published_or_final_version / Nursing Studies / Master / Master of Nursing

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

No description available.

Research has shown that children born low birth weight (i.e., ≤2500 grams) and/or premature (i.e., birth prior to 37 weeks gestation) are at increased risk of experiencing developmental delays, as well as long-standing executive functioning and academic challenges. Despite these well-known risks, children born low birth weight are under-enrolled nationally in Part C Early Intervention (EI) services intended to support developmentally vulnerable children. Little is known regarding why EI enrollment is low in this high risk population, especially given children born LBW are readily identifiable as at increased risk of delays at birth. This study explored EI referral outcomes from a high risk infant follow up program serving children with complex early medical histories that place them at increased risk of experiencing developmental delays to determine how many children referred to EI were ultimately evaluated and enrolled in the program. This explanatory sequential mixed methods study included a quantitative phase characterizing the EI referral outcome and a qualitative phase consisting of interviews with families to explore the parent/caregiver's experience of the EI referral process. Data analysis included descriptive statistics to characterize the sample and Pearson Chi Square and independent samples t-tests to investigate child characteristics associated with successful referral. Qualitative interviews were transcribed and coded for themes in an iterative and cyclical fashion. Results indicate that only 62% of the children who were referred for EI services were evaluated by the program, with about the same percentage of those evaluated being found eligible (67%). Of those who were not found eligible, about a third of children should have qualified based on previous testing and/or medical conditions. However, these qualifying medical conditions were often not clearly documented on the referral form, and not all forms included documentation of the scores from developmental testing. There were also a significant number (71%) of Oregon children referred to EI but never evaluated who were likely to have qualified based on medical history and/or results from developmental testing. There were several key themes identified following analysis of the qualitative interviews. Most critically, the parent/caregiver's perception of the need for the EI referral was identified as an essential factor in facilitating a successful connection to EI. Other key themes included the need to honor the many different demands placed on the caregivers of these high risk children, as well as the necessity of providing clear explanation of the purpose of both the visit to the high risk infant follow up program and the EI referral. The Chronic Care Model is used as a framework for discussing implications for practice.

As intensive care of preterm infants and high-risk infants has evolved, the practice of close physical contact between parents and their infants has been curtailed, with the separation of mothers and their infants more the norm than the exception (Browne, 2004). However, in the past two decades, the physiologic and socio-emotional benefits of close physical contact between parents and their high-risk infants has been revisited, with the practice of Kangaroo Mother Care (skin-to-skin contact) dramatically increasing in neonatal care units worldwide (Browne, 2004). Although research on Kangaroo Mother Care’s effects is plentiful, literature reveals gaps in the research pertaining to the experiences of midwives and nurses in its practice (Chia, 2006 & De Hollanda, 2008). As the role of midwives/nurses has been identified as crucial for Kangaroo Mother Care practice, this gap was recognised, and impelled this research study to be conducted in order to further extend the practice of KMC for its benefits to infants and their families. Due to current staff shortages and poorly resourced neonatal facilities in our local hospitals, local data on midwives’ experiences of Kangaroo Mother Care was perceived to be a vital first step in exploring these experiences. The purpose of this qualitative study was to explore the lived experiences of midwives regarding the Kangaroo Mother Care initiative at a selected tertiary level hospital in the Ethekwini District. Interpretive phenomenology informed this study design, data collection and analysis. As Kangaroo Mother Care is a complex phenomenon, an interpretive paradigm allowed the researcher to access the meaning of participants’ experiences as opposed to explaining their predicted behaviour. Purposive sampling was used by the researcher to select the eight midwives working in the tertiary hospital in the Ethekwini District. The midwives were selected from the neonatal unit during August 2011. Data was collected through a single in-depth interview with each participant in the neonatal unit. The interviews were recorded and later transcribed verbatim to facilitate analysis. Colaizzi’s method of data analysis and representation was utilised. Eleven themes emerged from the analysis of the data. Themes were aligned to the research objectives and included the participants’ experiences of conceptualisations, experiences, hindering and facilitating factors of Kangaroo Mother Care. Conceptualisations were aggregated into two themes pertaining to a physiological concept of KMC and an emotive concept of KMC. The physiological concept regarded the catalytic action of KMC as a promotive agent in health through its effect in increasing average weight gain. Furthermore, KMC was seen as a protective agent in reducing cross-infection and hypothermia. These findings aligned with findings from authors in the literature review. An emotive concept of KMC was revealed by the participants’ input regarding the effect of the skin-to-skin contact in facilitating maternal-infant attachment through bonding. This study finding is supported by current literature. Lived experiences emerged regarding the theme of KMC in maternal instinct and capability, which findings encompassed increased maternal confidence and competence with which several authors concurred. Factors considered as hindering KMC included five themes which emerged as maternal concerns, increased work-load, lack of training, management support and resource scarcity. Contrary to these, facilitators of KMC included the need for motivation and education as well as the provision of a comfortable environment conducive to the practice of Kangaroo Mother Care. A number of recommendations for nursing practice, nursing education, communities and research based on the findings from the study were made available to relevant stakeholders. If implemented effectively, these recommendations may assist in the continued and increasing practice of KMC; resulting in its beneficial effects changing infants’ and families’ lives. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.