oct 24 caphc breakfast symposium - sponsored by huggies - sharon dore

Every Change Matters*: A New Look at Diapering for Healthy Skin and Development

October 24, 2016

Before we start

To thank you for your participation today, Huggies® will be donating a days worth of diapers to Food Banks of Canada for

every attendee.

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Voigtman, Barbara

Voigtman, Barbara

We will need to add the (R) here by Huggies.

Voigtman, Barbara

I would like to understand more how the No Baby Unhugged program works in Canada. do have literature on that, that I can review?

Huggies® Nursing Advisory Council • Sharon Dore, RN, BScN, M Ed, PhD, Clinical Associate Professor, McMaster

University, Ontario, Canada

• Media Esser, NNP-BC, APNP, Neonatal Nurse Practitioner, Children's Hospital of Wisconsin

• Felicia Fitzgerald, BSN, RNC-OB, C-EFM, Perinatal Outreach Educator, Chicago, Illinois

• Kelli Kelley, Founder & Executive Director, Hand to Hold

• Joanne Kuller, RN, MS, Neonatal Clinical Nurse Specialist, UCSF Benioff Children’s Hospital

• Sue Ludwig, OTR/L, Founder & President, National Association of Neonatal Therapists

• Debianne Peterman, PhD, MSN, RNC-NIC, NE-BC, Assistant Vice President, Women's and Obstetrics Services, Hospital Corporation of America

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Voigtman, Barbara

Do we want to note the home locations of each council member?

Meet the Speaker

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Sharon Dore, RN, BScN, M Ed, PhD, Clinical Associate Professor,

McMaster University, Ontario, Canada

Voigtman, Barbara

Please note my last name is spelled Voigtman. I would state that I am from Neenah, WI as this is where KC is located.

A New Look at Diapering CareDiapering = a repetitive, routine task ??

But ... it can create a strong connection with the infant fostering growth & neurodevelopment.

This literature review the first to consider diapering

• within the context of developmental care and

• discuss comprehensive diapering care (skin care, physical development, sensory elements and bonding

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Learning Objectives 1. Review the evidence regarding

• physiological and psychological developmental care associated with diapering

• Physiology of skin care re diapering and diaper dermatitis

2. List 5 focus areas of developmental diapering care

3. Provide examples of education for parents, family and health professionals regarding developmental diapering care

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Audit of literature showed:Majority of existing research focuses on • prevention, diagnosis or resolution of diaper dermatitis,

• research related to diapering, diapers and baby wipes

Several studies showing that even standard caretaking procedures like diapering can lead to increased pain and stress responses in newborns

Identified a gap in the literature regarding a comprehensive document discussing diapering in a holistic manner

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Literature review- methodology

Extensively reviewed AWHONN’s Neonatal Skin Care: Evidence-Based Clinical Practice Guidelines

A PubMed search of > 80 diaper-related terms

An analysis of over 400 articles

Reviewed in detail over 70 citations

Conducted 4 detailed reviews of the material by members of the council

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Every Change Matters: A New Look at Diapering for Healthy Skin

and Developmentoperationalized through 5 core foci

Focus Area Description

Calm and Clean The Optimal Environment

Change and Check Developmental Activities of Daily Living

Comfort Pain and Stress Assessment and Management

Champion Sleep Protected Sleep

Confidence and Closeness Family-integrated Care

Voigtman, Barbara

I thought the NANN presentation was going to put in the icons that match the Every Change Matters manuscript for each focus area. Will we able to do this too?

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Calm and CleanThe Optimal Environment

• Ensure infant safety and comfort• Use appropriate sanitation and hygiene measures• Practice mindfulness• Provide caregiving based on infant cues• Moderate noxious sensory stimulation• Provide developmentally appropriate touch, movement, other environmental stimuli• Encourage bonding and emotional connection between infant & caregiver

Benefits of an optimal environment can include improved physiological & psychological responses, early brain maturation and healthy neurodevelopment.2,3

• 1. Coughlin ME. Trauma-Informed Age-Appropriate Care. In: Transformative Nursing in the NICU. New York, NY: Springer Publishing Company; 2014:29-40; 2. Doheny L, et al. Pediatr Int. 2012;54:e1-3; 3. McMahon E, et al. Ann NY Acad Sci. 2012;1252:17-24.

To promote an optimal diapering environment1

Change and Check Developmental Activities of Daily LivingTo promote healthy infant skin:

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1. Association of Women’s Health, Obstetric and Neonatal Nurses. Neonatal skin care, evidence-based clinical guidelines, 3rd ed. Washington, DC: AWHONN; 2014; 2. Counts JL, et al. Clin Pediatr (Phila). 2014;53(suppl 9):10S-13S; 3. Heimall LM, et al.. Maternal Child Nursing. 2013;17:10-6; 4. Helmes CT, et al. Clin Pediatr (Phila). 2014;53(suppl 9):14S-16S; 5. Odio M, Thaman L. Pediatr Dermatol. 2014;31(suppl 1):9-14; 6. Shin HT. Pediatr Clin N Am. 2014;61:367-82; 7. Stamatas GN, et al. Pediatr Dermatol. 2010;27:125-31; 8. Clark-Greuel JN, et al. Clin Pediatr (Phila). 2014;53(suppl 9):23S-26S; 9. Lund CH, et al. J Obstet Gynecol Neonatal Nurs. 2001;30:30-40; 10. Blume-Peytavi U, et al. Pediatr Dermatol. 2014;31:413-29.

Perform focused assessment of perianal area at each changeUse disposable diapers with super absorbent polymers1-6

Change diapers every 1-3 hours during the day; with each feeding, or at least 1 time per night1

Use baby wipes to thorough clean genital area at every change1

Encourage diaper-free time6,7 Ensure proper diaper fit2,4,5,8

Skin integrity is a challenge for all infants when exposed to situations known to compromise the skin; diaper dermatitis is the most common skin condition in infants. 9,10

ComfortPain & Stress Assessment / Management

To minimize infant stress and pain during diapering

• Educate parents /health professions to assess infant cues related to stress and pain 1,2 3

• Provide pain-prevention techniques such as non-nutritive sucking, kangaroo care, facilitated tucking, and nesting of bedding4-10

• Provide state & motor support during potentially stressful events4,11

Stress and pain experienced by premature infants in the NICU can alter the normal course of pain expressed in toddlers and preschoolers and lead to long-term emotional, behavioral and learning disabilities. 12-14

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1. Coughlin M, et al. J Adv Nurs. 2009;65:2239-48; 2. American Academy of Pediatrics, Canadian Paediatric Society. Pediatrics. 2000;105:454-61; 3. Karl DJ, et al. MCN Am J Matern Child Nurs. 2006;31:257-62; 4. Comaru T, Miura E. J Perinatol. 2009;29:504-7; 5. Dodds E. Paediatr Nurs. 2003;15:18-21; 6. Gardner SL, et al. Pain and pain relief. In: Gardner SL, Carter BS, Hines ME, Hernández JA, eds. Merenstein & Gardner’s Handbook of Neonatal Intensive Care. 8th ed. St. Louis, MO: Elsevier; 2016; 7. Gibbins S, et al. Expert Opin Pharmacother. 2003;4:475-83; 8. Johnston CC, et al. Biol Neonate.1999;76:120-4; 9. Stevens B, et al. Cochrane Database Syst Rev. 2013 Jan 31;1:CD001069; 10. Ward-Larson C, et al. MCN Am J Matern Child Nurs. 2004;29:151-6; 11. Sizun J, et al. J Pain. 2002;3:446-50; 12; American Academy of Pediatrics. Pediatrics. 2006;118:2231-41; 13. Grunau RV, et al. Pain. 1994;58:341-6; 14. Grunau RV, et al. Pain. 1994;56:353-9.

Champion Sleep/Protected SleepTo promote sleep: • Encourage Kangaroo care, skin-to-skin contact, gentle healing touch1-6

• Employ strategies to facilitate sleep cycle (e.g sleep assessment tools, cycled lighting) 7,8

• Expose infants to music therapy, singing, biological maternal sounds9,10

• Use diapers with wetness indicators to avoid unnecessary disruptions7,8

Adequate sleep for infants is connected to immune function enhancement, reduction in stress, cortical development and optimal neuromaturation. Sleep is also needed for linear growth and increased weight, as well as increased growth hormone.8,11-13

1. Association of Women’s Health, Obstetric and Neonatal Nurses. Neonatal skin care, evidence-based clinical guidelines, 3rd ed. Washington, DC: AWHONN; 2014; 2. Counts JL, et al. Clin Pediatr (Phila). 2014;53(suppl 9):10S-13S; 3. Heimall LM, et al.. Maternal Child Nursing. 2013;17:10-6; 4. Helmes CT, et al. Clin Pediatr (Phila). 2014;53(suppl 9):14S-16S; 5. Odio M, Thaman L. Pediatr Dermatol. 2014;31(suppl 1):9-14; 6. Shin HT. Pediatr Clin N Am. 2014;61:367-82; 7. Stamatas GN, et al. Pediatr Dermatol. 2010;27:125-31; 8. Clark-Greuel JN, et al. Clin Pediatr (Phila). 2014;53(suppl 9):23S-26S; 9. Lund CH, et al. J Obstet Gynecol Neonatal Nurs. 2001;30:30-40; 10. Blume-Peytavi U, et al. Pediatr Dermatol. 2014;31:413-29.

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Confidence and Closeness – Family-Integrated CareTo promote family-integrated care during diapering: • Integrate and involve family in all aspects of infant caregiving1

• Support parents in their new role as “confident caregivers” 2

• Encourage parents to incorporate developmentally appropriate care measures2

• Model use of the diaper change as an opportunity to engage with the infant3,4

• Share the importance of proper positioning and handling during diapering5,6

Healthcare professionals should, when possible, reserve intentional care measures for families to implement with their infant6

141. Craig JW, et al. J Perinatol. 2015;35(Suppl 1):S5-S8; 2. Cong X, et al. J Pain. 2012;13:636-45; 3. Coughlin M, et al. J Adv Nurs. 2009;65:2239-48; 4. Karl DJ, et al. MCN Am J Matern Child Nurs. 2006;31:257-62; 5. Lyngstad LT, et alEarly Hum Dev. 2014;90:169-72; 6. Sizun J, et al. J Pain. 2002;3:446-50; 7. McGrath JM. Family: essential partner in care. In: Kenner CM, Lott JD, eds. Comprehensive Neonatal Care: An Interdisciplinary Approach. 4th ed. St. Louis, MO: Saunders Elsevier; 2007.

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Discussion and Questions

Voigtman, Barbara

Can we put these by each appropriate focus area?

Voigtman, Barbara

See suggested changes.

Voigtman, Barbara

Barb: Thank you Sharon for the wonderful overview. Now that we’ve gotten an introduction to Every Change Matters, let’s dig a little deeper. I’d like to ask you Sharon, in your own opinion, why do you believe Every Change Matters is so important?

Voigtman, Barbara

I am not sure if this question makes sense...perhaps we can re-word it? Maybe say.....: I’m interested to hear from you how Every Change Matters may help parents in interacting with their infant?

Voigtman, Barbara

I would suggest moving this quesiton up a bit for better flow.

Thank you!

Voigtman, Barbara

Will we be opening this up to the audience or taking questions after the formal presentation? Will we be distributing the manuscript and accompanying professional guide?