Guest Editorial - Standards for neonatal intensive care nursing education in Australia: Bring it on!
Victoria Kain

Maternal–infant synchrony: an integrated review of the literature
Brenda Baker, Jacqueline M McGrath

Background: A critical review of the literature was conducted to identify current science related to maternal–infant synchrony including: (a) definitions; (b) contributing factors; (c) measurement, and (d) how maternal–infant synchrony contributes to the continuum of the mothering experience.
Methods: Using the search terms maternal–infant synchrony, maternal–infant interaction and maternal–infant attachment, databases were searched including Medline, CINAHL, and PsychINFO. Only English language research and integrated reviews published after 1985 and applicable to maternal populations and infants less than one year of age were included. Studies specific to multiple gestations or infants with congenital anomalies were excluded. Research comparing term and preterm infants was included as prematurity provides a context to study the emergence of neurobehavioural development and effects of dysregulation on maternal–infant synchrony. Based on the inclusion criteria, 23 published articles were included in this review.
Results: Numerous overlapping definitions of maternal–infant synchrony were found. Findings clearly identify several positive newborn outcomes related to maternal–infant synchrony, including development of attachment relationships, development of infant language skills and social-emotional competence. Most research on maternal–infant synchrony has been conducted within the context of the behavioural sciences and/or in laboratory settings employing videotaping, analysis and coding of behaviours. Tools to specifically measure maternal–infant synchrony are limited.
Conclusion: Synchrony is a dynamic, timed relationship that benefits both mother and infant. Synchrony reflects an appropriate fit between maternal and infant behaviour that develops from responsive and sensitive mothering and fosters infant attachment and ultimately social, emotional and self-regulatory growth and trust.
Keywords: maternal–infant synchrony, maternal–infant interaction, maternal–infant attachment.

The trial and evaluation of a clinical pathway for parents with substance use issues
Robyn Penny, Jan Pratt

Aim: This study aimed to identify if a clinical pathway plan of care (SUPa) had the potential to improve outcomes for infants in families affected by substance use issues.
Background: Internationally, approximately 10% of children live in homes where there is some form of alcohol or other drug abuse or dependence. This places children at increased risk of poorer health outcomes including abuse and/or neglect. Traditionally, services such as child health have had limited capacity and knowledge to work with families with drug use issues. While many studies have focused on supporting parents in drug treatment, little has been done to examine preventive work with families presenting to universal community child and family health services.
Design: This prospective, quasi-experimental study was conducted in Queensland, Australia. Participants included women with substance use issues and child health service staff (child health nurses and early intervention parenting specialists). Data was collected by chart audit and focus groups.
Results: SUPa is a useful tool to develop evidence-based practice, improving teamwork and staff knowledge and skills. Service engagement with parents and safety planning for parenting also improved. Further evaluation is needed to assess other child health outcomes.
Implications for practice: Implementing clinical pathways in practice is a significant change that requires ongoing support. While structured care plans are an important evidence-based practice tool, they can be tailored to individual client need using sound clinical judgement. SUPa has the potential to improve outcomes for infants in families affected by substance use issues.
Keywords: substance use, SUPa, parenting, drug misuse, child health, home visiting, clinical pathway.

Don’t get lost in translation: nursing children as medical tourists
Ellen Ben-Sefer, Chaya Balik, Orna Friedman, Linda Shields

Medical tourism is a growing trend in health care as families seek more affordable options in medical care and treatment for their children. Children who require care outside their home country present special challenges, dilemmas and issues for nurses who must provide that care. Culture, language and social support must all be considered in a family-centred care approach. This paper explores the emergence of medical tourism as a health care phenomenon, and explores the essential skills of an experienced paediatric medical tourism nurse in Israel.
Keywords: medical tourism, culture, family, family-centred care.

Using the Delphi technique to develop standards for neonatal intensive care nursing education
Trudi Mannix

The purpose of this study was to use the Delphi technique to determine the first draft of national standards for neonatal intensive care nursing (NICN) education. The Australian College of Neonatal Nurses (ACNN) endorsed the project and assisted in the selection of members for a panel of 13 NICN and education experts from all Australian states that conducted NICN education programmes. These experts were consulted over a period of seven months using the Delphi technique. The researcher initially developed a set of questions to guide the expert panel.
Over a series of three iterations and using a consensus level of 75% agreement, most standards were agreed to. Areas addressed were programme requirements, prerequisite requirements, programme leadership, theoretical programme structure and content, clinical education programme structure and content and educator support. Subsequent work will finalise the standards for publication and subsequent use by NICN educators and clinicians across Australia. Throughout this paper, the terms ‘neonatal intensive care nursing’ and ‘neonatal nursing’ are used. The use of the word ‘nursing’ in these phrases refers to the provision of care to the infant in the neonatal intensive care unit (NICU). Both nurses and midwives provide this care.
Keywords: Delphi, standards, education, neonatal nursing.

Cochrane Nursing Care Network
Carmel Collins