Evidenced Based Practice with PICO Question

Introduction

Evidence – Based Nursing (EBN) practice incorporates the application of best research evidence, nursing professional knowledge, and patient values to deliver quality care. This paper seeks to present evidence based nursing practices for late preterm infants. It is notable that mothers of late preterm infants may face a myriad of challenges in feeding such children. The choice has to be made between breastfeeding and formula feeding. Nurses have to make the decision in order to guide mothers to feed their children well. The late preterm babies incorporate a constituent of rapidly escalating population in the country. They are normally cared for according the specific newborn feeding strategies and settings to promote healthy development and growth. The late preterm infants face massive challenges in the course of their development including weight loss and breastfeeding inabilities. The babies also face challenges associated with hypoglycemia, respiratory distress, and prematurity, and weak breast sucking abilities. Most of such children may end up dying than their normal term infants. Therefore, under the nursing settings evidence based practices should apply when advising on the best approaches for feeding late preterm infants. The nursing process should adopt a specific feeding care program for the late preterm infants as opposed to using the feeding strategies, which are applicable for term and normal children. The late preterm infants include babies born in the 34th or 35th week gestational period.

Asking the PICO Question

Among the population of late preterm babies, what are the consequences of breastfeeding on general development when related with formula nurturing?

Search for the Evidence

DeMauro, S., Medoff – Cooper, B., Posencheg, M., and Abbasi, S. (2011). Post discharge feeding patterns in early- and late-preterm infants. Clinical Pediatrics, 50(10), 957 – 962.

Radtke, J. V. (2011). The Paradox of Breastfeeding-Associated Morbidity Among Late Preterm Infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40, 9–24.

Souto, A., Pudel, M., and Hallas, D. (2011). Evidence-based care management of the late preterm infant. Journal of Pediatric Health Care, 25(1), 44 – 49.

Critical Analysis of the Evidence

Evidently, the PICO question contains the critical components of population, which describes the characteristics of the clients. The study by Radtke (2011) focused on research pertaining to breastfeeding of late preterm infants. The research focused on breastfeeding establishment and results among such babies. Furthermore, the study sought to describe the position of science on breastfeeding among the late preterm infants (Radtke, 2011). The research used a study selection approach of nine data – based articles, which examined breastfeeding patterns and results with the population. The study also extracted data from the articles including effect sizes and statistics, which focused on breastfeeding aspects such as initiation, length, exclusivity, and health results within the population of late preterm breastfed infants (Radtke, 2011).

The study indicated that within the population of late preterm infants, those who are initiated on breastfeeding account for about 59% through to 70%. The odds of exclusive breastfeeding are lower within the population (Radtke, 2011). The study also indicated that many late preterm infants were hospitalized again on several occasions. The reasons for hospitalization were associated with poor breastfeeding challenges (Radtke, 2011). The study indicated that non-breastfed late preterm infants were also taken to hospital again. The breastfeeding challenges for such children were common because the home based care settings lacked the application of evidence based feeding guidelines. The study concludes that the late preterm infants’ faces massive risks associated with breast-feeding (Radtke, 2011). This has made many of the babies to be taken back to hospital for management under the care of nurses. The poor breastfeeding establishment has caused the problem and has contributed to too many other health challenges (Radtke, 2011).

In this case, the client is a male baby boy delivered at the 35th gestational age. The baby’s mother has multi – gravida. The appropriate assessments are undertaken to confirm the gestational age of the baby immediately after delivery (Souto, Pudel and Hallas, 2011). The hospital discharge records are reviewed to reveal that the mother is a Hepatitis B antigen carrier. The mother underwent an emergency caesarean section for showing diminishing heartbeat rates before delivery. The evidence indicates that late preterm infants have challenges with cold stress since their glycogen store are normally less developed. Their epidermal barrier is also normally less developed (Souto, Pudel and Hallas, 2011).

The babies have increased metabolic rates and diminished capacities to generate heat. Their diminished muscle tone escalates the body surface area receiving direct heat.

In addition, the population of youngsters can undergo breathing distress at the primary hours of their birth. Their deliveries are normally facilitated through Caesarian section thus escalating their tachypnea and respiratory distress (Souto, Pudel and Hallas, 2011). The lessened glycogen and fat stores pose health risks to the babies. Furthermore, diminished abilities to generate glucose may endanger infants’ wellbeing. The incapacity that such youngsters show towards insulin production predisposes them to hypoglycemia. The significance of best practices in feeding late preterm infants cannot be overemphasized in such scenarios. Nursing practitioners have to monitor the blood glucose levels among such babies. Particularly, this should take place in their initial three hours of their delivery (Souto, Pudel and Hallas, 2011). The glucose levels of the children are then anticipated to escalate after that period.

Evidently, late preterm infants feeding challenges emanate from their weak sucking abilities. This diminishes the amount of breast milk in every sucking attempt. This is an indication that nurses should give mothers’ of late preterm infants’ attention in the initial days after their delivery. The nurses should put into use the evidence-based practice to enable mothers breastfeed their infants (Souto, Pudel and Hallas, 2011). The adoption of the late preterm infant feeding guidelines is crucial for helping the mothers. The guideline provides strategies for anticipating, recognizing, and managing the breastfeeding challenges in patients during home based care (Souto, Pudel and Hallas, 2011).

The study by DeMauro, Medoff – Cooper, Posencheg and Abbasi (2011) focused on comparing the incidence of feeding dysfunction associated with post discharge of late preterm infants from hospitals. It also focused on frequency of hospital revisits because of problems associated with feeding during the initial one year of life among the late preterm infant population groups.

The researchers used questionnaires to 319 mothers of late preterm infants at the intervals of 3, 6, and 12 months. The questionnaires incorporated issues of parents’ attitudes towards late preterm infants, their ease of initiating breastfeeding, and the number of times they revisited hospitals for feeding challenges (DeMauro et al., 2011).

The results indicated that preterm infants had breastfeeding dysfunction at the third month resulting in 29% and twelfth month resulting in 7%. Furthermore, the results indicated that late preterm infants showed evident breastfeeding habits at the third month at 33%. The study showed that dysfunction and breastfeeding avoidance reduced as the months progressed (DeMauro et al., 2011). The rates of hospital visits due to feeding problems among the children showed great similarities with the dysfunctions.

Nursing Implications

The nursing professionals should ensure that they screen all late preterm infants for any feeding challenges and dysfunction throughout the initial year in order to recommend the best feeding approach (DeMauro et al., 2011). Furthermore, it is paramount that nursing practitioners should recommend the late preterm infants feeding guidelines.

References

DeMauro, S., Medoff – Cooper, B., Posencheg, M., and Abbasi, S. (2011). Postdischarge feeding patterns in early- and late-preterm infants. Clinical Pediatrics, 50(10), 957 – 962.

Radtke, J. V. (2011). The Paradox of Breastfeeding-Associated Morbidity Among Late Preterm Infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40, 9–24.

Souto, A., Pudel, M., and Hallas, D. (2011). Evidence-based care management of the late preterm infant. Journal of Pediatric Health Care, 25(1), 44 – 49.

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NerdyRoo. (2022, May 15). Evidenced Based Practice with PICO Question. Retrieved from https://nerdyroo.com/evidenced-based-practice-with-pico-question/

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NerdyRoo. 2022. "Evidenced Based Practice with PICO Question." May 15, 2022. https://nerdyroo.com/evidenced-based-practice-with-pico-question/.

References

NerdyRoo. (2022) 'Evidenced Based Practice with PICO Question'. 15 May.

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