The Challenges of Implementing Family-Centered Care in NICU from the Perspectives of Physicians and Nurses

Environment Enrichment Strategies for Pre- and Post-Term Infants: A Summarized Communication From Pediatric Physical Therapists

PURPOSE

Environmental enrichment (EE) represents a dynamic approach to enhance infants' cognitive and motor development through augmented environment with stimulating, novel opportunities. Despite the recognized benefits of EE on neuromotor outcomes, its integration into early physical therapy interventions for infants at risk of neuromotor delays and disabilities remains under-defined and inconsistently applied in standard practice. This gap underscores the necessity for comprehensive guidance to systematically incorporate EE into early intervention programs and daily routines.

SUMMARY OF KEY POINTS

This paper provides a preliminary framework for the integration of EE into the clinical and home environments for infants from birth to 1 year of age.

RECOMMENDATIONS FOR PRACTICE

With the 7 key components of EE, including sensory system stimulation (auditory, proprioceptive, tactile, vestibular, and visual stimulations), cognitive challenges, and social engagement, this framework aims to maximize cognitive and motor development for infants at both pre and post-term age by leveraging the principles of EE(Supplemental Digital Content,Video, available at: http://links.lww.com/PPT/A624 ).

Culture of Family-Centered Care in the NICU

BACKGROUND

Family centered-care (FCC) has documented benefits for infants, parents, and staff, but is variably practiced.

PURPOSE

To describe parental and staff perspectives on the quality of FCC culture in a neonatal intensive care unit (NICU).

METHODS

Parents of hospitalized infants and staff at a referral NICU completed validated survey instruments to measure NICU FCC quality on topics including trust, communication, and shared decision-making at multiple time points. We compared parent and staff responses using a cumulative log-odds model with a single predictor to model the odds of a score lower than a prespecified value.

RESULTS

A total of 92 parents of 80 NICU infants and 96 NICU providers participated. Most rated items highly, indicating a positive experience with FCC. The items with the highest scores for parents were receiving guidance and being trusted in their infant's care (both 97.1% positive); for staff, listening to parents (95%). Receiving/providing emotional support received the lowest scores from parents (19.1% negative or neutral) and staff (24.5%). Parent and staff answers differed significantly for 6 of 8 questions, with lower scores reported by staff relative to parents.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Parents and staff have variable perspectives on different aspects of FCC. Understanding these nuances of centers' FCC culture can help target interventions and may strengthen FCC delivery for NICU infants and families and career satisfaction for staff. Future directions include assessing FCC quality over time and among specific infant, family, and staff cohorts, especially diverse populations to determine if FCC is equitably delivered.

Barriers to Developmental Care in the NICU: An Integrative Review

BACKGROUND

Variability in developmental care implementation in the neonatal intensive care unit (NICU) highlights the need to explore barriers to care delivery, yet few studies addressed these challenges.

PURPOSE

Drawing from NICU literature, this integrative review identifies barriers to implementing developmental care with premature infants.

METHODS

A systematic search of CINAHL and PubMed (2014-2024) was conducted, yielding 2 qualitative and 5 quantitative studies.

RESULTS

Thematic analysis revealed 3 key barriers based on the theory of planned behavior: attitude, subjective norm, and perceived control.

CONCLUSIONS

To improve developmental care, a multi-pronged approach engaging stakeholders is recommended. Future research should apply rigorous implementation science methods to overcome these barriers.

Outcomes Following Close Collaboration With Parents Intervention in Neonatal Intensive Care Units: A Nonrandomized Clinical Trial

Importance

Family-centered care (FCC) in neonatal intensive care units (NICUs) is critical for parental involvement and infant well-being, yet few studies have evaluated the impact of FCC interventions on practice or examined how implementation fidelity may affect these outcomes.

Objectives

To evaluate the association between the Close Collaboration With Parents intervention and FCC practices and how implementation fidelity may modify these outcomes.

Design, Setting, and Participants

This nonrandomized clinical trial had a before-and-after design. It was conducted between March 2021 and June 2023 at 6 NICUs in Estonia and included the parents of all newborns and all staff.

Intervention

Close Collaboration With Parents is an educational intervention for multiprofessional NICU staff including e-learning and bedside practices combined with reflection sessions. It aims to improve FCC culture by developing staff skills in communication and collaboration with parents and parenting support.

Main Outcomes and Measures

The quality of FCC was assessed using a 1-time questionnaire for the parents with 9 questions from the Digi Family-Centered Care-Parent version tool, and daily questions for the staff using Digi Family-Centered Care-Nurse version tool. The association between implementation fidelity, defined as the proportion of staff who completed the full education, and the quality of FCC was also analyzed.

Results

A total of 186 infants (with responses from 186 mothers and 22 fathers) were included in the preintervention period. The median (IQR) gestational age was 37.4 (34.0-39.9) weeks, 94 infants (50.5%) were male, and the median (IQR) parental age was 32 (28-36) years. A total of 208 infants (with responses from 208 mothers and 55 fathers) were included in the postintervention period. The median (IQR) gestational age was 38.1 (35.4-39.9) weeks, 114 infants (55.1%) were male, and median (IQR) parental age was 32 (27-35) years. From the staff, 7448 and 6717 daily responses were analyzed in the preintervention and postintervention periods, respectively. The total rating was significantly higher after the intervention than before, by both the parents (r = 0.07; P < .001) and the staff (r = 0.10; P < .001). The median ratings did not, however, change: the parents' median (IQR) overall rating before and after was 7.0 (6.0-7.0), and the staff's median (IQR) overall rating was 6.0 (5.0-7.0) before and 6.0 (6.0-7.0) after. Implementation fidelity ranged from 4 of 30 health care professionals (13.3%) to 37 of 45 (82.2%) at the NICUs. The NICUs with high fidelity, as opposed to low fidelity, had significantly greater improvement in FCC ratings by the staff after the intervention (β = 2.1 [95% CI, 0.8-3.4]; P = .002).

Conclusions and Relevance

In this nonrandomized clinical trial, FCC practices were rated higher by the staff and parents after the Close Collaboration With Parents intervention. Implementation fidelity was identified as an important factor.

Trial Registration

ClinicalTrials.gov Identifier: NCT06258655.

Evaluation of the impact of family-centered care training on pediatric nurses' attitudes

OBJECTIVE

This study aimed to evaluate the impact of structured Family-Centered Care training on pediatric nurses' attitudes toward Family-Centered Care.

METHODS

This quasi-experimental study utilized a pretest-posttest control group design with 140 pediatric nurses (70 intervention, 70 control). Conducted in public hospitals from March to August 2024, the intervention group received a four-week Family-Centered Care training. The Family-Centered Care Attitude Scale was used to measure attitudes, and data collection included a demographic data form administered both before the training and six weeks after its completion. Statistical analysis included t-tests and chi-square tests.

RESULTS

Nurses in the intervention group showed significant improvement in their attitudes toward Family-Centered Care after training, with higher posttest scores compared to the control group (P < 0.05). The control group showed no significant changes between pretest and posttest scores. These findings confirmed the hypothesis that Family-Centered Care training positively influences pediatric nurses' attitudes.

CONCLUSIONS

Structured Family-Centered Care training significantly improved pediatric nurses' attitudes toward Family-Centered Care, emphasizing the importance of innovative educational methods in promoting Family-Centered Care adoption in pediatric nursing.

IMPLICATIONS FOR PRACTICE

Incorporating regular Family-Centered Care training into pediatric nursing practices can foster more Family-Centered Care approaches, improve patient and family satisfaction, and promote nurses' professional growth, ultimately enhancing the overall quality of care in pediatric settings.

Fathers' experiences of nurses' roles and care practices during their preterm infant's stay in the neonatal intensive care unit

INTRODUCTION

Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents.

AIM

Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU.

DESIGN

Qualitative study using ethnographic data collection techniques.

METHODS

Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis.

RESULTS

Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities.

CONCLUSION

Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial.

RELEVANCE TO CLINICAL PRACTICE

Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities.

REPORTING METHOD

Adherence to the COREQ guidelines.

Caregiver experiences of oral feeding in infants on long-term high flow nasal cannula support

PURPOSE

Navigating the feeding journey of medically complex infants on long-term high flow nasal cannula support can be challenging for caregivers, especially given inconsistencies in clinical practice for oral feeding on high flow nasal cannula support. The aim of this study was to explore the perspectives of caregivers who have experienced this journey, to inform best practice care.

METHOD

This study used a generic qualitative inquiry approach. Semi-structured interviews were conducted with seven caregivers of children who had been on long-term high flow nasal cannula support as infants during 2021. Reflexive thematic analysis was used to generate meaning-united stories.

RESULT

All caregivers reported oral feeding difficulties that persisted beyond hospitalisation, resulting in demanding mental loads and care arrangements. Caregivers described how these difficulties were often exacerbated by complex medical needs and the strategies they experimented with to support oral feeding. Caregiver's experiences in the healthcare system were characterised by inconsistencies in care pathways and variable access to specialist feeding services. The importance of a collaborative relationship with healthcare professionals and a conducive hospital environment were also highlighted.

CONCLUSION

The oral feeding journey for families with infants on long-term high flow nasal cannula support was characterised by multifaceted challenges and implications. Further research is required to establish and provide consistent, family-centred, and evidence-based care for this population.

Beyond the healthcare system: The societal and contextual factors impacting parents' participation in decision-making for neonates with life-threatening conditions

BACKGROUND

Parents of neonates with life-threatening conditions and professionals, bear the burden of making complex decisions. Parents may not be fully involved in decision-making, and there is a paucity of evidence regarding the influence of social context on parents' participation. We aimed to explore factors that extended beyond the healthcare system and impacted parents' participation in decision-making for neonates with life-threatening conditions.

MATERIALS AND METHODS

This qualitative research was carried out in 2019 in four level-III Iranian NICUs, (neonatal intensive care units) where twenty-three face-to-face semi-structured interviews were conducted, transcribed, and analyzed using a conventional content analysis technique. Interviews were condensed into meaningful units during the coding phase, resulting in 206 open codes. These codes were then categorized into eleven categories based on commonalities and distinctions. This iterative process continued until 4 main subcategories were established.

RESULTS

The main categories and sub-categories were "unmodified regulations according to the neonatology advances" (lack of regulations to modify ineffective treatments, lack of a legally documented do not resuscitate order, lack of a defined regional neonatal viability threshold, and lack of maternal guardianship of child medical care), "deficiencies of the health insurance system" (covering the cost of ineffective treatments and lack of insurance covering for palliative care services), "treatment-oriented culture in society" (expecting a miracle for medical science, difficult acceptance of neonatal death and difficult acceptance of home death), and "physician-oriented culture in society" (excessive respect for physicians' decision-making eligibility and social position of physicians).

CONCLUSION

The findings revealed concepts surrounding parents' participation in decision-making for life-threatening conditions neonates are influenced by social, legal, cultural, and financial aspects. To bridge the gap between healthcare professionals' attitudes and cultural and religious beliefs, fatwas, and laws, a collaborative approach is necessary. To address the complex challenges of decision-making for these neonates, involving stakeholders like clinicians, legal experts, Islamic scholars, sociologists, jurists, judges, and medical ethicists is crucial for modifying laws to align with neonatology advancements.

Factors affecting family-centered care practice by nurses: A systematic review

PURPOSE

This study presents a systematic review of the obstacles to and enablers of family-centered care (FCC) implementation by nurses. FCC, which has demonstrated beneficial outcomes, is regarded as a crucial quality measure in certain pediatric units. However, not all nurses incorporate FCC into their practice.

DESIGN AND METHODS

A systematic review was conducted from January to June 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various medical subject heading keywords and terms were used to search electronic databases, with the aim of synthesizing and evaluating the results.

RESULTS

Twenty-three articles were identified for review. Most of these studies were carried out in Western countries. They revealed several facilitators and obstacles to FCC implementation by nurses when caring for sick children. Some of these factors are linked to the personal attributes of the nurses, while others are associated with the characteristics of the families and the healthcare system itself.

CONCLUSION

Nurses face multi-level barriers that hinder their ability to implement FCC practice. This systematic review identifies the need to leverage nurses' attributes, foster effective nurse-client relationships, and promote organizational changes.

PRACTICE IMPLICATIONS

Nurses need to comprehend and work toward altering the factors that influence the delivery of FCC. The findings of this review can be used by healthcare organization leaders and policymakers to customize interventions and allocate resources to promote FCC practice. Further research in diverse cultural contexts is needed to examine the cause-and-effect relationship concerning the influence of the identified barriers and facilitators on FCC practice. In addition, experimental studies are required to evaluate the effectiveness of evidence-based interventions on FCC practice by nurses.

Family-centered care for newborns: a global perspective and review

Person-centered models of care built on newborn and family needs and rights, such as nonseparation immediately after birth and during the care process, can address the complex needs of the newborn, family, and health system. This is particularly important in low- and middle-income countries, where cost-effective modalities are highly needed to accelerate the survival of newborn babies. We conducted a systematic review to explore country experiences on implementation and challenges to implement and scale-up family-centered newborn care models of care. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched to identify studies on patient-centered care and newborns between 1990 and 2023. Studies meeting our predefined inclusion criteria were quality assessed and relevant data extracted. We utilized the World Health Organization framework on integrated people-centered health services to summarize and analyze findings while highlighting patterns. Forty-one studies were included for review (including approximately 60% from low- and middle-income countries). Different research conducted over time highlighted how immediate and uninterrupted skin-to-skin care facilitates a series of critical processes for newborns, parents, and health system, including breastfeeding initiation and exclusivity rates, reduced incidence of post-partum depression, and prevention of infection and hospitalization. Thanks to the close contact of the kangaroo position or skin-to-skin contact, parents recount becoming more and more attached to and familiar with their baby, easily establishing a relationship. Overall, countries could transform the newborn care service in terms of family center care by adopting three simple rules: (i) minimizing mother-child separation; (ii) involving fathers; (iii) empowering parents from the time of birth. A paradigm shift is required to change the conventional model of provider-centric care to one of person-centered neonatal health care. Such an approach is feasible in diverse country settings and should be facilitated through political commitment and policies enabling early focus on the maternal-infant relationship. This could, in turn, help achieve improved dignity of care and help create a more efficient and responsive health system and society.

Factors Influencing Weight Management in Pregnant Women with Overweight or Obesity: A Meta-Synthesis of Qualitative Studies

BACKGROUND

Overweight and obesity have multiple negative consequences for the health of both the mother and the child. Interventions to prevent excessive weight gain during pregnancy have had varying success, and the proportion of pregnant women who exceed national guidelines for weight gain continues to increase.

OBJECTIVE

To investigate the influence of factors on weight management among pregnant women with overweight or obesity.

METHODS

This meta-synthesis of qualitative studies involved searching databases PubMed, Embase, Cochrane, Scopus, and Web of Science. The databases were searched on October 4, 2022, and the search was updated on April 21, 2023. The screening of titles, abstracts, and full texts was conducted utilizing Covidence software. The quality assessment of the articles was performed using the Critical Appraisal Skills Programme checklist. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was used to enhance transparency in reporting. A meta-aggregation approach was used to guide the data extraction and synthesis.

RESULTS

A total of 46 studies with appropriate Critical Appraisal Skills Programme scores were included for qualitative synthesis. Findings were extracted and integrated into 4 themes: psychological factors (personally driven negative emotions and society-driven negative emotions), social factors (societal attitudes and beliefs and social support resources), factors related to education and counseling (information provision and communication), and factors associated with effective care (provided care components and the method of providing effective care).

CONCLUSIONS

To improve weight management during pregnancy, health care providers should provide tailored and individualized recommendations that take into consideration the factors influencing these women.

Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study

PURPOSE

There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care.

DESIGN AND METHODS

A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model.

RESULTS

The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000).

CONCLUSIONS

Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care.

PRACTICAL IMPLICATIONS

The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.

Improvement of family-centered care in the pediatric rehabilitation ward: a participatory action research

Background and aim

The improved life expectancy of children with disability in recent years has led to their increased request for using lifelong rehabilitation services. Family-centered care (FCC) is a model with potential positive effects on the rehabilitation of children with disability. The present study aimed at improving FCC in the pediatric rehabilitation ward.

Methods

This participatory action research was conducted in 2021-2023 in the pediatric rehabilitation ward of a hospital in Tehran, Iran. Participants were 16 rehabilitation staff and 48 mothers recruited via convenient and purposive sampling methods. Data were collected using semi-structured interviews, focus group discussions, and the 20-item and the 27-item Measures of the Processes Of Care (MPOC). Data were analyzed using qualitative content analysis as well as the Kolmogorov-Smirnov and the Wilcoxon's tests.

Findings

The major barrier to the implementation of FCC was staff and family limited knowledge about the importance and the benefits of FCC and the best facilitator to change was improvement of their knowledge. Therefore, an action plan based on staff and family education was designed and implemented. Participants' positive experiences of the plan were improvement of satisfaction, knowledge, collaboration, and coordination in care and their negative experiences were educational problems and dissatisfaction with the ward atmosphere. The strengths of the plan were adequate number of staff, long enough hospital stay of children, chronic course of disability, and mothers' previous experiences. Its weaknesses were the long course of a single action plan cycle, exclusive focus on education, and the high risk of plan termination after the study. The practical problems of the study were also small physical space of the ward, transfer of some trained staff to other wards, and child discharge from the hospital.

Conclusion

Staff and family limited knowledge about the importance and the benefits of FCC is a major barrier to effective FCC. Continuous education as well as family and staff collaboration may improve FCC in pediatric rehabilitation ward.

Implementation of Family Centered Care for Neonates Admitted in a Special Care Baby Unit in Sierra Leone

Purpose

To assess the feasibility of implementing family centered care and the impact this would have on parental satisfaction in a special care baby unit in Sierra Leone.

Patients and Methods

A cross-sectional, mixed methods study was conducted at the Rokupa Government Hospital, Sierra Leone. 16 nursing staff of the Special Care Baby Unit and 7 caregivers of neonates admitted in the unit participated in the study. Quantitative data on feasibility was obtained from nursing staff using a five-point Likert scale administered to staff before and after implementation of family centered care in the unit. Qualitative data on perception of impact was obtained through focus group discussions for caregivers whose neonates had received family centered care and a control group who had received standard unit care. Quantitative data was analyzed using univariate analysis and thematic analysis was undertaken for qualitative data.

Results

Before implementation, most nursing staff felt implementation of family centred care was not feasible (87.5%) and more than half of nursing staff either strongly agreed or agreed with each of the negative statements regarding the practice of family centred care indicating a generally negative perception. After implementation there was improvement in nursing staff perception of family centred care, however the majority still doubted the continued feasibility of this practice (68.8%). Qualitative discussions with caregivers demonstrated that caregivers whose babies received family centered care were less distressed and more satisfied during the period of admission than those who received routine care.

Conclusion

Family centered care improved the experiences of caregivers in the unit. Nursing staff also demonstrated a better understanding of the benefits of family centered care after it was implemented. Concerns regarding understaffing and the unit being too small to accommodate caregivers and staff at the same time need to be addressed. There is need to integrate family centered care into hospital policy.

Implementation of Listening Visits with Parents of Preterm Infants in an Italian Neonatal Intensive Care Unit

PURPOSE

To assess the feasibility of implementing Listening Visits (LV) in an Italian neonatal intensive care unit (NICU).

STUDY DESIGN AND METHODS

This feasibility implementation of LV included empathic listening and problem-solving sessions provided by a psychologist to 26 parents of hospitalized preterm newborns. Using the RE-AIM implementation framework, three facets of feasibility were assessed: reach, adoption, and implementation.

RESULTS

It is feasible to integrate LV into the NICU: 76% of families were willing to try LV (reach). Listening Visits recipients reported high satisfaction. Twelve of the 16 families (75%) received six or more LV sessions (adoption), with mothers attending more sessions. Implementation fidelity, defined here as the percentage of LV recipients that received at least four sessions, was 94% among mothers and 30% among fathers.

CLINICAL IMPLICATIONS

The LV intervention for parental support during the NICU stay is feasible and deemed helpful by parents. Parents were motivated to participate even though their levels of depression, stress, and anxiety were not high. In addition to the use of standardized screening questionnaires, parental requests and clinical team indications should be included in the decision-making for the provision of parental support services.

Nurse-mother communication and support: Perceptions of mothers in neonatal units

Introduction

Having a hospitalized neonate is a stressful experience for parents, especially mothers. Thus, in recent years, a paradigm shift occurred in the neonatal units, focusing on the needs of parents and supporting them in addition to caring for neonates. The aim of this study was to evaluate the nurse-mother communication and support in neonatal units in Bushehr, Iran.

Method

This descriptive cross-sectional study was performed in neonatal units of 6 hospitals in Bushehr, Iran, in 2022. Using the census method, all eligible mothers who met the inclusion criteria were included in this study. Data collection tools included demographic information form, nurse-parent support tool and nurse-parent communication questionnaire. The collected data were analyzed by SPSS version 24 using descriptive statistics, independent t-test, one-way ANOVA and Pearson correlation test.

Results

The total mean score of nurse-parent support tool was 3.72 ± 0.72 and the total mean score of nurse-parent communication questionnaire was 59/27 ± 12/82. Caregiving support had the highest mean score (4.07 ± 73 0.73) and emotional support had the lowest (3.42 ± 91 0.91). Also, a statistically significant difference was seen between the admitted unit variable and the mean score of nurse-mother communication and support. Additionally, there was a statistically significant difference between the mechanical ventilation status of the neonate and the mean score of nurse-mother support. A significant positive correlation was seen between the neonatal gestational age and the mean score of nurse-mother communication.

Conclusions

The total mean score of nurse-parent support and communication was moderate. Therefore, nursing support and communication need to be improved. Planning is needed to enhance the role of neonatal nurses and strengthen their support and communication skills in line with the family-centered care approach.

Nurses' beliefs and perceptions regarding family-centered care services in acute pediatric healthcare settings

OBJECTIVES

To describe pediatrics nurses' beliefs about family-centered services (FCS) as a model of providing healthcare to children in acute care settings in Jordan.

DESIGN AND METHODS

This is a cross-sectional descriptive study. Nurses who provide direct acute care to children (n = 246) completed the 'Measure of Beliefs about Participation in Family-Centered Service' questionnaire. Descriptive statistics were used to describe nurses' beliefs about participation, practical feasibility, implementation self-efficacy, principles, and potential adverse outcomes of FCS.

RESULTS

Many nurses feel confident (70%) about their ability to work with others in providing FCS and perceive having the ability to operate according to family-centered care (FCC) principles (68%). Many (75%) nurses believed parents should be encouraged to decide how much they want to be involved in the child's care. However, only 46% of the nurses valued attending to family priorities if the health decisions made by the family differed from the healthcare providers' priorities. Many nurses (70%) believed that healthcare professionals' competencies and capacities to work utilizing FCC are more important than their personal preferences and opinion.

CONCLUSIONS

The findings of this study clearly indicate that nurses positively viewed providing children's care within a FCS. This supports the efforts to reasonably integrate FCC as an operating model in the pediatric healthcare settings in Jordan.

PRACTICE IMPLICATIONS

FCS is a complex task requiring integrating multidisciplinary effort and healthcare providers' positive attitudes toward families as care partners. Steps should help maximize the organizational resources to facilitate family presence and create opportunities for professional-families partnerships for children's care.

Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis

AIMS

To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP).

DESIGN

This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique.

METHOD

Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery.

RESULTS

Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care.

CONCLUSION

The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments.

IMPACT

This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments.

REPORTING METHOD

EQUATOR guidelines were followed, using the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.

Competing Tensions: Nurse Perceptions of Family-Centered Care and Parents' Needs in Neonatal Care

BACKGROUND

Family-centered care is founded upon collaboration between parents and healthcare professionals, caring for a child and parents as one entity. The unfamiliar neonatal environment and complexity of care can make family-centered care challenging.

PURPOSE

To explore neonatal nurses' perceptions of family-centered care and parents' cultural needs.

METHODS

This was a qualitative descriptive study using interviews to gather data from registered nurses, and analyzed using inductive content analysis.

RESULTS

Ten neonatal nurses participated in online interviews, lasting an average of 25 minutes. Parents' cultural needs were poorly understood and assumed synonymous with family-centered care. While all acknowledged the importance of family-centered care, most described tasks to parent-infant bonding, rather than a broader embodiment of family-centered care. In time of uncertainty, emergent clinical priorities took priority over a family-centered approach to care. Cultural care was poorly understood, and care tasks associated with supporting parent-infant bonding suggest further work is necessary to promote embodiment of family-centered care beyond individual tasks. While emergent clinical priorities and neonate well-being will always be the priority, finding a way to respond that concords with the ethos of family-centered care is also essential.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Clear and consistent leadership is needed to demonstrate greater embodiment of family-centered care, which includes cultural care for parents. Strong leadership and targeted education are key to supporting this change. Further research is warranted to examine and observe practice, in particular how parents' cultural needs are assessed and integrated into family-centered care in neonatal settings.

Multisensory stimulation bundles on sleep and neurobehavioral development in the first year after birth in very preterm infants: a randomized crossover controlled study protocol

BACKGROUND

Disrupted sleep is believed to contribute to short- and long-term neurodevelopmental problems in very preterm infants (VPIs). This study presents a protocol for an evaluator-blinded, randomized crossover trial. It aims to assess the sleep efficiency of hospitalized VPIs by providing multisensory stimulation bundles. Furthermore, it aims to observe the intervention impacts on sleep during hospitalization of the VPIs and their sleep and neurodevelopmental outcomes during the first year of post-discharge follow-up.

METHODS

The study will be conducted in the neonatology department of a tertiary pediatric teaching hospital. All the eligible VPIs will undergo two types of care in random order: "standard care" (2 weeks) and "standard care plus multisensory stimulation bundles," each lasting 2 weeks. A generated list of random numbers will be used for case sequence allocation. Sleep outcomes will be evaluated using the Actiwatch-2 Actigraph. Moreover, the amplitude-integrated electroencephalography and the Griffiths Mental Development Scales will be used to measure the neurodevelopmental outcomes during hospitalization and in the first year of follow-up of the VPIs.

DISCUSSION

The intervention protocol of this study differs from that of other traditional interventions by producing precise and consistent supportive stimulations, similar to maternal tactile, auditory, posture, and visual effects for hospitalized VPIs. This protocol could be an effective measure to facilitate sleep and early neurodevelopment of VPIs. The expected outcomes will help confirm the implementation and generalization of the multisensory stimulation bundles' care protocol in neonatology departments. We expect that the study will positively impact hospitalized VPIs, especially in their sleep and early neurodevelopmental outcomes. It will also provide a new perspective regarding parent and infant interaction strategies, particularly for newborn intensive care units that limit visits because of the global spread of COVID-19.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR 2200059099. Registered on 25 April 2022, https://www.chictr.org.cn/showproj.html?proj=166980 ; the Hospital Research Ethics Committee (approval number: SCMCIRB-K2021086-1, Version 01), approved on 21 January 2022.

Investigation of predictor factors of the nursing students attitudes toward parents' participation in care

PURPOSE

A positive attitude toward family-centered care practices should be developed in undergraduate education. This study aimed to investigate nursing students' attitudes toward parental participation in child patient care and the factors that influence it.

DESIGN AND METHODS

This study was a descriptive cross-sectional study. The study data were collected from the nursing department of a university located in the west of Turkey. The study was conducted with 260 nursing students. The descriptive Features Form, Family-Centered Care Practices Form, and Parental Participation Attitude Scale were used in data collection.

RESULTS

The students' average parental participation attitude in care scores was at a moderate level. It has been determined that gender, hospitalization experience, education on family-centered care, and support from instructors in family-centered care practices had a positive effect on the student's attitudes toward parental participation in care (p < 0.05). The regression analysis showed gender and family-centered care education as predictors of student' attitudes toward parent participation in care.

CONCLUSIONS

It was found that students' attitudes toward parental participation in the care of child patients were at an indecision level and not at the desired grade, and it was affected by gender, hospitalization experience, education, and instructor support.

PRACTICE IMPLICATIONS

The development of family-centered care practices should begin in nursing education. It is recommended that detailed attention be given to topics related to family-centered care in nursing education, and seminars be organized on this subject. Thus, nursing students can both develop a positive attitude toward family-centered care and learn to work together with the family.

The barriers to family-centered care in the pediatric rehabilitation ward: A qualitative study

BACKGROUND

Family-centered care (FCC) is one of the fundamental principles of care provision to children with disability (CWD). It is based on the collaboration of healthcare providers, patients, and families. However, there is limited information about the barriers to FCC in pediatric rehabilitation settings in Iran. This study aimed at exploring the barriers to FCC in the pediatric rehabilitation ward.

METHODS

This descriptive qualitative study was conducted in 2022. Participants were nine rehabilitation staff and twelve mothers of hospitalized CWD purposively selected from the pediatric rehabilitation ward of hospital Rofeideh, Tehran, Iran. Rehabilitation staff were three nurses, a head nurse, a nursing manager, a medical specialist, a social worker, a physical therapist, and an occupational therapist. Eleven semi-structured interviews and three focus group discussions were conducted for data collection, and conventional content analysis proposed by Graneheim and Lundman (2004) was used for data analysis.

RESULTS

The three main categories of the barriers to FCC in the pediatric rehabilitation ward were family-related barriers (subcategories: knowledge about child rehabilitation, sociocultural background, and participation), staff-related barriers (subcategories: knowledge, ethical concerns, and collaboration), and organizational barriers (subcategories: factors related to FCC policies, managerial factors, environmental factors, and factors related to the coronavirus disease 2019 pandemic).

CONCLUSION

The barriers to FCC in the pediatric rehabilitation ward are very diverse due to the long-term course of child disability and long-term interaction of families with rehabilitation centers. Data collection from both families and rehabilitation staff helped acquire an in-depth understanding about these barriers. More in-depth explorations of family-related barriers such as sociocultural factors are essential to determine the reasons for family resistance to healthcare providers' recommendations to develop more effective care plans.

Holistic nursing can improve family engagement

ABSTRACT

Family engagement is relevant to patient outcomes and ensures patient efficacy, support, and quality of life. Such engagement is facilitated by holistic nursing methods. This article discusses the importance of and barriers to family engagement and practical strategies for its implementation.

"It Takes a Village" to Implement Family-Centered Care in the Neonatal Intensive Care Unit

BACKGROUND

Although research has demonstrated positive impacts of family-centered care (FCC), many neonatal intensive care unit (NICU) nurses hesitate to fully engage in its practice. There has been little scientific focus on investigating the challenges of FCC implementation in the NICU setting.

PURPOSE

The purpose of this study was to generate a grounded theory explaining the process by which neonatal nurses experience facilitators and challenges through engaging in FCC practices in the context of the NICU setting.

METHODS

This qualitative, grounded theory portion of a mixed-methods study employed individual, semistructured, video-based dyadic interviews with 20 neonatal nurses.

RESULTS

Successful implementation of FCC by neonatal nurses is affected by various factors. The adage that "it takes a village to raise a child" described this process for the nurse participants. The delivery of FCC involves respectful engagement and participation by multiple internal and external stakeholders. The process of delivering FCC was influenced by factors across 6 categories: equitable relationships, bond of trust, knowledge sharing, empowerment in workplace, environment and culture, and regulations. The findings suggest that FCC implementation is not an individual initiative; rather, it involves a complex set of interrelationships between care team members. NICU nurses may consider these findings when they are proposing a change to a FCC model.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Flexibility is necessary by multidisciplinary teams to achieve maximum benefits of FCC and minimize potential harm, despite the unit design. Facilities may support nurses with continuing education programs to expand their FCC knowledge and skills.

Organisational challenges of pain management in neonatal intensive care unit: a qualitative study

OBJECTIVES

Despite credible evidence, optimal neonates' pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing challenges vary depending on the context, and investigating them can help to improve the quality of care. The study aimed to explore organisational challenges to neonates' pain management in the NICU.

METHODS

This qualitative study included 31 nurses and physicians in the NICU of Children's Hospital, Tabriz, Iran. Data collection was done through individual and focus group interviews. For data analysis, we used conventional content analysis.

RESULTS

The identified challenges included organisational culture (poor interprofessional collaboration and low parental participation), organisational structure (lack of unified approach in relieving pain and limited supervision for pain management) and organisational resources (lack of time due to high workload and inadequate educational programmes).

CONCLUSIONS

Many organisational factors consistently affect neonatal pain management. Adopting some approaches to enhance the cooperation of treatment team members, holding educational programmes, proper organisational supervision and implementing a unified neonatal-based pain management programme could improve neonatal pain management.

Improving the Implementation of Family-Centered Care Within the Neonatal Care Unit: Empowering Parents to Participate in Infant Care

BACKGROUND

Internationally, approximately 15 million babies are born prematurely every year. In New Zealand, 1 neonatal ward may care for 1000 infants annually. Family-centered care (FCC) is a philosophy used in neonates to enhance positive outcomes for infants, parents, and staff by recognizing the strengths and needs of infants and their families.

OBJECTIVE

This research assessed how a neonatal environment could be improved to ensure parents feel welcomed and empowered to participate in their infant's care.

PARTICIPANTS

Survey data from 67 health professionals and 51 parents of infants who received neonatal care for more than 7 days. Four in-depth interviews with parents and 5 with health professionals.

METHODS

A mixed-methods research design was used. Phase 1 collected quantitative data using the Family-Centered Care Questionnaire. Phase 2 composed of face-to-face interviews with health professionals and parents.

RESULTS

Implementing FCC practices to improve health outcomes for infants, parents, and staff is important. Recommendations for improvement were formulated from the themes.

CONCLUSION

The perspectives of parents and health professionals have enabled the development of recommendations to improve the implementation of FCC practice in the neonatal environment. These may lead to better parental experience and improved infant health outcomes.

Concepts of family-centered care at the neonatal and paediatric intensive care unit: A scoping review

BACKGROUND

Understanding family-centred care (FCC) concepts is critical for its implementation in any context. The researchers synthesised studies on FCC in neonatal and paediatric critical care units in order to present its concepts and gaps in the literature to guide further research in the area.

METHOD

The study used the JBI methodology, and the PRISMA-ScR guidelines confirmed the final report. The search for material, with the use of library sources, used Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Google Scholar, and Wiley Library online for papers published in English from 2015 to 2019 and updated to 2023.

RESULTS

From 904 references, 61 studies were identified for inclusion. The majority of the studies (29; 55.77%) were qualitative ethnography and phenomenology. Four themes and ten subthemes emerged from the data to support the main concepts of FCC.

CONCLUSION

To guide its useful integration and implementation, more research on family-centred care in neonatal and paediatric intensive care units, involving families, staff, and managers, should be undertaken.

PRACTICE IMPLICATION

Findings presented in this review may provide a guide for nurses to adjust nursing interventions for critically ill neonates and children in intensive care units.

Development and Psychometric Evaluation of a Caregiver Survey to Assess Family-Centered Care in the Emergency Department

OBJECTIVE

To develop and evaluate the psychometric properties of a family caregiver-reported survey that assesses family-centeredness of care in the context of pediatric emergency department (ED) encounters.

METHODS

We created a caregiver-reported scale, incorporated content expert feedback, and iteratively revised it based on cognitive interviews with caregivers. We then field tested the scale in a survey with caregivers. We dichotomized items using top-box scoring and obtained a summary score per respondent. Using a sample of 191 caregivers recruited from 9 EDs, we analyzed internal consistency reliability, dimensionality via item response theory modeling, and convergent validity with the ED Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

RESULTS

Feedback from the 9 experts led us to remove 4 items. We conducted 16 cognitive interviews and revised the survey in 4 rounds. An 11-item survey was field tested. Mean (standard deviation) respondent 11-item summary score was 77.2 (26.6). We removed 2 items given inconsistent response patterns, poor variability, and poor internal consistency, which increased coefficient alpha from 0.85 to 0.88 for the final scale. A multidimensional model fit the data best, but factor scores correlated strongly with summary scores, suggesting the latter are sufficient for quality improvement and future research. Regarding convergent validity, adjusted partial correlation between our scale's 9-item summary score and the ED CAHPS summary score was 0.75 (95% confidence interval 0.67-0.81).

CONCLUSIONS

Psychometric analyses demonstrated strong item performance, reliability, and convergent validity for the 9-item scale. This survey can be used to assess family-centered care in the ED for research and quality improvement purposes.

Nursing students' views on trauma-informed pediatric nursing care and family-centered care

PURPOSE

We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care.

METHODS

This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the "Student Information Form," "Family-Centered Care Attitude Scale," and "trauma-informed care (TIC) Provider Survey."

RESULTS

Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score.

CONCLUSIONS

Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients.

PRACTICE IMPLICATIONS

Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients.

Mothers' involvement in providing care for their hospitalised sick newborns in Kenya: a focused ethnographic account

INTRODUCTION

There is growing evidence that parental participation in the care of small and sick newborns benefits both babies and parents. While studies have investigated the roles that mothers play in newborn units in high income contexts (HIC), there is little exploration of how contextual factors interplay to influence the ways in which mothers participate in the care of their small and sick newborn babies in very resource constrained settings such as those found in many countries in sub-Saharan Africa.

METHODS

Ethnographic methods (observations, informal conversations and formal interviews) were used to collect data during 627 h of fieldwork between March 2017 and August 2018 in the neonatal units of one government and one faith-based hospital in Kenya. Data were analysed using a modified grounded theory approach.

RESULTS

There were marked differences between the hospitals in the participation by mothers in the care of their sick newborn babies. The timing and types of caring task that the mothers undertook were shaped by the structural, economic and social context of the hospitals. In the resource constrained government funded hospital, the immediate informal and unplanned delegation of care to mothers was routine. In the faith-based hospital mothers were initially separated from their babies and introduced to bathing and diaper change tasks slowly under the close supervision of nurses. In both hospitals appropriate breast-feeding support was lacking, and the needs of the mothers were largely ignored.

CONCLUSION

In highly resource constrained hospitals with low nurse to baby ratios, mothers are required to provide primary and some specialised care to their sick newborns with little information or support on how undertake the necessary tasks. In better resourced hospital settings, most caring tasks are initially performed by nurses leaving mothers feeling powerless and worried about their capacity to care for their babies after discharge. Interventions need to focus on how to better equip hospitals and nurses to support mothers in caring for their sick newborns, promoting family centred care.

Providers' perspectives of the neonatal intensive care unit context and care provision for adolescent parents: an interpretive description

BACKGROUND

The neonatal intensive care unit (NICU) is a complex care environment, with the NICU patient population among the most vulnerable in a hospital setting. Adolescent parents are a unique group within the broader NICU parent population and admission of their infant to the NICU contributes to an already complex situation as adolescent pregnancy and parenting is often associated with a range of psychosocial challenges. How the NICU care context influences care provision for adolescent parents is a significant gap in the NICU parenting and support discourse. Therefore, this study aimed to explore health and social care providers' perspectives of the NICU care context and how providers perceive the context as influencing the experiences of adolescent parents in the NICU.

METHODS

This was a qualitative, interpretive description study design. In-depth interviews were conducted with providers, including nurses and social workers, caring for adolescent parents in the NICU. Data was collected between December 2019 and November 2020. Data were analyzed concurrently with data collection. Constant comparison, analytic memos, and iterative diagramming techniques were used to challenge developing analytic patterns.

RESULTS

Providers (n = 23) described how the unit context influenced care provision as well as experiences for adolescent parents. We learned that having a baby in the NICU was perceived by providers as a traumatic experience for parents - impacting attachment, parenting confidence and competence, and mental health. Environmental factors - such as privacy and time - and perceptions that adolescent parents are treated differently in the NICU were also seen as influencing this overall experience.

CONCLUSIONS

Providers involved in the care of adolescent parents in the neonatal intensive care unit described the distinctiveness of this group within the broader parent population and how quality of care may be impacted by contextual factors as well as experiences of age-related stigma. Further understanding of NICU experiences from the parents' perspectives are warranted. Findings highlight opportunities for strengthened interprofessional collaboration and trauma- and violence-informed care strategies within the neonatal intensive care environment to mitigate the potential negative influence of this experience and improve care for adolescent parents.

Nurse-to-family telehealth for pediatric transfers: protocol for a feasibility and pilot cluster randomized controlled trial

BACKGROUND

Children presenting to emergency departments of community hospitals may require transfer to a children's hospital for more definitive care, but the transfer process can be distressing and burdensome to patients, families, and the healthcare system. Using telehealth to bring the children's hospital nurse virtually to the bedside of the child in the emergency department has the potential to promote family-centered care and minimize triage issues and other transfer-associated burdens. To explore the feasibility of the nurse-to-family telehealth intervention, we are conducting a pilot study.

METHODS

This parallel cluster randomized controlled feasibility and pilot trial will randomize six community emergency departments to use either nurse-to-family telehealth (intervention) or usual care (control) for pediatric inter-facility transfers. All eligible children presenting to a participating site during the study period who require inter-facility transfer will be included. Eligibility requires that there be an English-speaking adult parent or guardian at the emergency department bedside. We will examine feasibility objectives that assess protocol assignment adherence, fidelity, and survey response rates. We will measure subject-level exploratory outcome data to test feasibility of data collection and to obtain effect size estimates; exploratory outcomes include family-centered care, family experience, parent acute stress, parent distress, and change in level of care. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.

DISCUSSION

The findings from this trial will increase our understanding about nurse-to-family telehealth during pediatric transfers. The mixed methods implementation evaluation will provide relevant insight about the contextual factors that influence the implementation and rigorous evaluation of our intervention.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05593900. First Posted: October 26, 2022. Last Update Posted: December 5, 2022.

Care providers' experiences regarding barriers to maternal participation in neonatal pain management

BACKGROUND

Mothers' involvement in the pain management of infants admitted to the intensive care unit can alleviate the infants' pain. Despite International guidelines, maternal involvement in neonatal pain management is low. Hence, investigating the perspectives of care providers (CPs) on barriers to maternal participation can be helpful in developing practice guidelines.

AIMS

The purpose of this study was to investigate the experiences of CPs on barriers to maternal involvement in neonatal pain management in the intensive care unit.

DESIGN

In this study, a qualitative design based on the content analysis approach was used.

METHOD

We included 24 nurses and physicians in the neonatal intensive care unit from February to September 2020. Data were collected through conducting 11 individual interviews and two focus group discussions with eight and five participants, respectively.

RESULTS

Three main categories and seven sub-categories were found, including maternal barriers (inadequate emotional readiness and unfamiliarity with role), CPs' barriers (time pressure, fear of family-care provider tension, and insufficient knowledge), and organizational barriers (neglected joint decision-making and restricted organizational participative policies).

CONCLUSIONS

The identified barriers could be classified into those related to mothers, care providers, and organizations. The lack of appropriate interaction and cooperation between parents and care-providers can affect the emergence of barriers related to the mothers and staff.

RELEVANCE TO CLINICAL PRACTICE

There is a lack of knowledge regarding neonatal pain management in the health care team and mothers. Educating mothers and CPs about the benefits and ways of mothers' participation can increase readiness and capabilities. Providing clear guidelines about family-centred care and promoting parent-CPs' interactions can increase the mothers' participation.

Contextual factors influencing parents' assessments of family-centred care in the paediatric emergency department: A qualitative study

AIM

To identify the contextual factors influencing parents' assessments of the family-centredness of care received during a paediatric emergency department visit.

DESIGN

A qualitative cross-sectional case study.

METHODS

We interviewed parents who were at their child's bedside during an emergency department encounter. We independently coded the first 3 transcripts and met to discuss the coding structure and to refine existing codes, add new codes and develop tentative categories. We repeated this process for every 3-5 transcripts until thematic saturation was reached.

RESULTS

We conducted 16 interviews and identified 2 themes: (1) Not all parents expected physicians to provide family-centred care in the emergency department and (2) feeling overwhelmed and powerless influenced parents' perceptions of family-centred care. Poor family-centred care worsened parents' sense of powerlessness and reinforced parents' low expectations from physicians. Similarly, low expectations and powerlessness exacerbated poor family-centred care. Interventions are needed to break this cycle and improve family-centredness of care.

Neonatal Nurses' Report of Family-Centered Care Resources and Practices

BACKGROUND

A paucity of studies describes the prevalence of family-centered care (FCC) practices and resources in US neonatal units.

PURPOSE

To identify US prevalence of FCC practices and resources and to identify the largest gaps in resource provision.

METHODS

Neonatal nurses completed an online survey through national conferences (eg, NANN educational conference), neonatal organization Web sites (eg, NANN research survey), and social media (eg, NANN and NPA Facebook). Nurses provided demographics and the National Perinatal Association Self-Assessment on Comprehensive Family Support, a 61-item checklist of FCC practices and resources from 6 categories: family-centered developmental care, staff education/support, peer support, palliative care, discharge education, and mental health support.

RESULTS

Nurses (n = 103) reported lowest resources for Peer Support and Mental Health Support. About a third had a neonatal intensive care unit parent advisory committee (n = 39; 37.9%). Only 43.7% (n = 45) had necessary amenities for families to stay with their infants. Less than a third felt that mental health professionals were adequately staffed to provide counseling to parents (n = 28; 27.5%). Very few nurses had adequate training on providing parents psychological support (n = 16; 15.8%). More than half (n = 58; 56.3%) stated that all staff receive training in family-centered developmental care. Finally, less than half (n = 42; 40.8%) stated that staff see parents as equal members of the care team.

IMPLICATIONS FOR PRACTICE

We demonstrate a consistent and widespread lack of training provided to neonatal staff in nearly every aspect of comprehensive FCC support.

IMPLICATIONS FOR RESEARCH

Researchers need to identify unit/organizational interventions that increase adoption and implementation of FCC practices and resources.

Parental psychosocial needs in Brazilian paediatric intensive care units

BACKGROUND

Having children admitted in the intensive care unit is a demanding experience for parents. They encounter several difficulties during this process, and it is important to properly identify their psychosocial needs for the health team to address appropriately.

OBJECTIVE

The aim of the study is to identify the psychosocial needs encountered by parents of children in pediatric intensive care units in Brazil.

METHODS

A descriptive study with a qualitative approach was used to increase understanding of psychosocial experiences of parents. Individual semi-structured interviews were conducted with 11 parents of hospitalized children in pediatric intensive care units in Brazil. Thematic analysis was used to analyze the data. The university ethics review committee approved the research protocol. All parents were informed on study details and provided written consent prior to the interview.

RESULTS

Four themes were constructed: 1) Support from family and peers; 2) Support from the healthcare team; 3) Parental role; and 4) Emotional recovery. Parents expressed diverse psychosocial needs based on family and peer social support, child's clinical condition, as well as the structure, norms, and routines of health care teams during hospitalization.

CONCLUSIONS

The findings highlight the importance of nursing assessment of psychosocial experiences encountered by parents of children in pediatric intensive care units, which will guide planning of individualized interventions and to increase family-centered care in pediatric intensive care units.

The influence of nurse characteristics on practice skills and attitudes towards working with families in critical care: A regression analysis

OBJECTIVES

The study aimed to identify nurse characteristics that influence their self-perceived practice skills in working with families and their attitudes towards engaging families in adult and neonatal intensive care units.

RESEARCH METHODOLOGY/DESIGN

Secondary data analysis using a descriptive, cross-sectional design.

SETTING

An online survey was completed by 256 nurses from six adult intensive (73% response rate) and two neonatal intensive and one intermediate care unit (27% response rate) in a Swiss, university affiliated hospital.

MAIN OUTCOME MEASURES

Nurses' self-perceived practice skills in working with families were assessed with the "Family Nursing Practice Scale". Attitudes towards families were measured with the "Families' Importance in Nursing Care - Nurses' Attitudes Scale". Data were analysed with multiple linear regression models.

RESULTS

Prior education in family nursing significantly influenced nurses' self-perceived practice skills in working with families. Nurses' clinical speciality had a significant influence on their attitudes towards overall, and on the subscale "family as a burden". Neonatal intensive care nurses showed more open attitudes towards families overall, but perceived family more often as a burden than nurses in adult intensive care. Nurses' perceived skills and attitudes in family engagement significantly influenced each other.

CONCLUSION

The results suggest that nurses' prior education in family nursing and clinical speciality determine their ability to work with and engage families in critical care. Our study suggests that integration of family nursing engagement practices in critical care requires educational implementation strategies combined with culture change efforts.

Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy-An Exploratory Study

BACKGROUND

Due to the progress in neonatology, in particular, in the past three decades, the mortality rate among patients of intensive care units has decreased. However, this is connected not only with newborns needing to stay longer in the unit, but also with the exposure of newborns to many painful procedures and stresses. Lack of or insufficient pain prevention has a negative impact on the sensory or locomotor development of newborns. Despite the presence of guidelines based on scientific evidence, the use of pharmacological and non-pharmacological pain-management methods in newborns is still insufficient.

AIM

The aim of the study was to: identify the knowledge nurses/midwives have of recommended non-pharmacological and/or pharmacological methods, in particular, in relation to medical intervention procedures; assess the interventions for pain relief applied by midwives/nurses most often in their clinical practice; examine the role of age, general work experience, education level and years of work of medical professionals on a neonatal ward, as well as the referral level of a unit, versus the application of pharmacological and non-pharmacological methods.

METHODS

A descriptive and quantitative study conducted in 2019 among Polish nurses/midwives working at neonatal intensive care units.

RESULTS

The analysis of the material reflected the deficit of knowledge and the insufficient daily use of recommended pain-relief measures among the respondents.

CONCLUSIONS

The interpretation of data indicates that despite the clear and easily available recommendations of scientific societies concerning the mode of conduct in particular medical procedures, medical personnel do not apply those recommendations in their everyday practice. It is necessary to plan and implement education strategies for nurses/midwives on standard pain-management interventions during painful medical procedures.

Staff Perceptions of Family-Centered Care in Italian Neonatal Intensive Care Units: A Multicenter Cross-Sectional Study

Family Centered Care (FCC) in Neonatal Intensive Care Units (NICUs) included family involvement in the care process of newborns and infants. Staff perceptions of FCC may influence clinical practice and management strategies in NICUs, with an impact on quality and humanization of the care. The Family-Centred Care Questionnaire-Revised (FCCQ-R) was adapted for the NICU setting, therefore the FCCQ-R@it-NICU was developed and used for the present study in 32 Italian NICUs. We calculated internal consistency using Cronbach’s alpha correlation between Current and Necessary dimensions of the scale using the Pearson correlation coefficient. Furthermore, we investigated which characteristics could influence staff perceptions of FCC in NICUs. 921 NICU professionals participated in the study. The FCCQ-R@it-NICU revealed good internal consistency (0.96) and good correlation between dimensions (p < 0.05). Statistical and significant differences in Current and Necessary dimensions were found and some demographic characteristics were found predictable on FCC practice. The FCCQ-R@it-NICU is a valid tool to investigate staff perceptions about FCC in NICU settings. Profession, education level and work experience seem to positively influence the perception of what is required for FCC practice within NICUs.

The COVID-related mental health load of neonatal healthcare professionals: a multicenter study in Italy

Background

The COVID-19 pandemic has dramatically affected healthcare professionals’ lives. We investigated the potential mental health risk faced by healthcare professionals working in neonatal units in a multicentre cross-sectional observational study.

Methods

We included all healthcare personnel of seven level-3 and six level-2 neonatal units in Tuscany, Italy. We measured the level of physical exposure to COVID-19 risk, self-reported pandemic-related stress, and mental health load outcomes (anxiety, depression, burnout, psychosomatic symptoms, and post-traumatic symptoms) using validated, self-administered, online questionnaires during the second pandemic wave in Italy (October 2020 to March 2021).

Results

We analyzed 314 complete answers. Scores above the clinical cutoff were reported by 91% of participants for symptoms of anxiety, 29% for post-traumatic symptoms, 13% for burnout, and 3% for symptoms of depression. Moreover, 50% of the participants reported at least one psychosomatic symptom. Pandemic-related stress was significantly associated with all the measured mental health load outcomes, with an Odds Ratio of 3.31 (95% confidence interval: 1.87, 5.88) for clinically relevant anxiety, 2.46 (1.73, 3.49) for post-traumatic symptoms, 1.80 (1.17, 2.79) for emotional exhaustion, and 2.75 (1.05, 7.19) for depression. Female health care professionals displayed a greater risk of anxiety, and male health care professionals and nurses, of depressive symptoms.

Conclusions

Despite the low direct clinical impact of COVID-19 in newborns, neonatal professionals, due to both living in a situation of uncertainty and personal exposure to contacts with parents and other relatives of the newborns, and having to carry out activities once routine and now fraught with uncertainty, displayed clear signs of mental health load outcomes. They must be considered a specific population at risk for psychological consequences during the pandemic.

Systematic review of family engagement interventions in neonatal, paediatric, and adult ICUs

AIMS AND OBJECTIVES

The purpose of this systematic review was to evaluate interventions that have been used to engage families in direct care activities (active family engagement) in adult, paediatric, and neonatal intensive care unit (ICU) settings.

BACKGROUND

Family engagement is universally advocated across ICU populations and practice settings; however, appraisal of the active family engagement intervention literature remains limited.

SEARCH STRATEGY

Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were searched for family interventions that involved direct care of the patient to enhance the psychological, physical, or emotional well-being of the patient or family in neonatal, paediatric, or adult ICUs.

INCLUSION/EXCLUSION CRITERIA

Studies were included if an active family engagement intervention was evaluated. Studies were excluded if they were not published in English or reported non-interventional research.

RESULTS

A total of 6210 abstracts were screened and 19 studies were included. Most studies were of low to moderate quality and were conducted in neonatal ICUs within the United States. Intervention dosage and frequency varied widely across studies. The interventions focused on developmental care (neonatal ICU) and involved families in basic patient care. Family member outcomes measured included satisfaction, stress, family-centred care, confidence, anxiety, and depression. Most studies found improvements in one or more outcomes.

CONCLUSIONS

There is a paucity of literature about active family engagement interventions, especially in adult and paediatric populations. The optimal dosage and frequency of family engagement interventions remains unknown. Our systematic review found that data are limited on the relationship between family engagement and patient outcomes, and provides a timely appraisal to guide future research.

RELEVANCE TO CLINICAL PRACTICE

Further research on the efficacy of family engagement interventions is warranted. The translation of active family engagement interventions into clinical practice should also be supported.

Family-centered care and pediatric death in the emergency department: A qualitative study using framework analysis

BACKGROUND

Family-centered care is an important concept underpinning care of children. Although much researched in some settings, little research has explored specialist settings, or areas where both children and adults are cared for, such as the emergency department.

METHODS

This study sought to explore how nurses employ family-centered care in delivering care to children and families when a child dies in the emergency department. Using a descriptive, qualitative approach, semi-structured interviews were conducted with 24 emergency nurses from six Australian states. Interviews were audio-recorded and transcribed verbatim. Framework analysis was applied to examine alignment with family-centered care principles.

FINDINGS

Nurses described providing support and education, and encouraged families to engage in care decisions, including about ceasing resuscitation efforts. Commonly, senior staff members were allocated during emergencies to support parents.

DISCUSSION

Emergency nurses should be offered education on family-centered care, and research undertaken to explore families' experiences of their child dying in the emergency department.

PRACTICE IMPLICATION

Family-centered care should be a focus for the care of children and their families in the emergency department, regardless of the pressure from rapidly occurring events.

Opportunities and challenges for family-centered postpartum care during the COVID-19 pandemic: a qualitative study of nurse perspectives

Background

The global COVID-19 pandemic has forced the health care sector to make wide-ranging changes to protect patients as well as providers from the risk of infection. Many of these changes are likely to have greatest impact in contexts of care that employ family-centered care (FCC) models, including perinatal and maternity care. Research conducted in perinatal care settings during the pandemic has shown that some of these restrictions have negatively impacted patient and family experiences and outcomes, while others have been perceived as beneficial. The present qualitative study aimed to understand what changes have occurred in postpartum nursing practice during the pandemic, and how these changes have affected nurses, women and families during their stay in the hospital following a new birth.

Methods

Structured interviews were completed with 20 postpartum nurses from five hospitals across Texas. The interview protocol was designed to elicit information about changes to hospital policies in postpartum units during the pandemic, nurses’ attitudes about these changes, perceived benefits and challenges for performance of their duties, and perceived effects on patients and their families. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by video conference using Zoom and lasted approximately 30 to 45 min. Data were analyzed using a qualitative descriptive approach.

Results

Participants reported that their hospitals placed restrictions on the number and mobility of support persons allowed to stay with the mother in the unit and prohibited all other visitation. Some challenges of these policies included reduced opportunities for hands-on learning and an increased number of patients opting for early discharge. Perceived benefits for patient education and outcomes included improved frequency and effectiveness of nurse-family communication, increased father involvement, and greater opportunities for maternal rest, breastfeeding, skin-to-skin care and family bonding.

Conclusions

Study findings suggest that some limitations on postpartum hospital visitation may achieve important, family-centered goals. Protected time for family-bonding, maternal rest, breastfeeding, father involvement and individualized education are critical to quality FCC. Research must examine which visitation policies maximize these benefits while preserving patient access to family and social support.

Alberta Family Integrated Care™ and Standard Care: A Qualitative Study of Mothers' Experiences of their Journeying to Home from the Neonatal Intensive Care Unit

Globally, one in ten infants is born preterm. Most preterm infants require care in a level II Neonatal Intensive Care Unit (NICU), which are highly technological critical care environments that can be overwhelming for parents. Alberta Family Integrated Care (AB-FICare™) is an approach to care that provides strategies to integrate parents into their infant’s care team. This sub-study is the first to compare mothers’ experiences in the context of AB-FICare™ and standard care. Semi-structured interviews with mothers from AB-FICare™ (n = 14) and standard care (n = 12) NICUs were analyzed using interpretive description informed by grounded theory methods. We identified a major theme of Journeying to Home with six categories: Recovering from Birth, Adapting to the NICU, Caring for Baby, Coping with Daily Disruption, Seeing Progress, and Supporting Parenting. Mothers in the AB-FICare™ group identified an enhancement to standard care related to building reciprocal trust with healthcare providers that accelerated Journeying to Home.

Nurses' view of the nature of the support given to parents in the neonatal intensive care unit

Background

Most parents of Neonatal intensive care unit (NICU) babies often expressed dissatisfaction with the nursing care in NICU because of their unaddressed needs, resulting in emotional strain. This raises an essential question of how NICU nurses provide support for the parents. However, this can be relatively challenging in the NICU setting.

Objective

To explore nurses' views on the nature of parental support provided in NICU settings in Brunei Darussalam.

Methods

This study employed a qualitative research approach conducted in 2020. Ten nurses were individually interviewed in semi-structured interviews. The data were analysed using thematic analysis.

Results

Three broad themes were identified, namely: (1) Emotional and informational support (2) Keeping the support going (3) Seeking help from others. The data provide insights into how nurses provide emotional and informational support to parents in the NICU setting. Challenges were encountered in providing support and were addressed through the involvement of the doctors and emotional support continuity by nursing colleagues.

Conclusion

This paper describes two critical supports given to the parents in the NICU setting and the challenges that underline these supports and proposes strategies used by nurses to help the parents. The balance needed between work demand and parental support is highlighted. In order to give more robust parental support, ongoing interactions with doctors and nursing colleagues are required.

Implementing Family-Centered Care in the Neonatal Intensive Care Unit - A Quality Improvement Initiative

OBJECTIVE

The present study aims to implement family-centered care (FCC) in neonatal intensive care unit (NICU). FCC facilitates mother-infant bonding with benefits for both families and health system. The authors used quality-improvement (QI) methods to implement FCC in level-2 NICU from an existing baseline of 30% to 80% over a period of 6 mo.

METHODS

Using the Institute of Healthcare model for improvement, the authors implemented strategies for family participation in caregiving activities, oral feeding and kangaroo care for neonates admitted in level-2 NICU. Eligibility criteria included the availability of at least one family member, preferably the mother for at least 6 h/d and a stable neonate based on physiological criteria irrespective of gestational age. The key interventions were: (1) adoption of a unit protocol for FCC with expanded visitation hours; (2) parental education through audio-visual aids, and (3) capacity building through training and peer support.

RESULT

Between August 2019 and January 2020, 1587 neonates were admitted to the NICU and 505 admitted in level-2 were enrolled. The proportion of eligible mother-infant dyads participating in FCC increased from a baseline of 32% to 44% during intervention and to 66% in the postintervention phase. The number of days per month FCC was tracked increased from 67% in the baseline to 82% in postintervention phase. There was no increase in the incidence of sepsis after implementation of FCC.

CONCLUSION

Orientation of parents to FCC using audio-visual aids, provision of hands-on training and peer-support facilitated them to become active participants in their neonates' care.

Clinician-family relationships may impact neonatal intensive care: clinicians' perspectives

OBJECTIVE

Collaborative clinician-family relationships are necessary for the delivery of successful patient- and family-centered care (PFCC) in the NICU. Challenging clinician-family relationships may undermine such collaboration and the potential impacts on patient care are unknown.

STUDY DESIGN

Consistent caregivers were surveyed to describe their relationships and collaboration with families of infants hospitalized ≥ 28 days. Medical record review collected infant and family characteristics hypothesized to impact relationships. Mixed methods analysis was performed.

RESULTS

Clinicians completed 243 surveys representing 77 families. Clinicians reported low collaboration with families who were not at the bedside and/or did not speak English. Clinicians perceived most clinician-family relationships impact the infant's hospital course. Negative impacts included communication challenges, mistrust or frustration with the team and disruptions to patient care.

CONCLUSION

This study identifies features of clinician-family relationships that may negatively impact an infant's NICU stay. Targeting supports for these families is necessary to achieve effective PFCC.

Healthcare professionals' sense of coherence of parental involvement in neonatal intensive care units: A framework synthesis

Family-centered care is recognized as the gold standard in pediatric healthcare practice. However, despite the acknowledgment of its benefits and importance, inconsistent and questionable implementation persists in neonatal intensive care units (NICUs) without a consolidated understanding of healthcare professionals' experiences. Therefore, this review aims to explore and consolidate healthcare professionals' perspectives on parental participation in the NICU. A systematic review of qualitative studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven electronic databases were searched from their respective dates of inception until December 30, 2020. Twenty-eight studies were included in this review. The analysis was conducted via a framework synthesis approach using Antonovsky's Sense of Coherence theory. Three over-arching themes, guided by Antonovsky's Sense of Coherence theory emerged: (1) "Comprehensibility of parental involvement in family-centered care," (2) "Manageability of parental involvement in care and decision-making," and (3) "Meaningfulness of parental involvement in shared decision-making in neonatal care," with nine corresponding subthemes. Healthcare professionals had mixed views of parental involvement, recognizing the benefits attributed to infants and parents, but were greatly hindered by organizational, environmental, and personal obstacles that weakened their sense of coherence in coping with the situation, making them feel unconfident and unprepared to involve parents in care. To cope, more integrated and formalized support was required. Organizational, environmental, and policy changes, as well as psychological support, were strategies identified to enhance healthcare professionals' sense of coherence, and consequently, their ability to cope.

Healthcare professionals-related factors affecting parents' participation in decision making for neonates with life-threatening conditions: A qualitative study

RATIONALE, AIMS, AND OBJECTIVES

Neonates with life-threatening conditions face complex clinical circumstances that confront parents and professionals with ethical decisions. Parents' participation in decision making has not gained sufficient attention in practice. Understanding factors affecting parents' participation is required. This study is part of a comprehensive project that explored the process of parents' participation in decision making for neonates with life-threatening conditions. The current study aimed to explore healthcare professionals-related factors affecting parents' participation in decision-making for neonates with life-threatening conditions.

METHODS

A grounded theory methodology was used in the comprehensive project. Twenty-two interviews/68 hours of observation were conducted. Data were concurrently analysed throughout data generation and constant comparative analysis. Data collected until theoretical saturation was reached, the extracted categories were coherent and the emerging theory made sense. After coding stages, the core category and the relationships with other main categories involved in the process of parents' participation in decision-making were developed. For this study, the category reflecting healthcare professionals-related factors affecting parents' participation in decision-making was reported.

RESULTS

Four themes were found: risk aversion including fear of litigation, fear of being accountable to the parents, and fear of bearing emotional distress; unprofessionalism including poor adherence to professional ethics, inadequate skill/knowledge, poor communication, and nurses' negligence in playing their professional role; information deficiencies including insufficient information, conflicting information, and complex and technical information, and clashes of attitudes including conflict about parents' participation in decision-making and conflict about the best interest of neonates.

CONCLUSION

Professionals should be aware of their role in involving parents in decision making. Training professionals on family centred care principle and communication skills contribute to support parents emotionally and respond empathically to their negative expressions. Training on ethics, development, and dissemination of guidelines and rules of conduct can make professionals more sensitive to ethical aspects of their work and may reduce their fear of litigation.