Infants in the NICU undergo many painful procedures and literature supports KMC as an effective intervention to diminish pain however, it is not used routinely in NICUs. The purpose of this qualitative study is to provide NICU nurses an opportunity to describe their experience of utilizing KMC for pain, and to interpret this experience with the goal of generating patterns that explain this understanding. The findings can be used to formulate interventions that foster the use of KMC. Using Interpretive Description as a philosophy of inquiry and research methodology, 8 NICU nurses were interviewed and participated in a focus group. Four patterns emerged: (1)”Seeing is Believing”; (2) Human Heartedness: “It’s the Least I can do”; (3) Playing it Safe; and (3) Creating the Possibility within Constraints.

Neonatal Intensive Care Unit (NICU) patients present unique patient identification challenges. Prospective hazard analysis (PHA) assesses safety by identifying hazards before an adverse event occurs. This project analyzes a barcoded feeding process in one NICU, and conducts a preliminary evaluation of PHA methods. Observations were conducted to quantify patient identification methods used in one NICU; the unit’s barcoded feeding process was examined for potential failures. The process underwent PHA with two methods, Global Hazard Ratings (GHR), a simplified method developed for this project, and Failure Modes and Effects Analysis (FMEA). FMEA showed greater interrater reliability; there was poor agreement between methods. A list of 21 hazards was developed for the clinical team from the FMEA results. Recommendations are for the unit to formulate and implement mitigation strategies for the identified hazards. Future work involves a more in depth look at FMEA interrater reliability and reliability comparison with other PHA methods.

Objective: The primary purpose of this study was to determine the relationship between respiratory status and feeding difficulties in infants with NAS in comparison to full-term infants with no exposure to opioids. Methods: A group of infants with NAS (262) were compared to a group of full-term infants with no exposure to opioids (279). These groups were further divided into feeding and respiratory groups based on severity. These groups were analyzed for differences in behavior and outcomes. Results: Infants with NAS are 34.23 times more likely to develop respiratory distress and 111.03 times more likely to develop severe feeding difficulty. For infants with NAS, respiratory and feeding impairment may occur in isolation, suggesting a different withdrawal-based etiology of impairment as compared to premature infants. Conclusion: This study is unique in its size, scope, and attention to the respiratory factors involved in the feeding outcomes of infants with NAS.

Indiana University-Purdue University Indianapolis (IUPUI) / Objective: Nutritional assessment of infants in the Newborn Intensive Care Unit (NICU) depends on the performance of accurate, serial anthropometric measurements. In this Level IV NICU, nurses used tape measures more often than length boards making the length measurements inaccurate. The purpose of this study is to determine if an in-person, hands-on length board training program versus a self-instruction poster education, increases the use of length boards to measure length in NICU infants. Methods: Two nursing in-service education training sessions on how to correctly use a length board were held with the NICU staff over two separate two (2-week) periods. One session consisted of a self-direct education training method. The second education method was an in-person interactive learning experience with hands on practice. At the end of each education session, the participants completed the same four-question post-test. One month later, data was collected for one month following each of the training periods on the tool used to obtain linear measurements on infants in the NICU. Statistics: A 2x2 contingency table was constructed using the two qualitative variables of length board uses after the poster education versus length board uses after the live in-service education. Analysis was performed using SAS 9.4 ™ statistical software. Chi squared equals 93.980 with 1 degree of freedom. P-value <0.0001. Results: The month following the self-directed poster education, two hundred ninety-one (291) or 92% measurements were obtained using a tape measure and 19 (7%) obtained using a length board. The month following the interactive, in-service training, one hundred forty-eight (148) or 57% measurements were obtained using a tape measure and 105 (41%) with a length board. Thirty five percent (35%) more length measurements were obtained using a length board after the line in-service training (P-value <0.0001). Conclusion: Nurses in a Level IV Newborn Intensive Care Unit utilized length boards significantly more after a live in-service education than after a self-directed education.

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The purpose of this thesis is to provide a critical analysis of research findings about nonpharmacological techniques used independently of pharmacological techniques to prevent or reduce procedural pain for infants in the neonatal intensive care unit (NICU). A synthesis of the current research related to nonpharmacological pain relief techniques for infants was conducted for this thesis. Nonpharmacological interventions reviewed in this study include: Kangaroo Care, swaddling, facilitated tucking, positioning, music, non-nutritive sucking and sucrose. An interdisciplinary review of the research was performed using the interdisciplinary databases Cumulative Index of Nursing and Allied Health, PubMED, and PsychINFO. Inclusion criteria for this thesis consists of research focused on preterm neonates (born less than] 37 weeks gestational age) in the neonatal intensive care unit, the use of nonpharmacological interventions for procedural analgesia, peer reviewed articles, and those written in the English language. This study excludes full term neonates due to the significant number of preterm neonates in the NICU. A total of 18 studies were included in this review. All interventions except for positioning show statistically significant evidence to support their use to reduce procedural pain in preterm neonates. Findings of this thesis may promote further studies and exploration into this field. In addition, this thesis establishes the role of the nurse in providing pain relief for infants in the NICU, as well as provide for enhancement of interdisciplinary care amongst other health care providers.

The purpose of this study was to conduct a literature review that examined parental coping mechanisms and stress relief techniques for parents of infants admitted to the neonatal intensive care unit (NICU). A search was conducted using multiples databases using key terms such as stress AND coping, parent* OR caregiver, ped* OR child*, support* or aid, NICU OR neonatal intensive care unit, and nurs*. The results were limited to scholarly, peer reviewed journals in the English language. Exclusion criteria included not relating to parents or caregivers and mechanisms of coping with stress or if they pertain to palliative or end-of-life care. Each article meeting the inclusion criteria were critiqued and analyzed for information pertaining to the topic of this review. The thirteen articles yielded from the search revolved around the common themes of Visitation/Participation, Communication, and Comfort Measures. The literature revealed an overall positive association in reducing the amount of stress experienced when an intervention was provided. Implications for further research involve directly comparing the efficacy of interventions to determine which could be most useful in practice.

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Background: Recent research is revealing the high rate of false-positive screening results for IEMs in the NICU population. No study published to date has specifically studied the possible relationship between nutrition and newborn screening in this population. Objective: It is suspected that NICU infants who receive PN are more likely to have abnormal newborn screening results than infants who receive EN. An understanding of the role of nutrition will assist in developing protocols for screening in the NICU and decrease false-positives. Design: Infants admitted to the NICU between January 1-June 30, 2009 were included in this retrospective chart review study (n=339). The type of nutrition and timing of its initiation was recorded and compared to newborn screening results to identify correlations with false-positives. Statistical analysis included means, percentages, Fisher's exact test, Chi-square test, and the Cochran-Mantel-Haenszel test. Results: Nutrition type was significantly associated with newborn screening (p<0.001); those who received parenteral nutrition were more likely to have a false-positive. For infants who also received PN, EN of breast milk exclusively increased risk of an abnormal screen more than formula exclusively or breast milk plus formula. The timing of parenteral nutrition had no effect on screening. Premature infants who received PN exclusively had a higher percentage of false-positives than those who received EN Conclusions: Although the hypothesis could not be statistically supported, PN appears to contribute to false-positive newborn screens. More research is needed to ascertain the role of EN and GA in newborn screening and to develop standardized protocols. / Master of Science