NICU Nurses

newborn in the neonatal intensive care unit (NICU), the differences between their
posttraumatic stressors, the factors that affect posttraumatic stress, and the
experiences of parents. Methods: The parents of 66 newborn infants (66 mothers
and 66 fathers) in the NICU were the sampling group, and a descriptive design
was used. The sociodemographic traits of parents were identified using a data
collection form, and posttraumatic stress experiences of parents were identified by
using the Impact of Events Scale-Revised (IES-R). Analysis of variance and
t-test for two independent groups were used for the comparisons, and a
chi-square test was used. Results: The mean of the total scale scores (mothers
43.61 ± 14.98; fathers 36.26 ± 17.01), mean of the intrusion scores (mothers
18.17 ± 6.25; fathers 15.13 ± 7.14), and mean of the avoidance scores
(mothers 11.21 ± 4.94; fathers 9.17 ± 5.17) were high. When the scores for the
IES-R and subscale scores of parents were compared, mothers scored 20 higher
than fathers, a statistically significant difference. When the cut-off point was 30,
81.8% of mothers and 66.7% of fathers experienced posttraumatic stress.
Conclusion: In light of these findings, it is recommended that health professionals
monitor all parents with a newborn in the NICU for symptoms of posttraumatic
stress and that parents are informed about their newborns.

The objective of this study was to describe our NICU’s (neonatal intensive care unit) experience with mobile surgical team and to demonstrate its effectiveness. Method: We analyzed the data of 17 consecutive very low birth weight and extremely low birth weight infants over 3 years who underwent 22 procedures (19 emergency and 3 elective). The gestational age at birth was a median of 25 weeks (range 24 - 39), and the median birth weight was 613 g (range from 340 g to 1100 g). The infants received their operations during their first 2 weeks of life (median 7 days, range from 1 to 14). Results: The spectrum of primary surgical diagnoses included spontaneous intestinal perforations (n = 8), gastric perforations (n = 3), necrotizing enterocolitis (n = 2), meconium ileus (n = 2), and miscellaneous (n = 2). An emergency laparotomy with either a bowel or a gastric procedure was performed in 16 cases. Postoperatively, all infants required mechanical ventilation from 1 to 43 days (median 6.5 days). Complications included a metachronous small bowel perforation, an ileostomy retraction, a prolapsed stoma, and impaired wound healing; we had one postoperative death. Two infants died later in the NICU (mortality 3 of 16; 19%). Conclusion: Off-site surgery for preterm infants in the NICU is feasible. This approach prevents the risks of transportation, and parents and neonatologists alike feel comfortable with this regimen. However, biases may exist regarding the surgeon’s decision to operate, the choice of procedure, and the follow-up.

North-American and Western European societies are multicultural. This affects hospital and outpatient organizations: the hospitalizations of patients coming from totally different cultural contexts are becoming more and more frequent. Among the hospitalized patients, there are also newborns and infants. Unfortunately, some of them do not survive. The importance of this phenomenon should not be underestimated.1
Ways of dealing with death and mourning are closely related to collective and cultural characteristics of a society, which possesses its own collective language to express emotions. It is also known that, in every age and cultural setting, there is always a potential for individual emotional variability, which also depends on the sexual gender of the grieving person.
At first glance, the reactions to the death of a child and the stages of the grieving process do not show substantial dissimilarities in people that belong to and/or embrace cultures or religions that are totally different from one another. Many foreign parents seem to have deserted their ancestral death rituals replacing them with those of Western origin. But if we look beyond appearances, we are able to discover that this phenomenon is just the (superficial) result of a process of adaptation to the Western cultural environment into which the parents of the hospitalized child have immigrated. Foreign parents do adapt (probably worrying about being judged) to Western culture, but these adopted reactions to death as well as the modes and taboos of mourning, manifest themselves in ways that do not belong to them. It is therefore possible to state that beneath this ‘westernized’ appearance lies a quintessentially different reality, one deeply infused with the beliefs and precepts of the culture of origin.
To make it possible for professionals to create for the parents a sufficiently suitable environment in which to deal with the loss of their child and begin the work of mourning, they must acquire specific knowledge about the customs and traditions of the parents’ culture of origin. This is not a task to be regulated or standardized on the basis of protocols and precedents. It must be ‘customized’ to fit each specific case.

Background: Incentives play an important role in organizations as it influences a variety of work-related behavior, as well as the motivation of employees. Aims of the study: The present study was conducted in the main Assiut University Hospital to assess nurse's awareness and satisfaction regarding the incentives system. Subjects and Methods: This study included 271 nurses who randomly selected from all units at the main Assiut University Hospital. The study included both quantitative and qualitative methods for data collection. Results: High percent of the participants reported that the most important incentives are fair remuneration, bounces, appropriate working hours, and different services (health/ education) (69.7%, 60.9%, 60.5, % 60.5%, respectively). The promotion, appreciation of work efforts, good relations with colleagues and superior encouragement were the most important morale incentives reported by (77.1 %, 71.2 %, 66.8 %, 64.6%) respectively. This is confirmed by the results of Focus group discussions as about half of the participants especially female nurses considered the morale incentives are more important than the financial one especially the good dealing and the respect from the physicians. Conclusion and Recommendations: In conclusion, this study indicates that nurses know what they want from incentives. Attention to priorities and flexible incentives system may help to create the cohesive work environment that nurses seek. Determine the objectives are the most important factors to increase the effectiveness of the incentive system.

A recent multicenter study in adult ICUs showed that doctors often fail to talk with patients about advance directives, prognosis, or the patients' pain. We assessed how well MDs and RNs in 2 NICUs communicate with parents.METHODS: We identified a subpopulation of high risk babies(<750g, Grade IV IVH, congenital anomaly, chronic lung disease) in 2 NICUs, and interviewed MDs, RNs, and parents biweekly. We asked parents from whom they received infor-mation, and asked MDs and RNs how often they had met parents. RESULTS: During the 9 month study, 260/1204 admissions to the NICUs met study criteria. We were able to interview parents of 147(57%)babies. UC had more babies with birthweight <750 (27 v 17% p<0.01) and with chronic lung disease (39 vs. 15% p<0.01). UA had more babies with congenital anomalies (59 v 19% p<0.001). At UC, a higher percentage of parents hadn't visited the NICU (29% v 14%, p<0.01) and there were more cases in which the MD or RN caring for the baby at the time of the interview had not met parents (42% v 16% p<0.01). Parents in both NICUs more often said that RNs, not MDs, were their primary source of information (45% vs 23% p<0.01). Discontinuity of care was the norm. Among doctors, it resulted from attendings going on [Illegible Text] off service or call. Doctors in both NICUs were responsible for >35 babies, and generally focused on the sicker ones. Among RNs, discontinuities resulted from staffing patterns. They were often assigned to different babies each day. Parents of babies who died seldom identified an MD by name. They often remembered a particular RN.CONCLUSIONS: At 2 NICUs, in different countries, serving different populations of patients, there were pervasive problems with communication and continuity of care by MDs and RNs. Similar problems are found in adult ICUs. They seem inherent to the staffing models in tertiary care academic ICUs.

The SUPPORT study, a large multicenter study of EOL care in adult ICUs, showed that, even for very high-risk patients, doctors were unlikely to discuss DNR orders until 24-48h prior to death. We wondered whether there were similar patterns in discussions about EOL care or DNR orders in NICUs.METHODS: Babies were eligible for the study if they met ≥1 of the following criteria: <750g, congenital anomalies, grade IV IVH, asphyxia, chronic lung disease. We asked MDs to estimate each baby's chance of survival, anticipated quality of life on a 1-10 scale, and likelihood of developing cognitive or motor problems. We then asked whether there had been a discussion about DNR or EOL care prior to the baby's last day of life. RESULTS: 260/1204 (21%) admissions to the NICU met eligibility criteria. These babies accounted for 97% of deaths. We interviewed MDs in 138 (53%) of these cases. MDs had discussed EOL care prior to the last day of life in 46(33%) cases. Comparing babies about whom there was or was not such a discussion, there was no difference in MD assessments of the baby's likelihood of survival to discharge, of developing cognitive or motor problems, or of anticipated quality of life. 24/138 (17%) babies died. 17 (71%) babies who died did not receive CPR at the time of death. 76% of babies about whom there was a discussion of EOL options survived. There was discussion about EOL options about 11/24 (46%) of babies who died. CONCLUSIONS: For most babies who don't get CPR, there hasn't been discussion of DNR prior to the last day of life. Most babies about whom there is some discussion of DNR don't die. Prognostic estimates do not correlate well with discussions of EOL care in these 2 NICUs. In deciding which parents should discuss EOL treatment options, prognostic assessments are only part of the puzzle. Other factors seem to drive many such decisions.

Respiratory distress syndrome is a common health problem in preterm due to immaturity of lungs with deficiency of surfactant. Surfactant reduces surface tension in the alveoli, thereby preventing collapse of the lungs during expiration. Bubble continuous positive airway pressure (CPAP) is a low cost intervention that provides continuous distending pressure to the alveoli so that they will not collapse during expiration.