Neonatal skin assessments and injuries: Nomenclature, workplace culture and clinical opinions—Method triangulation a qualitative study

Abstract

Aim and objective: To explore and establish the language, clinical opinions and workplace culture around neonatal skin injury nomenclature. Specifically, what nomenclature is used to describe, define, identity and communicate neonatal skin injuries including (a) terms, (b) locations, (c) associated risks and (d) mechanical forces. Background: Skin injuries are affirmed or denied based on visual assessment with findings reported by language rather than measurements. However, if language or nomenclature is ambiguous, assessments could be misinterpreted effecting healthcare delivery. Design: Qualitative enquiry including applied discourse analysis and betweenmethod triangulation, within a larger exploratory mixed-methods study. Methods: Data were collected over two years from four sources: literature, documents, interviews/focus groups and free text injury assessments. Data analysis included content analysis, selective coding and thematic analysis. The collective data were further explored using discourse analysis and triangulation to achieve collective conclusions about opinions, emotions, feelings, perceptions and workplace cultures. The COREQ checklist provided structure for the reporting of study methods, analysis and findings. Results: A total of 427 data points were collected from literature, documentation and two clinical data sources. Data convergence revealed that neonatal skin injuries are described by numerous terms with preferences for "injury," "trauma" or "redness." Injuries occur in over 20 anatomical locations and risks for injuries included hospitalisation, specific treatments and prematurity. Essential medical devices, clinical condition, lack of clinician experience and overactive neonates were uniquely associated risks. There was incongruency between sources. The literature and documents empathise pressure as the primary force related to skin injury, while varied forces were identified within interviews, focus groups and free text injury assessments. | 3987 AUGUST eT Al.

Evaluating the Effectiveness of Brief Training for Neonatal Intensive Care Nurses on the Prevention of Medical Device-Related Nasal Pressure Injury

“…Decreased cohesion between the dermis and the epidermis in the newborn is responsible for the more rapid disruption of skin integrity. 17,32 At early gestational ages, neonatal skin is thinner, and the decreased cohesion between the epidermis and dermis layers 16,22,33 causes higher incidence of MDRPI in preterm infants. 16,33 Broom et al 34 reported that skin injuries occurred in 54% of neonates younger than 32 weeks of gestation, 44% of those between 32 and 36 weeks of gestation, and 28% of neonates older than 36 weeks of gestation.…”

“…These injuries are common in babies in the NICU. 16,32 García-Molina et al 36 reported that 84.1% of neonates admitted to the NICU developed PI, of which 54% were NIV related. The first nursing intervention to prevent nasal MDRPI is to perform a risk assessment using a tool with proven validity and reliability and plan nursing care according to the infant's risk level.…”

“…15,18,32,37 Providers should evaluate the area under the medical device every 2 to 4 hours by separating the apparatus from the infant's nasal cavities. 18,28,32 However, in the present study, fewer than 20% of the participants responded Studies on the correct use of the NIV apparatus to prevent nasal injuries have indicated that the cap bands should not be tightened in an effort to better fit the cannula to the nose, because this applies pressure to the face and contributes to injury. 21,22,28 In addition, the interface connecting the cannula to the ventilator should be at the midline; otherwise, the resulting leakage does not sufficiently prevent pressure and leads to nasal injury.…”

Neonatal skin injury scales: a scoping review with narrative synthesis protocol

“…Mechanical force skin injuries have been identified in the literature as a neonatal complication since the 1980s 1,2 . Neonates are particularly vulnerable to skin injuries related to hospitalised care, with a variety of severities identified in previous studies 3 .…”

“…The NPUAP injury staging system has been co-endorsed by the European Pressure Ulcer Advisory Panel and the Pan Pacific Pressure Injury Alliance for all populations, including neonates. However, while neonates sustain skin injuries from a number of mechanical forces similar to adults, the maturity of neonatal skin puts the application of adult injury scales into question 1,2,7 . A mechanical skin injury is defined as a distortion or injury of the integrity of the skin and/or underlying integumentary structures by external motion 3,6 .…”