Massage Therapy for Feeding Intolerance in NICU Preterm Infants
This paper examines massage therapy as a nursing intervention for feeding intolerance in preterm infants (less than 37 weeks gestation) in the Neonatal Intensive Care Unit. Using a PICO framework, the paper investigates whether massage application can reduce feeding intolerance in this vulnerable population. Roy's Adaptation Model (RAM) is identified as the applicable nursing theoretical framework, with the paper explaining how RAM's emphasis on physiological adaptation aligns with the digestive challenges faced by preterm neonates. The paper argues that massage therapy promotes physiological adaptation by stimulating parasympathetic activity, improving gastric motility, and reducing symptoms of feeding intolerance.
- Introduction and PICO Question: Clinical problem identified; PICO question formulated
- Roy's Adaptation Model Overview: RAM's four adaptive domains explained
- Applying RAM to Preterm Infant Care: RAM applied to neonatal digestive physiology
- Massage Therapy as a Nursing Intervention: Massage mechanism and physiological adaptation effects
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What makes this paper effective
- Clearly frames the clinical problem using a PICO question, grounding the inquiry in evidence-based nursing practice.
- Logically connects a nursing theory (RAM) to a specific clinical intervention, demonstrating how theoretical frameworks inform bedside practice.
- Explains physiological mechanisms (peristalsis, bowel transit time, gastric emptying) concisely, making the argument clinically credible.
Key academic technique demonstrated
The paper demonstrates theory-to-practice application: it introduces Roy's Adaptation Model at a conceptual level, then systematically maps each component of the model (especially physiological needs) onto the specific problem of feeding intolerance in preterm infants. This technique shows how abstract nursing frameworks can justify and guide concrete clinical decisions.
Structure breakdown
The paper opens by identifying the clinical problem and posing a PICO question. It then introduces RAM, explains its four adaptive domains, and narrows focus to the physiological domain most relevant to neonatal feeding. The final section bridges theory and intervention by explaining the physiological mechanisms through which massage therapy promotes adaptation. The argument flows linearly from problem identification to theoretical justification to intervention rationale.
Introduction and PICO Question
Feeding intolerance has been identified as a significant problem for infants in the Neonatal Intensive Care Unit (NICU). Inquiry has revealed massage therapy as a possible nursing intervention for this problem (Shaeri et al., 2017). Additional knowledge is desired to determine whether new research findings present clinically significant evidence for use of the intervention in the NICU patient population. Toward this end, a PICO question has been formulated: does massage therapy applied to infants born at less than 37 weeks gestation reduce feeding intolerance?
Roy's Adaptation Model Overview
Given the increased prominence of theory-based nursing, identifying an applicable nursing framework is important. One model that can be used in addressing the identified problem is Roy's Adaptation Model (RAM). Indeed, RAM is one of the most widely used nursing models. Essentially, the model emphasises patient adaptation to the environment (Saini et al., 2017). As per the model, the nurse focuses on improving the patient's ability to interact with the adjacent environment.
Viewing the individual as an adaptive system, RAM asserts that the role of the nurse during the care process is to help the individual adapt to changes in four areas: physiological needs (e.g., oxygenation, nutrition, and neurologic function); self-concept (e.g., self-perception and spirituality); role function (e.g., social roles); and interdependent relationships (e.g., social support, social relationships, and communication). Adaptation in this context denotes the process by which an individual consciously integrates their human perception with their surrounding environment. Theoretically, an individual has the ability to identify internal and external stimuli and to respond to those stimuli through autonomic and cognitive mechanisms, ultimately leading to behavioural change.
Applying RAM to Preterm Infant Care
RAM is applicable to the paediatric population and, more specifically, to the identified PICO problem. As per the model, the paediatric patient's adaptive behaviour is enhanced by applying a nursing intervention that manipulates the underlying causes of the problem, thereby resulting in physiological and psychological adaptation (Saini et al., 2017). Feeding intolerance in preterm infants is mainly attributable to poor functioning of the infant's digestive system, such as slow gastric emptying (Shaeri et al., 2017). In line with RAM, this represents a physiological need.
As a result, the role of the NICU nurse is to help the infant adapt to extrauterine life during the neonatal period. The nurse can achieve this by enhancing the infant's interaction with the surrounding environment — more specifically, by applying interventions that improve the infant's digestive function and thereby increase extrauterine adaptation.
References
Saini, N., Sharma, V., Arora, S., & Khan, F. (2017). Roy's adaptation model: Effect of care on paediatric patients. International Journal of Nursing & Midwifery Research, 4(1), 52–60.
Shaeri, M., Ghadami, A., Valiani, M., Armanian, A., & Rarani, S. A. (2017, March). Effects of abdominal massage on feeding tolerance in preterm infants hospitalized in selected hospitals of Isfahan-Iran. International Journal of Pediatrics, 5, 4503–4510. http://dx.doi.org/10.22038/ijp.2017.21376.1795
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