CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Por ser de interesse à saÃde pÃblica, o teste do reflexo vermelho, tambÃm conhecido como teste do olhinho, vem se firmando como estratÃgia de prevenÃÃo da cegueira infantil com participaÃÃo multiprofissional, particularmente do enfermeiro. Tecnologias aplicadas a esse contexto devem ser estimuladas com vistas a ser utilizadas como ferramentas integrantes de atuaÃÃo profissional com a finalidade de facilitar e melhorar a qualidade da assistÃncia. Objetivou-se avaliar um gradiente de cores direcionado para a avaliaÃÃo do teste do reflexo vermelho em recÃm-nascidos quanto à validade de conteÃdo e de aparÃncia, verificar a confiabilidade interobservadores na aplicaÃÃo da tecnologia desenvolvida e investigar a opiniÃo dos enfermeiros quanto à aplicabilidade do instrumento apÃs a experiÃncia da sua utilizaÃÃo. Trata-se de uma pesquisa metodolÃgica, quantitativa, cuja coleta de dados ocorreu de maio a agosto de 2010 em duas etapas metodolÃgicas. Na primeira, a tecnologia proposta foi analisada por trÃs juÃzes especialistas, os quais, por meio de um questionÃrio de avaliaÃÃo na forma de escala Likert, opinaram sobre aspectos relacionados aos objetivos, estrutura e apresentaÃÃo, aparÃncia e relevÃncia. Para emitir suas opiniÃes, os especialistas responderam aos itens avaliativos entre cinco nÃveis de respostas: Totalmente adequado; Adequado com pequenas ressalvas; Parcialmente adequado, Inadequado; NÃo se aplica. ApÃs a anÃlise dos especialistas e inclusÃo das sugestÃes à tecnologia avaliada, na segunda etapa buscou-se averiguar a confiabilidade entre os examinadores na aplicaÃÃo do gradiente de cores para avaliaÃÃo do teste do reflexo por enfermeiros. Para isso, uma amostra constituÃda por sessenta recÃm-nascidos internados na unidade neonatal de baixo risco de uma maternidade pÃblica de referÃncia, em Fortaleza, foi avaliada por dois examinadores (a pesquisadora e um enfermeiro) de modo simultÃneo e independente. Os dados receberam tratamento descritivo e com o auxÃlio do PASW versÃo 18.0 calculou-se a confiabilidade do gradiente de cores por meio do coeficiente de correlaÃÃo intraclasse. A tecnologia recebeu ajustes atà sua aprovaÃÃo, em duas etapas de avaliaÃÃo. Sobre as avaliaÃÃes de conteÃdo e aparÃncia, foi consenso entre os especialistas o julgamento quanto ao excesso de quantidade de gradientes, a sugestÃo de retirar as nuances de cores muito prÃximas, como tambÃm de rever aquelas com o centro esbranquiÃado, pois poderiam ser confundidas com reflexo alterado. Sugeriu-se o acrÃscimo de uma nova nuance de cor e a complementaÃÃo no tÃtulo da tecnologia da expressÃo gradiente de cores do teste do olhinho. A maioria das respostas dos juÃzes ficou entre totalmente adequado e adequado com pequenas ressalvas. Os juÃzes especialistas consideraram a tecnologia desenvolvida um recurso didÃtico complementar à prÃtica do teste do reflexo vermelho e Ãtil no treinamento de profissionais para a realizaÃÃo do teste. Observaram-se bons Ãndices de confiabilidade (0,928 e 0,894) estimados pelo coeficiente de correlaÃÃo intraclasse. Diante das consideraÃÃes, o gradiente de cores mostrou-se uma tecnologia vÃlida para ser adotada como um recurso facilitador para a aprendizagem sobre o teste e aplicÃvel à prÃtica do cuidado em saÃde ocular como ferramenta complementar. Espera-se que a aplicaÃÃo do conhecimento adquirido nesse estudo proporcione impacto positivo na divulgaÃÃo e realizaÃÃo do teste do reflexo vermelho. / Due to its relevance for public health, the red reflex test, also known as little eye test, has become an established strategy to prevent infant blindness within a multi professional team work, involving the nurse in particular. Applied technologies in this context constitute a useful tool for the professional and their use has to be stimulated aiming the assistance improvement. The main goal of this work is to assess a color gradient projected to measure the red reflex test in newborns regarding contents and appearance validation, accordance among different observers and nurseâs opinion on the tool applicability after its use. This is a methodological research, quantitative, whose data acquisition happened between May and August 2010 in two methodological steps. Firstly, the proposed instrument was analyzed by three judges. These specialists gave their opinions by means of an evaluation questionnaire in the Likert scale format. The survey covered subjects like goals, structure and presentation, appearance and relevance. In order to quantify their opinions, the answers were restricted to five levels: Absolutely adequate; Adequate with little observations; Partially adequate; Inadequate; It does not apply. In the second step, after collecting the answers and taking into account suggestions from the specialists, we checked the test accordance among different nurses in the color gradient application top the red reflex test. This was made by using a sixty newborns sample. These neonates were in the low risk neonatal sector of a reference public maternity hospital in Fortaleza. Each newborn was examined by two examiners (the researcher and a nurse) simultaneously and independently. The data were treated within PASW 18.0 software. The gradient reliability was calculated by means of the intraclass correlation coefficient. Adjustments were applied to the instrument until its approval. Regarding the contents and appearance evaluation, the judges agreed about the excessive number of gradient colors and they suggested the elimination of several similar patterns. They also recommended to reconsider those patterns with a white center since they could be confused with an altered reflex. Additional suggestions from the specialists pointed to the inclusion of a new color in the instrument as well as a new title to the gradient: color gradient for the little eye test. Most of the answers from the judges were between Absolutely adequate and Adequate with little observations. The specialists considered the developed technology as a complimentary to the practice of the red reflex test, as well as a useful tool for training of professionals to do this test. Good reliability indices were observed (0,928 e 0,894). Such numbers were estimated by the intraclass correlation coefficient. After these considerations, the color gradient was shown to be a valid technology suitable to be considered as a pedagogical tool and as a useful additional instrument on the visual health care. It is expected that the knowledge constructed in this work results in a positive impact on the red reflex test propagation and application.

Introdução: o cateter central de inserção periférica (CCIP) tornou-se amplamente utilizado nas unidades de terapia intensiva neonatal (UTIN) na última década em razão da facilidade de sua instalação, permitindo a infusão de soluções endovenosas vesicantes, irritantes, hiperosmolares e de longa duração em veias centrais. Uma das complicações mais temidas relacionadas ao uso do CCIP é infecção de corrente sanguínea associada ao cateter cujo diagnóstico se confirma somente após a sua remoção, com o resultado de cultura da ponta do dispositivo e o resultado de hemocultura periférica do neonato. Objetivo: determinar a incidência de remoção por suspeita de infecção de corrente sanguínea relacionada ao CCIP e identificar os seus fatores de risco. Metodologia: coorte prospectiva composta por neonatos com CCIP internados em uma Unidade de Terapia Intensiva Neonatal de um hospital privado da cidade de São Paulo no período de 31 de agosto de 2010 a 30 de agosto de 2012. As variáveis de exposição analisadas foram às relacionadas às características demográficas e clinicas dos neonatos, procedimentos relacionados à inserção do cateter, tipo de terapia intravenosa infundida pelo CCIP e o tempo de permanência do cateter. O desfecho analisado foi o motivo de remoção do cateter - eletivo ou por suspeita de infecção. Os dados obtidos de registros de prontuário foram armazenados em planilha Microsoft Excel 2010® e analisados com o software Stata 11,1. Foram determinadas medidas de tendência central e dispersão para as variáveis contínuas e frequências absolutas e relativas para as variáveis nominais. A existência de associação entre as variáveis de exposição e desfecho foi determinada pelo teste Qui-quadrado (teste 2), exato de Fisher e t Student. As variáveis com valor p < 0,05 foram incluídas na análise multivariada com regressão de Poisson. O nível de significância estatística adotado foi p < 0,05 com intervalo de confiança de 95%. O projeto de pesquisa foi aprovado pelo Comitê de Ética e Pesquisa da instituição campo do estudo. Resultados: A coorte inicial foi composta por 551 neonatos com CCIP e atenderam os critérios de elegibilidade, 401. A incidência de remoção por suspeita de infecção associada ao cateter foi 13,7%. A média de permanência de cateteres removidos por suspeita de infecção foi de 16,4 dias e dos removidos eletivamente, 11,7 dias, valor p=0,0001. Os fatores de risco para remoção por suspeita de infecção foram os diagnósticos de distúrbio hidroeletrolítico, RR 3.04. IC95%[1,727-5,054], valor p = 0,000 e apnéia, RR 2,38, IC95% [1,105-4,564], valor p = 0,016. As variáveis, média da idade gestacional corrigida superior a 32 semanas, RR 0,893, IC95% [0,832-0,956], valor p = 0,002 e o uso de cateter monolúmen de silicone, RR 0,278, IC95% [0,128-0,536], valor p = 0,000 se configuraram como fatores de proteção para remoção por suspeita de infecção associada ao CCIP. Dos 72 cateteres removidos por suspeita de infecção, 3 (4,2%)apresentaram confirmação de infecção do cateter. Conclusão: Os resultados sugerem que os diagnósticos identificados como fatores de risco devem ser incluídos no protocolo assistencial como fatores preditores de remoção por suspeita de infecção. Estes recém-nascidos necessitam ser especialmente monitorados em busca de sinais de infecção. Além disso, a escolha do tipo de dispositivo CCIP deve ser objeto de mais investigações, bem como os critérios de decisão para remoção do CCIP, por suspeita de infecção, tendo em vista a reduzida frequência de confirmação de infecção entre os cateteres removidos por suspeita. / Introduction: The peripherally inserted central catheter (PICC line) has become widely used in the neonatal intensive care units (NICU) in the last decades due to its ease installation and to allow infusion of vesicant, irritant and hiperosmolar solutions by long period in central veins. One of the most feared complications related to the use of PICC lines is the catheter associated bloodstream infection, which is confirmed after its removal with the result of catheter\'s tip culture and the results of neonate peripheral blood culture. Objective: to determine the incidence of removal due to PICC-line associated bloodstream infection and identify its risk factors. Methods: a prospective cohort of neonates with PICC line hospitalized in a NICU of a private hospital of the city of São Paulo. Data were collected from August 31st, 2010 to August 30th, 2012. The independent variables analyzed were related to demographic and clinical characteristics of newborns, procedures related to insertion of catheter, type of intravenous therapy infused and the catheter dwell time. The outcome variable analyzed was the reason for catheter removal elective or due to PICC-line suspected bloodstream infection. Data were obtained from the medical charts and stored in Microsoft Excel 2010 ® spreadsheet. Statistics analysis was conducted in the software Stata 11.1®. The continuous variables were showed by central and dispersion tendency measures and for qualitative variables, the data were showed by absolute and relative frequencies. The association between independent and outcome variables was determined by chi-square test (2), Fisher exact and t Student. Variables with p <0.05 were included in Poisson multivariate regression model. The level of statistical significance adopted was p<0.05 with a confidence interval of 95%. The research project was approved by the Ethics and Research Committee of the hospital where the study was carried out. Results: the initial cohort was composed of 551 neonates with PICC-line and 401 met the eligibility criteria. The incidence of suspected catheter associated bloodstream infection removal was 13.7%. The mean dwell time of PICC removed due suspicious of infection was 16,4 days and due to elective removal was 11,7 days, p value=0,0001. The risk factors for catheter-associated bloodstream infection identified were the diagnosis of hydroelectrolytic disorder, RR 3.04, CI95% [1.727 - 5.054], p value= 0.000 and diagnose of apnea, RR 2.38, CI95% [1.105 - 4.564], p value=0.016. The variables identified as protective factors for removal due suspected infection were: corrected gestational age of more than 32 weeks, RR 0.893, CI95% [0.832 - 0.956], p value=0.002 and single-lumen silicone catheter, RR 0.278, CI95% [0.128 - 0.536], p value= 0.000. From 72 catheters removed due to PICC-line suspicious of bloodstream infection, the infection was confirmed only to 3 (4.2%)of them. Conclusion: The results suggested that the diagnosis identified as risk factors should be included in the protocol of PICC lines management as predictors for removal due to suspected of infection. These neonates need to be carefully monitored for signs of infection. Moreover, choosing the most appropriate type of PICC should be further investigated, as well as the criteria to support the decision of removing the catheter considering the low number of confirmed catheter-associated infection.

Na atualidade, a educação permanente do enfermeiro pode ser potencializada se oferecida online, em especial, numa temática em que há escassez de conhecimento e materiais educativos. Assim, sentimo-nos motivadas em oferecer um curso pela internet que seja capaz de atualizar enfermeiros de unidades neonatais sobre o ambiente sensorial de bebês pré-termo. O estudo teve como objetivos descrever o processo de desenvolvimento de um curso de atualização online junto aos enfermeiros acerca do ambiente sensorial da unidade neonatal com enfoque no ruído, manipulação e luminosidade e avaliar a aprendizagem cognitiva do enfermeiro neonatal no curso de atualização online. O projeto foi desenvolvido em duas fases: 1 - desenvolvimento do curso de atualização online; 2 - avaliação da aprendizagem cognitiva influenciada pelo curso. A fase 1 tratou-se de um estudo metodológico no qual foi desenvolvido um curso de atualização online com duração total de 30 horas, disponibilizado em um ambiente virtual de aprendizagem e contou com o auxílio de tecnologias educacionais digitais. A fase 2 foi realizada por meio de uma pesquisa quase-experimental envolvendo intervenção educacional (curso desenvolvido) e avaliação de pré e pós-teste para comparação de desempenho cognitivo dos participantes sob influência do curso online. Foram convidados a participar do estudo enfermeiros que trabalham nas Unidades de Cuidado Intermediário Neonatal (UCIN) e Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP) e UCIN do Centro de Referência em Saúde da Mulher de Ribeirão Preto - MATER. A coleta de dados ocorreu no período de 11/09/2017 a 02/10/2017. Utilizou-se análise descritiva com apresentação de frequências para os dados qualitativos e média, mediana e desvio padrão para as variáveis quantitativas. Para análise de impacto do curso na aprendizagem dos 22 enfermeiros participantes utilizou-se o teste estatístico não paramétrico de Wilcoxon. A avaliação de desempenho foi realizada a partir da diferença entre a pontuação obtida pelo participante no pós-teste em relação à pontuação do pré-teste. Os dados foram tabulados e testados através do programa SPSS 18 e o nível de significância nas análises foi de 5%. A diferença entre o pos e pré-teste, para a avaliação do conhecimento cognitivo proporcionado pelo curso de atualização, resultou em p<0,001, demonstrando que houve diferença estatísticamente significante e que, portanto, houve aprendizagem cognitiva dos enfermeiros que participaram do curso de atualização online auxiliado pelas tecnologias educacionais digitais / Currently, nurses\' continuing education can be enriched if offered online, especially in subjects lacking knowledge and educational tools. Therefore, we were motivated to offer an online course that would be able to update nurses of neonatal units on the sensory environment of preterm infants. The aims of the study were: to describe the process of developing an online update course with nurses about the sensory environment of the neonatal unit focusing on noise, manipulation and luminosity and to evaluate the cognitive learning of neonatal nurses after the online update course. The study had two phases: 1 - development of the online update course; 2 - evaluation of the cognitive learning generated by the course. Phase 1 was a methodological study in which a 30 hours online update course was created with the incorporation of digital educational technologies and made available in a virtual learning platform. Phase 2 was performed through a quasi-experimental methodology involving educational intervention through the online course and a pre and post cognitive performance test to evaluate participants\' progress due to the online course. Nurses working at the Neonatal Intermediate Care Unit and the Neonatal Intensive Care Unit of the Hospital das Clínicas of the Faculty of Medicine of Ribeirão Preto of the University of São Paulo and the Neonatal Intermediate Care Units of the Reference Center on Women\'s Health of Ribeirão Preto - MATER. Data collection was from 9/11/2017 to 10/2/2017. Descriptive analysis with frequency distribution was used for the qualitative data and mean, median and standard deviation for the quantitative variables. Wilcoxon nonparametric statistical test was used in the analysis of the course learning impact and in the intra-group comparisons to assess the acquired cognitive knowledge of the 22 enrolled nurses. The performance evaluation was based on the difference between the score obtained in the post-test and the pre-test. The data were tabulated and tested with SPSS 18 and the level of significance was set at 5%. The evaluation of the cognitive knowledge provided by the update course measured by the difference between the pos and pretest was statistically significant difference (p<0.001). Therefore, the update online course with digital educational technologies was able to generate cognitive learning by nurses enrolled

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

Trata-se de um estudo exploratório, descritivo de abordagem quantitativa, que teve por objetivo avaliar o processo de identificação do neonato admitido na unidade de terapia intensiva neonatal e semi-intensiva de um hospital privado no Município de São Paulo. A casuística compôs-se de 540 oportunidades de análise, selecionadas pela amostragem probabilística aleatória simples. A coleta de dados ocorreu no período de maio a agosto de 2010, por meio de um formulário, contendo as três etapas do processo de identificação: componentes de identificação, condições da pulseira e quantitativo de pulseiras. Os dados foram analisados em função da estatística descritiva, e sendo aplicado o teste estatístico com significância de 5%. No que diz respeito ao desempenho geral do processo, o percentual de conformidade foi de 82,2%. No que tange as três etapas integrantes do processo, o maior índice de conformidade (93%) foi atribuído a segunda etapa e o menor (89,3%) a terceira etapa, com diferença estatística significante (p=0,046). Em relação a primeira etapa, a presença do código de internação obteve (98,5%) de conformidade; na segunda,o melhor percentual (99,8%), foi atribuído à confecção correta da pulseira e na terceira, houve (88,5%) de conformidade para o grupo de neonatos em condições especiais, não apresentando diferença estatística significante p=0,895. Acredita-se que os achados deste estudo subsidiem as reestruturações necessárias no processo de identificação dos recém-nascidos e o estabelecimento de metas assistenciais e gerenciais, para a melhoria contínua da qualidade e da segurança dos pacientes. / This is an exploratory, descriptive study of quantitative approach, aiming to evaluate the identification procedure for newborns admitted to a neonatal intensive and semi-intensive care unit of a private hospital in the city of São Paulo. The sample consisted of 540 opportunities for analysis, selected by the simple random probability sampling. Data collection occurred between May and August 2010, using a form containing the three phases of the identification procedure: identification components, conditions of ID bracelet and quantitative of ID bracelets. Data were analyzed according to descriptive statistics and the statistical test was applied with a significance of 5%. Regarding performance of the general process, the percentage of compliance was 82.2%. Regarding the three phases of the process, the highest compliance rate (93%) was related to the second phase and the lowest (89.3%) to the third phase, with a statistically significant difference (p = 0.046). Regarding the first phase, the presence of a hospitalization code obtained (98.5%) of compliance, in the second, the best percentage (99.8%) was attributed to correct manufacturing of the ID bracelet and third, with (88, 5%) of compliance for the group of newborns under special conditions, showing no statistically significant difference p = 0.895. It is believed that the findings of this study will subsidize the necessary reorganization of newborn identification procedure and establishment of assistance and management of goals for the constant improvement of quality and patient safety.

Philosophiae Doctor - PhD / Literature has shown that Malawi is experiencing a shortage of qualified healthcare providers, with the greatest burden on maternal and neonatal health. The majority of health service providers are Nurse-Midwife Technicians (NMT), contributing to 87% of the nursing and midwifery workforce. However, research has shown that the NMTs lack the ability to transfer skills into different clinical settings. It was not known what competencies were taught in Christian Health Association of Malawi colleges to equip the NMTs with clinical competence in neonatal nursing practice and how the clinical teachers assisted these NMTs to acquire the competencies. Furthermore, there was no documentation on the availability of a clinical competency-based assessment tool to validate the NMTs’ achievement of clinical competence in neonatal nursing. The purpose of this study was to develop a neonatal nursing care clinical competency-based assessment tool to validate NMTs’ achievement of clinical competence in CHAM nursing colleges. The competency, outcomes and performance assessment (COPA) model and the skills acquisition model were the conceptual frameworks used as the foundation of the study. The study adopted a sequential mixed method approach in which both qualitative and quantitative methods were utilized. Data collection was conducted using focus group discussions, document review and cross-sectional survey. The design and development model developed by Reeves (2006) and steps to development of assessment tools identified by the Department of Training and Workforce Development (2012) guided the study and development of the competency-based assessment tool. The study was conducted in eight CHAM nursing colleges. The researcher employed purposive, convenient and proportional stratified sampling to select the participants. Ethics clearance was obtained from the University of Western Cape and the National Health Sciences Ethical Research Committee in Malawi, prior to data collection. The data collection involved 31 midwifery clinical teachers and 140 third year students for the FGD and 48 midwifery clinical teachers and 195 third year students for the cross section survey. Document analysis was conducted at all the eight nursing colleges. The qualitative data was analysed using content analysis with Atlas.ti 7 and the quantitative data was analysed using descriptive analysis with SPSS 22. The research findings showed that the NMTs were taught basic nursing skills to enable them provide basic care to the health newborn baby. However, there were inadequate clinical assessments done to validate the NMT’s achievement of clinical competence in this setting. In addition, the clinical teachers used skills checklists to evaluate the NMTs clinical performance on specific procedures. The outcome of this study was the establishment of neonatal nursing clinical competencies, and development of a neonatal nursing care clinical competency-based assessment tool for the validation of NMT’s achievement of clinical competence. The tool provides a framework for neonatal nursing clinical teaching and assessments as well as tracking of the NMT’s clinical performance in this setting. It is recommended that training institutions should reinforce mechanisms to track the students’ clinical experience and performance assessments using this tool to ensure quality student outcomes. Furthermore, the clinical teachers should be oriented on the use of the developed assessment tool for familiarisation; thereby enhancing consistency and objectivity in the students’ performance assessments. / ICAP-NEPI Project Malawi

Every year, 16 million women aged 15 to 19 years give birth globally. Adolescent births account for 11% of all births globally and 23% of the overall burden of disability and diseases due to pregnancy and childbirth. In the United States, 750,000 adolescents (15-19 years) become pregnant each year, making the United States the developed country with the highest rates of adolescent pregnancy. The economic burden of adolescent pregnancy in the U. S. is $7-15 billion per year. Adolescent pregnancy brings risks associated with pregnancy induced hypertension, preterm infants, maternal and neonatal mortality. Social factors include poverty, low educational levels, alcohol, and drug use. Between 30-50% of adolescent mothers who have a first birth before age 18 years will have a second child within 12 to 24 months. Subsequent adolescent pregnancies compound fetal and maternal risks. Many vulnerable adolescent mothers succumb to external pressures and have a repeat adolescent pregnancy while others are able to overcome the challenges of an adolescent pregnancy and prevent a repeat adolescent pregnancy. This cross sectional survey designed study investigated the effects of resilience and social influences on contraceptive use or abstinence by Black and Hispanic adolescent parenting mothers to prevent a repeat adolescent pregnancy. 140 adolescent mothers were recruited from three postpartum units of a tertiary hospital system in Miami, Florida. The Wagnild and Young Resilience Scale and the Adolescent Social Influence Scale were used to measure resilience and social influences, respectively. Demographic data, length of labor, plan for contraceptive use or abstinence were measured by an investigator developed instrument. Point biserial correlation showed a significant positive correlation between Black adolescent mothers’ resilience and contraceptive use (r =.366, p2(11, N=133) = 27.08, p =.004. (OR = .28). These results indicate a need for interventional strategies to maximize resilience in parenting adolescents to prevent a repeat adolescent pregnancy.

The purpose of this study was to investigate the relative contributions of previously identified Polycystic ovary syndrome (PCOS) manifestations (infertility, hirsutism, obesity, menstrual problems) to multiple psychological symptoms. Participants were 126 female endocrinology patient volunteers diagnosed with PCOS who completed a cross-sectional study of PCOS manifestations and psychological symptoms. Participants had significantly elevated scores on nine subscales of psychological symptoms. Menstrual problems were significantly associated with all symptom subscales as well as the global indicator, while hirsutism and obesity were significantly related to five or more subscales. After controlling for demographic factors, menstrual problems were the strongest predictor of psychological symptoms. Findings suggest features of excess body hair, obesity, and menstrual abnormalities carry unique risks for adverse psychologic symptoms, but menstrual problems may be the most salient of these features and deserve particular attention as a marker for psychological risk among women with PCOS.

Many babies are delivered by using the standard lithotomy birthing position. However, evidence shows several benefits to an upright birthing position. The purpose of this study is to discover birthing positions that lead to more positive outcomes in laboring women delivering in hospitals. This research was conducted by examining previous studies conducted on a similar topic. However, the studies found mainly focused on the benefits of squatting positions and the implementation of devices that helps achieve an upright position. All findings support an upright birthing position provides a more optimal position for birthing a child due to the force of a more natural pelvic expansion and gravity. One of the barriers of this area of study includes the lack of pregnant mothers willing to participate in a study skewing the reliability of many studies. In conclusion, the articles analyzed provide pertinent information that supports the intervention of nurses and midwives providing patient education to explore birthing options outside of standard practice that could lead to more positive outcomes.

Introduction and background Opioid use disorder (OUD) is an epidemic in the U.S. OUD affects both the mother’s and infant’s health. Substance-exposed infants suffer from decreased health outcomes relative to non-exposed infants. Purpose The aim is to identify infant health outcomes when pregnant women are prescribed medication-assisted treatment (MAT) for OUD. Among pregnant women with OUD in the U.S., is medication-assisted therapy as compared to no therapy associated with decreased negative infant health outcomes? Literature review Five studies on OUD and infant outcomes in the U.S. were reviewed. CINAHL and PubMed were searched using terms opioid use disorder, pregnancy, and neonatal abstinence syndrome (NAS). The search was limited to the last five years and full text only. Of the 815 results, five articles were selected that focused on infant outcomes and prevention of NAS. Articles were excluded if the focus was solely on the maternal outcomes, cost, or unoriginal research. One meta-analysis was included that compared two types of MAT for pregnant women with OUD. Findings MAT is correlated with a shorter hospital stay and less severe NAS symptoms in infants. Conclusion and implications Rates of NAS and OUD have increased significantly in the US. Some of the increase may be attributed to the transition to ICD-10 codes. MAT for pregnant women with OUD is associated with better health outcomes for infants. Patient-centered care could help decrease negative health outcomes for both infants and women with OUD. Future study should focus on degrees of opioid exposure and related outcomes.