Download - Thank You! Environment of Care Literature Review · 2016-05-15 · Environment of Care Literature Review NTMC Recer6ﬁcaon II Shannon Usher, MSOT,OTR/L, NTMTC These Handouts are

EnvironmentofCareLiteratureReviewNTMCRecer6fica6onII

ShannonUsher,MSOT,OTR/L,NTMTC

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EnvironmentofCareLiteratureReview


Toallresearcherswhohavespentstudyingtheneurodevelopmentoftheprematureinfant.Your

researchguidesourclinicalpractice.

ThankYou!

*  Systematicreview&meta-analysisofrandomizedcontrolledtrials;clinicalguidelinesbasedonsystematicreviewsormeta-analyses

*  Oneormorerandomizedcontrolledtrials*  Controlledtrial(norandomization)*  Case-controlorcohortstudy*  Systematicreviewofdescriptive&qualitativestudies*  Singledescriptiveorqualitativestudy*  Expertopinion

Source:Melnyk,B.M.&Fineout-Overholt,E.(2011).Evidence-basedpracticeinnursingandhealthcare:Aguidetobestpractice.Philadelphia:Lippincott,Williams&Wilkins.

LevelsofEvidence

*  Nonpharmacologicalapproachestoreducestress*  NICUDesign*  SoundExposure*  Skin-to-Skin*  InfantMassage

EnvironmentofCare

� SwaddledBathing� PositioningandHandling� OralFeeding� NeonatalTherapy� StaffEducation

Pandey,M.,Datta,V.,Rehan,H.(2013)RoleofSucroseinReducingPainfulresponsetoorogastrictubinsertioninpretermneonates.IndianJournalofPediatrics,80(6),476-82.*  DoubleBlindedRandomizedControlledTrial*  Subjects:ClinicallyStablepreterminfantswithinfirst7daysoflife*  TestSubjectsReceivedSucrose,ControlSubjectsrecievedwater*  EvaluatedPainusingPrematureInfantPainProfile(PIPP),HeartRate

andSpO2changes*  Results:PostprocedurePIPPscorewassignificantlylowerintest

subjectscomparedtocontrols

NonpharmacologicApproachestoReducingStress

Naughton,K.(2013).Thecombineduseofsucroseandnonnutritivesuckingforproceduralpaininbothtermandpretermneonatesanintegrativereviewoftheliterature.AdvancesinNeonatalCare,13(1),9-19.*  Integrativeliteraturereview*  Synergisticeffectcombiningsucrosewithnonnutritivesucking






Ho,L.,Ho,S.,Leung,D.,So,W.,Chan,C.(2016).Afeasibilityandefficacyrandomizedcontrolledtrialforswaddlingforcontrollingpaininpreterminfants.JournalofClinicalNursing,25(3-4),472-482.*  Randomizedcontrolledtrial*  Subjects:54preterminfantsbetween30-37weeksGA.*  Infantswereassignedtoeitheracontrolgroup(standardcare)or

swaddlinggroup*  Painwasassessedduringheelstick*  Results:PIPPscores,SpO2andHRweresignificantlylowerin

swaddlinggroupcomparedtocontrols


Hartley,K.Miller,C.,Gephart,S.(2015).Facilitatedtuckingtoreducepaininneonates:evidenceforbestpractice.AdvancesinNeonatalCare,15(3),201-208.*  MetaAnalysis*  Facilitatedtuckreducespain*  Maybeusedasearlyas23weeks


*  ProvideSucroseandpacifierpriortoallpainfulprocedures,includingroutineprocedureslikeOGtubeinsertions*  Makesurethereareconsistentandsafepoliciesandprocedurestoguideprovingsucrose*  Swaddleinfantswhenable*  Facilitatedtuckasanalternativetoswaddlingorskintoskin

ClinicalApplication

Lester,B.,Hawes,K.,Abar,B.,Sullivan,M.,Miller,R.,Bigsby,R.,Laptook,A.,Salisbury,A.,Taub,M.,Lagasse,L.,Padbury,J.(2014).Singlefamilyroomcareandneurobehavioralandmedicaloutcomesinpreterminfants.Pediatrics,134(4),754-760.*  Subjects:Preterminfantsweighing<1500grams

151admittedopen-bayNICU 252preterminfantsadmittedtosinglefamilyrooms*  Results:Improvedmedicalandneurobehavioraloutcomesat

discharge,maternalinvolvementandpsychosocialstatus,family-centeredcare,developmentalsupport,andnurses’attitudesrelatedtosinglefamilyrooms

NICUDesign

Pineda,R.,Neil,J.,Dierker,D.,Smyser,C.,Wallendorf,M.,Kidokoro,H.,Reynolds,L.,Walker,S.,Rogers,C.,Mathur,A.,VanEssen,D.,Inder,T.(2014)AlterationsinBrainStructureandNeurodevelopmentalOutcomeinPretermInfantsHospitalizedinDifferentNeonatalIntensiveCareUnitEnvironments.JournalofPediatrics,164,52-60.*  ProspectiveLongitudinalCohortStudy*  Subjects:136Preterminfants<30weeksGA*  Randomlyassignedtoeithersinglefamilyroomoropenbayunit*  Results:Infantsinprivateroomshadtrendtowardhavinglower

electroencephalographcerebralmaturationscoresattermequivalentandlowerlanguageandtrendtowardlowermotorscoresat2years.

NICUDesign

*  OpenBayNICUs*  Ensuresensorystimulationisappropriateandnot

noxious*  SingleFamilyRooms*  Ensureinfantsareprovidedwithenoughinteractionand

sensoryexposure,especiallyiffamilyvisitationislimited*  PlayanactiveroleonyourNICUdesigncommittee

ClinicalApplication





Caskey,M.,Stephens,B.,Tucker,R.,Vohr,B.(2014).AdultTalkintheNICUwithPretermInfantsandDevelopmentalOutcomes.JournalofPediatrics.133(3),e578-584*  Subjects:36medicallystablepreterminfants*  Recordedvoiceexposureat32and36weeksPMA*  Followupwascompletedat7and18monthsCA*  Results:HigherwordcountduringtheNICU

admissionwasassociatedwithhighercumulativecognitiveandlanguageandreceptivecommunicationat7mothsCAandhigherexpressivecommunicationscoresat18monthsCA

SoundExposure

Webb,A.,Heller,H.,Benson,C.,Lahav,A.(2015).Mother’svoiceandheartbeatsoundelicitauditoryplasticityinthehumanbrainbeforefullgestation.ProceedingsoftheNationalAcademyofSciencesoftheUnitedStatesofAmerica,112(10),3152-3157.*  Randomizedcontrolledtrial*  Subjects:40preterminfantsbornbetween25-32

weeksGA*  Randomlyassignedtoeithercontrolgroup

(routinehospitalsounds)ortestgroup(audiorecordingsofmother’sheartbeatandvoice)*  Results:At30daysoflifeinfantsinthetestgroup

hadsignificantlylargerbilateralauditorycortex

SoundExposure

Doheny,L.,Hurwitz,S.,Insoft,R.,Ringer,S.,Lahav,A.(2012).Exposuretobiologicalmaternalsoundsimprovescardiorespiratoryregulationinextremelypreterminfants.PediatricsInternational,25(9),1591-1594.*  Subjects:14preterminfantbornbetween26-32

weeksGA*  Infantsservedastheirowncontrol*  Comparedcardiorespiratoryeventswhen

exposedtoroutinehospitalsoundstorecordingsofmaternalvoiceandheartbeat*  Results:Lowerfrequencyofeventsduring

maternalsoundstimulationcomparedtoroutinehospitalsounds

SoundExposure

Standley,J.(2012).MusictherapyresearchintheNICU:anupdatedmetaanalysis.NeonatalNetwork,31(5),311-316.*  Metaanalysis*  NICUMusictherapywashighlybeneficial*  GreatestBenefits:*  LiveMusic*  InitiatedEarlyintheNICUstay(<1000grams,<28

weeksGA)*  Uses:pacification,reinforcementofsuckingandpart

ofamultimodal,multilayeredstimulation

SoundExposure

*  Educatemoms*  Talktotheirbaby*  Bringinbookstoread*  Sing

*  Skin-to-skinholding*  Talk,read,singtothebabieswhileyoucareforthem*  ImplementamusictherapyprograminyourNICU*  ProvideCDplayers/radiosforbabieswhen

developmentallyappropriate

ClinicalApplication

Feldman,R.,Rosenthal,Z.,Eidelman,A.(2014)Maternal-pretermskin-toskincontactenhanceschildphysiologicorganizationandcognitivecontrolinthefirst10yearsoflife.BiologicalPsychology,75(1)56-64.*  Subjects:146preterminfantsat32weeksPMA*  Testsubjectsreceivedskin-to-skinholdingfor1hourperdayfor14

consecutivedayscomparedtocontrolswhoreceivedroutine,incubatoronlycare

*  Followupcompletedat3,6,12and24months,5yearsand10years*  Outcomes:*  6months-10yearfollowupshowedimprovedautonomicfunctioning,

maternalattachment,reducedmaternalanxiety,andenhancedchildcognitivedevelopmentandexecutivefunctions

*  10yearfollowupshowedbetterneuropsychologicalability,autonomicfunctionandsleepefficiency,marginallyquickerrecoveryfromstress,mildercortisolstressactivityandautonomicreactionstostress.Mothersdemonstratedgreaterreciprocityduringinteractions

Skin-to-skin





Baley,J.&CommitteeonFetusandNewborn(2015).Skin-to-skincarefortermandpreterminfantsintheneonatalICU.Pediatrics,136(3),596-599.*  Benefitsandrisksofskin-to-skinwerediscussed*  Benefits:*  Improvedmilkproduction*  Longerdurationofbreastfeeding*  Improveattachmentandbonding*  Strengthensfamilyroleincareofinfant*  Increasedparentsatisfaction*  Bettersleeporganization*  Longerdurationofquietsleep*  Decreasedpainperceptions.

*  Risk:Mustensureanopenairwayduringskintoskinholding

Skin-to-skin

Luong,K.,Nguyen,T.,Thi,D.,Carrara,H.,Bergman,N.(2015).Newlybornlowbirthweightinfantsstabilisebetterinskin-to-skincontactthanwhenseparatedfromtheirmothers:arandomisedcontrolledtrial.ActaPaediatrica,105(4),381-390.*  RandomizedControlledTrial*  100preterminfantswithbirthweight1500-2000grams*  Testsubjects:Transitionedtoextrauterinelifeskin-to-skin*  Controlgroup:Receivedstandardhospitalcareandadmittedtoresuscitationroomthentoincubators*  Observedtransitiontoextrauterinelife6hoursafterbirthusingstabilityofcardio-respiratorysysteminpreterms*  Results:TestsubjectshadbetterSCRIPscores,neededlessrespiratorysupport,IVYluidsandantibioticsduringremainderofhospitalstay

Skin-to-skin

Moore,H.(2015).ImprovingKangarooCarePolicyandImplementationintheNeonatalIntensiveCareUnit.JournalofNeonatalNursing,21(4),157-160.*  Analyzedcurrentevidencebasedpracticeofskin-to-skinintheNICU*  Results:Researchsupportsskin-to-skinwithpreterminfants,however,thefollowingbarriersexist:*  InsufYicientNursingEducation*  InsufYicientParentEducation*  ManagerialSupport*  Overalllackofstandardkangaroocarepolicy

Skin-to-skin

*  Skintoskinshouldbeprovidedassoonaspossible,asoftenaspossible,foraslongaspossible!*  Creatingpoliciesandproceduresforstaffto

followforskintoskin*  Educationalcompetenciestoensurestaff

comfortwithtransfersandpositioning*  Creatingacomfortableenvironmentfor

parentssothattheyenjoytheirtimeholdingtheirinfant*  Ex:Skintoskinchairs,Wraps,Mirrors,Water,

DVDplayers

ClinicalApplication

Badr,L.,Abdallah,B.,Kahale,L.(2015).Ameta-analysisofpreterminfantmassage:anancientpracticewithcontemporaryapplications.AmericanJournalofMaternalChildNursing,40(6),344-358.*  MetaAnalysis*  34studiesmetinclusioncriteria*  Results:Massageimprovesdailyweightgainandmentalscores

InfantMassage

Juneau,A.,Aita,M.,Heon,M.(2015).Reviewandcriticalanalysisofmassagestudiesfortermandpreterminfants.NeonatalNetwork,34(4),165-177.*  SystematicLiteratureReview*  TermInfantBenefits:*  Improvedweightgain*  ImprovedGrowth*  ImprovedSleep*  DecreasedHyperbilirubinemia

*  PretermInfantBenefits:*  Improvedweightgain*  Decreasedresponsetopain*  Increasedinteractionswithparents.

InfantMassage





Hahn,J.,Lengerich,A.,Byrd,R.,Stoltz,R.,Hench,J.,Byrd,S.,Ford,C.(2016).Neonatalabstinencesyndrome:theexperienceofmassage.CreativeNursing,22(1),45-50*  QualitativeStudy*  Subjects:InfantswithadiagnosisofNAS,atleast48hoursold,>32weeksPMA,>1500gramsandalerttimebeforefeeding*  Educatedmomhowtocompleteinfantmassage*  Interviewscompletedwithmomaftereducationand2weeksafterdischarge*  Results:Empowerment,EnjoymentandBondingandCalmandComfortwerethethemesderived

InfantMassage

*  BenefitsofMassage*  ImprovedWeightGain*  ImprovedMentalScores*  ImprovedHeartRateVariability*  ImprovedNeurobehavioral

States*  DecreasedPainResponse*  ImprovedMaternalOutcomes*  ImprovedBreastfeeding

ClinicalApplication

�  ImprovedPhysiologicParameters

�  ImprovedBoneFormation�  ImprovedImmunologic

Markers�  ImprovedBrainMaturity�  ImprovedTemperature�  ImprovedInteractionswith

Parents�  ImprovedGrowthVelocity

*  Educatestaffonthebenefitsandimportanceofneonatalmassage*  EnsurepoliciesareinplacetosupportmassageintheNICU*  Createeducationalhandoutsorreferencesforstaffandfamily*  UsethisinformationforGrantwriting

ClinicalApplication

Edraki,M.,Paran,M.,Montaseri,S.,RazaviNejad,M.,&Montaseri,Z.(2014).Comparingtheeffectsofswaddledandconventionalbathingmethodsonbodytemperatureandcryingdurationinprematureinfants:arandomizedclinicaltrial.JournalofCaringSciences,3(2),83-91.*  Subjects:50preterminfants*  Testsubjectsreceivedswaddledbathandcontrolsubjectsreceivedconventionalbath*  Results:Meantemperatureandcryingweresignificantlylowerinswaddledbathinggroupcomparedtocontrols

SwaddledBathing

Quraishy,K.,Bowles,S.,Moore,J.(2013).Aprotocolforswaddledbathingintheneonatalintensivecareunit.Newborn&InfantNursingReviews.13(1):48-50.*  Createdswaddledbathingguidelinesbasedonlackofresearch*  Recommendationsincluded:*  Swaddling*  WaterTemperaturebetween100-102degrees*  Bathlimitedto8minutes

SwaddledBathing

*  Swaddledbathingshouldbeprovidedforallbathingprocedures,regardlessofPMA

*  Educationneedstobecompletedwithstafftoensureconsistencyofbathingproceduresandfamiliestoensurecomfortpriortodischarge

*  SwaddledBathingProcedures:*  Swaddlewithablanketduringsubmersionorbedbath*  Watertemperaturebetween100-102degrees*  Bathsshouldbelimitedto8minutes

*  Adaptationsfordifferentdiagnosismayinclude:*  ProgressivebathsforELBWorExtremelyprematureinfants*  Warmerbed/radiantheatforsmallerinfants*  TherapeuticbathforthoseinfantswithNeonatalAbstinenceSyndrome

ClinicalApplication





Madlinger-Lewis,L.,Reynolds,L.,Zarem,C.,Crapnell,T.,Inder,T.,&Pineda,R.(2014).Theeffectsofalternativepositioningonpreterminfantsintheneonatalintensivecareunit:arandomizedclinicaltrial.ResearchinDevelopmentalDisabilities,35(2),490-497.*  RandomizedControlledTrial*  Subjects:100preterminfantsborn<32weeksGA*  Comparedalternativepositioning(DandleRoobyDandleLion

Medical)totraditionalpositioning(swaddling,snuggleup,bendybumper,sleepsackandblakletrolls)*  Results:Attermequivalentinfantsinthealternativepositioning

grouphadlessassymetryofreflexeandmotorresponses

PositioningandHandling

Liao,S.M-C.,Rao,R.,&Mathur,A.M.(2015).Headpositionchangeisnotassociatedwithacutechangesinbilateralcerebraloxygenationinstablepreterminfantsduringthefirstthreedaysoflife.AmericanJournalofPerinatology,32(7),645-652.*  Subjects:22preterminfantsborn<30weeksGA*  Cerebraloxygensaturationwasmonitoredwithheadinmidline,headturned45-60degreestowardtheleftandheadturned45-60degreestotherightfor30minutesperiods*  Results:InrelativelystablepretermSpO2remainedwithinnormallimitswhenheadwasturnedfrommidlinetoeitherside.


Nuysink,J.,Eijsermans,M.J.,vanHaastert,I.C.,Koopman-Esseboom,C.,Helders,P.J.,deVries,L.S.,&vanderNet,J.(2013).Clinicalcourseofasymmetricmotorperformanceanddeformationalplagiocephalyinverypreterminfants.JournalofPediatrics,163(3),658-665.*  Subjects:120preterminfants<30weeksGAorBirthweight<1000

grams*  Examinedpositionalpreferencesanddeformationalplagiocephaly

attermequivalent,3monthsand6monthsCA*  Results:*  Positionalpreferenceswas65.8%attermequivalent,36.7%at3months

CAand15.8%at6monthsCA*  Deformationalplagiocephalywas30%attermequivalent,50%of3

monthsCAand23.3%at6monthsCA


Collett,B.R.,Aylward,E.H.,Berg,J.,Davidoff,C.,Norden,J.,Cunningham,M.L.,&Speltz,M.L.(2012).Brainvolumeandshapeininfantswithdeformationalplagiocephaly.Child’sNervousSystem,28(7),1083-1090.*  Subjects:20childrenwithdeformationalplagiocephaly(DP)and21

childrenwithoutdeformationalplagiocephalywiththemeanageof7.9months*  MRIimaginingandneurodevelopmentalassessmentusingBayley

ScalesofInfantandToddlerDevelopment*  Results:ChildrenwithDPhadgreaterasymmetryandflatteningof

posteriorbrainandcerebellarvermis,shorteninganddifferingorientationofthecorpuscallosum.AswellaslowerscoresontheBSID-III


Collett,B.R.,Gray,K.E.,Starr,J.R.,Heike,C.L.,Cunningham,M.L.,&Speltz,M.L.(2013).Developmentatage36monthsinchildrenwithdeformationalplagiocephaly.Pediatrics,131(1),e109-e115.*  Subjects:224childrenat36monthswithdeformationalplagiocephaly(DP)and231childrenwithoutdeformationalplagiocephaly*  Results:ChildrenwithDPscoredloweronallscalesoftheBSID-IIIthanchildrenwithoutDP


*  Maximizemotordevelopmentwithuseofdevelopmentalequipment*  UsethisresearchtoapplyforagranttoaccessfundingforyourNICU

*  DeformationalPlagiocephaly*  EducationtofamiliesduringtheNICUadmissionandalso

howtoavoidupondischarge

ClinicalApplication





Wellington,A.&Perlman,J.(2015).Infant-drivenfeedinginprematureinfants:Aqualityimprovementproject.ArchivesofDiseaseinChildhoodFetal&NeonatalEdition.doi:10.1136/archdischild-2015-308296*  Qualityimprovementprojectevaluatingtimetofullfeedingsand

dischargefollowingInfantDrivenFeedingApproach(IDF)orPractitionerDriveFeeding(PDF)

*  Subjects:Categorized<28weeksGA,28-31weeksGAand32-34GA*  Results:*  PMAatfullnipplefeedingsandatdischargewassignificantlylowerinthe

IDFgroup*  <28weeks:Fulloralfeedings17dayssooneranddischarged9dayssooner*  28-31weeks:Fulloralfeedings11dayssooneranddischarged9dayssooner*  32-34weeks:Fulloralfeedings3dayssooneranddischarged3dayssooner

OralFeeding

Asadollahpour,F.,Yadegari,F.,Soleimani,F.,&Khalesi,N.(2015).Theeffectsofnon-nutritivesuckingandpre-feedingoralstimulationontimetoachieveindependentoralfeedingforpreterminfants.IranianJournalOfPediatrics,25(3),e809.*  RandomizedControlledTrial*  Subjects:32preterminfants26-32weeksPMA*  Groups:NNS,pre-feedingoralstimulationandcontrol*  Results:*  NNSreachedfulloralfeedings7.55dayssoonerthancontrols*  Oralstimulationreachedfulloralfeedings6.07dayssooner

OralFeeding

Niela-Vilen,H.,Axelin,A.,Melender,H.,Salantera,S.(2015).Aimingtobeabreastfeedingmotherinaneonatalintensivecareunitandathome:athematicanalysisofpeer-supportedgroupdiscussiononsocialmedia.Maternal&ChildNutrition,11(4),712-726.*  Subjects:22motherswhohadgivenbirthtopremature

infant<35weeksPMA*  Analyzedthemespostedonsocialmedialsite*  Results:Mainthemesincluded;thebreastfeedingparadox

inhospital,the'realitycheck'ofbreastfeedingathomeandthebreastfeedingexperienceaspartofbeingamother.

OralFeeding

*  Ensureyourhospitalhasaninfantdriven/cuebasedfeedingpolicyinplacethatisconsistentlyfollowed*  HoldinfantsduringtheirNG/OGfeedingsandofferinga

pacifiertoprovideNNSinpreparationoforalfeeding*  Treatmentrecommendationfortherapistscouldincludeoral

stimulation*  Staypresentintheroomwithmomduringbreastfeedingattemptstoensuremom’scomfortandinfant’struesuccesswithbreastfeedingpriortodischarge

ClinicalApplication

FrolekClark,G.J.&Schlabach,T.L.(2013).Systematicreviewofoccupationaltherapyinterventionstoimprovecognitivedevelopmentinchildrenagesbirth–fiveyears.TheAmericanJournalofOccupationalTherapy,67,425-430.*  SystematicLiteratureReview*  Results:EducationbyOTstoparentswithpreterminfants

helpedtheparentstobemoresensitivetotheirchild’sneedsandmoreresponsiveintheirinteractions

NeonatalTherapy

Spittle,A.,Orton,J.,Anderson,P.J.,Boyd,R.,&Doyle,L.W.(2015).Earlydevelopmentalinterventionprogramsprovidedposthospitaldischargetopreventmotorandcognitiveimpairmentinpreterminfants.CochraneDatabaseofSystematicReviews,11,CD005495.*  Metaanalysis*  Reviewedtheeffectivenessofearlyinterventionwheninitiated

inthefirst12monthsforthoseinfantsborn<37weeksgestation*  Results:Therapeuticinterventionimprovedcognitiveoutcomes

atinfantage(0-2years)andpreschoolage(3-<5years)butdidnotfindthatthiseffectwassustainedthroughschoolage(5-17years)

NeonatalTherapy





Spittle,A.J.,Lee,K.J.,Spencer-Smith,M.,Lorefice,L.E.,Anderson,P.J.,&Doyle,L.W.(2015).Accuracyoftwomotorassessmentsduringthefirstyearoflifeinpreterminfantsforpredictingmotoroutcomeatpreschoolage.PLoSOne,10(5),e0125854.*  AnalysisofthepredictivevalidityoftheAlbertaInfantMotorScale(AIMS)and

theNeuro-SensoryMotorDevelopmentalAssessment(NSMDA)*  Subjects:99infantsborn<30weeksgestation*  Followupassessmentscompletedat4,8and12monthsCA*  Results:*  MotorimpairmentontheMABC-2wasmostaccuratelypredictedbytheAIMSat4

months*  CPwasmostaccuratelypredictedbytheNSMDAat12months.*  Thelikelihoodratioformotorimpairmentincreasedwiththenumberofdelayed

assessments.*  WhencombiningboththeNSMDAandAIMSthebestaccuracywasachievedat4

months.

NeonatalTherapy

*  Parenteducationisahugeopportunityforneonataltherapists!*  AlbertaInfantMotorScaleandNeuro-SensoryMotorDevelopmentAssessmentmaybeusefultoolsinassessingandpredictinglaterneuromotoroutcomes*  Weneedmoreresearchinregardstoneonataltherapistseffectiveness

ClinicalApplication

Jeanson,E.(2013).One-to-onebedsidenurseeducationasameanstoimprovepositioningconsistency.Newborn&InfantNursingReviews.13(1):27-30*  Nursetonurseeducationisthebestwaytogetstaff‘buy

in*  Havingateamthatrandomlyassessperformance

improvedpositioning.*  Immediatefeedingwithhandsoncorrectionofpositioning

allowednursestoseefirsthandwhatadifferenceproperpositioningcancreate.

StaffEducation

Hendricks-Munoz,K.,Mayers,R.(2014)AneonatalnursetrainingprograminKangarooMotherCareDecreasedbarrierstoKMCUtilizationintheNICU.AmericanJournalofPerinatology.31(11)987-992.*  Provided7.5hoursofeducationtostaffonskin-to-skin,both

lectureandhandsontraining*  Results:Aftertheeducationandsimulation:*  Staffcompetencyincreasedfrom30%-92%whenKMCwas

practicedwithintubationandventilation*  DiscomfortwithprovidingKCMdroppedto0%*  Actualpracticeofskin-to-skinwitheligiblebabiesincreasedfrom

26.5%to85.9%

StaffEducation

*  EducationShouldIncludetheFollowing*  Clearpoliciesorguidelinestoguidepractices*  Peertopeereducation*  Interactivetrainingopportunitiesinacontrolled

environment*  Atthebedsideasmuchaspossibletominimizeotherdailycaregivinginterruptions

*  Instantfeedbackchangessolearnerisabletovisualizehowachangepositivelyaffectstheoutcome

ClinicalApplication

Wheretogofromhere?