Implementation of a Perinatal Hospice Program.

BACKGROUND: In 2017, the Nebraska Unicameral passed legislative bill 506, which required physicians to inform patients carrying fetuses diagnosed with a life-limiting anomaly of the option to enroll in a comprehensive perinatal hospice program. The bill also required the Department of Health & Human Services to provide information about statewide hospice programs. Families enrolled in hospice programs are better prepared for the birth and death of their child. This large academic medical center was listed on the registry but did not have a formal perinatal hospice program. PURPOSE: Implementation of a comprehensive perinatal hospice program. METHODS: The program was designed and implemented, beginning with the formation of an interdisciplinary team. Guidelines were developed for program referral, care conferences, team communication, and family follow-up. The team was educated. Electronic record documentation and order set were implemented. A data collection process was developed to track referrals and critical data points. RESULTS: The perinatal hospice program has been accepting referrals but has not had any qualifying referrals. IMPLICATIONS FOR PRACTICE: The development of an evidence-based guideline for referral that can improve referral consistency. While trisomy 13 and 18 diagnosis was historically considered life-limiting, these families now have the option of full intervention and transfer for specialists. IMPLICATIONS FOR RESEARCH: Future research will include collecting data from patients who could have benefited from hospice, including infants who were born 20 to 22 weeks, or for maternal reasons. Future research will evaluate the experience after bereavement, the hospice team's experience, and the effectiveness of the referral process.

Development and Evaluation of a Radiation Safety Program in the NICU.

PURPOSE: To develop and evaluate a radiation safety program used to educate NICU staff regarding safety procedures to minimize the effects of radiation on the newborn.
Background: Advancements in medical care have resulted in infants born at lower gestational ages and higher acuity. With increased acuity comes an increase in diagnostic testing, including radiologic imaging. Although x-rays are necessary, they do not come without risk, including the future development of cancers.
Methods: The number of x-rays completed in the NICU over a one-year period, was evaluated prior to the radiation safety program, directly after implementation, and five years postintervention.
Results: Prior to the radiation safety program, the mean number of x-rays was 4.2 per patient per NICU admission. Immediately after implementation, the mean decreased to 3.8 per patient, and five years postintervention, the mean significantly decreased to 1.9 x-rays per patient per NICU stay.

Bacterial sepsis in the neonate.

Neonatal bacterial infections leading to sepsis occur frequently in the first few days or weeks of life. NPs must be able to recognize the early signs of sepsis and understand the need for rapid evaluation and treatment. This article discusses antibiotic treatments for various types and locations of bacterial infections and sepsis in the neonate.

Development of the Gastrointestinal System: An Embryonic and Fetal Review.

The embryonic and fetal development of the gastrointestinal (GI) tract is important in understanding the development of many GI disorders. This article will review the GI development and relate it to various defects and disorders seen in the preterm and term infant.

Supporting Families of Children With Disabilities.

Advanced technology combined with improvements in neonatal care have increased the survival rates of low-birth-weight infants and infants born with severe birth defects. These infants are at greater risk for long-term health and developmental problems. The effect of having a child with a disability on the family is described, and emerging interventions and resources available for these families are provided.

Extracorporeal Membrane Oxygenation in the NICU.

Extracorporeal membrane oxygenation (ECMO) was developed for adults but has been used in neonates as a life-saving rescue therapy for infants with respiratory failure and/or cardiac collapse as a result of congenital diaphragmatic hernia, meconium aspiration syndrome, persistent pulmonary hypertension, or systemic sepsis. ECMO has been proven to increase the survival rate for these diseases. This article provides an overview of neonatal ECMO: the history and development of neonatal ECMO, patient selection criteria, clinical management, the ECMO circuit, weaning from ECMO, and possible complications of ECMO.

Respiratory Development and Respiratory Distress Syndrome.

Respiratory development is crucial for all newborn infants. Premature infants may be born at an early stage of development and lack sufficient surfactant production. This results in respiratory distress syndrome. This article reviews the normal fetal development of the lung as well as the disorder that develops because of an early birth.

Genetic testing in infants.

Genetic testing has made diagnosis and treatment possible for many infants. With the addition of many new tests over the past few years, it is important to understand the clinical usefulness of each of these tests. Selecting the correct method of genetic testing assists in obtaining an accurate diagnosis and development of a plan of care for the infant.

Infants of diabetic mothers.

Infants of diabetic mothers (IDMs) can present with various symptoms and disorders. The neonatal nurse must be able to assess the infant for glucose control and other anomalies.

Job satisfaction of neonatal intensive care nurses.

PURPOSE: The purpose of this study was to describe the job satisfaction of neonatal intensive care unit (NICU) nurses in the Midwestern United States. The factors explored in job satisfaction were monetary compensation (pay), job stress, caring for patients in stressful situations, level of autonomy, organizational support, level of knowledge of the specialty, work environment, staffing levels, communication with physicians, communication with neonatal nurse practitioners, interdisciplinary communication, team spirit, and the amount of required "floating" to other nursing units. SUBJECTS: Participants were 109 NICU nurses working as either staff nurses (n = 72) or advanced practice nurses (n = 37). Of the participants, 96% worked in a level 3 NICU. DESIGN: A descriptive, correlational design was used to study job satisfaction among NICU nurses. METHODS: Nurses were recruited at 2 regional NICU conferences in 2009 and 2010. The questionnaire was a researcher-developed survey consisting of 14 questions in a Likert-type response rating 1 to 5, with an area for comments. Descriptive statistics and correlations were used to analyze the resulting data. MAIN OUTCOME MEASURES: The majority of participants were moderately satisfied overall in their current position and workplace (mean ranking = 4.07 out of 5.0). Kendall's Tau b (TB) revealed that the strongest positive correlations were between organizational support and team spirit with overall job satisfaction (TB = 0.53). RESULTS: : The individual factors with the highest mean scores were caring for patients in a stressful situation, level of autonomy, and communication between nurses and neonatal nurse practitioners. This indicates that our population of NICU nurses feels most satisfied caring for patients in stressful situations (m = 4.48), are satisfied with their level of autonomy (M = 4.17), and are satisfied with the interdisciplinary communication in their units (m = 4.13). CONCLUSIONS: Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU nurses proves to be a limitation for generalization. Additional research is needed to further evaluate nursing role, educational level, and job satisfaction in the NICU.

Women's experience of hospitalized bed rest during high-risk pregnancy.

OBJECTIVE: To describe the lived experience of the hospitalized pregnant woman on bed rest. DESIGN: A qualitative, phenomenological design. SETTING: Three high-risk antepartum units in the midwestern United States. PARTICIPANTS: A self-selected, convenience sample of 11 high-risk pregnant women. METHOD: Phenomenological study using thematic analysis of completed handwritten journals and/or online blogs. RESULTS: Women described the battles that they fought each day for the lives of their unborn children. Using an imagery of war, three categories emerged: (a) the war within, (b) fighting each battle, and (c) bringing in reinforcements. CONCLUSIONS: Women experience many different emotions and stressors during restricted bed rest. A nurse's understanding of this experience is essential to provide adequate care and coping strategies for women at this time.

Blood types and ABO incompatibility.

Using the Punnett square and having an understanding of the relationship between genes and blood types will assist you in explaining blood type inheritance to parents and answering their many questions. Using this tool, nurses can show parents what is happening during the division of genes and how blood type genes are expressed.

The lived experience of nurses caring for newborns with sepsis.

OBJECTIVE: To describe the lived experience of nurses who care for newborns with sepsis. DESIGN: Phenomenology, a qualitative study using open-ended, tape-recorded interviews, followed by a focus group discussion. The data were analyzed using Colaizzi's step-by-step procedure, resulting in an essential structure of the experience. SETTING: The nursery and neonatal intensive-care unit of a large community hospital in the southwestern United States. PARTICIPANTS: Eleven registered nurses who cared for newborns in both a transitional nursery and the neonatal intensive-care unit were interviewed individually or in a focus group. RESULTS: Three major themes were generated from the data: (a) "Dealing With Death and the Blessings of Life," (b) "Sepsis: The Cancer in the NICU," and (c) "Losing the Dream: Parents' Reactions." The nurses had feelings of helplessness and frustration while caring for these sick newborns. Nurses described the changes in newborns' condition as sepsis developed, the actions taken to reverse the downhill course, and the experiencing of the outcome. Nurses perceived that parents responded with overwhelming fear, guilt, and loss of control. CONCLUSIONS: The nurse caring for the infant with sepsis experiences many different emotions, reactions, and perceptions. These findings can assist nurses to have a better understanding of the role of the nurse and the emotional burden of working in the NICU.