Comprehensive and Innovative Clinical Tools for Nurses and Parents to Help Promote Family and Sibling Adaptation in the NICU

Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant's NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents' and siblings' adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families' adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families.

Comprehensive mapping of NICU developmental care nursing interventions and related sensitive outcome indicators: a scoping review protocol

INTRODUCTION

Neurodevelopmental outcomes of preterm infant are still a contemporary concern. To counter the detrimental effects resulting from the hospitalisation in the neonatal intensive care unit (NICU), developmental care (DC) interventions have emerged as a philosophy of care aimed at protecting and enhancing preterm infant's development and promoting parental outcomes. In the past two decades, many authors have suggested DC models, core measures, practice guidelines and standards of care but outlined different groupings of interventions rather than specific interventions that can be used in NICU clinical practice. Moreover, as these DC interventions are mostly implemented by neonatal nurses, it would be strategic and valuable to identify specific outcome indicators to make visible the contribution of NICU nurses to DC.

OBJECTIVES

The overarching objective of this review is to identify the nature, range, and extent of the literature regarding DC nursing interventions for preterm infants in the NICU. The secondary twofold objectives are to highlight interventions that fall into identified categories of DC interventions and suggest nursing-sensitive outcome indicators related to DC interventions in the NICU.

INCLUSION CRITERIA

Papers reporting on or discussing a DC nursing intervention during NICU hospitalisation will be included.

METHODS AND ANALYSIS

The Joanna Briggs Institute's methodology for scoping reviews will be followed. CINAHL, MEDLINE, Embase, PubMed, Web of Science, Scopus, ProQuest and PsycInfo databases from 2009 to the present will be searched. Any type of paper, published in English or French, will be considered. Study selection and data extraction will be conducted by pairs of two review authors independently. A qualitative content analysis will be conducted.

ETHICS AND DISSEMINATION

No Institutional Review Board ethical approbation is needed. Results of this review will be presented in scientific meetings and published in refereed papers.

Nurturing and quiet intervention (NeuroN-QI) on preterm infants' neurodevelopment and maternal stress and anxiety: A pilot randomized clinical trial protocol

OBJECTIVES

Primary objective of this pilot study is to evaluate the feasibility and acceptability of the NeuroN-QI and the study procedures. Secondary objectives are to assess the feasibility and acceptability of the NeuroN-QI by the nurses, assess the nurses' training needs about the components of the NeuroN-QI, and estimate the preliminary effects of the NeuroN-QI on infants' neurodevelopment as well as maternal stress and anxiety at infants' 36 weeks of gestational age.

DESIGN

A two-group pilot parallel randomized clinical trial stratified by center.

METHODS

The pilot study will be conducted in two neonatal intensive care units (NICUs). A sample of 24 mother-infant dyads born between 26 and 31^6/7 gestational age will be randomized into an experimental or control group. Fifty nurses will be recruited. The NeuroN-QI consists of four 2-hour skin-to-skin contact sessions/week with a 15-minute auditory stimulation by mothers with controlled ambient levels of light and noise. A 1-hour quiet period will follow where infants will rest in their incubator/crib with their mother's milk for olfactory stimulation and where the light and noise control will be continued. In the control group, mother-infant dyads will do four skin-to-skin contacts per week and receive standard care. Acceptability and feasibility of the NeuroN-QI in addition to maternal stress and anxiety will be measured through questionnaires, while infants' neurodevelopment will be assessed with Assessment of Preterm Infant Behaviour and General Movement Assessment.

CONCLUSIONS

This pilot trial will address knowledge gaps and generate evidence in neonatal care by evaluating the feasibility and acceptability of a multi-component developmental care intervention.

IMPACT

This project is an innovative step towards optimizing the neurodevelopmental trajectory of infants in NICUs and consequently promoting their long-term health outcomes.

TRIAL REGISTRATION

NCT04593095.

An Educational Intervention to Support the Development of a Sense of Mastery of the Anticipated Paternal Role in Expectant Fathers: A Clinical Project

This article presents a clinical project of the development and evaluation of an educational intervention that aimed at promoting the development of a sense of mastery of the anticipated paternal role in soon-to-be fathers. The preventive role supplementation conceptual framework guided the development of 4 educational sessions that were delivered to 6 expectant fathers attending prenatal classes at a local community services center in Greater Montreal area. The participants highly appreciated the content and format of the educational intervention. They also expressed to have developed a sense of mastery of the anticipated paternal role. This interactive educational intervention, which focused on the specific needs of expectant fathers, seems appropriate to support men in their transition to fatherhood.

An Intervention to Promote Breast Milk Production in Mothers of Preterm Infants

A pilot study was conducted to estimate the effects of a breast milk expression education and support intervention on breast milk production outcomes in mothers of very and extremely preterm infants. Forty mothers of hospitalized preterm infants (<30 weeks of gestation) were randomized to the experimental intervention or standard care for 6 weeks. Duration and frequency of breast milk expressions and volume of expressed breast milk were measured daily. Samples of breast milk were collected thrice during the study and analyzed for their lipid concentration. Mothers in the experimental group had a statistically significant higher duration of breast milk expression in min/day ( p = .043). Differences observed between the two groups regarding the frequency of breast milk expression, volume of breast milk, and lipid concentration were not statistically significant. Results suggest that the experimental intervention may promote breast milk production in mothers of very and extremely preterm infants.

[State of knowledge: couples' experiences of hospitalization due to high-risk pregnancy]

Taking charge of women with high-risk pregnancy is emerging. In some cases, hospitalization of the pregnant woman might be needed. In nursing sciences, few is known on the couples' experience of the hospitalization, because this event has mostly been explored using a maternal perspective. Some authors however suggest that using a systemic perspective would enhance the comprehension of this phenomenon and guide nursing cares development. In order to clarify the actual understanding of the phenomenon, a literature review has been made. The aim of this article is to present the state of knowledge regarding couples' experience of the women's hospitalization due to high-risk pregnancy. This is compared with the actual nursing practice in the context of practice of the first author of this article. The main themes emerging of this literature review include: giving sense to the antenatal hospitalization, organizing themselves to face danger, taking charge of stress and anxiety through hospitalization and needing each other support. This is followed by a consideration of possible research and nursing practice recommendations, while adopting a systemic constructivist perspective. It takes into account relations between partners and the hospitalization context. Finally, a model presenting the actual nursing practice is discussed.

The importance of piloting an RCT intervention

The pilot study provides a unique opportunity to identify and prepare for the challenges of evaluating an intervention. Ultimately, it will enhance the scientific rigour and value of the full-scale study. Although some journals publish reports of pilot studies, little attention has been given to the types of research questions and issues specific to these studies. This article focuses on the utility of a pilot randomized controlled trial (RCT) as a first step towards conducting an RCT. Three major objectives of a pilot RCT are discussed: assessing the feasibility and acceptability of the intervention, assessing the feasibility and acceptability of the design and procedures, and facilitating the determination of effect sizes for use in sample-size calculations.

Illuminating the processes of knowledge transfer in nursing

RATIONALE

Over the past 10 years, there has been a propensity to translate research findings and evidence into clinical practice, and concepts such as knowledge transfer, research dissemination, research utilization, and evidence-based practice have been described in the nursing literature.

AIM

This manuscript shows a selective review of the definitions and utilization of these concepts and offers a perspective on their interrelationships by indicating how knowledge transfer processes are the basis of all the concepts under review.

FINDINGS

Definitions and utilization of knowledge transfer in the literature have been influenced by educational and social perspectives and indicate two important processes that are rooted in the mechanisms of research dissemination, research utilization, and evidence-based practice. These processes refer to a cognitive and an interpersonal dimension. Knowledge transfer underlies a process involving cognitive resources as well as an interpersonal process where the knowledge is transferred between individuals or groups of individuals.

CONCLUSION AND IMPLICATIONS

This manuscript can contribute to our understanding of the theoretical foundations linking these concepts and these processes by comparing and contrasting them. It also shows the value and empirical importance of the cognitive and interpersonal processes of knowledge transfer by which research findings and evidence can be successfully translated and implemented into the nursing clinical practice.

[Evidence-based practice: Part 2: Steps in the process]

Evidence-based (EBP) aims for a new distribution of power centered on scientific evidence rather than clinical expertise. The present article describes the operational process of EBP by describing the implementation stages of this type of practise. This stage presentation is essential given that there are many conceptions end models of EBP and that some nurses have a limited knowledge of its rules ans implications. Given that number and formulation of the stages varies by author, the process presented here attempts to integrate the different stages reviewed.

[Evidence-based practice. Part 1: Origins, definitions, critiques, obstacles, advantages and impact]

The increasing popularity of evidence-based practice (EBP) requires that nurses take a stand regarding this type of practice. This positioning rests on knowledge of EBP, however this notion varies by discipline and many definitions exist even within the nursing discipline. An improved understanding of the basic tenets of this type of practice is thus essential. This first, of a series of two articles describes the origin of EBP as well as various definitions, it also presents the major criticisms raised and takes a look at the impact of the increased tendency towards EBP on professional practice.

[Radiological demonstration of an intradural epidermoid cyst rupture]

We report an unusual lumbar intradural epidermoid cyst found in an eight-year-old boy. At the age of 11 months, the child had one lumbar puncture to exclude possible meningitis, but seven years later he was experiencing pain. Lumbar myelography showed three intradural lesions, two of which were mobile in the subarachnoid space. Surgery revealed the presence of a single epidermoid ruptured cyst with free detached subarachnoid fragments, the dissemination of which had not caused aseptic meningitis.