Lund CH, Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA, et al.
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN. Date of publication 2001 Jan 1;volume 30(1):41-51.
1. J Obstet Gynecol Neonatal Nurs. 2001 Jan-Feb;30(1):41-51.
Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical
practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses
and the National Association of Neonatal Nurses.
Lund CH(1), Osborne JW, Kuller J, Lane AT, Lott JW, Raines DA.
Author information:
(1)Intensive Care Nursery, Children's Hospital Oakland, CA 94609, USA.
OBJECTIVE: To test the effectiveness of an evidence-based clinical practice
guideline for neonatal skin care on selected clinical outcomes for newborns in
neonatal intensive-care units (NICU), special-care units (SCU), and well-baby
nurseries.
DESIGN: Prospective evaluation of the collaborative neonatal skin care
research-based practice project of the Association of Women's Health, Obstetric
and Neonatal Nurses and the National Association of Neonatal Nurses.
SETTING: NICU and well-baby units in 51 hospitals located throughout the United
States.
PARTICIPANTS: Member site coordinators (N = 51) and the neonates (N= 2,820)
observed during both the pre- and postimplementation phases of the project.
METHOD: Site coordinators received specialized education in neonatal skin care
and implemented an evidence-based clinical practice guideline addressing 10
aspects of neonatal skin care. Baseline observations of skin condition, care
practices, and environment of newly admitted neonates were collected by site
coordinators. Postimplementation observations were then completed.
MAIN OUTCOME MEASURES: Skin condition was assessed with the Neonatal Skin
Condition Score (NSCS), which ranges from a score of three (best condition) to a
score of nine (worst condition), based on dryness, erythema, and skin breakdown.
Changes in frequency of selected skin care practices were used to assess the
effectiveness and feasibility of using the practice guideline in everyday
clinical practice. Aspects of the care environment with potential effect on skin
integrity were monitored to determine risk factors.
RESULTS: Fifty-one site coordinators made 11,468 systematic assessments of 2,464
NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in
well newborns compared with premature newborns. After implementation of the
guideline, skin condition was improved, as reflected by less visible dryness,
redness, and skin breakdown in both the NICU/SCU and well newborns. The
guideline was integrated into care, as evidenced by increased use of emollients,
particularly with premature infants, and decreased frequency of bathing. A
relationship was shown between selected aspects of the environment and
alterations in skin integrity.
CONCLUSIONS: Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical
Practice Guideline was successfully implemented at 51 sites, and effectiveness
was demonstrated by changed care practices and improved skin condition in
premature and full-term newborns. The results of this project support a wider
dissemination of the project's practice guideline for neonatal skin care.
PMID: 11277161 [Indexed for MEDLINE]
