Factors Influencing Developmental Care Practice Among Neonatal Intensive Care Unit Nurses

Elastic sac to support oral feeding performance of preterm infants: Crossover randomized controlled study

BACKGROUND

Swaddling is recommended for preterm infants during feeding. Swaddling preterm infants with elastic cotton materials allows infants to easily stretch and move their extremities. This study aimed to assess the effect of bottlefeeding in a novel "elastic sac" on physiological parameters and feeding performance of preterm infants.

METHODS

A randomized controlled, crossover trial was conducted with total of 26 preterm infants at 26-36+6 weeks of gestation. Infants randomly assigned to group 1 (n = 13) were bottlefed in an elastic sac (researcher-designed single-piece pouch made of soft, elastic cotton) for the first feeding and in normal clothes for the next feeding. Infants randomly assigned to group 2 (n = 13) were fed first in normal clothes and then in the elastic sac. The physiological parameters and feeding performance of the infants were assessed during each feeding.

RESULTS

Preterm infants fed in the elastic sac had lower heart rate and higher oxygen saturation during and after feeding than infants fed in normal clothes (P < 0.05). Although all values were within clinically normal ranges, the findings suggest that feeding preterm infants in the elastic sac had a favorable effect on physiological parameters compared with feeding in normal clothes. There was no significant difference in the infants' feeding performance (P > 0.05).

CONCLUSION

A semielevated right lateral position and flexed body posture are recommended while feeding preterm infants, which can be easily maintained using the elastic sac. Feeding preterm infants in an elastic sac may support physiologic stability during oral feeding.

Developmental care education in Australian surgical neonatal intensive care units: A cross-sectional study of nurses' perceptions

Background

Nurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses' perceptions of developmental care.

Objective

To determine perceptions and attitudes towards developmental care in a specialty neonatal setting.

Design

Cross-sectional study.

Settings

Two surgical neonatal intensive care units in Australia.

Participants

Registered nurses permanently employed at the study sites between May 2021 to April 2022.

Methods

A modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses' perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)].

Results

Of 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3-8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1-6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1-6.2].

Conclusions

The results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Interdisciplinary collaborative eye examinations to protect preterm infant neurodevelopment: a quality improvement project

Introduction

Infants born <31 weeks gestational age with birth weight ≤ 1,500 grams receive routine eye examinations to screen for Retinopathy of Prematurity (ROP) while in the Neonatal Intensive Care Unit (NICU) to help prevent vision threatening complications; however, preterm infants' sensory systems are underdeveloped, and repeated exposure to painful stimuli is associated with worse developmental outcomes.

Methods

An interdisciplinary NICU team designed a collaborative eye exam model (CEEM) incorporating best practice recommendations for infant pain control during exams. Pain scores and vital signs were recorded before, during, and after exams. Two sets of mixed-effects regression models with a random intercept on infants were established to investigate relationships between the intervention, birth gestational age (BGA), postmenstrual age (PMA), and outcomes associated with painful stimuli. Survey feedback was elicited from NICU stakeholders about the CEEM.

Results

Thirty standard of care (SC) and 35 CEEM exams of 37 infants were included in final analysis. In infants of the same BGA, the number of desaturation events was significantly reduced in the CEEM group (p = 0.003) and became 1.53 times smaller with each additional week of BGA (p = 0.009). Probability of heart rate recovery within 15 min lowered significantly in the CEEM group (p = 0.04). In SC or CEEM or between infants of the same PMA, no differences were observed for bradycardia, heart rate range, chance of heart rate recovery, or pain scores. Increases in tachycardia (p < 0.001) events and desaturations p = 0.006 were discovered in the CEEM group. When considering interaction effects, the CEEM appeared to reduce the number of desaturations to a greater degree for infants at earliest BGAs with attenuation of this effect with greater BGA. Regarding PMA, bradycardia and tachycardia events were reduced for infants across PMAs in the CEEM, but the effect for tachycardia improves with age, while the effect for bradycardia diminishes with age. Stakeholders agreed that the infant's eye exam experience and the staff experience was "very much" improved by the CEEM.

Discussion

Despite variable findings in selected outcome measures, the CEEM was positively viewed by staff. Infants may benefit from the CEEM differently based on BGA and PMA.

A cross-sectional study quantifies the independent contribution of nurses and midwives in child health outcomes

INTRODUCTION

As the largest profession within the healthcare industry, nursing and midwifery workforce (NMW) provides comprehensive healthcare to children and their families. This study quantified the independent role of NMW in reducing under-5 mortality rate (U5MR) worldwide.

DESIGN

A retrospective, observational and correlational study to examine the independent role of NMW in protecting against U5MR.

METHODS

Within 266 "countries", the cross-sectional correlations between NMW and U5MR were examined with scatter plots, Pearson's r, nonparametric, partial correlation and multiple regression. The affluence, education and urban advantages were considered as the potential competing factors for the NMW-U5MR relationship. The NMW-U5MR correlations in both developing and developed countries were explored and compared.

RESULTS

Bivariate correlations revealed that NMW negatively and significantly correlated to U5MR worldwide. When the contributing effects of economic affluence, urbanization and education were removed, the independent NMW role in reducing U5MR remained significant. NMW independently explained 9.36% U5MR variance. Multilinear regression selected NMW as a significant factor contributing an extra 3% of explanation to U5MR variance when NMW, affluence, education and urban advantage were incorporated as the predicting variables. NMW correlated with U5MR significantly more strongly in developing countries than in developed countries.

CONCLUSION

NMW, indexing nursing and midwifery service, was a significant factor for reducing U5MR worldwide. This beneficial effect explained 9.36% of U5MR variance which was independent of economic affluence, urbanization and education. The NMW may be a more significant risk factor for protecting children from dying under 5 years old in developing countries. As a strategic response to the advocacy of the United Nations to reduce child mortality, it is worthy for health authorities to consider a further extension of nurses and midwives' practice scope to enable communities to have more access to NMW healthcare services.

The osteopath-parent-child triad in osteopathic care in the first 2 years of life: a qualitative study

Background

Enactivism and active inference are two important concepts in the field of osteopathy. While enactivism emphasizes the role of the body and the environment in shaping our experiences and understanding of the world, active inference emphasizes the role of action and perception in shaping our experiences and understanding of the world. Together, these frameworks provide a unique perspective on the practice of osteopathy, and how it can be used to facilitate positive change in patients. Since the neonatal period is a crucial time for development, osteopaths should aim to create a therapeutic relationship. Arguably, through participatory sense-making, osteopaths can help the baby build a generative model (with positive priors) to deal with stress and needs throughout their life.

Aim

Since the literature considers that interactions with the environment, which enact the patients' experiences, depending on contextual factors and communication between patient and caregiver, this research explored whether there is a correspondence between the indications in the literature and clinical practice in the management of the mother/parent-child dyad during osteopathic care on children aged 0 to 2 years old.

Methods

Semi-structured interviews were conducted with a purposive sample of nine osteopaths with experience in the field of pediatrics. Interviews were transcribed verbatim, and constructivist grounded theory was used to conceptualize, collect and analyze data. Codes and categories were actively constructed through an interpretive/constructionist paradigm.

Results

The core category was the idea of the pediatric osteopath as a support for the family, not only for the child. Four additional categories were identified: (1) Preparing a safe environment for both children and parents, (2) Communication, (3) Attachment and synchrony, and (4) Synchronization.

Conclusion

Through participatory sense-making, osteopaths manage contextual factors to establish an effective therapeutic alliance through the osteopath-parent-child triad to facilitate the construction of the child's internal generative model to promote healthy development. The therapeutic encounter is considered an encounter between embodied subjects, occurring within a field of affordances (ecological niche) that allows the interlocutors to actively participate in creating new meanings through interpersonal synchronization. Participatory sense-making and the establishment of a therapeutic alliance through the osteopath-parent-child triad are crucial to promote healthy development in the child.

Development of the Individualised Developmental Care Knowledge and Attitude Scale

BACKGROUND

There is a need for a valid and reliable scale to determine the individualised developmental care levels of nurses who provide care for preterm newborns.

AIMS

To develop the Individualised Developmental Care Knowledge and Attitude Scale for nurses who provide care to preterm newborns and to evaluate its validity and reliability.

METHODS

This methodological study was performed with 260 nurses who provide care for preterm newborns in neonatal intensive care units. The content validity of the research was evaluated under the guidance of professionals working in the pediatric field. Collected data were analysed using values, percentage, mean, standard deviation, correlation analysis, Cronbach's alpha reliability coefficient and factor analysis methods.

RESULTS

The total Content Validity Index for all items was found to be 0.930. The result of Bartlett's test of sphericity (x² = 4691.061, p = 0.000) was significant, and the KMO (Kaiser-Meyer-Olkin) measure of sampling adequacy was 0.906. The fit indices for confirmatory factor analysis were x²/SD = 4.35, GFI = 0.97, AGFI = 0.97, CFI = 0.97, RMSEA = 0.057 and SRMR = 0.062. All of the related fit indices were in the accepted range. The Individualised Developmental Care Knowledge and Attitude Scale was developed at the end of the study, and 34 items and four dimensions were identified. The Cronbach's alpha of the full scale was 0.937.

CONCLUSIONS

From the results, it can be concluded that the Individualised Developmental Care Knowledge and Attitude Scale is both a reliable and valid measurement tool for determining individualised developmental levels.

The competence of neonatal intensive care nurses: A systematic review

OBJECTIVE

The objective was to conduct a systematic review describing the competencies required from nurses working in neonatal intensive care settings.

DESIGN

Systematic review.

DATA SOURCES

A total of eight databases, including PubMed, Scopus, CINAHL, MEDLINE, Mednar, Web of Science, ProQuest and Medic, were screened for relevant literature during February and September 2022.

REVIEW METHODS

The systematic review process followed Joanna Briggs Institute guidelines. The inclusion criteria were: 1) (P = population) registered nurses; 2) (C = concept) the competence; 3) (C = context) nursing in neonatal intensive care units; and 4) cross-sectional study as study method. A critical appraisal tool for cross-sectional studies from Joanna Briggs Institute was used by two independent reviewers. After data extraction, thematic analysis was performed.

RESULTS

The database searches yielded a total of 8887 studies and after two independent evaluations, a total of 50 eligible studies were identified comprising of 7536 registered nurses working in neonatal intensive care units across 19 countries. The studies described four main competence themes: 1) neonatal care interventions; 2) caring for a dying infant; 3) family-centered care; and 4) neonatal intensive care interventions.

CONCLUSION

Previous research has focused on evaluating specific competencies that are necessary in the neonatal intensive care setting. There is a need for research concerning the overall competence of nurses working in neonatal intensive care units. There was a lot of variety within the quality of the eligible studies and within the used instruments.

PROTOCOL REGISTRATION

This systematic review was registered in Prospero (PROSPERO 2022 CRD42022308028).

Developmental Care Rounds: An Initiative to Improve Nursing Confidence and Contributions at the Bedside

Purpose: To describe the use of developmental care (DC) rounds as an initiative to ensure the implementation of bedside DC. To measure the confidence of NICU nurses with participation in DC rounds. Design: Evidence-based practice/quality improvement initiative aimed to answer the following questions: What are the implementation rates of bedside DC nursing interventions used or discussed during DC rounds? Do NICU nurses report agreement with education about DC rounds prior to DC rounds starting? Do nurses in the NICU feel confident participating in DC rounds Do nurses with more years of NICU nursing experience feel more confident than nurses with fewer years of nursing experience? Sample: 513 DC rounds and 101 nursing surveys. Main Outcome Variable: Nursing survey Likert score response and implementation rate of DC nursing interventions. Results: Implementation of bedside DC nursing interventions was strong in the NICU. Areas of opportunity include developmental bath, oral care with breast milk, use of scent clothes, kangaroo care, breastfeeding, use of head plan when appropriate, assignment of a primary baby buddy when appropriate, and use of schedule when needed. Nurses reported their confidence in participation in DC during the implementation of this project.

The effects of education levels of developmental care in Australia: Perceptions and challenges

BACKGROUND

Developmental care consists of a range of clinical, infant-focused, and family-focused interventions designed to modify the neonatal intensive care environment and caregiving practices to reduce stressors on the developing brain. Since the inception of developmental care in the early 1980s, it has been recommended and adopted globally as a component of routine practice for neonatal care. Despite its application for almost 40 y, little is known of the attitude of neonatal nurses in Australia towards the intervention.

AIMS AND OBJECTIVES

The objective of this study was to establish Australian neonatal nurse perceptions of developmental care and explore associations between developmental care education levels of the nurses and personal beliefs in the application of developmental care.

DESIGN

This involves a cross-sectional survey design.

METHODS

An online questionnaire was completed by 171 neonatal nurses. Participants were members of the Australian College of Neonatal Nursing (n = 783). Covariate associations between key components of developmental care and respondents' geographical location, place of employment, professional qualifications, and developmental care education level were analysed. The reporting of this study is in accordance with the Enhancing the Quality and Transparency of Health Research Checklist for Reporting Results of Internet E-Surveys.

RESULTS

Differences were observed between groups for geographical location, place of employment, and professional qualification level. Rural nurses were less likely to support the provision of skin-to-skin care (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.2-1.8) than nurses in a metropolitsan unit. Nurses working in a neonatal intensive care unit and nurses with postgraduate qualifications were more likely to support parental involvement in care ([OR: 2.3, 95% CI: 0.9-6.2] and [OR: 2.1, 95% CI: 0.6-7.4], respectively). Rural respondents were more likely to have attended off-site education (OR: 3.6, 95% CI: 1.3-9.9) than metropolitan respondents.

CONCLUSION

The application of developmental care in Australia may be influenced by inadequate resources and inequitable access to educational resources, and similar challenges have been reported in other countries. Overcoming the challenges requires a focused education strategy and support within and beyond the neonatal intensive care unit.

Psychometric Properties of the Turkish Version of the Developmental Support Competency Scale for Nurses (DSCS-N)

PURPOSE

Developmental care is considered an important component of development and health promotion of premature infants, however, studies regarding assessment of nurses' competency of developmental care are inadequate. This study is designed to determine the psychometric properties of the Turkish version of the Developmental Support Competency Scale for Nurses (DSCS-N).

DESIGN AND METHODS

This methodological study includes 140 nurses working at a tertiary level neonatal intensive care unit (NICU). Data were collected using the Nurse Introductory Form and Developmental Support Competency Scale for Nurses. The scale was assessed in terms of language and content validity, construct validity, internal consistency and time invariance.

RESULTS

The scale consisted of 19 items and six subscales. In the confirmatory analysis, which is a validity analysis, it was found that the scale's factor loadings ranged between 0.27 and 0.92, and the ratio of chi-square to degrees of freedom was 1.64. Other fit indices (CFI = 0.96, NFI = 0.92, NNFI = 0.95) were at desirable levels. Cronbach's alpha coefficient was found to be 0.90. According to item analysis results, item-total correlations ranged between 0.26 and 0.66. It was found that nurses' responses to the scale items at two different times were consistent and did not change over time (p > 0.05).

CONCLUSIONS

DSCS-N is a valid and reliable scale for measuring Turkish nurses' competency of developmental support.

PRACTICE IMPLICATIONS

DSCS-N can be used as a tool contributing to the implementation of developmental care. The scale can help nurses working in neonatal intensive care units to determine their competency of developmental care.

Impact of nurse staffing on reducing infant, neonatal and perinatal mortality rates: Evidence from panel data analysis in 35 OECD countries

Objectives

To investigate the magnitude of effect nurse staffing had on decreasing the newborn mortality rates in member countries of Organisation for Economic Co-operation and Development (OECD).

Methods

The statistical technique of panel data analysis was applied to explore the possibility of association between the number of nurses’ density per 1,000 population and infant, neonatal and perinatal mortality rates (IMR, NMR and PMR) per 1000 births. The observations of 35 OECD countries were collected over the period of 2000 through 2016.

Results

There were significant associations between nurse staffing and IMR, NMR and PMR i.e. a 1% increase in nurse-staffing level reduced IMR, NMR and PMR by 0.98%, 0.97% and 0.96%, respectively. Furthermore, the role of nursing-related services in declining the average of newborn mortality rates were investigated at the highest level in Slovenia (−5.50), Sweden (−3.34), Iceland (−2.51), Czech Republic (−1.86), Japan (−1.64) and Finland (−1.64). Moreover, if the current relationship between nurse-staffing level and newborn mortality rates are disturbed with nursing shortage (e.g. in Slovak Republic and Israel), then it takes about 17 years for the mortality rates to reduce and restore back to the previous equilibrium.

Conclusions

A higher proportion of nurses’ density per 1,000 population is associated with lower newborn mortality rates. In addition, the nursing-related services of Slovenia, Sweden, Iceland, Czech Republic, Japan and Finland with the highest impact on improving the health level of newborns would be good patterns for other developed countries in maternity and child health care .