Conference Schedule: Thursday, October 18
NANN's 34th Annual Conference officially opens with a focus on nurse empowerment and offers foundational, advanced, and leadership sessions throughout the day.
8:00 am–9:45 am
Opening General Session I: The New R.N.’s (r)Evolution: How to Survive and Succeed Using Empowerment (GSI) CE: 1
Cristina Carballo-Perelman, MD
This session will focus on some of the factors that affect how nurses navigate through their careers, such as a consistently higher percentage of women in nursing, the educational requirements of the profession and how they are perceived by others in healthcare education, and the new norm in medicine corporate “takeover.”
9:45 am - 10:00 am
10:00 am - 11:00 am
Neonatal Evidence-based Skin Care Guide (101) CE:1
Joanne Kuller, RN BSN MS
Debra Brandon, PhD, MSN, BSN; Lauren Heimall, MSN, RNC-NIC, PCNS-BC; Carolyn Lund, RN, MS, FAAN; Tom McEwan, MSc, PgDip (ANNP), RM; Karen New, RN, PhD
The evidence supporting neonatal skin care will be described with an emphasis on new knowledge developed since the third edition of the Neonatal Skin Care guidelines. The skin is one of the most important organs at birth with responsibility for barrier protection, temperature regulation, infection control, electrolyte regulation, and tactile sensory function. Therefore, skin protection and optimization of function is essential to prevent skin injury, dehydration, and infection in both healthy and sick neonates. This session will cover skin assessment requirements, stress and protective interventions during bathing, umbilical cord care, transepidermal water loss, intravenous extravasations treatment and circumcision care; emollient use for dry skin and atopic dermatitis prevention in high-risk populations; the role of breastfeeding to protect infants against diaper dermatitis and current recommendations about the use of diaper wipes; interventions for the prevention of skin injury from medical equipment, disinfectants and medical adhesives; and emerging issues in skin care. Gaps in the evidence to support many routine and complex skin care needs of neonates remains. Neonatal nurses must play a major role in developing collaborative initiatives to foster needed knowledge development in neonatal skin care.
1. Describe the function, development and assessment of neonatal skin.
2. Analyze essential intervention development in their practice setting essential to the maintenance of skin integrity and function.
3. Describe areas needed for future knowledge development of neonatal skin care.
NAPNAP Presentation: Primary Care Follow-Up of the NICU Graduate (102) CE: 1
Linda Merritt, DNP APRN CPNP-PC/AC PMHS
Preterm and high-risk infants continue to have complex issues after discharge from the neonatal intensive care unit (NICU). This session will present common medical and developmental problems specific to this population. The latest evidence to promote optimal achievement of health and development of the NICU graduate will be discussed.
- Discuss common medical issues in infants and children after discharge from the NICU.
- Describe preventive strategies to decrease risk of mortality and morbidity in preterm and high-risk infants.
- Identify strategies to optimize long-term medical and developmental outcomes of NICU graduates.
Sleep Protection in the NICU (103) CE: 1.0
Terrie Lockridge, MSN RNC
This session will highlight the critical role of sleep in normal CNS development and identify strategies to protect sleep cycles for those infants who must complete portions of the third trimester within the NICU. Normal newborn states of consciousness will be reviewed, so that nurses can determine the best time to handle and interact with infants. The session will conclude with a description of one NICU's efforts to provide caregiving based upon an individual infant's own sleep-wake states rather than at pre-scheduled "clustered care" intervals.
- Describe the long-term consequences of sleep deprivation on neurosensory development, memory, behavior, and cognitive function.
- Discuss how caregivers can use newborn states to guide interaction and handling.
- Identify interventions to support both REM and non-REM sleep.
Neonatal Hypoglycemia and Dextrose Gel as a New Emerging Treatment Modality (110) CE: 1
Kristine Karlsen, PhD, APRN, NNP-BC
Hypoglycemia is the most common metabolic problem affecting neonatal patients, with as many as half of the at-risk infants (IDM, late preterm, SGA, LGA) requiring treatment to help raise their blood sugar into a normal range. New evidence is emerging regarding the use of dextrose gel and we’ll explore issues and controversies regarding glucose treatment thresholds, algorithms and the important question: is asymptomatic hypoglycemia benign? There’s a lot to talk about!
- Discuss historical perspectives regarding use of dextrose gel and neurodevelopmental outcomes following use of dextrose gel.
- Compare what to do and not do when utilizing dextrose gel to treat neonatal hypoglycemia.
- Describe glucose treatment threshholds advocated by the American Academy of Pediatrcis, The Pediatric Endocrine Society, and the New Zealand hypoglycemia study group.
11:00 am - 1:00 pm
Light Lunch in Exhibit Hall
1:00 pm - 2:30 pm
2016 Small Grant Recipient Presentations (104) CE: 1.5
The Small Grants Mentee/Mentor Program accepts applications from NANN members interested in developing their research skills and/or initiating their own research study or evidence-based practice (EBP) project. With a special thanks to our sponsors, three awards are given each year.
The Neonatal Eating Assessment Tool (NeoEAT) - Bottle feeding: Factor Structure and Psychometric Properties
Brit Pados, NNP-BC, PhD, RN
There are currently no valid and reliable parent-report assessments of bottle feeding for the infant less than 7 months old. This study presents a new, valid, and reliable assessment of bottle feeding that can be used for clinical practice and research.Learning Objectives:
- Define the process of determining the factor structure and psychometric properties of the NeoEAT - Bottle feeding.
- Describe the possible uses of the NeoEAT - Bottle feeding for clinical practice and research
Comparing Workplace Stress among Nurses in Single Family Room and Open Bay Design Neonatal Intensive Care Units
Melinda C. Brand, PhD, RN, NNP-BC
While single family rooms (SFRs) in the NICU reduce stress in parents, the impact on stress in NICU nurses is less clear. This study examined stress in NICU RNs working in SFRs vs. Open Bay Units (OBU) using the Nursing Stress Scale (NSS) and salivary cortisol samples. The NSS score did not correlate significantly with cortisol level (r=0.063, p=0.607) or change in cortisol level (r=0.038, p=0.759). Cortisol level was significantly higher in night shift compared to day shift RNs (p<0.001) and the change in cortisol level was significantly higher for night shift than day shift (p<0.001). Overall, there was no significant difference in the change in cortisol level for SFR vs. OBUs after controlling for shift (p=0.764). Stress was similar in nurses working in SFR and OBU NICUs. Higher cortisol levels in night-shift RNs warrants further exploration.
- Discuss the effects of stress on health and wellbeing.
- Compare stress in NICU nurses working in single family room designed NICUs with stress in open bay designed NICUs.
Improving Thermoregulation in our Low Birth Weight Population in the Golden Hour
Milena Frazer, BS-RNC
Co-Author: Amy Ciarlo, BS-RNC
All neonates rely on external help to maintain normal body temperature particularly in the first “Golden Hour” of life (Castrodalte & Rinehart, 2014). Heat can be lost very quickly in the delivery room via conduction, convection, radiation, and evaporation (World Health Organization, 1997). Compared to term infants, preterm infants can quickly become dangerously hypothermic if specific supports are not in place at the time of delivery (Laptook, Salhab, & Bhaskar, 2007). With our QI project we were able to significantly reduce the number of infants admitted hypothermic (from 30% to 2.1%) by making changes to our delivery room routine thermal care protocols. The addition of chemical mattresses and polyurethane lined hats in our unit, along with staff education and a pre-determined workflow, were relatively easy practice changes which significantly improved admission temperatures for our VLBW infants.Learning Objectives:
- Examine issues with hypothermia in VLBW and define modes of heat loss.
- Recommend ideal routine thermal care.
- Discuss unit specific issues and evaluate a plan for the future.
1:00 pm - 2:30 pm
Paper Session I (105) CE: 1.5
This session will consist of three Evidence-based Practice (EBP) Paper Presentations.
An Educational Greenhouse: Using Communication & Teamwork to Rapidly Transform a NICU Nurse into a Successful Acute Care Cardiology Nurse
In this current economic climate we are in need of new cost effective ways to expedite and implement staff education.
- Explain prinicples to quickly establish competence in caring for unfamiliar population.
- Synthesize tools to be able to create a process for fast-tracked education.
Developmental Care: In the NICU and Beyond
Lauren Long, BSN, RNC-NIC
Co-Author: Hannah E. Malone, RN
Research shows that consistent, high quality, developmentally supportive care can decrease length of stay and infants transition to oral feeding faster and a decrease in parental stress. A standardized evidenced-based clinical practice guideline is necessary to ensure regular use of neuroprotective interventions and improve developmental outcomes of infants in the NICU.
- Identify strategies for providing high quality developmentally supportive care.
- Interpret infant behavior cues and demonstrate family-centered developmentally supportive care.
Using Noldus Observer®XT and ®Tableau10.3.1 Software for Intensive Case Analysis Examining the Association between Daily Care Procedures and the Trajectory of Body Temperature in VLBW Infants
Jane Ralphe, RN, MSN, PNP, NNP-BC
Co-Author: Robin B. Dail, PhD, RN, FAAN
Temperature instability, which increases the risk of morbidity and mortality, occurs frequently during the first 2 weeks of life in VLBW infants. The extent and dynamics of this temperature variability is unknown due to single point temperature assessments. This software provides the ability to analyze and visualize of the impact of essential daily care events on infant temperature over time.
- Describe how Noldus Observer®XT behavior software can be used to analyze the relationship between daily care events occurring inside the incubator and longitudinal body temperatures in VLBW infants.
- Demonstrate how ©Tableau10.3.1 visual analysis software can be used to visualize the trajectory of VLBW infant body temperature in relationship to daily care events occurring inside the incubator.
1:00 pm - 2:30 pm
Paper Session II (106) CE: 1.5
This session will consist of three Research-based Paper Presentations
Intimate Partner Violence and the NICU: How are Nurses Prepared to Respond?
Kathleen Ellis, PhD RN
It is well documented in the literature that intimate partner violence (IPV) during pregnancy harms the health of pregnant women and their unborn children and that IPV during pregnancy is a risk for postpartum IPV (Agrawal et al., 2014). While there is solid research on the experience of IPV throughout the childbearing year, there is little to no evidence on the experience of families within the NICU setting. This presentation will provide research results as well as information on identifying IPV within the NICU setting.
- Describe the effects of intimate partner violence on mother and fetus during pregnancy.
- Identify signs of intimate partner violence that mothers may display while visiting their infants.
The Effect of the Nurse Work Environment on Mortality of Very Low Birth Weight Infants
Elizabeth S. Schierholz, MSN, NNP
Research documents considerable medical practice variation at the institution level that affects neonatal outcomes. This institutional variation in VLBW mortality has resulted in studies that have evaluated hospital system characteristics such as resident duty-hour restrictions, health insurance status, level of care available at birth hospital, NICU volume and education and training of NICU providers on the effect of neonatal outcomes- mainly using mortality in the NICU as a metric of quality. Variation in nursing practice and the association of nursing on neonatal outcomes is less known and studied.
- Identify elements of nursing that have been linked to better infant outcomes.
- Define the "nurse work environment" and recognize the impact of variation of the "nurse work environment" on infant outcomes in the NICU.
Healthcare Providers Needs and Preferences in Kangaroo Care Devices: A National Survey
Ashley M. Weber, PhD, RN
Co-Author: Yamile Jackson, PhD, PE, PMP
In addition to the publication of clinical practice guidelines and tools, kangaroo care products may be another important way that healthcare professionals can best facilitate kangaroo care for their mother-baby dyads. In recent years, there has been a rise in the production of kangaroo care devices for mothers and their newborns. However, the safety, efficacy, and cost effectiveness of these devices are not known. There is no promotion of any products or specific kangaroo care devices in this research study, and there will be no discussion of any specific products or devices during this scholarly presentation.
- Identify the reason for use of a kangaroo care device
- Differentiate between aspects of kangaroo care devices that may or may not be desirable, and healthcare providers differences in preferences for aspects of kangaroo care devices based on provider demographics.
1:00 pm - 2:30 pm
Paper Session III (111) CE: 1.5
NANN Research Summit Presentations - Supported by Mead Johnson Nutrition
Neonatal Nurses Knowledge and Attitudes Regarding Two-Month Immunizations
Janelle Macintosh, RN, PhD
- Identify the attitudes and competencies of neonatal nurses regarding 2-month immunizations. Describe ways to increase neonatal nurses' knowledge regarding 2-month immunizations.
Infant Illness Severity and the Development of Post-traumatic Stress in the NICU
Kathryn J. Malin, MSN, NNP-BC, APNP
- Recognize infant illness risk factors for parental PTSD after discharge from the NICU. Explain how perceptions of infant illness are associated with parental PTSD after discharge from the NICU.
Psychometric Validation and Generalizability of the Withdrawal Assessment Tool (WAT-1) for NICU Patients
Julie Long, BSN, RN, RNC-NIC
2:30 pm - 3:30 pm
Break in Exhibit Hall
3:30 pm - 4:30 pm
How to Communicate and Support Parents More Effectively in the NICU (107) CE: 1
Linda A. Merritt, MSN RNC-NIC
Co-Authors: Kelli Kelley, Keira Sorrels
Hospitals are passionate about their Baby Friendly distinctions and have changed the way care is provided to families. Nurses need to become just as passionate about family-centered care (FCC), especially in the NICU. FCC recognizes that the only constant in the infant's life are his or her parents; therefore, the parents need to be equal partners in the infant's care. Three speakers will share their experiences, from the parent perspective to illustrate successful or unsuccessful FCC.
1. Identify the barriers to practicing family-centered care in the NICU.
2. Discover how to improve support for parents in the NICU.
3. Discuss resources for measuring how to improve FCC in their NICU.
3:30 pm - 4:30 pm
To Close or Not To Close: Current Trends in the Management & Treatment of Patent Ductus Arteriousus (108) CE: 1
Moni K. Snell, MSN, RN, NNP-BC
Patent Ductus Arteriousus (PDA) management is a controversial topic in any NICU, and impacts the decisions associated with providing safe care of extremely preterm infants. PDA management impacts whether the ELBW infant will have an increased risk for developing morbidities, and affects neurodevelopmental outcomes.
1. Review the definitions of PDA currently described in the literature.
2. Identify the morbidities and mortality assosciated with a PDA in the preterm infant.
3. Describe the current trends in the management of PDA.
3:30 pm - 4:30 pm
Making a U-Turn in the NICU: Creating Change to Promote Infant-driven Feedings and Sustainable Use of Human Milk (109) CE: 1
Lori J. Wood, MSN, CNS, RNC-NIC, IBCLC
Cue-based or infant driven feeding is an important developmental practice in the NICU. Attainment of this process involves making changes to current procedures in today’s NICU culture in order to overcome outdated practices. Education, evidence-based protocols, standardized tools, evaluations, and unit competencies are effective tools in leading the effort to create this change. This session will discuss one NICU’s journey to embrace human milk, beginning with oral care colostrum practices, eradicating Ventilator Associated Pneumonia, and the initiation of a donor milk program.
1. Discuss the negative effects associated with volume driven feedings and outcomes of the neonate.
2. Describe the needed culture change associated with moving from volume driven feedings to cue based feedings in the NICU.
3:30 pm - 4:30 pm
Behavioral Intervention in Conjunction with Maternal Participatory Guidance Improves Preterm Infant Outcomes (112) CE: 1
Rosemary White-Traut, PhD, RN, FAAN
Intervening with both mother and preterm infant during initial hospitalization and the first month following hospital discharge is a promising strategy to support infant behavior, oral feeding and infant growth, improve mother-infant interaction, and reduce infant illnesses following hospital discharge.
- Discuss infant behavioral curs prior to feeding and following feeding.
- Review the following responses: physiological, behavioral, feeding, mother-infant interaction, and health care utilization and cost following developmental interventions.
- Identify strategies for teaching parents how to implement developmental interventions for their infants.
4:30 pm - 6:30 pm
Reception in Exhibit Hall
7:30 pm - 9:30 pm
NANN After Dark