The old practice of separating the mother-baby-dyad was without measurable benefits to mothers or their infants. Evidence has shown that skin-to-skin care (SSC) prevents hypothermia and hypoglycemia, decreases crying during painful procedures in newborns, and reduces maternal anxiety, stress, and postpartum depression. Rooming-in care (RIC) has been linked to an increase in the rate of breastfeeding and mother-infant interaction, as well as a decrease in the infant morbidity rate. This project assessed the effect of an educational intervention to increase rates of SSC and RIC in an obstetric unit, in addition to measuring nurses' attitudes and barriers in relation to SSC and RIC. The obstetric nurses received educational content related to SSC and RIC based on Kotter's model of change. A pre and postintervention evaluation showed a significant increase in the rates of SSC and RIC from pretest of 10%, to posttest of 96%; and RIC from pretest of 10% to posttest of 92%. Using a Wilcoxon test, a significant difference was found from pretest to posttest for every subscale score of the Mother-Newborn Skin-to-Skin Contact Questionnaire and Nurse Attitudes and Barriers to nonseparation Scale (p < 0.001), with the exception of belief about obstacles for SSC, which yielded a nonsignificant change (p = 0.57). This DNP project led to changes in the organization's culture, including the closure of the well-baby nursery. This project promoted social change across the organization, in that the team health care providers delivered evidence-based, standardized, unbiased, and family-centered care to the mother-baby dyad.

Licentiatavhandling (sammanfattning) Linköping : Linköpings universitet, 2009. / Härtill 2 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2004. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

It has previously been found that complexes comprised of vitronectin and growth factors (VN:GF) enhance keratinocyte protein synthesis and migration. More specifically, these complexes have been shown to significantly enhance the migration of dermal keratinocytes derived from human skin. In view of this, it was thought that these complexes may hold potential as a novel therapy for healing chronic wounds. However, there was no evidence indicating that the VN:GF complexes would retain their effect on keratinocytes in the presence of chronic wound fluid. The studies in this thesis demonstrate for the first time that the VN:GF complexes not only stimulate proliferation and migration of keratinocytes, but also these effects are maintained in the presence of chronic wound fluid in a 2-dimensional (2-D) cell culture model. Whilst the 2-D culture system provided insights into how the cells might respond to the VN:GF complexes, this investigative approach is not ideal as skin is a 3-dimensional (3-D) tissue. In view of this, a 3-D human skin equivalent (HSE) model, which reflects more closely the in vivo environment, was used to test the VN:GF complexes on epidermopoiesis. These studies revealed that the VN:GF complexes enable keratinocytes to migrate, proliferate and differentiate on a de-epidermalised dermis (DED), ultimately forming a fully stratified epidermis. In addition, fibroblasts were seeded on DED and shown to migrate into the DED in the presence of the VN:GF complexes and hyaluronic acid, another important biological factor in the wound healing cascade. This HSE model was then further developed to enable studies examining the potential of the VN:GF complexes in epidermal wound healing. Specifically, a reproducible partial-thickness HSE wound model was created in fully-defined media and monitored as it healed. In this situation, the VN:GF complexes were shown to significantly enhance keratinocyte migration and proliferation, as well as differentiation. This model was also subsequently utilized to assess the wound healing potential of a synthetic fibrin-like gel that had previously been demonstrated to bind growth factors. Of note, keratinocyte re-epitheliasation was shown to be markedly improved in the presence of this 3-D matrix, highlighting its future potential for use as a delivery vehicle for the VN:GF complexes. Furthermore, this synthetic fibrin-like gel was injected into a 4 mm diameter full-thickness wound created in the HSE, both keratinocytes and fibroblasts were shown to migrate into this gel, as revealed by immunofluorescence. Interestingly, keratinocyte migration into this matrix was found to be dependent upon the presence of the fibroblasts. Taken together, these data indicate that reproducible wounds, as created in the HSEs, provide a relevant ex vivo tool to assess potential wound healing therapies. Moreover, the models will decrease our reliance on animals for scientific experimentation. Additionally, it is clear that these models will significantly assist in the development of novel treatments, such as the VN:GF complexes and the synthetic fibrin-like gel described herein, ultimately facilitating their clinical trial in the treatment of chronic wounds.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.