Advances in neonatal care : official journal of the National Association of Neonatal Nurses
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To isolate the threshold point in which the goal of care for an infant with life-limiting conditions transitions from curative efforts to purely palliative care. ⋯ Although this study is based on end-of-life decision making for newborns, the findings may resonate to nurses who care for dying patients of any age group, with any diagnosis, cared for in any type of medical-surgical or critical care unit. The findings describe the American concept of patient and family autonomy and problems that have arisen from the implementation of autonomy in end-of-life decision making regarding withholding/withdrawing therapies that provide artificial life support.
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Review Randomized Controlled Trial
The analgesic properties of intraoral sucrose: an integrative review.
The treatment of pain is an essential component of the clinical and ethical care of infants. Despite evidence-based practice consensus statements recommending that infants receive analgesia during minor painful procedures, numerous studies have shown that procedural pain remains poorly managed in this population. ⋯ The objective of this integrative review is to synthesize findings from published randomized controlled trials evaluating the efficacy and safety of oral sucrose as a preprocedural intervention for mild to moderate procedural pain in infants. Overall, studies indicate that oral sucrose is an effective, safe, convenient, and immediate-acting analgesic for reducing crying time and significantly decreases biobehavioral pain response following painful procedures with infants.
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Emergency situations arise in health care every day. High-risk environments such as Neonatal Intensive Care Units and labor and delivery units are more susceptible to such emergencies. ⋯ Delivering resuscitative efforts can be difficult when the team trains in separate venues. This article will discuss the importance of multidisciplinary high-fidelity simulation training as an effective tool in the development and maintenance of resuscitation expertise across disciplines, the history of simulation, simulation legislation, and the evidence behind simulation and explore the art and utilization of medical simulation in a multidisciplinary setting.
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To evaluate whether the establishment of a dedicated percutaneously inserted central catheter (PICC) team is associated with reduced risk of catheter-related bloodstream infection (CRBSI) in the neonatal intensive care unit. ⋯ Catheter-related bloodstream infection in extremely low-birth-weight infants requiring long-term central venous access was reduced by nearly half after the institution of a dedicated PICC team in the neonatal intensive care unit. Standardizing PICC line placement is important, but standardizing line maintenance is essential to improvement of CRBSI rates.
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Preterm infants in neonatal intensive care units frequently require oxygen therapy. Clinicians are responsible for titrating oxygen to maximize the benefits and minimize the risks of this therapy. Studies have identified various toxic effects of oxygen on the developing tissues of the preterm infant; however, optimal target SpO(2) ranges have not been identified. ⋯ Understanding factors shaping clinical decision-making about oxygen titration is critical when designing policies and educational programs to change oxygen titration practice and ultimately improve patient outcomes. In this article, the literature outlining the importance of oxygen titration for preterm infants is reviewed. Discussion then focuses on factors that influence clinical decision-making and how these factors may influence decisions surrounding the use of oxygen for preterm infants.