Neonatal Nurses' Perceptions of Palliative Care in the Neonatal Intensive Care Unit.

PURPOSE: Neonatal palliative care is widely endorsed as an essential aspect of neonatal intensive care unit (NICU) practice, yet inconsistencies in its use continue to exist. We examined neonatal nurses' perceptions of barriers and facilitators to palliative care in their NICU setting. STUDY DESIGN AND METHODS: A cross-sectional design using the Neonatal Palliative Care Attitude Scale (NiPCAS™©) was administered using an online survey distributed to neonatal nurses through the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and National Association of Neonatal Nurses (NANN). Parametric statistical analyses were conducted to explore relationships between unit policy and neonatal palliative care (NPC) education, and the nurses' perceptions. RESULTS: Ninety-nine of 1,800 AWHONN members who identified as NICU nurses completed the survey, representing a response rate of 5.5% and 101 of 4,000 NANN members who subscribe to the MYNANN message boards completed the survey, reflecting a 2.5% response rate. N = 200 surveys were completed with minimal data missing, resulting in a final sample of 200. Exploratory factor analysis yielded these subconstructs: Unit Culture, Resources, and Perceived Inappropriate Care. Barriers identified were Perceived Inappropriate Care and Societal Understanding of NPC. A positive correlation was noted for NiPCAS™© scores and unit culture support (r(185) = .66, n = 187, p < .01), unit NPC policy (r(184) = .446, n = 186, p < .01), and NPC education (r(185) = .373, n = 187, p < .01). CLINICAL IMPLICATIONS: Nurses who work in a NICU with an NPC policy and who have received palliative care education demonstrated more favorable attitudes toward NPC. Policy and educational programs are important strategies to promote high-quality care for high-risk infants and their families.

Randomized controlled trial evaluating the effects of cobedding on weight gain and physiologic regulation in preterm twins in the NICU.

OBJECTIVE: To compare the differences in growth and physiologic regulation in cobedded preterm twins versus individually bedded preterm twins while in the neonatal intensive care unit (NICU). SUBJECTS: Infants born between 28 to 34 weeks gestation in a Level III NICU were eligible for enrollment into the study. Forty-nine sets of twins were enrolled in the study and 41 sets were ultimately analyzed. There were 21 twin sets (42 infants) in the experimental group and 20 sets (40 infants) in the control group. DESIGN: A prospective randomized design was used. METHODS: Parents of twins in a level III NICU were approached for consent to participate in the study. Twins were randomized using sealed envelopes that designated placement in either the control or experimental group. Twin sets who were randomized to the control group received routine care in separate beds. Twin sets in the experimental group received routine care in the same bed. Guidelines for positioning of cobedded twins were utilized. Treatment and data collection started when infants met the inclusion criteria for the study. MAIN OUTCOME MEASURES: Measurements of weekly weight gain and episodes of apnea/bradycardia/desaturation (A/B/D) were collected for each group. PRINCIPAL RESULTS: After adjusting for baseline weight in an analysis of covariance model, the cobedded group demonstrated a significantly higher mean weight compared to the control group at week 1 (1,644 vs. 1,572 grams, respectively, F = 11.6, P = 0.001) and at week 2 (1,755 vs. 1,693 grams, respectively, F = 5.7, P = 0.02). There was no difference in the median number of total combined A/B/D episodes between the 2 groups. CONCLUSIONS: A greater increase in mean weight gain was noted in the cobedded group compared to the control group.