Growth Measurement Practices from a National Survey of Neonatal Nurses.

PURPOSE: To describe neonatal nurses' growth measurement practices, attitudes, knowledge, bases of practice knowledge, and barriers and facilitators for changing practice; and to identify differences in practices and knowledge by nursing organization, unit type, education, and experience. DESIGN AND METHODS: A cross-sectional online survey of U.S. neonatal nurses was distributed through two neonatal nursing organizations. RESULTS: The survey was completed by 301 nurses. Some evidence-based practices (EBPs) were infrequently reported including recording frontal-occipital head circumference (FOC) and length using 0.1 cm increments (17.9% and 17.6%, respectively); measuring FOC, weight, and length more than once before recording (61.9%, 27.2%, and 39.6%, respectively); and for length, using a length board instead of tape measure (19.4%), with a second person assisting (25.1%), with Frankfort plane head positioning (3.3%), and measuring from crown to heels of both feet (19.1%). Most nurses perceived their measurements as accurate or highly accurate (96.7% for FOC, 99.3% for weight, and 87.1% for length). The mean percentage correct on knowledge items was 68.1%. NICU nurses scored slightly better than well-newborn nurses (mean 69.3% correct vs. 65.1% correct, p = .04). Most based measurement practices on clinical practice guidelines (86.6%) and unit policies and procedures (85.9%). Team culture (33.3%) and insufficient resources (32.6%) were the most common barriers to EBP. The support of nurse managers (70.0%) and unit educators (68.5%) were common facilitators. CONCLUSIONS AND IMPLICATIONS: Knowledge gaps and practice improvement areas were identified. Results can inform interventions to improve the accuracy and reliability of neonatal growth measurement practices.

Academic and Institutional Review Board Collaboration to Ensure Ethical Conduct of Doctor of Nursing Practice Projects.

BACKGROUND: Navigating the regulations to protect human subjects and private health information for Doctor of Nursing Practice (DNP) projects can be a formidable task for students, faculty, and the institutional review board (IRB). METHOD: Key stakeholders from the University of Iowa College of Nursing and the Human Subjects Office developed a standardized process for DNP students to follow, using a decision algorithm, a student orientation to the human subjects review process conducted by faculty and IRB chairs and staff, and a brief Human Subjects Research Determination form. RESULTS: Over 2 years, 109 students completed the process, and 96.3% of their projects were deemed not to be human subjects research. Every student submitted documentation of adherence to the standardized process. Less time was spent by students, faculty, and the IRB in preparing and processing review requests. CONCLUSION: The interprofessional collaboration resulted in a streamlined process for the timely review of DNP projects.

Optimizing linear growth measurement in children.

A child's pattern of linear growth is one of the most sensitive indicators of health and well-being. However, many health care personnel use casual techniques and faulty instruments to measure children's growth and keep imprecise growth charts, making interpretation of growth patterns problematic. This situation can delay diagnosis and treatment of children with growth disorders and other conditions that affect growth. It can also lead to undue anxiety and unnecessary evaluation of children who are actually growing well. A clinical practice guideline was developed to optimize the accuracy and reliability of linear growth measurement. This article presents strategies to implement the guideline and thereby increase awareness of the importance of standardized growth measurement techniques and instruments, facilitate staff training and competency, and encourage standardized record keeping. These strategies will give providers more confidence in their interpretation of children's growth patterns and allow them to recognize potential problems, possibly before other symptoms appear.

Development of an evidence-based clinical practice guideline on linear growth measurement of children.

Growth is an important indicator of child health; however, measurements are frequently inaccurate and unreliable. This article reviews the literature on linear growth measurement error and describes methods used to develop and evaluate an evidence-based clinical practice guideline on the measurement of recumbent length and stature of infants, children, and adolescents. Systematic methods were used to identify evidence to answer clinical questions about growth measurement. A multidisciplinary team critically appraised and synthesized the evidence to develop clinical practice recommendations using an evidence-based practice rating scheme. The guideline was prospectively evaluated through internal and external reviews and a pilot study to ensure its validity and reliability. Adoption of the clinical practice guideline can improve the accuracy and reliability of growth measurement data.