A descriptive study of current neonatal nurse practitioner practice.

This study describes the role of the neonatal nurse practitioner (NNP) in current practice and identifies facilitators and constraints to practice perceived by individuals currently practicing as NNPs. The 7-point scale used in this study allowed respondents to identify specific conditions of NNP practice, from highly facilitating (+3) to very constraining (-3). Each item was followed by a clarification section. The questionnaire was mailed to 1,521 individuals holding current NNP certification in the U.S. Data were analyzed using a total facilitation score. The possible range for this score (+225 - (-)225) is based on the numerical range of the scale (+3 - (-)3) multiplied by the 75 items in the facilitation section of the questionnaire. Actual scores ranged from +195 to -114, indicating that NNPs are more facilitated than constrained in their practice. Empirical data generated by this study will help in developing a theoretical model for NNP practice and provide important information for shaping the future role of the NNP.

Symbiosis of nurse and machine through fuzzy logic: improved specificity of a neonatal pulse oximeter alarm.

This article describes the theoretical underpinnings that preceded the design of a new neonatal pulse oximeter alarm that differentiates true from false alarms based on an artificial intelligence theory called "fuzzy logic." The connection between the intuition and sense of advocacy gained through neonatal primary nursing and the application of fuzzy logic to solve the problem of false alarms--that is, the symbiosis between nurse and machine--are explained. Emphasis is placed throughout on the importance of involving nurses in the development of the technology for which they are responsible.

Deficient hypoxia awakening response in infants of smoking mothers: possible relationship to sudden infant death syndrome.

OBJECTIVE: To determine whether fetal exposure to cigarette smoke impairs postnatal chemoreceptor control of ventilation and hypercapnic and hypoxic awakening responses. STUDY DESIGN: Smoking (n = 13) and nonsmoking (n = 34) women were recruited during pregnancy. Serum cotinine levels were measured to assess level of nicotine exposure. The infants were studied at 2 to 3 months of age for ventilatory and awakening responses to hypoxia (17%, 15% and 13% inspired O2) and hypercapnia 4%, 6%, and 8% inspired CO2). Continuous measures were analyzed with unpaired t tests and analysis of variance for repeated measures. Proportions of awakening and periodic breathing were analyzed by means of a comparison of proportions. RESULTS: The infants of smokers had lower birth weights (3022 +/- 566 vs 3518 +/- 491 gm; p < or = 0.005) and were older at the time of study (10.4 +/- 2.8 vs 8.7 +/- 1.3 weeks; p < 0.01) than the control infants. Maternal cotinine levels were higher in smokers (97.8 +/- 107 ng/ml vs no cotinine; p < 0.0001). More infants of smokers failed to awaken with hypoxia than did control infants (54% vs 15%; p = 0.006). The ventilatory responses to hypoxia and hypercapnia were similar in the two groups. All infants awakened with hypercapnia, and there was no difference in the awakening threshold for carbon dioxide (50.3 +/- 4.5 vs 48.3 +/- 5.4 mm Hg; p = 0.28). CONCLUSION: Infants of mothers who smoked during pregnancy have deficient hypoxic awakening responses, which may contribute to the increased risk of sudden infant death syndrome in infants of smoking mothers.

Pulse oximetry and intuition in the neonatal intensive care unit.

This article poses an argument supporting the position that it is important for nurses to become involved, at every level, in the development of the technology that they use. The advantages and disadvantages of one commonly used technological device in the intensive care nursery, the pulse oximeter, are identified. An example of how nursing intuition affected and was incorporated into the design of a new neonatal pulse oximeter is described.

Physiologic measures of kangaroo versus incubator care in a tertiary-level nursery.

OBJECTIVE: To determine the safety and feasibility of kangaroo care in a tertiary-level nursery as defined by apnea, bradycardia, and oxygen desaturation. DESIGN: Prospective, long-term, repeated measures with a convenience sample. SETTING: A 20-bed, tertiary-level nursery with approximately 400 admissions a year. PARTICIPANTS: Eight mother-infant pairs. INTERVENTIONS: Researchers compared incubator care with kangaroo care for 4 hours a day, 6 days a week, for 3 weeks. Physiologic variables were monitored daily and recorded continuously on a polygraph for 8 hours each week. MAIN OUTCOME MEASURES: Amount of apnea, bradycardia, and oxygen desaturation. SECONDARY OUTCOME MEASURES: Heart rate, respiratory rate, percent sleep time, and skin temperature. RESULTS: Apnea, bradycardia, oxygen saturation, heart rate, and respiratory rate were similar during both kangaroo (K) and incubator (I) care. The infants experienced a lower percent (mean +/- standard deviation, K versus I) of total sleep (47 +/- 15 versus 64 +/- 19, p < .003) during kangaroo care. The infants' mean +/- standard deviation temperature during the kangaroo care (36.5 degrees C +/- 0.64 degrees C) was lower (p < .03) than that of the control periods before (36.8 degrees C +/- 0.27 degrees C) or after (36.7 degrees C +/- 0.26 degrees C). Percent sleep time and skin temperature were slightly lower during kangaroo care, but the differences were not clinically significant. CONCLUSION: Kangaroo care is safe and feasible for selected mothers and infants in a tertiary-level nursery.