Marta José Avena

Conceptual validation of the defining characteristics of respiratory nursing diagnoses in neonates

Objective: To develop and validate conceptual and operational definitions for the defining characteristics of the respiratory nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation, in newborns. Methods: This was a methodological study of conceptual validation of the defining characteristics of three respiratory nursing diagnoses, by consensus analysis of a committee of five specialist nurses, and then a group of five non-nursing professionals, using the Delphi technique. Results: After two rounds of evaluation, consensus was obtained that was equal to or greater than 80% on all of the definitions, which were then considered validated. Conclusion: The definitions developed for the defining characteristics of three nursing diagnoses were validated with a high level of consensus.

Avaliação polissonográfica do sono e vigília de recém-nascidos prematuros

OBJECTIVE to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. METHOD a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. RESULTS the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). CONCLUSION the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.

Respiratory Nursing Diagnoses: Presenting Evidence for Identification of the Defining Characteristics in Neonatal and Pediatric Populations

PURPOSE To identify and summarize clinical data supporting selection of nursing diagnoses related to the respiratory system for pediatric and neonatal populations. METHOD A literature review conducted in indexed publications was used. FINDINGS The final sample consisted of 13 studies conducted in children with cardiac disease, respiratory infection, and asthma with nursing diagnoses such as ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance. CONCLUSION The higher frequency defining characteristics were dyspnea, abnormal breathing pattern, use of accessory muscle to breathe, change in frequency and respiratory rate, decreased SaO2 , and agitation. IMPLICATION FOR NURSING KNOWLEDGE This literature review may provide a basis for consideration of important diagnostic criteria in the pediatric population; however, clinical validation in different stages of development is critical for ensuring diagnostic accuracy.

Polysomnography assessment of sleep and wakefulness in premature newborns

OBJECTIVE to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. METHOD a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. RESULTS the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). CONCLUSION the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.

Frequency of Respiratory Nursing Diagnoses and Accuracy of Clinical Indicators in Preterm Infants: Respiratory Nursing Diagnoses in Preterm Infants

PURPOSE To identify the frequency of the nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation in newborns; and, to analyze the accuracy of diagnostic indicators identified for each of these diagnoses. METHODS This was a cross-sectional study conducted with a nonprobability sample of 92 infants. Data collected were represented by demographic and clinical variables, clinical indicators of the three respiratory nursing diagnoses from NANDA International, and were analyzed according to frequency and agreement between pairs of expert nurses (Kappa). FINDINGS Ineffective breathing pattern was identified in 74.5% of infants; impaired gas exchange was noted in 31.5%; impaired spontaneous ventilation was found in 16.8% of subjects. Use of accessory muscles to breathe showed the highest sensitivity for ineffective breathing pattern; abnormal blood gases had the best predictive value for impaired gas exchange. Use of accessory muscles to breathe had the highest sensitivity for impaired spontaneous ventilation. CONCLUSIONS Ineffective breathing pattern was the most frequently identified; use of accessory muscles, alteration in depth of breathing, abnormal breathing, and dyspnea were the most representative signs/symptoms. IMPLICATION FOR NURSING PRACTICE Early recognition of respiratory conditions can support safe interventions to ensure appropriate outcomes.

Influence of Ear Protectors on the Sleep of Preterm Newborns: A Randomized Controlled Clinical Study

The purpose of this study was to compare the effect of ear protectors on the sleep of preterm newborns during the “quiet” times in intermediate care nursery. This was a clinical, randomized, controlled crossover study conducted in two neonatal units in São Paulo, Brazil. The sample consisted of preterm infants who met the inclusion and exclusion criteria for the study. Polysomnography and unstructured observation were used for data collection. Twenty-four preterm infants with a mean gestational age of 33.2 weeks and current weight of 1.747 g were analyzed. There was no significant difference in the total sleep time of preterm infants with and without the use of ear protectors. Newborns with lower gestational age showed a significant reduction in total sleep time with the use of ear protectors (p < .05). The use of ear protection did not increase the total sleep time for preterm infants.

Evaluación polisomnografíca del sueño y vigilia de bebés prematuros

OBJECTIVE to describe the total sleep time and its stages, total wake time, heart rate values and oxygen saturation shown by premature infants, and the influence of the periods of the day on sleep and physiological parameters. METHOD a descriptive study was conducted of 13 hospitalized premature infants. Data collection was performed using polysomnography and unstructured observation for 24 uninterrupted hours. RESULTS the newborns remained asleep for 59.6% of the day, predominantly in quiet sleep, with a higher mean heart rate during wakefulness (p<0.001). No difference was found between the variables related to sleep, physiological parameters and periods of the day, but in the morning a predominance of quiet sleep was observed (p=0.002). CONCLUSION the preterm newborn presented more total sleep time than wakefulness; quiet sleep was the predominant stage, and heart rate was higher during wakefulness.

Influência da posição da criança no leito sobre o sono: revisão integrativa

This study aimed to verify the influence of infant sleeping position on sleep. An integrative literature review was conducted in Pubmed, LILACS, SciELO and Cochrane, with the descriptors, “sleep”, “infant” and the terms “position” and “positioning”, in Spanish, English and Portuguese, published between 2000 and 2013. Six articles met the criteria for inclusion and exclusion. These studies were categorized into arousal from sleep and sleep stages. The results indicated that in the prone position, the infant had fewer arousal events, enabling deeper active sleep and greater amount of quiet sleep. The supine position is related to a greater amount of active sleep and more arousals, and does not expose the infant to the risk of Sudden Infant Death Syndrome. The supine position results in more arousals than the prone position, however, it promotes greater safety to the infant during sleep.