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Biomedical subjects

P C Grunwald

Publications and source records attributed to P C Grunwald.

5 recordsLinked to original sources
PubMed2000

Contextual dynamics of ethical decision making in the NICU.

The manner in which the contextual dynamics of the neonatal intensive care unit (NICU) culture influence decisions around withholding and withdrawing treatment for very low birth weight infants is examined based on sociological studies of the NICU culture. The influence of these dynamics on nurse and parent participation in treatment decisions is discussed. Steps toward increasing nurses' role in decision making and ability to empower the participation of parents include (a) using an understanding of the dynamics of the individual NICU to establish a collaborative team culture, and (b) demonstrating that data obtained through relationship with the infant make an important and valid contribution to ethical decision making.

Decision Making↗
PubMed1999

Motor organization in very low birth weight infants during caregiving: effects of a developmental intervention.

The purpose of this study was to determine whether an individualized approach to handling very low birth weight (VLBW) infants designed to support development would result in less motor disorganization than the task-oriented approach in traditional use. Using a quasi-experimental crossover design, motor responses were investigated in 38 infants (< or = 1700 g, 53% male, 89% white) observed at 28, 32, and 36 weeks post-conceptional age. Subjects served as their own controls. Motor responses were coded from direct observation and videotapes. Results demonstrated that during developmental handling, (1) the overall amount of movement was less, the number of organized movements was greater, and the number of disorganized movements was less than during traditional handling; and (2) the amount of movement increased over time, but in the traditional condition, it peaked at 32 weeks. Results support positive effects of developmental handling and suggest the potential for reducing the prevalence of minor motor impairments in VLBW infants.

Age Factors↗
PubMedDate not supplied

Outcomes of developmentally supportive nursing care for very low birth weight infants.

Numerous aspects of the intensive care environment are stressful for low birth weight infants and may play a role in adverse developmental and behavioral outcome. The purpose of this study was to determine whether staff education in care protocols designed to make the environment less stressful and thereby support the infant's development would improve short-term outcomes. Twenty-one infants (less than 1,501 gms) were studied during the preeducation period and 24 infants were studied following staff education. The educational program successfully altered nursing care. Experimental infants had more optimal respiratory and feeding status, lower levels of morbidity, shorter hospitalization, and improved behavioral organization.

Analysis of Variance↗
PubMedDate not supplied

Effects of developmental care on behavioral organization in very-low-birth-weight infants.

The purpose of this study was to determine whether modifying care to reduce stressors in the neonatal intensive care unit and support infant development affected physiological, motor, and behavioral state organization. Twenty-one infants weighing less than 1501 g were studied prior to a nursing staff-training program (control) and 24 infants were studied posttraining (study). Nurses were taught to lower environmental stress, reduce procedural stress, and facilitate motor and sleep-wake organization. Oxygen saturation, motor activity, posture, and sleep-wake states were measured biweekly during routine care. Study infants showed higher oxygen saturation levels, fewer disorganized and jerky movements, more flexor movements, more flexed posture, and more alert-wakefulness than controls. Results suggest that this approach to care may have potential to improve behavioral organization during the preterm period.

Behavior↗