Purpose The purpose of this study was to identify the noise level and frequency experienced by premature infants receiving incubator care in the neonatal intensive care unit (NICU).
Methods The participants were 20 premature infants receiving incubator care in the NICU of a university hospital in Daejeon Metropolitan city. The noise level was measured using a professional sound-level meter (ET-958, FLUS, Shenzhen, China) based on a noise classification table developed by the author. The data were analyzed with descriptive statistics, the t-test, analysis of variance, and Pearson correlation coefficients using SPSS for Windows version 22.0.
Results The average noise level experienced by premature infants receiving incubator care in the NICU was 51.25 dB (range: 45.0~81.7 dB). The frequency of noises was highest for factors related to nursing activities (40.3%), followed by human factors (29.1%), machine alarm sounds (20.1%), incubator operation (6.6%), and internal environmental factors (3.9%).
Conclusion According to the above results, the noise level experienced by premature infants receiving incubator care in the NICU exceeded the recommendations of the American Academy of Pediatrics. Therefore, it is necessary to develop an interventional program to reduce noise in the NICU, and to conduct follow-up studies to verify its effectiveness.
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Purpose Caring for a vulnerable premature baby is a challenging task, but some mothers experience growth through that process. The purpose of this study was to investigate the factors influencing post-traumatic growth in mothers with premature infants admitted to the neonatal intensive care unit.
Methods A correlational research design was used and 105 mothers of premature infants were recruited from an online community. Data were collected from January 15 to January 25, 2019. Post-traumatic growth was measured using the Korean version of the Posttraumatic Growth Inventory. Data were analyzed using descriptive statistics, the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical multiple regression.
Results The final model developed in this study explained 45.5% of post-traumatic growth (F=13.66, p<.001). Resilience (β=.54, p<.001) was the strongest predictor of post-traumatic growth, followed by the age of the mother when giving birth (β=.17, p=.028) and current employment status (β=.17, p=.049).
Conclusion For mother with premature infants to grow psychologically after their experience, it may be needed to support them to develop and strengthen their resilience through either education or their own support network.
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Purpose Nursing protocols for glucose management are well known for both healthy term newborns and high-risk newborns. However, for less risky newborns who are under only observation surveillance, hypoglycemia could be overlooked unless clinical symptoms develop.
Methods A retrospective study was performed to explore factors influencing variations in glucose levels in 91 newborns who did not require any interventions, but were under nursing surveillance, at a level II neonatal intensive care unit. Data were retrieved from electrical medical records on glucose levels, demographic characteristics, and other clinical characteristics of newborns in their first day of life from January 2016 to May 2019.
Results Glucose levels tended to stabilize within the normal range (60~80 mg/dL) as time passed during the first day of life. Cesarean section, multiple gestation, abnormal growth, and later preterm birth were associated with low glucose levels in the first 2 hours of life. Thirty-one newborns experienced a hypoglycemic episode (< 45 mg/dL) during the first 24 hours of life.
Conclusion The findings of this study support the active encouragement of early feeding within 2 hours of birth and urgent adoption of a structural protocol for glucose surveillance in newborns with potential health problems immediately after birth.
Purpose The purpose of this study was to explore nursing students' recognition and understanding of the clinical environment of high-risk neonatal nursing care after watching a documentary about the neonatal intensive care unit (NICU), where high-risk newborns are treated.
Methods This study was a qualitative content analysis. In total, 151 nursing students’ personal essays describing their reactions to a documentary about the NICU were analyzed using the NVivo 12 program.
Results Nursing students’ experiences of engaging with a documentary about the NICU were structured into four thematic categories: ‘actual observations of the imagined NICU’, ‘observation and recognition of nursing knowledge’, ‘empathy with people related to the baby’, and ‘establishing attitudes and values as a nurse’.
Conclusion Based on the results of this study, it is suggested that documentaries can be applied in nursing education about high-risk newborns.
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Purpose This study was conducted to identify factors related to developmental care performance among neonatal intensive care units (NICU) nurses.
Methods The participants were 139 nurses who had provided care to premature infants for more than 6 months and were recruited from the NICU of 8 hospitals. Data were collected from September 1 to December 1, 2017 through questionnaires that encompassed developmental care performance, developmental care perceptions, and the nursing work environment.
Results More than half (51.8%) of the participants responded that they had never received developmental care education, and for 89.6% of those who had received developmental care education, it was a one-time event. The average developmental care performance of NICU nurses was 0.81, with a range of 0.5~1 point. Multiple regression analysis, demonstrated that the nursing work environment (β=.27, p=.001) and developmental care perceptions (β=.23, p=.004) influenced developmental care performance, with a total explanatory power of 14%.
Conclusion Based on these results, developmental care education for the NICU nurses must be provided systematically. In addition, strategies to improve nurses' perceptions of developmental care and to provide appropriate support for the nursing work environment can promote developmental care performance.
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Purpose The purpose of this study was to identify the effects of an educational intervention by evaluating neonatal emergency airway management knowledge, critical thinking disposition, problem- solving ability, and confidence in clinical performance after developing and operating a simulation-based neonatal emergency airway management education program for nurses in a neonatal intensive care unit.
Methods The participants were 30 nurses in a neonatal intensive care unit. Data were collected from June 6 to 15, 2018 and analyzed using IBM SPSS version 22.0.
Results The results of the pretest and posttest for each educational group showed statistically significant improvements in neonatal emergency airway management knowledge, critical thinking, problem- solving ability, and confidence in clinical performance.
Conclusion The simulation-based neonatal emergency airway management training program was an effective educational program that enhanced neonatal emergency airway management knowledge, critical thinking disposition, problem-solving ability, and confidence in clinical performance among nurses in a neonatal intensive care unit. Therefore, it is suggested that the program described in this study can contribute to improving nursing quality by enhancing the ability of nurses to cope with emergencies in practice. It can also be used for education for new nurses and contribute to the development of nurses’ practices.
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Purpose The purpose of this study was to investigate partnerships with nurses, social support and readiness for discharge among mothers of premature infants in the neonatal intensive care unit (NICU) and to examine the factors associated with readiness for discharge.
Methods A survey was conducted among 85 mothers of premature infants hospitalized in a NICU in Seoul, Korea. The collected data were analyzed with descriptive statistics, the t-test, one-way analysis of variance, Pearson’ correlation coefficients, and multiple linear regression using SPSS version 25.0.
Results The results of the regression analysis showed that partnerships with nurses (β=.32, p=.011) and parenting experience (β=.32, p=.001) were significantly associated with readiness for discharge.
Conclusion To improve the readiness for discharge among mothers of premature infants, developing strategies to strengthen their partnership with nurses and to provide family-centered care will be needed.
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Purpose The purpose of this study was to examine the correlation between a flexible parental visiting environment and parental stress in neonatal intensive care units (NICUs).
Methods The study participants included 60 parents of premature infants in NICUs. Structured questionnaires and interviews, as well as observations by researchers using a caregiving behavior checklist, were used to measure the flexibility of the parental visiting environment and parents' stress levels. Quantitative and qualitative data were collected concurrently and were initially analyzed as separate data sets. Data collection extended from March 11, 2018 to June 30. 2018 and the data were analyzed using descriptive statistics, the independent t-test, one-way analysis of variance, and Pearson correlation coefficients.
Results There was a negative correlation (r=-.30, p=.021) between parental stress and the total number of visits in 7 days. We also found that the average duration of each visit and the number of caregiving behaviors performed by parents were positively correlated (r=.73, p<.001).
Conclusion When designing a flexible visiting environment for parents, parents should be encouraged to visit their babies. By doing so, stress can be reduced both for babies and for parents. Therefore, it is suggested that the related polices and regulations in South Korea should be changed to provide more a flexible visiting environment to promote better parent-child attachment and family adjustment.
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Purpose The purpose of this study was to explore and describe the meaning and essence of a mother’s experience of hospitalization of her newborn in the neonatal intensive care unit (NICU).
Methods This study employed a qualitative research design. An interview was conducted with a mother whose newborn was hospitalized in the NICU, and the data were analyzed using Giorgi’s phenomenological method.
Results Five main themes and 19 formulated meanings were indentified. The 5 themes were ‘drowning in pain’, ‘just look outside the glass door’, ‘being a pillar’, ‘a deepening attachment’, and ‘prepare for nurturing with hope’.
Conclusion The results of this study provided an in-depth understanding of the experience of a mother with a newborn in the NICU. These results can be used in the development of a nursing intervention program that provides psychological and emotional support to the mother and family.
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Purpose This study aimed to evaluate the effects of an empowerment program on maternal stress, anxiety, depression and parenting confidence.
Methods A total of 44 mothers of preterm infants were assigned into an experimental or a control group (n=22 each). The experimental group received the usual nursing care and 7 sessions of an empowerment program. The control group only received the usual care. The program was implemented from June to December, 2016 in the neonatal intensive care unit of K university-affiliated hospital in Daegu, Korea. The outcome variables measured were parental stress (PSS: NICU), anxiety (STAI), depression (CES-D) and parenting confidence. Data were analyzed using t-test or repeated measures ANOVA.
Results Scores for both parental stress (t=3.07 p=.004) and depression (F=3.76, p=.26) were significantly lower in the experimental group than in the control group. However, there were no significant differences in anxiety between the groups (F=0.79, p=.505). Parenting confidence scores (F=9.05, p=.001) were significantly higher in the experimental group than in the control group.
Conclusion A maternal empowerment program can be an effective means of reducing parental stress and depression as well as enhancing parenting confidence, for mothers of preterm infants.
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Purpose This study was conducted to assess the knowledge and performance of developmentally supportive positioning for premature infants (DSPP) among neonatal intensive care unit (NICU) nurses.
Methods The participants in this study were 131 nurses working in the NICU at five university hospitals in Daejeon and the city of Cheong-ju. The collected data were analyzed with descriptive statistics, the t-test, analysis of variance, and Pearson correlation coefficients using SPSS for Windows version 22.0.
Results NICU nurses’ average DSPP knowledge score was 24.7 out of 33.0, and their average DSPP performance score was 3.2 out of 4.0. A statistically significant positive correlation was observed between knowledge and performance of DSPP (r=.32, p<.001).
Conclusion To improve the level of NICU nurses’ knowledge and performance of DSPP, educational programs should be developed and their effectiveness should be verified.
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Purpose Maintaining body temperature is a key vital function of human beings, but little is known about how body temperature of high-risk infants is sustained during early life after birth. The aim of this study was to describe hypothermia in high-risk infants during their first week of life and examine demographic, environmental, and clinical attributors of hypothermia.
Methods A retrospective longitudinal study was done from January 1, 2013 to December 31, 2015. Medical records of 570 high-risk infants hospitalized at Neonatal Intensive Care Units (NICU) of a university affiliated hospital were examined. Body temperature and related factors were assessed for seven days after birth.
Results A total of 336 events of hypothermia (212 mild and 124 moderate) occurred in 280 neonates (49.1%) and most events (84.5%) occurred within 24 hours after birth. Logistic regression analysis revealed that phototherapy (aOR=0.28, 95% CI=0.10-0.78), Apgar score at 5 minute (aOR=2.20, 95% CI=1.17-4.12), and intra-uterine growth retardation or small for gestational age (aOR=3.58, 95% CI=1.69-7.58) were statistically significant contributors to hypothermia.
Conclusion Findings indicate that high-risk infants are at risk for hypothermia even when in the NICU. More advanced nursing interventions are necessary to prevent hypothermia of high-risk infants.
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Purpose To investigate the perception and barriers of Kangaroo-Mother Care (KMC) among nurses in Neonatal Intensive Care Units (NICU).
Methods Participants were 131 nurses working in NICU who completed self-report questionnaires which included information regarding perception, barriers, and practice of KMC. Collected data were analyzed using SPSS 18.0 program for descriptive statistics, t-test, ANOVA, and Pearson correlation coefficients.
Results Of the participants, 33.6% reported the practice of KMC in their NICU, with 75.6% wanting to receive training in KMC and 31.3% having received KMC education. Most of the participants agreed that KMC enhances attachment, parental confidence, and effective breast feeding but they reported a negative perception in providing KMC for premature infants weighing less than 1,000 grams or intubated premature infants. Major barriers to practicing KMC were safety of infants, possible work overload for nurses, as well as absence of consistent guidelines. Barriers to KMC among nurses who received the KMC training were lower than nurses who did not receive the KMC training (t=-2.11, p=.037).
Conclusion Education program and standardized clinical practice protocol should be developed to foster the positive perception and to reduce nurse barriers to KMC.
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Purpose This study was conducted to examine the effect of education on infection control for multidrug resistant organism (MDRO).
Methods One group pre-post time series design was used. Infection control education for MDRO infection was provided to nurses working in the Neonatal Intensive Care Unit (NICU). Knowledge and recognition were evaluated before and after education. Hand hygiene compliance, MDRO isolation rate and central line-associated bloodstream infection (CLABSI) rate were used as outcome variables. Data from 45 nurses was used for analysis.
Results General knowledge about MDRO increased (p=.011). Responses to questions about image of MDRO and MDRO management tended to change in a positive direction (p = .046). Hand hygiene compliance was 100% at pre-test, 79.5% during education period and 98.4% at post-education period. MDRO isolation rate was 6.83 per 1,000 patient days at pre-test, 10.24 during education period and 6.68 at post-education period. CLABSI rate was 3.76 per 1,000 central line days at pre-test, 6.84 during education period and 4.71 at post-education period.
Conclusion Findings indicate that the education program is effective in improving knowledge about MDRO in NICU nurses. However, more reliable indicators should be used to determine long-term effects.
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Purpose This study was performed to explore the weight variations in high-risk term newborns hospitalized during the early postnatal period.
Methods A retrospective explorative study was performed with 64 term newborns who were hospitalized in the NICU after birth. Data on daily weight, birth information, and clinical features such as phototherapy, placements, nutritional status were reviewed through medical records for 14 days of life. General Linear Model, GLM was applied to analyze the weight variation by clinical features of these high–risk term newborns for 14 days of life.
Results Newborns at 40 weeks of gestation showed little weight loss during the few days after birth then steadily gained weight to 7.6% at the 14th day. Infants born at 37-39 gestation showed little weight gain for 14 days though the weight loss itself was not apparent. As well, return to birthweight was not observed in newborns with phototherapy, infants placed on a warmer or infants having gastrointestinal dysfunction for 14 days of life.
Conclusion Even for term newborns, physiologic weight loss may not be warranted even if newborn is born at less than 40 week of gestation, or with high-risk conditions that warrant admission to NICU.
Purpose This study was done to identify the meaning and substantial nature of NICU practice among nursing students by applying a research method based on hermeneutic phenomenology in an attempt to lay a foundation for enhancing theoretical and practical child nursing education.
Methods The participants were eight nursing student who had experience in clinical practicing in NICU. In-depth interviews were performed from April to December, 2014 until data were fully saturated. Collected data were analyzed using Colaizzi’s method.
Results Seven theme clusters were extracted from fourteen themes. The seven theme clusters of the nursing students’ clinical practice experience in NICU were: 1) Excitement about the clinical practice setting 2) Afraid of practice environment 3) Babies have priority over clinical practice 4) Comparing with adult nursing clinical practice 5) Feeling pity for babies and their parents 6) New awareness about the role of nurses 7) Demands of enhancing clinical practice.
Conclusion The results of the study provide useful information in understanding nursing students’ practice experience in NICU and establishing effective strategies to support these nursing students.
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PURPOSE The purpose of this study was to describe breastfeeding knowledge, attitude and nursing practice of neonatal intensive care unit (NICU) nurses. METHODS Survey methodology using a self administered questionnaire was employed as the research design. A total of 153 questionnaires from 7 university hospital NICUs in Seoul, Daejeon, and Daegu were used for data analysis. RESULTS The percentage of correct answers on the breastfeeding knowledge questions for the NICU nurses was 59.3%. The nurses in NICU reported a somewhat positive attitude to breastfeeding, mean per item 3.70+/-0.41 on a scale of 5 points. Their breastfeeding nursing practice was at a moderate level, mean per item, 3.26+/-0.74.
Breastfeeding knowledge had significant correlations with breastfeeding attitude (r=.554, p<.001) and nursing practice (r=.203, p=.002). Also, There was a significant correlation between breastfeeding attitude and nursing practice (r=.243, p=.002). CONCLUSION These results suggest that breastfeeding educational programs and strategies for NICU nurses should be developed to increase their breastfeeding knowledge, attitude, and nursing practice.
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