Alice S. Hill

Oral support measures used in feeding the preterm infant

BACKGROUND Evidence that bottle-feeding is a stressor for inefficient preterm infant feeders is seen in untoward changes in the physiologic system and nutritive sucking patterns. OBJECTIVE To determine whether a therapeutic technique, oral support (cheek and jaw support), would influence the cardiopulmonary functions or nutritive sucking patterns of preterm infants during feeding. METHODS A crossover repeated measures design was used with 20 preterm infants for a total of 40 bottle-feeding sessions. The Whitney Mercury Strain Gage and a Nonin Cardiopulmonary monitor were used to observe sucking characteristics and cardiopulmonary functions during feeding. RESULTS Infants not receiving support paused longer (F= 6.37, df= 5, p < .001) and more frequently (F= 5.01, df= 5, p < .001) than supported infants. There were no differences between the groups in the number of sucks and bursts, the burst duration, the stability of the total sucking activity, or the rate of sucking. Oxygen saturation (SaO2) values, heart rate, and respiratory rate did not differ between the groups during feeding. Postfeeding SaO2 levels were lower than prefeeding levels for infants not receiving oral support (t= 0.96, df= 19, p= .03). CONCLUSION Oral support provided stability for the jaw and fostered the return of the infants prefeeding SaO2 values, but it did not interfere with cardiopulmonary function during feeding. Further research is needed to determine whether there is a cumulative effect of oral support, and whether it influences state behavior.

Identifying the components of a nursing service philosophy.

A framework for writing a nursing service philosophy provides the nurse manager with a quick and easy reference to identify essential organizers for the philosophy. The framework described here pinpoints three areas of importance, nursing/nursing practice, the patient/client, and the nurse, and describes specific subject matter to be addressed with each area. By organizing the subject matter into three practical areas of concern, the nurse manager can explore each area and develop a realistic and operational philosophy for the Nursing Service Department.