Development of a Neonatal End‐of‐Life Care Education Program for NICU Nurses in Japan

We developed the first end‐of‐life care education program for neonatal intensive care unit (NICU) nurses in Japan. It focused on ethical decision making, care of dying neonates, bereavement, and cultural communication. The program improved nurses’ knowledge, F(2.16, 62.5) = 260.6, p < .001, and understanding, F(2.05, 59.4) = 29.1, p < .001, and significantly reduced weaknesses in neonatal end‐of‐life care. It was considered well designed and may provide further mentoring support for NICU nurses.     

Validity and Reliability of the Modified Attitudes About Drug Use in Pregnancy Scale

ObjectiveTo contemporize the Attitudes About Drug Abuse in Pregnancy questionnaire, keep the length of the modified scale brief to promote use, and test the psychometric properties of the modified scale among perinatal nurses.DesignCross-sectional survey.SettingFour hospitals in the Midwestern United States.ParticipantsRegistered nurses who worked in perinatal units (N = 440).MethodsWe collected data from participants using survey methods. Seven experts in perinatal substance use research and clinical care informed scale modifications. We used a split-sample design involving maternal–newborn units (labor, postpartum) and newborn-focused units (NICU, pediatrics). We evaluated construct validity using factor analysis and reliability using Cronbach’s alpha. We tested for differences between units using analysis of variance and Tukey’s post hoc honest significant difference test of pairwise differences.ResultsThe final modified scale included 13 items that loaded on one factor and showed internal consistency reliability in both samples (α = .88?.91). We found a statistically significant difference in mean score between NICU and pediatric units; however, the absolute difference was small and likely not clinically significant.ConclusionsThe Modified Attitudes About Drug Use in Pregnancy scale has initial evidence for validity and reliability, was updated to reflect current terminology in the field, and is a pragmatic tool for use in research.     

Predictors of Women's Sexual Desire: The Role of Psychopathology,Cognitive-Emotional Determinants,Relationship Dimensions,and Medical Factors

IntroductionDeficient sexual desire is a common sexual difficulty among women, often related to medical and psychiatric problems, lack of adjustment in a relationship, or age. However, the relative contribution of each one of these dimensions is not yet well establish.AimThe aim of this study was to evaluate the main predictive factors of female sexual desire.MethodsA total of 237 women from the general population answered to a set of questionnaires assessing psychopathology, cognitive-emotional factors, dyadic adjustment, presence of medical pathologies, and menopause.Main Outcome MeasuresPsychopathology measured by the Brief Symptom Inventory (BSI), dysfunctional sexual beliefs measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotions in sexual context measured by the Sexual Modes Questionnaire, dyadic adjustment measured by the Dyadic Adjustment Scale, medical condition measured by the Medical History Formulation, and sexual desire measured by the Sexual Desire subscale of the Female Sexual Function Index.ResultsFindings indicated that psychoticism was the only psychopathological dimension that significantly predicted sexual desire (β = 0.37). Conservative beliefs (β = ?0.33) and age-related beliefs (β = ?0.25) were also significant predictors of desire. Additionally, lack of erotic thoughts (β = ?0.28), failure and disengagement sexual thoughts (β = ?0.64), and thoughts related to female passivity (β = 0.31) during sexual activity were significant predictors of desire. Regarding relationship dimensions, dyadic cohesion (β = 0.37), and dyadic affection (β = 0.45) were the best predictors of sexual desire. Moreover, postmenopausal women and women with medical problems presented reduced sexual desire. A multiple regression analysis (enter method) including all these variables plus age, indicated that failure/disengagement thoughts during sexual activity was the only significant predictor of sexual desire in women (β = ?0.52).ConclusionsResults support the role of cognitive dimensions in the maintenance of women's sexual interest, and suggest implications for assessment and treatment of sexual desire difficulties. Carvalho J, and Nobre P. Predictors of women's sexual desire: The role of psychopathology, cognitive-emotional determinants, relationship dimensions, and medical factors.     

Effect of Fathers’ Presence and Involvement in Newborn Care in the NICU on Mothers’ Symptoms of Postpartum Depression

ObjectiveTo determine the prevalence of symptoms of postpartum depression (PPD) and examine how fathers’ presence and involvement in the care of their newborns affect symptoms of PPD within the first 2 weeks after birth among mothers with newborns in the NICU.DesignObservational cohort study.SettingOpen-bay, 40-bed, tertiary level NICU in Eastern Canada.ParticipantsMothers (N = 105) of newborns who were anticipated to survive and required more than 5 days of hospitalization in the NICU.MethodsParticipants completed the Postpartum Depression Screening Scale (PDSS) 14 days after they gave birth. They kept daily diaries to record the amount of time that fathers spent by the newborns’ bedsides (i.e., presence) and actively caring for their newborns (i.e., involvement such as skin to skin). Participants completed daily diaries from the time of enrollment in the study until their newborns were discharged home. We analyzed the data using linear regression; score on the PDSS was the dependent variable, and fathers’ presence and involvement were the independent variables. We adjusted for covariates.ResultsThe prevalence of positive screening for symptoms of major PPD was 24.1% (n = 20), and the prevalence of significant symptoms of PPD was 27.7% (n = 23). Participants reported that fathers were present in the NICU an average of 3.8 hours per day and were actively involved with their newborns 53% of the time. Fathers’ involvement was significantly associated with lower scores on the PDSS (adjusted β = −3.85; 95% confidence interval [CI] [−6.10, −1.60]). A history of anxiety was significantly associated with greater scores on the PDSS (adjusted β = 12.06, 95% CI [2.07, 22.05]). Maternal age and income less than $50,000 CAD were marginally associated with greater scores on the PDSS (adjusted β = −0.86, 95% CI [−1.77, 0.05] and adjusted β = 10.69, 95% CI [−0.73, 22.11], respectively). The overall explained variance in the PDSS scores with the independent variables was R² = 0.35.ConclusionFathers’ involvement in the care of their newborns in the NICU was significantly associated with fewer symptoms of PPD among mothers. We recommend research with targeted interventions to promote fathers’ involvement in the NICU to potentially mitigate the symptoms of PPD among mothers of newborns in the NICU.     

Risk and protective factors related to immediate postpartum depression in a baby-friendly hospital of Taiwan

ObjectivePostpartum depression (PPD) can occur in women soon after childbirth. The aim of this study was to investigate the risk and protective factors for immediate PPD in a baby-friendly hospital.Materials and methodsThis cross-sectional study of singleton term pregnancies was performed at MacKay Memorial Hospital in Taiwan from January to September 2019. The enrolled women completed the Edinburgh Postnatal Depression Scale (EPDS) within 48 h after childbirth. Maternal characteristics, pregnancy and delivery factors, maternal comorbidities, supportive and childbirth factors, and neonatal outcomes were investigated.ResultsOf the 1197 enrolled women, 1104 (92.23%) were at low risk (EPDS score ≤9), 66 (5.51%) were at moderate risk (EPDS score 10 to 12), and 27 (2.26%) were at high risk (EPDS score ≥13) of PPD. Significant independent risk factors for immediate PPD included the number of miscarriages (adjusted odds ratio (aOR) 1.33, 95% confidence interval (CI) 1.03–1.72, p = 0.031) and intermediate care nursery (ICN) or neonatal intensive care unit (NICU) admission (aOR 2.29, 95% CI 1.13–4.64, p = 0.022). Significant independent protective factors included planned pregnancy (aOR 0.51, 95% CI 0.28–0.92, p = 0.026), husband accompanying his wife (aOR 0.41, 95% CI 0.22–0.75, p = 0.004), early mother and newborn skin-to-skin contact (aOR 0.44, 95% CI 0.24–0.84, p = 0.012), and breastfeeding (aOR 0.23, 95% CI 0.08–0.71, p = 0.010).ConclusionThe number of miscarriages and ICN or NICU admission were independent risk factors for immediate PPD. Planned pregnancy, husband accompanying his wife, early skin-to-skin contact, and breastfeeding were independent protective factors for immediate PPD. Health care providers should pay attention to the risk factors and promote the protective factors into hospital policies to prevent the consequences of PPD.     

Barriers to provision of developmental care in the neonatal intensive care unit: neonatal nursing perceptions

The role of the neonatal nurse is vital for the successful implementation of developmental care and the provision of an optimal neonatal intensive care unit (NICU) environment. The goal was to identify nurses' perceived barriers to implementation or improving developmental care in their NICUs. Nursing perceptions related to barriers for implementing developmental care were assessed using a 12-point questionnaire during two New York City Neonatal Nursing regional conferences. One hundred forty-six (86%) of 170 nurses representing 24 regional hospitals returned the survey. Developmental care was viewed as essential by 136 nurses (93%), yet 125 nurses (86%) believed that their NICU was not providing optimal developmental care. Light and sound standards were viewed as important to providing care by 71% and 91% of respondents, respectively, yet only four NICUs (3%) had light and sound meters to identify or standardize this environmental source of pain. As a group, the perceived barriers to provision of optimal developmental care in order of decreasing importance were staff nurses and staff physicians (53%) > NICU funds (42%) > physician leadership (37%) > facility limitations (31%) > registered nurse leadership (25%). In contrast, 90% of nurses whose NICU did not use developmental multidisciplinary team meetings or developmental care champions or advocates were significantly more likely to identify nursing or physician colleagues as barriers to implementing or improving developmental care, compared with 38% of nurses whose NICU used such activities ( P < 0.001). Developmental care is perceived by the neonatal nurse as a vital component to the care provided in the NICU. Use of simple light and sound measures may enhance perception of providing an optimal NICU environment. Neonatal nurses perceived barriers to care are often attributed to neonatal staff nursing and physician colleagues. This perception is decreased considerably in those NICUs in which multidisciplinary team meetings or champions are used to address the needs of caregivers by providing developmental care strategies.     

Evaluation of an educational intervention on breastfeeding for NICU nurses.

The effect of breastfeeding education on breastfeeding knowledge and attitudes of nurses in a neonatal intensive care unit (NICU) was evaluated. NICU nurses (intervention) and pediatric nurses (untreated control) working at a northeastern US children's hospital participated in the pretest/posttest design study. Both groups answered the same breastfeeding questionnaire on 2 occasions. NICU nurses completed the questionnaire the second time after attending the education session. Outcome measures evaluated by questionnaire items were (1) breastfeeding knowledge, (2) pro-breastfeeding attitudes, (3) baby-focused care attitudes, and (4) nurse-focused care attitudes. Comparison groups were similar at pretest on demographic variables and remained so despite attrition between pretesting and posttesting. A significant increase (P < .001) occurred in NICU nurses' breastfeeding knowledge after the education session. Findings suggest that an educational intervention has potential for improving NICU nurses' knowledge and certain attitudes about breastfeeding but may not alter other attitudes of interest in the desired direction.     

Development and Psychometric Testing of the Nurses’ Confidence Scale: Unique Families

ObjectiveTo develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses’ Confidence Scale: Unique Families.DesignProspective instrument development and psychometric study.SettingHealth system in the U.S. Mountain West region.ParticipantsConvenience sample of 62 perinatal/neonatal nurses.MethodsWe developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale’s content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis.ResultsThe content validity index was 0.82. The Cronbach’s alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach’s alpha coefficient = .89) and awareness and sensitivity (Cronbach’s alpha coefficient = .87). Part B had a Cronbach’s alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48).ConclusionThe Nurses’ Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.     

Predicting outcome of care in the neonatal intensive care unit

The accuracy of a neonatal intensive care unit (NICU) staff in predicting the outcome and length of stay of infants admitted to the NICU, and the factors they felt were important in making these predictions, were evaluated. This prospective study used a questionnaire to survey 44 nurses, residents, and attending neonatologists working in the NICU about the predicted outcomes of 52 infants admitted to the NICU at the University of Nebraska Medical Center over a 1-month period. Factors previously identified by the staff as important indicators of infant outcome were assigned points of importance by the respondents, and specific values for these factors were recorded for each infant. The NICU staff indicated that gestational age was the most important indicator of infant outcome. The attending neonatologists placed more value on gestational age (analysis of variance [ANOVA] P less than .0001) than did the nurses or residents. Among the staff groups, there were significant differences in the weight or points assigned to a given factor for pulmonary function, renal function, number of resuscitations, and the "other" category (ANOVA P less than .05). The nurses ranked pulmonary function criteria lower than the residents did (P less than .04), but considered renal function more important than either the residents (P = .005) or the attending neonatologists considered it to be (P = .01). The number of resuscitations was ranked higher by the nursing staff than by other groups, whereas the attending neonatologists assigned less importance to the "other" category.(ABSTRACT TRUNCATED AT 250 WORDS)     

Experiences of Fathers Shortly After the Birth of Their Preterm Infants

ObjectiveTo explore the experiences of fathers shortly after the birth of their preterm infants.Design/MethodA focused ethnography conducted over 33 months (2003–2006) in the neonatal intensive care unit (NICU) of a large U.K. National Health Trust (NHS) teaching hospital. Data were collected through participant observation, in‐depth interviews with fathers (n = 10), and an ethnographic survey distributed to NICU staff (n = 87). Practices and relationships with fathers were concurrently analyzed thematically through the conceptual perspective of emotion work.FindingsFathers’ emotional reactions to their experiences were described in three themes: emotional withdrawal and control, stereotyping, and mixed feelings. Fathers’ emotional behaviors were governed by complex, culturally determined conventions and expectations.ConclusionsFathers engaged in considerable effort to manage their emotions as they attempted to reconcile the tension between what they wanted to feel and what they thought others expected them to feel. The results of this study support the view that focusing on emotional externalities alone tends to underplay the amount of emotion work carried out by less expressive individuals; this “silent emotion work” was characteristic of the fathers in this study.     

Prevention of Deformational Plagiocephaly in Hospitalized Infants Using a New Orthotic Device

ObjectiveTo measure the feasibility, safety, and efficacy of the cranial cup device in a sample of hospitalized infants at risk for deformational plagiocephaly (DP).DesignA multisite, stratified, and randomized single‐blinded study.SettingNeonatal intensive care units (NICU) from three urban and one suburban hospital participated.ParticipantsSubjects included 62 infants with lengths of stay ≥ 14 days.MethodsNurses caring for infants in study group 1 used the moldable positioner. In study group 2, nurses rotated the moldable positioner and cranial cup devices using the cranial cup for a target goal of 12 hours/day. Both study groups received routine position changes. Outcome measures included hours of device use (feasibility), cardiorespiratory and emesis events (safety), and cranial measurements obtained at discharge (efficacy) by one of four, licensed orthotists who were blinded to the study.ResultsA total of 35 infants were randomized to study group 1 (moldable positioner) and 27 infants to study group 2 (moldable positioner and cranial cup). The median hours per day on the cranial cup was 10.7 (range 4.5 – 15.3). Emesis and cardiorespiratory events were equally distributed for the moldable positioner and cranial cup devices in study group 2. At discharge, more infants in study group 1 (46%, n = 16) exhibited abnormal cranial measurements than those in study group 2 (19%, n = 5) (p = .03).ConclusionRotating the cranial cup with the moldable positioner provides a feasible, safe, and potentially efficacious therapy for prevention of DP.     

Allometric Metabolic Scaling and Fetal and Placental Weight

BackgroundWe tested the hypothesis that the fetal–placental relationship scales allometrically and identified modifying factors of that relationship.Materials and methodsAmong women delivering after 34 weeks but prior to 43 weeks' gestation, 24,601 participants in the Collaborative Perinatal Project (CPP) had complete data for placental gross proportion measures, specifically, placental weight (PW), disk shape, larger and smaller disk diameters and thickness, and umbilical cord length. The allometric metabolic equation was solved for α and β by rewriting PW = α(BW)β as ln(PW) = ln α + β[ln(BW)]. α_ι was then the dependent variable in regressions with p < 0.05 significant.ResultsMean β was 0.78 + 0.02 (range 0.66, 0.89), which is consistent with the scaling exponent 0.75 predicted by Kleiber's Law. Gestational age, maternal age, maternal BMI, parity, smoking, socioeconomic status, infant sex, and changes in placental proportions each had independent and significant effects on α.ConclusionsWe find an allometric scaling relation between the placental weight and the birthweight in the CPP cohort with an exponent approximately equal to 0.75, as predicted by Kleiber's Law. This implies that: (1) placental weight is a justifiable proxy for fetal metabolic rate when other measures of fetal metabolic rate are not available; and (2) the allometric relationship between placental and birthweight is consistent with the hypothesis that the fetal–placental unit functions as a fractal supply limited system. Furthermore, our data suggest that the maternal and fetal variables we examined have at least part of their effects on the normal balance between placental weight and birth weight via effects on gross placental growth dimensions.