Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU.

BACKGROUND: Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms. PURPOSE: To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol. METHODS: A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation. RESULTS: The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03). IMPLICATIONS FOR PRACTICE AND RESEARCH: Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.

A Primer on Updates to the Neonatal Resuscitation Program.

In October 2015, the American Heart Association and the American Academy of Pediatrics released advanced notification of substantive changes to appear in the seventh edition of the Neonatal Resuscitation Program (NRP) scheduled for release in the spring of 2016. The expectation is that all NRP providers will be educated in the seventh edition of the NRP during 2016, with the national implementation target date set as January 2017. This column presents a brief discussion and summary of changes to the NRP.

Postresuscitation Care and Pretransport Stabilization of Newborns Using the Principles of STABLE Transport.

The practice of perinatal regionalization is designed to ensure that newborns are born in facilities with a care level designation that is consistent with expected pregnancy outcomes. Regionalization practices have resulted in lower neonatal mortality and morbidity rates. However, despite regionalization efforts, approximately 10 percent of newborns will require some level assistance with breathing, and a few (<1 percent) will require resuscitation in the birthing room. After resuscitation, many of these newborns require acute transport to a different facility. This column provides an overview of principles from the STABLE Program, which guides clinicians in providing postresuscitation care and pretransport stabilization for compromised newborns.

Daily Breastmilk Volume in Mothers of Very Low Birth Weight Neonates: A Repeated-Measures Randomized Trial of Hand Expression Versus Electric Breast Pump Expression.

BACKGROUND: There are no randomized trials comparing early exclusive hand expression (HE) with early exclusive electric pump expression (electric expression [EE]) for milk removal in mothers of very low birth weight (VLBW) infants. SUBJECTS AND METHODS: Mothers of VLBW infants were randomized to exclusively HE or EE for the first 7 days postpartum. Daily volumes of milk were compared between groups for the first 28 days, adjusting for repeated measures. RESULTS: The HE (n=12) and the EE (n=14) groups did not differ with respect to age, parity, single versus multiple gestation, or number of expression sessions per day. There were 728 values for daily milk volumes in the first 28 days, including 105 HE and 623 EE. Mothers using exclusive HE had significantly (p<0.05) less cumulative daily milk production throughout the first 7 days postpartum compared with exclusive EE. Mean cumulative milk production among mothers using HE in the first postpartum week remained approximately half that of those using the electric pump throughout the first 28 days, without evident catch up. In multivariable analysis, each postpartum day was associated with an adjusted increase of 50 mL of human milk/day during the first 7 days postpartum and an increase of 13 mL/day between postpartum Days 8 and 28. After adjusting for repeated measures, number of expression sessions per day, and postpartum day, EE was associated with an advantage in milk production of 119 mL/day during the first 28 postpartum days compared with HE. CONCLUSIONS: Compared with mothers using EE, mothers using HE had significantly less cumulative daily milk production during the first 7 days postpartum. This trend continued after the intervention had been discontinued, and the great majority of expressions in both groups were with EE. Further research to confirm and expand these findings is warranted.

What Parents Need to Know About Vitamin K Administration at Birth.

Prophylactic treatment of newborns with intramuscular vitamin K has been the standard of care for many years in the United States. However, instances of parental refusal of routine prophylaxis are currently on the rise. Refusal of routine prophylaxis can have serious long-term neurodevelopmental consequences for some newborns, who may subsequently develop vitamin K deficiency-associated hemorrhagic disease of the newborn (HDN).

State of the state: NNP program update 2013.

Findings from a spring 2013 survey of neonatal nurse practitioner (NNP) program directors are presented and concerning trends identified. Implications of these findings, in combination with other external factors influencing the supply/demand ratio on the stability of the NNP workforce nationwide, are explored. Present and future NNP workforce demands in relation to the educational programs available to prepare nurses for NNP practice are examined. Finally, discussion focuses on the politics and pragmatics of sustaining the NNP role for posterity.

The doctor of nursing practice graduate as faculty member.

This article focuses on the emerging role of the Doctor of Nursing Practice (DNP) graduate as faculty member. Discussion includes historical composition of faculties. Re-evaluation of Boyer's model of scholarship in relation to faculty roles is examined. Discussion includes barriers facing current DNP faculty as well as the potential advantages that DNP graduates may make toward school of nursing faculties. Discussion concludes with considerations for the future of the discipline as demographics and traditional values shift over time.

Heparinized saline vs normal saline for maintenance of intravenous access in neonates: an evidence-based practice change.

PURPOSE: To design, implement, and to evaluate the outcomes of an evidence-based practice change regarding the use of heparin in intravenous (IV) locks to improve patient safety. Phase I of the project examined dwell time, hours of patency, gestational age at birth and at time of IV lock insertion, birthweight and weight at time of insertion, and reason for discontinuation for IV access devices prior to and following the practice change from heparinized saline (HS) to normal saline (NS) flush. Phase II of the project was to determine the effect of the educational program on staff knowledge of the use of heparinized saline vs normal saline flushes. SUBJECTS: The setting was an 18 bed level III NICU located in the northeastern United States. A sample of 70 infants with IV locks were included in the study; HS (n = 34) and NS (n = 36) respectively. Infants with IV's that were converted to IV locks were excluded. Only professional NICU staff (n = 40) were recruited for the educational offering. DESIGN: A comparative descriptive design with two components was utilized. METHODS: A retrospective and prospective chart review was used to compare the outcomes of neonates with IV locks flushed with heparin and normal saline flush and evaluated the outcomes. A pretest/posttest design was used to analyze the change of the NICU staff's knowledge concerning heparin flush before and after an educational offering. MAIN OUTCOME MEASURES: IV lock patency after practice change to NS flush and the change of the NICU staff's knowledge concerning heparin flush after an educational offering. PRINCIPAL RESULTS: There was a statistically significant difference in IV catheter patency with NS flushed catheters averaging 13 hours longer than HS flushed catheters (p = 0.02). Also a statistically significant increase in mean scores was noted for the NICU staff posttest after the educational offering (p = .0001). There was a 20% increase in knowledge scores. CONCLUSIONS: Findings from this project support the current literature base suggesting that the use of heparin is unnecessary for the maintenance of IV access devices. Unnecessary exposure of neonates to heparin increases risk to patient safety and should therefore be avoided. Future research should examine the use of heparin in central lines in neonates. Findings additionally support educating staff prior to practice changes.

Nurses' knowledge, attitudes/beliefs, and care practices concerning do not resuscitate status for hospitalized neonates.

OBJECTIVE: To describe the knowledge, attitudes/beliefs, and care practices of neonatal intensive care unit nurses concerning do not resuscitate status for hospitalized neonates and to assess differences based on years of neonatal intensive care unit experience and educational background. DESIGN: Comparative descriptive design. SETTING: Level 3 neonatal intensive care unit located in the northeastern United States. PARTICIPANTS: A convenience sample of 66 neonatal intensive care unit nurses. METHODS: Nurses responded anonymously to an adapted pen and paper questionnaire assessing knowledge, attitudes/beliefs, and care practices regarding the care of hospitalized neonates with do not resuscitate status. RESULTS: There was much ambiguity concerning the legal meaning of the term "do not resuscitate." Three fourths of respondents did not recognize do not resuscitate by its legal definition. A variety of attitudes/beliefs and care practices related to do not resuscitate designation was reported. Nurses with increased years of experience were less supportive of initiating certain aggressive care modalities for do not resuscitate patients. Responses regarding knowledge, attitudes/beliefs, and care practices related to do not resuscitate designation for neonates did not appear to be influenced by the educational background of neonatal intensive care unit nurses. CONCLUSION: Neonatal intensive care unit nurses need further education regarding the legal definition and scope of do not resuscitate orders in the clinical care of terminally ill neonates.