Facilitating Early Breast Milk Expression in Mothers of Very Low Birth Weight Infants.

BACKGROUND: Although early initiation of human milk (HM) expression after birth is known to increase lactation success in mothers of very low birthweight (VLBW) infants, initiation is frequently delayed, potentially decreasing both short- and long-term HM production. Obstetrical (OB) nurses are typically the healthcare provider responsible for facilitating the initial HM expression session. As delays in initiation are common, it is likely that nurses experience obstacles to facilitation of an early initiation of HM expression. The purpose of this study was to determine barriers OB nurses perceive in facilitating early initiation of HM expression in mothers of VLBW infants. STUDY DESIGN AND METHODS: An online survey was administered to nurses from three tertiary care OB units in Florida to determine perceived barriers to early initiation of HM expression in mothers of VLBW infants. RESULTS: Eighty-three nurses completed the survey. The following barriers were identified: (1) lack of time and personnel to assist mothers with HM expression, (2) nurse's perception of the mother's acuity level, and (3) nurse's perception of maternal pain and stress. Discrepancies between nursing judgment, action, and knowledge of unit policies were evident. CLINICAL IMPLICATIONS: Obstetric nurses encounter barriers when facilitating early HM expression in mothers giving birth to VLBW infants. It is possible these barriers could be removed through improvements in education, use of innovative staffing strategies, and maintenance of evidence-based policies.

Supporting and retaining preceptors for NNP programs: results from a survey of NNP preceptors and program directors.

Preceptors are vital resources for the clinical education of healthcare providers, especially neonatal nurse practitioners (NNPs). With the increasing number of NNP programs, including distance accessible programs, there is a need for research to identify effective strategies for recruiting, preparing, and supporting preceptors in their roles. This article presents a review of existing literature and describes findings from a survey of NNP program directors in the United States and from a survey of preceptors for a distance-based NNP program in an Academic Health Sciences Center in the southern United States. The survey focused on current practices in recruiting and supporting preceptors and on perceptions of strategies that would facilitate success and enhance preceptor satisfaction with their roles. The article concludes with presentation of a model based on survey findings and recommendations from the literature that can guide NNP faculty and researchers in identifying effective strategies for recruiting, preparing, and supporting clinical preceptors.

A case of shaken baby syndrome after discharge from the newborn intensive care unit.

Preterm infants may be at higher risk of physical abuse after hospital discharge. Nonaccidental or inflicted head neurotrauma is the most common cause of mortality and morbidity in physical-abuse cases, and shaken baby syndrome (SBS) is the most common form of abuse. In the majority of the cases, parents who shake their infant do not intend to harm the infant. This article presents a report of a former preterm infant who presented to the pediatrician's office with a maternal report of an accidental fall. Shaken baby syndrome was suspected based on bilateral subdural hemorrhages of varying ages, which were inconsistent with the history provided. The differential diagnosis and systematic clinical evaluation for SBS are provided, and medical and nursing management is discussed. Patient care, advocacy, and mandatory reporting are reviewed. The newborn intensive care unit caregivers' role in preventing SBS in this high-risk population, including specific parent teaching and anticipatory guidance, is reviewed with an emphasis on teaching all caregivers about the dangers of shaking an infant.