Guest Editorial - The more things change: the pivotal role of nursing leadership in achieving cultural transformation.
Jenni Jarvis
Assessment of jaundice in the term infant - accuracy of transcutaneous bilirubinometers compared with serum bilirubin levels: part two
Sandie Bredemeyer, Jan Polverino, Philip Beeby
Objective: To evaluate the use of two transcutaneous bilirubinometers – the BiliChek® (Respironics Inc, Murrysville PA, USA) and the Konica Minolta JM-103® Jaundice Meter (Dräger Air-Shields, USA) – and to compare the transcutaneous bilirubinometer readings of each device with SBLs in a midwifery setting.
Methods: Between 01 June and 30 October 2003, seventy-six newborn infants were recruited from the postnatal wards and special care nursery at RPA Women and Babies, by one of the investigators approaching parents if their newborn infant was jaundiced and had been ordered an SBL as part of their clinical management. Blood samples for SBLs were drawn via heel lance and transcutaneous bilirubinometers readings using both devices were taken within 30min of the heel lance. The sequence with which each device was used was random and the forehead was used for all transcutaneous bilirubinometers readings.
Findings: The study group consisted of 76 infants who had 94 invasive heel lances to determine the SBL. There were a total of 94 SBLs measured from heel lancing, 94 TcB readings using the Konica Minolta JM-103® and 85 using the BiliChek®. The correlation of the transcutaneous bilirubinometers readings and SBLs was statistically significant for the BiliChek® (r = 0.69, 95%; CI = 0.59, 1.0) and the Konica Minolta JM-103® (r = 0.75, 95%; CI = 0.64, 0.95).
Conclusions/Implications: Both the BiliChek® and the Konica Minolta JM-103® demonstrated good accuracy in the term population when compared with SBLs. however, the Konica Minolta JM-103® has the advantage of simplicity of use, does not require expensive consumables and appears more likely to succeed with multiple operators. The use of both devices can reduce the number of invasive SBLs routinely used to screen the otherwise well term infant for jaundice. For infants aged less than 48 hours who present with jaundice and/or with a transcutaneous bilirubinometer reading >260 µmol/L, SBLs are recommended to allay concerns and validate the need for further intervention.
An Australian Pilot Study of a Parent-Child Interaction Program - “You Make the Difference”
Toni Dowd, Elizabeth Withers, Janet Hackwood, Patricia Shuter
Communication impairments represent a significant public health issue. Failure to achieve communicative competence has social, emotional, educational and financial costs to the individual and society. A community-based health promotion strategy 'Play and Talk' was implemented in a disadvantaged community to enhance communication skills in children prior to school entry. Within the context of the Play and Talk initiative, the parent-child interaction program You Make the Difference (YMTD) developed by the hanen Centre in Ontario, Canada, was piloted and evaluated using a case study design within a collaborative action research framework. An opportunistic sample of eleven mothers participated in the ten-week program. All participants completed pre- and post-program questionnaires and four-week follow-up interviews. Feedback indicated that all mothers who attended the program experienced positive changes in their interactions and communication with their child, and strategies learnt were transferred to and maintained in the home environment. however, longer term follow-up is needed to further validate these results. The overall outcome of the program reinforced the need to provide community-based programs of this type to support the critical role of parents as facilitators of communication development in their children.
Predictors of postnatal depression in a community sample.
Lisa Milne, Philip Greenway, Lara Hansen
The aim of this study was to determine the relationship between postnatal depression and adult attachment style; maternal attachment style; and infant social-emotional behaviour. The sample comprised 139 mothers and 139 infants aged between three and twenty-four months. all respondents completed the ages and Stages Questionnaire, adult attachment Scale and Maternal attachment Scale as part of a battery of questionnaires. Results supported a relationship between a mother’s adult attachment style, maternal attachment style, certain infant behaviours and postnatal depression. Along with major adjustments following childbirth and consequent hormonal fluctuations, women need to adapt to their new role as mothers, and reorganise marital and family relationships. These changes are generally positive, but they can predispose women to psychiatric disorders. Although many women experience feelings of sadness after giving birth, an estimated 10-20% experience postnatal depression, a major depressive episode with the onset in the postnatal phase. Epidemiological studies define the postnatal phase as ranging from birth to six months after delivery
Turning Around Talipes: Nursing Considerations
Elizabeth Forster, Jennifer Fraser
The management of congenital talipes equinovarus (TEV) has received much clinical and research attention within the disciplines of medicine and physiotherapy. However, few articles have been published about the role of the registered nurse in contributing to the optimum health and wellbeing of the child and family presenting for assessment and treatment of the condition. Much of the most intense treatment for TEV occurs in the first few weeks of the child’s life; a time of critical growth and development when the infant is both sensitive and vulnerable to the environment within which it is nurtured. This is also a crucial time for developing a secure attachment to the caregiver and nurses can assist parents in optimising their infant’s opportunities for a secure attachment relationship. This paper thus provides an overview of the medical and physiotherapy management of TEV and highlights the role nurses have in providing nursing care and psycho-social support to parents of infants with TEV, in areas such as the maintenance of skin integrity and circulation, providing effective pain relief, and optimising growth, development, and a secure attachment relationship. Congenital TEV or 'club foot' is one of the most common congenital orthopaedic anomalies of infants. in Queensland in 2000, in approximately 50,000 births, 244 infants were born with talipes; almost five infants per 1000 births. National statistics are not as specific, with coding providing only 'other lower limb' as the category that would encompass talipes; the 1997 national incidence of such lower limb congenital malformations is reported as 1.7 per 10,000 births.
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