Of the 500,000 premature babies born each year in the United States, 75% are born at 34 0/7 through 36 6/7 weeks gestation, known as the late preterm infants (LPIs) (Phillips, 2013).
The baby may go to the postpartum unit with the mother, where care can be a challenge for well-newborn nurses. However, they are not fully mature and miss a critical growth period of brain (seen in Figure 1), lungs, and other systems
Healthy newborn nurses are sometimes �at a loss of what special considerations are required and parents lack anticipatory guidance, leading to readmission
Figure 1. The Fetal Brain. MRIs imaging shows difference in brain development and smoothness even just between 36 weeks compared to term.
Figure 2. Fishbone Diagram. Analysis of causes leading to gap in LPI knowledge, used to develop the project objectives.
Evidence Synthesis
Standardized Care is Essential: Variation in processes may lead to increased rates of error. Guidelines decrease the number of LPIs that experience hypothermia, hypoglycemia, respiratory instability, and the number of septic evaluations (Baker, 2014).
Feedings: Feeding challenges due to poor oral motor control, decreased tone, lack of coordination, and less alert state (Forsythe & Allen, 2013). Late preterm mothers are less likely to provide milk (Tully, Holditch-Davis, Silva, & Brandon, 2017). LOS, even during readmission, can be three times greater for formula-fed late preterm infants (Griffin, Hopkins, Martin, & DellaValle, 2015).
Family Education: Need anticipatory guidance (Currie at al., 2018). Educate on signs of respiratory distress, dehydration, cold stress, infection, and when to call their pediatrician.
Goals & Objectives
Specific aim: To improve education of standard care for late preterm infants so that 100% of staff can identify special care points based on gestational age within three months after education. Identified through fishbone analysis (Figure 2).
Associated objective: To improve patient satisfaction and readiness for discharge by 50% within six months
Standardized Care of the Late Preterm Infant
in the Well Newborn Nursery
Natalia Dabrowska, MSN, RN
Methods & Evaluation
All nurses completed pre-survey questionnaires on knowledge and feelings of competence.
Competence was rated on a scale of 0-10 with 0 being no competence and 10 being full competence
All nurses received educational PowerPoint in their mandatory online learning with a set deadline to complete it by. Planning and implementation steps were designed with a PDSA Cycle shown in Figure 3. A Gantt chart (Figure 4) was then projected to determine timelines for each phase.
All nurses completed post-survey questionnaires and quizzes to measure educational gain and increased feelings of competence in care.
Parents of late preterm infants on the unit were interviewed to see if nurses were translating their education into patient care.
Press Ganey scores and interviews during follow-up phone calls post-discharge are to be utilized to determine parental preparedness for special needs of their LPI once available.
Figure 5. Nurse Knowledge & Competence. Run chart displaying increase in feelings of competence after education compared to pre-survey questionnaire.
Figure 4. Gantt Chart. Activity schedule of plans and tasks to achieve aims and goals.
Figure 3. PDSA Cycle. Planning, implementation, and evaluation process.
Results & Findings
Utilizing online education led to high compliance in education completion. For the few nurses who did not complete it as quickly, arrangements should be made such as to use a computer in a separate room where they are free from interruptions.
Nurse feelings of competence in care increase after education as displayed in Figure 5.
Families who were interviewed reported that their nurses translated this information into care and provided them with useful education regarding their late preterm infant.
Families reported satisfaction, but there is no way to know if their perception is skewed. Nurses will chart the education done and a tool for personalized care plans for LPI education will be added to LPI charts.
Some nurses reported feeling more competent, but still lacking information such as what resources are appropriate to which parents.
Implications for Practice�
This project allows for standardized, evidence-based care that improves the quality of care and outcomes for these infants and their families
Increased nurse competence leads to increased parental confidence with better preparedness to care for LPI after discharge & reduce readmissions
This project is sustainable with yearly refresher education and the education and guidelines can be implemented on other OB/newborn units..
Conclusion
The specific aim was met overall as nurses reported greater levels of knowledge and competence. This trend is likely to continue as all the nurses finish their education.
Parents reported improved satisfaction but better data will be gathered upon receiving Press Ganey scores back and speaking with them on follow-up calls.
SACRED HEART UNIVERSTIY COLLEGE OF NURSING
Acknowledgements
A thank you to those who helped implement this project:
Dr. Linda Cook of Sacred Heart University, Nurse Manager, Nurse Educator, & Staff Nurses