Lund C H, Osborne J W, Kuller J, Lane A T, Lott J W, Raines D A
Intensive Care Nursery, Children's Hospital Oakland, CA 94609, USA.
J Obstet Gynecol Neonatal Nurs. 2001 Jan-Feb;30(1):41-51.
To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries.
Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses.
NICU and well-baby units in 51 hospitals located throughout the United States.
Member site coordinators (N = 51) and the neonates (N= 2,820) observed during both the pre- and postimplementation phases of the project.
Site coordinators received specialized education in neonatal skin care and implemented an evidence-based clinical practice guideline addressing 10 aspects of neonatal skin care. Baseline observations of skin condition, care practices, and environment of newly admitted neonates were collected by site coordinators. Postimplementation observations were then completed.
Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. Aspects of the care environment with potential effect on skin integrity were monitored to determine risk factors.
Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in well newborns compared with premature newborns. After implementation of the guideline, skin condition was improved, as reflected by less visible dryness, redness, and skin breakdown in both the NICU/SCU and well newborns. The guideline was integrated into care, as evidenced by increased use of emollients, particularly with premature infants, and decreased frequency of bathing. A relationship was shown between selected aspects of the environment and alterations in skin integrity.
Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical Practice Guideline was successfully implemented at 51 sites, and effectiveness was demonstrated by changed care practices and improved skin condition in premature and full-term newborns. The results of this project support a wider dissemination of the project's practice guideline for neonatal skin care.
检验一项基于证据的新生儿皮肤护理临床实践指南对新生儿重症监护病房（NICU）、特殊护理病房（SCU）和健康婴儿护理室中新生儿特定临床结局的有效性。
对妇女健康、产科和新生儿护士协会以及全国新生儿护士协会合作开展的基于新生儿皮肤护理研究的实践项目进行前瞻性评估。
美国各地51家医院的NICU和健康婴儿护理单元。
项目实施前和实施后阶段观察到的成员单位协调员（N = 51）和新生儿（N = 2820）。
单位协调员接受新生儿皮肤护理方面的专业教育，并实施一项基于证据的临床实践指南，该指南涉及新生儿皮肤护理的10个方面。单位协调员收集新入院新生儿的皮肤状况、护理措施和环境的基线观察数据。然后完成实施后的观察。
采用新生儿皮肤状况评分（NSCS）评估皮肤状况，根据干燥、红斑和皮肤破损情况，评分范围为3分（最佳状况）至9分（最差状况）。通过选定皮肤护理措施频率的变化来评估在日常临床实践中使用该实践指南的有效性和可行性。监测对皮肤完整性有潜在影响的护理环境方面，以确定风险因素。
51名单位协调员对2464名NICU和SCU新生儿以及356名健康新生儿进行了11468次系统评估。健康新生儿的基线皮肤评分优于早产儿。实施该指南后，皮肤状况得到改善，NICU/SCU新生儿和健康新生儿的干燥、发红和皮肤破损情况均减轻。该指南已融入护理工作，润肤剂的使用增加，尤其是对早产儿，洗澡频率降低，这证明了这一点。环境的选定方面与皮肤完整性的改变之间存在关联。
AWHONN/NANN基于研究的新生儿皮肤护理临床实践指南在51个单位成功实施，早产儿和足月儿护理措施的改变和皮肤状况的改善证明了其有效性。该项目的结果支持更广泛地传播该项目的新生儿皮肤护理实践指南。
