Levesque Valerie, Johnson Krystal, McKenzie Amy, Nykipilo Andrea, Taylor Barbara, Joynt Chloe
Neonatal Intensive Care Program (Mss Levesque, Johnson, Nykipilo, and Taylor) and Respiratory Therapy Department (Ms McKenzie), Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada; and Division of Neonatology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada (Dr Joynt).
Adv Neonatal Care. 2021 Apr 1;21(2):E24-E34. doi: 10.1097/ANC.0000000000000770.
Skin-to-skin care (SSC) has been integrated as an essential component of developmental care for preterm infants. Despite documented benefits, SSC is not routinely practiced in the cardiac and surgical neonatal intensive care unit, with a predominantly term population, due to staff apprehension, patient factors and acuity, and environmental constraints.
The purpose of this quality improvement project was to increase SSC, parental holds, and parent touch events for infants in our cardiac and surgical neonatal intensive care unit. When traditional SSC was not possible, alternative holds and alternative parent touch (APT) methods were encouraged.
Quality improvement and qualitative descriptive methodology were utilized to assess baseline, develop education and practice changes, and evaluate the use of SSC, holds, and APT methods at 12 and 18 months postintervention. Implementation included educational tools and resource development, simulations, peer champions, in-class teaching, and team huddles. Decisions around the type of hold and parent touch were fluid and reflected complex infant, family, staff, and physical space needs.
Given its initial scarcity, there was an increased frequency of SSC and variety of holds or APT events. Staff survey results indicated support for the practice and outlined persistent barriers.
Skin-to-skin care, holds, and APT practices are feasible and safe for term and preterm infants receiving highly instrumented and complex cardiac and surgical care.
Future research regarding the intervention's impact on neurodevelopmental outcomes of infants and on parent resilience in the surgical and cardiac neonatal intensive care unit is warranted.
肌肤接触护理（SSC）已被纳入早产儿发育护理的重要组成部分。尽管有文献记载其益处，但由于工作人员的担忧、患者因素和病情严重程度以及环境限制，在以足月儿为主的心脏和外科新生儿重症监护病房，SSC并未得到常规实施。
本质量改进项目的目的是增加我们心脏和外科新生儿重症监护病房中婴儿的SSC、父母怀抱及父母触摸次数。当传统的SSC无法进行时，鼓励采用替代怀抱和替代父母触摸（APT）方法。
采用质量改进和定性描述方法来评估基线情况、制定教育和实践变革措施，并在干预后12个月和18个月评估SSC、怀抱及APT方法的使用情况。实施内容包括教育工具和资源开发、模拟演练、同伴倡导者、课堂教学以及团队碰头会。关于怀抱类型和父母触摸方式的决策是灵活的，反映了婴儿、家庭、工作人员以及物理空间的复杂需求。
鉴于其最初的稀缺性，SSC的频率增加，怀抱或APT事件的种类增多。工作人员的调查结果表明对该实践的支持，并概述了持续存在的障碍。
对于接受高度仪器化和复杂心脏及外科护理的足月儿和早产儿，肌肤接触护理、怀抱及APT实践是可行且安全的。
有必要开展关于该干预措施对婴儿神经发育结局以及对心脏和外科新生儿重症监护病房中父母适应能力影响的未来研究。
