Scholarship & Research
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Item Implementation of a tummy time protocol: a quality improvement project in a level 3B NICU(Montana State University - Bozeman, College of Nursing, 2024) Chaffin, Taylor Christine; Chairperson, Graduate Committee: Benjamin J. Miller; This is a manuscript style paper that includes co-authored chapters.Background: Infants who spend prolonged periods in the supine position, particularly in the NICU, face an increased risk of plagiocephaly and developmental delays. Supine sleeping is recommended by the American Academy of Pediatrics, "Back to Sleep" campaign, which has successfully reduced sudden infant death syndrome by 40-60%. However, an increase in cranial abnormalities was observed following the widespread adoption. Daily tummy time supports motor development, reduces the risk of plagiocephaly, and promotes parental bonding. Methods: A six-week tummy time protocol was implemented in a level 3b NICU for infants who were 32 weeks corrected gestational age and medically stable. Brief 1-2-minute tummy time sessions were completed in the infant's bed or while holding with a parent. Tummy time sessions, education, and return demonstrations were documented on a bedside tracker. Pre- and post-implementation surveys were distributed to staff to gather perspectives. Parent surveys were distributed at discharge to evaluate readiness to complete tummy time at home. Results: Between January 15th and February 25th, only 23 out of 42 eligible infants had tracker sheets returned (55%). Out of 504 eligible days, tummy time sessions were recorded on 214 days, accounting for 42%. Post-implementation staff surveys showed positive results regarding their confidence in educating parents (M=4.7, sd=0.47) and the ease of implementation (M=4.38, sd=0.65). Comparing the results of the pre-and post-implementation surveys using a t-test yielded no significance. Obstacles to compliance included difficulty integrating new workflows, time constraints for education completion, tummy time, and documentation. Conclusion: Implementing the Tummy Time Protocol was crucial in changing practice patterns to align with best practices for infants admitted to the NICU. However, more work must be done to integrate tummy time sessions, early education, and documentation into a new workflow. Suggestions for improvement were provided, focusing on incorporating documentation into the electronic health record (EHR) system to improve compliance and reduce the risk of losing tracking sheets. In addition, future research is necessary to evaluate the long-term effects of tummy time implementation within the NICU. Specifically, research should focus on rates of plagiocephaly and outpatient therapy referrals following discharge from the NICU.Item A study of selected factors that may contribute to the incidence of premature infant births in Twelve southwestern Montana counties(Montana State College, Division of Professional Schools, 1961) Burcham, Genevieve S.; Chairperson, Graduate Committee: Eleanore L. ModeThis study was concerned with three selected factors (socio-economic, geographic, and health facilities) that may contribute to the incidence of premature infant births in twelve southwestern counties in Montana. The documentary and exploratory method was employed in securing the data. The results of this study showed no established pattern of the three factors to the incidence of premature infant births.Item Change in practice used to quantify breast milk intake of pre-term infants in a neonatal intensive care unit : test-weighing to 'Salt Lake City Feed Plan'(Montana State University - Bozeman, College of Nursing, 2009) Treloar, Allison Kirsch; Chairperson, Graduate Committee: Elizabeth S. KinionA local community hospital in Montana expressed a desire to establish a written clinical guideline for transitioning preterm infants from enteral gavage feedings to oral feedings. This desire was prompted by a change in the method of quantifying breast milk intake of preterm infants when transitioning them from enteral gavage feedings to at-breast feedings in a Neonatal Intensive Care Unit (NICU). The hospital changed from the practice of test-weighing as a clinical indicator to quantify breast milk intake to the "Salt Lake City Feed Plan". Procedures: Retrospective data from four consecutive years were collected from quality assessment chart audit data provided to the author in aggregate form. Twenty-nine records met the selection criteria. A descriptive presentation of the aggregate data follows. Results: The average number of total deliveries per year was 1,151. The average percentage of preterm deliveries that occurred between 32 - 37 completed weeks of gestation was 16.3 percent. Of the twenty-nine records that met the selection criteria, 17 were male and 12 were female. The birth weight ranged from 1.75 kilograms (kg) to 2.31 kg. Weight at discharge ranged from 2.66 kg. to 2.99 kg., indicating a weight gain of 0.68 kg. to 0.91 kg. at discharge. Number of days with an indwelling nasogastric enteral feeding tube ranged from 1 to 23 days. Length of hospital stay ranged from 7 to 29 days. The length of stay for exclusively bottle fed preterm infants ranged from 13 to 27 days, whereas the breastfeeding preterm infants who utilized test -weighing or the "Salt Lake City Feed Plan" ranged from 7 to 29 days. Breast fed preterm infants in whom test-weighing or the "Salt Lake City Feed Plan" was utilized had 4 to 4.315 fewer days of hospitalization compared to preterm infants who were exclusively bottle-fed. Conclusion: The literature review and the aggregate data collected by the rural community hospital provide baseline information to create, implement and support an evidence-based clinical guideline to transition preterm infants from enteral gavage feedings to oral feeding.