Comparison of Infant Length Measurements Using Tape Measure Versus Length Board.

BACKGROUND: For infants requiring intensive care, infant length is a primary gauge of nutrition and forms the basis for important future treatment decisions. However, existing evidence demonstrates discrepancies in infant length measurements between tape measure and length board. PURPOSE: To compare the accuracy and reliability of infant length measurements using tape measure (standard practice) and length board in a neonatal intensive care unit (NICU) at a public academic medical center. METHODS: Using a single-group, quasi-experimental, repeated-measures design, 108 infants (35.58 ± 3.68 weeks, male 59%, 2124.83 ± 881.69 g) admitted to the NICU were prospectively enrolled. Clinical nurses measured infants weekly per unit-based protocol using tape measures. Study team measured length using length boards within 24 hours of tape measurement. Primary outcome was infant length. Length measurements were converted to sex-specific Fenton or WHO growth percentiles. Linear mixed-effects regression, κ coefficient, intraclass correlation coefficient, and positive predictive value were calculated. FINDINGS/RESULTS: The main effect of measurement conditions and time was significant. Predicted length was 0.38 cm lower for length board than for tape measure over time. Weighted κ coefficient and intraclass correlation coefficient indicated good to excellent agreement. More than 37% of infants shifted to a new percentile category based on both measurements. Positive predictive value of length board at time 1 was 63%. IMPLICATIONS FOR PRACTICE: Length board measurements are reliable for accurate classification of an infant's growth curve to influence diagnosis and future plan of care. IMPLICATIONS FOR RESEARCH: Future research warrants replication using a longitudinal design across multiple sites.

Parent Readiness for Their Preterm Infant's Neonatal Intensive Care Unit Discharge.

This study aims to examine the influence of hospital experience factors on parental discharge readiness, accounting for key background characteristics. Parents/guardians of infants 33 weeks of gestation or less at birth receiving neonatal intensive care at 6 sites were enrolled from April 2017 to August 2018. Participants completed surveys at enrollment, 3 weeks later, and at discharge. Multiple regression analysis assessed relationships between parental experience, well-being, and perceived readiness for infant discharge, adjusting for socioenvironmental, infant clinical, and parent demographic characteristics. Most (77%) of the 139 parents reported high levels of readiness for their infant's discharge and 92% reported high self-efficacy at discharge. The multiple regression model accounted for 40% of the variance in discharge readiness. Perceptions of family-centered care accounted for 12% of the variance; measures of parent well-being, anxiety, and parenting self-efficacy accounted for an additional 16% of the variance; parent characteristics accounted for an additional 9%; and infant characteristics accounted for less than 3% of the variance. Parental perceptions of the family-centeredness of the hospital experience, anxiety, and parenting self-efficacy accounted for a substantial proportion of the variance in readiness for discharge scores among parents of preterm infant. These influential perceptions are potentially modifiable by nursing-led interventions.

Clinical Nurse Specialist Expands to Crisis Management Role During COVID-19 Pandemic.

PURPOSE: Emergence of the COVID-19 crisis into the healthcare system challenged existing roles and shifted organizational priorities and staff responsibilities. Operating within the spheres of impact, clinical nurse specialists (CNSs) adapted to the needs of the organization and expanded their responsibilities to provide crisis leadership. DESCRIPTION OF PROJECT: The CNSs used advanced practice nursing skills and leadership to implement hospital rounds, identify issues, make decisions, collaborate with stakeholders, disseminate new and emerging information, and evaluate processes in an ongoing pandemic. Using the health crisis management framework, the CNSs demonstrated authentic leadership throughout the prevention, preparedness, response, recovery, and rehabilitation phases. OUTCOME: Data analysis of CNS handoff and meeting communications generated these areas of focus involving the CNSs: (1) clinical practice, (2) supplies, (3) workflows, and (4) people. CONCLUSION: The CNS played a vital role in the planning, training, and evaluation of crisis preparation. New and emerging infectious diseases may continue to confront the healthcare system. Thus, healthcare systems need to remain prepared for public health threats. In the crisis leadership role, the CNS helped the transition to learn and relearn practices. As authentic leaders, CNSs instilled calmness, confidence, trust, and resiliency to the staff during the COVID-19 pandemic.

What parents want to know about caring for their preterm infant: A longitudinal descriptive study.

OBJECTIVES: To describe the characteristics of parent knowledge needs and skill acquisition over the course of their infant's neonatal intensive care unit hospitalization. METHODS: 148 parents/guardians of infants ≤33 week gestation enrolled during the usual care phase of a multi-site quasi-experimental study, completing weekly surveys about their learning needs for the coming week and skills learned in the past week. RESULTS: The topics of most interest or concern for parents included feeding their infant and their infant's medical course. Knowledge needs varied by phase of hospitalization (early, middle, late) and by parent age, prior parenting experience, infant gestational age and hospital length of stay. The most common skills learned related to feeding and basic infant care. The number of skills parents reported learning each week varied by parent age, gender, and education. CONCLUSIONS: Parents of preterm infants expressed specific learning needs and acquisition of skills that varied over the course of the hospitalization and by parent and infant characteristics. PRACTICE IMPLICATIONS: The findings can be used to improve parent learning experiences so that they can become full partners in their infant's caregiving and are better prepared to care for their infant after discharge. STUDY REGISTRATION: ClinicalTrials.gov, ID NCT03418870.