When change becomes the constant in the patient care equation, it can be a challenge to keep up with new information and processes and make plans to use the best new evidence. In this issue on innovations in clinical practice, we look at several types of change that affect practice, from prenatal counseling and interventions to team-based improvements to the physical space in which birth occurs.
Knutzen and Stoll review the several types of genetic screening and diagnostic testing offered during pregnancy. As they point out, this area of prenatal assessment has become increasingly complex and requires time and sensitivity to help families put the choices into perspective. Because most testing falls under the category of optional rather than standing prenatal care, the authors address best counseling practices.
The microbes living within us are becoming understood as a significant contributor to health. Dunn, Hanson, VandeVusse, and Leslie offer a scoping review of research regarding the human microbiome, probiotic use, and common prenatal complications. As their use is better understood, probiotics may help decrease adverse outcomes from preeclampsia, gestational diabetes, and preterm birth.
Gams, Neerland, and Kennedy discuss the Reducing Primary Cesarean Births Project, a team-based intervention that is part of a national collaboration sponsored by the American College of Nurse-Midwives. Noting the increased risks of both immediate- and long-term challenges that result from a woman's first cesarean birth, their birthing unit participated in a patient safety project that has led to decreased numbers of primary cesareans. Nurses, midwives, and physicians all shared in developing and implementing the plan. Their description of the process can serve as an exemplar for teams interested in changing unit culture.
Finally, Breedlove and Rathbun examine how the space in which women give birth can affect their labors; they reverse the equation to see how the space in which care is provided (unit workflow) affects the nursing staff's ability to care for families effectively. They point out that research exists to guide best design practices and discuss the resources that are available to support change. Human-centered design is one path to improving the odds of a physiologic birth.
We encourage the reader to review the Expert Perinatal column. In addition, this issue does not contain the Legal Issues and Risk Management column, but instead there is A Tribute to Lisa Miller, former Perinatal Contributing Editor for The Journal of Perinatal & Neonatal Nursing (JPNN), who for the past 8 years has written the Legal Issues and Risk Management column. That column will continue with the next JPNN issue with a new Contributing Editor.
Our current issue is focused on innovations in clinical practice. It is an important topic for neonatal nurses, who have led countless innovations in clinical practice over the past several decades. These nurse-led innovations, along with the types of innovations reported in our current issue, have resulted in a positive impact on health outcomes for infants and their families.
The neonatal section of the journal features 5 outstanding contributions, highlighting various innovations in clinical practice. Our first and final articles in the issue report on the use of novel technologies for the placement of peripheral intravenous catheters in preterm infants, the first being reported from authors in Turkey and the other from authors in China. The second article highlights the effects of paternal skin-to-skin contact in newborns and fathers following birth via cesarean section, as reported from a study conducted in China. In the third article, we hear about a novel approach to parent education regarding infant pain management. While it has long been known that most newborns undergo painful procedures, pain management strategies are inconsistently used. In this article, we learn about an effective parent-targeted video demonstrating use of pain-reducing strategies that was tested in a mother-baby unit in Canada. Finally, our fourth article is a systematic review of the effectiveness of the neonatal early-onset sepsis calculator. This work, reported by an authorship team from the United States, critically evaluates a recent innovation in clinical practice, that being the neonatal early-onset sepsis calculator. As you can see, we have clinical innovations occurring across the world that will make the next generation of impact on health outcomes for infants and their families.
Our expert columnist Joan Smith has provided a thought-provoking column for our consideration, and Terese Verklan has given us some parting thoughts to ponder. I want to thank Sara Rostas, who led our Pharmacology Principles and Practice column over the past few years. Due to new professional demands on Sara's time, she is no longer able to write this column for the Journal of Perinatal and Neonatal Nursing (JPNN). If you know of a colleague who might be willing to write a similar column in Sara's absence, please let me know. We are grateful to Sara for starting this column and hope that we might be able to find someone to continue to provide up-to-date information on pharmacology for neonatal nurses.
Please reach out to us with any thoughts or suggestions for the journal. We have several great topic areas planned for forthcoming issues of the journal: disparities and access to care, emergency and disaster readiness, intrapartum care and the birth experience, preterm labor and birth issues, and the microbiome. It is never too soon to begin preparation of a manuscript for one of these topics-we welcome your submissions!
-Jan M. Kriebs, MSN, CNM, FACNM
Perinatal Guest Editor
-Katherine E. Gregory, PhD, RN, FAAN
Neonatal Editor