Ethical Performance of Neonatal Nurses in Neonatal Intensive Care Units

Introduction: Lack of adherence to the nursing code of ethics in neonatal wards is usually an issue in hospitals. The present study explored neonatal nurses’ adherence to the nursing code of ethics in the neonatal ward, using the Neonatal Nurses' Ethical Performance Self-Report Questionnaire and the Neonatal Nurses' Ethical Performance Observation Checklist.Methods: In this descriptive study, 132 Nurses from 5 neonatal wards from two pediatric hospitals in Tehran were recruited by census sampling.Results: The results showed that the mean score of the self-report questionnaire (86.12+10.34) and observational checklist (80.98+10.34) was within the desired performance range. The domain of improving the quality of care had the highest score (94.25+3.40) in the self-report questionnaire, and the domain of justice had the highest score (95.00+0) in the observational checklist. The domain of respect for autonomy had the lowest mean score in the self-report questionnaire (64.31+22.22) and the observational checklist (67.50+6.19). There was no significant relationship between the ethical performance score reported by nurses and nurses' demographic variables (P>0.05), and the specific condition of the neonates affected the ethical performance of nurses in neonates' demographic variables (P-value =0.002).Conclusions: The finding showed that, overall, the performance of neonatal nurses regarding ethical codes is desirable

Parent–Infant Attachment in Infants with Respiratory Assist Devices Hospitalized in Intensive Care Units: A Descriptive Cross-Sectional Study

Background: Hospitalization of an infant in an intensive care unit may disrupt the normal process of parent-infant attachment. This study aimed to evaluate the quality of attachment and determine its related factors in parents of infants with respiratory assist devices.Methods: This correlational descriptive study was conducted with 180 parents of infants with respiratory assist devices hospitalized in Mofid Children Hospital in Tehran, Iran. The data gathering instrument consisted of a demographic questionnaire and the Parent-Infant Attachment Questionnaire. The data was analyzed through SPSS version 22.Results: The total score of attachment was 57.43+ and among the dimensions of the attachment questionnaire, the quality of attachment had the highest score. Also in parental and infant demographic variables, the previous history of hospitalization, father's age, and unit type were significantly correlated with attachment score. Moreover, regression results revealed that parent–pediatric attachment score of parents of infants admitted to the pediatric intensive care unit is 1.97 units less than that of the parents whose infants were admitted to NICU. And with the increase in father’s age, the rate of the parent–pediatric attachment to the child decreases by 0.19 and the history of the previous hospitalization leads to an increase in attachment to the infant by 3.76 units.Conclusion: Although the overall score of attachment in the parents of pediatrics dependent on the respiratory devices in the present study was undesirable, but the respiratory assisted device did not affect the parent-pediatric attachment score. Therefore, further studies are recommended to more accurately determine the relevant factors of the parent-pediatric attachment

Nursing Satisfaction with Medication Care by Using Neonatal Electronic Medication Management Systems

Background: Medication management is a complex process with multiple stages that involves different health care teams. Based on the evidence, an electronic medication management system offers significant benefits, such as reduced medication errors, improved conformity, enhanced time and cost efficiency, and increased patient safety. This study aimed to design and implement an electronic medication management system and measure the nurse’s satisfaction regarding the application of this system. Methods: In this technical action research, the nurses' satisfaction with the use of the designed system was evaluated. The electronic medication system development and data collection were conducted in two phases. The first phase included the design and development of an electronic nursing medication management system to be used in the neonatal intensive care unit. The second phase involved the evaluation of the nurses’ satisfaction with the use of the electronic system by applying a five-point Likert scale questionnaire. Results: The findings were divided into two categories, including results related to the design of the electronic systems and those regarding the evaluation of nurses’ satisfaction with the use of the electronic systems. The design of the electronic system was successful as the nurse's satisfaction evaluation revealed a high level of satisfaction with the use of the system. Conclusion: Electronic medication management system has more practical advantages than other similar systems. This system helps the nurses to identify and prevent many medication errors and save time in drug care documentation. Therefore, this system is a big step towards satisfaction with nursing medication care

Skin Injuries and its Related Factors in the Neonatal Intensive Care Unit

Background: Skin is the most important defense mechanism of the neonate's body. The admission to the Neonatal Intensive Care Unit (NICU) is a risk factor for neonatal skin injuries. Therefore, to prevent these complications, it is essential to identify the risk factors. The present study aimed to investigate the incidence of skin injuries and its related factors in neonates admitted to the NICU.Methods: This cohort study was conducted in two NICUs in one perinatal hospital in Tehran, Iran, from January 2018 to June 2018. The sampling was performed using the census method. The data were collected through a demographic characteristics form, a risk factor assessment checklist, and the European Pressure Ulcer Advisory Panel (EPUAP) tool. The data were analyzed in SPSS software (version 19) through Fisher's exact test and chi-square test.Results: Out of 368 neonates, 126 cases had skin injuries, and the others were healthy. The mean values of weight and age of the neonates with skin injuries were 796.68±1606.82 g and 5.18±30.82 days, which was significantly lower than those of the infants without skin injury (p <0.05). The results of the risk factors analysis also showed that the second-grade injuries were the most frequent. Moreover, the drug leakage (14.2%, n=33) and nasal continuous positive airway pressure (12.06%, n=28) had the highest prevalence. The results of the effect of risk factors on the wound grade also showed that drug leakage, diaper rash, and surgical injuries had a significant effect on the wound grade.Conclusion: The results showed that in addition to neonatal conditions, equipment, and neonatal care play a significant role in the incidence of skin injuries. Skin is the most important defense barrier of the neonate's body and it is vitally important to take care of it. Therefore, it is necessary to identify and prevent such injuries

Evaluating the Neonatal Intensive Care Nursing MSc Program Based on CIPP Model in Isfahan University of Medical Sciences

Introduction: Since neonatal nursing MSc program has not been evaluated systematically, it requires systematic and coherent evaluation for qualitative and quantitative improvement. Therefore, the purpose of this study was to evaluate the neonatal intensive care nursing MSc program based on CIPP model in Isfahan University of Medical Sciences. Methods: As a CIPP-based educational evaluation, this descriptive cross-sectional study was performed in 2014 on 40 participants including one head of department, 7 faculty members of pediatric nursing department, 25 students and 7 graduates of NICU nursing MSc program at Isfahan University of Medical Sciences. Participants were selected by means of census method. The program was evaluated using a researcher-made CIPP-based questionnaire that consisted of context, input, process, and product dimensions. Experts’ opinion was used to verify face and content validity and Cronbach’s alpha coefficient was used to determine the questionnaire’s reliability. Data were analyzed in SPSS software. Results: Findings showed that the mean scores of context (47/18±7/77), process (120/23±24/5) and product (59/85±17/16) were significantly higher than the average while the mean score of input (84/18±17/9) was lower (p=0. 003). Conclusion: Results indicate that the input aspect of the neonatal intensive care nursing MSc program at Isfahan University of Medical Sciences is at an undesirable level. Therefore, it seems that improvement of the educational quality and revision of the program require greater emphasis on enhancing factors that might affect the input, especially curriculum and faculty members

Effect of Non-nutritive Sucking on Weight Gain and Length of Stay in Preterm Infants Requiring Gavage Feeding: A Clinical Trial

Background and purpose: Gavage feeding tubes increase the length of stay and reduce the growth process in neonates. The aim of this study was to determine the effect of non-nutritive sucking on weight gain and length of stay in neonates that required gavage feeding. Materials and methods: In a clinical trial, neonates were selected via convenience sampling and randomly assigned into an intervention group (n=37) or a control group (n=38). Data including demographic information, admission and discharge dates, and neonates’ weights were recorded. In the intervention group, non- nutritive sucking was performed by the mother's finger at the same time as the gavage feeding. Data analysis was performed in SPSS V20 applying independent t-test, Mann-Whitney, and Chi-square. Results: The mean weight at discharge was 90.73 g higher in the intervention group than the control group (P=0.121). The mean weight loss was found to be higher in control group than the intervention group (P= 0.818). The mean length of stay was 14.22± 8.32 days in intervention group and 14.61±7.34 in control group, indicating no significant differences between the two groups (P=0.830, statistical power=60%). Conclusion: Non-nutritive sucking had no significant positive effect on length of stay and weight gain in preterm infants. Further studies with larger sample size are suggested. (Clinical Trials Registry Number: IRCT20200617047806N1

The Effect of Oketani Breast Massage on Successful Breastfeeding, Mothers’ Need for Breastfeeding Support, and Breastfeeding Self-Efficacy: an Experimental Study

Background: The negative effects of cesarean section on breastfeeding are a major global concern. Purpose: This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy. Setting: Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019. Study Design: The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann–Whitney U test, and the chi-square test. Results: The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p &lt; .001). In addition, the mother’s need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p &lt; .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p &lt; .001). Conclusion: Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections

The effect of guided imagery on stress and attachment of mothers of premature infants in neonatal intensive care unit: A quasi-experimental study

Background. Premature birth, in addition to causing health problems in infants, increases stress in the mother and reduces attachment between mother and baby. Therefore, the present study was conducted to determine the effect of guided visualization on stress and attachment of mothers of preterm infants in the neonatal intensive care unit (NICU). Methods. This quasi-experimental study was performed on 35 mothers with premature infants admitted to the NICU of Mahdieh Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mothers were selected by available sampling method and randomly assigned into intervention and control groups. For mothers in the intervention group, the intervention was performed from the first to the fifth day of birth through training and sending guided imagery files. On the day of admission and discharge, the parental stress questionnaire and the postpartum attachment questionnaire were completed by the mother. SPSS software (version 20) was used to analyze the data. Results. The mean total score of maternal attachment on the fifth day of the intervention was significantly higher in the intervention group (P<0.001). Also, the mean total score of mothers' attachment status on the day of discharge was significantly higher in the intervention group (P<0.001). Conclusion. Implementation of guided visualization program reduced stress in mothers with premature infants admitted to the NICU, and consequently increased the level of attachment. Practical Implications. Mothers are the primary caregivers of infants, and promoting maternal health has an effect on infants. In addition to reducing stress in preterm infants, this study can help improve the quality of infant care and increase attachment and parenting. The present study offers a completely cost-effective way to reduce the costs of long-term hospitalization and improve the quality of nursing

Nursing Care and Documentation Assistant with an Electronic Nursing Management System in Neonatal Intensive Care Unit

Background: All nursing cares require decision-making, and the ability to make the best decisions impact upon the quality of nursing care. Moreover, authenticity and accuracy of the best cares may be questioned if not recorded and reported properly and in a standard manner. We aimed to design and implement an electronic nursing managementsystem and then evaluate satisfaction of nurses with the designed electronic system.Methods: This technical action research was conducted in four phases of a) designing an electronic nursing process decision support system, b) designing an electronic nursing care documentation system, c) integrating these two systems and developing an electronic nursing information management system, and d) implementing the system and system satisfaction evaluation using quantitative methods (satisfaction questionnaire).Results: The results of this project led to design and development of an electronic nursing information management system for neonatal intensive care units, which enables nurses to carry out standard care and documentation with high level of nursing satisfaction.Conclusion: In order for an electronic system to support nurses in their care process, it must be accepted by nurses. If nurses are satisfied with the performance and nature of this system, they are much less likely to develop workaround solutions and much more likely to spend their efforts focusing on the professional aspects of nursing care