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Systematic Literature Review

Introduction to Neonatal Nursing

Neonatal nursing is the subspecialty of the nursing domain that specializes in working with the newborn children who are premature infants or have some serious health issues (Alfes et al., 2018). They are the primary care takers of the newborn infants that ensures that the infants are breathing and developing properly. This subspecialty of nurses works in health care settings, community settings and hospitals for the newborn infants that have some conditions that requires substantial medical care. These nurses highly rely on delivering evidence based care practices to the new born infants so that safe and high quality of care can be ensured (Walvoord, 2019). The Australian College of Neonatal Nurses (ACNN) is the peak professional body for neonatal nurses and it suggests that the neonatal nurses understand the importance of research in nursing practice. The standard 14 states that the neonatal nurses practices within an evidence-based framework, participates in activities related to the enhancement of neonatal nursing practice and is able to critically review research articles. The neonatal assessment of growth and development is done in this literature review (Kaye, 2016). The neonatal nurses also makes use of evidence based practice to refine their practice and in order to achieve better patient outcomes that is better health outcomes of the new born infants.

Research question

What is the impact of use of evidence based practice in neonatal nursing on the patient outcomes?

Search Strategy of Neonatal Nursing

The literature search will be carried out using databases. A range of databases like PubMed, CINAHL, MEDLINE and ProQuest will be searched using relevant key terms and search terms so that various articles can be extracted. The search terms will be used in combination with the Boolean operators as it helps in finding the more relevant articles as the key terms are separated using AND, OR and NOT. The variety of keyterms are used so that diverse search can be carried out. The search terms used for finding the relevant literature are:

  • Neonatal nurses AND evidence based practice
  • Evidence based practice AND neonatal health
  • Neonatal nurses AND evidence based practice AND patient outcomes
  • Evidence based practice OR Evidence based care AND neonatal nurses
  • Evidence based nursing AND neonatal nursing
  • Neonatal care AND Evidence based practice

The above mentioned key terms will be used for the search of relevant articles that has the potential to answer the framed research question. The articles will be selected based on inclusion and exclusion criteria. The articles will only be included for review if they are from 2014- 2019 and any article with publishing date before 2014 will be excluded from the list. The second inclusion criteria is the language. The articles that are in English language will only be selected. The selected articles will then be evaluated for their content so that their findings can best answer the research question.

Research Methodology of Neonatal Nursing

This is a literature review in which the research methodology is the qualitative research design. This is the secondary qualitative design in which variety of secondary sources from the databases and other online sources will be extracted for their review. The data will be collected as per inclusion and exclusion criteria and this will then be reviewed to answer the framed research question. The advantage of qualitative research design is that it answers the research question as a phenomena is being answered and the literature search gives evidence for the answer of the question (Bearman, 2019). This data collected from various articles will then be evaluated for their findings prior to data analysis. The data analysis will be performed after the data collection and evaluation.

The data analysis will be done using thematic analysis in which various themes will be generated based on the findings of the data collected from the databases. The thematic analysis helps in categorizing the common themes that represents the varied data collected from the articles (Braun et al., 2019).

The findings will be presented in the terms of themes and then a discussion will be made that will take into account different themes to answer one research question farmed.

Evaluation of Chosen Articles



Type of study



Article- 1

Baker, 2015

Qualitative; descriptive study

The findings of this study suggests that the increased risk of hypothermia among late preterm infants is common and this when addressed using evidence based approach helped in better patient outcomes. The clinical practice guide was established to be used as standard of evidence based care as it provided preventive care strategies for LPI.

The limitation of this study is this is only relied on their own guidelines and does not consider other approaches.

Article- 2

Saunders et al., 2014

Secondary study; retroscpective study

The findings of this study states that the use of evidence based practice is common among the neonatal nurses and this has a direct impact on the length of neonatal intensive care unit length of stay as it was seen to be reduced by 10.35 days after the implementation of evidence based multidisciplinary neonatal abstinence syndrome protocol.

The limitation of this study is that the findings of this article is based on the very small data that is based 386 cases that does not ensures the efficacy of this protocol.

Article- 3

Briere et al., 2015

Qualitative secondary study

As per this study, the neonatal nurses used evidence based recommendations for guiding the practice and for addressing the challenges that late preterm infants face with breastfeeding and they were successful in achieving better patient outcomes in this context. Thus the use of evidence based practice made them address this challenge which was done as per the literature, guidelines and policies.

The limitation of this study is that it does not take into account the lack of education among mothers and also is based on the LPI only.

Article- 4

McQueen, Murphy- Oikonen & Desaulniers, 2015

Descriptive study; Retrospective chart review

The findings of this study suggests that the evidence based interventions like methadone was used in mothers who are addicted to substance use during pregnancy and it resulted in better patient outcomes. There is a need of exploration of other evidence based interventions so that the negative outcomes associated with the NAS can be minimized. The evidence based practice utilized by the neonatal nurses resulted in better patient outcomes.

The limitation of this study is the sample size because it is just 131 mother- infant pairs who were studied for the efficacy of methadone as a solution for neonatal abstinence syndrome.

Article- 5

Benoit & Semenic, 2014

Qualitative; descriptive design

In this study, the evidence based approach of baby- friendly hospital initiative in the neonatal intensive care units was analysed when implemented in the hospital setting. The findings of this study suggests that this evidence based approach is associated with better patient outcomes and the potential value of BFHI was recognized in the NICU settings.

The limitation of this study is that interview of sample of medical and nursing managers were conducted and as per their role they may be more inclined in implementing evidence based breastfeeding and the second limitation is the high risk of positive response bias.

Discussion of Themes

Use of evidence based practice in breastfeeding

As per the studies taken into consideration for this literature review, it is analysed that the use of evidence based practice for the neonatal care is common in the health care settings. The use of EBP is known to produce better patient outcomes when measured in the terms of breastfeeding (Kenner, 2019). Breastfeeding issue is encountered by mothers of new born infants and the nurses make use of EBP from the literature and other sources to teach mothers the accurate way that is safe and productive. The evidence based care for breastfeeding was referred from the guidelines and policies that are set for the mothers and neonatal nurses in the NICU settings.

Use of evidence based practice in Neonatal abstinence syndrome

Neonatal abstinence syndrome protocol provides EBP care and allows the nurses to use this practice for better patient outcomes (Tobin, 2018). The use of EBP is common in such cases because many women use opioids during pregnancy and when the child is born with NAS, they use EBP for their care. This is highly effective and commonly used by the nurses (Parker et al., 2018). NAS is a group of conditions with which the baby is born due to mother being addicted to substance abuse. As per the studies considered for this literature review, the use of EBP proves to be effective and safe in the cases of NAS.

Impact of the use of evidence based practice

This theme of impact of the use of EBP on the patient is commonly taken from all the articles selected. The impact of the use of EBP is always found to be positive in the patients and is helpful in achieving positive patient outcomes. The use of EBP has proven its worth from saving the nurses from the difficult situations to saving the new born infants thus this is highly safe and effective for the patients and for the neonatal nurses (Milligan & Goldstein, 2017). As per the findings of these studies, the neonatal nurses promote the use of EBP among their colleague nurses due to its high effectivity.

Nurses’ satisfaction on using evidence based practice

The findings of this study also suggests that the nurses feel highly satisfied with positive patient outcomes because the use of EBP makes them confident on the quality of the care they provide to the new mothers and their newborn infant children (White et al., 2019).

Findings of Neonatal Nursing

The findings of this literature review suggests that the use of EBP is quite common among the neonatal nurses and it is associated with positive patient outcomes. The neonatal nurses serves the new mothers and the newborn infants who are really sick or are premature. The premature babies require special care and attention because they are weak and sick because of non- familiar conditions outside the womb and also because of their underdeveloped body and structure (Kukla et al., 2018). The nurses feel highly satisfied with their job and the service they provide to the new born infants and the new mothers because they become successful in providing safe care. The nurses use EBP for various issues like breastfeeding issues with the new born infants, the issues with substance use disordered pregnant women, neonatal abstinence syndrome and other issues.

The use of EBP is successful in providing high quality of nursing care for each of these issues (Thomas, 2019). In neonatal nursing, the care environment exhibits multiple aspects of EBP and the whole neonatal health care team engages in it. It also allows the nurses to build a good environment for the new mother and new born infants thus positive outcomes are achieved (Aredes et al., 2018). The use of EBP enables the application of empirically acquired knowledge into practice and it also associated with preventing deaths in neonatal units due to hypothermia and breastfeeding issues. The key to application of EBP is staff knowledge and other contextual factors that are highly influential in making neonatal nurses use EBP. These studies suggests that the increased use of EBP results in the improved neonatal care thus a great reduction in neonatal mortality. The major contributing factor that results in inequities in quality of care and neonatal survival is low level of staff knowledge (Lago et al., 2017).

Conclusion on Neonatal Nursing

The conclusion drawn is that the neonatal nurses use EBP in the neonatal intensive care unit and this is positively associated with the advancement in neonatal care that is given to the new born infants. The neonatal nurses get multiple opportunities where they apply EBP projects that helps in improving the quality of care for the mothers and the families. The inclusion of evidence- based clinical guidelines helps the neonatal nurses in adhering to this approach of applying knowledge into practical work. The use of EBP is high among neonatal nurses and it is associated with positive patient outcomes. The neonatal nurses faces various challenges while caring for the new born infant who is really sick or premature and the use of EBP into the care helps them in achieving patient outcomes. This is also associated with job satisfaction among the nurses because they feel confident while delivering nursing care to the child and the new mother.

References for Neonatal Nursing

Alfes, C. M., Hickman, R., & Fitzpatrick, J. (Eds.). (2018). Handbook of Clinical Nursing: Pediatric and Neonatal Nursing. Springer Publishing Company.

Aredes, N. D. A., Dias, D. M. V., Fonseca, L. M. M., Campbell, S. H., Martins, J. C. A., & Rodrigues, M. A. (2018). E-baby skin integrity: Evidence-based technology innovation for teaching in neonatal nursing. Escola Anna Nery22(3).

Baker, B. (2015). Evidence‐based practice to improve outcomes for late preterm infants. Journal of Obstetric, Gynecologic & Neonatal Nursing44(1), 127-134.

Bearman, M. (2019). Key concepts in qualitative research design. In Healthcare Simulation Research (pp. 73-78). Springer, Cham.

Benoit, B., & Semenic, S. (2014). Barriers and facilitators to implementing the baby-friendly hospital initiative in neonatal intensive care units. Journal of Obstetric, Gynecologic & Neonatal Nursing43(5), 614-624.

Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic analysis. Handbook of Research Methods in Health Social Sciences, 843-860.

Briere, C. E., Lucas, R., McGrath, J. M., Lussier, M., & Brownell, E. (2015). Establishing breastfeeding with the late preterm infant in the NICU. Journal of Obstetric, Gynecologic & Neonatal Nursing44(1), 102-113.

Kaye, S. (2016). Historical trends in neonatal nursing. The Journal of Perinatal & Neonatal Nursing30(3), 273-276.

Kenner, C. (2019). Comprehensive neonatal nursing care. Springer Publishing Company.

Kukla, A., Dowling, D. A., & Dolansky, M. A. (2018). The history and state of neonatal nursing quality improvement practice and education. Neonatal Network37(2), 78-84.

Lago, P., Garetti, E., Bellieni, C. V., Merazzi, D., Savant Levet, P., Ancora, G., ... & Pain Study Group of the Italian Society of Neonatology. (2017). Systematic review of nonpharmacological analgesic interventions for common needle‐related procedure in newborn infants and development of evidence‐based clinical guidelines. Acta Paediatrica106(6), 864-870.

McQueen, K. A., Murphy-Oikonen, J., & Desaulniers, L. (2015). Maternal substance use and neonatal abstinence syndrome: A descriptive study. Maternal and Child Health Journal19(8), 1756-1765.

Milligan, P. S., & Goldstein, M. R. (2017). Implementation of an evidence-based non-invasive respiratory support (NIRS) bundle in the NICU to decrease nasal injury complications. Journal of Neonatal Nursing23(2), 89-98.

Parker, L. A., Withers, J. H., & Talaga, E. (2018). Comparison of neonatal nursing practices for determining feeding tube insertion length and verifying gastric placement with current best evidence. Advances in Neonatal Care18(4), 307-317.

Saunders, C., King, T., Smith, S., Buchheit, J., Cook, K., Edds, J., & Mefford, L. (2014). Neonatal abstinence syndrome: Evaluating the effectiveness of an evidence-based multidisciplinary care approach. The Journal of Perinatal & Neonatal Nursing28(3), 232-240.

Thomas, P. E. (2019). 27 Evidence-based practice. Neonatal Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions, 417.

Tobin, K. B. (2018). Changing neonatal nurses' perceptions of caring for infants experiencing neonatal abstinence syndrome and their mothers: An evidenced-based practice opportunity. Advances in Neonatal Care18(2), 128-135.

Walvoord, E. (2018). Implementation of an Evidence-based practice model in a rural community hospital: a guide to neonatal nursing practice. Retrieved from http://dspace.creighton.edu:8080/xmlui/handle/10504/117878

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2019). Translation of evidence into nursing and healthcare. United States: Springer Publishing Company.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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