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Tajik F, Mahmoodi M, Azodi P, Jahanpour F. Nurse-mother communication and support: Perceptions of mothers in neonatal units. Heliyon 2024; 10:e29325. [PMID: 38644893 PMCID: PMC11033110 DOI: 10.1016/j.heliyon.2024.e29325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
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.
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Affiliation(s)
- Farnoosh Tajik
- Department of Pediatric and Neonatal nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
- MSc in Pediatric Nursing, Nursing and Midwifery Department, Member of Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Marzieh Mahmoodi
- Biostatistics and Epidemiology Department, Health and Nutrition Faculty, Clinical Research Development Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Parviz Azodi
- Paramedical Sciences Department, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Faezeh Jahanpour
- Nursing and Midwifery Department, Bushehr University of Medical Sciences, Bushehr, Iran
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Quinn M, Gephart S, Crist J. Exploring Parent Experiences With Early Palliative Care Practices in the NICU. Adv Neonatal Care 2024; 24:98-109. [PMID: 38324727 DOI: 10.1097/anc.0000000000001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND The anxiety and uncertain outcome of an admission of a seriously ill infant to the neonatal intensive care unit (NICU) can cause great stress for parents and contribute to poor mental health outcomes. Early implementation of family-centered palliative care (PC) may provide support for NICU parents. Key concepts of early PC in the NICU include shared decision-making, care planning, and support for coping with distress. PURPOSE The purpose of this study was to explore parent experiences during their child's NICU admission with the early PC practices of shared decision-making, care planning, and coping with distress. METHODS Qualitative descriptive methodology was used. Strategies of reflexive journaling, peer debriefing, and data audits were used to enhance trustworthiness. Parents (N = 16) were interviewed, and data were analyzed by conventional content analysis. Targeted recruitment of fathers occurred to ensure they comprised 25% of sample. RESULTS Parents' descriptions of decision-making were contextualized in gathering information to make a decision, the emotional impact of the decision, and influences on their decision-making. In experiences with care planning, parents described learning to advocate, having a spectator versus participant role, and experiencing care planning as communication. Key themes expressed regarding parental coping were exposure to trauma, survival mode, and a changing support network. IMPLICATIONS FOR PRACTICE AND RESEARCH These findings highlight key areas for practice improvement: providing more support and collaboration in decision-making, true engagement of parents in care planning, and encouraging peer support and interaction in the NICU and in online communities.
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Affiliation(s)
- Megan Quinn
- Author Affiliations: Oregon Health Sciences University, Portland (Dr Quinn); and University of Arizona, Tucson (Drs Gephart and Crist)
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Franco Fuenmayor ME, Fawcett A, Schwartz KE, Horner S, Balasundaram M, Burke BL, Bean KA, Russell LN, Simonton E, Machut KZ, Fry JT. Understanding family-centered care in the NICU: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00276. [PMID: 38385497 DOI: 10.11124/jbies-23-00252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This scoping review aims to identify and categorize the definitions of neonatal intensive care unit (NICU) family-centered care (FCC) and its associated concepts. It also aims to identify and categorize the practices and interventions that comprise NICU FCC, and catalog the metrics used to evaluate NICU FCC. INTRODUCTION FCC has been identified as an important element of care for neonates and infants admitted to the NICU, and there is clear evidence that the incorporation of families in care improves clinical outcomes. However, FCC has been linked to numerous associated terms and concepts and lacks a unifying definition or framework, thus limiting the ability to categorize, prioritize, and identify practices and interventions to optimize both institutional approaches for individual centers and for the field at large. INCLUSION CRITERIA Studies that include or apply at least one FCC concept or its associated terms will be considered eligible for inclusion. Studies not related exclusively to the NICU will be excluded. METHODS The review will follow the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Several electronic databases and sources of gray literature will be searched from 1992 to the present day. The review will include only full-text studies in English and will be independently screened by a minimum of 2 authors. Data will be extracted using a modified JBI data extraction tool and presented using narrative summaries; concept mapping; and categorization of practices, interventions, and metrics.
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Affiliation(s)
- Maria E Franco Fuenmayor
- Department of Pediatrics, Division of Neonatology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea Fawcett
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical and Organizational Development, Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine E Schwartz
- Division of Neonatal-Perinatal Medicine, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Susan Horner
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Malathi Balasundaram
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Barbara Lawlor Burke
- Patient Family Experience Department, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine A Bean
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Laura N Russell
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jessica T Fry
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Chan SH, Shorey S. Effectiveness of psychosocial interventions on the psychological outcomes of parents with preterm infants: A systematic review and meta-analysis. J Pediatr Nurs 2024; 74:23-34. [PMID: 37988885 DOI: 10.1016/j.pedn.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Parents of preterm infants are often thrown unexpectedly into the care of their vulnerable infant, causing them to be stressed and overwhelmed. Social support has been previously highlighted as a crucial factor in helping parents cope with stress. Several psychosocial interventions have thus been developed to support parents of preterm babies, which warrant further investigations. OBJECTIVES To evaluate the effectiveness of psychosocial interventions in reducing stress (primary outcome), anxiety, depression, pediatric medical traumatic stress (PMTS) and increasing social support among parents with preterm infants. METHODS A systematic-review and meta-analysis were conducted. Eight electronic databases were searched for relevant studies from their respective inception dates till September 2023. Meta-analysis was performed with RevMan, using the random-effects model. Heterogeneity was investigated using Cochran Q and I2 tests, and publication bias was assessed using funnel plots. Subgroup analyses were conducted for follow-up measurement, gender of parent, type of intervention provider, and setting. FINDINGS Eighteen studies were included in this review, and all studies were meta-analysed. Participants who received psychosocial interventions reported significantly lower stress and depression in comparison to control group participants. Psychosocial interventions delivered by psychologists and trained researchers were more effective compared to the nurses. The GRADE assessment indicated that the certainty of evidence for all outcomes were very low. CONCLUSION Psychosocial interventions effectively reduce stress and depression levels in parents with preterm infants. Our findings encourage the implementation of psychosocial interventions to improve parental psychological wellbeing. Future higher quality trials are needed to measure psychological outcomes among parents, especially fathers.
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Affiliation(s)
- Sian Hui Chan
- Nursing Division, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074.
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore.
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Bry A, Wigert H, Bry K. Need and benefit of communication training for NICU nurses. PEC INNOVATION 2023; 2:100137. [PMID: 37214501 PMCID: PMC10194117 DOI: 10.1016/j.pecinn.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 05/24/2023]
Abstract
Objectives To assess the effects of a new communication course for neonatal intensive care unit (NICU) nurses on nurses' confidence in communicating with families, and to explore communication-related issues experienced by the nurses and their relationship to burnout. Study design Twenty-nine nurses participated in an interactive course based on communication cases from the NICU. Participants' experience of communication with parents was assessed. They completed the Maslach Burnout Inventory. Self-reported communication skills were assessed before and after the course and at four-month follow-up. Results Only one nurse reported previous nursing-related communication training. High burnout scores were associated with communication-related difficulties, especially lack of time for communication. The course improved participants' confidence in their communication skills in challenging situations, including those where parents express distress or ask questions the nurse cannot answer. Participants found the course highly interesting, useful and necessary for their work. Conclusion Interactive, learner-centered training addressing issues specific to communication at the NICU was effective and highly appreciated. Innovation The course centered on a unique variety of reality-based communication cases from the NICU, relevant to the nurses' work and stimulating their reflection. An innovative feature was the emphasis on nurses' perspective and the importance of communication for their coping.
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Affiliation(s)
- Anna Bry
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, 413 46 Gothenburg, Sweden
- Division of Neonatology, Sahlgrenska University Hospital, Diagnosvägen 15, 416 50 Gothenburg, Sweden
| | - Helena Wigert
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens Backe, 413 46 Gothenburg, Sweden
- Division of Neonatology, Sahlgrenska University Hospital, Diagnosvägen 15, 416 50 Gothenburg, Sweden
| | - Kristina Bry
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Queen Silvia Children's Hospital, 416 85 Gothenburg, Sweden
- Division of Neonatology, Sahlgrenska University Hospital, Diagnosvägen 15, 416 50 Gothenburg, Sweden
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Cheng A, Molinaro M, Ott M, Cristancho S, LaDonna KA. Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S65-S71. [PMID: 37983398 DOI: 10.1097/acm.0000000000005355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE Learning to navigate difficult clinical conversations is an essential feature of residency training, yet much of this learning occurs "on the job," often without the formative, multisource feedback trainees need. To generate insight into how on-the-job training influences trainee performance, the perspectives of parents and health care providers (HCPs) who engaged in or observed difficult conversations with Neonatal Intensive Care Unit (NICU) trainees were explored. METHOD The iterative data generation and analysis process was informed by constructivist grounded theory. Parents (n = 14) and HCPs (n = 10) from 2 Canadian NICUs were invited to participate in semistructured interviews informed by rich pictures-a visual elicitation technique useful for exploring complex phenomena like difficult conversations. Themes were identified using the constant comparative approach. The study was conducted between 2018 and 2021. RESULTS According to participants, misalignment between parents' and trainees' communication styles, HCPs intervening to protect parents when trainee-led communication went awry, the absence of feedback, and a culture of sole physician responsibility for communication all conspired against trainees trying to develop communication competence in the NICU. Given beliefs that trainees' experiential learning should not trump parents' well-being, some physicians perceived the art of communication was best learned by observing experts. Sometimes, already limited opportunities for trainees to lead conversations were further constricted by perceptions that trainees lacked the interest and motivation to focus on so-called "soft" skills like communication during their training. CONCLUSIONS Parents and NICU staff described that trainees face multiple barriers against learning to navigate difficult conversations that may set them up to fail. A deeper understanding of the layered challenges trainees face, and the hierarchies and sociocultural norms that interfere with teaching, may be the start of breaking down multiple barriers trainees and their clinician supervisors need to overcome to succeed.
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Affiliation(s)
- Anita Cheng
- A. Cheng is a neonatologist and assistant professor, Department of Pediatrics, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0002-6787-7275
| | - Monica Molinaro
- M. Molinaro is a banting postdoctoral fellow, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; ORCID: https://orcid.org/0000-0002-5629-5974
| | - Mary Ott
- M. Ott is a researcher, Centre for Education Research & Innovation, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0003-4010-6558
| | - Sayra Cristancho
- S. Cristancho is associate professor and scientist, Centre for Education Research & Innovation, Department of Surgery and Faculty of Education, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0002-8738-2130
| | - Kori A LaDonna
- K.A. LaDonna is associate professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-4738-0146
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Bansal S, Willis R, Barks MC, Pollak KI, Brandon D, Kaye EC, Lemmon ME. Supporting Disclosure of Unmet Mental Health Needs among Parents of Critically Ill Infants. J Pediatr 2023; 262:113596. [PMID: 37399922 PMCID: PMC10757990 DOI: 10.1016/j.jpeds.2023.113596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To characterize (1) the prevalence of mental health discussion and (2) facilitators of and barriers to parent disclosure of mental health needs to clinicians. STUDY DESIGN Parents of infants with neurologic conditions in neonatal and pediatric intensive care units participated in a longitudinal decision-making study from 2018 through 2020. Parents completed semi-structured interviews upon enrollment, within 1 week after a conference with providers, at discharge, and 6 months post-discharge. We used a conventional content analysis approach and NVIVO 12 to analyze data related to mental health. RESULTS We enrolled 61 parents (n = 40 mothers, n = 21 fathers) of 40 infants with neurologic conditions in the intensive care unit. In total, 123 interviews were conducted with 52 of these parents (n = 37 mothers, n = 15 fathers). Over two-thirds of parents (n = 35/52, 67%) discussed their mental health in a total of 61 interviews. We identified two key domains when approaching the data through the lens of mental health: (1) self-reported barriers to communicating mental health needs: parents shared uncertainty about the presence or benefit of support, a perceived lack of mental health resources and emotional support, and concerns about trust; (2) self-reported facilitators and benefits of communicating mental health needs: parents described the value of supportive team members, connecting to peer support, and speaking to a mental health professional or neutral third party. CONCLUSIONS Parents of critically ill infants are at high risk of unmet mental health needs. Our results highlight modifiable barriers and actionable facilitators to inform interventions to improve mental health support for parents of critically ill infants.
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Affiliation(s)
- Simran Bansal
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Rheaya Willis
- Department of Psychiatry, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Mary C Barks
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Debra Brandon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke University School of Nursing, Durham, NC
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC.
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Kelly S, Garner J, Treadway V, Sadera G. Knowledge mobilization in critical care and the evolving communication role of nurses. Nurs Crit Care 2023; 28:913-922. [PMID: 35794068 DOI: 10.1111/nicc.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The importance of appropriate communication skills within a health care setting rests upon the need for effective information sharing. When successful, this provides a supportive working environment for staff and has a positive impact on patient care and outcomes. AIMS The purpose of this study was to explore how knowledge/evidence is acquired, shared, and applied in the Critical Care (CC) environment for staff and patients/family members. STUDY DESIGN A qualitative approach was used, consisting of semi-structured interviews and focus groups. Data analysis was conducted using an iterative thematic approach. RESULTS Data collected prior to the COVID-19 pandemic from United Kingdom (UK) critical care workers (N = 46), patients, and family members (N = 21) identified four communication roles performed by the nursing staff: team member; diplomat; translator and friend. CONCLUSIONS It was evident that without suitable training and support, the stresses and demands placed upon the nurses could lead to disenfranchisement and burnout. RELEVANCE TO CLINICAL PRACTICE These findings are relevant and timely given the impact of the pandemic, highlighting the need for accessible and alternate communication strategies to support nurses by reducing stress, moral distress and increasing psychological safety. Improved communication can provide tailored information for staff and patients/family improving the CC experience for all.
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Affiliation(s)
- Sioban Kelly
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Jayne Garner
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Victoria Treadway
- Library and Knowledge Service, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
- NHS England, Leeds, UK
| | - Girendra Sadera
- Department of Critical Care and Anaesthesia, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
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Ginsberg KH, Serlachius A, Rogers J, Alsweiler J. Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey. J Pediatr 2023; 259:113456. [PMID: 37172808 DOI: 10.1016/j.jpeds.2023.113456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand. STUDY DESIGN A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices. RESULTS Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P < .001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents. CONCLUSIONS Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.
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Affiliation(s)
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jen Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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McKeown L, Burke K, Cobham VE, Kimball H, Foxcroft K, Callaway L. The Prevalence of PTSD of Mothers and Fathers of High-Risk Infants Admitted to NICU: A Systematic Review. Clin Child Fam Psychol Rev 2023; 26:33-49. [PMID: 36564614 DOI: 10.1007/s10567-022-00421-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/25/2022]
Abstract
Admission of a preterm or sick full-term infant to the neonatal intensive care unit (NICU) is a stressful experience for parents. Indeed, the 'NICU experience' may constitute a traumatic event for parents, distinct from other birth-related trauma, leading to significant and ongoing posttraumatic stress disorder (PTSD) symptoms. However, the rates at which this outcome occurs are not well understood. This review aimed to identify the prevalence of PTSD in mothers and fathers of high-risk infants admitted to the NICU, specifically focusing on the NICU experience as the index trauma. The PRISMA-P: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols were used to conduct this review. We searched PsycINFO, PubMed, Scopus, EMBASE, Web of Science, ProQuest Dissertations and Theses databases, and reference lists of included articles (1980-2021). Two independent reviewers screened titles and abstracts and conducted the full-text screening assessment. Of the 707 records identified, seven studies met the inclusion criteria. In this systematic review, PTSD symptomatology was assessed by self-report measures rather than a clinical interview. We identified significant variations in the methodologies and quality between studies, with a wide variation of reported prevalence rates of PTSD of 4.5-30% in mothers and 0-33% in fathers. Overall, the findings indicate that up to one-third of parents experience PTSD symptomatology related to the NICU experience. These results emphasize the importance of universal routine antenatal and postnatal screening for symptoms of PTSD to identify parents at risk of distress during the NICU experience and after discharge.Trial registration: The study protocol was registered with Prospero registration number CRD42020154548 on 28 April 2020.
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Affiliation(s)
- Lisa McKeown
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia.
| | - Kylie Burke
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, Brisbane, Australia
- Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Hayley Kimball
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Katie Foxcroft
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Leonie Callaway
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
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Heidarzadeh M, Heidari H, Ahmadi A, Solati K, sadeghi N. Evaluation of parental stress in neonatal intensive care unit in Iran: a national study. BMC Nurs 2023; 22:41. [PMID: 36788549 PMCID: PMC9930338 DOI: 10.1186/s12912-023-01200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND More attention is paid to the survival and treatment of the sick infant in the neonatal intensive care unit (NICU) and parental stress is not considered. The purpose of this study was to determine samples of the level of parental stress in the NICU. METHOD This study is a descriptive-analytical study in which Parental Stress and General Health were used in an analytical national survey in Iran. The research sample consists of 2456 parents of infants admitted to NICU. The sampling method was multi-stage random. We used 11- item parental stress questionnaire and 28-item general health questionnaire for the data collection. RESULT Baloch ethnicity with an average of 11.52 had the highest level of stress. The mean stress score of mothers was higher than fathers. The mean score of all dimensions of physical symptoms, anxiety, social functioning, depression, and total mental health score in mothers was higher than fathers. There was a statistically significant difference in the length of hospitalization in terms of different levels of parental stress scores (p < 0.002). Lack of decisive response to parents was one of the most stressful issues (8.1%). CONCLUSION Our result shows mothers' stress was higher than fathers. So that health policymakers should pay attention to stress risk factors to provide appropriate interventions according stress risk factors Future studies should design appropriate interventions to reduce parental stress, especially in high-risk mothers.
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Affiliation(s)
- Mohammad Heidarzadeh
- grid.488433.00000 0004 0612 8339Zahedan University of Medical Sciences, Zahedan, Iran
| | - Haydeh Heidari
- Faculty of Nursing and Midwifery, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Ali Ahmadi
- grid.440801.90000 0004 0384 8883Department of Epidemiology and Biostatistics, School of Health and Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Kamal Solati
- grid.440801.90000 0004 0384 8883Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Narges sadeghi
- grid.411757.10000 0004 1755 5416Islamic Azad University, Isfahan, Iran
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Shdaifat E, Sudqi AM, Abusneineh FT, Al-Ansari NM. Assessment of Parent and Nurse Perceptions of Parental Participation in Hospital Paediatric Care. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2208160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background:
Parent and nurse perceptions about the care of hospitalized children have been examined in developed countries, but little is known in developing countries.
Objective:
The study aims to evaluate the perceptions of nurses and parents towards parental participation in care for hospitalized children and associated factors.
Methods:
A cross-sectional design was used to collect data from nurses and parents in paediatric units in the Eastern Region of Saudi Arabia using a convenience sampling technique. Data were collected using the Parent Participation Attitude Scale (PPAS), and the agreement and differences between groups were analysed.
Results:
The present results found that both parents and nurses agreed on 7 out of 20 statements regarding parental involvement in care for their children. Nurses in paediatric surgery had a higher perception of involving parents (P = 0.002), while nurses in Well Baby Nursery (WBN) ward had the lowest perception. The present findings confirm that married caregivers had higher perceptions (P = 0.035) than their single counterparts.
Conclusion:
Parent participation attitude was agreed on for seven statements between parents and nurses. More studies are required to explore the relationship between healthcare providers and parents with regard to parental participation in caring for hospitalized children.
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13
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Caillaud I, Torchin H, Basset A, Mouillé M, Jarreau PH, Zana-Taïeb É. [Caregivers' experiences with extreme prematurity]. Soins Psychiatr 2022; 43:10-13. [PMID: 36731975 DOI: 10.1016/j.spsy.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neonatal intensive care units receive very immature premature newborns. Mortality and morbidity rates remain high in this particularly fragile population. Caregivers involved with the child and his or her parents may experience moral distress. There are few studies on the experience of caregivers in these situations. Training, service architecture and sharing of experiences with specifically trained psychologists can improve this experience in these highly technical services.
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Affiliation(s)
- Isabelle Caillaud
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France
| | - Héloïse Torchin
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France; Centre de recherche en épidémiologie et statistiques/Cress, Inserm, Inrae, Université Paris Cité, 1 place du Parvis Notre-Dame, 75004 Paris, France
| | - Aurélie Basset
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France
| | - Marion Mouillé
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France
| | - Pierre-Henri Jarreau
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France; Centre de recherche en épidémiologie et statistiques/Cress, Inserm, Inrae, Université Paris Cité, 1 place du Parvis Notre-Dame, 75004 Paris, France
| | - Élodie Zana-Taïeb
- Service de médecine et réanimation néonatales de Port-Royal, AP-HP, Université Paris Cité, Site Cochin, 123 boulevard de Port-Royal, 75014 Paris, France; Fédération hospitalo-universitaire Combattre la prématurité (FHU Préma), Maternité de Port-Royal, AP-HP, 123 boulevard de Port-Royal, 75014 Paris, France.
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14
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Weber A, Kaplan H, Voos K, Elder M, Close E, Tubbs-Cooley H, Bakas T, Hall S. Neonatal Nurses' Report of Family-Centered Care Resources and Practices. Adv Neonatal Care 2022; 22:473-483. [PMID: 34743109 PMCID: PMC9061894 DOI: 10.1097/anc.0000000000000964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati, College of Nursing, Cincinnati, Ohio (Drs Weber and Bakas); University of Cincinnati, College of Medicine, Cincinnati, Ohio (Dr Kaplan); Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kaplan and Ms Elder); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Drs Weber and Kaplan); University Hospitals Cleveland Medical Center, Rainbow Babies & Children's Hospital, Highland Hills, Ohio (Drs Weber and Voos); Case Western Reserve University, School of Medicine, Cleveland, Ohio (Dr Voos and Ms Close); The Ohio State University, College of Nursing, Columbus (Dr Tubbs-Cooley); The Ohio State University, College of Medicine, Columbus (Dr Tubbs-Cooley); Nationwide Children's Hospital, Columbus, Ohio (Drs Weber and Tubbs-Cooley); and St John's Regional Medical Center, Oxnard, California (Dr Hall)
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15
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Witt RE, Malcolm M, Colvin BN, Gill MR, Ofori J, Roy S, Lenze SN, Rogers CE, Colson ER. Racism and Quality of Neonatal Intensive Care: Voices of Black Mothers. Pediatrics 2022; 150:188766. [PMID: 35965288 DOI: 10.1542/peds.2022-056971] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Black preterm infants are more likely to die than White preterm infants within the same NICU. Racism may lead to disparate quality of NICU care contributing to disparities in preterm infant health outcomes. The objective of our study was to understand Black mothers' perspectives of the impact of racism on the quality of care for Black preterm infants in the NICU and what might be done to address it. METHODS Using qualitative research methods, we conducted in-depth, semistructured interviews with 20 Black mothers of preterm infants in a single Level IV NICU 6 to 18 months after hospital discharge regarding experiences with disparate quality of NICU care. We developed themes iteratively and conducted interviews until thematic saturation was reached. RESULTS The majority of mothers believed that racism impacted the quality of NICU care and described examples of racism in the NICU at structural, institutional, and interpersonal levels. Mothers also provided ideas for interventions that would decrease racism and improve quality of NICU care for Black families, including increased Black representation, increased peer support, and improved staff education and training. CONCLUSIONS Black mothers of preterm infants experienced racism during NICU hospitalization that impacted the quality of care they received. Interventional studies directed toward mitigating these racial disparities may focus on addressing racism during the NICU period and should include input from Black stakeholders at all stages of design, implementation, and analysis.
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Affiliation(s)
| | - Mia Malcolm
- Family Partners Program, BJC HealthCare/St Louis Children's Hospital, St Louis, Missouri
| | | | | | - Joel Ofori
- School of Medicine, Washington University, St Louis, Missouri
| | - Shireen Roy
- School of Medicine, Washington University, St Louis, Missouri
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16
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Lyngstad LT, Le Marechal F, Ekeberg BL, Hochnowski K, Hval M, Tandberg BS. Ten Years of Neonatal Intensive Care Adaption to the Infants' Needs: Implementation of a Family-Centered Care Model with Single-Family Rooms in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5917. [PMID: 35627454 PMCID: PMC9140644 DOI: 10.3390/ijerph19105917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023]
Abstract
Ten years ago, the Neonatal intensive care unit in Drammen, Norway, implemented Single-Family Rooms (SFR), replacing the traditional open bay (OB) unit. Welcoming parents to stay together with their infant 24 h per day, seven days per week, was both challenging and inspiring. The aim of this paper is to describe the implementation of SFR and how they have contributed to a cultural change among the interprofessional staff. Parents want to participate in infant care, but to do so, they need information and supervision from nurses, as well as emotional support. Although SFR protect infants and provide private accommodation for parents, nurses may feel isolated and lack peer support. Our paper describes how we managed to systematically reorganize the nurse's workflow by using a Plan-Do-Study-Act (PDSA) cycle approach. Significant milestones are identified, and the implementation processes are displayed. The continuous parental presence has changed the way we perceive the family as a care recipient and how we involve the parents in daily care. We provide visions for the future with further developments of care adapted to infants' needs by providing neonatal intensive care with parents as equal partners.
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Affiliation(s)
- Lene Tandle Lyngstad
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, 3004 Drammen, Norway; (F.L.M.); (B.L.E.); (K.H.); (M.H.)
| | | | | | | | | | - Bente Silnes Tandberg
- Department of Paediatric and Adolescent Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, 3004 Drammen, Norway; (F.L.M.); (B.L.E.); (K.H.); (M.H.)
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17
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Perceptions of Parent Stressors in the Neonatal Intensive Care Unit Among the General Public and Healthcare Professionals. J Perinat Neonatal Nurs 2022; 36:186-197. [PMID: 35476773 DOI: 10.1097/jpn.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Intervention efforts to improve the psychosocial well-being of parents with an infant in the neonatal intensive care unit (NICU) are high priority. This study assessed public and healthcare professionals' perceptions of prominent NICU stressors to highlight areas where NICU parents are in need of further support. Relations with sample characteristics were also examined to establish the generalizability of known parent demographic/sociofamilial risk factors. METHODS A cross-sectional design was used to assess public (n = 96) and staff (n = 55) responses on the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). RESULTS The public perceived parental stress as being low to moderate. This was significantly lower than the staff estimate and highly comparable with past parent reports. Staff communication was perceived as most stressful by the public with this influenced by gender and education. Staff with more NICU experience were more likely to overestimate parental stress, particularly those working at the highest care level. CONCLUSIONS Collectively, these findings highlight preconceived anxiety around staff communication and behaviors and indicate that education on the potential for traumatic unit experiences to influence staff-parent communication may be important.
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18
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Dahan S, Bourque CJ, Reichherzer M, Prince J, Mantha G, Savaria M, Janvier A. Community, Hope, and Resilience: Parental Perspectives on Peer Support in Neonatology. J Pediatr 2022; 243:85-90.e2. [PMID: 34843711 DOI: 10.1016/j.jpeds.2021.11.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To describe the perspective of parents who participated in peer-to-peer support meetings with parents of children in a neonatal intensive care unit (NICU) and veteran resource parents with previous NICU experience. STUDY DESIGN During a longitudinal evaluation in a tertiary care NICU, participating parents were asked to evaluate meetings; with open-ended questions, they were asked about their perspectives. Results were analyzed using mixed methods. RESULTS Forty-five NICU parents participated over a 10-week study period. They were followed longitudinally after attending at least 1 of the 10 meetings offered; 95% of parents (43 of 45) reported that the meeting was useful to them and gave an overall evaluation of 8.7 out of 10 (average). For each meeting, all the subjects on the checklist of the moderators (veteran resource parents) were discussed with new parents. When describing why and how the meetings were useful to them in their answers to open-ended questions, NICU parents reported 3 major themes: (1) decreasing isolation and being a community (73%), (2) hope and resilience (63%), and (3) getting practical "parent" information (32%). Sharing stories with parents who also had experienced loss, sadness, and grief, NICU parents trusted that it was possible to adapt and thrive. The meetings normalized parents' emotions (92%), decreased negative emotions (eg, anger, sadness, guilt), empowered them in their parental role, and helped them communicate with loved ones and providers. CONCLUSIONS Peer support meetings are a unique and useful means to support parents. Future investigations will investigate whether and how this type of intervention can improve clinical outcomes.
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Affiliation(s)
- Sonia Dahan
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Espace Éthique Méditerranéen, Aix-Marseille University/EFS/CNRS, UMR 7268 ADÉS, Marseille, France
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | - Melissa Savaria
- Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Annie Janvier
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada; Unité d'éthique clinique, CHU Sainte-Justine, Montreal, Quebec, Canada; Division of Neonatology, CHU Sainte-Justine, Montreal, Quebec, Canada; Centre d'excellence en éthique et partenariat, CHU Sainte-Justine, Montreal, Quebec, Canada; Préma-Québec, Quebec, Quebec, Canada; Bureau de l'Éthique Clinique, University of Montreal, Montreal, Quebec, Canada; Unité de soins palliatifs, CHU Sainte-Justine, Montreal, Quebec, Canada.
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19
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Pirrello J, Sorin G, Dahan S, Michel F, Dany L, Tosello B. Analysis of communication and logistic processes in neonatal intensive care unit. BMC Pediatr 2022; 22:137. [PMID: 35291967 PMCID: PMC8922841 DOI: 10.1186/s12887-022-03209-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In neonatology, parents play a central role as guarantors of the new-born's autonomy. Notifying parents about their infant's status in neonatal critical care is an integral part of the care. However, conveying this information can be very difficult for physicians and the neonatal medical team. The objective of this work is to assess the dimensions and dynamic processes of critical care communications in neonatal intensive care in order to enhance the development of theoretical and applied knowledge of these discussions. METHODS This qualitative, descriptive study was conducted on critical care new-borns less than 28 days-old who were hospitalized in a neonatal intensive care unit. Verbatim communications with the parents were recorded using a dictaphone. RESULTS The verbatim information had five themes: (a) critical care, (b) establishing the doctor-patient relationship, (c) assistance in decision making, (d) Socio-affective and (e) socio-symbolic dimensions. Our recordings underscored both the necessity of communication skills and the obligation to communicate effectively. Analysis of the dynamics of the communication process, according to the categories of delivering difficult information, showed few significant differences. CONCLUSION Physician training needs to include how to effectively communicate to parents to optimize their participation and cooperation in managing their care.
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Affiliation(s)
- J Pirrello
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.,Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France
| | - G Sorin
- Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France
| | - S Dahan
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - F Michel
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.,Pediatric Intensive Care Unit, Hôpital de la Timone, Assistance-Publique des Hôpitaux de Marseille, 13005, Marseille, France
| | - L Dany
- Aix Marseille University, LPS, Aix-en-Provence, France.,Service of Medical Oncology, Hôpital de la Timone, Assistance-Publique des Hôpitaux de Marseille, 13005, Marseille, France
| | - B Tosello
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France. .,Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France.
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20
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Vetcho S, Cooke M, Petsky H, Saito A, Ullman AJ. Family-centred care change during COVID-19. Nurs Crit Care 2022; 27:460-468. [PMID: 35234320 PMCID: PMC9115396 DOI: 10.1111/nicc.12766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Family-centred care (FCC) is an approach to promote family and health care provider partnership. This has been incorporated into neonatal intensive care units (NICUs) worldwide. However, FCC in low resource health settings, such as Thailand, is challenging and further impacted by coronavirus disease 2019 (COVID-19). AIMS To evaluate FCC innovations to improve respect, collaboration and support in a Thai NICU. STUDY DESIGN A quasi-experimental study was conducted in an NICU in southern Thailand. Pre-implementation was prior to COVID-19, and parental and staff perceptions of FCC were measured via Perceptions of Family Centred Care-Parent (PFCC-P) and -Staff (PFCC-S) survey. The FCC innovations were developed by stakeholders based on the COVID-19 restrictions, pre-survey results, parents' and clinicians' interviews and integrative review, then implemented via a flowchart. Post-implementation evaluation was via repeated surveys. Comparisons were made pre-and post-implementation, with Mann-Whitney U-test statistics for parents and Wilcoxon's Rank Sum for staff. RESULTS A total of 185 (85 pre; 100 post) parents and 20 (pre and post; paired group) health care professionals participated. Because of COVID-19, many planned interventions were unfeasible, however, other innovations achieved (e.g., structured telephone updates, information booklet revision). There was an increase in parents' perception of respect ([median] 2.50-3.50), collaboration (2.33-3.33) and support (2.60-3.60) domains and overall (2.50-3.43; p < .001; 95% CI: 2.93-3.11). Interdisciplinary professionals' perception of FCC did not significantly change pre-and post-implementation/COVID-19 pandemic for respect (3.00-2.92), collaboration (3.22-3.33), support (3.20-3.20) and overall (3.15-3.20; 95% CI: 3.10-3.25). CONCLUSION Despite the challenges of COVID-19 restricting NICU access, the provision of FCC was maintained and even improved. RELEVANCE TO CLINICAL PRACTICE Further research is necessary to develop FCC practice innovations associated with communication, across diverse health care systems and resources.
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Affiliation(s)
- Siriporn Vetcho
- School of Nursing and Midwifery, Griffith University, Brisbane.,Menzies Health Institute Queensland, Griffith University, Brisbane.,Faculty of Nursing, Prince of Songkla University, Songkhla
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane
| | - Helen Petsky
- School of Nursing and Midwifery, Griffith University, Brisbane.,Menzies Health Institute Queensland, Griffith University, Brisbane
| | - Amornrat Saito
- School of Nursing and Midwifery, Griffith University, Brisbane.,Menzies Health Institute Queensland, Griffith University, Brisbane
| | - Amanda J Ullman
- School of Nursing and Midwifery, Griffith University, Brisbane.,Children's Health Queensland and Health Service, Centre of Children's Health Research, Brisbane, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
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21
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Fernández-Medina IM, Granero-Molina J, Hernández-Padilla JM, Jiménez-Lasserrotte MDM, Ruiz-Fernández MD, Fernández-Sola C. Socio-family support for parents of technology-dependent extremely preterm infants after hospital discharge. J Child Health Care 2022; 26:42-55. [PMID: 33599522 DOI: 10.1177/1367493521996490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Parents of extremely preterm infants (<28 weeks of gestation) report high levels of stress and anxiety related to daily needs after hospital discharge. Social support has a significant role in reducing the negative psychological impact of preterm birth and parents' adaptation to caregiving. We conducted a hermeneutic phenomenological study using Gadamer's approach to explore and describe the experiences of parents of technology-dependent extremely preterm infants of socio-family support after hospital discharge. The study was conducted in four several Spanish organizations for families with preterm infants. It includes 17 semi-structured interviews (12 mothers and 5 fathers). Three main themes emerged from the analysis: post-discharge formal support for extremely preterm infants and families, home neonatal care: family support, and a thread of hope: parent-to-parent support. The parents' main support resources to deal with everyday difficulties are healthcare professionals, their partners, grandmothers, and peer parents of extremely preterm infants. The findings may be used to guide healthcare professionals in the creation of a support program according to preferences and needs of parents.
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Affiliation(s)
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, 16721University of Almería, Spain.,Faculty of Health Sciences, 16721Universidad Autónoma de Chile, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, 16721University of Almería, Spain.,Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University, UK
| | | | | | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, 16721University of Almería, Spain.,Faculty of Health Sciences, 16721Universidad Autónoma de Chile, Chile
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22
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Johnson Rolfes J, Paulsen M. Protecting the infant-parent relationship: special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents. J Perinatol 2022; 42:815-818. [PMID: 34711936 PMCID: PMC8552434 DOI: 10.1038/s41372-021-01256-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022]
Abstract
Perinatal mood and anxiety disorders (PMADs) are common, particularly among parents of infants requiring admission to the neonatal intensive care unit (NICU), yet remain underdiagnosed and undertreated. Undertreated parental mental health disorders can interfere with healthy infant development, compounding abnormal neurodevelopment and psychosocial development that preterm or ill newborns may already face. Interdisciplinary efforts to increase PMAD awareness, screening, and referral uptake may improve family-infant health and developmental outcomes in high-risk infants requiring NICU admission. Therefore, special emphasis on PMAD screening and treatment in NICU parents aligns with the American Academy of Pediatrics mission and should be a focus in neonatal care and included in education, quality improvement, and outcome-based research initiatives.
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Affiliation(s)
- Julie Johnson Rolfes
- Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Megan Paulsen
- grid.17635.360000000419368657Department of Pediatrics, Division of Neonatology, University of Minnesota Medical School, Minneapolis, MN USA
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23
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Sidek SM, Marup S, Zolkefli Y. Nurses' view of the nature of the support given to parents in the neonatal intensive care unit. BELITUNG NURSING JOURNAL 2021; 7:522-528. [PMID: 37497293 PMCID: PMC10367982 DOI: 10.33546/bnj.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 07/28/2023] Open
Abstract
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.
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Affiliation(s)
- Syazwana Mohd. Sidek
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
| | | | - Yusrita Zolkefli
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
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24
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Molinaro ML, Cheng A, Cristancho S, LaDonna K. Drawing on experience: exploring the pedagogical possibilities of using rich pictures in health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1519-1535. [PMID: 34152494 DOI: 10.1007/s10459-021-10056-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
In both clinical and health professions education research, rich pictures, or participant-generated drawings of complex phenomena, are gaining recognition as a useful method for exploring multifaceted and emotional topics in medicine. For instance, two recent studies used rich pictures to augment semi-structured interviews exploring trainees', health care professionals' (HCPs), and parents' experiences of difficult conversations in the Neonatal Intensive Care Unit (NICU)-an environment in which communication is often challenging, anxiety-provoking, and emotionally distressing. In both studies, participants were invited to draw a picture depicting how they experienced a difficult conversation in this setting. As part of the interview process, participants were asked to both describe how they engaged with rich pictures, and to share their perceptions about the affordances and limitations of this research method. Here, their perspectives are reported and the possibilities of using rich pictures to inform pedagogical innovations in health professions education and research are considered.
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Affiliation(s)
- Monica L Molinaro
- Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.
| | - Anita Cheng
- Department of Neonatal and Perinatal Medicine, London Health Sciences Centre, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Sayra Cristancho
- Department of Surgery, Faculty of Education, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Kori LaDonna
- Department of Innovation in Medical Education and Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Gilstrap CM. Organizational Sensegiving in Family-Centered Care: How NICU Nurses Help Families Make Sense of the NICU Experience. HEALTH COMMUNICATION 2021; 36:1623-1633. [PMID: 32643420 DOI: 10.1080/10410236.2020.1785373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As frontline caregivers, nurses play a central role in the coordination and delivery of family-centered care (FCC) in neonatal intensive care units (NICUs). Nurses see first-hand the fear, uncertainty, and anxiety parents experience due to unfamiliar and intimidating elements of neonatal care and the NICU environment. This study examines the sensegiving strategies nurses use to help families make sense of their NICU experience. In-depth, semi-structured interviews were conducted with 14 NICU nurses at a mid-size nonprofit hospital. Findings reveal nurses utilize four sensegiving strategies to influence parents' understanding of, response to, and participation in neonatal care practices: educate parents, personalize information, promote open communication, and encourage meaningful involvement. Overall, nurses rely on communication to align parents' meaning construction with FCC features and goals. Hospital administrators and nurse managers should integrate this study's findings into nurse training and professional development opportunities to teach nurses about parental sensemaking, factors that affect nurse sensegiving efforts, how to create effective sensegiving strategies, and sensegiving challenges they may face. Healthcare leaders should also provide organizational structures, resources, and continuing education programs that help nurses cope with the emotional demands of sensegiving. Moreover, nurses should talk to colleagues or supervisors and participate in self-care activities if sensegiving starts to impact their well-being or ability to provide effective FCC.
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Koch A, Kozhumam AS, Seeler E, Docherty SL, Brandon D. Multiple Roles of Parental Caregivers of Children with Complex Life-Threatening Conditions: A Qualitative Descriptive Analysis. J Pediatr Nurs 2021; 61:67-74. [PMID: 33780717 PMCID: PMC8464614 DOI: 10.1016/j.pedn.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Children born with Complex Life-Threatening Conditions (CLTCs) often require complex and specialized services. Parents of children with CLTCs balance the role of caregiver with other responsibilities of employment, education, relationships, and self-care. The purpose of this paper is to describe the challenges for parents serving as caregivers of children with CLTCs and their intersection with health care provider expectations through utilization and adaptation of the role theory framework. DESIGN/METHODS We employed a qualitative descriptive design, secondary analysis of a longitudinal study on parent and provider decision making for children with CLTC. There were 218 interviews from sixty-one parents of 35 infants with prematurity, bone marrow transplant, and/or complex cardiac disease, followed for one year unless death occurred. Content analysis and thematic generation were performed capturing the various parental roles embedded within provider expectations of informal parental caregiving. RESULTS Results showed that parents of children with CLTCs serve multidimensional roles, including that of informal nurse and care coordinator, while maintaining additional personal roles as parent and family provider. Parents experienced challenges as caregivers that were shaped by perceived expectations of health care providers as well as lack of support, often leading to role strain, conflict, overload, and sometimes exit. CONCLUSIONS Parents of children with CLTCs experience both common and unique challenges inn balancing multiple roles as an informal caregiver. Despite utilizing positive coping mechanisms, their status as parent caregiver carries significant risk for role strain and overload. We recommend the implementation of strategies for increasing parental support and family-centered care.
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Affiliation(s)
- Amie Koch
- Duke University School of Nursing, Family Nurse Practitioner Transitions Lifecare, Nurse Practitioner Lincoln Community Health Clinic, NC, United States of America.
| | - Arthi S Kozhumam
- Duke University, Global Health Institute, NC, United States of America
| | - Erika Seeler
- Duke University, School of Nursing, NC, United States of America
| | | | - Debra Brandon
- Duke University, School of Nursing, NC, United States of America
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Schmöker A, Ericson J, Flacking R, Udo C. Needs and Perceptions Relative to Emotional Support in Parents With Preterm Infants. J Perinat Neonatal Nurs 2021; Publish Ahead of Print:00005237-900000000-99937. [PMID: 34643604 DOI: 10.1097/jpn.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives of this study were to explore parents' needs for emotional support and how such support could be best delivered during admittance to a neonatal unit. This study took place at 6 neonatal units in Sweden. Forty-two semistructured interviews were analyzed using qualitative content analysis: 26 individual telephone interviews with mothers of preterm infants 6 to 10 months after discharge and 16 face-to-face interviews with parents of preterm infants admitted to neonatal units. The main category to emerge was needs and preferences for emotional support , which consisted of 2 generic categories: emotional needs and preferences for potential support interventions . Emotional needs define the importance of comprehending the new situation, finding meaning, and managing the situation through resources. Preferences for potential support interventions identify possible ways to deliver emotional support in the form of parental group, diary writing, professional counseling, and Internet support. The results highlight the importance of supporting parents' sense of coherence in their situation and parenthood by offering different interventions according to parent preferences. Parental groups could serve as a keystone for emotional support with the possibility to combine with other support mechanisms.
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Affiliation(s)
- Annika Schmöker
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden (Ms Schmöker); School of Education, Health and Social Studies, Dalarna University, Falun, Sweden (Ms Schmöker, and Drs Ericson, Flacking, and Udo); Center for Clinical Research Dalarna, Uppsala University, Sweden (Drs Ericson and Udo); Department of Paediatrics, County of Dalarna, Falun, Sweden (Dr Ericson); and Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden (Dr Udo)
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Self-Report and Biological Indexes of Work-Related Stress in Neonatal Healthcare Professionals: A Repeated-Measures Observational Study. Adv Neonatal Care 2021; 21:E120-E128. [PMID: 33538493 DOI: 10.1097/anc.0000000000000848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Healthcare providers working in neonatal intensive care units (NICUs) are considered at high risk for psychological work-related stress. PURPOSE To evaluate both perceived and biological measures of work-related stress in neonatal healthcare professionals and to compare professionals working in the NICU with their colleagues working in less critical environments (ie, neonatal wards [NWs]). METHODS The salivary cortisol level at the beginning (CORT-B) and at the end (CORT-E) of a daily work shift was collected once a week for 6 weeks and a psychological questionnaire was submitted to NW and NICU workers of a tertiary university center. RESULTS No differences emerged in the overall cortisol secretion between professionals (NW 45 vs NICU 28), but the decrease in the mean cortisol values between CORT-B and CORT-E was less pronounced in NICU professionals (P < .001) who had greater psychological stress (P < .001). Lack of correlation between perceived and biological indexes was observed. IMPLICATIONS FOR PRACTICE NICU professionals reported greater levels of self-perceived psychological stress, especially in terms of professional self-doubt and the complexity of interactions with infants and their parents.The disconnection between psychological and biological indexes raises the issue that work-related stress might be covert to the professionals themselves. Dedicated resources should be developed to address quality of life and the work environment of NICU professionals. IMPLICATIONS FOR RESEARCH The absence of a correlation between perceived and biological indexes highlights the need to incorporate multidimensional physiological and biological measurements in evaluating burnout levels in neonatal healthcare providers.
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Abstract
BACKGROUND Parental support in the neonatal intensive care unit (NICU) is critical; yet, the nursing staff may struggle to provide optimal support to NICU fathers. Generally, fathers are not viewed as equally competent caregivers when compared with mothers, and fathers often impart these beliefs on themselves. Increasing the nursing staff's knowledge and understanding of paternal support can change attitudes and foster positive behavior changes, enhancing the perception of support received by NICU fathers. PURPOSE To implement a needs assessment and educational intervention for the nursing staff designed to increase the perception of nursing support received by NICU fathers. METHODS The Nurse Parents Support Tool (NPST) was administered to the clinical nursing staff and fathers in a pre/posttest design comparing support given by nurses with the fathers' perception of received support. Data from the preintervention assessment was used to design an educational intervention on improving fathers' support. Following the intervention, a postintervention NPST was administered to fathers to determine whether there was an improvement in support perception. FINDINGS/RESULTS Improvement in the NICU fathers' perception of nursing staff support was noted between father groups. In addition, the NPST can be used to assess paternal support needs and develop staff education. IMPLICATIONS FOR PRACTICE Support provided to NICU fathers can enhance the father's perception of himself as an equal and competent caregiver, leading to improved father-infant bonding as the child ages. Educational interventions targeting father support should be a routine part of nursing staff training. IMPLICATIONS FOR RESEARCH Future research should examine the long-term effects of early paternal support on psychosocial, cognitive, and developmental outcomes of NICU infants.
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Psychological Wellbeing of Parents with Infants Admitted to the Neonatal Intensive Care Unit during SARS-CoV-2 Pandemic. CHILDREN-BASEL 2021; 8:children8090755. [PMID: 34572187 PMCID: PMC8471119 DOI: 10.3390/children8090755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/25/2023]
Abstract
The current SARS-CoV-2 disease (COVID-19) pandemic is a sudden major stressor superimposed on pre-existing high distress in parents of infants admitted to the neonatal intensive care unit (NICU). This study aimed to investigate the psychological wellbeing of NICU parents during the COVID-19 pandemic. Forty-four parents of 25 inpatients of the Padua University Hospital NICU were included from June 2020 to February 2021. At 7–14 days postpartum parents completed the Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Parental Stressor Scale: NICU (PSS:NICU) and an ad-hoc questionnaire measuring parental COVID-19 related stress. About one third of parents reported extreme/high stress and a relevant negative impact on parenthood experience. Less time (82%) and less physical contact (73%) with infants due to COVID-19 preventive measures were the most frequent negative factors. Higher COVID-19 related parental stress was positively associated with anxiety, depression, NICU parental stress, stress related to NICU environment, and parental role alterations. Depression symptoms, stress related to infant condition and parental role alterations were higher in mothers. The pandemic affected parental emotional and relational wellbeing directly through additional stress due to COVID-19 concerns and indirectly through the impact of restrictions on the experience of becoming parents.
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Jonsson A, Jakobsson M, Ericson J. A qualitative study of recorded telephone support calls with mothers of preterm infants: Expressing both positive and negative feelings. Nurs Open 2021; 8:3065-3072. [PMID: 34337890 PMCID: PMC8510739 DOI: 10.1002/nop2.1019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/07/2022] Open
Abstract
AIM To describe the structure and content of telephone support calls between mothers of preterm infants and support team members after hospital discharge. DESIGN This is a qualitative study. METHODS Data consisted of 19 recordings of telephone calls that occurred between March 2013 and December 2015. The calls were made by support team members to mothers within two weeks of discharge from the neonatal unit. Analyses were performed using content analysis. RESULTS One category referred to what the support team members said that facilitated or did not facilitate the conversation. It was found that the support team members managed to have conversations that were tailored to the mother's current needs and conversations where the focus was on what the support team members thought was important. A second category referred to the topics the mothers talked about and that the mothers expressed both negative and positive feelings.
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Affiliation(s)
- Anna Jonsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Primary Healthcare, Falun, Sweden
| | - Magdalena Jakobsson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Jenny Ericson
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Centre for Clinical Research Dalarna, Falun, Sweden.,Department of Paediatrics, Falu Hospital, Falun, Sweden
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Wreesmann WJW, Lorié ES, van Veenendaal NR, van Kempen AAMW, Ket JCF, Labrie NHM. The functions of adequate communication in the neonatal care unit: A systematic review and meta-synthesis of qualitative research. PATIENT EDUCATION AND COUNSELING 2021; 104:1505-1517. [PMID: 33341329 DOI: 10.1016/j.pec.2020.11.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the main functions of parent-provider communication in the neonatal (intensive) care unit (NICU) and determine what adequate communication entails according to both parents and health professionals. METHODS A systematic review and meta-synthesis of qualitative research. PubMed, Ebsco/PsycINFO, Wiley/Cochrane Library, Ebsco/CINAHL, Clarivate Analytics/Web of Science Core Collection, and Elsevier/Scopus were searched in October-November 2019 for records on interpersonal communication between parents and providers in neonatal care. Title/abstract screening and full-text analysis were conducted by multiple, independent coders. Data from included articles were analyzed using deductive and inductive thematic analysis. RESULTS 43 records were included. Thematic analysis of data resulted in the development of the NICU Communication Framework, including four functions of communication (1. building/maintaining relationships, 2. exchanging information, 3. (sharing) decision-making, 4. enabling parent self-management) and five factors that contribute to adequate communication across these functions (topic, aims, location, route, design) and, thereby, to tailored parent-provider communication. CONCLUSION The NICU Communication Framework fits with the goals of Family Integrated Care to encourage parent participation in infants' care. This framework forms a first step towards the conceptualization of (adequate) communication in NICU settings. PRACTICE IMPLICATIONS Findings can be used to improve NICU communication in practice, in particular through the mnemonic TAILORED.
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Affiliation(s)
| | - Esther S Lorié
- Athena Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Nicole R van Veenendaal
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, the Netherlands
| | | | | | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Pediatrics and Neonatology, OLVG, Amsterdam, the Netherlands.
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Davis B, Baggett KM, Patterson AL, Feil EG, Landry SH, Leve C. Power and Efficacy of Maternal Voice in Neonatal Intensive Care Units: Implicit Bias and Family-Centered Care. Matern Child Health J 2021; 26:905-912. [PMID: 34160758 DOI: 10.1007/s10995-021-03199-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Implicit bias can lead medical professionals in Neonatal Intensive Care Units (NICUs) to disregard mothers who are Black and economically disadvantaged as they advocate for their infants' health. Disregard can weaken underlying communication principles within the Family-Centered Care (FCC) model of pediatric health in NICUs and increase maternal distress. This study is the first to address communication disregard by examining mothers' perceived power and efficacy of voice with NICU doctors and nurses. We hypothesized that mothers who are Black and economically disadvantaged would report lower efficacy of voice and higher levels of distress as compared to White mothers with higher income. METHODS During pre-assessment within a small clinical trial of a parenting intervention, 33 racially and economically diverse mothers, from three Midwest NICUs serving the urban poor, responded to a 14-item measure of maternal power and efficacy of voice and measures of somatization, depression, anxiety and eating/sleeping disorders. Nonparametric examinations assessed the relation of power and efficacy of voice to maternal race, income, and distress. RESULTS In contrast to White, higher-income mothers, Black, economically disadvantaged mothers reported lower perceived efficacy of voice with doctors (U = 74.5, d = 0.65) and nurses (U = 74.0; d = .0.66). These mothers with lower perceived efficacy with doctors and nurses, reported higher levels of somatization (U = 16.5, d = 1.14; U = 13.5, d = 1.38, respectively) and eating disorders (U = 14.0, d = 1.29; U = 12.0, d = 1.48, respectively). DISCUSSION Study results are discussed within the framework of implicit bias in FCC in the NICU, expanding our understanding of effective communication with economically stressed, Black mothers.
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Affiliation(s)
| | | | | | | | - Susan H Landry
- University of Texas Health Science Center, Houston, TX, USA
| | - Craig Leve
- Oregon Research Institute, Eugene, OR, USA
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Glazer KB, Sofaer S, Balbierz A, Wang E, Howell EA. Perinatal care experiences among racially and ethnically diverse mothers whose infants required a NICU stay. J Perinatol 2021; 41:413-421. [PMID: 32669647 PMCID: PMC7886019 DOI: 10.1038/s41372-020-0721-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/28/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To learn how diverse mothers whose babies required a neonatal intensive care unit (NICU) stay evaluate their obstetric and neonatal care. STUDY DESIGN We conducted three focus groups stratified by race/ethnicity (Black, Latina, White, and Asian women, n = 20) who delivered infants at <32 weeks gestation or <1500 g with a NICU stay. We asked women to assess perinatal care and applied classic qualitative analysis techniques to identify themes and make comparisons across groups. RESULTS Predominant themes were similar across groups, including thoroughness and consistency of clinician communication, provider attentiveness, and barriers to closeness with infants. Care experiences were largely positive, but some suggested poorer communication and responsiveness toward Black and Latina mothers. CONCLUSION Feeling consulted and included in infant care is critical for mothers of high-risk neonates. Further in-depth research is needed to remediate differences in hospital culture and quality that contribute to disparities in neonatal care and outcomes.
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Affiliation(s)
- Kimberly B Glazer
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Shoshanna Sofaer
- American Institutes for Research, Washington, DC, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Amy Balbierz
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eileen Wang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kirolos S, Sutcliffe L, Giatsi Clausen M, Abernethy C, Shanmugalingam S, Bauwens N, Orme J, Thomson K, Grattan R, Patel N. Asynchronous video messaging promotes family involvement and mitigates separation in neonatal care. Arch Dis Child Fetal Neonatal Ed 2021; 106:172-177. [PMID: 32928897 PMCID: PMC7490916 DOI: 10.1136/archdischild-2020-319353] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the parent and staff experience of a secure video messaging service as a component of neonatal care. DESIGN Multicentre evaluation incorporating quantitative and qualitative items. SETTING Level II and level III UK neonatal units. POPULATION Families of neonatal inpatients and neonatal staff. INTERVENTION Use of a secure, cloud-based asynchronous video messaging service to send short messages from neonatal staff to families. Evaluation undertaken July-November 2019. MAIN OUTCOME MEASURES Parental experience, including anxiety, involvement in care, relationships between parents and staff, and breastmilk expression. RESULTS In pre-implementation surveys (n=41), families reported high levels of stress and anxiety and were receptive to use of the service. In post-implementation surveys (n=42), 88% perceived a benefit of the service on their neonatal experience. Families rated a positive impact of the service on anxiety, sleep, family involvement and relationships with staff. Qualitative responses indicated enhanced emotional closeness, increased involvement in care and a positive effect on breastmilk expression. Seventy-seven post-implementation staff surveys were also collected. Staff rated the service as easy to use, with minimal impact on workload. Seventy-one percent (n=55) felt the service had a positive impact on relationships with families. Staff identified the need to manage parental expectations in relation to the number of videos that could be sent. CONCLUSIONS Asynchronous video messaging improves parental experience, emotional closeness to their baby and builds supportive relationships between families and staff. Asynchronous video supports models of family integrated care and can mitigate family separation, which could be particularly relevant during the COVID-19 pandemic.
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Affiliation(s)
- Sandy Kirolos
- Neonatology, Princess Royal Maternity Hospital, Glasgow, UK
| | | | | | | | | | | | - Judith Orme
- Neonatology, Simpson Centre for Reproductive Health, Edinburgh, UK
| | | | | | - Neil Patel
- Neonatology, Royal Hospital for Children, Glasgow, UK
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Sorin G, Dany L, Vialet R, Thomachot L, Hassid S, Michel F, Tosello B. How doctors communicated with parents in a neonatal intensive care: Communication and ethical issues. Acta Paediatr 2021; 110:94-100. [PMID: 32364306 DOI: 10.1111/apa.15339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/15/2023]
Abstract
AIM Doctors have a moral and legal obligation to keep patients and their families informed, and this is an integral part of care. We explored the communication strategies used by doctors when they spoke to parents in a French neonatal intensive care unit (NICU). METHODS This was a single-centre qualitative pilot study carried out from October 2015 to January 2016. We asked five doctors (three female) to audiotape their discussions with the parents of newborn infants during their NICU stay. The doctors' mean age was 43 years, and they had a mean of 14 years of NICU experience. Each discussion was subjected to thematic content analysis. RESULTS We analysed 40 discussions carried out between doctors on 26 newborn infants. Five communication strategy themes emerged: building understanding, how the communication was constructed, the role of the doctor, and of the parents, in the overall care of the newborn infant and how the information given to the parents developed over time. CONCLUSION Analysing the content of the information discussed with parents provided us with the opportunity to understand the communication and ethical issues surrounding the delivery of information in a NICU. This could be used to improve future discussions between doctors and parents.
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Affiliation(s)
- Gaelle Sorin
- Hospital La Timone Aix‐Marseille University/EFS/CNRS, UMR 7268 ADÉS, Espace Éthique Méditerranéen Marseille France
- Department of Neonatal Medicine, North Hospital Assistance Publique‐Hôpitaux de Marseille Marseille France
| | - Lionel Dany
- Aix‐Marseille University Aix‐en‐Provence France
- Department of Oncology Hospital La Timone Assistance Publique‐Hôpitaux de Marseille Marseille France
| | - Renaud Vialet
- Department of Neonatal Medicine, North Hospital Assistance Publique‐Hôpitaux de Marseille Marseille France
| | - Laurent Thomachot
- Department of Neonatal Medicine, North Hospital Assistance Publique‐Hôpitaux de Marseille Marseille France
| | - Sophie Hassid
- Department of Neonatal Medicine, North Hospital Assistance Publique‐Hôpitaux de Marseille Marseille France
| | - Fabrice Michel
- Hospital La Timone Aix‐Marseille University/EFS/CNRS, UMR 7268 ADÉS, Espace Éthique Méditerranéen Marseille France
- Department of Pediatric Intensive Care Unit Hospital La Timone Assistance‐Publique des Hôpitaux de Marseille Marseille France
| | - Barthélémy Tosello
- Hospital La Timone Aix‐Marseille University/EFS/CNRS, UMR 7268 ADÉS, Espace Éthique Méditerranéen Marseille France
- Department of Neonatal Medicine, North Hospital Assistance Publique‐Hôpitaux de Marseille Marseille France
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Donoho K, Fossa M, Dabagh S, Caliboso M, Lotstein D, Nair S. Compassionate extubation protocol to improve team communication and support in the neonatal intensive care unit. J Perinatol 2021; 41:2355-2362. [PMID: 34006968 PMCID: PMC8129605 DOI: 10.1038/s41372-021-01085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Compassionate extubation (CE) can be stressful for staff and families in the neonatal intensive care unit (NICU). Our quality improvement initiative developed and implemented a novel symptom management and family support checklist and post-debriefing template to improve team communication and staff support. STUDY DESIGN An interprofessional team performed a needs assessment, determined key drivers and intervention steps, and implemented changes using Plan-Do-Study-Act cycles. Outcomes included nursing perception of good communication with the medical team, nursing assessment of patient comfort after CE, and frequency of post-event debrief. Outcomes were analyzed using time series design with 12 months baseline data and 6 months post-implementation monitoring. RESULT Eighteen events were studied. Respondents endorsing "good" communication with the medical team increased by 60%, and debrief participation rate improved by 96%. CONCLUSION Implementation of a CE checklist and post-event debriefing sheet was associated with increased rate of debriefs and improved team communication.
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Affiliation(s)
- Kelsey Donoho
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Mallory Fossa
- grid.239546.f0000 0001 2153 6013Division of Comfort and Palliative Care, Department of Anesthesia and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.414666.70000 0001 0440 7332Present Address: Division of Pain and Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT USA
| | - Sarah Dabagh
- grid.239546.f0000 0001 2153 6013Division of Comfort and Palliative Care, Department of Anesthesia and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.239546.f0000 0001 2153 6013Present Address: Department of Palliative Care, Memorial Care Miller Women and Children’s Hospital, Long Beach, CA USA
| | - Menchie Caliboso
- grid.239546.f0000 0001 2153 6013Division of Comfort and Palliative Care, Department of Anesthesia and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Present Address: Department of Quality Information and Analytics, University of California, Los Angeles, Los Angeles, CA USA
| | - Debra Lotstein
- grid.239546.f0000 0001 2153 6013Division of Comfort and Palliative Care, Department of Anesthesia and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Srikumar Nair
- grid.239546.f0000 0001 2153 6013Division of Neonatology, Department of Pediatrics, Fetal and Neonatal Institute, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
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Infant-Family Mental Health in the NICU: A Mixed-Methods Study Exploring Referral Pathways and Family Engagement. J Perinat Neonatal Nurs 2021; 35:68-78. [PMID: 33528190 DOI: 10.1097/jpn.0000000000000545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parents and infants in the neonatal intensive care unit (NICU) are exposed to considerable stress, and infant-family mental health (IFMH) services foster emotional well-being in the context of the parent-infant relationship. This mixed-methods study examined the role of an IFMH program introduced in a level 4 NICU. The study included (1) retrospective medical record review of NICU patients who were referred to the IFMH program and (2) qualitative interviews with NICU nurse managers, neonatologists, and medical social workers to explore their understanding of the IFMH program, explore the referral pathways and factors that supported family engagement, and identify specific recommendations for program improvement. Of the 311 infant-parent dyads referred to the IFMH program, 62% had at least one session and Spanish-speaking families were more likely to engage. Of those families receiving services, about one-third had brief intervention, one-third had 4 to 10 sessions, and one-third had long-term services, including in-home after-discharge services. Qualitative interviews with health providers identified unique qualities of the IFMH program and why families were and were not referred to the program. Recommendations centered on adding a full-time IFMH mental health provider to the NICU and increasing communication and integration between the IFMH program and the medical team.
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Pisoni C, Provenzi L, Moncecchi M, Caporali C, Naboni C, Stronati M, Montirosso R, Borgatti R, Orcesi S. Early parenting intervention promotes 24-month psychomotor development in preterm children. Acta Paediatr 2021; 110:101-108. [PMID: 32392381 DOI: 10.1111/apa.15345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
AIM Although parenting is key to promoting healthy development of at-risk preterm infants, parents have often restricted access to neonatal intensive care units (NICUs). This study aimed to assess the effect of an early parenting intervention on the psychomotor outcome in preterm children at 24 months of corrected age. METHODS Forty-two preterm children and their parents were consecutively recruited at a level III NICU in Northern Italy and randomly allocated to early intervention (two educational peer-group sessions and four individual infant observation sessions) or care as usual (no educational or infant observation sessions). During NICU stay, parents provided information on daily holding and skin-to-skin. Psychomotor development was measured at 24 months of corrected age using the Griffith Mental Development Scales. RESULTS There were no significant differences in socio-demographic and clinical variables between early intervention (n = 21; 13 females) and care as usual (n = 21; 12 females) groups. At 24 months of corrected age, children in the early intervention arm had greater scores for global psychomotor development as well as for Hearing-Speech and Personal-Social sub-scales, compared to those in the care as usual group. CONCLUSION The present NICU parenting intervention was found to be associated with better psychomotor outcomes in preterm children at 24-month age. The effects were especially evident for domains related to language and socio-emotional functioning. Results are promising and should be retested with more heterogeneous and representative preterm sample.
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Affiliation(s)
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Michela Moncecchi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Camilla Caporali
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Cecilia Naboni
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | | | - Rosario Montirosso
- 0‐3 Center for the at‐Risk Infant Scientific Institute IRCCS E. Medea Lecco Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
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Hemle Jerntorp S, Sivberg B, Lundqvist P. Fathers' lived experiences of caring for their preterm infant at the neonatal unit and in neonatal home care after the introduction of a parental support programme: A phenomenological study. Scand J Caring Sci 2020; 35:1143-1151. [PMID: 33179339 PMCID: PMC9291611 DOI: 10.1111/scs.12930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 01/04/2023]
Abstract
Aim To describe fathers’ lived experiences of caring for their preterm infant at the neonatal unit and in hospital‐based neonatal home care after the introduction of an individualised parental support programme. Method Seven fathers from a larger study were included due to their rich narrative interviews about the phenomenon under study. The interviews took place after discharge from neonatal home care. The theoretical perspective was descriptive phenomenology. Giorgi’s outlines for phenomenological analysis were used. Findings The general structure of the phenomenon was described by the following four themes: The partner was constantly present in the fathers’ minds; The fathers’ were occupied by worries and concerns; The fathers felt that they were an active partner to the professionals and Getting the opportunity to take responsibility. The fathers were satisfied with the support and treatment during their infant’s hospitalisation. However, there were times when they felt excluded and not fully responsible for their infant. The fathers prioritised the mother, thus ignoring their own needs. Furthermore, they worried about their infant’s health and the alteration of their parental role. Neonatal home care was experienced as a possibility to regain control over family life. Conclusion The general structure of fathers’ experiences highlights the importance of professionals becoming more responsive to fathers’ needs and to tailoring support to fathers by focusing on their individual experiences and needs.
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Affiliation(s)
- Sofia Hemle Jerntorp
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Bengt Sivberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Pia Lundqvist
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Lakatos PP, Matic T, Carson M, Williams ME. Child-Parent Psychotherapy with Infants Hospitalized in the Neonatal Intensive Care Unit. J Clin Psychol Med Settings 2020; 26:584-596. [PMID: 30941622 DOI: 10.1007/s10880-019-09614-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hospitalization in the Neonatal Intensive Care Unit (NICU) is a stressful and potentially traumatic experience for infants as well as their parents. The highly specialized medical environment can threaten the development of a nurturing and secure caregiving relationship and potentially derail an infant's development. Well-timed, dose-specific interventions that include an infant mental health approach can buffer the impact of medical traumatic stress and separations and support the attachment relationship. Many psychological interventions in the NICU setting focus on either the parent's mental health or the infant's neurodevelopmental functioning. An alternative approach is to implement a relationship-based, dyadic intervention model that focuses on the developing parent-infant relationship. Child-parent psychotherapy (CPP) is an evidence-based trauma-informed dyadic intervention model for infants and young children who have experienced a traumatic event. This article describes the adaptation of CPP for the NICU environment.
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Affiliation(s)
- Patricia P Lakatos
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA.
| | - Tamara Matic
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Melissa Carson
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Marian E Williams
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
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Johnson Rolfes J, Christensen K, Gershan LA. Acceptance of Traditional Chinese Medicine in the Neonatal Intensive Care Unit: A Launching Point. Glob Adv Health Med 2020; 9:2164956120924644. [PMID: 32426181 PMCID: PMC7218323 DOI: 10.1177/2164956120924644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Because neonatology is a relatively new medical specialty, it is host to on-going, rapid adaptation and evolution of medical treatments and practices. This process has almost exclusively focused on Western, biomedical treatment modalities, without inclusion of potentially beneficial Traditional Chinese Medicine practices. It is unclear how receptive health-care providers in the neonatal intensive care unit (NICU) and families of NICU patients would be to the introduction of adapted Traditional Chinese Medicine treatments into the NICU environment. OBJECTIVE To assess the potential for engagement of patients, families, and staff in the NICU with Traditional Chinese Medicine therapies and to provide targeted education and low-risk Traditional Chinese Medicine treatments to support the health and well-being of those 3 groups. METHODS A feasibility pilot study including weekly walk-in Traditional Chinese Medicine sessions within the NICU for parents and staff, and neonatal patient consultations, both of which included hands-on therapies and education tailored to each participant's unique needs. Pre- and postsurveys were administered over 3 phases. RESULTS Walk-in sessions were attended by 83 adults and participants reported benefits, with no ill effects. There were 5 neonatal consultations with staff expressing an interest in more. Several obstacles to accessing Traditional Chinese Medicine modalities were identified in pre-surveys and were addressed with education and preemptive modifications to the therapies offered. CONCLUSION Acceptance of Traditional Chinese Medicine modalities in the NICU opens the door to future studies implementing integrative health services into the NICU care model.
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Affiliation(s)
- Julie Johnson Rolfes
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Kimberly Christensen
- Division of Hematology-Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Pediatric Integrative Health and Wellbeing, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Lynn A Gershan
- Division of Hematology-Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Pediatric Integrative Health and Wellbeing, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
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Abstract
BACKGROUND Stillbirth and neonatal death are one of the most stressful life events, with negative outcomes for parents. Society does not recognize this type of loss, and parental grieving is particularly complicated and intense. PURPOSE The aim of this study was to describe and understand the experiences of parents in relation to professional and social support following stillbirth and neonatal death. METHODS This was a qualitative study based on Gadamer's hermeneutic phenomenology. Twenty-one semistructured interviews were carried out. Inductive analysis was used to find themes based on the data. RESULTS Twenty-one parents (13 mothers and 8 fathers) from 6 families participated in the study. The analysis identified 2 main themes: (1) "professional care in dealing with parents' grief," with the subthemes "important aspects of professional care," "continuing of pathways of care"; and (2) "effects of social support in parental grief," including the subthemes "the silence that surrounds grieving parents," "family and other children: a key element," and "perinatal loss support groups: a reciprocal help." IMPLICATIONS FOR PRACTICE Counseling and support according to parents' requirements by an interdisciplinary team of professionals educated in perinatal loss and ethical family-centered care is needed. A social support system for families is necessary to avoid negative emotional consequences. IMPLICATIONS FOR RESEARCH Further research is needed to analyze midwives' and nurses' experience as facilitators to improve parental grief and the difficulties experienced by the family, other children, and friends of parents with perinatal loss in providing support.
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Dombrecht L, Cohen J, Cools F, Deliens L, Goossens L, Naulaers G, Beernaert K, Chambaere K. Psychological support in end-of-life decision-making in neonatal intensive care units: Full population survey among neonatologists and neonatal nurses. Palliat Med 2020; 34:430-434. [PMID: 31739740 DOI: 10.1177/0269216319888986] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Moral distress and burnout related to end-of-life decisions in neonates is common in neonatologists and nurses working in neonatal intensive care units. Attention to their emotional burden and psychological support in research is lacking. AIM To evaluate perceived psychological support in relation to end-of-life decisions of neonatologists and nurses working in Flemish neonatal intensive care units and to analyse whether or not this support is sufficient. DESIGN/PARTICIPANTS A self-administered questionnaire was sent to all neonatologists and neonatal nurses of all eight Flemish neonatal intensive care units (Belgium) in May 2017. The response rate was 63% (52/83) for neonatologists and 46% (250/527) for nurses. Respondents indicated their level of agreement (5-point Likert-type scale) with seven statements regarding psychological support. RESULTS About 70% of neonatologists and nurses reported experiencing more stress than normal when confronted with an end-of-life decision; 86% of neonatologists feel supported by their colleagues when they make end-of-life decisions, 45% of nurses feel that the treating physician listens to their opinion when end-of-life decisions are made. About 60% of both neonatologists and nurses would like more psychological support offered by their department when confronted with end-of-life decisions, and 41% of neonatologists and 50% of nurses stated they did not have enough psychological support from their department when a patient died. Demographic groups did not differ in terms of perceived lack of sufficient support. CONCLUSION Even though neonatal intensive care unit colleagues generally support each other in difficult end-of-life decisions, the psychological support provided by their department is currently not sufficient. Professional ad hoc counselling or standard debriefings could substantially improve this perceived lack of support.
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Affiliation(s)
- Laure Dombrecht
- End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Ghent, Belgium
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Linde Goossens
- Department of Neonatology, Ghent University Hospital, Ghent, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kim Beernaert
- End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel (VUB), Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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45
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Grauerholz KR, Fredenburg M, Jones PT, Jenkins KN. Fostering Vicarious Resilience for Perinatal Palliative Care Professionals. Front Pediatr 2020; 8:572933. [PMID: 33134232 PMCID: PMC7579417 DOI: 10.3389/fped.2020.572933] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/26/2020] [Indexed: 01/17/2023] Open
Abstract
Background: The demands on healthcare professionals caring for families grappling with a life-limiting condition in an unborn or newly born child can be overwhelming. Clinicians working in emergency/trauma, hospice, and pediatric settings are already at high risk for burnout and compassion fatigue, which can leave healthcare institutions increasingly vulnerable to poor retention, absenteeism, and waning quality of care. The provision of exemplary palliative care requires a cohesive interdisciplinary team of seasoned professionals resilient to daily challenges. In September 2019, the American College of Gynecology, in a committee opinion, published standard of care guidelines for perinatal palliative care. This has created an impetus for exceptional caregiving and a greater demand for both physician and interdisciplinary healthcare provider education, training, and ongoing support that promotes truly beneficent care for pregnant patients confronted with life-limiting fetal conditions. Methods: A scoping review of the research literature was conducted in order to distinguish the barriers and facilitators of professional resiliency in perinatal palliative care. PubMed, Medline, CINAHL, and EBSCO Psychology & Behavioral Sciences Collections were systematically reviewed. Because of the paucity of studies specific to perinatal palliative care, several interviews of nurses and physicians in that field were conducted and analyzed for content distinctly pertaining to personal practices or workplace factors that support or hinder professional resiliency. Results: The research indicated that medical professionals often cite a lack of knowledge, inexperience using effective communication skills related to perinatal palliative care and bereavement, challenges with interdisciplinary collaboration, misconceptions about the role and function of palliative care in the perinatal or neonatal settings, moral distress, and workload challenges as encumbrances to professional satisfaction. Strategic implementation of facility-wide bereavement care training, effective communication modalities, and evidenced-based practical applications are critical components for a thriving perinatal palliative care team. Authentic formal and informal debriefing, peer mentoring, adequate caseloads, robust provider self-care practices, exceptional relational efficacy, and cultural and spiritual humility can foster personal growth and even vicarious resilience for perinatal palliative care professionals. Conclusions: Support should be strategic and multifaceted. The onus to implement salient measures to cultivate resilience in the perinatal palliative caregiver should not be only upon the individuals themselves but also upon prevailing regulatory governing bodies and healthcare institutions.
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Affiliation(s)
| | | | - Premala Tara Jones
- Life Perspectives, San Diego, CA, United States.,Counseling and Testing Center, University of Akron, Akron, OH, United States
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46
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Hall EM, Shahidullah JD, Lassen SR. Development of postpartum depression interventions for mothers of premature infants: a call to target low-SES NICU families. J Perinatol 2020; 40:1-9. [PMID: 31439918 DOI: 10.1038/s41372-019-0473-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/29/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022]
Abstract
In the United States, ethnic minority status and low socioeconomic status both confer greater risk of premature birth. These sociodemographic factors also contribute to a greater risk of postpartum depression, as does giving birth prematurely. Considering the known adverse effects of postpartum depression on children's development, NICU-based mental health services for these high-risk mothers is an important public health intervention. Although counseling and educational interventions in the NICU have been shown to decrease maternal depressive symptoms, these interventions require parental presence on the unit. Mothers of both low socioeconomic and ethnic minority status face systemic barriers that may prevent them from visiting their infants, such as lack of paid leave, transportation, and childcare. We propose directions for future research with the aim of increasing access to services. Directions include brief individual therapy, telehealth, and increasing the psychosocial support skills of other health professionals. Potential barriers to implementation are discussed.
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Affiliation(s)
- Eleanore M Hall
- Department of Clinical Psychology, Rutgers University, New Brunswick, NJ, USA.
| | - Jeffrey D Shahidullah
- Department of Psychiatry, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Stephen R Lassen
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
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Improving Staff Knowledge and Attitudes Toward Providing Psychosocial Support to NICU Parents Through an Online Education Course. Adv Neonatal Care 2019; 19:490-499. [PMID: 31306236 PMCID: PMC6882527 DOI: 10.1097/anc.0000000000000649] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is Available in the Text. Provider–parent communication is a critical determinant of how neonatal intensive care unit (NICU) parents cope, yet staff feel inadequately trained in communication techniques; many parents are not satisfied with the support they receive from hospital providers.
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48
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Bry A, Wigert H. Psychosocial support for parents of extremely preterm infants in neonatal intensive care: a qualitative interview study. BMC Psychol 2019; 7:76. [PMID: 31783784 PMCID: PMC6883543 DOI: 10.1186/s40359-019-0354-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 11/15/2019] [Indexed: 01/25/2023] Open
Abstract
Background Extremely premature infants (those born before 28 weeks’ gestational age) are highly immature, requiring months of care at a neonatal intensive care unit (NICU). For parents, their child’s grave medical condition and prolonged hospitalization are stressful and psychologically disruptive. This study aimed at exploring the needs of psychosocial support of parents of extremely premature infants, and how the NICU as an organization and its staff meets or fails to meet these needs. Method Sixteen open-ended interviews were conducted with 27 parents after their infant’s discharge from the NICU. Inductive content analysis was performed. Results Four themes were identified: Emotional support (with subthemes Empathic treatment by staff, Other parents as a unique source of support, Unclear roles of the various professions); Feeling able to trust the health care provider; Support in balancing time spent with the infant and other responsibilities; Privacy. Parents of extremely premature infants needed various forms of emotional support at the NICU, including support from staff, professional psychological help and/or companionship with other patients’ parents. Parents were highly variable in their desire to discuss their emotional state with staff. The respective roles of nursing staff, social workers and psychologists in supporting parents emotionally and identifying particularly vulnerable parents appeared unclear. Parents also needed to be able to maintain a solid sense of trust in the NICU and its staff. Poor communication with and among staff, partly due to staff discontinuity, damaged trust. Parents struggled with perceived pressure from staff to be at the hospital more than they could manage and with the limited privacy of the NICU. Conclusions The complex and individual psychosocial needs of parents of extremely preterm infants present many challenges for the NICU and its staff. Increasing staffing and improving nurses’ competence in addressing psychosocial aspects of neonatal care would help both nurses and families. Clarifying the roles of different professions in supporting parents and developing their teamwork would lessen the burden on nurses. Communicating with parents about their needs and informing them early in their NICU stay about available support would be essential in helping them cope with their infant’s hospitalization.
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Affiliation(s)
- Anna Bry
- Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Helena Wigert
- Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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49
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Hassankhani H, Negarandeh R, Abbaszadeh M, Craig JW, Jabraeili M. Mutual trust in infant care: the nurses and mothers experiences. Scand J Caring Sci 2019; 34:604-612. [PMID: 31657062 DOI: 10.1111/scs.12758] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
The relationship between healthcare providers and parents of infants in neonatal intensive care unit is based on trust and constitutes a core measure of family-centred care and health. The aim of the present qualitative study was to explore mothers and nurses experiences of trust in one another around the caregiving of the hospitalised infant in intensive neonatal care unit. Focused ethnographic research study conducted through observations and in-depth interviews with 20 mothers and 16 nurses in NICU of Tabriz (Iran) in 2017. Two main themes of 'gradual and fragile trust of mother-to-nurse' (subthemes: Primary trust-mistrust, mother's trust to responsible nurse, mother trust Increase with skilful nurse performance, and vulnerability to trust) and 'gradual and fragile trust of nurse-to-mother' (subthemes: Nurse's initial assessment of trust to mother's readiness to participate, Development of trust to mother, and vulnerability of nurse's trust to mother) were obtained. The present study revealed that mutual trust between the nurse and the mother in the care of the infant was a gradual and progressive process that was achieved over time. Complexities around the care of a hospitalised infant influenced how fragile or vulnerable the trust became between nurse and mother. Findings from this research can be used in supporting increased maternal participation in infant care and improvement of family-centred care in the neonatal intensive care unit.
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Affiliation(s)
- Hadi Hassankhani
- Center of Qualitative Studies, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Negarandeh
- Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Jenene W Craig
- Brenau University, Norcross, GA, USA.,National Association of Neonatal Therapists, Cincinnati, OH, USA.,National Perinatal Association, Lonedell, MO, USA
| | - Mahnaz Jabraeili
- Pediatric Department, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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50
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Diamonstein CJ. Factors complicating the informed consent process for whole exome sequencing in neonatal and pediatic intensive care units. J Genet Couns 2019; 28:256-262. [DOI: 10.1002/jgc4.1097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Callie J. Diamonstein
- Division of Medical Genomics; Inova Translational Medicine Institute; Falls Church Virginia
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