Using the Delphi technique to develop standards for neonatal intensive care nursing education

The purpose of this study was to use the Delphi technique to determine the first draft of national standards for neonatal intensive care nursing (NICN) education. The Australian College of Neonatal Nurses (ACNN) endorsed the project, and assisted in the selection of members for a panel of 13 neonatal intensive care nursing and education experts from all states of Australia that conducted NICN education programs. These experts were consulted over a period of seven months using the Delphi technique. The researcher initially developed a set of questions to guide the expert panel

Cochrane Review summary: Oral rinses, mouthwashes and sprays for improving recovery following tonsillectomy

Tonsillitis (inflammation or enlargement of the tonsils) occurs mainly in children due to a variety of reasons including chronic illness due to recurrent infection and enlargement of the tonsils, with difficulties in swallowing and breathing, very large tonsils that obstruct breathing, and recurrent ear infections. Tonsillectomy is the surgical removal of the tonsils, two pads of lymphoid (glandular) tissue located on each side at the back of the throat. There are side effects to the tonsillectomy procedure such as pain and bleeding, and various postoperative treatments have been used to minimise these symptoms from occurring. The aim of this Cochrane Review was to assess the effects of oral rinses, mouthwashes and sprays in improving recovery following tonsillectomy. The search for this review was updated in April 2011

Cochrane Review summary: High flow nasal cannula for respiratory support in preterm infants

In the preterm infant requiring respiratory support for apnoea, respiratory distress syndrome (RDS) or chronic lung disease (CLD), a variety of non-invasive ventilation options are available. Nasal continuous positive airway pressure (CPAP) is commonly used as an alternative to endotracheal intubation and more recently, high flow nasal cannula (HFNC) is being used to deliver positive end-expiratory pressure (PEEP), oxygen, blended oxygen and air. Both methods however may have adverse effects despite being moderately easy to apply and manage. The most significant risks related to nasal CPAP are nasal trauma and distortion of the nares, and for HFNC, mucosal irritation, obstruction, nosocomial infection and possible lung injury from PEEP which is not measured and inconsistent. The aim of this Cochrane Review was to compare the safety and efficacy of HFNC with other forms of non-invasive respiratory support in preterm infants

Positioning for acute respiratory distress in hospitalised infants and children

An association has been established between prone positioning and sudden infant death syndrome (SIDS) which has lead to the recommendation that young infants be positioned supine. Yet, the prone position has been shown to improve the arterial oxygenation in older infants and children with respiratory distress. Due to structural and physiological immaturity, the respiratory mechanics differ between adults and children, which means that the risks and benefits of positioning in the younger age group may have more clinical significance. Given the SIDS recommendations for supine positioning in young infants and the benefits associated with prone positioning with respiratory distress, a systematic review of the literature was necessary to guide clinical practice in hospitalised infants and children. The aim of this Cochrane Review was to compare the effects of different body positions (prone, supine, lateral, elevated and flat) on infants and children hospitalised with acute respiratory distress. The search for this review was updated in August 2008

Cochrane Review summary: Preoperative fasting for preventing perioperative complications in children

During general anaesthetic, in adults and children alike, the protective reflexes that prevent lung aspiration of stomach contents are inhibited. Preoperative fasting is thought to reduce the risk of regurgitation and gastric aspiration during surgery. Several professional body guidelines have recommended a more relaxed fasting period than the traditional ‘nil by mouth from the midnight before surgery’ policy. However, practices vary widely due to a lack of confidence in the evidence. The aim of this Cochrane Review was to determine the effects of different fasting regimens (duration, type and volume of permitted intake) and the impact on perioperative complications and patient well being (aspiration, regurgitation, related morbidity, thirst, hunger, pain, comfort, behaviour, nausea and vomiting) in children. The search for this review was updated in 2009

Identification of parental stressors in an Australian neonatal intensive care unit

Author version made available in accordance with the publisher's policy.Aims: This study explored the types and levels of stress in parents with infants in a South Australian NICU, and identifies the psychometric properties of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) in this Australian setting. Background: It is well recognised that many parents experience stress following a preterm birth and subsequent hospitalisation and separation from their baby or from the admission of a newborn infant to intensive care. Methods: This mixed method study used a parental stress assessment tool, a maternal needs inventory, and a measure of the degree of required therapeutic interventions for the neonate to assess types and levels of parental stress. Quantitative and qualitative data was collected and analysed using descriptive statistics and thematic analysis respectively. Results: Moderate stress levels in parents (n=40), predominantly related to alteration of their parental role, and the appearance and behaviours of their infant was demonstrated. These findings are further supported by a qualitative analysis and maternal needs inventory assessment which suggests the need for good communication, information sharing and consistent and empathetic staff practices. Conclusion: These findings suggest the need to develop local interventions to reduce stress and enhance parents’ abilities and understanding of their infant. Furthermore, despite the low number of participants, the PSS:NICU subscales were found to be reliable. Implications for Practice: Neonatal nurses working in a NICU environment need to be aware of the common situations which cause stress in parents, and develop skills in communicating with and supporting parents through this traumatic period

A Comparison of Sound Levels in Open Plan Versus Pods in a Neonatal Intensive Care Unit

Author version made available in accordance with publisher copyright policy.OBJECTIVE: The objective of this study was to compare the noise levels recorded in two different neonatal intensive care unit (NICU) settings: a pod and an open plan NICU located in the same hospital. BACKGROUND: The NICU is a busy environment with ambient noise levels that often exceed established recommendations. This noise deleteriously affects the physiological stability and developmental outcomes of sick and preterm infants. Pods have reduced numbers of cots (in this case, 6) compared to open plan NICUs (in this case, 11), yet the noise levels in pods have not been reported. METHOD: This study compared real-time decibel (dB) levels in an A-weighted scale, captured continuously by sound dosimeters mounted in both NICU settings for a period of 4 weeks: a pod setting and an open plan NICU. Researchers also collected observational data. RESULTS: The average noise level recorded in the pod was 3 dBs less than in the open plan NICU. This result was statistically significant. However, dB recordings in both areas were over the recommended limits by 4-6 dBs, with isolated peaks between 74.5 dBs (NICU) and 75.9 dBs (pod). Observational data confirmed this correlation. CONCLUSIONS: Further research to evaluate interventions to decrease the noise levels in both settings are needed, especially during times of peak activity. Staff working in these settings need to be more aware that control of acoustic levels is important in the neuroprotection of neonates. Coupling this with careful consideration to structural components and evidence-based design planning may contribute to lowering dB levels in the NICU environment

Understanding the effects of neonatal early discharge on parents: a literature review

© 2019 Wolters Kluwer Health, Inc. All rights reserved. This author accepted manuscript is made available following a 12 month embargo from date of publication (April 2019) in accordance with publisher's author permission guidelines.Problem: A Neonatal Early Discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds, and are gavage fed by their parents while they transition to breast and/or bottle feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. Objective: To summarize and critically appraise the literature regarding the effects of neonatal early discharge on parents. Method: A literature search was conducted for English language publications since 2007 using Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. Conclusion: An integrative thematic synthesis identified four themes: establishing parenting skills/confidence, bonding with the newborn, psychological distress, and the need for support and resources. Findings suggests that parents have various concerns regarding discharge from the neonatal unit, and therefore support from health professionals and family play a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences which impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area