Trauma-Informed Care Education Initiative Explores Impact on Perinatal Nurse Secondary Traumatic Stress and Workforce Challenges

BACKGROUND

Psychological trauma refers to long-lasting adverse effects on well-being precipitated by the experience of a distressing event or a combination of events. High rates of psychological birth trauma in patients contribute to secondary traumatic stress (STS) in perinatal nurses, creating workplace challenges and resulting in dissatisfaction, apathy, and attrition. Perinatal nurses experience high rates of STS, and researchers have called for a universal standard of trauma-informed care (TIC). However, there is a lack of published results on effectively creating TIC education in this nurse population.

METHODS

A pre/posttest design evaluated an online pilot evidence-based practice project addressing a perinatal nurse education initiative on STS and its correlation with nurse attitudes toward TIC. Participants include perinatal nurses in the United States (n = 29). Two scales measured the program's effect on nurses: the Secondary Traumatic Stress Scale (STSS) and the Attitudes Related to Trauma-Informed Care (ARTIC) scale.

RESULTS

A paired t test evaluating pre- and postprogram levels of the STSS showed a decrease in STS (t28 = -3.28, P = .003, Cohen's d = 0.609), the ARTIC scale results showed an increased receptiveness to TIC (t28 = 3.8, P < .001, Cohen's d = 0.706], and a not significant correlation was found between pretest STS and ARTIC scores (Spearman' ρ = -0.248, P = .194).

CONCLUSION

This program supported a significant reduction in nurses' identification of STS. Future perinatal nurse education can expand to build a standard of TIC that is patient-centered and reduces nurse STS.

Translation into Practice: Dextrose Gel Treatment for Neonatal Hypoglycemia to Reduce NICU Admissions and Increase Breastfeeding Exclusivity

BACKGROUND

Oral dextrose gel is an evidence-based treatment that has been shown to reduce NICU admissions and support exclusive breastfeeding.

PURPOSE

We summarize a knowledge translation project to introduce dextrose 40 percent oral gel to treat hypoglycemia or hyperglycemia. Implementation took place during the months of May, June, and July 2017.

RESULTS

Through chart audit, rates for NICU admissions and exclusive breastfeeding were measured for a three-month period before implementation and the three-month period after implementation.There were 234 doses indicated, 128 doses given, 93 doses missed, and 13 doses declined by parents in the first three months of implementation. Admission rates to the NICU for the groups audited were 13 percent in 2016 and 6 percent in 2017.Principles of knowledge translation were used to successfully introduce this change. Centers providing maternal newborn care should consider similar projects to enable introduction.

Disseminated Intravascular Coagulation in the Neonate

Disseminated intravascular coagulation (DIC) is a serious secondary disease that alters the events in the clotting cascade. DIC leads to microclots in the peripheral vasculature. The uncontrolled formation of these clots consumes the body's clotting factors, which precipitates bleeding. Neonates, defined as newborns zero to one month old, are born with slightly altered hemostasis, also known as developmental coagulopathy. This coagulopathy puts neonates at a greater risk of developing DIC, specifically when additional body systems have been compromised by a primary disease. Because of the serious nature of this disease and its precipitating factors, advanced practitioners should study the nuances of DIC to provide accurate diagnosis and proper treatment. The aim of this article is to discuss the pathophysiology behind DIC along with etiologies, diagnosis, treatment, and prognosis in neonates, along with gaps in current research.

Hypotonia at Birth: A Case Study of ACTA-1 Mutation, a Congenital Myopathy

Congenital myopathy is an uncommon neonatal disorder that can manifest in the neonatal period with severe features. Presentation with signs of global hypotonia and respiratory insufficiency are among the classic findings. Rapid diagnosis is essential for medical management and family support. This case study reviews the presentation of hypotonia in the newborn, followed by a path to a diagnosis of nemaline myopathy in the form of an ACTA-1 mutation. This review can aid the clinician in the diagnosis of patients in whom hypotonia is present at birth. Included is a discussion of the incidence, pathophysiology, diagnosis, and management of this devastating disease.

Lung Ultrasound as a New Technique for Diagnosis of Neonatal Respiratory Diseases

Point-of-care ultrasound in the NICU is becoming more commonplace and is now used for a number of indications. Over the past ten years, the use of ultrasound as an alternative to a chest x-ray for the diagnosis of neonatal lung disease has been explored, and protocols were developed to refine the interpretation of ultrasound images in neonatal lung disease. The purpose of this column is to briefly explain the physics of ultrasound and describe the application of ultrasound to neonatal lung assessment.

Associated Factors of Psychological Distress among Japanese NICU Nurses in Supporting Bereaved Families Who Have Lost Children

PURPOSE

This study aimed (1) to examine the current status of psychological distress experienced by neonatal intensive care unit (NICU) nurses in supporting bereaved families, (2) to identify the factors associated with psychological distress, and (3) to understand the professional characteristics of nurses experiencing high psychological distress by comparing the study results with those of pediatricians.

METHODS

We sent questionnaires to 64 NICUs. The psychological distress of nurses was classified into two groups based on the frequency of psychological distress experienced and analyzed using the χ2 test and Fisher's exact test. A multiple logistic regression analysis was used to investigate the factors related to psychological distress.

RESULTS

Of the 384 nurse respondents, 190 (49.5%) reported having supported bereaved families, 169 of who were included in the analysis. A total of 123 nurses (72.8%) reported high levels of psychological distress. Our study revealed that the use of coping methods is associated with high psychological distress. The comparison with pediatricians revealed that nurses were significantly more likely to be female and had fewer years of working experience. Nurses were also significantly more likely to use coping methods and to experience high psychological distress.

CONCLUSION

Clarifying the coping methods for psychological distress in supporting bereaved families may be necessary, and nurses need to identify appropriate coping methods. In nursing education, information on psychological distress related to children's deaths and bereavement care should be conveyed from the early stage and nurses must obtain preliminary knowledge. The creation of a bereavement follow-up system is recommended.

Feasibility of Air Transport Simulation Training: A Case Series

Limited clinical site availability and an increased need for clinical training experiences often make it difficult for prehospital health care providers to complete new and annual training requirements. Medical simulation provides an alternative learning environment that provides trainees the opportunity to acquire and perfect new clinical skills without compromising patient care. The following is a detailed description of an air medical transport simulation of a neonate with hypoxic ischemic encephalopathy requiring transport to a higher level of care. Patient parameters were altered during flight to simulate potential complications unique to air medical transport. Use of this training strategy is particularly beneficial for low-volume, high-risk patients, and these lessons can be applied across all age patient groups, making the experience broadly applicable.