Niang-Huei Peng

To explore the conditions of dying infants in NICU in Taiwan

PURPOSES Research purposes were to document the symptoms characteristic of neonates during their last week of life and to describe the activities undertaken in nursing care of dying neonates in neonatal intensive care unit (NICU). METHODS A retrospective chart review was used in this research. All charts of neonatal inpatients who died in the NICU between 2002 and 2008 and who met entry criteria were included the research review. RESULTS Sixty-one charts were evaluated in this research. The major underlying disease was the complications of prematurity (33%). Major physiological distress signs in the last week of life included respiratory distress (67.2%), cyanosis (54.1%), bradycardia (36.1%), oliguria (31.1%), and generalized edema (37.7%). All infants were intubated and received artificial ventilation in the last week of life. Physicians prescribed an analgesic medicine for 7 infants, and 7 infants received comfort interventions to manage their distress signs. Forty-one infants had preexisting do-not-resuscitate order at the time of death. CONCLUSIONS Research findings suggest that the application of palliative care paradigm and more aggressive comfort care to manage signs in NICU might be beneficial to dying infants.

Cultural Practices and End-of-Life Decision Making in the Neonatal Intensive Care Unit in Taiwan

The purpose of this research was to describe conditions of decision making for dying infants and cultural effects on the process of infant death in the neonatal intensive care unit. A retrospective chart review was used in this research. Fifty charts were reviewed; the major cause of death for the research subjects was complications of prematurity (52%). Eighty-two percent of the charts documented a do not resuscitate order, and 16% of parents allowed discontinuation of ventilator support when they realized the futility of continued care. In 30 nursing records, parents and their dying infants were offered a quiet place in which to grieve. In 10 cases, nurses accompanied these parents and allowed them to express their emotions. Research findings showed great outward expression of religion at the time of death. Various cultural issues affected both the grieving process of the families and the dying process of their infants.

Comparison of the Educational Needs of Neonatologists and Neonatal Nurses Regarding Palliative Care in Taiwan

Background: Education and training are very critical to development of high-quality neonatal palliative care. However, little investigation has been done into Taiwanese neonatal clinicians’ educational needs regarding neonatal palliative care. Purposes: The purposes of this study were to characterize and identify neonatal clinicians’ educational needs regarding neonatal palliative care. Methods: A cross-sectional descriptive surveyed method via a self administered questionnaire was used in this research. Thirty neonatologists were recruited by a convenience sampling and 30 nurses were recruited by a randomized sampling. Results: Out of sixty neonatal clinicians’ survey, few had received the education in neonatal palliative care. Most reported minimal training in, experience with, and knowledge of neonatal palliative care. For neonatologists, two of twelve most strongly-felt educational needs were “discussing palliative care and ethical decision-making with parents” (70%) and “informing parents the poor progress in neonates” (63.3%). In contrast, neonatal nurses wanted more training regarding pain control (50%). Communication skills, including the discussing poor prognosis, bad news, and code status and talking with neonates about end-of-life care, were the educational need most commonly felt by both neonatologists and nurses. Conclusions: Survey data from neonatologists and neonatal nurses in Taiwan indicate a need for further training on a range of neonatal palliative care competencies.

Effectiveness of Pediatric Palliative Care Education on Pediatric Clinicians

A lack of knowledge and skills in pediatric palliative care may create hesitation in caring for children with serious life-threatening conditions and their families. Our research examined the effectiveness of pediatric palliative care training for pediatric clinicians. A pretest–posttest study provided educational training in pediatric palliative care to pediatric clinicians and used a pretest and a posttest to assess outcomes. Fifty pediatric clinicians attended this research with 83.3% response rate. After training, participants reported significantly increased confidence in a variety of areas, including providing emotional support to clinicians, personal knowledge, skills, and communication; ethical and legal concerns; and providing emotional support to dying children and their families. Results showed a significant main effect of training on confidence levels (p < .000). This suggests that education can effectively boost pediatric clinicians’ confidence regarding providing pediatric palliative care and therefore should regularly be provided to clinicians.

Relationships between environmental stressors and stress biobehavioral responses of preterm infants in NICU.

Although research has demonstrated that the neonatal intensive care unit (NICU) is a stressful environment for preterm and high-risk infants, little research validates the suspected relationships between infant biobehavioral responses and environmental stress in the NICU. This exploratory study examined the relationship between environmental stress and biobehavioral responses of preterm infants. The study used a repeated-measures research design to examine research variables in one group of preterm infants. Measurements of research variables were recorded every 2 minutes during two 60-minute observation periods for each research day (1 hour in the morning and 1 hour in the afternoon) and conducted over 2 days. A convenience sample of 37 preterm infants was recruited from 2 medical centers in Taiwan. A total of 4164 observations were made and recorded during the study. There was a statistically significant (P < .05) relationship between environmental stressors and changes in physiological signals. There were also statistically significant (P < .05) relationships between environmental stress and some specific stress behaviors. This research is applicable to neonatal clinical practice because it demonstrates the importance of recognizing the preterm infants biological stress responses to environmental stressors, allowing for early interventions to reduce the possibility of more serious physiological or pathological changes in the status of the preterm infant.

PS-255 Social Support, Perceived Stress And Maternal Confidence In Mothers With Preterm Infants At Home In Taiwan

Purpose The purpose of study is to explore the relationships between social support, perceived stress and maternal confidence in mothers with preterm infant after discharged at one month in Taiwan. Methods The study is a cross-sectional designed. Data were collected by purposive sampling. A total of 90 mothers with preterm infants were recruited in a sick baby room (SBR) at a medical centre in the central district of Taiwan. The measurement is self-reported questionnaire including both demographic data, Social Support Scale, Perceived Stress Scale, and Maternal Confidence Scale. Participants filled the questionnaire after infants discharged one month. Results The study showed that mothers’ social support at one month after discharge, average score was 76.47 (total 104), which indicated 70% of social support. The average score of perceived stress was 28, equivalent levels of stress. The average score of maternal confidence was 64.20 (total 90), which showed 70% of confidence. The related factors of mother perceived stress were mothers’ perceived health status, daily sleep hour, perceived sleep quality, tangible support and emotional support, positive interaction, affection, and number of baby (p < 0.05). The daily sleep hour, perceived sleep quality and affection were the predictors of mothers’ perceived stress with 32.5% of prediction explanation. Conclusion These results suggest that factors related with mother perceived stress and maternal confident. The study suggests that the needs of mother with preterm infants should be included in nursing education and in-service education. The findings of this study will serve as a reference for nursing practice.