Nursing Interventions That Promote Sleep in Preterm Newborns in the Neonatal Intensive Care Units: An Integrative Review

The Effect of Massage and Foot Reflexology on Sleep in Newborns

Objective: This study was conducted to examine the effects of massage and foot reflexology on the sleep of premature infants. Materials and Methods: The research was designed as a randomized controlled experimental study. The study population consisted of premature infants born at 30-37 weeks of gestation who were admitted to the Neonatal Intensive Care Unit of a hospital in the Central Anatolia Region. The sample included 108 premature infants divided into three groups: Massage group (n = 36), Foot reflexology group (n = 36), and Control group (n = 36). Data were collected using a neonatal follow-up form and actigraphy. Massage and foot reflexology interventions were administered to the respective groups twice daily (Morning: 07:00-09:00 and Evening: 19:00-21:00) for 15 minutes each session over two consecutive days, making up a total of four sessions. The control group received routine nursing care without any additional intervention. Pre-test (once) and post-test (once) measurements of 24-h sleep durations were assessed using actigraphy for all groups. Results: Sleep duration in the massage group increased compared to pre-intervention (251 minutes) and the control group (272 minutes), while the sleep duration in the foot reflexology group similarly increased compared to pre-intervention (268 minutes) and the control group (266 minutes) (p < .001). Sleep efficiency also showed a significant increase post-intervention, rising to 73% in the massage group and 71.8% in the foot reflexology group compared to the control group (p < .001). Furthermore, the number of awakenings and wakefulness duration significantly decreased in the massage and foot reflexology groups compared to the control group (p < .05). Conclusion: The findings indicate that massage and foot reflexology are effective non-pharmacological methods for improving sleep duration and sleep efficiency while reducing wakefulness duration and the number of awakenings in premature infants.

Nurses' perspectives on implementing sleep protection for premature infants in the neonatal intensive care unit: a qualitative study

BACKGROUND

The normal development of sleep-wake cycles is crucial for the long-term neurological health of preterm infants, yet sleep protection practices remain suboptimal. Given China's large population of preterm infants and its distinct cultural background and healthcare policies compared to Western countries, NICU nurses in China may face unique challenges. However, our understanding of the barriers and facilitators encountered by nurses in implementing sleep protection for preterm infants is limited.

METHODS

From November 2023 to February 2024, we conducted semi-structured interviews with 15 nurses at a tertiary children's hospital in China. The interview guide was based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Data analysis employed inductive thematic analysis, aligning the findings with the COM-B model and the Theoretical Domains Framework (TDF) to identify key barriers to effective management and potential interventions.

RESULTS

Three major themes emerged: (1) Capability: Lack of knowledge among practitioners; Limited communication with parents; Inability to understand the cues of the baby; and Developing guidelines to support decision-making; (2) Opportunity: Time constraints; Poor interdisciplinary collaboration; Lower priority for sleep; and Additional medical expenses; (3) Motivation: Positive management attitude; Organizational expectations and support; Professional sense of responsibility; and Being an example to peers.

CONCLUSION

To improve sleep protection for preterm infants in NICU settings, it is imperative to address several key barriers. Firstly, elevating the priority of sleep protection is essential. Specifically, a comprehensive strategy focusing on enhancing healthcare professionals' knowledge and skills, promoting multidisciplinary collaboration, strengthening communication with parents, and optimizing human resource allocation is crucial for effectively implementing sleep protection measures.

TRIAL REGISTRATION

Not required.

Knowledge, attitudes, practices and perceived barriers of health professionals in the neonatal intensive care unit towards protecting the sleep of premature infants: A cross-sectional study

BACKGROUND

Protecting the sleep of premature infants is crucial, particularly in the neonatal intensive care unit (NICU). Health care professionals in NICUs play a vital role in supporting and ensuring the protection of infants' sleep.

AIM

The study aimed to examine the knowledge, attitudes, practices and perceived barriers among NICU health care professionals in Türkiye regarding the protection of premature infants' sleep.

STUDY DESIGN

This cross-sectional study was conducted online through social media platforms, involving 104 health care professionals (physicians and nurses). A survey was used to evaluate their knowledge, attitudes, practices and perceived barriers in protecting the sleep of premature infants.

RESULTS

The total scores of NICU health care professionals in knowledge, attitude, practice and perceived barriers were as follows: knowledge score, 27.10 ± 2.126; attitude score, 8.65 ± 0.942; practice score, 21.25 ± 2.139; and perceived barriers score, 26.98 ± 2.028. Significant relationships were found between knowledge and attitude (p = .003), knowledge and practices (p = .005), attitude and practices (p < .001), attitude and perceived barriers (p < .001) and practices and perceived barriers (p = .005).

CONCLUSION

NICU health care professionals demonstrated high levels of knowledge, attitude, practice and perceived barriers regarding the protection of premature infants' sleep. A positive relationship was observed between knowledge and attitude, knowledge and practices, and attitude and practices. Conversely, a negative relationship was found between attitude and perceived barriers, as well as practices and perceived barriers.

RELEVANCE TO CLINICAL PRACTICE

It will be easier to protect the sleep of premature infants by determining the knowledge, attitude, practice and perceived barriers of NICU health care professionals. In particular, by examining the knowledge, attitudes and practices of nurses regarding sleep protection and identifying the obstacles to successful sleep management, premature infants' sleep will be of better quality.

Clustering of care activities for promoting development and preventing morbidity in hospitalized preterm infants

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of clustering of care activities for promoting development and preventing morbidity in preterm infants.

Best evidence summary of sleep protection in premature infants in the neonatal intensive care unit: a narrative review

Background and Objective

Sleep influences the interaction between infants and their environment, as well as the achievement of crucial milestones in motor and language development. This is particularly significant for preterm infants in vulnerable positions. However, prematurely born infants in the neonatal intensive care unit (NICU) are exposed to various stimuli such as noise and light, which disrupt their normal sleep patterns. This study assesses and consolidates the existing evidence on non-pharmacological strategies for protecting and promoting sleep in preterm infants. By providing an evidence-based data repository, it offers a valuable reference for clinical interventions.

Methods

We conducted computer-based searches using various databases and resources, including UpToDate, BMJ Best Practice, Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Registered Nurses Association of Ontario (RNAO), Joanna Briggs Institute (JBI), World Health Organization (WHO), Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, and China Biology Medicine disc (CBM). The search period spanned from January 2014 to May 2024.

Key Content and Findings

We have included a total of 22 articles in our review, comprising two guidelines, 11 systematic reviews, 1 evidence summary, 1 technical report, 2 practice recommendations, and 5 randomized controlled trials. The evidence was synthesized from eight domains: sleep team construction, risk factor assessment, sleep assessment tools, positional management, noise control, light management, sensory stimulation, and hospital-home transition sleep management, resulting in 27 pieces of evidence.

Conclusions

This study summarizes the optimal evidence for the management of sleep in premature infants, providing empirical support for standardizing the management of sleep in premature infants. It is recommended that healthcare professionals judiciously apply the best evidence while considering the clinical context, thus promoting safe sleep for premature infants.

Parents' Perception and Use of Skin-to-Skin Care in Jeddah, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Skin-to-skin care (SSC) between newborns and their parents provides many positive outcomes for both newborns and their parents. However, there is a lack of research assessing the perception of parents, especially fathers, of SSC in Saudi Arabia.

PURPOSE

The aim of the study is to assess parents' perception of SSC in Saudi Arabia.

METHODS

This cross-sectional study used an online survey. Data were collected from a convenience sample of 140 parents of hospitalized neonates between January and June 2023. Data were collected from one private hospital (Dr. Soliman Fakeeh Hospital) and one public hospital (King Abdulla Medical Complex) in Jeddah, Saudi Arabia. The parents' perceptions of SSC were assessed using the Parents' Perceptions of SSC tool. An independent t-test was used to compare mothers and fathers in their perceptions of SSC.

RESULTS

One hundred and forty parents completed the online survey (70 females and 70 males). The majority of the parents did not use SSC with their babies (n=102, 73%), did not read or hear about the use and benefits of skin-to-skin care (n=100, 71%), and did not receive information or training on SSC from healthcare professionals (n=112, 80%). Mothers' perception of SSC was significantly higher than that of fathers (p ≤ 0.05).

CONCLUSION

Fathers' perception of SSC was lower than that of mothers. Awareness and training programs are needed to inform parents, especially fathers, regarding SSC and its benefits in Saudi Arabia.