Neonatal skin care : staff awareness and practice at the neonatal unit

Abstract

Maintaining an intact skin barrier is necessary for all newborns, during the adaptation from intrauterine to extrauterine life. However, this is particularly challenging for premature and full-term newborns requiring intensive or special care. The skin is subject to potential disruption and trauma during clinical practices, such as bathing, nappy changing and umbilical cord care, hence, the aim of this small-scale, quantitative research project is to investigate neonatal staff awareness and neonatal skin care practices in the neonatal unit. The objective set to achieve the overall aim of the study involves determining neonatal staff awareness of and practices concerning neonatal skin cleansing, antisepsis and the use of skin care products, the prevention of nappy dermatitis, and umbilical cord care. A total of 50 nurses and midwives (N = 50) recruited using purposive sampling, were selected from the neonatal intensive care unit (NICU) of the local general hospital. In total, 38 questionnaires were returned, resulting in a 76% (n = 38) response rate. The analysis of the closed-ended questions was carried out manually using simple, descriptive statistics. The results are presented in the form of absolute numbers, calculated percentages, pie-charts, bar-graphs, and frequency tables. The findings suggest that the neonatal staff carry out good practices in relation to skin cleansing, the prevention of nappy dermatitis, and umbilical cord care. Despite this, some practices, such as neonatal bathing and nappy changing, are done routinely, every three to four hours, and not according to evidence-based recommendations. Most of the participants seemed to be unaware of the possible harm of antiseptics, and emollient use in the unit seems to be inconsistent. There was lack of agreement between participants when they were asked about the availability of neonatal skin care protocols on the unit. Furthermore, while the midwives seemed to be more aware on the importance of vernix and the use of emollients, the nurses seemed to be more knowledgeable about antiseptics. The main recommendations generated from the present small-scale study include the introduction and promotion of evidence-based protocols in the neonatal and intensive care unit. The researcher also recommends the implementation of a practice nurse or midwife who specialises in neonatal skin care. Such professionals could promote the neonatal skin care guidelines in the unit and aid staff when they are faced with any skincare-related queries. Comparative studies should be undertaken, before and after the implementation of a practice nurse or midwife, in order to perceive the possible benefits and limitations. In view of the fact that evidence-based skin care guidelines are always changing, it is recommended that neonatal staff members are kept updated through regular neonatal skin-care courses. Moreover, further studies using a larger, randomly selected sample of neonatal staff is also suggested so that the outcomes can be evaluated.