Home care of the high-risk newborn

Description of the clinical practice of advanced practice nurses in family-centered early intervention in two rural settings

The purpose of this study was to describe the scope of clinical practice of advanced practice nurses who were involved in a project designed to increase access of families with at-risk and disabled young children, newborn to 3 years of age, to early intervention services in rural Washington State. The findings from this study are based on the retrospective review of records of clients seen by the advanced practice nurses. Nursing diagnoses and nursing interventions were assigned to chart recordings. The most frequently occurring nursing diagnoses assigned to parents were Altered Parenting, Altered Family Processes, Fear, Noncompliance, and Knowledge Deficit. The most frequently occurring nursing diagnoses assigned to children were Impaired Physical Mobility, Impaired Verban Communication, Altered Nutrition: Less than Body Requirements, Sensory-Perceptual Alteration, and Altered Thought Processes. Categories of nursing intervention recorded most frequently were Monitoring, Planning and Information. Discussion of findings addresses the roles and reimbursement of advanced practice nurses who provide family-centered early intervention services in rural communities.

The difficult first week at home with a premature infant

The results reported were obtained from the findings of a larger descriptive study that surveyed the support needs of 56 mothers of high-risk premature infants. Forty-eight percent of the mothers found the first week after their infant's discharge home difficult. Data analysis indicated the more premature the infant (birth weight r = 0.29, P = 0.03; gestational age r = 0.34, P = 0.008), and the greater the severity of illness as determined by length of hospital stay (r = -0.27, P = 0.04), the more likely the mother was to have a difficult first postdischarge week. The visit of the community health nurse during that first week was a significant factor in whether the mothers perceived the time as difficult (Fisher's exact test, P = 0.02). It was found, as well, that the community health nurses were less likely to visit mothers of very low-birth-weight infants during that week (Fisher's exact test, P = 0.02). Other variables related to difficulty during the first week were whether the infants had apnea in hospital (r = 0.33, P = 0.01), mothers' need for specific kinds of information such as knowledge about colic (chi 2 = 24.31, df = 12, P = 0.02), and an earlier scheduled visit to a physician for mothers whose infants were of lower birth weight (r = -0.26, P = 0.05), earlier gestational age (r = -0.34, P = 0.009), and had spent longer time in hospital (r = 0.37, P = 0.006).

Nurse Supportive Acts for Mother-Preterm Infant Pairs

Nurse Supportive Acts were measured during the conduct of a nursing intervention designed to facilitate mother-preterm infant acquaintance in the hospital and at home. The most frequently performed supportive acts included "active listening," "sounding board," "information exchange," and "validation." Use of these communication skills allows the health care provider to give care which is flexible and sensitive for mothers and their preterm infants.

Clinical specialist pre- and postdischarge teaching of parents of very low birth weight infants

This study examined the pre- and postdischarge teaching needed by parents of very low birth weight infants (less than or equal to 1,500 g). The sample consisted of 36 families observed from the births of their infants to 18 months' postdischarge. Content analyses yielded five major teaching categories of infant, mother, family, home, and resources. Major predischarge teaching included feeding, recognition of infections, and growth and development. Major postdischarge teaching included feeding, current health problems, growth and development, and managing within the health-care system.

Early intervention

This paper provides an overview of the critical nced for early intervention services, the specific role of occupational therapists in early intervention settings, and the training implications for the preparation of occupational Therapists with expanded roles, responsibilities and skills. An intervention approach that is multidisciplinary, culturally relevant, and family centered in nature is proposed as one way of redefining the occupational therapist's contribution and strategy in early intervention settings. Recommendations are presented regarding the education and preparation of occupational thera ists for their new directions in early intervention and the potenliarincrease in demands for their services.