Newborn and infant nursing reviews : NAINR最新文献

Staff preparation is the key driver for safety in neonatal intensive care unit (NICU) transitions. The move to a single family room (SFR) NICU challenges staff to adapt to new care delivery processes. Simulation enables hands-on practice in the new environment and identifies specific areas that need adjustment prior to going live in the SFR model. Dissemination of a shared mental model prepares staff for practice changes in emergent and non-emergent situations. Attention to both the process and psychosocial components of organizational transition facilitate change. This article reviews techniques that facilitated management of one institution's transition, including engaging frontline staff, effective bidirectional communication, pre-move immersive clinical simulation, and development of an orientation workshop.

The number of neonatal intensive care units (NICUs) designed to meet basic criteria for green design is increasing. Some organizations, however, are reluctant to embark on a program of sustainability. The resistance is typically due to cost concerns and lack of knowledge about how to accomplish goals of sustainability. This paper evaluates the availability and quality of information with regard to sustainable NICU design. Sources of information are provided including LEED (Leadership in Energy and Environmental Design), a system authored by the U.S. Green Building Council, and the recommended standards for newborn ICU design. Among the topics explored via this literature review on green NICUs are sustainable materials and equipment, energy and water conservation, and recycling and waste disposal. Nature and access to daylight are also identified as contributors to sustainability. As such, the role of biophilia (the innate affiliation of humans with nature) in NICU settings is also discussed.

The study evaluated the effectiveness of a neonatal nurse-training program in improving knowledge, patient care practices and processes of nurses in a neonatal intensive care unit in a resource-limited setting. The study was a pre-post intervention design assessing a nurse-training program in Kenya. We found a significant improvement in the primary outcome of nursing competency assessed on measures of knowledge and patient care practices post-intervention (p < 0.0001). There was a decrease in the median length of stay post-intervention (p = 0.03). After controlling for birth weight, mortality rate was significantly reduced post-intervention, OR 0.63 (95% CI: 0.42–0.99). In conclusion, a nurse training program, using a modified S.T.A.B.L.E. Program, among nurses in a resource-limited setting can significantly improve nurse competency and the quality of patient care as measured by improvement in knowledge, processes and crucial patient outcomes such as mortality.

Lighting technologies are rapidly evolving, creating many opportunities for good lighting within the NICU. With the widespread adoption of advanced solid-state lighting technologies, lighting no longer needs to be static. Rather, lighting systems can be more easily adjusted to the different and changing visual and non-visual needs of the professional staff, infants and family members throughout the 24-hour day. This paper provides a conceptual framework for defining good lighting in the NICU, recognizing the needs of various constituent groups, each with very different needs from the lighting. Several other papers on the topic of lighting for various constituent groups at different times of the day in the NICU are summarized. Attention is given specifically to the Recommended Standards for Newborn ICU Design, a consensus standard developed by a wide range of experts, to help the reader translate this conceptual framework to practice.

Early preterm infants (EPT) (<33 6/7 weeks) are at increased risk for autism spectrum disorders (ASDs) but prevalence estimates vary widely across studies. Furthermore, there are very few studies addressing the association between late preterm (LPT) births (34–36 6/7 weeks) and ASDs. To address the question of whether LPT infants carry the same risk for ASDs as full-term infants, this study aimed to estimate the relative probability of an ASD diagnosis using Bayes rule. A retrospective cohort analysis of 406 children was undertaken to look at gestational age, ASDs, and birth history. The application of Bayes rule was used, given that there is not sufficient information about the joint probabilities related to prematurity and autism. Using the estimated gestational age proportions within ASD diagnosis, plus national estimates of ASDs, probabilities for ASDs within a given gestational age were calculated. Among these 406 children with ASDs, 6.7% were EPT and 10.6% were LPT. In comparison to full term, EPT children are at 1.9 multiplicative increase in risk (95% CI [1.3, 2.5]). While the probability of ASDs for LPT children was higher than that for term, the estimated relative risk of the LPT infants was not statistically significant (95% CI [0.9, 1.5]). EPT infants were significantly more likely to be diagnosed with ASDs compared to their term peers. While the relative probability of ASD diagnosis among children born LPT was not statistically significant in this limited sample, the results indicate a possible elevated risk. A larger cohort is needed to adequately estimate this risk.

The NICU experience impacts all family dynamics not just during the intensive care unit stay but in the months and years afterwards. For each family, the first experiences with their baby, whether in the home or the intensive care unit, can set the trajectory for the long-term parent–child relationship and the parent's perspective of their parent roles. These difficult experiences have the potential to be addressed through infant and early childhood mental health (I/ECMH) methods. In this article we review the need for a wide range of social and emotional supports that present in intensive care and continue as families and infants transition to home and community. The potential for addressing these ongoing issues by a variety of providers within many different settings using Infant and Early Childhood Mental Health (I/ECMH) approaches is discussed and examples of successful programs are provided. Finally, we make recommendations for infusing I/ECMH across programs that serve intensive care unit graduates and their families, from the hospital to the home, with primary care providers and other community support programs.

For families, the modern NICU is a place of both trauma and celebration. In order to support families through these types of experiences, NICUs should be designed to encourage family reunification and presence, facilitate psychosocial support, address/minimize sensory impact, offer social connection, and enable positive framing and revisioning of NICU parental experiences. Design teams must also consider how the NICU becomes an educational space for families, and ensure that the lessons parents learn there will serve them and their children well in the future. “The opposite of a fact is falsehood, but the opposite of one profound truth may very well be another profound truth,” – Niels Bohr.

Notwithstanding several child survival and safe motherhood programmes, maternal expenditures including antenatal care (ANC) and postnatal care (PNC) are gaining new heights every day. This study examines the extent of healthcare expenditure incurred for seeking delivery care including ANC and PNC across the socio-economic characteristics. Further, this study examines the extent of catastrophic delivery expenditure and its impoverishing effect on Indian women. The present study used unit level records of the 71st round of the National Sample Survey Office (NSSO) which was surveyed during January to June in 2014 on the theme ‘Social Consumption: Health.’ Results reveal that women who gave births to their babies in public hospitals spend rupees 1587 for the childbirth whereas the women who gave births to their babies in private hospitals spend more than nine times higher money for the delivery in rural areas (rupees 14,777.2). What's worse is that any additional burden on the already facing high maternal healthcare expenditure tips 46.6% women (among those who delivered) below the poverty line. In conclusion, there is a dire need of strengthening maternal health services which should be readily available, accessible and affordable to all irrespective of class-caste-region.

This Research Methodology Column will address issues and topics pertinent to conducting neonatal and infant research. Some of the columns will address current issues and topics while others will address longstanding or classic issues and topics. The goal of these columns is to inform novice and expert nurse researchers about the research process with neonates and infants, and help troubleshoot issues that might prevent, impede, or suspend research. This column is devoted consideration of timing of specific tests and measures with neonate/infant research participants.