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1
Stadd, Karen. "Initiating Kangaroo Care in the Neonatal Intensive Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5267.
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Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway within a multifaceted champion-based simulated educational training program for NICU staff and parents. Published outcomes and generated organizational data for program synthesis connected the gap in practice. Kolcaba's comfort theory served as the guiding framework to ensure a partnership in care. This quasi-experimental quantitative study used the generalized liner model for data analysis. Study findings indicated that KC occurred 2.4 more times after the intervention compared to before (p = 0.001). Descriptive data revealed that KC episodes for intubated patients nearly doubled after implementation (11.1% from 6.2%). Post-survey scores for nursing knowledge and comfort level also improved after the intervention. Although earlier KC practice was non-conclusive (p = 0.082), future trials should control groups for day of life since admission. Disseminating the KC pathway can have a positive social change on family-centered care by increasing NICU nurses' knowledge, comfort, and adoption of this evidence-based practice as an expected routine standard of care.
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Brundage, Janice Kay. "Maternal attachment in the neonatal intensive care unit." Diss., The University of Arizona, 1987. http://hdl.handle.net/10150/184255.
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The purpose of this study was to describe the phenomenon of maternal attachment as it specifically relates to moderate premature delivery. The study investigated the impact of educational, counseling and therapeutic interventions on mothers who delivered premature infants. Research hypotheses were that mothers who participated in the treatment group would demonstrate significant increases in the independent variables of self esteem, social networking and family function strategies. This study also hypothesized that there would be a significant positive relationship between treatment and the dependent variable of maternal attachment. The sample consisted of 30 mother-infant dyads between the ages of 15 and 38 years of age. Infants' gestational age ranged from 32 to 36 weeks. Data were gathered using three measures: (1) a demographic profile of the subjects; (2) a questionnaire including the Tennessee Self Concept Scale, Sarason's Life Event Survey, Norbeck's Social Support Questionnaire, Feetham's Family Function Index; and (3) Barnard's Nursing Child Assessment Feeding Scale (NCAFS). The research study consisted of a field experiment. Fifteen subjects were assigned to the experimental and control group via a modified randomized block procedure. A questionnaire was issued during infant's hospitalization and at 4 months post infant discharge from the hospital to measure the independent variable. The dependent variable was measured at 1 month, 2-1/2 months and 4 months using the NCAFS. Treatment consisted of a minimum of seven sessions during the infant's hospitalization and discharge to home. Statistical analyses were conducted in the form of frequency distributions, means, standard deviations, t-tests and correlation scores. Stepwise multiple regression techniques were used for predictor variables. Results indicated that mothers who participated in the treatment group demonstrated significantly improved maternal attachment processes than those mothers who did not receive intervention. The results did not indicate that there was a significant difference between the two groups on self esteem, social support, life events or family function. Implications for the study were noted. Recommendations for medical and mental health practitioners and future areas of research were discussed.
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Chudleigh, Jane. "Infection control in the neonatal intensive care unit." Thesis, London South Bank University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.618660.
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The literature review highlighted the continuing problem of hospital acquired infection. This study examined this problem in depth, in a high-risk area, the Neonatal Intensive Care Unit. A multi-centre study was conducted using multi-methods in order to capture data regarding nurses' infection control practices in neonatal units. Ninety nurses/ nursery nurses from six neonatal units were included in the study. Non-participant observation was used to investigate nurses' existing infection control practices, interviews were used to explore nurses' opinions of infection control, questionnaires were used to collect demographic data about the sample and assess nurses' knowledge of infection control issues and a Likert-type scale was developed to investigate the unit atmosphere/environment. Microbiological laboratory work was undertaken to compare the efficacies of three products (soap, alcohol hand rub and chlorhexidine) at removing/reducing the numbers of bacteria found on the hands. The effectiveness of gloves at preventing contamination of the hands was also assessed. Finally, the numbers of bacteria recovered from the hands of university administrative staff and nurses were compared to determine whether or not nurses had higher numbers of bacteria on their hands due to the number of organisms they are exposed to and their increased frequency of hand hygiene. Overall, nurses' hand hygiene practices were found to be relatively poor. However, there was some evidence that length of shift, as a proxy indicator of fatigue, and unit atmosphere/environment may influence nurses' infection control practices. Opinions and knowledge were not associated with observed practice. Nursery nurses had lower hand hygiene scores and knowledge scores than nurses and increased experience in the neonatal unit was associated with increased infection control knowledge. The number of bacteria recovered from the hands of nurses was significantly higher than the numbers of bacteria recovered from the hands of administrative staff. In the clinical setting, chlorhexidine was found to be the only product that consistently removed significant numbers of bacteria from the hands. Indeed, the alcohol hand rub was found to increase the numbers of bacteria on the hands. The number of bacteria recovered from the hands did not differ when gloves were worn. This suggests the inside of gloves may be providing a medium for the multiplication of bacteria. However, the number of bacteria recovered from the surface of used gloves was significantly lower than the numbers of bacteria recovered from nurses' hands after nursing activities. The use of gloves for all procedures on the neonatal unit may be advantageous.
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Phillips, Raylene May. "Supporting parents in the neonatal intensive care unit." CSUSB ScholarWorks, 1996. https://scholarworks.lib.csusb.edu/etd-project/1163.
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Probst, Piper. "Alarm Safety in a Regional Neonatal Intensive Care Unit." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1655.
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Alarm fatigue is a practice problem that applies to hospitalized patients and the nurses who care for them. Addressing alarm fatigue is important to promote alarm safety and to decrease the risk of patient harm or death. The purpose of this study was to decrease alarm fatigue and improve alarm safety in a regional neonatal intensive care unit (RNICU). Guided by the conceptual model for alarm fatigue and alarm safety, this study addressed whether or not alarm management protocols designed to decrease false and nuisance alarms in the physiological monitoring of neonates improve alarm safety via decreased alarm burden and alarm fatigue as evidenced by statistically significant reductions in false and nuisance alarms. A quantitative, time series quasi-experimental design was used with 4 waves of data collection. One wave was baseline data collected preintervention, and 3 waves of data were postprotocol implementation to obtain an initial indication of sustainability. Alarm observation data collection sheets were developed and used to track numbers and types of alarms pre- and post-protocol implementation. The data analysis showed statistically significant decreases in both false alarms and nuisance alarms related to the physiological monitoring protocol and lead changing protocol. Overall, high protocol adherence was noted, and the total number of alarms per hour per bed was reduced by 42% (p < .001), 46% (p < .001), and 50% (p < .001) from baseline at Weeks 2, 4, and 6, respectively. Implications from this study include impact on practice and policy, direction for future study, and a call for social change to promote alarm safety in the care of neonates.
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Ferreira, Josà Hernevides Pontes. "Team perception of nursing care humanized in intensive care unit neonatal." Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=16481.
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CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel SuperiorHospitalization of the newborn is necessary when health conditions require immediate assistance for their recovery. Humanized actions in the neonatal unit have been developed in order to make it less painful separation parent-child when it needs technological support and team of trained professionals. It was aimed to analyze the perception and knowledge of the nursing team on the promotion of humanized care for newborn in a Neonatal Intensive Care Unit . It is a qualitative study conducted in a public hospital, large, tertiary level, in Fortaleza, Brazil, in the months October and November 2015, after approval by the Research Ethics Committee, under Protocol N. 1,191,339. The subjects were 14 nurses and 20 nursing technicians working in neonatal care. The data collected through semi-structured interviews consist identification data and five guiding issues that permeate the knowledge of the nursing team about the care and promotion of humanized care in the UTIN. In addition, we used no-participant observation and field diary. For analysis, we sought to Bardin technique that extracted the three categories lines: âTaking care of the human personâ, ânursing contributions to the humane careâ and âFactors that affect the quality of humanized care.â The results showed that the nursing team understands humanization as an indispensable element for the comprehensive care to the baby and family, which was observed from the speeches of welcome, restoring health and disease of the newborn process. The professionals had knowledge of the humanized care, played their actions conscious, oriented and appreciative way about the quality of neonatal care and parents who face the challenges inherent in the admission process. We conclude that the performance of these professionals permeates compliance with the regulations of the National Humanization Policy regarding humanized care to the newborn, family and neonatal ambience. It is believed that such actions minimize the impact caused by the characteristics of the disease treatment as well as stressors.
A hospitalizaÃÃo do recÃm-nascido faz-se necessÃria, quando as condiÃÃes de saÃde requerem assistÃncia imediata para o seu restabelecimento. As aÃÃes humanizadas na unidade neonatal tÃm sido desenvolvidas, a fim de tornar menos dolorosa à separaÃÃo pais-filho, quando este necessita de suporte tecnolÃgico e equipe de profissionais capacitados. Objetivou-se analisar a percepÃÃo e conhecimentos da equipe de enfermagem sobre a promoÃÃo do cuidado humanizado ao recÃm-nascido internado na Unidade de Terapia Intensiva Neonatal (UTIN). Trata-se de estudo qualitativo, realizado em hospital pÃblico, de grande porte, nÃvel terciÃrio, em Fortaleza-CE-Brasil, nos meses outubro e novembro de 2015, apÃs aprovaÃÃo pelo Comità de Ãtica em Pesquisa, sob Protocolo n 1.191.339. Os sujeitos foram 14 enfermeiros e 20 tÃcnicos de enfermagem atuantes na assistÃncia ao neonato. Os dados coletados, por meio de entrevista semiestruturada, consistem dados de identificaÃÃo e cinco questÃes norteadoras, que permeiam o conhecimento da equipe de enfermagem acerca do cuidado e a promoÃÃo da assistÃncia humanizada na UTIN. Ademais, utilizou-se observaÃÃo nÃo participante e diÃrio de campo. Para anÃlise, sÃntese e descriÃÃo, buscou-se a tÃcnica de Bardin, que se extraÃram das falas trÃs categorias: âCuidar do ser humanoâ, âContribuiÃÃes de enfermagem para o cuidado humanizadoâ e âFatores que interferem na qualidade do cuidado humanizadoâ. Os resultados revelaram que a equipe de enfermagem compreende a humanizaÃÃo como elemento indispensÃvel para o cuidado integral ao bebà e famÃlia, o que se observou desde as intervenÃÃes de acolhimento, ao restabelecimento do processo saÃde-doenÃa do neonato. Os profissionais apresentaram conhecimentos acerca do cuidado humanizado, desempenharam suas aÃÃes de forma consciente, orientada e sensibilizada, quanto à qualidade da assistÃncia ao neonato e aos pais que enfrentam os desafios inerentes ao processo de internaÃÃo. Percebe-se, portanto, que a atuaÃÃo desses profissionais permeia o cumprimento aos regulamentos da PolÃtica Nacional de HumanizaÃÃo. Conclui-se que o cuidado humanizado aplicado nessa ambiÃncia à essencial ao recÃm-nascido e famÃlia, uma vez que minimiza o impacto causado pelas caracterÃsticas da doenÃa, tratamento, bem como os fatores estressantes da UTIN.
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de, la Cruz-Schmedel Dorothy. "Neonate psychophysiological responses to ambient features of the neonatal intensive care unit." Scholarly Commons, 1989. https://scholarlycommons.pacific.edu/uop_etds/549.
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Hospital treatment environments have become a major concern in recent years. Noise and illumination are potential stress sources in hospitals. The purpose ofthis study was to examine the effects of hospital noise levels and ambient illumination on newborn infants (neonates). Noise levels and lighting were varied and the effect upon neonatal heart rate, respiration rate, blood pressure, and oxygen consumption were measured. These measures are sensitive tosympathetic nervous system reactivity such as that brought about by stressful environments. In addition, noise and lighting levels were measured to determine if differences existed across conditions. Psychophysiological responses to various noise and lighting levels varied within and across neonates with some changes in the expected direction. Some unexpected results of Quiet Time were noted among neonatal intensive care staff and hospital personnel.
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Oraka, Ebele. "Early Detection of Neonatal Abstinence Syndrome by Neonatal Intensive Care Unit Nurses." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5580.
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Neonatal abstinence syndrome (NAS) is a public health concern that is increasing in the United States due to the use of illicit drugs by pregnant women, which exposes the fetus to these substances. NAS results in increased infant morbidity and prolonged stay in the hospital, which can lead to increased cost of care. The inability of the nurses to care for at-risk infants can lead to inconsistent NAS scores, which can affect the infant's care treatment. The project examined the effectiveness of educating the neonatal intensive care unit (NICU) nurses on the correct use of the modified Finnegan Neonatal Abstinence Tool (FNAST) and implementing a practice protocol in the management of infants experiencing NAS, thereby reducing inconsistencies in NAS scores. Implementing clinical guidelines and proper use of the modified FNAST can lead to early intervention and treatment of infants exhibiting withdrawal symptoms. An educational session was conducted, pretests and posttests were used to evaluate the NICU nurses' baseline knowledge of the correct use of the modified FNAST and their acquired knowledge after the educational intervention on the correct use of the modified FNAST. The goal of the project was met with the NICU nurses experiencing knowledge gain evidenced by a 30% increase between the pretests and posttests and obtaining consistent NAS scores by applying the correct technique of scoring. The mastery of the use of the modified FNAST brought about social change by impacting positive attitudes and behaviors among the NICU nurses and enhancing collaboration between the physicians and nurses.
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Nathan, Lisa. "Noise levels in a neonatal intensive care unit in the Cape Metropole." Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/2339.
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Thesis (MScMedSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2007.Noise is a noxious stimulus with possible negative physiological effects on the infant, especially in the Neonatal Intensive Care Unit (NICU). The present study conducted a detailed noise assessment in a NICU of a state hospital in the Cape Metropole and documented 6 infants’ physiological responses to noise levels. Noise levels ranged from 62.3-66.7dBA (LAeq), which exceed all American and British standards (50dBA -60dBA) for a NICU. Continuous exposure to noise of these levels is potentially harmful to the infants’ auditory system and health stability. The general well-being of the staff working in the NICU may also be compromised. Analysis of the noise events revealed that staff conversations were the largest single contributor to the number of noise events, while the largest single non-human contributor was the alarm noise of the monitors. No significant correlations were found between the heart rates and noise levels and the respiratory rates and the noise levels for any of the participants in either room. The NICU was found to be an extremely reverberant environment, which suggested that the NICU noise levels were largely a result of reverberant noise reinforcements. NICU nursing staff’s most common suggestion for noise abatement strategies was reduction of staff conversation. Results of this study highlight the need for NICU noise abatement to optimise newborn patient care, reduce the risk of acoustic trauma and to improve the neonate’s quality of life, thus enhancing the infant’s physiologic stability, growth and health.
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Steedman, Wendy Kate. "Stress experienced by parents from the neonatal intensive care unit." Thesis, University of Canterbury. Psychology, 2007. http://hdl.handle.net/10092/2781.
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The psychometric properties of this Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) were assessed, before using the scale to describe stress experienced by parents in a Neonatal Intensive Care Unit (NICU). The extent to which parental stress from the parent-infant relationship in the unit was linked to parenting they received as a child, and adjustment to their couple relationship, was also examined. The sample consisted of 182 mothers and 183 fathers, who were in a cohabitating relationship, of infants from the NICU at Christchurch Women's Hospital. The self-report questionnaires included the PSS:NICU, Parental Bonding Instrument, and the Dyadic Adjustment Scale, and were administered to parents within 2-3 weeks of their infant's birth. This study extends the finding of satisfactory psychometric properties of the PSS:NICU (Franck, Cox, Allen & Winter, 2005; Miles, Funk & Carlson, 1993; Reid & Bramwell, 2003) to this New Zealand sample. Mothers experienced significantly higher stress from the unit compared to fathers (p < .01). A previous finding, for mothers, of the parent-infant relationship being the most stressful aspect of the unit (Franck et al., 2005; Reid & Bramwell, 2003; Shields-Poe & Pinelli, 1997) extends to the New Zealand sample. The most stressful aspect of the unit for fathers was sights and sounds. Lack of evidence was found for associations between parental stress from the parent-infant relationship in the unit and parenting received as a child, or adjustment to their couple relationship. A weak but significant negative correlation was, however, found between stress from the mother-infant relationship and maternal care received in childhood. It is unnecessary to provide all parents with intervention further to what is already being practiced in the unit, as overall low levels of stress were reported. Some parents, however, did find the unit more stressful, and they may benefit from increased intervention.
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Fabrize, Lauren E. "Neonatal Intensive Care Unit Speech-Language Pathologists’ Perceptions of Infants with Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/100.
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Neonatal abstinence syndrome (NAS) refers to the withdrawal infants exposed to opioids in utero may experience following birth. In recent years, the number of infants born who present with NAS has grown exponentially. This increase in the number of infants with NAS has led to a new population within the caseloads of speech-language pathologists (SLPs) who work in neonatal intensive care units (NICUs). SLPs’ knowledge base and skill set of assessment and treatment of swallowing and feeding disorders in infancy play a vital role in the treatment of infants with NAS in the NICU. A dearth of research exists regarding the specific nature of the feeding problems and skills of infants with NAS and whether SLP intervention for infants with NAS needs to differ from that of other infant NICU populations. Identifying how SLPs can best serve infants with NAS in the NICU is essential to their immediate well-being as well as the development of these infants. The purpose of this survey-based research study was to examine NICU SLPs’ perceptions of infants with NAS, and more specifically, how NAS affects the infants’ feeding skills, structural, and oral-motor characteristics. A questionnaire was developed based on an in-depth literature review to collect information on NAS, caseloads, treatment environment, and respondent demographics. The survey consisted of three sections: NAS (further divided into Assessment, Treatment, and Education), Environmental Description, and Respondent Demographics. The secure web-based questionnaire was distributed through SurveyMonkey™, an online survey platform. Survey research was conducted, and hospital-based speech-language pathologists within the USA acted as respondents. The findings will contribute to establishing a preliminary base of information on this topic. The results are expected to further inform the field as well as current practices in evidenced-based practice care for infants with NAS.
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Fabrize, Lauren. "Neonatal Intensive Care Unit Speech-Language Pathologists’ Perceptions of Infants with Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etd/3638.
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Objective: The purpose of this study was to determine the characteristics, assessment, and treatment of infants with Neonatal Abstinence Syndrome (NAS) as perceived by Speech-Language Pathologists (SLP) and whether it differed from those of other Neonatal Intensive Care Unit populations.
Methods: A secure web-based questionnaire with 62 questions collected information on NAS, caseloads, treatment environment, and demographics. Twenty-six respondents initiated the survey; 42% completed most or all questions. Response analyses included descriptive and nonparametric inferential statistics.
Results: Infants with NAS were on the caseloads of 73% of respondents. The majority (79%) only saw infants with NAS and feeding problems. Primary problems included incomplete or increased time to complete feeds, increased/excessive/irregular sucking rates, and reflux. Working on teams, respondents provided assessment, treatment, and education of infant feeding and state.
Conclusion: Growing demand for SLP intervention with infants with NAS is likely to persist if opioid use continues to increase as projected.
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Fabrize, Lauren, Kerry Proctor-Williams, and Brenda Louw. "Neonatal Intensive Care Unit Speech-Language Pathologists’ Perception of Infants With Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7755.
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This survey research explores neonatal intensive care unit speech-language pathologists’ perceptions of infants with neonatal abstinence syndrome; specifically, how NAS affects infants’ feeding skills, along with structural and oral-motor characteristics. The findings of this research will contribute to this population’s information base. The results are expected to inform the field and current evidence-based practice care for infants with NAS.Learner Outcome(s): Explain Neonatal Abstinence Syndrome (NAS) Describe infants with NAS and how NAS affects the infants’ feeding skills from the perspective of Neonatal Intensive Care Unit (NICU) Speech-Language Pathologists (SLPs) Identify how SLPs in the NICU participate in intervention for infants with NAS and their families
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Petteys, Annie R. "Effects of neonatal palliative care consultation on parental stress of patients in the neonatal intensive care unit." Thesis, California State University, Long Beach, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1522646.
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The hospitalization of one's infant is a stressful situation that can lead to decreased bonding and poor health outcomes. This longitudinal comparative design study examined the effects of neonatal palliative care (PC) consultation on stress levels and satisfaction scores of parents of neonatal intensive care unit (NICU) infants. Clinical data was abstracted from the medical record. Demographic data, stress scores, and satisfaction reports were obtained via self-report.
Mean stress scores indicated most parents experienced moderate stress due to NICU hospitalization. Some parents met diagnostic criteria for acute stress disorder. While all parents expressed satisfaction with care received; PC parents were extremely satisfied with care. No statistically significant differences in stress or satisfaction scores were noted between parents who received PC consultation and those who did not. Study conclusions validate previous research regarding NICU parent stress and show that additional quantitative and qualitative research regarding NICU palliative care is warranted.
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Lovejoy-Bluem, Arlene. "Neonatal Intensive Care Unit Discharge Transitioning| Nursing Practices, Perspectives, and Perceptions." Thesis, Brandman University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3665293.
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The American Academy of Pediatrics (AAP) delineated four criteria for management of perinatal care and discharge (DC) of high-risk neonates: 1) physiological stability, 2) tracking and surveillance of growth and development for each infant, 3) active parental involvement with the infant's care, and 4) follow-up care arranged with experienced primary care provider. Registered Nurses in California Neonatal Intensive Care Units (NICUs) were surveyed about NICU DC transitioning programs to 1) identify current common standards of care used in DC transitioning and 2) define the nature and extent of additional criteria and procedures used in DC transitioning. Useable surveys were obtained from 32 of the 79 facilities queried (41%): 17 (53%) Level II, 10 (31%) Level III, and 5 (16%) Level IV. All responding facilities were located in communities of 100,000 people or more. All but one of the facilities (97%) used all four AAP criteria for determining readiness for DC. Facilities differed in whether they also used weight, corrected gestational age, or both as criteria for DC. They differed in the definition of active parental involvement with care, the degree to which parents participated in DC planning, who arranged for post-DC primary care, and how outcomes of DC planning practices were evaluated. Profiles derived from these data can be used to expand procedures, guidelines, and policies for DC transitioning of the NICU graduate.
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Rowland, Emily. "Influences of the Neonatal Intensive Care Unit Microsystem on Mothers' Experiences." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32418.
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The goal of this project was to explore mothers’ experiences of caring for infants in the Neonatal Intensive Care Unit (NICU) using a microsystem perspective. This perspective focuses on the structure, processes and people and in so doing allows for a critical exploration of how these elements work together to influence mothers in the NICU. The research framework involved an institutional ethnography to explore care delivery, relationships, and discourses in the NICU. Data was collected using nonparticipant-observations, interviews, and collection of discourse artifacts. There is clear evidence that caring for an infant in the NICU can result in significant increases in maternal stress and associated outcomes. Results from triangulation of the data indicated that being separated from the infant and learning to mother in the unit were particularly salient experiences retold by the mothers. These experiences were affected – either positively or negatively – by different elements of the microsystem including consistency in communications, increased opportunities for mothers’ inclusion in decision-making and infant care and lastly, access to more support resources. Implementing improvements to the microsystem could better empower mothers adjusting to parenthood within the NICU context.
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Lawhon, Gretchen. "Facilitation of parenting within the newborn intensive care unit /." Thesis, Connect to this title online; UW restricted, 1994. http://hdl.handle.net/1773/7195.
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Ponto, Jamie. "The role of the physiotherapist in the neonatal intensive care unit: perceptions from neonatal healthcare professionals." University of the Western Cape, 2020. http://hdl.handle.net/11394/7570.
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Magister Scientiae (Physiotherapy) - MSc(Physio)Background: The role of the physiotherapist in the neonatal intensive care unit is unclear. How other neonatal healthcare professionals and physiotherapists themselves perceive their role in the management of neonates, their practice patterns and services, their role in the neonatal intensive care multidisciplinary team, their use of evidence-based practice and awareness of the profession in this setting has not been well explored. This information is lacking in the South African healthcare context as well. Therefore, the aim of the study was to explore and describe the perception of doctors, nurses and physiotherapists of the role of the physiotherapist in public and private sector neonatal intensive care units in South Africa. Methods: A qualitative exploratory research design was used. All medical practitioners (paediatricians and neonatologists), nurses and physiotherapists working in the neonatal intensive care units in two private sector and two public sector hospitals in the Cape Metropole region in the Western Cape South Africa who provided consent to participate were included. An inclusive (total population) sampling method was used where all healthcare professionals working in these units were invited to an individual face-to-face audiotaped interview using a semi-structured interview guide and conducted by the researcher at a time and place convenient to the participants following informed consent. Data was transcribed verbatim and analysed using both deductive and inductive thematic content analysis to develop codes, categories and themes. Trustworthiness was ensured by ensuring credibility, conformability, dependability and transferability of data. Ethics was obtained from the relevant Institutional Review Board. Results: Twenty-one healthcare professionals participated, including doctors (n=5), nurses (n=6) and physiotherapists (n=10). The mean age in years of the participants was 41+/–11 years with the physiotherapists having the lowest mean age. The participants had various years of general and neonatal intensive care experience and physiotherapists in specific only had basic undergraduate qualifications with minimal specialised training in neonatal intensive care. Five major themes emerged namely: i) the role of the physiotherapists in the management of the neonatal ICU patient, ii) practice patterns and services iii) teamwork iv) training and qualifications including evidence-based practice, v) awareness of and exposure to neonatal intensive care physiotherapy. Conclusion: Physiotherapists working in this neonatal intensive care setting need to promote their profession through education of other neonatal healthcare professionals in order to improve awareness, referral patterns and integration into the multidisciplinary team. Evidence-based practices and improving training and skills development in the area of neonatal physiotherapy can be further explored in this setting.
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Romesberg, Tricia L. "Midline Catheter Use in the Newborn Intensive Care Unit." UNF Digital Commons, 2014. http://digitalcommons.unf.edu/etd/544.
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Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs.
The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the use of MC use in the NICU, there is a wide range of practice pertaining to MC unit-specific protocols, competencies, success with placement, and clinician agreement of appropriate use for this vascular access device (VAD). Multicenter, randomized control trials are needed to evaluate current MC practice in the NICU, and institutions must incorporates current, evidence based practice into policies, procedures, and guidelines.
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McCanless, Lauri Lynn. "A SIBLING'S-EYE VIEW OF THE NEWBORN'S NEONATAL INTENSIVE CARE UNIT HOSPITALIZATION." Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/275267.
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Matsumoto, Maya. "Improving the Timing of Bilirubin Screening in the Neonatal Intensive Care Unit." Scholarship @ Claremont, 2018. http://scholarship.claremont.edu/cmc_theses/1976.
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Background
Hyperbilirubinemia is a condition that affects most infants, but typically self-resolves and is not harmful. However, if bilirubin levels exceed neuroprotective defenses, the compound can cross the blood-brain barrier and have neurotoxic and potentially fatal effects. Treatment of neonatal hyperbilirubinemia with phototherapy is necessary for the prevention of kernicterus. Guidelines for the use of phototherapy in infants born at ≥ 35 weeks’ gestation were published by Bhutani et al. and endorsed by the American Academy of Pediatrics. Consensus-based recommendations for phototherapy treatment and exchange transfusion of premature infants were published in 2012 by Maisels, et al. However, there are no published recommendations for the timing of screening for hyperbilirubinemia in NICU patients. In 2012, the Kapʻiolani Medical Center for Women & Children Neonatology Division implemented internal guidelines for phototherapy with recommendations for the timing of screening serum bilirubin levels, based on the group’s opinion. Five years later, the current study queried whether these guidelines for screening were appropriate.
Objective
The present study sought to describe current practices of obtaining serum bilirubin levels and the use of phototherapy in the NICU during the first five days of life. It was hypothesized that many bilirubin levels obtained at ≤ 48 hours of life are below published recommended treatment thresholds and are potentially unnecessary.
Methods
Retrospective chart review was performed on all infants admitted to the NICU at
< 24 hours of life, from July 2016-June 2017. Eligible infants were divided into three gestation age groups: ≤ 28, 29-35, and ≥ 36 weeks at birth. Patient demographics, bilirubin levels, and phototherapy treatment were noted. The primary outcome of interest was the percent of serum bilirubin levels obtained during the first 48 hours of life that did not meet phototherapy treatment criteria.
Results
931 charts were reviewed. Infants born at ≤ 28, 29-35 and ≥ 36 weeks’ gestation made up 10%, 51% and 39% of the cohort. Overall mortality was 3%, and no exchange transfusions were performed during the study period. At least one serum bilirubin level was obtained for 96% of the patients, but only 55% were treated with phototherapy within the first five days of life. Phototherapy was rarely prescribed on day of life (DOL) 1 (0.7%). By DOL 2, a total of 563 bilirubin levels were obtained, but only 108 infants (19%) were treated with phototherapy. However, one-third of these patients’ bilirubin levels did not meet published criteria for treatment. The timing of phototherapy treatment varied by gestational age. Ninety percent of infants born ≤ 28 weeks’ gestation who received phototherapy were treated starting between DOL 2-3. In contrast, eighty-five percent of infants born ≥ 29 weeks’ gestation who received phototherapy, started on DOL 3-5.
Discussion
Far more bilirubin levels were obtained than courses of phototherapy prescribed. Given the distinct patterns of phototherapy for infants of varying gestational age, there is ample opportunity to improve resource utilization with targeted recommendations for obtaining screening bilirubin levels in the neonate without early jaundice.
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Karl, Bethany C. "The Importance of Child Life Within the Neonatal Intensive Care Unit (NICU)." Ohio University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1428577797.
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Lewis, Lory A. "Nursing Care Procedures, Thermal Regulation and Growth of the Moderately Premature Neonate in the Neonatal Intensive Care Unit." Kent State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=kent1405595920.
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Oliveira, NeulÃnio Francisco de. "Terminalidade em UTI PediÃtrica e Neonatal: prÃticas mÃdicas que antecedem o Ãbito em um hospital de referÃncia do Nordeste Brasileiro." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12419.
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nÃo hÃMudanÃas que aconteceram no sÃculo XX, permitiram que avanÃos tecnolÃgicos aumentassem a sobrevida diante de doenÃas anteriormente incurÃveis e processos patolÃgicos irreversÃveis. No entanto, a busca incessante pela cura, alÃm de levar ao aumento da sobrevida, tambÃm gerou a obstinaÃÃo terapÃutica, ou seja, medidas terapÃuticas fÃteis diante de evoluÃÃo inexorÃvel para a morte, impactando em indicadores como Ãndice de satisfaÃÃo do cliente e cuidadores, tempo mÃdio de permanÃncia, elevaÃÃo de custos, bem como em prejuÃzo na distribuiÃÃo equitativa de recursos. No inÃcio dos anos 90, a limitaÃÃo do suporte de vida (LSV) comeÃou a ser estudada e considerada, em paÃses da Europa, Estados Unidos, Canadà e Austrlia, como forma de assistir os pacientes nesses casos, uma vez que as medidas terapÃuticas nÃo mais trariam benefÃcios, mas gerariam prolongamento do sofrimento e do processo de morrer. No Brasil, contudo, os estudos sÃo limitados e os dados referentes ao Nordeste do paÃs sÃo ainda muito escassos. O objetivo do estudo foi caracterizar as condutas mÃdicas que antecederam o Ãbito de pacientes em UTI pediÃtrica e neonatal em um hospital de referÃncia do Nordeste Brasileiro. Foram estudados 86 prontuÃrios de pacientes que morreram nas referidas UTIs no perÃodo de dezembro/09 a novembro/10. Apenas 3,5% dos Ãbitos ocorreram apÃs LSV registrada em prontuÃrio, destes 33,7% tinham doenÃa crÃnica associada, sendo as neoplasias as mais comuns. As causas de Ãbito mais comuns foram sepse (23,5%), falÃncia de mÃltiplos ÃrgÃos (18,8%), insuficiÃncia respiratÃria (12,9%), cardiopatias congÃnitas (8,2%) e as outras causas somaram 36,6%. A maior parte dos pacientes morreu apÃs aumento das medidas de suporte avanÃado de vida, considerando as ultimas 24h antes do Ãbito: drogas vasoativas (59,3% 24h antes e 70,9% no momento do Ãbito); VentilaÃÃo mecÃnica (89,5% 24h antes e 95,2% no momento do Ãbito). Enquanto as medidas de cuidados e conforto nÃo tiveram a mesma expressÃo, tendo um aumento irrelevante: sedaÃÃo (39,5% 24h antes e 43% no momento do Ãbito); analgesia (60% 24h antes e 60,5% no momento do Ãbito). As manobras de ressuscitaÃÃo cardiopulmonar foram registradas em 4,7% 48h antes do Ãbito, 29,1% 24h antes e 69,4% no momento do Ãbito. O uso de adrenalina foi registrado em 55,4% antes do Ãbito. Conclui-se que a LSV ainda nÃo à frequentemente considerada como uma alternativa de assistÃncia de final de vida a pacientes pediÃtricos e neonatais no Estado do CearÃ, onde as condutas mais prevalentes incluem o incremento do suporte avanÃado de vida em detrimento das medidas de conforto e cuidados paliativos. Comparando-se com estudos do Sul e Sudeste do paÃs, evidencia-se uma grande diferenÃa, onde se observam uma maior prevalÃncia de LSV e cuidados paliativos para pacientes em fase terminal, o que denota prÃticas mais humanas e de maior qualidade na assistÃncia.
Changes around the world at the XX century allowed new technologies to improve the possibilities of surviving in so many cases of sickness that were incurable before. Besides the benefits it brought, other consequences have come together specially futility, in other words futile therapeutic measures when the cure is impossible and the death is inevitable. These facts have influence in client satisfaction, lengh of stay and costs elevation. Since 1990 life support limitation (LSL) started to be considered in Europe, United States, Canada and Austrlia to assist patients in terminal conditions to whom curative practices wouldnât bring any benefit. In Brazil there is a limited number of studies and the data from the Northeastern are even less. The aim of this study was to describe the medical practices before death in patients in PICU and NICU at a reference pediatric hospital in Brazilian Northeastern. Data were collected from 86 medical charts. Only 3.5% of LSL was registered. 33.7% of patients had some chronic disease and neoplasic ones were more comons. The main causes of death were: sepsis (23.5%), MDOS (18.8%), respiratory failure (12.9%), congenital heart disease (8.2%) and the other causes 36.6% together. Most of patients died after increment in vasoatives administration, considering the final 24 hours before death (59.3% 24h before, 70.9% at the momento of death). Mechanical ventilation (89.5% 24h before, 95.2% at the moment). In the other hand palliative care and pain control were not so frequent as could be expected: sedative (39.5 24h before, 43% at the moment) analgesic (60% 24h before, 60.5% at the moment). CPR was offered in 4.7% of patients 48h before death, 29.1% 24h before and 69.4% at the moment of death. Adrenaline was used in 55.4% at the moment of death. These data show that LSL is not a frequente alternative to assist terminal patients at PICU and NICU in Brazilian Northeastern, where more prevalent practices are to maintain life support instead of offer palliative care and pain control. At Southern and Southeastern practice include LSL and palliative care more frequently, what suggests better practices of the end-of-life care.
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Stanley, Leisa J. "Association among neonatal mortality, weekend or nighttime admissions and staffing in a Neonatal Intensive Care Unit." [Tampa, Fla.] : University of South Florida, 2008. http://purl.fcla.edu/usf/dc/et/SFE0002421.
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Ndango, Immaculate Nyonka. "Parents’ perception of nursing support in neonatal intensive care units in private hospitals in the Western Cape." University of the Western Cape, 2018. http://hdl.handle.net/11394/6867.
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Magister Curationis - MCurParents undergo negative experiences that include parental anxiety, depression, and posttraumatic stress when their new-born babies are hospitalised in neonatal intensive care unit. During this stressful period, parents need assistance from staff in order to cope. A quantitative, descriptive survey design was used to describe parents’ perception of nursing support during their baby’s admission in neonatal intensive care units (NICU) at three selected private hospitals in the city of Cape Town in the Western Cape Province. A structured existing 21- item Likert type questionnaire, the Nurse-Parent Support Tool (NPST) was used to collect data from an all-inclusive sample of 85 parents with a response rate of 78.8% (n=67). The purpose of the questionnaire was to determine their perception of information giving and communication by nurses; emotionally supportive behaviours by nurses; care given support or instrumental support and to identify parents’ perception of esteem or appraisal support while in the NICU environment. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24. The findings of this study suggested that the overall mean score for parents’ perception of nursing support was high 4.6 (±0.5) out of a possible of 5. There was no significant difference in the overall mean perceived support score between the different facilities. No significant differences were found in terms of all the demographics characteristics with regard to perceptions of the support that was received, thus indicating that there was no relationship between the demographic variables and perception of support. The findings suggested that though high parental support was reported, the area of involving parents in the care of their babies i.e. letting them decide whether to stay or leave during procedures need improvement.
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Farr, Shirley Marie. "A developmental care program in the Neonatal Intensive Care Unit at Arrowhead Regional Medical Center." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2741.
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Fernandez, Maria Isabel. "Comparison of perceived needs of mothers of neonates and nurses in the neonatal intensive care unit." FIU Digital Commons, 1996. http://digitalcommons.fiu.edu/etd/3298.
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The transition to motherhood is not easy for any new parent but it is especially difficult for the mother of an infant in the Neonatal Intensive Care Unit (NICU). There may be instances in the NICU where the nurses' perception of maternal needs may be incongruent with the mother's perception. Many NICU nurses focus on the physical needs of infants such as cardiorespirartory monitoring, mechanical ventilator support, and I.V. therapy. Mothers may instead be focused on their own need for emotional and psychological support.
This study investigated the differences and similarities regarding maternal needs as perceived by the mothers and NICU nurses. A 30 item questionnaire called the Perceived Needs of Family Members of Critically Ill Patients (Norris and Grove, 1986) was given to a group of mothers and a group of NICU nurses. The instrument consists of "needs" statements which are ranked on a Likert Scale from "very important" to "not important". The rankings by mothers and the rankings by nurses were compared.
The results of this study demonstrated that the mothers' perceptions and the nurses perceptions of maternal needs were similar in most instances, althought there were some differences. Therefore, it is important that the mothers' needs are accurately identified so that nursing interventions can be developed to meet them.
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Flaherty, Lauren E. "Effectiveness of nonpharmacological techniques for procedural analgesia in the neonatal intensive care unit." Honors in the Major Thesis, University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/380.
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The purpose of this thesis is to provide a critical analysis of research findings about nonpharmacological techniques used independently of pharmacological techniques to prevent or reduce procedural pain for infants in the neonatal intensive care unit (NICU). A synthesis of the current research related to nonpharmacological pain relief techniques for infants was conducted for this thesis. Nonpharmacological interventions reviewed in this study include: Kangaroo Care, swaddling, facilitated tucking, positioning, music, non-nutritive sucking and sucrose. An interdisciplinary review of the research was performed using the interdisciplinary databases Cumulative Index of Nursing and Allied Health, PubMED, and PsychINFO. Inclusion criteria for this thesis consists of research focused on preterm neonates (born less than] 37 weeks gestational age) in the neonatal intensive care unit, the use of nonpharmacological interventions for procedural analgesia, peer reviewed articles, and those written in the English language. This study excludes full term neonates due to the significant number of preterm neonates in the NICU. A total of 18 studies were included in this review. All interventions except for positioning show statistically significant evidence to support their use to reduce procedural pain in preterm neonates. Findings of this thesis may promote further studies and exploration into this field. In addition, this thesis establishes the role of the nurse in providing pain relief for infants in the NICU, as well as provide for enhancement of interdisciplinary care amongst other health care providers.B.S.N.
Bachelors
Nursing
Nursing
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Wood, Ashley Hodges. "Effects of music therapy on preterm infants in the neonatal intensive care unit." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/wood.pdf.
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Yufei, Gu, and Xiong Shuyan. "Nurse's experience of caring infants in neonatal intensive care unit - A descriptive review." Thesis, Högskolan i Gävle, Avdelningen för vårdvetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-33135.
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WALKER, KATHLEEN HUNTER. "REHOSPITALIZATION OF INFANTS AFTER DISCHARGE FROM A NEONATAL INTENSIVE CARE UNIT: MATERNAL OPINIONS." University of Cincinnati / OhioLINK, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1013690751.
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Thomas, Angeline. "The use of unlicensed and off label drugs in Tygerberg Hospital neonatal intensive care unit." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86722.
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Thesis (MMed)--Stellenbosch University, 2014.ENGLISH ABSTRACT: OBJECTIVE The aim of this study is to establish the frequency of unlicensed and off label drug use in infants admitted to the neonatal intensive care unit (NICU) in Tygerberg Hospital. METHOD This was a prospective descriptive survey conducted over 3 consecutive months (September 2011-November 2011) of all medicine charts of neonates admitted during this time period to the NICU. Data collected included demography, diagnoses, medicines prescribed according to dose, frequency, route of administration and indication. Medicine use was defined as unlicensed, licensed or off label use according to the latest South African Medicines Formulary (2012) and the manufacturer’s package insert. Unlicensed drug use is per definition a drug not registered with South African Medicine Control Council (SA MCC) for children and off label drug use is where the use is outside of its authorized license with SA MCC. RESULTS There were 112 neonates enrolled in the study, of whom 51% were preterm and 49% term infants. The most common diagnoses on admission for the preterm babies were hyaline membrane disease (33%) and sepsis (21%), while it was hypoxic ischemic encephalopathy (42%) and post-operative care (22%) for term infants. There were 759 drug events of which 37% were licensed and followed all the licensing terms, 51% were prescribed in an off label manner and the remaining 12% were of unlicensed drugs. The most common reasons off label drug use were for weight (74%), followed by age (44%), frequency (44%), indication (21%), or a route not described in the licensing terms (13%). There was a lack of pediatric data for 9% of the drugs prescribed. In 203 drug events (27%) a drug was used in an off label manner for more than one reason. Sixty one percent of the drugs used had no information on the use of the drug in neonates. CONCLUSION This is the first study conducted in an African NICU, according to our knowledge and the results are similar to studies conducted in Europe and America. Neonates are exposed to a significant proportion of unlicensed and off label drugs. Neonatal clinical trials should be conducted to address the need for proven safe and efficacious treatment for neonates.
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Tibbs, Jennifer Leigh. "A comparison of attachment in mothers of newborns in a neonatal intensive care unit." Oklahoma City : [s.n.], 2004.
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Souza, Sandra Regina de [UNIFESP]. "Tradução, adaptação cultural e validação para a língua portuguesa da Parenteral Stress Scale:Neonatal Intensive Care Unit (PSS:NICU)." Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/10125.
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Para citação, referenciar também o artigo: Adaptação cultural e validação para a língua portuguesa da Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) (http://repositorio.unifesp.br/handle/11600/6920) conforme determinação da autora.Made available in DSpace on 2015-07-22T20:50:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-24
Introdução: a internação de um recém-nascido na Unidade de Terapia Intensiva Neonatal (UTIN) é um acontecimento inesperado e assustador com o qual os pais não estavam preparados para lidar.Esse evento, que gera sofrimento na família, traz para os profissionais da saúde uma demanda de cuidado, cujo intuito é amenizar as repercussões dessa hospitalização no cotidiano da família. Como enfermeira neonatologista, a autora percebe o estrese dos pais no ambiente neonatal e a necessidade de instrumentos objetivos para identificá-lo e para elaborar as intervenções de enfermagem. No Brasil não encontramos um instrumento para avaliar este tipo de estresse. A escala Parenteral Stress Scale Neonatal Intensive Care Unit(PSS:NICU) é um instrumento desenvolvido por Margaret S. Milles nos Estados Unidos, cuja finalidade é avaliar esse tipo de estresse, tem sido utilizado em vários países. Objetivo: fazer a tradução, a adaptação cultural e a validação da PSS:NICU na língua portugues. Método: fora, utilizadas as etapas de tradução e adaptação cultural proposta Guillemin et al.(1993) que incluem tradução, retradução, análise por um comitê de revisores e preteste da escala. Foi reaizada também análise da confiabilidade por meio do teste e reteste e da consistência interna. Foi feita a validação clínica da versão da escala PSS:NICU na língua portuguesa a uma amostra de 163 país em dois hospitais no Estado de São Paulo.Resultados: a escala na língua portuguesa foi prestada e o nível de compreensão dela foi considerado adequado. A investigação da confiabilidade mostrou boa consistência interna na aplicação a pais brasileiros.Os valores obtidos dos coeficientes de correlação intraclasse ficaram em torno de 0,70, mostrando-se uma boa estabilidade entre as duas avaliações. A análise fatorial pelo método de componentes principais utilizou os mesmos critérios da escala original, com rotação Varimax, que apresentaram grau de variância adequado de 57,9%.Os escores de estresse dos pais foram de 2,3(pouco estressante) na subescala "sons e imagens"; 2,9(moderadamente estressante)na subescala "aparência e comportamento do bebê" e 3,7(muito estressante) na subescala "alteração papel de pais" na métrica 1(Nível de Ocorrência de Estresse")e 2,2; 2,6 e 3,4(pouco, moderadamente e muito estresse) respectivamente na métrica 2(Nível Geral de Estresse").Conclusão: a PSS:NICU na versão em português é uma ferramenta válida e confiável para avaliar o estresse de pais na Unidade de Terapia Intensiva Neonatal.
TEDE
BV UNIFESP: Teses e dissertações
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Korol, Christine T. "Contextual influences on the facial expression of pain in the neonatal intensive care unit." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0020/NQ45177.pdf.
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Stearn, Natalie Anne. "Hearing screening for infants from a neonatal intensive care unit at a state hospital." Diss., Pretoria : [s.n.], 2007. http://upetd.up.ac.za/thesis/available/etd-07212008-131627.
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Pinner, Relaine. "A replication study of neonatal intensive care unit nurses participation in ethical decision making." Virtual Press, 1994. http://liblink.bsu.edu/uhtbin/catkey/917042.
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The purpose of this study was to determine the extent to which Neonatal Intensive Care Unit (NICU) nurses participate in ethical decision making, and to describe the role NICU nurses have in the ethical decision making process.This study replicated a 1991 study conducted by Elizondo. According to Lowe, 1991, replication research is the repeating of a study for the purposes of validating the findings of the original investigation. The traditional theory of utilitarianism provides the theoretical framework for this study, a goal-based approach to ethical decison making that focuses on consequences of actions. Findings provide information about satisfaction and conflicts related to nurse participation in ethical deecision making in the NICU.The Nurse Participation in Ethical Decision Making (NPEDM) questionnaire (Elizondo, 1991) was used for data collection. Of fifty NICU nurses, seventeen (34%) of the sample completed the questionnaire. Confidentiality was maintained. Results showed that all respondents were able to identify methods that are used for participation in ethical decision making. Informal conversations with physicians was identified as the primary method of participation. Forty-one percent of respondents were satisfied with the nurse's role in ethical decision making. Forty-seven percent were only somewhat satisfied.An indication of satisfaction demonstrated by 100% of the study sample was that nurses' ideas are respected by other health care professionals.Findings indicated that a significant positive relationship exists between role satisfaction and study variables. Eighty-eight percent of respondents stated that conflicts related to participation were experienced. Overwhelmingly, respondents felt that the primary source of conflicts were with physicians. These findings are consistent with results reported in the original study.When asked what factors impact on how decisions are made, 40% of respondents indicated that ethical decisions are often impacted by generalized decisions based on viability of the neonate as determined by the gestational age, and "quality of life."Seventy-six percent of respondents believed nurses should be more involved in the ethical decision making. Conferences with physicians and parents was identified by 69% of the study sample. This study found that the older the nurse, the more satisfied with role in the ethical decison making process. Length of employment also contributed positively to satisfaction in ethical decision making. The more educated the nurse, the more satisfied with role in the ethical decision making process. Nurses were less satisfied if conflicts were experienced or identified.Findings suggest that collaborative relationships exist between nurses and other health team members and that nurses feel some sense of fulfillment with their role in the ethical decision making process. It was concluded that many issues were unsolved and need to be discussed.School of Nursing
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Martinez, Geraldine. "Factors that Influence Implementation of Pain Management Strategies in the Neonatal Intensive Care Unit." Honors in the Major Thesis, University of Central Florida, 2014. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1618.
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In the United States, 10% to 15% of newborns are admitted to the neonatal intensive care unit (NICU). Painful procedures are unavoidable during NICU care; the neonate experiences approximately 12 painful procedures per day. Inconsistent and/or inappropriate pain management in the NICU remains a problem. The purpose of this study is to identify the prevalent factors that influence the implementation of pain management strategies among nurses who work in a NICU setting in a Central Florida hospital. This study was conducted using a voluntary and anonymous electronic survey. The survey was divided into two sections; the first section designed to describe the sample, and the second section containing a Likert-type scale that assessed the nurses’ general pain knowledge, knowledge of pain assessment, and awareness of accepted pain management strategies. The survey was adapted from previously published research. Results indicate pain was more likely to be addressed when nurses collaborated closely with the attending physician. The majority of nurses were aware of current protocols for pain management on the unit but not all nurses agreed those protocols were adequate. Results also indicated pain assessment education is being provided in the NICU and the nurses feel confident in their skills to assess pain, however, not all nurses agreed that pain is being well managed in their unit. There appears to be a gap between the nurse’s knowledge/skill to assess pain and implementation of strategies to decrease pain. Although it is the nurse’s responsibility to prevent and treat newborn pain in the NICU, not all nurses agreed that newborn pain is well managed in their unit and some believe pain to be an unavoidable experience in the NICU. Nurse-physician collaboration is key to evidence based newborn pain management.B.S.N.
Bachelors
Nursing
Nursing
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Scott, Megan. "Cummulative radiation exposure during premature infants neonatal intensive care unit stay (C-RED-PINS)." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12616.
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Thesis (M.A.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Background: During pregnancy, x-ray exposure to the maternal-fetal unit is avoided unless absolutely necessary. Viable premature infants survive because of the technology of modern Neonatal Intensive Care Units (NICU), but are exposed to many x-rays. We reviewed the x-ray exposure to those infants in our NICU, quantifying the number of x-rays taken for placement of central venous lines (CVL), respiratory illnesses, and gastrointestinal illnesses (GI). Design Methods: 5-yr retrospective analysis of premature infants less than 33 weeks gestation who received CVL placement during their NICU stay. The study was reviewed by the Institutional Review Board and classified as exempt. X-rays were categorized by indication. X-rays for CVL placement were counted separately. Gl indications included: necrotizing enterocolitis evaluation, bilious aspirates, and other Gl symptoms. Respiratory indications included: diagnosis of respiratory distress syndrome, endotracheal tube placement, and respiratory deterioration. Results: There were 216 infants 29.2±2.3 (mean± SO) weeks gestation, 1262±441 g birth weight. An average of 15.0±15.0 x-rays were taken per infant of which 4.4±2.9 were taken for CVL placement, 5.7±9.9 for Gl indications, and 5.2±9.3 for respiratory indications. These infants had 2.2±1.2 CVL's placed per patient (93% of patients had an umbilical venous catheter and 69% a PICC line). There were 4.5±4.3 babygrams (including gonadal exposure for all females and many males) per patient, 2.8±2.0 babygrams/patient were taken for CVL placement. Conclusions: More research is needed to quantify and reduce the x-ray exposure to vulnerable premature infants, and to assess the long-term effects of this level of radiation exposure. Bedside ultrasounds and other strategies should be considered as ways to reduce the number of x-rays that are taken in NICU patients.
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Thernström, Blomqvist Ylva. "Kangaroo Mother Care : Parents’ experiences and patterns of application in two Swedish neonatal intensive care units." Doctoral thesis, Uppsala universitet, Pediatrik, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-180047.
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Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment. The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B). Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V). This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.
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Hawes, Katheleen A. "Nurse job stress, burnout, practice environment and maternal satisfaction in the neonatal intensive care unit /." View online ; access limited to URI, 2009. http://0-digitalcommons.uri.edu.helin.uri.edu/dissertations/AAI3367992.
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Araya, Elsa Semere. "An assessment of kangaroo mother care among staff in a specialized neonatal intensive care unit, Asmara, Eritrea." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29346.
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Introduction: Preterm delivery remains the major cause of newborn infants’ morbidity and mortality globally and more so in low-income countries like Eritrea. Research has shown that the provision of Kangaroo mother care (KMC) can contribute to a reduction in morbidity and mortality among newborn infants. However, there is limited research on the practice of KMC in Eritrea. Methods: A mixed methods approach was adopted in a phenomenographic study to collect the data. Eleven participants with work experience of at least two years were recruited from the Specialised Neonatal Intensive Care Unit (SNICU) at Orotta Paediatric Hospital (OPH), Asmara, Eritrea. Data were collected via individual interviews and observations. Results: The results showed that participants had no prior KMC training and education. In addition, staff had limited knowledge and mixed attitudes about KMC practice. There were also no KMC guidelines and protocols. Furthermore, space was not adequate for full KMC practice except for implementation of the kangaroo position. The researcher’s observation confirmed similar evidence of a lack of availability of a KMC ward and lack of protocols and guidelines. Limited interaction and communication about KMC between participants and parents was also observed. Some of the most common hindrances to KMC practice were the perception that KMC increased staff work load and that it was time consuming. In addition, lack of regular KMC training for staff, lack of a convenient setup and too few staff members were among the hindrances. One staff members also perceived that KMC practice was not culturally accepted. 15 Conclusion: The results of this study showed that there were no proper KMC guidelines and protocols in the ward. In addition, only the kangaroo position was practiced, not the full KMC protocol. Furthermore, staff had limited knowledge and mixed attitudes. The observation component of the research highlighted the lack of space and KMC protocols and guidelines as key limitations for delivering KMC. Therefore, it is recommended that a programme to improve staff knowledge be implemented, that evidence-based KMC guidelines and polices be made available, that the KMC ward be expanded, and that health education about KMC practice be brought to the population through mass media
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Leighton, P. H. "Monitoring blood stream infection in neonatal intensive care units." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1302069/.
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Comparisons of the incidence of blood stream infection (BSI) between neonatal intensive care units (NICUs) can promote sharing of potentially better practices for infection control. Comparisons should take into account differences in babies’ vulnerability and the invasive procedures which can introduce infection. I carried out a systematic review of methods reported in the literature, or used by regional monitoring systems, for comparing the incidence of BSI among NICUs. I found substantial variation, especially in the risk factors used to adjust incidence estimates. The use of routinely recorded administrative data would minimize and accelerate staff workload for BSI monitoring. I investigated which risk factors recorded in routine data should be adjusted for when comparing BSI incidence between NICUs. I linked microbiology laboratory records with administrative records collected over four years for three London NICUs. I analysed rates of BSI using various methods, including Poisson regression and logistic regression assuming a matched case control design. With both approaches, National Health Service level of care was the strongest predictor for BSI incidence. Using Poisson regression models, the rate ratio for BSI, adjusted for birth weight, inborn/outborn status and postnatal age, was 3.15 (95% confidence interval (CI) 2.01, 4.94) for intensive care and 6.58 (95% CI 4.18, 10.36) for high dependency care, relative to special care. The case control study gave slightly larger estimates of effect than the Poisson regression models. Total parenteral nutrition was significantly associated with BSI incidence but explained less of the variance among babies than level of care. Using the results from the risk adjustment model, I demonstrated how routine data can be integrated into a method for prospective, risk adjusted monitoring. This method involved standardised infection ratios and a sequential probability ratio test. The method can evaluate changes in BSI rates over time and between NICUs. It could also be used to quantify improvements following infection control interventions.
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Kruger, Irma. "Paediatric and neonatal admissions to an intensive care unit at a regional hospital in the Western Cape." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86757.
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Thesis (MMed)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.
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Isaacs, Kathy B. "A GROUNDED THEORY MODEL OF MOTHER ROLE DEVELOPMENT WHILE IN THE NEONATAL INTENSIVE CARE UNIT." UKnowledge, 2013. http://uknowledge.uky.edu/nursing_etds/10.
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When a woman discovers that she is pregnant, she begins a process of internal work to develop her mother role. This process has been outlined in the literature for the delivery of a healthy full-term baby, however little is known about the process for mothers of medically fragile babies. A threatened pregnancy and subsequent delivery of a medically fragile baby involves a different process of internal work by the mother to prepare for her role. Mothers with a baby in the Neonatal Intensive Care Unit (NICU) experience stress, uncertainty, and anxiety potentially causing a permanent impact on the successful development of her role.
It is the purpose of this dissertation to explore the process of mother role development among those first-time mothers having a baby in the NICU. This study was conducted using a qualitative grounded theory method. Data collection consisted of personal journals, in-person interviews, researcher notes and observation.
The specific aims include (1) describing the disruption in the individual’s preconceived idea of being a mother, (2) exploring specific strategies that support the mother in the development of her role while in the NICU, (3) describing the mother’s perception of her role during physiologic changes in her baby, (4) examining the mother’s evaluation of her mother-role success, (5) developing a deeper understanding of the process of developing the role of mother while in the NICU, and (6) constructing a theoretical model to illustrate the process of becoming a mother while in the NICU.
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Boynewicz, Kara, and Raquel Keithly. "Supporting Families and Infants with Neonatal Abstinence Syndrome (NAS) in the Neonatal Intensive Care Unit & transition to EI." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/8352.
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In Part 2 of this 2 part sequence, use of abstinence assessment tools to rate NAS scores will be discussed to guide understanding of withdrawal symptoms commonly observed. Abstinence tools will be compared and contrasted against infant assessments commonly used by therapist to guide neurodevelopmental implications of symptoms. Guided by NAS assessments non-pharmological management will be addressed including environmental adaptations, state regulation, rest and sleep (use of swaddling, nonnutritive sucking, rocking, positioning), feeding (formula and breastfeeding). Applied examples of the therapist role in NICU along with treatment interventions for infants and their families will be discussed. Once the caregivers within the NICU are better to understand the scope of the problem, this knowledge will translate into improved developmentally supportive and age appropriate care. A through understanding of infants with NAS and their families will lead to more responsive care for their infants during and after their hospital stay.
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Gonçalves, Nádia Ferreira. "Artigos, superfícies e equipamentos utilizados em unidades de terapia intensiva neonatal e pediátrica contaminados por Staphylococcus spp. resistentes aos antimicrobianos." Universidade Federal de Goiás, 2013. http://repositorio.bc.ufg.br/tede/handle/tede/6728.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Compliance with preventive measures by health professionals is a large challenge, and it is believed that in the intensive care unit, especially those classified as neonatal and pediatric, contamination of goods, equipment, and environmental surfaces contribute significantly to the increased epidemiology of healthcare associated infections (HAIs). The objective of this study was to analyze the epidemiological and microbiological profiles of tools, equipment, and ambient surfaces contaminated with antimicrobial resistant Staphylococcus spp. in neonatal and pediatric intensive care units. It is a cross-sectional epidemiological study carried out from August 2011 to September 2012, in a neonatal and pediatric intensive care unit specializing in maternal and child health of the public health system in GoiâniaGoiás, Brazil. Samples were collected using sterile swabs moistened with saline solution 0.9%, which were subjected to microbiological processing consisting of isolation, identification and antimicrobial susceptibility testing. Analysis and interpretation of results followed. Of the 137 samples, 1 02 were identified as Staphylococcus spp. and, in six of the 12 incubators, different strains of these microorganisms were isolated, totaling 108 isolates. Among the isolates, only four were identified as Staphylococcus aureus, and the remaining 104 were coagulasenegative Staphylococcus. During the processing of isolates it was revealed that 74.5% of the tools, surfaces and equipment were infected by Staphylococcus spp., and of these, more than 80% were resistant to antimicrobials. In four, MLSB phenotype was detected. As for oxacillin-resistant isolates, 82.3 % had resistance confirmed by Etest®. Upon completion of the analysis, it became clear that the tools, surfaces and equipment used in pediatric neonatal intensive care units are reservoirs of bacteria. This immediately highlights an important contributor to the epidemiology of HAIs: compliance with procedure for the safety of infants and healthcare workers, since these findings signal gaps in the work process and therefore in the processing of these items. Therefore, it is believed that the perception of the professionals who work in health facilities (related to the risks of cross-contamination) is of unique value to understanding the need to adopt safe work practices. It is hoped, that contributing to the development of other studies, with the goal of identifying possible gaps, involving both the management of the service and standard operating procedures for the cleaning and disinfection of ambient surfaces, tools and equipment in compliance with guidelines.
A adesão às medias preventivas pelos profissionais de saúde é um amplo desafio e, acredita-se que na unidade de terapia intensiva, em especial nas de caráter neonatal e pediátrico, a contaminação de artigos, superfícies ambientais e equipamentos contribua expressivamente para o avanço da cadeia epidemiológica das Infecções Reacionadas à Assistência à Saúde (IrAS). Objetivou-se neste estudo analisar os aspectos epidemiológicos e microbiológicos de artigos, superfícies ambientais e equipamentos contaminados por Staphylococcus spp. resistentes aos antimicrobianos em unidades de terapia intensiva neonatal e pediátrica. Trata-se de um estudo epidemiológico tipo transversal desenvolvido de agosto de 2011 a setembro de 201 2, nas unidades de terapia intensiva neonatal e pediátrica de uma instituição especializada em saúde materna e infantil do Sistema Único de Saúde de Goiânia-Goiás, Brasil. Os dados foram obtidos por meio de swab, coletou-se amostras biológicas dos artigos, superfícies ambientais e equipamentos existentes nas unidades selecionadas para estudo. Realizou-se fricção bidirecional com swab estéril umedecido em solução salina a 0,9%; em seguida foi feito o processamento laboratorial dos espécimes, com isolamento, identificação e teste de suscetibilidade dos micro-organismos aos antimicrobianos; por fim, a análise e interpretação dos resultados. Das 1 37 amostras, em 1 02 foram identificados Staphylococcus spp. sendo que, em seis das 12 incubadoras foram isoladas diferentes cepas desses micro-organismos, totalizando 1 08 isolados. Dentre os isolados, apenas quatro foram identificados como Staphylococcus aureus, e os 104 restantes de Stafilococos coagulase negativo. Durante o processamento dos isolados, verificou-se que 74,5% dos artigos, superfícies e equipamentos se encontravam contaminados por Staphylococcus spp., destes mais de 80%, resistentes aos antimicrobianos testados. Mas em apenas quatro foi detectado o fenótipo resistente a macrolídeos, lincosamidas e estreptogramina B (MLSB). Quanto aos isolados resistentes à oxacilina, 82,3% tiveram a resistência confirmada pelo Epsilometer Test (Etest®). Ao concluir as análises, evidenciou-se que artigos, superfícies e equipamentos de unidades de terapia intensiva neonatal e pediátrica, são reservatórios de bactérias. Logo, representam importante papel na cadeia epidemiológica das IrAS, o que configura inconformidades com a segurança do recém nascido e do trabalhador, uma vez que, esses achados sinalizam falhas no processo de trabalho e consequentemente no processamento desses artefatos. Nessa direção, acreditase que a percepção dos profissionais que laboram em estabelecimentos de saúde relacionada aos riscos de contaminação cruzada é de singular valor para compreenderem a necessidade de adotarem atitudes seguras no ato laboral. Espera-se ainda, contribuir com o desenvolvimento de outros estudos, com o objetivo de compreender as possíveis falhas envolvendo o tanto a gestão do serviço, quanto aos processos de trabalho e de limpeza e desinfecção das superfícies ambientais, artigos e equipamentos em conformidade com as diretrizes.
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Manogaran, Myuri. "Managing Transitions of Care: An Examination of Parents’ and Providers’ Perspectives on the Transitions of Care of Neonatal Patients from the Neonatal Intensive Care Unit." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35751.
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Objectives: Transitions of care (ToC) for a high-risk neonatal population, and in some cases inappropriate and early discharge, can have important implications for community and broader population health. As it is a key indicator of the efficiency of the system of health services, the ease of ToC has been a priority for improving care outcomes across all settings in our nation’s healthcare system. Research shows that inappropriate discharges can lead to negative outcomes for patients and their families, health professionals, and the health system. Collaboration amongst the health care professionals, the community, and the patient’s family is needed for an efficient transition. This research examined how interprofessional collaboration (IPC) can act as a catalyst for efficient and effective ToC from a high-risk neonatal unit to care back in the community.
Approach: Twelve infants were observed from their admission on the Neonatal Intensive Care Unit (NICU) until their discharge home. The 12 consisted of four patients discharged directly home, four to another unit within the same hospital, and four to another institution. Stage one involved a document analysis of documents related to ToC policy on the NICU. Stage two involved observation. Stage three involved interviews with healthcare professionals (HCPs) in the hospital and community (n=30) and family members (n=12). Stage four consisted of deliberative workshops with the hospital management and research participants to share the results and obtain their feedback.
Results: Including parents early in the ToC planning process helps parents feel they’re a part of the interprofessional care team, in-charge of their infant’s care and thus better equipped mentally to handle their infant’s ToC. Knowing early on their infant’s discharge plan allows parents the opportunity to ask questions regarding caring for the infant at home or to meet the new healthcare team at the new site (hospital/floor) prior to the transfer. Mechanisms need to be in place to ensure that communication regarding ToC is consistent and clear to and between all HCPs whether in the hospital (e.g. bedside nurse) or in the community (e.g. family doctor). Having a clear understanding of what information should be transferred during a ToC will prevent unnecessary tests and misunderstandings. Increasing HCPs’ knowledge of available community resources will aide in transitioning infants to community care and thus freeing bed space and decreasing unnecessary costs at the hospital (i.e. A feeding and growing baby can be weighed by family doctor or Rapid Response Nurse and not necessarily the neonatologist). A consistent ToC policy across all NICUs would also be beneficial to ensuring a smoother ToC of infants.
Conclusion: It is believed that communication and education in an interprofessional context is critical for more efficient and effective ToC of neonates.
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Nicholas, Amy Lynne. "An examination of the needs of mothers with infants in the neonatal intensive care unit." College Park, Md. : University of Maryland, 2006. http://hdl.handle.net/1903/3465.
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Thesis (Ph. D.) -- University of Maryland, College Park, 2006.Thesis research directed by: Special Education. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.