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In the United States, 10% to 15% of newborns are admitted to the neonatal intensive care unit (NICU). Painful procedures are unavoidable during NICU care; the neonate experiences approximately 12 painful procedures per day. Inconsistent and/or inappropriate pain management in the NICU remains a problem. The purpose of this study is to identify the prevalent factors that influence the implementation of pain management strategies among nurses who work in a NICU setting in a Central Florida hospital. This study was conducted using a voluntary and anonymous electronic survey. The survey was divided into two sections; the first section designed to describe the sample, and the second section containing a Likert-type scale that assessed the nurses’ general pain knowledge, knowledge of pain assessment, and awareness of accepted pain management strategies. The survey was adapted from previously published research. Results indicate pain was more likely to be addressed when nurses collaborated closely with the attending physician. The majority of nurses were aware of current protocols for pain management on the unit but not all nurses agreed those protocols were adequate. Results also indicated pain assessment education is being provided in the NICU and the nurses feel confident in their skills to assess pain, however, not all nurses agreed that pain is being well managed in their unit. There appears to be a gap between the nurse’s knowledge/skill to assess pain and implementation of strategies to decrease pain. Although it is the nurse’s responsibility to prevent and treat newborn pain in the NICU, not all nurses agreed that newborn pain is well managed in their unit and some believe pain to be an unavoidable experience in the NICU. Nurse-physician collaboration is key to evidence based newborn pain management.

Synchronous interaction between adolescent mothers with preterm infants in the Neonatal Intensive Care Unit was examined in this study. Understanding the characteristics of synchrony in adolescent mother and premature infant interactions during this early period in the development of the relationship provides direction for the development of nursing strategies to foster synchronous interaction in the neonatal intensive care unit (NICU) setting and, subsequently, positive developmental outcomes for preterm infants. The research design was a one-group, pretest-posttest, exploratory intervention assessing synchronous interaction using the Nursing Child Assessment Feeding Scale (NCAFS) among 27 adolescent mothers and their premature infants in the NICU. The study examined the differences in adolescent mother-premature infant interaction in the NICU environment prior to an intervention and within 48 hours after receiving the Preterm Infant Cues Intervention (PICI). Additional variables including stress, social support, age of the adolescent mother and preterm infant, ethnicity, length of stay in the NICU, and preterm infant weight were considered. Results showed a statistically significant difference between Time 1 and Time 2 synchronous interaction measurements indicating that the PICI may have resulted in the adolescent mother better understanding the preterm infant’s behavior. The Caregiver Total Scale score (t = -3.93, p < .001) and the Total Scale score (t = -3.96, p < .001) were the two main scales that the PICI could have affected. There were no correlations among the other independent variables and the dependant variable. Future research should focus on a large scale longitudinal study to measure synchronous interaction over multiple time points beginning in the NICU carrying through the first year of child development. Adding a qualitative component to future studies would provide further insight into experience of adolescent mothers with preterm infants. / text

There are different opinions on who the appropriate decision makers are for extremely premature infants. Some argue the responsibility should fall to the parents, and others argue the neonatal experts should be responsible for decision making. This study explored parental perceptions of their involvement in decision making in the neonatal intensive care (NICU). The NICU operated from the philosophy of Family Centered Care (FCC). FCC situates the parents as central to all aspects of their child’s care and as such, the parents should be well informed and actively involved in decision making. An interpretative descriptive approach was used to examine the experiences of seven parents who had infants born at 24-26 weeks gestation who were admitted to the NICU. Thematic analysis revealed that the culture of the NICU along with the relationships developed in the NICU had an impact on the parents’ perceptions of decision making.

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When a woman discovers that she is pregnant, she begins a process of internal work to develop her mother role. This process has been outlined in the literature for the delivery of a healthy full-term baby, however little is known about the process for mothers of medically fragile babies. A threatened pregnancy and subsequent delivery of a medically fragile baby involves a different process of internal work by the mother to prepare for her role. Mothers with a baby in the Neonatal Intensive Care Unit (NICU) experience stress, uncertainty, and anxiety potentially causing a permanent impact on the successful development of her role. It is the purpose of this dissertation to explore the process of mother role development among those first-time mothers having a baby in the NICU. This study was conducted using a qualitative grounded theory method. Data collection consisted of personal journals, in-person interviews, researcher notes and observation. The specific aims include (1) describing the disruption in the individual’s preconceived idea of being a mother, (2) exploring specific strategies that support the mother in the development of her role while in the NICU, (3) describing the mother’s perception of her role during physiologic changes in her baby, (4) examining the mother’s evaluation of her mother-role success, (5) developing a deeper understanding of the process of developing the role of mother while in the NICU, and (6) constructing a theoretical model to illustrate the process of becoming a mother while in the NICU.

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The purpose of this review of literature is to understand the current state of the science and to make recommendations for practice and research in regards to the gastrointestinal condition affecting premature infants, necrotizing enterocolitis (NEC). Emphasis is placed on reviewing the literature to identify prevention strategies nurses can use to reduce the incidence, morbidity and mortality of NEC. The introduction will focus on discussing the problem of NEC including its risk factors, pathophysiology, and disease presentation. The findings sections will focus on the most promising and researched areas of intervention. The discussion section will focus on how this knowledge can be translated into practice and what nurses can do about it. The research will be conducted through nursing databases with conceptual primary sources that will further expand upon the selected studies on this topic.

This research examines the structure of the NICU (neonatal intensive care unit), a venue that juxtaposes a highly technological and medical setting against the care and nurturing of child by her parents. In this site, parents must construct and refine their definition of what it means to be a good parent in the context of the environment, medical professionals' expertise, and their child's hospitalization. At the same time, the health professionals on the unit are also impacted by their own experiences, preconceptions, and faith in medicine. Particularly relevant actors are the registered nurses, who care for babies but interact with parents; how nurses conceive of the parenting role influences the nature of this interaction, and therefore the experience of the parents in the unit. Yet nurses' definition of good parenting in the NICU often contradicts that of parents, and those who fail to meet the nurses' definition may find themselves labeled bad parents. Data for this research was collected in two urban NICUs. Mixed qualitative methods were used in the form of participant observation and in-depth interviews with both parents and staff members at both institutions, to the end of uncovering themes regarding commonalities of characterizations of good and bad parenting. Findings demonstrate that in constructing a definition of good parenting, parents medicalized themselves in the context of the NICU. Many incorporated medicalization into the parental role by accepting the notion that they could help to heal their baby, not just through care work but by actively taking on responsibilities that they felt could be beneficial. Parents' definitions of good parenting also included relying on the opinions of medical experts, which demonstrated a faith in the professionalization of medicine and the medicalization of childbirth and child care. Nurses' conceptions of what made up a good parent included deference. Many believed that parents needed to do what was best for the baby, defining this in part by stating that it meant listening to the experts, including themselves. Taking a Foucauldian approach to examine the position of nurses in the hospital, this fulfilled a need many nurses had to be respected for their skills and feel powerful on the unit. Additionally, nurses would label those whom they did not feel were meeting their parameters for being a good parent as bad parents, which often involved judging parents on the basis of their actions before or during their pregnancy. Parents were also judged based on how they acted in the unit. The bad parent label was applied both to parents who had confidence in their own abilities to parent while in the NICU, and also to mothers with a history of drug abuse. In accordance with labeling theory, once this label was affixed, it impacted the way that nurses and other staff treated parents and viewed all of their activities. The recent nature of this work reflects the impact of the newest technological innovations on the parental experience. This includes the increasingly sophisticated medical equipment in the NICU, what this has meant in terms of pushing the limits of viability, and the ability of parents to access information via the Internet. It also demonstrates the gap in parents' and nurses' ideas in the NICU, validating the place of sociology in discussions of family-centered care. / Sociology