Understanding the Effects of Neonatal Early Discharge on Parents: A Literature Review.

A neonatal early discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds and are gavage fed by their parents while they transition to breast- and/or bottle-feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. The objective of this study was to summarize and critically appraise the literature regarding the effects of NED on parents. A literature search was conducted for English language publications since 2007 using MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. An integrative thematic synthesis identified 4 themes: establishing parenting skills/confidence; bonding with the newborn; psychological distress; and the need for support and resources. Findings suggest that parents have various concerns regarding discharge from the neonatal unit and therefore support from healthcare professionals and family plays a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences that impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area.

Improving clinical handover in a paediatric ward: implications for nursing management.

AIM: To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. BACKGROUND: ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. METHOD: Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group. RESULTS: After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks. IMPLICATIONS FOR NURSING MANAGEMENT: A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise.

A Comparison of Sound Levels in Open Plan Versus Pods in a Neonatal Intensive Care Unit.

OBJECTIVE: The objective of this study was to compare the noise levels recorded in two different neonatal intensive care unit (NICU) settings: a pod and an open plan NICU located in the same hospital. BACKGROUND: The NICU is a busy environment with ambient noise levels that often exceed established recommendations. This noise deleteriously affects the physiological stability and developmental outcomes of sick and preterm infants. Pods have reduced numbers of cots (in this case, 6) compared to open plan NICUs (in this case, 11), yet the noise levels in pods have not been reported. METHOD: This study compared real-time decibel (dB) levels in an A-weighted scale, captured continuously by sound dosimeters mounted in both NICU settings for a period of 4 weeks: a pod setting and an open plan NICU. Researchers also collected observational data. RESULTS: The average noise level recorded in the pod was 3 dBs less than in the open plan NICU. This result was statistically significant. However, dB recordings in both areas were over the recommended limits by 4-6 dBs, with isolated peaks between 74.5 dBs (NICU) and 75.9 dBs (pod). Observational data confirmed this correlation. CONCLUSIONS: Further research to evaluate interventions to decrease the noise levels in both settings are needed, especially during times of peak activity. Staff working in these settings need to be more aware that control of acoustic levels is important in the neuroprotection of neonates. Coupling this with careful consideration to structural components and evidence-based design planning may contribute to lowering dB levels in the NICU environment.

Maternal Child and Family Health Nurses: Delivering a Unique Nursing Speciality.

Introduction This study aimed to describe Maternal Child and Family Health Nurses' (MCaFHNs) perception of their role across Australia. MCaFHNs deliver services to positively influence the growth and development of children in the early years. Little is known about their role as they deliver care to children and families in Australia. Methods This study used in-depth qualitative inquiry. Sixteen expert MCaFHNs from the eight jurisdictions in Australia took part in semi-structured interviews conducted from April 2013 to August 2013. The data were transcribed verbatim, validated by participants, and analysed thematically. Results The results indicated that the MCaFHNs' role is embedded in the principles of primary health care under an umbrella of universal service delivery with increasing overall complexity. Health promotion and early intervention are key components of the role, with services focused heavily on child growth and development and maternal mental health. Delivery of services by MCaFHNs was enriched by specific approaches to care, such as working in partnership with families, and all aspects of the role were enabled by essential specialist skills and knowledge. Discussion While role descriptors, educational backgrounds and experiences vary, participants overwhelmingly report similarities in practice. This study identified tangible reasons for the development of a nationally consistent role and practice in Australia, enabling consistency and equity of best models of practice. Such a description is essential to enable transferability and comparison with nurses working in similar contexts internationally.

Nurses' experiences of the hospitalisation of their own children for acute illnesses.

BACKGROUND: The hospitalisation of a child is a stressful event for parents. Parents who are also nurses may face additional challenges not encountered by other parents; yet, scant attention has been given to this issue in the literature. AIM: To explore the experiences of Nurse-Parents whose children were hospitalised for acute illnesses. METHODS/DESIGN: Using a case-study design, semi-structured interviews were conducted with six registered nurses and thematically analysed. RESULTS/FINDINGS: Nurse-Parents experienced significant conflicts between their parental role and nurse persona as they were 'torn between dual roles'. Nurse-Parents' specialised knowledge prompted them to elevate the care their child needed, leading to increased stress and anxiety as they struggled to balance these roles. CONCLUSION: Nurse-Parents want and need a different type of input into their children's care than non-nurse-parents. An increased awareness among healthcare professionals is the first step to ensuring that effective and individualised support is provided to Nurse-Parents.

Developing renal nurses' buttonhole cannulation skills using e-learning.

BACKGROUND: It has previously been shown that nurses can learn clinical nursing skills by e-learning (online), and that many variables will influence how well nurses adopt learned clinical skills using distance education. OBJECTIVES: This study aimed to identify and measure the strength of those factors which would simultaneously influence registered nurses' (RNs') beliefs about their own learning about buttonhole cannulation, using e-learning. DESIGN: An online Likert style survey consisting of a list of statements related to knowledge and skill domains considered crucial in the area of buttonhole cannulation was distributed to 101 RNs before and after completing an e-learning programme. Participants were required to identify their current level of self-confidence in relationship to each of the statements. MEASUREMENTS: Measures of RNs' self-rated abilities to assess and implement buttonhole cannulation after completing a related e-learning program were tested using a Partial Least Squares Analysis (PLS-PATH) programme. RESULTS: The study's results strongly identify that the nurses' ability to meet both clinical and educational outcomes of the renal e-learning module can be predicted by six variables, none of which are directly related to the participants' demographic or clinical backgrounds. CONCLUSION: These findings support the use of e-learning to teach clinical skills to RNs, and demonstrate the value of Partial Least Squares Analysis in determining influential learning factors.