The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates

BACKGROUND

Neonates in a neonatal intensive care unit are exposed to a high number of painful procedures. Since repeated and sustained pain can have consequences for the neurological and behaviour-oriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology. Non-pharmacological treatment methods are being increasingly discussed with regard to pain prevention and relief either alone or in combination with pharmacological treatment.

AIMS

To identify effective non-pharmacological interventions with regard to procedural pain in neonates.

METHODS

A literature search was conducted via the MedLine, CINAHL, Cochrane Library databases and complemented by a handsearch. The literature search covered the period from 1984 to 2004. Data were extracted according to pre-defined criteria by two independent reviewers and methodological quality was assessed.

RESULTS

13 randomised controlled studies and two meta-analyses were taken into consideration with regard to the question of current nursing practice of non-pharmacological pain management methods. The selected interventions were "non-nutritive sucking", "music", "swaddling", "positioning", "olfactory and multisensorial stimulation", "kangaroo care" and "maternal touch". There is evidence that the methods of "non-nutritive sucking", "swaddling" and "facilitated tucking" do have a pain-alleviating effect on neonates.

CONCLUSIONS

Some of the non-pharmacological interventions have an evident favourable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures. However, unambiguous evidence of this still remains to be presented. Further research should emphasise the use of validated pain assessment instruments for the evaluation of the pain-alleviating effect of non-pharmacological interventions.

Mothers' stories about their experiences in the neonatal intensive care unit

The purpose of this article is to let mothers tell the stories of their neonatal intensive care unit (NICU) experiences and to determine how well these experiences fit the Preterm Parental Distress Model. Interviews were conducted with 31 mothers when their infants were six months of age corrected for prematurity and were analyzed using the conceptual model as a framework. The analysis verified the presence in the data of the six major sources of stress indicated in the Preterm Parental Distress Model: (1) pre-existing and concurrent personal and family factors, (2) prenatal and perinatal experiences, (3) infant illness, treatments, and appearance in the NICU, (4) concerns about the infant's outcomes, (5) loss of the parental role, and (6) health care providers. The study indicates that health care providers, and especially nurses, can have a major role in reducing parental distress by maintaining ongoing communication with parents and providing competent care for their infants.

The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates

BACKGROUND

Procedural pain management for very low birth weight (VLBW) neonates has been minimal or nonexistent in most neonatal intensive care units (NICUs).

OBJECTIVES

To compare the efficacy of developmentally sensitive behavioral interventions (nonnutritive sucking via a pacifier, positioning) and sucrose for relieving procedural pain in VLBW infants and to determine the influence of contextual factors (gestational age, postnatal age, birth weight, severity of illness, frequency of painful procedures) on pain response.

METHOD

In a prospective randomized crossover trial, pain was assessed in 122 VLBW neonates using the Premature Infant Pain Profile following four randomly ordered interventions during consecutive routine heel lance procedures.

RESULTS

Significant differences in pain existed among treatment interventions (F = 16.20, p < .0001). The pacifier with sucrose (F = 24.09, p < .0001) and pacifier with sterile water (F = 9.00, p = .003) significantly reduced pain. Prone positioning did not decrease pain (F = 2.24, p = .137). Frequency of painful procedures approached significance in influencing pain response (F = 3.59, p = .01).

CONCLUSIONS

The most efficacious interventions for reducing pain from single painful events were the pacifier with sucrose and the pacifier with sterile water. Research on the efficacy and safety of implementing these interventions, alone and in combination, for repeated painful procedures is needed. In addition, research is needed on the influence of implementing these interventions on pain response and clinical outcomes (e.g., health status and neurodevelopmental status) in VLBW neonates in the NICU.

The early feeding skills assessment for preterm infants

Preterm infants develop the skills necessary to begin oral feeding as their health stabilizes and as they reach a postconceptional age that supports coordination of breathing and swallowing with oral-motor functioning. The time from initiation of oral feeding to full oral feedings (with adequate intake for growth and maintenance of physiologic stability) can vary from days to months for the preterm infant. The approach to feeding the infant during this transition period must be developmentally supportive and tailored to meet the needs of the individual. To accomplish this, caregivers--notably nurses and parents--need to communicate about the specific skills that the infant has gained, about skills that are emerging, and about skills that the infant has not yet developed. The Early Feeding Skills (EFS) Assessment is a checklist for assessing infant readiness for and tolerance of feeding and for profiling the infant's developmental stage regarding specific feeding skills: the abilities to remain engaged in feeding, organize oral-motor functioning, coordinate swallowing with breathing, and maintain physiologic stability. This article introduces the EFS.

Ten steps for promoting and protecting breastfeeding for vulnerable infants

Human milk is the preferred food for infants, including ill and preterm infants. Ensuring skilled and comprehensive breastfeeding support for these vulnerable infants requires a specialized approach. The author outlines 10 steps for promoting and protecting breastfeeding in vulnerable infants. The steps include providing the parents with information necessary to make an informed decision to breastfeed; assisting the mother with the establishment and maintenance of a milk supply; ensuring correct breast milk management (storage and handling) techniques; developing procedures and approaches to feeding the infant breast milk; providing skin-to-skin care (kangaroo care) and opportunities for non-nutritive sucking at the breast; managing the transition to the breast; measuring milk transfer; preparing the infant and the family for infant hospital discharge; and providing appropriate follow-up care. Material and examples are drawn from the author's research and clinical work at the Children's Hospital of Philadelphia. Current research is utilized, and the role of the nurse is emphasized throughout.

Music therapy research in the NICU: an updated meta-analysis

PURPOSE

To provide an overview of developmental and medical benefits of music therapy for preterm infants.

DESIGN

Meta-analysis.

SAMPLE

Empirical music studies with preterm infants in the neonatal intensive care unit (NICU).

MAIN OUTCOME

Evidence-based NICU music therapy (NICU -MT ) was highly beneficial with an overall large significant effect size (Cohen's d = 0.82). Effects because of music were consistently in a positive direction.

RESULTS

Results of the current analysis replicated findings of a prior meta-analysis and included extended use of music.(1) Benefits were greatest for live music therapy (MT ) and for use early in the infant's NICU stay (birth weight <1,000 g, birth postmenstrual age <28 weeks). Results justify strong consideration for the inclusion of the following evidence-based NICU -MT protocols in best practice standards for NICU treatment of preterm infants: music listening for pacification, music reinforcement of sucking, and music pacification as the basis for multilayered, multimodal stimulation.

Impact of packaged interventions on neonatal health: a review of the evidence

A disproportionate burden of infant and under-five childhood mortality occurs during the neonatal period, usually within a few days of birth and against a backdrop of socio-economic deprivation in developing countries. To guide programmes aimed at averting these 4 million annual deaths, recent reviews have evaluated the efficacy and cost-effectiveness of individual interventions during the antenatal, intrapartum and postnatal periods in reducing neonatal mortality, and packages of interventions have been proposed for wide-scale implementation. However, no systematic review of the empirical data on packages of interventions, including consideration of community-based intervention packages, has yet been performed. To address this gap, we reviewed peer-reviewed journals and grey literature to evaluate the content, impact, efficacy (implementation under ideal circumstances), effectiveness (implementation within health systems), type of provider, and cost of packages of interventions reporting neonatal health outcomes. Studies employing more than one biologically plausible neonatal health intervention (i.e. package) and reporting neonatal morbidity or mortality outcomes were included. Studies were ordered by study design and mortality stratum, and their component interventions classified by time period of delivery and service delivery mode. We found 41 studies that implemented packages of interventions and reported neonatal health outcomes, including 19 randomized controlled trials. True effectiveness trials conducted at scale in health systems were completely lacking. No study targeted women prior to conception, antenatal interventions were largely micronutrient supplementation studies, and intrapartum interventions were limited principally to clean delivery. Few studies approximated complete packages recommended in The Lancet's Neonatal Survival Series. Interventions appeared largely bundled out of convenience or funding requirements, rather than based on anticipated synergistic effects, like service delivery mode or cost-effectiveness. Only two studies reported cost-effectiveness data. The evidence base for the impact of neonatal health intervention packages is a weak foundation for guiding effective implementation of public health programmes addressing neonatal health. Significant investment in effectiveness trials carefully tailored to local health needs and conducted at scale in developing countries is required.

Skin-to-Skin Contact (Kangaroo Care) Analgesia for Preterm Infant Heel Stick

The purpose of the study was to compare a heel stick conducted during Kangaroo Care (skin-to-skin contact) with the mother to a heel stick in a warmer in reducing premature infant physiologic and behavioral pain responses. Twenty-four premature infants in a university-based neonatal intensive care unit were recruited and randomized to 2 sequences: sequence A group received 3 hours of Kangaroo Care (with a heel stick in Kangaroo Care) followed by 3 hours in a warmer (with a heel stick in the warmer). Sequence B group had warmer care and a heel stick (in the warmer) before Kangaroo Care and a heel stick (in Kangaroo Care). Heart rate, respiratory rate, oxygen saturation, crying time, and behavioral state were measured before, during, and after heel stick. Repeated measures ANOVA and Mann Whitney U statistics were performed. Heart rate and length of crying in response to pain were significantly reduced during Kangaroo Care and the Kangaroo Care heel stick as compared to when infants were in the warmer and had a heel stick in the warmer. Three infants did not cry at all during the Kangaroo Care heel stick; infants slept more during Kangaroo Care than in the warmer. Kangaroo Care positioning before and during heel stick is a simple and inexpensive analgesic intervention to ameliorate pain in stable premature infants.

Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates

BACKGROUND

Preterm and acutely ill term neonates who are hospitalized in a neonatal intensive care unit are subjected to multiple frequent invasive and painful procedures aimed at improving their outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain in preterm and acutely ill term neonates have been developed, these have generally lacked methodological rigor and have not provided clinicians with clear practice guidelines.

OBJECTIVES

To compare the efficacy and safety of three interventions for relieving procedural pain associated with heel lances in preterm and term neonates, and to explore the influence of contextual factors including sex, severity of illness, and prior painful procedures on pain responses.

METHODS

In a randomized controlled trial, 190 neonates were stratified by gestational age and then randomized to receive (a) sucrose and nonnutritive sucking (n = 64), (b) sucrose alone (n = 62), or (c) sterile water and nonnutritive sucking (control) (n = 64) to evaluate the efficacy (pain response as measured using the Premature Infant Pain Profile) (Stevens, Johnson, Petryshen, & Taddio, 1996) and safety (adverse events) following a scheduled heel lance during the first week of life. Stratification was used to control for the effects of age on pain response.

RESULTS

Significant differences in pain response existed among treatment groups (F = 22.49, p <.001), with the lowest mean Premature Infant Pain Profile scores in the sucrose and nonnutritive sucking group. Efficacy of sucrose following a heel lance was not affected by severity of illness, postnatal age, or number of painful procedures. Intervention group and sex explained 12% of the variance in Premature Infant Pain Profile scores. Few adverse events occurred (n = 6), and none of them required medical or nursing interventions.

CONCLUSIONS

The combination of sucrose and nonnutritive sucking is the most efficacious intervention for single heel lances. Research on the effects of gestational age on the efficacy and safety of repeated doses of sucrose is required.

Facilitated tucking: a nonpharmacologic comfort measure for pain in preterm neonates

OBJECTIVE

To identify the effectiveness of "facilitated tucking," a nonpharmacologic nursing intervention, as a comfort measure in modulating preterm neonates' physiologic and behavioral responses to minor pain.

DESIGN

Prospective, repeated measure, random sequencing, and experimental.

SETTING

Level III neonatal intensive-care unit of a tertiary care university pediatric hospital.

PARTICIPANTS

Thirty preterm neonates, 25-35 weeks gestation.

INTERVENTIONS

Heart rate, oxygen saturation, and sleep state were recorded 12 minutes before, during, and 15 minutes after two heelsticks, one with and one without facilitated tucking.

HYPOTHESIS

Premature neonates will have less variation in heart rate and hemoglobin oxygen saturation, shorter crying and sleep disruption times, and less fluctuation in sleep states in response to the painful stimulus of a heelstick with facilitated tucking than without.

RESULTS

Neonates demonstrated a lower mean heart rate 6-10 minutes post-stick (p < 0.04), shorter mean crying time (p < 0.001), shorter mean sleep disruption time (p < 0.001), and fewer sleep-state changes (p = 0.003) after heelstick with facilitated tucking than without.

CONCLUSION

Facilitated tucking is an effective comfort measure in attenuating premature neonates' psychologic and behavioral responses to minor pain.

Struggling to mother: a consequence of inhibitive nursing interactions in the neonatal nursery

This paper reports on one aspect of a grounded theory study of women's experiences of mothering in the nursery. Over 60 hours of interview data with 28 Australian women were analyzed. The analysis revealed that mothering in the nursery was a three-way interaction. "Struggling to mother" was the label given to the major category that represented how women responded to unsatisfactory nursing encounters. The findings illuminate how inhibitive nursing interactions relegate women to the periphery of care and engender an array of negative emotional responses that leave women feeling inconsequential to the welfare of their infant. Ultimately this has implications for how women take up their role as mothers in the nursery and for their sense of confidence, competence, and connection with their infant.

Randomized controlled trial of kangaroo care: cardiorespiratory and thermal effects on healthy preterm infants

PURPOSE

To determine the safety and effects on healthy preterm infants of three continuous hours of kangaroo care (KC) compared to standard NICU care by measuring cardiorespiratory and thermal responses.

DESIGN

Randomized controlled trial-pretest-test-posttest control group design.

SAMPLE

Twenty-four healthy preterm infants (33-35 weeks gestation at birth) nearing discharge. Eleven of the infants received KC; 13 received standard NICU care.

MAIN OUTCOME VARIABLES

Heart rate, respiratory rate, oxygen saturation, and abdominal skin temperature were manually recorded every minute. Apnea, bradycardia, periodic breathing, and regular breathing were captured continuously on a pneumocardiogram printout. Three consecutive interfeeding intervals (three hours each) on one day constituted the pretest, test, and posttest periods.

RESULTS

Mean cardiorespiratory and temperature outcomes remained within clinically acceptable ranges during KC. Apnea, bradycardia, and periodic breathing were absent during KC. Regular breathing increased for infants receiving KC compared to infants receiving standard NICU care.

Supplementary feeding in the maternity ward shortens the duration of breast feeding

In a prospective study, feeding routines of a maternity unit and the subsequent feeding patterns of 521 newborns were analysed. During the stay in the maternity unit, 69% of newborns were exclusively breast fed and 1% received only donor's milk from the milk bank and/or formula. Nine percent received their mothers' milk by bottle at least once and 21% received one or more supplementary feedings with donor's milk from the milk bank. One-quarter of the children received supplementary feeds on the third day of life, the indications for this being birth weight less than 3.0 kg, maternal diabetes or gestational diabetes, "insufficient amounts" of milk or fussiness. At three months, 65% were being exclusively breast fed and 15% partially breast fed. In a multiple logistic regression analysis, the potential determinants (neonatal feeding, maternal characteristics, characteristics of the delivery and the child) for the duration of breast feeding were included. The adjusted relative risk (estimated as odds ratios, OR) of not being breast fed at three months was associated with maternal age (< 25 years, OR 4.2), maternal smoking (OR 4.0), neonatal feeding (supplements given, OR 3.9) and initial weight loss (10% or more, OR 2.8). Thus the administration of supplementary donor's milk or formula during the early neonatal period was associated with an increased risk of a short duration for breast feeding, even after adjustment for a number of potential confounders.

Kangaroo care: national survey of practice, knowledge, barriers, and perceptions

PURPOSE

A national survey was conducted to assess practice, knowledge, barriers, and perceptions regarding Kangaroo Care (KC)--the holding of diaper-clad preterm infants skin-to-skin, chest-to-chest by parents.

DESIGN

A descriptive survey was conducted.

METHODS

Kangaroo Care Questionnaires (KCQs), developed for the study, were sent to nurse managers in all hospitals in the United States that were identified as providing neonatal intensive care services (N = 1,133), and were to be completed by the nurse most familiar with the practice of KC in that unit. A second KCQ was sent to non-respondents. Descriptive statistics were used to summarize the data.

RESULTS

A response rate of 59% (N = 537) was achieved. Over 82% of the respondents reported practicing KC in their neonatal intensive care units (NICUs). Nurses were knowledgeable about KC. Major barriers to practicing KC for certain types of infants were infant safety concerns, as well as reluctance by nurses, physicians, and families to initiate or participate in KC. Many NICUs do not permit KC for certain types of infants (e.g., those on vasopressors or high-frequency ventilation). Over 60% of respondents agreed that low gestational age or weight were not contraindications. Respondents from NICUs in which KC is practiced were more positive in their perceptions than respondents from NICUs that do not practice KC.

CLINICAL IMPLICATIONS

The findings suggest that in order to overcome barriers to the practice of KC, nurses need educational offerings highlighting the knowledge and skills needed to provide KC safely and effectively. These educational offerings should also emphasize the value of KC to infants and parents. In addition, knowledgeable practitioners need to develop evidence-based policies and procedures that will lead to successful KC.

Noise and the premature infant: physiological effects and practice implications

Premature infants in the neonatal intensive-care unit often are exposed to continuous loud noise. This excess auditory stimulation creates negative physiological responses, such as increased heart and respiratory rates and decreased oxygen saturation. Modifying the neonatal intensive-care unit to reduce noise levels provides an environment more conducive to maturation and recovery from illness. This article reviews the literature addressing the pathophysiology and physiological changes of the premature infant in response to stress and discusses practice interventions for decreasing noise levels in the neonatal intensive-care unit. These interventions include installing sound absorbing materials and minimizing conversations of the staff.

State of the science: feeding readiness in the preterm infant

Finding ways to consistently prepare preterm infants and their families for more timely discharge must continue as a focus for everyone involved in the care of these infants in the neonatal intensive care unit. The gold standards for discharge from the neonatal intensive care unit are physiologic stability (especially respiratory stability), consistent weight gain, and successful oral feeding, usually from a bottle. Successful bottle-feeding is considered the most complex task of infancy. Fostering successful oral feeding in preterm infants requires consistently high levels of skilled nursing care, which must begin with accurate assessment of feeding readiness and thoughtful progression to full oral feeding. This comprehensive review of the literature provides an overview of the state of the science related to feeding readiness and progression in the preterm infant. The theoretical foundation for feeding readiness and factors that appear to affect bottle-feeding readiness, progression, and success are presented in this article.

Experiences of mothers of infants with neonatal abstinence syndrome in the neonatal intensive care unit

OBJECTIVE

To describe the experiences of mothers of infants with neonatal abstinence syndrome (NAS) in the neonatal intensive care unit (NICU).

DESIGN

Qualitative description.

SETTING

We recruited participants from community-based, out-patient, addiction treatment facilities in a large urban city in the southwestern region of the United States.

PARTICIPANTS

A convenience sample of 15 Hispanic, substance addicted mothers of infants with NAS participated.

METHODS

We conducted semistructured, individual, interviews and analyzed the data using qualitative content analysis. First, we analyzed the data independently and then discussed the themes until a consensus was reached.

RESULTS

We identified four themes: (a) understanding addiction, (b) watching the infant withdraw, (c) judging, and (d) trusting the nurses. The participants felt there was a lack of understanding concerning addiction that was particularly noted when interacting with the nurses. They shared their feelings of guilt and shame when observing their infants withdrawing. The participants felt judged by the nurses for having used illicit drugs during pregnancy. Feeling judged interfered with the participants' ability to trust the nurses.

CONCLUSION

These findings provide nurses with a better understanding of the experiences of mothers who have addiction problems and may lead to more customized nursing care for this high-risk population of mothers and their infants.

Caring for dying infants: experiences of neonatal intensive care nurses in Hong Kong

Ten registered nurses working in a neonatal intensive care unit in Hong Kong were interviewed to explore their experiences of caring for infants whose disease is not responsive to curative treatment, their perceptions of palliative care, and factors influencing their care. Eight categories emerged from the content analysis of the interviews: disbelieving; feeling ambivalent and helpless; protecting emotional self; providing optimal physical care to the infant; providing emotional support to the family; expressing empathy; lack of knowledge and counselling skills; and conflicting values in care. The subtle cultural upbringing and socialization in nurse training and workplace environment also contributed to their moral distress. Hospital and nurse administrators should consider different ways of facilitating palliative care in their acute care settings. For example, by culture-specific death education, peer support groups, bereavement teams, modification of departmental policies, and a supportive work environment. Future research could include the identification of family needs and coping as well as ethical decision-making among nurses.

Mothers' experience of being separated from their newborns

OBJECTIVE

To elucidate mothers' experiences related to separation from their newborns during their 1st week of life, when the newborns had been transferred to a neonatal intensive-care unit (NICU).

DESIGN

A phenomenologic-hermeneutic approach. Tape-recorded narrative interviews were conducted 1 to 2 months postpartum in the participants' homes. The mothers were asked to describe and reflect upon their experiences during the time when they were separated from their children.

PARTICIPANTS

Eight women whose full-term newborns had been treated in the NICU for between 2 and 10 days and then declared healthy and sent home.

RESULTS

The women's narratives revealed that their experiences had caused them emotional strain and anxiety. From the analysis, three themes emerged: Being an outsider was based on feelings of despair, powerlessness, homelessness, and disappointment. Lack of control included emotional instability, threat, guilt, and insecurity. The theme of caring included trust, love, anxiety, relief, closeness, and explanations. The experiences were related to the staff, the child, the environment, the mother herself, the child's father, and other mothers.

CONCLUSIONS

Separating a mother and her newborn during the 1st week of the child's life involves much emotional strain for the mother, even though the newborn is not seriously ill.

Communicating with parents of premature infants: who is the informant?

OBJECTIVES

To determine what sources of information are most helpful for neonatal intensive care unit (NICU) parents, who provides NICU parents with the information, and also what expectations parents have regarding obtaining information.

STUDY DESIGN

A 19-item questionnaire was given to the parents of infants 32 weeks or younger prior to discharge from the NICU.

RESULTS

Out of the 101 parents who consented, almost all of the parents (96%) felt that 'the medical team gave them the information they needed about their baby' and that the 'neonatologist did a good job of communicating' with them (91%). However, the nurse was chosen as 'the person who spent the most time explaining the baby's condition, 'the best source of information,' and the person who told them 'about important changes in their baby's condition' (P<0.01).

CONCLUSION

Although the neonatologist's role in parent education is satisfactory, the parents identified the nurses as the primary source of information.

A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity

Kangaroo care (KC) has been the intervention for preterm infants in numerous published studies. However, most well designed studies to date have used a one-group repeated measure design. This methodology is not as definitive as an experimental design. Because of the absence of a comparable control group, change between pretest and posttest may be due to any other environmental variables or normal variation of subjects (Kirk, 1995). This randomized controlled trial (RCT) was done to test the hypotheses that KC infants would have higher mean tympanic temperatures, less weight loss, more optimal behavioral states, and lower acuity (length of stay). Thirty-four eligible mother-infant dyads were randomly assigned to the KC or the control group by computerized minimization on the day following birth. Stratification variables included infant gender, birth weight, delivery method, and parity. KC infants compared to control infants had higher mean tympanic temperature (37.3 degrees C vs. 37.0 degrees C), more quiet sleep (62% vs. 22%), and less crying (2% vs. 6%) all at p=.000. No significant difference was found for weight loss and acuity (length of stay). These findings can be used for evidence-based nursing practice in Taiwan. With the knowledge attained from this RCT, nurses can educate and motivate mothers to keep their stable preterm infants warm by skin-to- skin contact inside their clothing, thereby encouraging self-regulatory feeding.

Kangaroo care compared to incubators in maintaining body warmth in preterm infants

Many preterm infants cared for in incubators do not experience Kangaroo Care (KC), skin-to-skin contact with their mothers, due to fear of body heat loss when being held outside the incubator. A randomized clinical trial of 16 KC and 13 control infants using a pretest-test-posttest design of three consecutive interfeeding intervals of 2.5 to 3.0 h duration each was conducted over 1 day. Infant abdominal and toe temperatures were measured in and out of the incubator; maternal breast temperature was measured during KC. Repeated measures ANOVA showed no change in abdominal temperature across all periods and between groups. Toe temperatures were significantly higher during KC than incubator periods, and maternal breast temperature met each infant's neutral thermal zone requirements within 5 min of onset of KC. Preterm infants similar to those studied here will maintain body warmth with up to 3 h of KC.

Effective nurse parent communication: a study of parents' perceptions in the NICU environment

OBJECTIVE

This study examined mothers' and fathers' perceptions of effective and ineffective communication by nurses in the neonatal intensive care unit (NICU) environment, using communication accommodation theory (CAT) as the framework.

METHODS

Twenty mothers and 13 fathers participated in a semi-structured interview about their perceptions of effective and ineffective communication with nurses when their infant was in the NICU. The interviews were coded for using the CAT strategies.

RESULTS

Descriptions of effective and ineffective communication differed in terms of the strategies mentioned with effective communication about shared management of the interaction and appropriate support and reassurance by nurses. Ineffective communication was more about the interpretability strategy, particularly for fathers, and these interactions were seen as more intergroup. Mothers emphasised more being encouraged as equal partners in the care of their infant.

CONCLUSION

Effective communication by nurses was accommodative and more interpersonal while ineffective communication was generally under-accommodative and more intergroup.

PRACTICE IMPLICATIONS

The findings provide a framework for communication skills training for nurses that identifies both effective and ineffective communication strategies to use with mothers and fathers.

An evidence-based guideline for introducing oral feeding to healthy preterm infants

The ability of a preterm infant to make the transition from gavage to oral nipple feeding depends on the infant's neurodevelopment in relation to behavioral organization, to a rhythmic suck-swallow-breathe pattern, and to cardiorespiratory regulation. Research-based knowledge about infant neurodevelopment in these three areas has led to the creation of a semidemand feeding method to aid in this transition. The method combines the use of nonnutritive sucking to promote awake behavior for feeding, use of behavioral assessment to identify readiness for feeding, and systematic observation of and response to infant behavior cues to regulate frequency, length, and volume of oral feedings. Semidemand feeding may be individualized for healthy preterm infants. This article discusses both the relevant knowledge about neurodevelopment and the semidemand feeding method itself.

Room for improvement: nurses' perceptions of providing care in a single room newborn intensive care setting

Theoretically, single patient room newborn intensive care units are designed to optimize the developmental outcomes of critically ill infants by providing individual patient environments with decreased stimulation and noise. This article reports the perceptions of 127 neonatal intensive care nurses after the move into a single room neonatal intensive care unit (NICU). The observations of the nurses were obtained using a questionnaire to identify some of the benefits, risks, and specific patient safety concerns related to the single room NICU design. The results suggest that in this setting the single patient room concept was deemed superior for patient care and parent satisfaction when compared to the large open unit. However, the nurses emphasize that the success of single room care model primarily depends on providing sufficient staff coverage, given the decreased patient visibility and greater distances between patients. Larger units also present unique communication, staff education, and quality improvement challenges. To further evaluate the impact of single room designs we evaluated data on important clinical issues, specifically noise levels and catheter-related infections provide objective measures of important improvements. Noise levels decreased from an average of 63 to 56 decibels and catheter-associated bloodstream infections fell from 10.1 per 1000 device days to 3.3 per 1000 device days in the 9 months after the move to single patient rooms. This article provides pragmatic design suggestions that should be prospectively considered to minimize staff isolation and stress.