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The clinical-academic nursing role: what it is and how to make it work
Evidence-based nursing rounds: a novel approach to engage bedside nurses in research
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Many barriers and facilitators for the adoption of evidence-based practice in nursing have been identified. This lecture will discuss the problems with clinical nurses engaging with and using research and best evidence in practice. It will discuss a novel way to engage clinical bedside nurses in evidence and latest research related to PICU nursing and present some results of a preliminary evaluation of these ‘Evidence based Nursing Rounds’.
VALIDATION OF THE STRESS IN PRETERMS (SIP) LIST: A CHECKLIST TO QUANTIFY STRESS EXPOSURE IN VERY PREMATURE INFANTS
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Valid quantification of stress exposure is an essential step in better understanding the amount and impact of stress during NICU stay. This study aims to develop and validate a checklist to quantify stress exposure during the first 28 days in infants born with a gestational age less than 29 weeks.
Four existing checklists to measure stress in NICU patients were combined, resulting in 77 items. These items were included in a Dutch survey that was distributed among 83 NICU nurses and physicians February 2019. Items ranged from heelsticks to surgery. Relevance was scored on a four-point Likert scale. Content Validity Index for each item (I-CVI) was calculated and items with an I-CVI of at least 0.78 in all respondents or the nurse/physician respondents separately were considered relevant. Also, participants were asked if each item was comprehensible and if relevant items were missing.
Twenty-two physicians and 40 nurses returned the survey (response rate 75%). Total I-CVI was 0.78 or higher for 27 items. Additionally, eight items were considered relevant by nurse respondents and were therefore included although total I-CVI was below 0.78. Based on the comments, one item was divided into two items and another item was adjusted. Three missing items were added to make this list comprehensive.
Our study resulted in a checklist with established content validity, the SIP (Stress In Preterms) list. It includes all relevant items to quantify stress exposure in premature NICU patients with a gestational age less than 29 weeks and is both comprehensible and comprehensive.
THE EFFECT OF MASSAGE APPLIED TO PRETERM INFANTS ON GROWTH AND STRESS
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THE EFFECT OF MASSAGE APPLİED TO PRETERM INFANTS ON GROWTH AND STRESS
The aim of this research is to exprementally investigate the effect of massage applied to preterm infants on growth and stress.While the population of the research is preterm infants at the neonatal intensive care unit between January 2018 and February 2019,the sample is 60 preterm infants suitable for inclusion criteria. While massage was applied to the infants in the experimental group three times daily for 10 days,the control group received the usual care.Weight,length and head circumference and stress level experimental and control group were measured by the researcher on 1.,5.and10.days.When the effect of massage on growth measurements in infants is analyzed, it is observed that weight,length and head circumference of the infants in both experimental and control group increase as measurement days progressed.It is observed that this increase is bigger in massage group compared to control group and the difference between two groups were statistically significant (p<0.001).When the effect of massage on stress level of infants was analyzed,stress level of infants in the massage group is lower than those in the control group in a statistically significant manner (p<0.001).In accordance with the results of the research ,it is concluded that massage application has positive effects on growth and stress levels of preterm infants.It is suggested that infant massage should be applied in neonatal intensive care units; massage should be part of infants’ usual care in the post-discharge period; mothers should be trained and supported about infant massage.
RETROSPECTIVE AUDIT OF PRE-EXTUBATION MEAN AIRWAY PRESSURE AND EXTUBATION FAILURE IN EXTREMELY PRETERM INFANTS
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Background: Extubation failure is common in extremely preterm (EP, <28 weeks’ gestation) infants. Loss of functional residual capacity soon after extubation may contribute. We aimed to evaluate the relationship between pre-extubation mean airway pressure (MAP), post-extubation nasal continuous positive airway pressure (nCPAP) and extubation failure.
Methods: Two centre retrospective audit of the first extubation of EP infants conducted over a 2-year period. Extubation failure was defined as reintubation within 7 days.
Results: Ninety-six of 204 (48%) infants required reintubation. In a multivariable regression model MAP was the only significant ventilation parameter affecting extubation success. A pre-extubation MAP >8 cm H2O was associated with extubation failure (F [5,198] = 6.9, p <0.001). We also saw a relationship between pre-extubation MAP and post-extubation nCPAP level. Infants extubated to a pressure lower than the pre-extubation MAP were more likely to have extubation failure.
Variable | Extubation Failure (n=96) | Extubation Success (n=108) | MeanDiff./OR (95% CI) | P value |
Pre-extubation MAP, cm H2O, mean (SD) | 8.3 (1.7) | 7.2 (1.4) | -1.1 (-1.5,-0.7) | <0.001 |
Pre-extubation MAP higher than post-extubation set nCPAP pressure, no. (%) | 85 (88) | 28 (26) | 22 (10.3,47.2) | <0.001 |
Conclusions: In EP infants, it may be prudent use a nCPAP level at least equal to the set MAP on the mechanical ventilator.