Assessment of parent understanding in conferences for critically ill neonates

Neuropsychology's Role in Multidisciplinary Follow-Up Care of Neurologically Complex Infants and Toddlers

BACKGROUND

Adverse effects on brain development prenatally and during early childhood can disrupt cognitive development, with earlier neural insults often proving to be particularly detrimental. As such, infants and toddlers with neurological conditions are at increased risk for medical and neurodevelopmental complications. Pediatric neuropsychologists are well suited to evaluate brain-behavior relationships and identify emergent delays in these patients. The roles of pediatric neuropsychology in the care of neurologically complex young children are reviewed and discussed by highlighting a novel neonatal intensive care unit (NICU) follow-up clinic model.

METHODS

The Developmentally Ready: Engagement for Achievement of Milestones (DREAM) Clinic is a multidisciplinary NICU follow-up clinic designed for the care of neurologically complex young children. The DREAM Clinic is led by neonatal neurology and supported by pediatric neuropsychology, neonatology, physical medicine and rehabilitation, and pediatric psychology.

RESULTS

The review of pediatric neuropsychologists' contributions to the DREAM Clinic elucidated that pediatric neuropsychologists are valuable care partners to both medical providers and families in this multidisciplinary setting.

CONCLUSIONS

The DREAM Clinic provides a model for the structure, feasibility, and importance of involving pediatric neuropsychologists in the multidisciplinary developmental follow-up care of neurologically complex young children.

A Seat at the Table: Family Conferences for Infants with Neurological Conditions

Objective: We aimed to characterize parents' perspectives on the value of and opportunities to improve conferences between parents of critically ill infants and the health care team. Background: The parent perspective on the value of family conferences in the intensive care unit is not well characterized. Methods: In this descriptive qualitative study, parents of infants with neurological conditions in the intensive care unit at a U.S. academic medical center completed longitudinal semi-structured interviews about their experiences making decisions and communicating with clinicians. Parents were included if they had an upcoming family conference to discuss goals of care or neurological prognosis. This secondary data analysis targets interview content about family conferences. Parent responses were characterized using a conventional content analysis approach. Results: Fifty-two parents of 37 infants completed 123 interviews. Parents described valuing when clinicians (1) provided space to process emotions, (2) prioritized "big picture" discussions about serious decisions, (3) dedicated time to parent questions, and (4) responded to parent concerns and made an effort to foster consensus. Parent-identified opportunities for improvement included: (1) having the team assume responsibility for calling regular meetings, (2) prioritizing attendance of consistent and supportive team members, and (3) summarizing meeting content for parents and documenting discussions for clinicians. Conclusions: These findings demonstrate that parents of infants with neurological conditions value family conferences as an important venue for communicating with the health care team. Future studies should explore the feasibility and impact of regularly scheduled family conferences, attendees dedicated to parent support, and accessible meeting summaries on therapeutic alliance, parent well-being, and communication quality.

Medical Team Practices and Interpreter Alterations on Family-Centered Rounds

BACKGROUND

Robust evidence demonstrates inequities in communication during family-centered rounds for families who use a language other than English (LOE) for health care. This study aimed to characterize the type of interpreter alterations occurring on family-centered rounds and identify medical team communication practices associated with alterations.

METHODS

In this observational study of interpreter-supported family-centered rounds, we recorded and transcribed family-centered rounds encounters for Spanish-speaking families. We assessed measures of medical team communication behaviors and interpreter alterations (omissions, additions, and substitutions) using previously described instruments. We used a content analysis approach to apply defined codes to each interpreted segment and to characterize the nature of interpreter alterations. We assessed the association between medical team communication behaviors and interpreter alterations using χ2 tests.

RESULTS

We recorded, transcribed, and coded 529 interpreted segments of 10 family-centered rounds encounters. At least 1 alteration was present in 72% (n = 382/529) of interpreted segments. Omissions were the most common alteration (n = 242/529, 46%) followed by substitutions (n = 177/529, 34%) and additions (n = 71/529, 13%). Interpretation resulted in a potentially negative alteration in 29% (n = 155/529) and a positive alteration in 9% (n = 45/529) of segments. Greater number of sentences in the segment preceding interpretation was associated with an increase in loss of information (P < .001), loss of social support (P = .003), and loss of partnership (P = .020).

CONCLUSIONS

To improve communication with families that use an LOE, medical teams must abide by best practices for using an interpreter such as frequent pausing to prevent loss of both biomedical and psychosocial information.

Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation

AIM

To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care.

DESIGN

The concepts' uses in the literature were analysed to determine attributes, influences, and relationships.

METHODS

Delineations of each concept are established and conceptual definitions are proposed following Morses' methods.

DATA SOURCES

MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023.

RESULTS

Multinational publications dated 1991-2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family-integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf.

CONCLUSION

These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers.

IMPLICATIONS

Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family-integrated care delivery.

IMPACT

Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family-integrated care delivery.

FINDINGS

Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another.

IMPACT

Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family-integrated care delivery.

Improving Parental Knowledge of Medically Complex Neonates Through Scheduled Conferences

Reports of parental dissatisfaction from incomplete or inconsistent information led to a quality improvement (QI) project to establish planned family conferences at 10 days and 1 month of life, for 50% of the medically complex neonates admitted to a neonatal intensive care unit within 1 year. A QI team instituted a system in which social workers scheduled family conferences and a neonatologist conducted the conferences. Team members tracked measures using statistical process control charts over 21 months. The QI team scheduled conferences for greater than 80% of eligible families, with an 86% completion rate on days 10 and 30, exceeding project goals of 50%. The majority of the families surveyed were satisfied with the meetings. Only 2% of parents surveyed found meetings burdensome, compared to 14% of physicians. A sustainable method for scheduling meetings and preparation for conferences, including the use of a template led to success.

"You become a slightly better doctor": Doctors adopting integrated medical expertise through interactions with E-patients

The accessibility of information via the internet has radically altered the doctor-patient relationship. By means of in-depth interviews with Israeli physicians from four different specialties, this study explored how physicians cope with internet-informed patients, referred to as e-patients, and examined how they make sense of their new professional roles. Findings show that three types of boundaries in the doctor-patient relationship have been blurred by the emergence of the e-patient: the boundaries between doctors' and patients' knowledge, between doctors' authority and patients' autonomy, and between positivistic knowledge and humanistic knowledge. Each of these is a boundary between liberal and non-liberal values. Only the combination of all these components produces, according to the participants, a good doctor. I call this new phenomenon integrated medical expertise and explain how it diverges from previous notions of 'good doctoring'.