How many Cs in NICU?

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Neonatal clinicians are challenged to ensure practice is evidence based and health outcomes are positive, which necessitates ongoing innovation and change. In the neonatal intensive care unit (NICU), assessment of the effectiveness of both new and existing interventions is required to reduce the burden of illness for extremely preterm infants and their families. The initial focus of the doctoral work outlined within this thesis was the investigation of the use of incubator humidity in the care of premature infants. My original doctoral plan was to undertake a randomised controlled trial in order to produce robust evidence to guide clinicians in humidity use and reduce the existing variability in practice. The doctoral work evolved to include a review of the broad literature that examines the physiological and historical context of humidification practices; a systematic review of randomised controlled trials that identifies a lack of research evidence to direct practice; a survey of humidification practices in NICUs across Australia and New Zealand that highlights the extent of the diversity in day-to-day practices; a single centre audit that was unable to detect any patterns between incubator humidity and neonatal health outcomes, but did reveal diversity in practice; and, the development of a protocol for the randomised controlled trial required to test the effect of different levels and duration of humidity and its effect on clinically important outcomes. The final chapters build on these findings and explore the kind of workplace cultures that are required to maximise the generation of meaningful evidence and the likelihood that clinicians would use this evidence to inform practice. The final chapter also explores the potential of contemporary social, cognitive, affective neuroscience for providing causal explanations for interventions such as transformational practice development (tPD) as well as providing pointers to additional strategies for creating more positive workplaces for clinicians and families.
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