Introdução: O progresso tecnológico nas Unidades de Terapia Intensiva Neonatais (UTIN) possibilitou o aumento da sobrevida de recém-nascidos pré-termo (RNPT) muito imaturos. Este avanço tornou a UTIN estressante devido ao grande número de procedimentos invasivos, aos equipamentos, à presença de luz, ao ruído e à manipulação excessiva que contribuem para as alterações no desenvolvimento dos prematuros. Objetivo: Descrever a manipulação a que o RNPT é submetido na UTIN de um hospital do interior paulista. Metodologia: Estudo descritivo e exploratório realizado com 20 RNPT, os quais foram filmados, durante 24 horas consecutivas. As manipulações foram categorizadas em: monitoramento, terapêutica e de cuidado. Os procedimentos realizados conjuntamente foram considerados como uma manipulação na contagem da frequência de manipulações do RN. A duração foi registrada do início até o término de cada procedimento e, quando agrupado, foi considerado o momento exato do primeiro procedimento até o término do último, totalizando o período de uma manipulação em agrupamento. Resultados: Houve um total de 768 manipulações e 1.341 procedimentos, com médias de 38,4 e 67,05 respectivamente. As manipulações com apenas um procedimento (504) representaram 65,6% dos casos, e os agrupamentos contiveram de 2 a 10 procedimentos. Os profissionais foram responsáveis por 680 situações (91,8%) das manipulações contra 61 (8,2%) dos familiares. Os auxiliares de enfermagem foram os que mais manipularam os RNPT, com 597 (80%) manipulações realizadas apenas por eles e 5 manipulações auxiliando outros profissionais. A duração média do período de manipulação foi de 2 horas (h) 26 minutos (min) e 33 segundos (s). A mediana foi de 2 h 15 min 29 s e o desvio-padrão de 1 h 41 min 30 s. A duração total de tempo em que os RNPT foram submetidos à manipulação foi de 48 h 51 min, 9,37% do total de filmagem. O prematuro mais manipulado, durante as 24 horas, foi o RNPT3, com 5 h 9 min e 9 s em manipulação, e o RNPT17 foi manipulado no menor período de tempo, 53 min e 15 s. Os RNPT tiveram, em média, 19 h 28 min e 46 s sem ter sido manipulados contra 4 h 16 min 42 s de tempo de manipulação. A mediana do tempo sem manipulação foi de 19 h 44 min e 16 s e o desvio-padrão de 1 h 36 min e 53 s. O prematuro que teve o maior período sem ser manipulado, de forma ininterrupta, foi o RNPT18 com 5 horas 16 minutos e 18 segundos , e o que teve menor período máximo de descanso foi o RNPT2, com 30 min e 12 s. Conclusão: as manipulações individuais representaram a maior parte das manipulações, e, quando ocorrem os agrupamentos de cuidados, não houve uma organização dos procedimentos. Houve poucos procedimentos que visaram ao cuidado desenvolvimental. Preserva-se a manipulação com duração menor que 1 minuto, ainda que em frequências menores do que nos estudos anteriores. Ficou evidente a escassa participação da mãe e dos familiares no cuidado ao RNPT, apesar de a visita materna ser facilitada pela equipe. É necessário um envolvimento da equipe para promover maior participação dos familiares no cuidado aos RNPT. / Introduction: Technological progress at Neonatal Intensive Care Units (NICU) has allowed for increased survival of very immature preterm infants (PI). This advance has turned the NICU a stressful unit, due to the large number of invasive procedures, equipments, the presence of light, noise and excessive handling, contributing to alterations in the infants\' development. Objective: To describe the handling PI\'s are submitted to at the NICU of a hospital in the interior of São Paulo state. Method: Descriptive and exploratory study, involving 20 PI\'s who were filmed for 24 consecutive hours. The handling was categorized as: monitoring, therapeutics and care. Procedures carried out together were considering as one single manipulation in counting PI handling frequency. The duration was registered from the start until the end of each procedure and, when grouped, the exact moment when the first procedure started until the end of the last procedure totaled the group manipulation period. Results: In total, 768 manipulations and 1,341 procedures were counted, with averages amounting to 38.4 and 67.05, respectively. Manipulations involving only one procedure (504) represented 65.6% of cases, and grouped manipulations contained between 2 and 10 procedures. Professionals were responsible for 680 handling situations (91.8%), against 61 (8.2%) for relatives. Nursing auxiliaries were the professionals that most handled the PI\'s, performing 597 (80%) manipulations alone and 5 to help other professionals. The mean duration of the handling period was 2 hours (h) 26 minutes (min) and 33 seconds (s), with 2 h 15 min 29 s as the median and 1 h 41 min 30 s as the standard deviation. The total time during which PI\'s were submitted to manipulation was 48 h 51 min, i.e. 9.37% of total recordings. The most handled infant during the 24 hours was PI3, subject to 5 h 9 min and 9 s, against PI17 with the shortest handling time, 53 min and 15 s. The PI\'s mean time without handling was 19 h 28 min and 46 s, against 4 h 16 min 42 s of manipulation. The median time without manipulation was 19 h 44 min and 16 s and the standard deviation 1 h 36 min and 53 s. The infant with the longest uninterrupted period without handling was PI18, with 5 h 16 min and 18 s, against PI2 with the shortest maximum rest time, i.e. 30 min and 12 s. Conclusion: Most manipulations were individual and, when care is grouped, procedures were not organized. Few procedures were aimed at developmental care. Manipulations taking less than 1 minute still continue, although less frequently than in earlier studies. The scarce participation of mothers and relatives in PI care was evidenced, although the team facilitates maternal visits. Greater involvement by the team is needed to promote greater family participation in PI care.

O objetivo geral deste estudo foi investigar o efeito do leite humano na redução de respostas biocomportamentais de dor em RNPTs submetidos ao exame de fundo de olho para diagnóstico precoce da retinopatia da prematuridade, em comparação com a sacarose 25%. Trata-se de ensaio clínico randomizado, realizado na unidade neonatal de um hospital universitário de Ribeirão Preto-SP, com 48 prematuros distribuídos randomicamente em dois grupos: leite humano e sacarose, administrados por via oral 2 minutos antes do procedimento doloroso. As variáveis dimensionadas foram mímica facial da escala de dor NFCS, choro, frequência cardíaca e cortisol salivar. A coleta de dados foi realizada em cinco períodos para a mímica facial e o NFCS: basal (05 minutos), olho direito e olho esquerdo, recuperação imediata (05 minutos após o procedimento) e recuperação tardia (05 minutos após a recuperação imediata); quatro períodos para a frequência cardíaca e o choro: basal (05 minutos), procedimento, recuperação imediata e tardia. O cortisol salivar foi coletado antes do início do exame de fundo de olho (basal), após 30 (cortisol resposta) e 60 (cortisol recuperação) minutos do término do exame. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da instituição e foi registrado no Australian and New Zeland Clinical Trials. O Teste de Kolmogorov-Smirnov e o Teste t-student mostraram que os grupos são comparáveis. Para análise das variáveis de desfecho, utilizou-se a Análise de Variância com Medidas Repetidas (RM-ANOVA). Após testar a homogeneidade das variáveis (teste de Levene), foi avaliado o pressuposto da esfericidade das matrizes de variância (teste de Mauchly). Assumindo-se a esfericidade, adotaram-se a análise multivariada, com valor de épsilon < 0,75, e a estatística de Wilk´s Lambda. Para valores de épsilon > 0,75, adotaram-se a análise univariada e a estatística de Hunh-Feldt (HF) ou Greenhouse-Geisser. Para as variáveis categóricas, foi utilizado o teste Qui-quadrado ou Teste exato Fisher. O efeito do leite humano no alívio da dor, decorrente do exame de fundo de olho, não diferiu estatisticamente da sacarose 25%, ao avaliarmos a duração da presença de fronte saliente [Wilk\'s Lamba=0,918, F=0,960, p=0,241], do sulco nasolabial [Wilk\'s Lambda=0,883; F=1,43; p=0,241] e do choro [Wilk\'s Lambda=0,964; F=3,44; p=0,656], e o escore médio do NFCS adaptado ao considerarmos essas duas ações da mímica facial [Wilk\'s Lambda=0,924; F=0,884; p=0,481], a FC [Wilk\'s Lambda=0,977; F=3,44; p=0,792] e a concentração de cortisol salivar [Wilk\'s Lambda=0,978; F=2,45; p=0,612]. A comparação intrasujeitos mostrou diferença significativa nos períodos de coleta dos dados, com aumento nos escores do NFCS, na duração da fronte saliente e do sulco nasolabial, durante o exame do fundo de olho direito e esquerdo, como também no aumento do choro, durante o procedimento doloroso, em comparação com os períodos basal, recuperação inicial e tardia. A concentração do cortisol salivar aumentou significativamente aos 30 e 60 minutos após o procedimento, em comparação com os valores do cortisol basal; não houve diferença entre o cortisol resposta (30 minutos) e recuperação (60 minutos). A duração do sulco nasolabial, do choro e os escores do NFCS no basal não diferiram significativamente dos valores encontrados na recuperação inicial e tardia. Na FC, houve diferença no basal em relação à recuperação imediata, e na duração da fronte saliente houve diferença nas duas recuperações. Concluímos que o efeito do leite humano, na redução das respostas biocomportamentais de dor em prematuros submetidos ao exame de fundo de olho para diagnóstico da retinopatia da prematuridade, não é superior ao efeito obtido com a sacarose 25%, rejeitando-se a hipótese alternativa. / The general aim of this study was to investigate the effect of human milk on reducing biobehavioral pain responses in PN\'s undergoing the ocular fundus examination for the early diagnosis of retinopathy of prematurity, compared with 25% sucrose. This is a randomized clinical trial conducted in the neonatal unit of a university hospital of Ribeirão Preto-SP, with 48 premature newborns randomly distributed into two groups: human milk and sucrose, orally administered 2 minutes before the painful procedure. The variables investigated were the facial movements of the NFCS pain scale, crying, heart rate (HR) and salivary cortisol levels. Data collection was conducted in five periods for the facial movements and NFCS: baseline (05 minutes), right eye and left eye, immediate recovery (05 minutes after the procedure) and delayed recovery (05 minutes after immediate recovery); and in four periods for heart rate and crying: baseline (05 minutes), procedure, immediate and delayed recovery. Salivary cortisol was collected before the start of the fundus examination (baseline), and at 30 minutes (cortisol response) and 60 minutes (cortisol recovery) after the end of the examination. The project was approved by the Research Ethics Committee and was registered in the Australian and New Zealand Clinical Trials. The Kolmogorov-Smirnov test and Student\'s t-test showed that the groups were comparable. For the analysis of the outcome variables, the Analysis of Variance with Repeated Measures (RM-ANOVA) was used. After testing the homogeneity of the variables (Levene\'s test) the assumption of sphericity of the variance matrices was evaluated (Mauchly\'s test). Assuming sphericity, multivariate analysis was adopted, with a < 0.75 value of epsilon and Wilk\'s Lambda statistic. For values of epsilon > 0.75, univariate analysis and the Hunh-Feldt (HF) or Greenhouse-Geisser statistic were adopted. For the categorical variables, the chi-square test or Fisher exact test was used. The effect of human milk on pain relief, arising from the ocular fundus examination, did not differ statistically from 25% sucrose, when the duration of the presence of brow lowering [Wilk\'s Lambda=0.918; F=0.960; p=0.241], of deepening of the naso-labial furrow [Wilk\'s Lambda=0.883; F=1.43; p=0.241] and of crying [Wilk\'s Lambda=0.964; F=3.44; p=0.656] were evaluated, as well as the mean score of the NFCS adapted to consider these two facial movement actions [Wilk\'s Lambda=0.924; F=0.884; p=0.481], the HR [Wilk\'s Lambda=0.977; F=3.44; p=0.792] and the salivary cortisol concentration [Wilk\'s Lambda=0.978; F=2.45; p=0.612]. The intra-subject comparison showed a significant difference in the data collection periods, with an increase in the NFCS scores, in the duration of brow lowering and naso-labial furrow deepening, during the examination fundus of the right and left eyes, as well as increased crying during the painful procedure, compared with the baseline period, immediate and delayed recovery. The concentration of salivary cortisol increased significantly at 30 and 60 minutes after the procedure, compared with the baseline cortisol values; there was no difference between cortisol response (30 minutes) and recovery (60 minutes). The duration of naso-labial furrow deepening, of crying and the NFCS scores at the baseline did not differ significantly from the values found in the immediate and delayed recovery. In the HR, there was no difference between the baseline and the immediate recovery, and in the duration of brow lowering there was no difference in the two recoveries. We conclude that the effect of human milk, on the reduction of biobehavioral responses to pain in preterm infants undergoing the ocular fundus examination for the diagnosis of retinopathy of prematurity, is not greater than the effect obtained with 25% sucrose, rejecting the alternative hypothesis.

Em um esforço para auxiliar mães e famílias na prática e manutenção do aleitamento materno de bebês prematuros, motivamo-nos a realizar o presente estudo, visualizando a possibilidade de construir um instrumento educativo a fim de auxiliá-los neste cuidado com seus filhos prematuros. Neste sentido, os objetivos do presente estudo são: desenvolver um objeto digital de aprendizagem, um website sobre o aleitamento materno do prematuro, dirigido à família, e avaliar este objeto digital de aprendizagem junto a profissionais de enfermagem e informática. Trata-se de uma pesquisa descritiva, cujo referencial teórico para o desenvolvimento do objeto digital está fundamentado em Paulo Freire e na CAI (Computer Assisted Instruction - Instrução Assistida por Computador). Como modelo de desenvolvimento de website, utilizamos o User-Centered Design (projeto centrado no usuário) cujas fases foram: escolha do tema e fatores motivacionais do projeto, avaliação e análise das necessidades de saúde junto à profissionais (por meio de chats e ligações telefônicas com um comitê de especialistas, utilizando-se de temas geradores); identificação de soluções, articulação dos objetivos e análises dos questionamentos; e desenvolvimento e prototipagem com avaliação junto aos usuários. A amostra intencional constituiu-se de 29 enfermeiros e cinco profissionais da área da informática. O instrumento de avaliação utilizado baseou-se em princípios estabelecidos pela Norma ISO 9241 (divididos em sete grupos) e de Usabilidade. Para a análise dos dados utilizou-se a estatística descritiva. O projeto foi aprovado por Comitê de Ética em Pesquisa. Com base nos temas sugeridos pelo comitê de especialistas, revisão da literatura e experiência profissional, os conteúdos do site foram organizados em quatro grandes itens no website: \"Meu bebê nasceu prematuro\", \"Meu bebê ainda não está mamando\", \"Meu bebê já está mamando\" e \"Vamos para casa\". Além destes conteúdos, a construção do site se deu em sete outras etapas: construção de animações e \"personagens\" do website, desenvolvimento do layout, construção de jogos educativos de acordo com os conteúdos, desenvolvimento do sistema de login e cadastro dos usuários, fale-conosco e fórum de discussão, sistema para avaliação on-line do objeto digital de aprendizagem e área administrativa do site. As respostas \"muito bom\" e \"ótimo\" representaram 86% das avaliações dos enfermeiros e 77% das avaliações dos profissionais da área de informática. Tais percentuais ampliam-se para 96% e 92%, respectivamente, ao se incorporar o conceito \"bom\". A maioria das sugestões emitidas pelos avaliadores foi incorporada na edição final do site. Assim conclui-se que o website é válido para uso e disponibilização à comunidade, constituindo-se em tecnologia inovadora dirigida aos familiares de prematuros que pode contribuir com o aprendizado e incentivo ao aleitamento materno. Ressalta-se também a necessidade de ampliação da avaliação deste website junto a outros profissionais de saúde, bem como o impacto de seu uso no processo ensino aprendizagem e na prevalência do aleitamento materno dos prematuros. / In an effort to help mothers of preterm babies in the practice and maintenance of breast feeding their children, we felt motivated to perform the present study visualizing the possibility of building an educational tool to assist them in the care to their preterms. Thus, our objectives are: developing a digital learning object - a website - about maternal breast feeding of preterm babies, directed to their families as well as evaluating the use of such digital learning object by professionals in the nursing and in the informatics area. The theoretical reference for the development of the digital learning object of this descriptive research is based on Paulo Freire and on CAI (Computer Assisted Instruction ).As a website developing model we used the User-Centered Design whose steps were: choosing the theme and the emotional factors of the project; evaluating and analyzing the health needs with professionals (through chats and phone calls to an expert committee, utilizing theme generators); identifying solutions , articulating objectives and analyzing the doubts; and developing and prototyping it according to the users\" evaluation. The intended sample was composed by 29 nurses and 5 professionals from the informatics area. The evaluation tool was based on the principles established by the ISO 9241(division in seven groups) Usability standards. The data analysis was done through descriptive statistics. The project has been approved by a Research Ethics Committee. Based on the themes suggested by the experts committee, on a bibliographical research and on professional experience, the contents of the site were organized in four main items on the website: \"My baby was born premature\", ,, My baby is not nursing yet\", My baby is already nursing\" and ,, Let´s go home\". Besides these contents, the building of the site had seven others steps: building of animations and \"characters\" of the website, layout development , building of educational games according to the contents, developing of the login system and users registration, contact us, discussion forums, online evaluation system of the digital learning object and site administration area. The answers \"very good\" and \"excellent\" represented 86% of the evaluations of the nurses and 77% of the evaluations of the professionals in the informatics area. Such percentage increases to 96% and 92% respectively when the concept \"good\" is incorporated. Most of the suggestions given by the evaluators were incorporated to the site\"s final edition. Thus, we conclude that the website is valid for the use and availability to the community, being as such an innovative technology which can contribute to the knowledge and incentive to breast feeding for the families of preterm babies. The necessity of spreading the evaluation of this website to other professionals of health is also pointed out, as well as the impact of its use in the teaching - learning process and in the prevalence of the maternal breast feeding of preterms. Keywords:

INTRODUÇÃO: Pautados na importância da qualificação profissional de enfermeiros na avaliação e cuidado ao prematuro a partir da análise de óbitos infantis no mundo, desenvolvemos um serious game enquanto ferramenta tecnológica educacional para facilitar a aprendizagem em enfermagem neonatal. O serious game e-Baby é uma ferramenta digital cujo objetivo é oferecer ao estudante a possibilidade de realizar a avaliação clínica e o cuidado ao prematuro em simulação virtual, antes de lidar com o bebê real no cenário de prática, podendo errar e refletir até compreender e aprimorar suas habilidades em um ambiente seguro. Ainda, as tecnologias devem ser vinculadas ao contexto e objetivos educacionais, respeitando e compreendendo os diferentes estilos de aprendizagem. OBJETIVO: Avaliar o impacto do serious game e-Baby: integridade da pele na aprendizagem cognitiva de estudantes de enfermagem, considerando os estilos de aprendizagem. MÉTODO: Trata-se de pesquisa metodológica quanto ao desenvolvimento da tecnologia e possui delineamento experimental e randomizado, com coparticipação de outras universidades brasileiras, para a avaliação do impacto na aprendizagem. Foi oferecido um curso extracurricular semipresencial aos participantes e, mediante aceite voluntário e seguindo os preceitos éticos em pesquisa, estes foram submetidos a avaliações de pré e pós-teste, caracterização, estilos de aprendizagem, avaliação do serious game e do curso. Foram divididos em dois grupos: controle e experimental, aleatoriamente. O tema do curso foi a avaliação clínica do prematuro quanto à necessidade de integridade da pele em alinhamento com o serious game desenvolvido. A análise estatística foi paramétrica, t de Student, considerando distribuição normal, utilizando também os testes Qui- Quadrado e exato de Fisher em determinadas variáveis. RESULTADOS E DISCUSSÃO: O serious game e-Baby: integridade da pele é uma tecnologia inovadora, validada por experts nas heurísticas de usabilidade em interface, elementos educacionais, conteúdo, jogabilidade e multimídia. Foi considerado relevante para auxiliar a aprendizagem de estudantes de enfermagem por refletir a prática clínica do enfermeiro no tema, segundo avaliação de enfermeiros em neonatologia. Teve avaliação geral muito satisfatória pelos estudantes, independentemente de seus estilos de aprendizagem, indicando que apesar das especificidades e preferências, consiste em uma tecnologia versátil para uso na educação em enfermagem. O estudo corrobora a literatura indicando as preferências dos estudantes para a inovação tecnológica e adesão de dispositivos e ferramentas, já inseridas e populares no contexto de nossa sociedade. As estratégias de ensino preferidas pela amostra demonstram interesse pela resolução de problemas, pelo papel ativo e por tarefas claramente vinculadas à prática do enfermeiro, reforçando o potencial sucesso da mudança de paradigma no ensino superior partindo do modelo tradicional para a adoção de novas teorias que valorizam o estudante como centro de sua própria aprendizagem. Não representou impacto significativo na aprendizagem cognitiva entre os grupos do estudo, apesar de ter refletido em melhores escores analisados em média aritmética para o grupo experimental. CONCLUSÃO: Apesar de o serious game e- Baby não ter representado impacto estatisticamente significativo na aprendizagem cognitiva dos estudantes de enfermagem, foi muito bem aceito pela amostra independentemente dos estilos de aprendizagem de cada participante. As principais características atribuídas a ele são: didático, interessante, estimulante para acesso de outras ferramentas semelhantes no curso, educativo ao oferecer feedback imediato e auxiliar a aprendizagem na percepção dos participantes / INTRODUCTION: Based on the importance of professional qualification for nurses and preterm newborns\' care, taking into account the analysis of child mortality in the world, we have developed a serious game as an educational technological tool to facilitate learning in neonatal nursing. The serious game e-Baby: skin integrity is a digital tool which objective is to offer students the possibility to perform clinical evaluation and provide care to the premature baby in a virtual simulation, before he/she does it in a real baby in the scenario of practice. So, the students can make mistakes and reflect on them until comprehension is fully reached and the skills improved in a safe environment. Besides, technologies must be linked to the educational context and goals, respecting the different learning styles. OBJECTIVE: Evaluate the impact of the serious game e-Baby: skin integrity in the cognitive learning of nursing students, considering the learning styles. METHOD: It is a methodological research as the development of the technology and randomized experimental research because it evaluated the impact on students\' learning, with participation of other Brazilian universities. It was offered an extracurricular and blended course to the participants which responded to evaluations of pre and post-test, characterization questionnaire, learning style index, evaluation of the serious game and the course, following ethical in research precepts. The participants were divided into control and experimental groups, randomly. The course\'s theme was the clinical evaluation of a preterm newborn and the proper interventions about the need of tissue integrity focused on skin, in alignment with the developed serious game. It was used parametrical analysis Student t, considering normal distribution, using also tests as Chi-square and exact of Fisher in certain variables. RESULTS AND DISCUSSION: Serious game e-Baby: skin integrity is an innovative technology, validated by experts in usability heuristics of interface, educational elements, content, gameability and multimedia. It was considered relevant to support nursing students\' learning in neonatology and its general evaluation given by students was highly satisfactory regardless their learning styles, indicating that, in spite of specificities and preferences of different users, it is a versatile tool to use in nursing education. This study corroborates literature indicating students\' preferences for technological innovation and adhesion to devices and tools already inserted and popular in our society context. Preferred teaching strategies by the sample demonstrate its interest for problem resolution, active role and tasks clearly linked to the nurses\' practice, reinforcing the potential success of the paradigm change in higher education from traditional model to the adoption of students-centered new theories. E-Baby did not present statistical difference in cognitive learning between the groups, despite it reflected on better scores for experimental group when adopting arithmetic mean. CONCLUSION: Despite the serious game did not represent impact in cognitive learning of nursing students, it was highly accepted by the sample regardless learning styles and validated by experts. Its main characteristics given by participants were: didactical, stimulating to access other digital tools in the course, educative as it offers immediate feedback and supportive for learning in the perception of students

Purpose: The purpose of this ethnographic study was to describe the culture of care and nonpharmacological nursing interventions performed by NICU nurses for infants with NAS. Background: Infants with NAS are increasingly being cared for in the inpatient hospital setting by NICU nurses. Interventions used for the care of premature and sick infants in the NICU may or may not be the exact interventions that should be used for the care of the fragile infant with NAS. Research studies on the nonpharmacological nursing care of infants with NAS encompass 5 main areas of practice: environment, adequate rest and sleep, feeding, assessment and evaluation using Finnegan scoring by nurses, and nurses as caregivers. Method: Roper and Shapira’s (2000) framework for the analysis of ethnographic data was used for this research and included participant observation, individual interviews, and the examination to existing documents. Data analysis included: (a) coding for descriptive labels, (b) sorting to identify patterns, (c) identification of outliers or negative cases, (d) generalizing constructs and theories, and (e) memoing to note personal reflection and insights. Focused ethnography allows for the articulation of research questions before fieldwork while observing and describing a culture. Results: Five themes emerged from the data: learn the baby (routine care, comfort care, environment, adequate rest and sleep, feeding), core team relationships (support, interpersonal relationships), role satisfaction (nurturer or comforter, becoming an expert), grief, and making a difference (wonderful insanity, critical to them). Implications: The results of this were a description of the culture of care provided to infants with NAS by NICU nurses and provide general recommendations to the nurse caring for an infant with NAS in the areas of environment, adequate sleep and rest, feeding, and the role of the nurse. This study also has implications for future study of evidence-based research strategies to decrease withdrawal symptoms in infants with NAS. Research is needed in the areas of clinical practice guidelines to help the bedside nurse care for these infants using current research and evidence for practice. Nursing theory and nursing education both contribute to nursing research in how to better understand the culture of care provided by nurses.

Health and feeding outcomes for preterm infants depend upon healthcare providers’ ability to recognize non-verbal signs of distress during bottle-feeding. Methods of training future providers’ to interpret feeding behavior in preterm infants are unclear. This study used a pre-test/post-test design to compare the effects of in- vivo simulation and video-simulation training on students’ knowledge of feeding abnormalities, clinical judgment, and documentation accuracy. Fifty-two graduate level speech-language pathology students were assigned to the in-vivo (N= 27) or video-simulation (N= 25) group. Results revealed that both methods proved beneficial for increasing knowledge and clinical judgment skills. Participants trained using video-simulation training documented a greater number of distress signs. The use of patient simulators to train graduate level speech-language pathology students to use correct clinical judgment for managing abnormal feeding behavior is efficacious.

With increased advances in technology, the overall survival rates in the Neonatal Intensive Care Unit (NICU) for premature infants at lower gestational ages, has also increased. Although premature infants survive at lower gestational ages, they are often discharged to home with unresolved medical issues. While the birth of a new baby for parents is a joyous occasion, they often have difficulty coping and transitioning into a parental role. Premature infants also have ongoing complications such as difficulty with feeding, developmental delays in growth, and long-term eye and respiratory complications. As a result of chronic health sequelae, premature infants require extensive utilization of hospital and community health resources. In addition, hospitals must coordinate between community resources, while preparing parents for specialized discharge teaching. Furthermore, individuals living in rural and underserved areas face unique challenges and barriers to access healthcare resources. An interpretive phenomenology study was conducted to bring insight and develop an understanding into how families perceive discharge readiness, accessing health care resources, and ability to cope at home after discharge from a Level III NICU located in Appalachia. Ten parents total were enrolled in the study and consisted of three couples, three married mothers, and two single mothers. Interviews were conducted over a period of six months and transcript analysis revealed development of major and minor themes. The studies overarching theme was Adapting to a New Family Roles, Finding Normalcy, which described parents experience of being prepared for discharge and their transition to home. Three major themes related to discharge readiness from detailed analysis included; 1) Riding out the storm, 2) Righting the ship, and 3) Safe port, finding solid ground. Subthemes that supported development of the major these were 1a) having the carpet pulled out from under me, 1b) things I lost, 1c) feel like an outsider, 1d) sink or swim, 2a) quest for knowledge, 2b) caring for me, care for my baby, 2c) customized learning, 3a) getting to know baby, 3b) becoming the expert, 3c) ongoing emotions, and 3d) adjusted parental role. Practice and research implications for discharge readiness include providing customized support for parents as they adjust to a new normal for their family, identify necessary resources, and become self-reliant once home.

Transitioning to the father role can be complex and stressful and fathers may not be fully prepared to assume the father role. Since fathers have little formal preparation for becoming a father, they may need more social support resources to support their adaptations to the father role. In addition, fathers are instrumental in supporting mothers’ breastfeeding and other infant feeding decisions, but may experience difficulties with infant care tasks, such as feeding and providing care to their infant. Studies show that many fathers want to be productive and nurturing in the father role but little is known about fathers’ parenting knowledge and needs. Therefore, the purpose of this study is to describe the social support resources of fathers with infant feeding and related parent educational learning needs during the first year after birth. Cross-sectional data was obtained for this descriptive, exploratory study by using a questionnaire and semi-structured interviews. Descriptive statistics were used to analyze questionnaire findings and directed content analysis was used to analyze the qualitative data. Since there is little evidenced-based literature on social support and parenting knowledge and needs of fathers in general, the study design was descriptive, exploratory and included new and experienced fathers. The study was guided by Bandura’s Self-Efficacy Theory. The findings reported in this study originated in a larger study on social support needs of urban fathers with infants during the first year after birth. Thirty experienced and new fathers were recruited from community organizations that offer services to low-income families in a southern part of the United States. The mean age range of the fathers was 30 (SD = 5) and 60% were experienced fathers and 40% were new fathers. The majority of the fathers were single (67%), Black (90%), had some or completed high-school education (81%) and 85% reported low annual incomes of less than $20,000. Most infants were bottle-fed (73%) and all infants were between 2-12 months. Inclusion criteria included being 18 years old with an infant that was born full-term. The study was reviewed and approved by the university internal review board. Findings revealed most fathers were confident with feeding their baby, however, some fathers were not confident because they were afraid to handle their baby due to the baby’s size or felt awkward when holding the baby. When fathers had difficulties with feeding their babies, they primarily asked family and friends for advice. Other resources included the internet and healthcare professionals. Fathers reported positive and negative attitudes towards breastfeeding and reasons why breastfeeding was stopped. After the baby’s birth, fathers reported the majority of parent educational learning needs related to how to take of infant, normal infant behavior, basic, daily care, and recognizing signs and symptoms of illness. At time of interview, the majority of parent educational learning needs related to how to cope with a difficulty baby, accessing positive parenting tips and resources, being responsive to the infant, coping with being a new father, and recognizing signs of depression. Recommendations for practice and research will be provided.

PURPOSE: Pregnancy is a physically impactful process in a woman’s life. During this time, a woman will gain weight and research has shown that many women will retain some extra weight after delivery. Because of this, recovery in the postpartum period is pivotal to avoiding the implications of weight retention. The postpartum period is vastly understudied in both the research and medical communities and this gap between pregnancy and postpartum research needs to be bridged. Therefore, the purpose of this study was to investigate metabolic changes from pregnancy to postpartum and to study how factors such as sleep and breastfeeding can impact metabolic values in the postpartum period. METHODS: Women participated in a pregnancy study visit at 32-34 weeks of gestation (n = 25) and attended two subsequent visits at 4-6 months (n = 25) and 12-13 months postpartum (n = 16). At these visits, the women had a baseline blood draw and baseline metabolic measurements taken via indirect calorimetry. At the pregnancy visit, participants completed a demographic survey and a dietary questionnaire (DHQ-II). At the postpartum visits, they completed the same surveys, along with validated sleep and breastfeeding surveys. RESULTS: Absolute resting metabolic rate (RMR) was significantly higher during pregnancy than at 4-6 months postpartum and 12-13 months postpartum (p < 0.001 and p = 0.001, respectively). Accounting for body weight, relative RMR was significantly higher during pregnancy than at 4-6 months postpartum. With regard to sleep, women deemed to be “good sleepers” had a significantly higher relative RMR than those who were deemed “poor sleepers” (23.6 ± 2.5 vs 20.8 ± 2.3, p = 0.009). With regard to breastfeeding, women who breastfed had a relative RMR than the women who did not breastfeed (22.8 ± 2.6 vs 20.4 ± 2.3, p = 0.046). CONCLUSIONS: There are hypermetabolic changes that take place during pregnancy. These values seem to decrease into the postpartum period. Women who demonstrate an improved sleep quality and who opt to breastfeed tend to have improved metabolic responses. This could help combat the struggle with postpartum weight retention that some women face.

Rates of labor induction and augmentation have been increasing in recent decades (Glantz, 2005). According to the Listening to Mothers II survey, half of all labors in the U.S. are induced or augmented with Pitocin or other synthetic form of the hormone oxytocin (Declercq et al., 2006). Oxytocin, a naturally occurring hormone released in the pituitary gland, is involved in the stimulation of uterine contractions during labor and in the milk ejection reflex during breastfeeding, and research suggests it also has various effects on the brain, such as eliciting maternal behavior. However, studies have shown that exogenous oxytocin can interfere with the natural production and regulation of oxytocin and can have adverse effects on the fetus and mother. Therefore, I predict that the induction or augmentation of labor with Pitocin will negatively affect breastfeeding following birth. The proposed study will compare LATCH scores, used in hospitals to measure postpartum breastfeeding success, of dyads exposed to intravenous Pitocin prior to birth with control dyads that had no exposure to Pitocin during labor. It is hypothesized that dyads exposed to Pitocin will have significantly lower LATCH scores than controls. Given the countless health benefits of breastfeeding for both mother and infant, the results of this study will have important implications for the evaluation of common practices during labor and birth.