In neonates tracheostomies are most often indicated to provide a stable airway for infants with congenital or acquired airway obstructions and to provide long-term mechanical ventilation. Learning to care for an infant with a tracheostomy can be challenging for both professionals and families. This article provides an overview of tracheostomy care and the essential elements of family teaching. The surgical procedure and basic anatomical changes are reviewed. Complications such as accidental decannulation, mucus plugging, infection, bleeding, and granulation tissue formation are discussed. Humidification is critical for the infant with a tracheostomy and humidification delivery methods are discussed. Further, an overview of the impact of the tracheostomy on normal development, such as swallowing and language development, is provided. Teaching parents to safely care for the infant with a tracheostomy at home requires careful planning and systematic education. The parents must acquire a unique set of technical skills demonstrating competence and comfort in providing stoma care, suctioning, and tube changes. Parents must be prepared to initiate cardiopulmonary resuscitation (CPR) and need to understand alterations in CPR techniques in infants with a tracheostomy. They also need to develop critical thinking skills to handle emergency situations. A safe transition to the home can be accomplished by using a multidisciplinary approach to coordinate all facets of care.
Attention to staffing patterns is paramount. Team-building activities may help foster mutual respect and collegiality among the nursing staff and between disciplines. Research investigating creative staffing patterns would be helpful. Interprofessional research may also reduce stressors and enhance team performance.
Reed's theory of self-transcendence describes relationships between vulnerability, self-transcendence, and well-being. Contemplative practices can promote self-transcendence and well-being, consistent with this theory. The central concepts of Reed's theory of self-transcendence are presented. Ways contemplative practices can be utilized to promote 1 or more dimensions of self-transcendence and well-being are discussed.
The purpose of the study was to investigate the presence and relationship of self-transcendence and spiritual well-being in persons who have participated in short-term, faith-based, foreign, healthcare missions. This was a descriptive correlational study with the addition of open-ended questions. The mean Self-Transcendence Scale score for this sample was higher than mean scores of comparison studies and scores for women were higher than mean scores for men. Qualitative data provided rich accounts of the central concepts of Reed’s self-transcendence theory. Reed’s theory of self-transcendence was extended to a new and different population.
Forms of human milk banking and donation have been present for more than a century worldwide, but, since 1985, the Human Milk Banking Association of North America (HM BANA) has established guidelines to make the use of donor's breast milk safe and the second best form of feeding to maternal breast milk for a neonatal intensive care unit (NICU) infant. The Indiana Mother's Human Milk Bank provides an extensive and meticulous process of selecting breast milk donors. The process begins with a phone interview with a potential donor and includes the review of the donor's medical records, blood laboratory screening, medication and dietary intake, as well as consent from the donor's pediatrician. The milk bank follows steps of collecting, storing, and receiving the breast milk in accordance with the guidelines of the HM BANA. Pasteurization is the method used to ensure the proper heating and cooling of breast milk. Despite the rigorous pasteurization method, the donor's breast milk will not lose most of the important beneficial components needed for sick or ill NICU infants. Every batch of pasteurized breast milk will be cultured for any possible contamination and shipped to NICUs after it has been cleared by laboratory testing.
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