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Logo of bmcnursBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Nursing
BMC Nurs. 2012; 11: 3.
Published online Mar 12, 2012. doi:  10.1186/1472-6955-11-3
PMCID: PMC3395837
Capacity building of nurses providing neonatal care in Rio de Janeiro, Brazil: methods for the POINTS of care project to enhance nursing education and reduce adverse neonatal outcomes
Brian A Darlow,corresponding author1 Andrea A Zin,2 Gina Beecroft,3 Maria EL Moreira,4 and Clare E Gilbert5
1Department of Paediatrics, University of Otago, Christchurch, New Zealand
2Paediatric Ophthalmologist, Instituto Fernandes Figuera, FIOCRUZ, Rio de Janeiro, Brazil
3Neonatal Service, Christchurch Women's Hospital, Canterbury District Health Board, Christchurch, New Zealand
4Neonatologist, Instituto Fernandes Figuera, FIOCRUZ, Rio de Janeiro, Brazil
5International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
corresponding authorCorresponding author.
Brian A Darlow: brian.darlow/at/; Andrea A Zin: zin.andrea/at/; Gina Beecroft: Gina.Beecroft2/at/; Maria EL Moreira: bebete/at/; Clare E Gilbert: Clare.Gilbert/at/
Received December 19, 2011; Accepted March 12, 2012.
Increased survival of preterm infants in developing countries has often been accompanied by increased morbidity. A previous study found rates of severe retinopathy of prematurity varied widely between different neonatal units in Rio de Janeiro. Nurses have a key role in the care of high-risk infants but often do not have access to ongoing education programmes. We set out to design a quality improvement project that would provide nurses with the training and tools to decrease neonatal mortality and morbidity. The purpose of this report is to describe the methods and make the teaching package (POINTS of care--six modules addressing Pain control; optimal Oxygenation; Infection control; Nutrition interventions; Temperature control; Supportive care) available to others.
Six neonatal units, caring for 40% of preterm infants in Rio de Janeiro were invited to participate. In Phase 1 of the study multidisciplinary workshops were held in each neonatal unit to identify the neonatal morbidities of interest and to plan for data collection. In Phase 2 the teaching package was developed and tested. Phase 3 consisted of 12 months data collection utilizing a simple tick-sheet for recording. In Phase 4 (the Intervention) all nurses were asked to complete all six modules of the POINTS of care package, which was supplemented by practical demonstrations. Phase 5 consisted of a further 12 months data collection. In Phase 1 it was agreed to include inborn infants with birthweight ≤ 1500 g or gestational age of ≤ 34 weeks. The primary outcome was death before discharge and secondary outcomes included retinopathy of prematurity and bronchopulmonary dysplasia. Assuming 400-450 infants in both pre- and post-intervention periods the study had 80% power at p = < 0.05 to detect an increase in survival from 68% to 80%; a reduction in need for supplementary oxygen at 36 weeks post menstrual age from 11% to 5.5% and a reduction in retinopathy of prematurity requiring treatment from 7% to 2.5%.
The results of the POINTS of Care intervention will be presented in a separate publication.
Trial registration
Current Controlled Trials: ISRCTN83110114
Keywords: Brazil, Neonatal care, Neonatal nursing, Quality improvement, Neonatal mortality, Premature infant, Retinopathy of prematurity, Education, Continual professional development
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