Neonatal Network
July/August 2008
Vol. 27, No. 4

ABSTRACTS

Administration of Comfort Medication at End of Life in Neonates: Effects of Weight
Angela Lee Matthews, BSN, MS, NNP
Susan O'Conner-Von, DNSc, RNc

Purpose: To examine whether a relationship exists between a neonate’s weight and the neonate’s receipt of comfort medication between four hours prior to elective ventilator withdrawal and death. It was hypothesized that the greater the neonate’s weight, the more likely the neonate was to receive comfort medication at end of life.
Design: A retrospective chart review.
Sample: One hundred seventy-one neonates in a midwestern Level III NICU who died after withdrawal of ventilatory support.
Results: Of the 171 neonates in the sample, 27.5 percent (n = 47) did not receive comfort medication within the designated time frame; neonates who weighed <800 g were significantly less likely to receive comfort medication than were their heavier cohorts.
Conclusion: In this sample, smaller neonates were given comfort medication less often while they were dying than were their larger counterparts.

Implementing NICU Critical Thinking Programs: One Unit's Experience
Denise Zimmerman, RNC, BS
Jobeth Pilcher, RNC, BSN, MS

Critical thinking is the hallmark of today’s nursing practice environment. Nowhere is this more critical than in the high-tech environment of the NICU. Despite the importance of critical thinking in nursing practice, there is limited information on the process of teaching new NICU nurses to think critically. Based on the principles of adult education, orientation and continuing education for NICU nurses should be goal directed, build on the learner’s prior experience, and build in opportunities for active participation, reflection, and experiential learning. This article reviews the principles of adult education and their application to the process of teaching critical thinking in the NICU. One unit’s experience of critical thinking education is used to provide concrete examples of how NICU education can be transformed from a traditional didactic methodology to a more dynamic experiential approach.

2007 Manuscript of Exceptional Merit Excellence in Writing Award Winner
Father Surrogate: Historical Perceptions and Perspectives of Men in Nursing
and Their Relationship with Fathers in the NICU
Steven W. Peterson, BSN, RN, CCRN

Femininity is often associated with the nursing profession, but is not one of its defining characteristics. Men have been providing care to the sick and injured for many centuries, and they continue to do so for many reasons. Male nurses display a wide range of caring practices, which may not always be interpreted as such by their female counterparts. This article presents the male perspective and approach to caring, including the unique relationship that male nurses can have with fathers in the NICU.

Neonatal Peripherally Inserted Central Catheters:
Recommendations for Prevention of Insertion and Postinsertion Complications
Pamela R. Paulson, RN, MS, CPNP
Kellee M. Miller, RN, BS

Peripherally inserted central catheters (PICCs) continue to be necessary in neonatal care. They benefit many premature infants and those needing long-term intravenous access. An experienced inserter, early recognition of PICC candidates, early PICC placement, knowledge of anatomy, and correct choice of vein all increase placement success. As with any invasive procedure, there are risks. These include pain, difficulty advancing the catheter, damage to vessels, catheter malposition, and bleeding. Utilizing assessment skills, following the product manufacturer’s instructions, and carefully placing the catheter should minimize most of these risks. Additional risks include postinsertion complications such as occlusions, thrombosis, catheter failure, infection, and catheter malposition. Proper nursing care—which includes controlling infection, properly securing the catheter, and changing the dressing as needed—is key to preventing complications and maintaining the PICC until treatment has been completed.