势逐渐明显,在未来输液护理中需持续探究并发症的各项预防措施与方法,使脐静脉置管术更好地服务于患儿。     

新生儿真菌败血症11例临床分析

目的探讨真菌败血症的发病原因和临床特点,为早期诊断和预防提供临床依据。方法对江西省儿童医院新生儿重症监护室2009年4月至2011年12月诊断为新生儿真菌败血症11例患儿的临床资料进行回顾性分析。结果 11例患儿中,早产儿8例（72.73%）,其中极低出生体质量儿4例（36.36%）,超低出生体质量儿2例（18.18%）,6例（54.54%）使用2联抗生素,1例（18.18%）长期呼吸机治疗,2例（36.36%）CPAP治疗,平均使用抗生素时间19 d,通过外周静脉途径接受静脉营养时间平均为19 d。病原学检查：葡萄牙念珠菌4例,近平滑念珠菌2例,热带念珠菌1例,白色念珠菌3例,酵母菌1例。结论早产儿,极低、超低出生体质量儿,长期使用抗生素及静脉置管与新生儿真菌败血症有关。     

脐静脉置管在超低或极低出生体重儿的临床应用效果

分析脐静脉置管在超低或极低出生体重儿的临床应用效果。选择我院新生儿重症监护病房(NICU)2014年11月~2016年11月收治的超低或极低出生体重儿50例;按照数字随机原则将全部新生儿分成对照组和试验组,对照组新生儿给予常规静脉输液治疗,试验组新生儿采用脐静脉置管治疗。在低血糖持续时间、恢复到出生体重时间、经胃肠喂养时间、达足量喂养时间以及不良反应发生率方面,试验组均显著优于对照组(P0.05)。在超低或极低出生体重儿中,应用脐静脉置管具有比较显著的临床效果,值得临床推广和应用。     

8例超低出生体重儿动脉导管未闭结扎术后的护理体会

总结8例超低出生体重儿动脉导管未闭（PDA）结扎术后的护理体会。方法：8例超低出生体重儿均在全麻下床边行PDA结扎术,术后置于新生儿重症监护室正压隔离房单间专人护理,通过加强发展性照顾、呼吸道护理、液体平衡的观察护理,重视营养支持、并发症的监测与护理,密切监测生命体征,以降低超低出生体重儿PDA结扎术后的死亡率,提高生存质量。结果：术后护理顺利,除l例因家长放弃治疗死亡外,其余患儿均康复出院。结论：熟悉超低出生体重儿的生理特点与PDA结扎术的常见术后并发症,全面细心的护理,是提高手术成功率的重要保证。     

54例极低出生体重儿PICC置管的临床应用

目的探讨极低出生体重儿应用外周中心静脉置管（PinG）的护理。方法对54例体重小于1500g的极低出生体重儿经外周静脉穿刺置管,并进行静脉输液。结果54例均置管成功,置管保留时间15～48d,并发症包括导管相关性血流感染2例（发生率3．70％）、出血1例（1．85％）、导管异位1例（1．85％）,堵管4例（7．40％）、静脉炎5例（9．25％）,所有置管均按期拔管。结论PICC置管操作安全、简便,并发症少,可减轻极低出生体重儿的痛苦,提供安全有效的静脉营养和治疗通道。     

1例450 g近存活期分娩儿的个体化护理

总结1例胎龄23周,出生体重450 g的近存活期分娩儿的个体化护理措施,包括早期生命支持、发育支持护理、维持有效呼吸、早期营养管理、皮肤护理、预防和控制感染、母乳口腔护理与母乳喂养、锻炼离氧、训练经口喂养、家长参与式护理等。经过精心的治疗及护理,患儿顺利出院。     

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

ContextNurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting.ObjectivesTo examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge.Design and settingCross sectional analysis combining nurse survey data with infant discharge data.ParticipantsA national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997).MethodsSequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support).ResultsThe majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001).ConclusionsNeonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.     

Introducing first-year student placements in critical care

Pre-registration nurse education requires students to spend 50% of their programme in clinical practice. The intensive care unit (ICU) is an area that could accommodate students, provided that staff receive adequate support and preparation. This article discusses how staff in one ICU were prepared to support first-year nursing students and relates mentors' experience of assisting students at this stage of training. The article aims to give readers an insight into the types of activities that students can be involved in and the potential benefits of placements in an ICU for students.     

Contribution of unit managers to the training of student nurses in the Cape Peninsula

The article is based on research conducted over the period 1993 to 1996 in the Cape Peninsula. The purpose of the study was to determine the contribution of unit managers towards the training of student nurses coming to their units for clinical practica. The sample consisted of student nurses training in the four nursing colleges in the Cape Peninsula, and the unit managers working in the health services accommodating students for clinical practica in the same area. The findings revealed that the majority of unit managers were teaching students whenever they had the opportunity. Generally unit managers were prepared for their teaching function, but many students were not satisfied with some clinical learning opportunities presented to them, for example drawing up patient care plans, discussing patients' treatment plans when handing over report, giving assistance regarding care decisions and lending support when students are confronted with patient care problems. There appears to be a need to educate unit managers regarding these and other aspects of the students' training programme.     

Public nursing home staff's experience of participating in an intervention aimed at enhancing their self-esteem

Aim  The aim of the present study was to gain an understanding of how nursing staff experienced participating in a training programme aimed at strengthening their self-esteem and empowering them, to determine whether participation benefited them in any way, and to describe their opinions about possible benefits or disadvantages.
Background  Staff working in institutions such as nursing homes have a low status in society. A training programme was introduced to staff in a public nursing home. It focused on helping them understand factors in the work situation that influence them and on empowering them.
Method  The study was explorative and qualitative in design.
Findings  The participants in the programme were generally satisfied with it. Their opinions about the benefits they received from the programme can be described using three themes: 'improved communication skills', 'enhanced self-esteem' and 'sees work in a different light'.
Conclusions  The most important finding of the present study is that it was possible to strengthen and empower staff. Staff members were generally pleased and satisfied with the content/organization of the training programme. They felt the programme had been of value to them by improving their communication skills and increasing their self-esteem.
Implications for nursing management  The present result could be of value to managers and educators working in the area of nursing home care when planning education and development activities for staff. Learning to communicate better and understand the social structure at the workplace could improve staff members' self-esteem, thereby enhancing the work situation and atmosphere as well as empowering the individuals.     

Outcomes of developmentally supportive nursing care for very low birth weight infants

Numerous aspects of the intensive care environment are stressful for low birth weight infants and may play a role in adverse developmental and behavioral outcome. The purpose of this study was to determine whether staff education in care protocols designed to make the environment less stressful and thereby support the infant's development would improve short-term outcomes. Twenty-one infants (less than 1,501 gms) were studied during the preeducation period and 24 infants were studied following staff education. The educational program successfully altered nursing care. Experimental infants had more optimal respiratory and feeding status, lower levels of morbidity, shorter hospitalization, and improved behavioral organization.     

The palliative care education needs of nursing home staff

BACKGROUND: Palliative care is delivered in a number of settings, including nursing homes, where staff often have limited training in palliative care. AIM: We explored the level of palliative care knowledge among qualified staff delivering end-of-life care in nursing home settings, to inform the development of an appropriate education and training programme. DESIGN: An audit of the educational needs assessment was performed using an anonymous postal questionnaire sent to 528 qualified nursing staff within 48 nursing homes. FINDINGS: In total, 227 questionnaires were returned giving a response rate of 43%. Results indicated that less than half the sample had obtained formal training in the area of pain assessment and management and less than a quarter had obtained training in non-malignant conditions. Registered nurses in this study reported a lack of awareness of palliative care principles or national guidelines. CONCLUSION: Qualified nursing home staff agree that palliative care is a valuable model for care in their setting. There are clear opportunities for improvement in nursing home care, based on education and training in palliative care. Results also support the need for enhanced liaison between nursing homes and specialist palliative care services.     

Managing student transitions into primary care

In response to its specific recruitment needs, Walsall teaching primary care trust has implemented a new final placement programme for community nursing students that focuses on providing students with hands-on experience in the community setting. This article presents the results of an evaluation of the programme. Outcomes of the programme are discussed and analysis is drawn from all key participants. This has been the first stage of a career pathway for 80% of these students, who are now successfully employed as community staff nurses within the PCT.     

MISSED CARE phenomenon on neonatal intensive CARE unit (NICU)

AimTo evaluate missed nursing care (MNC) phenomenon on Neonatal Intensive Care Units (NICUs) infants.DesignA cross-sectional study.MethodsA sample of 113 eligible Registered Nurses (RNs) and Registered Midwives (RMs) were prospectively recruited at the Neonatal Intensive Care Units (NICUs). The study uses a self -designed authors questionnaire (ADQ) and the Neonatal Extent of Work Rationing Instrument (NEWRI).ResultsMNC evidence was the most significant in the parental support and teaching subscales (M = 2.21, SD = 0.87) and the least in life support and discharge planning (M = 1.19, SD = 0.9). MNC in the care coordination and discharge planning subscales significantly (p < 0.038) depends on the belief that a nurse's family issues affect the quality of their work. MNC in the life support and technology-oriented nursing care domain (p < 0.033) significantly depends on the belief that the ward manager is a good manager and leader.