Neonatal nurses: A call to action
Kaye Spence

Paediatric extended emergency care (PEEC): Establishing and evaluating a paediatric short-stay ward: a pilot study
Ruth Willis, Sharon Crowley, Dr Alison Hutton

Paediatric ‘short-stay wards’ are in existence in many paediatric centres around the country and appear to be a growing phenomenon. The purpose of this paper is to describe the journey of establishing, and subsequently evaluating, a short-stay unit on a paediatric unit. This paediatric unit is located in a general hospital, which has a separate paediatric emergency department unit. To improve patient care, a paediatric extended emergency care (PEEC) unit was established to provide a positive outcome for patients and their families by reducing avoidable admissions to the paediatric unit. Other goals were to relieve and reduce
cubicle block in the paediatric emergency department (PED) to provide discharge planning to families. Therefore a trial was implemented in the form of a PEEC unit.
Keywords: short stay ward, emergency department, paediatrics, extended care, nursing innovation

Exploring the barriers to palliative care practice in neonatal nursing: A focus group study
Dr Victoria Kain

Palliative care for the neonatal population has become more topical in recent years given the escalation of technological and medical advances and higher neonatal survival rates. Some newborns, however, will still die in the neonatal intensive care unit, often as a result of extreme prematurity and other complex medical problems. This paper explores previously identified barriers to palliative care practice in neonatal nursing. These barriers were inadequate staffing, unconducive physical environment, technological imperatives and parental expectations. Using an interpretive research framework, focus groups were conducted at three tertiary neonatal intensive care units (NICU) in Australia to elicit individual views to aid in clarifying the barriers to neonatal palliative care. A purposive sampling method accessed 24 registered nurses with neonatal intensive care experience. The three barriers identified by the survey data were
discussed at each of these focus groups. The three themes discussed at the focus groups emerged as central to the successful adoption of a palliative model of care in the NICU. The recommendations identified in this research can be translated into policy, curriculum development and training in the clinical environment.
Keywords: focus groups, neonatal palliative care, barriers, neonatal nurses.

Care of the low birthweight neonate in a developing country: a case study
Nicole J Lloyd-Nyunja

Siaya is located in rural western Kenya, an area with the highest infant mortality rate in the country. Malaria and HIV rates in this area are high, having a huge impact on maternal and neonatal health. Research shows that maternal malaria and HIV increases incidence of preterm delivery and foetal growth restriction, resulting in low birthweight (LBW) babies. Siaya district hospital covers a population approaching one million and encounters many premature and LBW babies; however, they lack the resources to cope with this. As an Australian volunteer nurse, I spent considerable time in Siaya, developing a nursery with basic resources
to cope with this demand. Basic principles of neonatal care were implemented to attempt to improve the outcomes for this neonatal population. Staff education played a large role in changing the care that was provided. There was a focus on effective neonatal resuscitation, thermoregulation, infection control and fluid management. Teaching and practices implemented were designed to be sustainable once I had left. LBW has implications for neonatal health; however, the application of basic neonatal
nursing principles can contribute to better outcome.
Keywords: low birthweight, neonate, developing country, nursing care.

Skin care guidelines for infants aged 23–30 weeks' gestation: a review of the literature
Margaret Allwood

The purpose of this study is to develop evidence-based skin care guidelines for premature neonates aged 23–30 weeks' gestation being cared for in the neonatal intensive care unit (NICU). This paper aims to provide an overview of the anatomy and physiology of neonatal, and specifically premature, skin. An understanding of the anatomy and physiology of premature neonates' skin is required before the full effect of environmental factors on the premature infant can be realised. Research relating to the care of premature infants' skin will be critically analysed and parallels and differences will be reported. Using this scientific knowledge and through critiquing the literature, guidelines for the skin care of infants aged 23–30 weeks will be developed. The guidelines will include recommendations for bathing, emollient use, the use of semi-permeable membranes in relation to trans-epidermal water loss, humidity and the use of adhesives. Areas for further research are identified and discussed. Infants born between 23 and 30 weeks' gestation have different skin structures than infants born at full term. For this reason, their skin requires specialised care by the neonatal nurse. Evidence-based guidelines will ensure the neonatal nurse delivers the best care for the extremely premature neonates in his/her care. The guiding question for this paper is: What is best practice for the care of the skin of infants aged 23–30 weeks' gestation?
Keywords: Neonatal, skincare, emollient, adhesives, transepidermal water loss, humidity.