Determining the Effect of Evidence Based Low-Stress Nursing Care on Premature Infants’ DNA Methylation

Faculty Sponsor

Christina Cavinder




Neonatal Nursing, Nursing Care, Low Stress Nursing Care

ORCID Identifier(s)

0000-0002-7525-3278, 0000-0002-8831-9360, 0000-0002-2854-0637, 0000-0002-9419-5798, 0000-0001-5165-685X, 0000-0002-3038-897X, 0000-0003-1722-4150, 0000-0002-0418-288X, 0000-0001-8257-5796, 0000-0002-4743-7512, 0000-0003-3230-3471, 0000-0002-7402-9311, 0000-0002-0759-2657, 0000-0001-5055-2442

Presentation Type

Oral Presentation

Symposium Date

Spring 4-29-2021



Evidence has shown that premature infants in the newborn intensive care units (NICU) experiencing stress in the areas of parental detachment, painful procedures, and exposure to noxious stimuli undergo DNA methylation (Montirosso & Provenzi, 2015). These epigenetic changes cause poor long-term psychological and social outcomes similar to post-traumatic stress disorder.


The purpose of this phase of the study is to provide additional education for the nurses and the parents to provide evidence-based low-stress nursing care.


Lighting and sound will be measured during the study to enable nurses to control the levels of noxious stimuli. Reduction in noise to less than 45 dB is recommended (Committee on Environmental Health, 1997). Nursing staff will be educated on the use of non-pharmacological agents for pain management during pain-inducing procedures. The use of kangaroo care will be promoted throughout the unit by the use of modest incentives for nurses and families. A pain assessment tool will be used to guide pain relief measures (Altimier, et al, 2015) along with comfort measures to improve physiologic stability (Altimier, et al, 2015).


This research project looks at providing low-stress nursing interventions to these vulnerable infants mitigating adverse DNA outcomes. Kangaroo Care regulates heart rate (Charpak et al., 2020), improves growth (Charpak, et al.,2020), decrease the length of stay (Ludington-Hoe, et al., 2008). Pain exposure results in epigenetic changes and adverse long-term developmental outcomes (Montirosso & Provenzi, 2015). Noxious stimuli, sound >70 dB causes changes in heart rate, blood pressure, pulse oximetry, respirations, peristalsis, glucose consumption (Graven, 2000). The correlation between interventions and DNA changes is significant to better understand the impact of evidenced-based practice nursing care. Educating nursing staff about the benefits and methods of low-stress nursing care could change the NICU environment by decreasing noxious stimuli, improving pain management, and increasing parental bonding leading to improved patient outcomes.

Biographical Information about Author(s)

  • Christina Cavinder teaches for the VU CONHP. Her area of expertise is pediatrics and infants. She has worked as a staff nurse in a NICU and PICU. As a NP in a NICU she does daily patient management and transports for critical infants. Her research is related to parent decision making in the newborn intensive care unit, and has published her evidence-based practice project regarding palliative care. She is a member of NAPNAP, ANA, NANN, and Sigma Theta Tau.

  • Angela M. Schooley develops nursing education efforts in the PNW undergraduate nursing curriculum. Schooley’s research focus includes neuroprotective care of the preterm infant. Prior to teaching she worked in the NICU at South Bend Memorial Hospital. As a NICU nurse she provided bedside care, acted as a charge nurse, and transporter for critically ill infants.

  • Additional authors include 14 Valparaiso University and 1 Purdue Northwest undergraduate nursing students.

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