Educating the next generation of nurses to be innovators and change agents.

With over 4 million nurses in the United States and an ever changing health care environment, undergraduate nursing faculty must consider proactively educating students on essential principles of innovation within the core curriculum. New nurses must be prepared to identify and facilitate innovations to enhance patient and populations outcomes. The purpose of this paper is to describe an approach to prepare the next generation of registered nurses to be innovators and change agents through a Health Care Innovation Program within an undergraduate nursing program.

Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship.

Objective: To examine changes that occur in infant and parent salivary oxytocin (OT) and salivary cortisol (SC) levels during skin-to-skin contact (SSC) and whether SSC alleviates parental stress and anxiety while also supporting mother-father-infant relationships.

Methods: This randomized crossover study was conducted in the neonatal intensive care unit (NICU) with a sample of 28 stable preterm infants and their parents. Saliva samples were collected from infants, mothers, and fathers on Days 1 and 2 (1/parent) for OT and cortisol measurement pre-SSC, during a 60-min SSC session, and a 45-min post-SSC.

Secondary Traumatic Stress in NICU Nurses: A Mixed-Methods Study.

Background: Secondary traumatic stress is an occupational hazard for healthcare providers who care for patients who have been traumatized. This type of stress has been reported in various specialties of nursing, but no study to date had specifically focused on neonatal intensive care unit (NICU) nurses.

Purpose: (1) To determine the prevalence and severity of secondary traumatic stress in NICU nurses and (2) to explore those quantitative findings in more depth through nurses' qualitative descriptions of their traumatic experiences caring for critically ill infants in the NICU.

Utilization of Mental Health Services in School-Based Health Centers.

Background: We summarize utilization patterns for mental health services in school-based health centers.

Methods: Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were stratified by sex, ethnicity/race, and insurance status.

Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information-Motivation-Behavioural Skills model-based pilot intervention.

Objective: Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low.

Direct-breastfeeding in the neonatal intensive care unit and breastfeeding duration for premature infants.

Aim: To explore the relationship between direct-breastfeeding in the neonatal intensive care unit (NICU) and breastfeeding duration after discharge.

Background: Initiating and maintaining breastmilk feeding is an important goal that begins in the NICU. Little is known about direct-breastfeeding in the NICU and its relation to breastfeeding duration.

Breastfeeding Self-efficacy: A Critical Review of Available Instruments.

Increasing breastfeeding rates in the United States is a national priority. Yet, initiation and duration of breastfeeding remains below national targets. Breastfeeding self-efficacy has been shown to be a strong predictor of both breastfeeding initiation and duration and is therefore an important characteristic to be able to measure.

Parental oxytocin responses during skin-to-skin contact in pre-term infants.

Objective: Maternal skin-to-skin contact (M-SSC) has been found to reduce adverse consequences of prematurity, however, its neurobiological mechanisms have been unknown. The purpose of the study was to examine oxytocin mechanism in modulating parental stress and anxiety during M-SSC and P-SSC (paternal SSC) with their pre-term infants.

Methods: Twenty-eight stable pre-term infants and their parents (triads) were recruited in a 2-day cross-over study and 26 mothers and 19 fathers completed the study protocol.

Direct-Breastfeeding Premature Infants in the Neonatal Intensive Care Unit.

Background: The neonatal intensive care unit (NICU) presents challenges for breastfeeding, especially with feeding directly at the breast (direct-breastfeeding).

Objectives: The objectives of this study were to describe the characteristics of direct-breastfeeding and identify factors that are associated with direct-breastfeeding in the NICU.

Methods: A retrospective chart review of 88 infants born < 34 weeks gestational age whose mothers provided human milk was conducted.

Cross-cultural adaptation of instruments assessing breastfeeding determinants: a multi-step approach.

Background: Cross-cultural adaptation is a necessary process to effectively use existing instruments in other cultural and language settings. The process of cross-culturally adapting, including translation, of existing instruments is considered a critical set to establishing a meaningful instrument for use in another setting. Using a multi-step approach is considered best practice in achieving cultural and semantic equivalence of the adapted version.

An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization.

Objective: To determine what factors affect breastfeeding duration after discharge home from the neonatal intensive care unit (NICU) for high-risk mothers and their premature infants.

Data Sources: The electronic databases of CINAHL and PubMed were used to identify studies published in English. Date of publication did not limit inclusion in the review.

State of the science: a contemporary review of feeding readiness in the preterm infant.

Oral feeding readiness has been described by researchers in the neonatal intensive care unit, and research has continued on this topic for many years. The purpose of this narrative review is to identify research and practice guidelines related to oral feeding readiness in preterm infants that have occurred during the last decade. The introduction and mastery of oral feeding is a major developmental task for the preterm infant that is often a prerequisite for discharge from the neonatal intensive care unit.

Pain assessment and measurement in neonates: an updated review.

Pain assessment and measurement are the cornerstones of pain management. Pain assessment connotes a comprehensive multidimensional description. Conversely, pain measurement provides a numeric quantitative description of each factor illustrating pain qualities.

Maternal influenza vaccination: evaluation of a patient-centered pamphlet designed to increase uptake in pregnancy.

We developed and tested a theoretically-based pamphlet entitled 'Influenza in Pregnancy,' specifically designed to increase pregnant women's knowledge, reduce barriers to maternal vaccination, and subsequently improve vaccine uptake. A randomized control trial was conducted on pregnant women (n = 135) at three locations in Connecticut during the 2011-2012 season to evaluate the impact of the patient-centered pamphlet. The women were randomized to one of three groups: the pamphlet; pamphlet/benefit statement (vaccinating the pregnant woman also benefits the young infant); or control.

The doctor of nursing practice graduate as faculty member.

This article focuses on the emerging role of the Doctor of Nursing Practice (DNP) graduate as faculty member. Discussion includes historical composition of faculties. Re-evaluation of Boyer's model of scholarship in relation to faculty roles is examined.

Kangaroo care and behavioral and physiologic pain responses in very-low-birth-weight twins: a case study.

The purpose of this case study was to describe pain responses in three study conditions: longer (30 minutes) kangaroo care (KC) before and throughout heel stick (KC30), shorter (15 minutes) KC before and throughout heel stick (KC15), and incubator care throughout heel stick (IC) in 28-week gestational age twins. Pain responses were measured by crying time, Preterm Infant Pain Profile (PIPP), and heart rate variability indexes, including low-frequency power (LF, representing sympathetic activity), high-frequency power (HF, parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance). Both twins cried more and had higher PIPP pain scores and tachycardia during heel stick in the IC condition.

Effects of skin-to-skin contact on autonomic pain responses in preterm infants.

Unlabelled: The purpose of this randomized crossover trial was to determine the effects on autonomic responses in preterm infants of longer Kangaroo Care (30 minutes, KC30) and shorter KC (15 minutes, KC15) before and throughout heel stick compared with incubator care (IC). Beat-to-beat heart rate (HR) and spectral power analysis of heart rate variability, low frequency power (LF), high frequency power (HF), and LF/HF ratio were measured in 26 infants. HR changes from Baseline to Heel Stick were significantly less in KC30 and KC15 than in IC, and more infants had HR decrease in IC than in 2 KC conditions.

Heparinized saline vs normal saline for maintenance of intravenous access in neonates: an evidence-based practice change.

Purpose: To design, implement, and to evaluate the outcomes of an evidence-based practice change regarding the use of heparin in intravenous (IV) locks to improve patient safety. Phase I of the project examined dwell time, hours of patency, gestational age at birth and at time of IV lock insertion, birthweight and weight at time of insertion, and reason for discontinuation for IV access devices prior to and following the practice change from heparinized saline (HS) to normal saline (NS) flush. Phase II of the project was to determine the effect of the educational program on staff knowledge of the use of heparinized saline vs normal saline flushes.

Neonatal nurse practitioner role transition: the process of reattaining expert status.

Neonatal nurse practitioners (NNPs) have managed care for high-risk hospitalized infants in the United States for over 30 years. The journey from being expert nurse to being novice NNP and then finally to being expert NNP is fraught with many challenges. This study used a qualitative descriptive design to describe advanced practice role transition among 70 NNPs.

Neonatal staff and advanced practice nurses' perceptions of bereavement/end-of-life care of families of critically ill and/or dying infants.

Background: Parents need compassionate care when an infant dies. Nurses can provide such care and possibly facilitate grieving, yet often have inadequate preparation in bereavement/end-of-life care.

Objective: To describe neonatal nurses' perceptions of bereavement/end-of-life care of families of critically ill and/or dying infants.

Factors influencing language development in preterm infants.

Objective: To examine factors influencing preterm infant language development.

Design: Longitudinal.

Setting: Infants were seen for developmental follow-up at 7, 13, and 26 months corrected age in the school of nursing.

Kangaroo care: national survey of practice, knowledge, barriers, and perceptions.

Purpose: A national survey was conducted to assess practice, knowledge, barriers, and perceptions regarding Kangaroo Care (KC)--the holding of diaper-clad preterm infants skin-to-skin, chest-to-chest by parents.

Design: A descriptive survey was conducted.

Methods: Kangaroo Care Questionnaires (KCQs), developed for the study, were sent to nurse managers in all hospitals in the United States that were identified as providing neonatal intensive care services (N = 1,133), and were to be completed by the nurse most familiar with the practice of KC in that unit.

Transition to the neonatal nurse practitioner role: making the change from the side to the head of the bed.

Role transition is never easy, but is complicated by the experienced neonatal nurse's frustration with reverting to a student role and becoming a novice practitioner, sometimes after years of developing a reputation as an expert nurse. This article discusses this transition, focusing on the skills needed to move successfully from nurse to nurse practitioner. Common to all advanced practice transitions are stages similar to those Benner identifies in her novice-to-expert theory of nursing practice.