Name: Elizangela Sant'Anna da Silva
Type: MSc dissertation
Publication date: 08/08/2022

Name Rolesort descending
Cândida Caniçali Primo Advisor *

Examining board:

Name Rolesort descending
Cândida Caniçali Primo Advisor *
Norma Suely Oliveira Garcia External Alternate *
Sarah Gimbel External Examiner *
Márcia Valéria de Souza Almeida Internal Alternate *
Eliane de Fátima Almeida Lima Internal Examiner *

Summary: Introduction: Premature birth has a significant relationship with infant morbidity and
Introduction: Preterm infants are extremely vulnerable and, therefore, during the first
hour of life, known as the golden hour, good practices must be performed to reduce
neonatal morbidity and mortality. This project aims to meet an institutional demand for
improvements in the care of premature infants, is aligned with the research line
organization and evaluation of health care systems and was developed in partnership
with the institution`s staff. General Objective: To implement good practices in the
golden hour of premature new-borns. Specific objectives: To design, implement and
evaluate the implementation process of the multiprofessional care protocol for the first
hour of life of the premature infant under 34 weeks of gestation. Methodology:
Implementation research conducted in a Neonatal Unit of a university hospital in the
state of Espírito Santo, Brazil. Participants were the multiprofessional team composed
of physicians, nurses, nursing technicians and physiotherapists. The research was
carried out in 6 stages and used the PDCA cycle. In the first stage, a situational
diagnosis was made about care during the first hour of life of preterm infants under 34
weeks of age. In the 2nd stage a work group was formed with 12 professionals from
the multidisciplinary team, for the planning and elaboration of the Protocol. In the 3rd
stage, online training was carried out, followed by on-site orientation in small groups
or individually. In the 4th stage, the Protocol was implemented over 4 months. In the
5th step, a survey of the barriers and facilitators of the implementation process was
carried out, using a questionnaire based on the domains of the Consolidated
Framework for Implementation Research. In the 6th step the protocol was monitored
and reviewed. Bardin`s content analysis was used to analyse the qualitative data, and
descriptive analysis was used for the quantitative data. Results: Through a collective
construction, the institution`s first protocol for the care of PIs under 34 weeks of age
during their first hour of life was finalized. The material was organized under four main
pillars: cardiorespiratory stabilization, hypothermia prevention, hypoglycaemia
prevention and infection prevention. After training and implementation, the protocol
was evaluated by the professionals as a quality, low cost, and not very complex
intervention necessary for the service. Training was considered the main facilitator for
team adherence, especially from other sectors, and lack of knowledge was cited
among the main barriers. Educational actions ranked first among suggestions for
improvement. Products: Protocol, Flowchart, Bundle and educational boards for the
first hour of life of premature new-borns under 34 weeks. Conclusion: The protocol
and products are already implemented and generating positive impacts in the
institution. This research has the potential to be applied regionally and nationally, as it
systematically describes an innovative method with the necessary steps and resources
to implement good practices. The research influenced changes in practice, but the
maintenance of evidence-based care and recommended in the protocol, demands a
permanent education of the neonatal team and other sectors involved, to assist
adherence and better results.

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