[Big responsibility for insecure nurses. Neonatal nursing: a vicious circle. Interview by Kjell Arne Bakke].
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Clinical Competence↗
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A focus of care for neonatal nursing: the relationship between neonatal nursing practice and outcomes. Part 1.
The developmental outcomes of survivors of neonatal intensive care are, in part, a measurement of the quality of care provision. The relationship between neonatal nursing practice and long-term outcomes of survivors remains unclear. This study aimed to determine the focus of care currently influencing qualified neonatal nurses' practice, to ascertain if nursing care is provided in response to the developmental needs and consequent future quality of life of high risk babies. Following a detailed literature review, a case study combining semi-structured interviews with documentary evidence was undertaken within a regional neonatal intensive care unit. The primary focus for the study was the perspective of qualified neonatal nurses working in the field. This first part of a two-part report, presents the background, aims, literature review and design of the study. The findings, discussion and conclusion will be presented in the June issue.
Child Development↗
A focus of care for neonatal nursing: the relationship between neonatal nursing practice and outcomes. Part 2.
A case study combining semi-structured interviews with documentary evidence was undertaken to ascertain whether neonatal nurses provide care in response to the developmental needs and consequent future quality of life of high risk babies (See Part 1 in May 2003 issue for the background, literature review and design of this study). Findings indicated that neonatal nurses are unable to focus their priorities for care on the long-term development of babies. Limited knowledge of, and unrealistic attitudes towards, potential outcomes posed a high challenge for nurses. Low staffing levels, reduced autonomy and conflicting responsibilities within the multidisciplinary team, were seen to be the main factors obstructing nurses in their caring roles. The overall picture was of a nursing service under pressure, with no continuous focus for care. Raising the profile of neonatology nationally may lead to the allocation of resources necessary to develop nursing practice in relation to outcomes. Creating a focus for care via a nursing model, with continuing infant development at its core, could enhance care provision and allow all babies to receive the optimal care to achieve their full potential.
Humans↗
Aspects of neonatal nursing. Advances in neonatal nursing.
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Humans↗
Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses.
OBJECTIVE: To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries. DESIGN: Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. SETTING: NICU and well-baby units in 51 hospitals located throughout the United States. PARTICIPANTS: Member site coordinators (N = 51) and the neonates (N= 2,820) observed during both the pre- and postimplementation phases of the project. METHOD: Site coordinators received specialized education in neonatal skin care and implemented an evidence-based clinical practice guideline addressing 10 aspects of neonatal skin care. Baseline observations of skin condition, care practices, and environment of newly admitted neonates were collected by site coordinators. Postimplementation observations were then completed. MAIN OUTCOME MEASURES: Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. Aspects of the care environment with potential effect on skin integrity were monitored to determine risk factors. RESULTS: Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in well newborns compared with premature newborns. After implementation of the guideline, skin condition was improved, as reflected by less visible dryness, redness, and skin breakdown in both the NICU/SCU and well newborns. The guideline was integrated into care, as evidenced by increased use of emollients, particularly with premature infants, and decreased frequency of bathing. A relationship was shown between selected aspects of the environment and alterations in skin integrity. CONCLUSIONS: Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical Practice Guideline was successfully implemented at 51 sites, and effectiveness was demonstrated by changed care practices and improved skin condition in premature and full-term newborns. The results of this project support a wider dissemination of the project's practice guideline for neonatal skin care.
Clinical Nursing Research↗
What's new in neonatal nursing care? 1st International Neonatal Nursing Conference.
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Humans↗
Legal issues in neonatal nursing: considerations for staff nurses and advanced practice nurses.
A neonatal nurse is a professional with special training, skill, and knowledge in the care of newborns and their families. The neonatal nurse is accountable to the patient, profession, and employer. Failure of the neonatal nurse to meet these obligations can result in liability in the profession, liability in the employment, a civil suit, or a criminal conviction. Regardless of the health care setting, professional nurses, whether at the bedside or in advanced practice, are morally, ethically, and legally accountable for their nursing judgments and actions. Although most nurses assume they will never be named in a lawsuit, and it is true that few are, their professional actions can be the focus of a suit. An overview of the legal implications found within neonatal nursing practice is presented. Two recent legal cases are presented and discussed to illustrate neonatal nursing and advanced practice liability.
Colorado↗
Combining the roles of clinical nurse specialist and neonatal nurse practitioner: the experience in one academic tertiary care setting.
The roles of clinical nurse specialist (CNS) neonatal nurse practitioner (NNP) have originated and evolved to meet specific needs in the nursing and medical community. The CNS role was developed in response to the perception that patient care needed to be improved; the NNP role resulted from an acute shortage of physicians to provide neonatal medical management. While on the surface these two roles may appear to be vastly different, many facets of each may be effectively interfaced. The NNP-CNS practice at Doernbecher Neonatal Care Center is an example of successful convergence of the two roles. The implementation of the combined practice is described in this article.
Academic Medical Centers↗
Developmental care in advanced practice neonatal nursing education.
Neonatal nursing education for the future is being influenced by two forces: expanding knowledge of infant development and health care reform. In response to the former and in anticipation of the latter, the University of Colorado School of Nursing incorporated developmentally based, family-centered care concepts in its recent revision of the master's program in neonatal nursing.
Child Development↗
Values influencing nursing practice: responses from neonatal nurses.
PURPOSE: An analysis of narrative comments from neonatal nurses to illustrate the values that motivate behavior in the practice setting. DESIGN: A descriptive study using content analysis of written, narrative text data. PARTICIPANTS: A self-selected subsample (N = 97) of a larger random sample of the membership of the National Association of Neonatal Nurses (NANN). MAIN OUTCOME MEASURES: The application of philosophical concepts of human relationships, patient need, keeping promises, human dignity, and unrestricting circumstances in the neonatal care setting. RESULTS: Individual participants made cognitive choices related to the application of conceptual ideals of the profession to the practice setting. However, there was a lack of congruence between what the individual nurse believes is important or good and the behavior enacted in the practice setting. CONCLUSION: As a discipline, nursing needs to identify and implement strategies that support proactive accountable nursing practice consistent with the philosophical foundation of the profession.
Adult↗
The neonatal nurse practitioner.
Neonatal nurse practitioners have been introduced into tertiary level neonatal intensive care units in the United States, Canada, and the United Kingdom in response to the increased survival rates of extremely low birth weight infants, the short-age of physicians, and the nursing profession's emphasis on development of advanced nursing practice roles. This brief review summarizes the recent research related to the facilitating and constraining factors that influence the role; the safety, effectiveness, and cost of the role; the impact of this role on other members of the health care team; and the satisfaction of those in the role.
Canada↗
Measuring neonatal nursing workload. Northern Neonatal Network.
A dependency scale has been devised for the assessment of the needs of neonates for nursing time. It has been validated by work studies which have shown that non-surgical babies can be grouped into one of two categories: high dependency babies generating a mean (SD) 25 (5) minutes and low dependency babies generating 12 (3) minutes of nursing work per hour, when the work is averaged out over the whole shift. Any one of five simple and unambiguous criteria serve as robust markers for identifying more than 95% of babies regularly generating more than 15 minutes of nursing work per hour. The scale is simpler, can be applied more rapidly, and with greater consistency, than other currently available neonatal dependency scales. Additional allowance needs to be made for miscellaneous activity not attributable to individual babies, for the occasional baby who requires almost continuous undivided nursing attention, for the possibility of new admissions, and for the provision of an emergency interhospital transport service. A formula is suggested by which safe staffing levels for any given nursing shift can be determined, based upon the number of babies present and their dependency levels as determined by the scale.
Humans↗
Perspectives on neonatal nursing: 1985-2005.
Neonatal nursing practice has been influenced by a number of external forces over the past 20 years. This article explores some of the influences that have altered practice in the 20-year history of the Journal of Perinatal & Neonatal Nursing. Attention is directed to several significant influences such as the development of the Internet and the World Wide Web and the role that information plays in care delivery. Changing practice roles with the continuing evolution of the neonatal nurse practitioner role and the emerging plans for the doctorate of nursing practice are described. The history of professional associations for neonatal nurses and the impact of evidence-based practice are considered. Finally, the legal environment surrounding practice is explored.
Education, Nursing, Continuing↗
Pilot survey of NICU nurses' interest in the neonatal nurse practitioner role.
PURPOSE: This descriptive, qualitative pilot study explored the interest and perceptions of neonatal intensive care unit (NICU) nurses regarding the neonatal nurse practitioner (NNP) role. Motivating factors to become an NNP, challenges facing NNPs, and rewards of the NNP role from the perspectives of NICU nurses were explored. SUBJECTS: The convenience sample was obtained using 2 survey techniques. The first sample group included nurses who were employed in Level III NICUs located within 2 major Midwestern cities. In order to confirm the data and to expand the scope, the second sample group was recruited from NICU nurses who were attending a regional educational conference. All participants were currently employed NICU nurses and were therefore potential NNP students. Combining the participants of both enrollment techniques resulted in a potential of 696 subjects. DESIGN AND METHODS: A simple self-administered survey was used to collect data. Narrative data were qualitatively analyzed. Demographic data and categorical items were quantified. RESULTS: This study achieved a total 30% response rate (n = 209). Of the total participants, only 32% of Level III NICU nurses were interested in becoming an NNP. Analysis of the data revealed 6 major categories (themes) of reasons why nurses were not interested in the NNP role. The themes most often mentioned by the participants were (1) obligations to family and/or work (46%) and (2) too much responsibility in the NNP role (30%). The data also revealed several different rewards and challenges for those in the NNP role as well as factors that may motivate nurses to become an NNP. CONCLUSIONS: Given the current NNP shortage, an increase in the supply of NNPs for the workforce is imperative. Current enrollment in NNP academic programs does not appear to be meeting the demand. Exploring the factors that influence enrollment in NNP programs from the perspective of potential NNP students is the first step towards increasing the supply of NNPs. The majority of participants were not interested in becoming an NNP for a variety of reasons. Negative perceptions of the NNP role were identified. Solutions posed from these results may provide scientifically sound solutions to help ease the shortage of NNPs. The findings of this naturalistic inquiry may be used to develop an instrument to measure interest in the NNP role.
Hospitals↗
Advanced practice in neonatal nursing.
The advanced practice neonatal nurse's participation in newborn care continues to be accepted and supported by the American Academy of Pediatrics. Recognized categories of advanced practice neonatal nurse are the neonatal clinical nurse specialist and the neonatal nurse practitioner. Training and credentialing requirements have been updated recently and are endorsed in this revised statement.
Education, Nursing, Graduate↗
Journey of change: building a bridge between neonatal nursing education and practice.
Faculty of a post-basic registered nurse preparation neonatal intensive care nursing education program in Canada questioned how well students' knowledge equipped them to handle the demands of the clinical setting. The response to their inquiry prompted the abandonment of traditional teaching approaches and laid the foundation for a modification of the curriculum. The faculty developed a novel way of looking at the program's content, so that it centered on the needs of the neonate. The article introduces a unique neonatal nursing framework and explains how this framework fits with neonatal nursing education and neonatal nursing. This framework has potential usefulness for inservice, orientation, and outreach programs.
Clinical Competence↗
Developing a strategic plan for a neonatal nurse practitioner service.
Neonatal nurse practitioners (NNPs) have been in practice for over 3 decades. More recently, NNPs have begun to take ownership for building their group practice models. The purpose of this article is to present a detailed case study demonstrating how one NNP group used a 4-phase strategic planning process to turn a crisis into an opportunity. The article describes data obtained during the strategic planning process from an informal national survey of NNP managers that focused on key benchmarks, such as role definition, responsibilities, protected nonclinical time, NNP salary and benefits, and educational and professional development support. Using the strategic planning process, the group defined mutually agreed upon minimum safe staffing levels for NNPs, interns, residents and neonatologists in their setting. Based on the data generated, the group successfully justified additional NNP positions and organizational support for 10% protected nonclinical time. A sample operational budget, comparison of 3 staffing scenarios, and a timeline are also provided.
Humans↗
Expanding the caregiving environment for advanced practice neonatal nurses.
Advanced practice neonatal nurses (APNNs) have participated as crucial care providers during the past two decades in supporting the development and implementation of safe, therapeutic interventions for critically ill infants in the neonatal intensive care unit (NICU). This role has been limited primarily to the NICU environment, however, and there has been minimal opportunity for APNNs to participate in caregiving that extends beyond this boundary. This boundary-based practice may no longer be practical as a result of significant changes in health care financing and health care reform. It is important for all neonatal health care providers to consider an expanded scope of practice for the APNN that extends beyond the NICU into the community and home and encompasses caregiving for the neonate and infant within the first year of life.
Health Care Reform↗