Céline Goulet

Kangaroo mother care diminishes pain from heel lance in very preterm neonates: a crossover trial.

BackgroundSkin-to-skin contact, or kangaroo mother care (KMC) has been shown to be efficacious in diminishing pain response to heel lance in full term and moderately preterm neonates. The purpose of this study was to determine if KMC would also be efficacious in very preterm neonates.MethodsPreterm neonates (n = 61) between 28 0/7 and 31 6/7 weeks gestational age in three Level III NICUs in Canada comprised the sample. A single-blind randomized crossover design was employed. In the experimental condition, the infant was held in KMC for 15 minutes prior to and throughout heel lance procedure. In the control condition, the infant was in prone position swaddled in a blanket in the incubator. The primary outcome was the Premature Infant Pain Profile (PIPP), which is comprised of three facial actions, maximum heart rate, minimum oxygen saturation levels from baseline in 30-second blocks from heel lance. The secondary outcome was time to recover, defined as heart rate return to baseline. Continuous video, heart rate and oxygen saturation monitoring were recorded with event markers during the procedure and were subsequently analyzed. Repeated measures analysis-of-variance was employed to generate results.ResultsPIPP scores at 90 seconds post lance were significantly lower in the KMC condition (8.871 (95%CI 7.852–9.889) versus 10.677 (95%CI 9.563–11.792) p < .001) and non-significant mean differences ranging from 1.2 to1.8. favoring KMC condition at 30, 60 and 120 seconds. Time to recovery was significantly shorter, by a minute(123 seconds (95%CI 103–142) versus 193 seconds (95%CI 158–227). Facial actions were highly significantly lower across all points in time reaching a two-fold difference by 120 seconds post-lance and heart rate was significantly lower across the first 90 seconds in the KMC condition.ConclusionVery preterm neonates appear to have endogenous mechanisms elicited through skin-to-skin maternal contact that decrease pain response, but not as powerfully as in older preterm neonates. The shorter recovery time in KMC is clinically important in helping maintain homeostasis.Trial Registration(Current Controlled Trials) ISRCTN63551708

Attitudes and Subjective Norms of Male and Female Adolescents Toward Breastfeeding

There is a lack of information regarding the attitudes of Québecs adolescents about breast-feeding and how others influence their opinions. The present study aims to describe attitudes and subjective norms of adolescent males and females toward breastfeeding and to determine whether these are related to gender, age, secondary education level, mother tongue, country of origin, feeding method as an infant, feeding method of siblings, and exposure to breastfeeding. Adolescents (N = 439) answered a questionnaire based on the theory of reasoned action.Both genders showed an overall positive attitude but negative subjective norms toward breast-feeding. Gender differences and relationships with external variables in terms of attitudes as well as subjective norms are presented. Possible avenues to promote breastfeeding are discussed. J Hum Lact. 19(4):402-410.

Assessment of neonatal nurses’ behaviors that prevent overstimulation in preterm infants

This study assessed the adoption by neonatal nurses of behaviors that prevent visual, auditory, and tactile overstimulations in preterm infants, as well as the intentions, attitudes, and subjective norms related to the adoption of these behaviors. The convenience sample consisted of 54 neonatal nurses working in three Montreal region teaching hospitals. A multiple-choice questionnaire, composed on the basis of a review of the literature and the Theory of Reasoned Action, was used for data collection. The results revealed that the nurses often adopted behaviors that prevented tactile overstimulation, and that their intentions, attitudes, and subjective norms all favored the adoption of such behaviors. However, more than the half of the nurses did not frequently adopt behaviors that prevent visual and auditory overstimulations, nor did their intentions, attitudes, and subjective norms favor the adoption of these behaviors. Findings suggest that neonatal nurses lack specific knowledge in this area and that they would benefit from the completion of an evidence-based educational program on the prevention of overstimulation of preterm infants prior to their employment in a Neonatal Intensive Care Unit (NICU).

A controlled clinical trial of home care management versus hospital care management for preterm labour

Prenatal hospitalisation has not been shown to reduce perinatal morbidity and mortality, yet it is still the treatment of choice for women who experience preterm labour. Home care management may be an alternative means of delivering safe, efficacious and care for these women. The objectives of this controlled clinical trial were to examine differences in neonates gestational age and birthweight, and antenatal stress, social support satisfaction, and family functioning among pregnant women receiving home care and those receiving hospital care management. Pregnant women experiencing preterm labour (N=250) were randomly assigned to home care management (the experimental group [EG]) or hospital care management (the control group [CG]). A Perinatal Information Form was used to collect data on sociodemographic and pregnancy variables. The High-Risk Pregnancy Stress Scale, Browns Social Behaviors Inventory, and the Family Assessment Measure III Dyadic Relationships Scale were administered to the women at randomisation (T1) and at 1-week (T2) and 2-weeks (T3) after randomisation. Gestational age and birthweight were similar in the two groups of neonates. Women in the EG reported that antenatal stress was significantly lower at T3 than at T1 and T2, while for those in the CG, antenatal stress was significantly lower at T3 than at T1, and significantly lower at T2 than at T1. Women in the EG were more satisfied with support from the male partner at T3 than women in the CG. There was no significant difference between the two groups in family functioning at T1, T2 and T3. These findings indicate that home care management is a safe and efficacious mode of health care delivery for women experiencing preterm labour.

LANG AND GOULET HARDINESS SCALE: DEVELOPMENT AND TESTING ON BEREAVED PARENTS FOLLOWING THE DEATH OF THEIR FETUS/INFANT

The process of development and testing of the Lang and Goulet Hardiness Scale (LGHS), a self-report instrument designed to measure hardiness in bereaved parents following the death of their fetus/infant, is presented. Hardiness is a personal resource, composed of 3 interdependent components that are characterized by a sense of personal control over the outcome of life events and hardships such as the death of a fetus/infant, an active orientation toward meeting the challenges brought on by the loss, and a belief in the ability to make sense of ones own existence following such a tragedy. The concept of hardiness has been studied by various disciplines and in a multitude of settings to understand its ability to lessen potentially negative effects of life stress. However, it has never been studied within the context of parental bereavement. The LGHS was developed systematically, originating from a concept analysis. A panel of 15 experts was used to establish content validity. A pretest was conducted on 73 bereaved individuals to assess convergent and discriminant validity of the LGHS. Subsequently, a validation study on 220 bereaved parents who had experienced the death of their fetus/infant 2 months previously was conducted including a retest 6 months after the loss with 192 of the remaining participants. Analyses reveal that the LGHS is a valid and reliable instrument for measuring hardiness and that it is sensitive enough to detect changes in the construct over time.

WEATHERING THE STORM OF PERINATAL BEREAVEMENT VIA HARDINESS

Hardiness is a personal resource that can potentially diminish negative effects of life stress. To increase understanding of the role that it can have on the health protection and promotion of bereaved parents following a perinatal loss, this article uses J. Wilsons (1969) method to present a concept analysis of hardiness. This analysis provides not only a fresh perspective for understanding the experience of perinatal loss but has also induced the development of a hardiness instrument. Knowledge development in this area is paramount for professionals interested in enabling bereaved parents to draw on and develop their hardiness, not only to transcend the experience but ultimately to gain a sense of personal growth following their loss.Hardiness is a personal resource that can potentially diminish negative effects of life stress.To increase understanding of the role that it can have on the health protection and promotion of bereaved parents following a perinatal loss, this article uses J. Wilsons (1969)method to present a concept analysis of hardiness.This analysis provides not only a fresh perspective for understanding the experience of perinatal loss but has also induced the development of a hardiness instrument. Knowledge development in this area is paramount for professionals interested in enabling bereaved parents to draw on and develop their hardiness, not only to transcend the experience but ultimately to gain a sense of personal growth following their loss.

Strategies to Elicit and Analyze Relational Family Data

Within the paradigm of qualitative methods of inquiry and data analysis are interesting avenues to address the complex task of capturing the family’s experience from a transactional viewpoint. The purposes of this article are to identify strategies for creating family-based data as well as to offer a theoretical discussion of how data analysis can attend to and enhance the knowledge base of the family experience. This discussion will be anchored within the description of an ongoing research study involving the examination of the process of parent-infant attachment. In this research, the processes of maternal and paternal attachments to their infants are regarded as co-constructed phenomena within the family environment. In this context, conceptualization of family interactional variables, strategies to elicit these variables, and paths to qualitative analysis of the data are presented.

Enfermería de práctica avanzada: un tesoro oculto

Resumen A traves del mundo entero, los logros de las enfermeras de practica avanzada son numerosos y remarcables. Sin embargo, llegado el tiempo de tomar decisiones en el ambito de las politicas de salud y de las transformaciones del sistema, se nos deja de lado. La ambiguedad sobre la esencia de la enfermeria de practica avanzada y las poco desarrolladas habilidades politicas de las enfermeras pueden ser dos de los factores contribuyentes. Las enfermeras debemos detenernos y pensar sobre estos aspectos con vistas al futuro de la enfermeria de practica avanzada y a la posicion de la profesion dentro del Sistema Canadiense de Salud. Esta reflexion debe tener lugar en un nivel mas elevado al de la discusion sobre titulos, roles, funciones y tareas. En la vanguardia, el desarrollo de un fuerte liderazgo, la adquisicion de poder colectivo, la busqueda de la cohesion dentro de la profesion y un profundo compromiso con el avance de la disciplina son obligaciones para las enfermeras comprometidas con la enfermeria de practica avanzada. Es tiempo de sacar a la luz los logros de las enfermeras de practica avanzada y de demostrar la verdadera valia de nuestras habilidades. Despues de todo, ello iria encaminado al beneficio de una sociedad mas saludable y de un sistema mas eficiente de salud, ya uno de los mejores en el mundo. Que ya habiamos jugado un papel en ello es incuestionable.

CANADIAN CROSS‐CULTURAL COMPARISON OF THE HIGH‐RISK PREGNANCY STRESS SCALE

The purpose of this article is to present the French and English versions of the High-Risk Pregnancy Stress Scale (HRPSS) and the reliability and validity analyses. This instrument contains 16 items representing psychological and environmental stressors of the at-risk pregnancy situation with or without hospitalization. The HRPSS was developed specifically to measure the degree of stress as experienced by women with high-risk pregnancy. The results of the principal component analyses with Varimax rotation (N = 105) reveal that the HRPSS has two components. The first component represents physical restriction, while the second represents concerns related to pregnancy. These two components have been identified as forming the basis of the concept of antenatal-related stress. The HRPSS demonstrates internal consistency, equivalence and stability reliability. The psychometric analyses reveal that both the French and English versions have similar qualities.

Maternal touch and talk for invasive procedures in infants and toddlers in the pediatric intensive care unit.

The aim of this single-blind, randomized, crossover trial was to test the effect of Touch & Talk (T&T) for infants and toddlers less than 36 months of age (N = 65) in the pediatric intensive care unit on their physiological stability and recovery to an invasive procedure. In the T&T condition, mothers touched, sang, or told stories or rhymes to their child during an invasive procedure. In the control condition, the mothers did not have contact with their child. Physiological measures included heart rate, heart rate variability, and oxygen saturation range during the procedure and change from baseline. Time from the end of the procedure until the heart rate returned to baseline levels gave the recovery time. Analysis was conducted using repeated-measures analysis of covariance. There were no significant differences on any of the physiological parameters by condition during the procedure. However, when controlling for severity of illness, recovery was faster with mothers.