Deborah A. Raines

Neonatal skin care: the scientific basis for practice.

Objective: To review the literature addressing the care of neonatal skin. Data Sources: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization. Study Selection: Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review. Data Extraction: Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown. Data Synthesis: Newborns’ skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin’s immature barrier function, and promoting skin integrity. Conclusions: This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.

Suspended mothering: women's experiences mothering an infant with a genetic anomaly identified at birth.

Purpose: To develop an understanding of the experiences of women who give birth to an infant with a genetic anomaly not identified during the prenatal period. Design: Exploratory design using selected qualitative methods. Sample: Seven mothers of liveborn infants with a genetic anomaly characterized by physical attributes evident at birth. Main Outcome Variable: Mother’s expressions of suspended mothering. Results: Two themes emerged that characterize the experience of suspended mothering: diminished maternal role and false protection. Practice Recommendations: Facilitating maternal involvement in decision making requires giving women unbiased information in a supportive manner.

Values Influencing Neonatal Nurses' Perceptions and Choices

The purpose of this research was to identify the values influencing the nurses perception and choice of behavior in a hypothetical clinical situation. The theoreticalframework was Rokeach s theory on the nature of human values and value systems. A descriptive study using a mailed survey was conducted on a random sample of 331 members of the National Association of Neonatal Nurses. Data on individual nurses values, perception of information, and behavioral choices were collected with an investigator-developed questionnaire consisting of a values scale, and an information scale and choice alternatives related to three hypothetical vignettes: a low-birthweight infant, an infant with chromosomal anomalies, and a chronically ill infant. Results of this study indicate that nurses identified a hierarchy of values related to their practice. Information related to infant characteristics was consistently most important; however, in uncertain situations, rules or external protocols had an increased influence on the behavioral choice process. The behavioral choice option with the greatest agreement was differentfor each situation. A consistently negative correlation between the options within each vignette indicates that nurses have clearly defined choice preferences. Model testing revealed a consistent relationship across the three vignettes between the variable being just and protocol, doing right and infant characteristics, and infant characteristics and the choice options (p < .05).

Fetal Surveillance: Issues and Implications

In the past, the fetus was considered healthy until evidence was presented to the contrary. With the acceptance of fetal surveillance as part of the pregnancy experience, diagnostic testing and data are thought to be necessary to prove the healthiness of the fetus. The availability of fetal surveillance techniques has transformed the pregnancy experience from a developmental process and a miracle of nature to a risk-dominated and technology-guided event. The implications of this trend significantly affect the care of pregnant women and the role of nurses as providers of comprehensive, individualized nursing care.

Preparing for NICU discharge: mothers' concerns.

Purpose: To quantify mothers’ concerns in anticipation of their infant’s discharge from the NICU Design: An exploratory, cross-sectional survey design was used. Sample: A convenience sample of 150 mothers Main Outcome Variable: The focus was the mothers’ concerns about their infant’s impending discharge. Results: The mothers expressed confidence in their ability as a caregiver but expressed concern about being tired, the need for readmission to the hospital, and missing a change in the infant’s conditions.

An evidence-based safe sleep teaching program.

ABSTRACT This column describes the experience of the units practice council in developing an evidence-based practice teaching program focused on safe sleep for newborn infants.

Factors That Influence Parents' Adherence to Safe Sleep Guidelines

Objective: To explore factors that influence parental behaviors related to newborn sleep positions and environments in the home after hospital discharge. Design: A descriptive qualitative study conducted by telephone. Setting: A 290‐bed academic teaching hospital in an urban setting with a Level 3 perinatal center and approximately 4,500 births per year. Participants: Participants (N = 60) were recruited from the patient population of the mother–baby unit. All participants were scheduled to be discharged simultaneously with their newborns. Methods: Qualitative interviews with grand tour–style questions were conducted by telephone. An inductive analysis process was used to identify themes and meaning. Results: Participants described three consistent factors that influenced how the newborn slept at home. The most frequently mentioned influence was Other People followed by Nobody/No One and Images from sources such as books, pictures, television, and the Internet. Conclusion: New parents need education about the rationale for the safe sleep guidelines from the American Academy of Pediatrics (AAP) as well as knowledge of the potential harm of behaviors such as bed sharing and prone or side‐lying positions for sleeping. The images to which parents are exposed send mixed messages. Health care professionals should portray safe sleep for infants in media, marketing materials, and other graphic representations. Nurses should help parents understand the AAPs recommendations for safe sleep position and environment for infants so that they can become advocates for their newborns well‐being.

Intraamniotic Infection and the Term Neonate

Abstract Intraamniotic infection (IAI) may occur when the amniotic membranes are ruptured >18 hours prior to birth. The term neonate is at risk for early onset sepsis. This article describes the pathophysiology of IAI and the role of the mother-baby nurse during the anticipated birth and the ongoing assessment of the neonate.

The Infant Born to a Woman with Gestational Diabetes

Abstract Gestational diabetes mellitus (GDM) is defined as glucose intolerance with onset during pregnancy. During pregnancy, women with GDM develop insulin resistance, which results in altered glucose tolerance. As a result, there are frequent episodes of hyperglycemia and high levels of circulating amino acids, increasing the transfer of nutrients to the fetus. This article discusses the role of the mother–baby nursing in the care of neonates born to women with gestational diabetes.

Evaluation of an Evidence-Based Teaching Program for Newborn Safe Sleep

Abstract Purpose: To evaluate the effectiveness of evidence-based teaching guideline and patient outcomes. Design: Descriptive evaluation study with two data collection points. Sample: A convenience sample of 48 new mothers. Main outcome variable: Mothers’ knowledge and practice of safe sleep behaviors for their newborn. Results: The findings of this evaluation study demonstrate that this unit-based teaching program was effective in impacting mothers’ knowledge about and practice of safe sleep for the newborn following discharge from the postpartum unit.