Regina M. Cusson

Kangaroo care: National Survey of Practice, Knowledge, Barriers, and Perceptions.

Purpose A national survey was conducted to assess practice, knowledge, barriers, and perceptions regarding Kangaroo Care (KC)—the holding of diaper-clad preterm infants skin-to-skin, chest-to-chest by parents. Design A descriptive survey was conducted. Methods Kangaroo Care Questionnaires (KCQs), developed for the study, were sent to nurse managers in all hospitals in the United States that were identified as providing neonatal intensive care services (N = 1,133), and were to be completed by the nurse most familiar with the practice of KC in that unit. A second KCQ was sent to nonrespondents. Descriptive statistics were used to summarize the data. Results A response rate of 59% (N = 537) was achieved. Over 82% of the respondents reported practicing KC in their neonatal intensive care units (NICUs). Nurses were knowledgeable about KC. Major barriers to practicing KC for certain types of infants were infant safety concerns, as well as reluctance by nurses, physicians, and families to initiate or participate in KC. Many NICUs do not permit KC for certain types of infants (e.g., those on vasopressors or high-frequency ventilation). Over 60% of respondents agreed that low gestational age or weight were not contraindications. Respondents from NICUs in which KC is practiced were more positive in their perceptions than respondents from NICUs that do not practice KC. Clinical Implications The findings suggest that in order to overcome barriers to the practice of KC, nurses need educational offerings highlighting the knowledge and skills needed to provide KC safely and effectively. These educational offerings should also emphasize the value of KC to infants and parents. In addition, knowledgeable practitioners need to develop evidence-based policies and procedures that will lead to successful KC.

Behavioral and Physiologic Effects of Nonnutritive Sucking during Gavage Feeding in Preterm Infants

ABSTRACT: Behavioral and physiologic responsivity to nasogastric gavage feeding was assessed in 36 preterm infants on 2 consecutive d. On one of these days, a pacifier was provided during and after the gavage segment of the standardized protocol. The protocol was divided into segments that included baseline, preparatory handling, pregavagc, gavage, and postgavage periods. Patterns of cardiac (heart period and vagal tone), oxygen saturation, behavioral state, and defensive behavioral responses to gavage were quantified. These stable preterm infants responded to handling and gavage feeding with reductions in heart period, vagal tone, and oxygen saturation. These responses were not altered by provision of a pacifier, although there was a tendency for fewer episodes of bradycardia and oxygen desaturation. Conversely, behavioral state was affected significantly by nonnutritive sucking: when provided with a pacifier, infants exhibited less behavioral distress, spent less time in fussy and active awake states during and after feeding, and returned to a sleep state significantly faster. There is converging evidence to suggest that nonnutritive sucking lessens behavioral distress to iatrogenic stressors but does not alter physiologic responsiveness.

Factors Influencing Language Development in Preterm Infants

OBJECTIVE To examine factors influencing preterm infant language development. DESIGN Longitudinal. SETTING Infants were seen for developmental follow-up at 7, 13, and 26 months corrected age in the school of nursing. PARTICIPANTS The sample consisted of 43 mothers and their preterm infants who were below 2,000 g and 36 weeks gestation at birth. More than 88% of the sample were from lower social classes. Seventy-three percent of the sample was African American and 27% was White. MAIN OUTCOME MEASURES Developmental outcome was assessed using the Bayley Scales of Infant Development, and language was assessed using the Reynell Developmental Language Scales. RESULTS By 26 months corrected age, infant development was within the normal range. Expressive and receptive language was delayed an average of 3 to 5 months. Factors influencing language included length of hospital stay, birth weight, Apgar scores, infant irritability and state regulation at hospital discharge, and maternal sensitivity. CONCLUSION Language development is delayed in preterm infants. Maternal sensitivity is positively associated with enhanced infant language. Nurses need to utilize opportunities to enhance sensitive mothering to optimize infant outcomes.

Pain assessment and measurement in neonates: an updated review.

Pain assessment and measurement are the cornerstones of pain management. Pain assessment connotes a comprehensive multidimensional description. Conversely, pain measurement provides a numeric quantitative description of each factor illustrating pain qualities. Pain scales provide a composite score used to guide practice and research. The type of infant pain instrument chosen is a significant factor in guiding pain management practice. The purpose of this review was to summarize current infant pain measures by introducing a conceptual framework for pain measurement. Although more than 40 infant pain instruments exist, many were devised solely for research purposes; several of the newly developed instruments largely overlap with existing instruments. Integration of pain management into daily practice remains problematic. Understanding how each instrument measures infant pain allows clinicians to make better decisions about what instrument to use with which infant and in what circumstances. In addition, novel new measurement techniques need further testing.

THE EFFECT OF ENVIRONMENT ON BODY SITE TEMPERATURES IN FULL-TERM NEONATES

The effect of environment on temperature was examined by comparing tympanic, rectal, inguinal, and axillary temperatures for 63 term infants in three environments: incubator, bassinet, and radiant warmer. Tympanic temperatures were collected with a FirstTemp (Intelligent Medical Systems, Carlsbad, CA) infrared thermometer in the cal-tympanic mode. Rectal, inguinal, and axillary temperatures were collected with an IVAC digital thermometer (San Diego, CA) in the predictive mode. There were moderate correlations between the body site temperatures. The environment significantly influenced temperature readings at the different sites. Temperatures assessed in the superheated environments of the radiant warmer and the incubator were consistently higher than temperatures in the bassinet.

Transition to the neonatal nurse practitioner role: making the change from the side to the head of the bed.

Role transition is never easy, but is complicated by the experienced neonatal nurse’s frustration with reverting to a student role and becoming a novice practitioner, sometimes after years of developing a reputation as an expert nurse. This article discusses this transition, focusing on the skills needed to move successfully from nurse to nurse practitioner. Common to all advanced practice transitions are stages similar to those Benner identifies in her novice-toexpert theory of nursing practice. Feelings of frustration and inadequacy are common during the first year as an NNP. Studies focusing on role transition and role development suggest that a strong nursing identity is important for success in the NNP practice environment. Strategies to enhance the transition are discussed.

An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization.

OBJECTIVE To determine what factors affect breastfeeding duration after discharge home from the neonatal intensive care unit (NICU) for high-risk mothers and their premature infants. DATA SOURCES The electronic databases of CINAHL and PubMed were used to identify studies published in English. Date of publication did not limit inclusion in the review. STUDY SELECTION Using exclusion and inclusion criteria, 292 articles were initially assessed for relevance to the research question through abstract review. Further screening resulted in full review of 52 articles. Reference list searching added an additional six articles. Finally, in-depth review of these 58 articles resulted in 24 studies that fully met inclusion and exclusion criteria. DATA EXTRACTION Studies were reviewed for information related to factors associated with breastfeeding duration for high-risk mothers and preterm infants after NICU discharge home. DATA SYNTHESIS Studies were categorized into five themes, including NICU factors, feeding and soothing methods, maternal characteristics, maternal experiences, and support programs. Most significant factors affecting duration included exposure to kangaroo mother care, prenatal education, and quantity of maternal breast milk supply during the first week after discharge. Breastfeeding also was affected by maternal breastfeeding knowledge and perception of providing appropriate volumes. CONCLUSIONS Mothers face many challenges breastfeeding their premature infants after NICU discharge. Ideally, all mothers need to receive support after NICU discharge, and the transition to home can be challenging even if breastfeeding is well established. However, NICU professionals are in a perfect position to provide guidance to families so they are able to anticipate and effectively solve lactation challenges at home.

State of the Science A Contemporary Review of Feeding Readiness in the Preterm Infant

Oral feeding readiness has been described by researchers in the neonatal intensive care unit, and research has continued on this topic for many years. The purpose of this narrative review is to identify research and practice guidelines related to oral feeding readiness in preterm infants that have occurred during the last decade. The introduction and mastery of oral feeding is a major developmental task for the preterm infant that is often a prerequisite for discharge from the neonatal intensive care unit. Having a better understanding of the evidence supporting the development of this skill will help the practicing nurse choose appropriate interventions and the researcher to develop trajectories of research that continue to increase our knowledge in this important practice area.

Cross-cultural adaptation of instruments assessing breastfeeding determinants: a multi-step approach

BackgroundCross-cultural adaptation is a necessary process to effectively use existing instruments in other cultural and language settings. The process of cross-culturally adapting, including translation, of existing instruments is considered a critical set to establishing a meaningful instrument for use in another setting. Using a multi-step approach is considered best practice in achieving cultural and semantic equivalence of the adapted version. We aimed to ensure the content validity of our instruments in the cultural context of KwaZulu-Natal, South Africa.MethodsThe Iowa Infant Feeding Attitudes Scale, Breastfeeding Self-Efficacy Scale-Short Form and additional items comprise our consolidated instrument, which was cross-culturally adapted utilizing a multi-step approach during August 2012. Cross-cultural adaptation was achieved through steps to maintain content validity and attain semantic equivalence in the target version. Specifically, Lynn’s recommendation to apply an item-level content validity index score was followed. The revised instrument was translated and back-translated. To ensure semantic equivalence, Brislin’s back-translation approach was utilized followed by the committee review to address any discrepancies that emerged from translation.ResultsOur consolidated instrument was adapted to be culturally relevant and translated to yield more reliable and valid results for use in our larger research study to measure infant feeding determinants effectively in our target cultural context.ConclusionsUndertaking rigorous steps to effectively ensure cross-cultural adaptation increases our confidence that the conclusions we make based on our self-report instrument(s) will be stronger. In this way, our aim to achieve strong cross-cultural adaptation of our consolidated instruments was achieved while also providing a clear framework for other researchers choosing to utilize existing instruments for work in other cultural, geographic and population settings.

Breastfeeding Self-efficacy A Critical Review of Available Instruments

Increasing breastfeeding rates in the United States is a national priority. Yet, initiation and duration of breastfeeding remains below national targets. Breastfeeding self-efficacy has been shown to be a strong predictor of both breastfeeding initiation and duration and is therefore an important characteristic to be able to measure. However, there is currently a myriad of instruments for measuring breastfeeding self-efficacy, which makes selection of an appropriate instrument difficult. Thus, our aim was to identify, compare, and critically review available breastfeeding self-efficacy instruments. In a systematic review, 6 breastfeeding self-efficacy instruments were identified. The instruments’ purposes, theoretical framework, final scale development, and application in 5 most recent settings were analyzed. The 6 breastfeeding self-efficacy instruments apply a number of theoretical and conceptual frameworks in their development, with Bandura’s social cognitive theory being most common. Content, construct, and predictive validity were strong for most scales. Some, but not all, have been successfully adapted to novel settings. In sum, there are several measurements of breastfeeding self-efficacy that can and should be employed to better understand reasons for suboptimal breastfeeding rates and the effects of interventions on breastfeeding self-efficacy. Instrument selection should be based on domains of primary interest, time available, peripartum timing, and assessment of previous adaptations. Failure to apply appropriate measures in research may garner results that are inconclusive, inaccurate, or nonrepresentative of true study effects.