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published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

As a baby is born, the umbilical cord is cut and clamped, then it dries up and detaches. During the course of cord detachment and before the wound completely heals up, umbilical cord care is essential for preventing any local infection, which may lead to septicemia or infection of other organs. However, the yellowish and blood-stained discharge from the base of the cord and the appearance of the cord stump often causes anxiety among parents and make them hesitant to provide cord care. Hence, healthcare professionals are responsible for explaining the importance of proper cord care and provide consistent information on the course of cord detachment. This will decrease parental anxiety or the cord-related issues and improve compliance. Currently, different solutions are being used at different healthcare facilities. This leads to confusion among healthcare professionals and parents. Moreover, as evidenced in many studies, different solutions can affect the umbilical cord detachment time and prolongation of umbilical cord separation time, which can cause immense anxiety among the parents. Hence, a solution that is effective in reducing the umbilical cord separation time can help to alleviate parental anxiety. Dry care, such as using cold boiled water to clean the cord, is suggested to be suitable for umbilical cord care as it shortens the umbilical cord separation time compares to alcohol, which is still being used in many healthcare facilities. Therefore, this proposed innovation attempts to promote dry care as the standard umbilical cord care practice, to shorten the umbilical cord separation time, which in turn, decreases parental anxiety and the workload related to cord care for the healthcare professionals. The implementation of dry care was explored and it was found that this innovation is cost-effective and has a high transferability and feasibility in the current setting of Hong Kong Maternal and Child Health Clinics. An evidence-based practice guideline was developed and would be launched initially on a trial basis at one of the Maternal and Child Health Clinics after a well-developed communication and implementation plan is established. It is expected to take about 12 months from gaining approval, implementation of the innovation, data collection and to the last stage, program evaluation. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Prematurity is a common health issue worldwide. In Hong Kong, the rate of prematurity is in an increasing trend, from 4.7% in 1999 to 5.1% in 2004 (Tertiary-wide Obstetric & Gynecology Audit Report, 2004). Preterm infants are usually required to hospitalize in neonatal intensive care unit (NICU) which expose them to certain stressors such as noise, caregiver procedure, medical manipulations and pain (Harrison et al., 2003). Stress would lead to certain illnesses likes metabolic and cardiovascular disorders (Caldji, Diorio, & Meaney, 2000). Facing stress of preterm infants not only affects the developmental and neurodevelopment outcome but also increase the morbidity and mortality (Mitchell & Boss, 2002). Preterm birth is a complicated health problem which affects the infant itself and also increase the burden to society as it costs nearly US$26 billion dollars per year for both inpatient and outpatient care (Richard & Adrienne, 2007). Although there were many known benefits of massage therapy in premature infants and the safety of practicing was being acknowledged, massage therapy is still not being practiced in Hong Kong health care settings. Massage therapy was effective in reducing signs of stress on premature infants and could be performed by parents safely as evidenced by six researches (Dieter, Field, Hernandez-Reif, Emory, & Redzepi, 2003; Hernandez-Reif, Diego, & Field, 2007; Lee, 2005; Kuhn, Schanberg, Field, Symanski, Zimmerman, Scafidi, & Roberts, 1991; Smith, Kux, Haley, Beechy, & Moyer-Mileur, 2012; Wheeden, Scafidi, Ironson, Valdeon, & Bandstra, 1993). Based on the evidence, a new evidence-based practice was developed for reducing signs of stress of premature infant by using massage therapy in NICU. Implementation potential was reviewed in relation to target setting, transferability of findings and cost-benefit analysis. Implementation plan was developed. Stakeholders were identified and communication process was discussed in details. Pilot testing would be carried out to assess the feasibility of implementing the guideline. Finally, evaluation on patient, parents and healthcare providers’ outcome were required in implementing this new change smoothly. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Hypothermia at birth is strongly associated with mortality and morbidity in preterm infants. Unfortunately, infants are prone to hypothermia immediately after birth. A large proportion of preterm infants, especially those of gestational age at less than 30 weeks, experience different levels of hypothermia. A frequently used possible preventive measure is the application of an occlusive wrap immediately after birth. However, no systematic review on this preventive measure supports its translation into practice. This dissertation aimed to evaluate the current evidence on the application of occlusive warp for preterm infants. Four electronic databases, Cochrane Library, PubMed, CINAHL, and Medline, were searched. Eight studies met the inclusion criteria of this dissertation. Data were extracted and the quality of the included studies was evaluated by the Scottish Intercollegiate Guidelines Network (SIGN). Six studies were graded as high quality studies and showed that occlusive wrapping significantly prevented the incidence of hypothermia among the preterm infants smaller than 30 weeks. An evidence-based Superwarm guideline was developed, which was deemed to be transferable to the local setting of neonatal intensive care unit with similar target clients and philosophy of care as with those in the identified studies. Also, the proposed innovation was considered to be feasible after examination of staff competency, resources, and approval methods. The potential benefits to preterm infants, nurses, and also the hospital were high, and risks to the patient were minimal. The estimated set-up cost including manpower and consumable cost was $1,720, and the running cost was also $1,720 per year. A 12 -month implementation program scheduled including communication with stakeholders, training to the frontline nurses, and a pilot of the guideline. Patient outcomes will be measured by admission temperature, temperature one hour after admission, and mortality rate. Healthcare provider outcomes include compliance rate, workload, acceptance of the proposed guideline, job satisfaction, knowledge, and skill enhancement in thermoregulation of the preterm infants. The quality of patient care was also considered in the system outcomes. Guideline effectiveness will be evaluated by the increase in admission temperature, nurse and physician satisfaction, and controlled program expenditure. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Skin is the major protective barrier in a human body. In premature infants, the immature skin barrier reduces the protection against germs. Emollient therapy is an effective prophylactic measure to improve premature infants’ skin condition so as to protect the premature infants against infection. A systematic review of studies shows that emollient therapy is a simple, safe and cost effective intervention for premature infants to improve skin condition. Evidence shows that emollient therapy can also decrease transdermal water loss, conserve heat and energy, stabilize fluid and electrolytes and prevent nosocomial sepsis. The potential of implementing the proposed evidence-based guideline is explored. It will be carried out in a clinical setting. The transferability of the findings, feasibility and cost-benefit ratio of the emollient therapy will be discussed. In order to ensure the evidence-based guideline will be carried out smoothly, a communication plan is necessary to be made in consultation with the stakeholders. A pilot study will also be conducted before the innovation is implemented to ensure frontline staff members to be familiar with the emollient therapy. At the end, the effectiveness of the emollient therapy will be evaluated in terms of skin score. Patients’ outcome and healthcare provider’s outcome will also be evaluated. / published_or_final_version / Nursing Studies / Master / Master of Nursing

This study is an investigation of factors which determine father involvement in infant caretaking activities. Concerns involved fathers' past parental relationships, fathers' preparation for childbirth, sex of the infant, complexity of the caretaking task, fathers' participation in childbirth, fathers' desire for a male or female infant, and amount of early physical contact between father and infant. Data indicated significant relationships between father participation and the sex of the child, complexity of the caretaking activity, and amount of early physical contact between the father and infant. Data indicated no significant relationships between father participation and fathers' past parental relationships, fathers' preparation for childbirth, fathers' participation in childbirth, and fathers' desires for a male or female infant.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

The quality of early infant-caregiver interactions determines the path of an infant's social, cognitive and emotional development. Theoretical and empirical evidence supporting this claim is reviewed, and the implications for early relationship-focussed interventions are considered. The study focuses on infants from birth to three years of age. Developmental psychology research findings are presented, and the role of risk and protective factors in planning preventative interventions are discussed. Recommendations are made for developing a centre-based relationship-enhancing early intervention program for infants and their depressed caregivers. The program is intended for implementation in a rural or periurban South African Primary Health Care setting. / Thesis (M.A.)- University of Natal, Pietermaritzburg, 2002.