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At least 19 recordsLinked to original sources
PubMedDate not supplied

Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses.

OBJECTIVE: To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries. DESIGN: Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. SETTING: NICU and well-baby units in 51 hospitals located throughout the United States. PARTICIPANTS: Member site coordinators (N = 51) and the neonates (N= 2,820) observed during both the pre- and postimplementation phases of the project. METHOD: Site coordinators received specialized education in neonatal skin care and implemented an evidence-based clinical practice guideline addressing 10 aspects of neonatal skin care. Baseline observations of skin condition, care practices, and environment of newly admitted neonates were collected by site coordinators. Postimplementation observations were then completed. MAIN OUTCOME MEASURES: Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. Aspects of the care environment with potential effect on skin integrity were monitored to determine risk factors. RESULTS: Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in well newborns compared with premature newborns. After implementation of the guideline, skin condition was improved, as reflected by less visible dryness, redness, and skin breakdown in both the NICU/SCU and well newborns. The guideline was integrated into care, as evidenced by increased use of emollients, particularly with premature infants, and decreased frequency of bathing. A relationship was shown between selected aspects of the environment and alterations in skin integrity. CONCLUSIONS: Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical Practice Guideline was successfully implemented at 51 sites, and effectiveness was demonstrated by changed care practices and improved skin condition in premature and full-term newborns. The results of this project support a wider dissemination of the project's practice guideline for neonatal skin care.

Clinical Nursing Research↗
PubMed1997

Position statement: early discharge of the high risk neonate. National Association of Neonatal Nurses.

It is the position of the National Association of Neonatal Nurses that in order for the neonate's specialized needs to be met in this era of early discharge, broad guidelines must exist for such discharge. Discharge preparations and follow-up care must be performed by knowledgeable and experienced neonatal registered nurses who can determine readiness for discharge and home care needs. Early discharge may be appropriate and safe if all discharge and teaching criteria are met to assure positive neonatal and family outcomes.

Child, Hospitalized↗
PubMed1997

Position statement on neonatal follow-up care of the high risk neonate. National Association of Neonatal Nurses.

It is the position of the National Association of Neonatal Nurses that an essential component of early discharge of the high risk neonate must be neonatal follow-up care. Broad guidelines for neonatal follow-up care have been outlined. Neonatal follow-up care must be performed by qualified health professionals and experienced neonatal registered nurses knowledgeable in the specialized needs of the high risk neonate. If follow-up care is an unavailable service of the unit, the neonate's care after discharge should be coordinated with the nearest existing program. Successful follow-up care will result in improved neonatal and family outcomes.

Aftercare↗
PubMedDate not supplied

The legal landscape at the threshold of viability for extremely premature infants: a nursing perspective, part II.

This is the second of a 2-part article exploring the legal landscape overlying the difficult decisions that can confront a family with an extremely premature infant at the threshold of viability. In Part I, recent legal regulations and litigation were analyzed to show that the baby doe regulations are largely inert and that recent litigation arises out of state laws and regulations. Part II takes up the analysis to show that the common thread through all these conflicts, and the subsequent litigation, is a failure to obtain parental consent for the course of treatment at issue. The author argues that the central focus of all parties seeking to minimize legal risks in these situations must be on creating a transparent decision-making process that includes the parents from the onset. Nurses play a pivotal role in that process and are supported broadly by the professional guidelines of the American Nurses Association, the Association of Women's Health Obstetric and Neonatal Nurses, the National Association of Neonatal Nurses, the American Academy of Pediatrics, and the Principles of Family-Centered Neonatal Care.

Fetal Viability↗
PubMedDate not supplied

Neonatal skin care: evaluation of the AWHONN/NANN research-based practice project on knowledge and skin care practices. Association of Women's Health, Obstetric and Neonatal Nurses/National Association of Neonatal Nurses.

OBJECTIVE: To develop and evaluate an evidence-based clinical practice guideline for assessment and routine care of neonatal skin, educate nurses about the scientific basis for practices recommended in the guideline, and design procedures that facilitate implementation of the project guideline into clinical practice. DESIGN: Descriptive report of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. SETTING: Neonatal intensive-care unit (NICU) and special-care nurseries and well-baby nurseries in 51 hospitals located throughout the United States. PARTICIPANTS: Member site coordinators (N = 51), nurses who work at the selected sites, and the neonates observed during both the pre- and postimplementation phases of the project (N = 2,820). METHOD: An evidence-based clinical practice guideline was developed, sites were selected from all respondents of the call for sites, site coordinator training was provided, data collection was facilitated by project-specific data collection tools, and the project was evaluated by the science team. MAIN OUTCOME MEASURES: Diversity and numbers of sites represented, patient representation, site coordinator knowledge of neonatal skin care pre- and postimplementation, use of project-designed implementation tools, satisfaction with project guideline and the data collection process, changes in practices and product use, and site coordinators' experiences during guideline implementation. RESULTS: Fifty-one sites completed the project, representing NICU, special-care, and well-baby nurseries in both academic and community hospital settings in 27 states. Registered nurses working in these sites totaled 4,754 full-time equivalent positions (FTEs) (in NICU/special-care and well-baby nurseries). Site coordinators demonstrated increased knowledge of research-based neonatal skin care and satisfaction with the implementation tools and data collection process. Product use changed, reflecting acquisition of new knowledge. Barriers to implementation of the guideline were identified. CONCLUSIONS: The AWHONN/NANN Neonatal Skin Care Research-Based Practice Project demonstrated increased knowledge among site coordinators who received training, facilitated changes in neonatal skin care as defined by the practice guideline, and thus advanced evidence-based clinical practice.

Clinical Nursing Research↗
PubMedDate not supplied

Validity and reliability of the neonatal skin condition score.

OBJECTIVE: To demonstrate the validity and reliability of the Neonatal Skin Condition Scale (NSCS) used in the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN) neonatal skin care evidence-based practice project. SETTING: NICU and well-baby units in 27 hospitals located throughout the United States. PARTICIPANTS: Site coordinators (N = 27) and neonates (N = 1,006) observed during both the pre and postimplementation phases of the original neonatal skin care project. METHOD: To assess reliability, two consecutive NSCS assessments on a single infant were analyzed. Site coordinators were contacted after the original project was concluded. Sites indicating that a single nurse scored all infant skin observations provided data that were used to evaluate intrarater reliability. Sites using more than one nurse to score skin observations provided data that were used to assess interrater reliability. To assess validity, the following variables were used from the original data set: the Neonatal Skin Condition Scale (NSCS), with three subscales for dryness, erythema, and breakdown; birth weight in grams; number of skin score observations for each infant; and the prevalence of infection, defined as a positive blood culture. RESULTS: For intrarater reliability, 16 sites used a single nurse for all NSCS assessments; total NSCS assessments 475. For interrater reliability, 11 sites used multiple raters; total assessments 531. The NSCS demonstrated adequate reliability for each of the three subscales and for the total score, with the percent agreement between scores ranging from 68.7% to 85.4% (intrarater) and 65.9% to 89% (interrater); all Kappas were significant at p < .001 and were in the moderate range for reliability. The validity of the NSCS was demonstrated by the findings that smaller infants were 6 times more likely to have erythema (chi2(6) = 109.55, p < .0001), and approximately twice as likely to have the most severe breakdown (chi2(6) = 108.01, p < .0001). Infants with more observations (longer length of stay) had higher skin scores (odds ratio = 1.21, p < .0001), and an increased probability of infection was noted for infants with higher skin scores (odds ratio = 2.25, p < .0001). CONCLUSIONS: The Neonatal Skin Condition Score (NSCS) is reliable when used by single and multiple raters to assess neonatal skin condition, even across weight groups and racial groups. Validity of the NSCS was demonstrated by confirmation of the relationship of the skin condition scores with birth weight, number of observations, and prevalence of infection.

Evidence-Based Medicine↗
PubMed1994

Values influencing neonatal nurses' perceptions and choices.

The purpose of this research was to identify the values influencing the nurses' perception and choice of behavior in a hypothetical clinical situation. The theoretical framework was Rokeach's theory on the nature of human values and value systems. A descriptive study using a mailed survey was conducted on a random sample of 331 members of the National Association of Neonatal Nurses. Data on individual nurse's values, perception of information, and behavioral choices were collected with an investigator-developed questionnaire consisting of a values scale, and an information scale and choice alternatives related to three hypothetical vignettes: a low-birthweight infant, an infant with chromosomal anomalies, and a chronically ill infant. Results of this study indicate that nurses identified a hierarchy of values related to their practice. Information related to infant characteristics was consistently most important; however, in uncertain situations, rules or external protocols had an increased influence on the behavioral choice process. The behavioral choice option with the greatest agreement was different for each situation. A consistently negative correlation between the options within each vignette indicates that nurses have clearly defined choice preferences. Model testing revealed a consistent relationship across the three vignettes between the variable being just and protocol, doing right and infant characteristics, and infant characteristics and the choice options (p < .05).

Adult↗
PubMed1996

Choices of neonatal nurses in ambiguous clinical situations.

This article reports a study of the nurse's choice of level of management and factors influencing that choice in three ambiguous clinical situations related to neonatal nursing. A nationwide mail survey, using a Likert scale, was conducted on a random sample of the membership of the National Association of Neonatal Nurses. The findings of this research suggest that nurses have clearly defined choices related to the degree of intensity of management of infants, based on consideration of the information available to the nurse in the neonatal setting. These findings have implications for nursing practice and education and consequences for the quality of nursing care provided to infants and their families.

Adult↗
PubMedDate not supplied

Values influencing nursing practice: responses from neonatal nurses.

PURPOSE: An analysis of narrative comments from neonatal nurses to illustrate the values that motivate behavior in the practice setting. DESIGN: A descriptive study using content analysis of written, narrative text data. PARTICIPANTS: A self-selected subsample (N = 97) of a larger random sample of the membership of the National Association of Neonatal Nurses (NANN). MAIN OUTCOME MEASURES: The application of philosophical concepts of human relationships, patient need, keeping promises, human dignity, and unrestricting circumstances in the neonatal care setting. RESULTS: Individual participants made cognitive choices related to the application of conceptual ideals of the profession to the practice setting. However, there was a lack of congruence between what the individual nurse believes is important or good and the behavior enacted in the practice setting. CONCLUSION: As a discipline, nursing needs to identify and implement strategies that support proactive accountable nursing practice consistent with the philosophical foundation of the profession.

Adult↗
PubMed1996

Developmental aspects of kangaroo care.

Kangaroo care (skin-to-skin holding) is an intervention that meets development care criteria by fostering neurobehavioral development. The five dimensions of neurobehavioral development are autonomic, motor, state, attention/interaction, and self-regulation. Kangaroo care promotes stability of heart and respiratory function, minimizes purposeless movements, improves behavioral state profiles, offers maternal proximity for attention/interaction episodes, and permits self-regulatory behavior expression. Kangaroo care satisfies in part the handling, self-consoling/soothing, nonnutritive sucking, and parenting interventions recommended by the National Association of Neonatal Nurses' Infant and Family Centered Developmental Care Guidelines.

Adult↗
PubMed1994

The changing role of the nurse in neonatal care: a study of current practice in England.

The boundaries of nursing in neonatal care, and the interface between the work of nursing and medical staff in delivering care, are changing. The enhanced or expanding role of the neonatal nurse is not a universally accepted one. If this professional development is to be widely accepted and implemented, some key issues will need to be addressed so that the changing role of the nurse and associated skill base are well founded. As part of a large-scale national study of neonatal nursing in England, data were collected from nurses working in 24 different units. Regional centres, subregional centres and district units from six widely separated health regions participated, and individual data were collected from 718 nurses (599 D-I grades and 119 A-C grades). While indicating that there is inter-unit variation in nursing practice, the results also show that many nurses are already in the process of changing their role in this acute specialty. Nurses doing so are more likely to have a qualification in this specialty, though not all of them have. A small number of nursery nurses and nursing auxiliaries were undertaking tasks that could be considered part of an expanded role. The implications of the findings are discussed.

Attitude of Health Personnel↗
PubMedDate not supplied

Positioning during the second stage of labor: moving back to basics.

The advantages of an upright position during labor are presented, with historic, physiologic, and psychosocial aspects discussed. The influences of modern obstetric practices such as electronic fetal monitoring and anesthesia practices are discussed with findings related to the use of upright positions from the Association of Women's Health, Obstetric, and Neonatal Nursing National Research Utilization Project on Second Stage Labor Management integrated. Recommendations for facilitating upright positions on the labor and delivery unit are presented.

Anesthesia, Obstetrical↗