One size does not fit all: parents' evaluations of a support program in a newborn intensive care nursery

Exploring individual parent-to-parent support interventions for parents caring for children with brain-based developmental disabilities: A scoping review

BACKGROUND

Brain-based developmental disabilities (BBDDs) comprise a large and heterogeneous group of disorders including autism, intellectual disability, cerebral palsy or genetic and neurodevelopmental disorders. Parents caring for a child with BBDD face multiple challenges that cause increased stress and high risk of mental health problems. Peer-based support by fellow parents for a various range of patient groups has shown potential to provide emotional, psychological and practical support. Here, we aim to explore existing literature on individual peer-to-peer support (iP2PS) interventions for parents caring for children with BBDD with a view to (1) explore the impact of iP2PS interventions on parents and (2) identify challenges and facilitators of iP2PS.

METHOD

An extensive literature search (January 2023) was performed, and a thematic analysis was conducted to synthesize findings.

RESULTS

Fourteen relevant articles revealed three major themes regarding the impact of iP2PS on parents: (1) emotional and psychological well-being, (2) quality of life and (3) practical issues. Four themes were identified describing challenges and facilitators of iP2PS: (1) benefits and burden of giving support, (2) matching parent-pairs, (3) logistic challenges and solutions and (4) training and supervision of parents providing peer support.

CONCLUSIONS

This review revealed that iP2PS has a positive impact on the emotional and psychological well-being of parents, as well as the overall quality of life for families caring for a child with a BBDD. Individual P2PS offers peer-parents an opportunity to support others who are facing challenges similar to those they have experienced themselves. However, many questions still need to be addressed regarding benefits of different iP2PS styles, methods of tailoring support to individual needs and necessity of training and supervision for peer support providers. Future research should focus on defining these components and evaluating benefits to establish effective iP2PS that can be provided as standard care practice for parents.

Parent needs assessment instruments in neonatal intensive care units: Implications for parent education interventions

OBJECTIVES

Psychosocial and educational interventions based on standardized needs assessment can help alleviate distress among parents of premature infants. This study aims to (1) provide an overview of standardized instruments used to assess parental needs in neonatal intensive care units (NICUs) and (2) discuss their potential to facilitate the provision of appropriate support to parents of premature babies.

METHODS

A systematic literature review was conducted. PubMed, CiNAHL, PsychARTICLES, PsychINFO, and Medline were searched for studies reporting on the use of validated parental needs assessment instruments in the NICU.

RESULTS

Following the analysis of 33 publications, 6 instruments designed to assess the needs of premature infants' parents were identified. Based on their good psychometric properties and practicality, the NICU Family Needs Inventory, the Critical Care Maternal Needs Inventory, and the Nurse Parent Support Tool were considered particularly relevant for use in clinical and research settings.

CONCLUSIONS

Validated parent needs assessment instruments are available for use in the NICU setting. Further research evaluating the benefits and usability of standardized parental needs assessment in the NICU is needed.

PRACTICE IMPLICATIONS

Validated needs assessment instruments should be consistently used to facilitate the development of targeted psychosocial and educational interventions for parents in the NICU.

Needs and Perceptions Relative to Emotional Support in Parents With Preterm Infants

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.

Experiences of mothers with preterm babies at a Mother and Baby Unit of a tertiary hospital: A descriptive phenomenological study

Aim

To describe the lived experiences of mothers with preterm babies at a Mother and Baby Unit (MBU) of a tertiary hospital.

Design

A descriptive phenomenological approach.

Method

Ten mothers were purposively sampled during the month of May, 2017 to describe their experiences of having preterm babies. Recorded in-depth individual interviews were transcribed verbatim; codes were generated and inductively organised into themes.

Results

Four themes were actively generated: 'Emotional experiences of mothers', 'Mother-baby interaction', 'Perception on care and support' and 'Challenges within Mother and Baby Unit environment'. Mothers were anxious about the premature delivery and were afraid of possible infant's death. They cherished interactions with their babies during kangaroo mother care and breastfeeding. Mothers applauded the nurses for their professional competence. They expressed concerns about inadequate accommodation, high cost of care, the frequency and duration of mother-baby interactions.

Measuring Parent Satisfaction With Care in Neonatal Intensive Care Units: The EMPATHIC-NICU-USA Questionnaire

Background: Neonatal intensive care unit (NICU) patient satisfaction is measured as parent satisfaction. Parents are critical to the family-centered care model and can evaluate care. Several EMpowerment of PArents in THe Intensive Care (EMPATHIC) instruments were developed in the Netherlands to measure parent satisfaction with neonatal and pediatric intensive care. EMPATHIC instruments comprise five domains and a total score: information, care and treatment, organization, parental participation, and professional attitude. To our knowledge, the EMPATHIC has not been adapted for USA use. Objectives: (1) To select a relevant EMPATHIC instrument for our study. (2) To expand the content reflecting the role of nurses and the cultural heterogeneity of USA NICU infants. (3) To adapt the selected EMPATHIC instrument to USA English. (4) To establish psychometric properties of the linguistically adapted instrument. (5) To evaluate instrument performance with additional items. Methods: The EMPATHIC-30 was selected based on shortest length, high overlap with neonatal EMPATHIC-N, and availability of a validated Spanish-language version. Six items from the EMPATHIC-N were added, two of which were split into separate items, resulting in the EMPATHIC-38. A neonatal nurse practitioner adapted wording to USA English. Cognitive debriefing was performed with eight NICU parents to evaluate adapted wording. Parent survey data from a study about missed nursing care and NICU parent satisfaction were utilized. Internal consistency of the five domains and overall score was measured by Cronbach's alpha. Spearman's rank correlations were computed for domains and overall score with four validity measures. Differential validity was determined using 13 parent demographic subgroups. Results: Data were from 282 parents. Parent race was predominantly White (61%) or Black (22%). One fifth were Hispanic. The adapted wording was satisfactory. Four of the five EMPATHIC-30 and EMPATHIC-38 domains had Cronbach alphas at or above 0.70, indicating acceptable reliability. Correlations between the domain, total scores, and validity indicators ranged from 0.30 to 0.57, indicating positive, moderate associations. Results were replicated in demographic subgroups. Reliability and validity of the three domains with additional items were better than or equivalent to values for the original. Conclusion: The linguistically adapted EMPATHIC-30-NICU-USA and the expanded EMPATHIC-38-NICU-USA exhibit satisfactory psychometric properties and are suitable for use in USA NICUs.

A systematic review of instruments for assessing parent satisfaction with family-centred care in neonatal intensive care units

This systematic review synthesised and described instruments measuring parent satisfaction with the increasing standard practice of family-centred care (FCC) in neonatal intensive care units. We evaluated 11 studies published from January 2006 to March 2016: two studies validated a parent satisfaction questionnaire, and nine developed or modified previous questionnaires to use as outcome measures in their local settings. Most instruments were not tested on reliability and validity.

CONCLUSION

Only two validated instruments included all six of the FCC principles and could assess parent satisfaction with FCC in neonatal intensive care units and be considered as outcome indicators for further research.

The neonatal intensive parenting unit: an introduction

This paper describes a paradigm shift occurring in neonatal intensive care. Care teams are moving from a focus limited to healing the baby's medical problems towards a focus that also requires effective partnerships with families. These partnerships encourage extensive participation of mothers and fathers in their baby's care and ongoing bi-directional communication with the care team. The term Newborn Intensive Parenting Unit (NIPU) was derived to capture this concept. One component of the NIPU is family-integrated care, where parents are intimately involved in a baby's care for as many hours a day as possible. We describe six areas of potentially better practices (PBPs) for the NIPU along with descriptions of NIPU physical characteristics, operations, and a relationship-based culture. Research indicates the PBPs should lead to improved outcomes for NIPU babies, better mental health outcomes for their parents, and enhanced well-being of staff.

Parent Support Programs and Coping Mechanisms in NICU Parents

BACKGROUND

Many neonatal intensive care unit (NICU) parents experience emotional distress leading to adverse infant outcomes. Parents may not cope positively in stressful situations, and support programs often are underutilized.

PURPOSE

To determine coping mechanisms utilized by NICU parents, and types of support programs parents are likely to attend. To determine whether sociodemographic and length-of-stay differences impact coping mechanisms utilized, and types of support programs preferred.

METHODS

A correlational cross-sectional survey design was used. The 28-item Brief COPE tool, questions about demographics and preferred support program styles, was distributed to a convenience sample of NICU parents in a level IV NICU in the southeastern United States.

RESULTS

One hundred one NICU parents used coping mechanisms, with acceptance emotional support, active coping, positive reframing, religion, planning, and instrumental support being the most common. Preferred support classes were infant development and talking with other NICU parents. Caucasians more commonly coped using active coping, planning, emotional support, acceptance, instrumental support, and venting compared with other races. Women utilized self-blame coping mechanisms more often compared with men. Younger parents were more likely to use venting and denial coping mechanisms. Parents with a shorter stay utilized self-distraction coping and preferred the class of talking with other parents.

IMPLICATIONS FOR PRACTICE

Support program preference, type of coping mechanism utilized, and sociodemographic factors may be used to guide the creation of NICU support programs.

IMPLICATIONS FOR RESEARCH

Additional studies are needed to determine whether support program offering according to preferences and sociodemographic characteristics increases attendance and decreases emotional distress.

The Influence of Neonatal Nursery Design on Mothers' Interactions in the Nursery

This study examined the influence of neonatal nursery design on interactions between nurses and mothers of infants in the nursery.

DESIGN AND METHODS

We used a natural quasi-experimental design, using semi-structured interviews and a structured measure of mothers' and nurses' perceptions of nursing care, to compare mothers (n=26 and n=40) and nurses (n=22 and n=29) in an open-bay (OB) nursery and a single family room (SFR) nursery. Thematic analysis was used to generate key themes from the interviews.

RESULTS

Mothers and nurses in both nursery designs talked about Valuing interactions; the importance of interactions between mothers and nurses. Mothers and nurses described SFRs as providing a space, My/their room, which enhanced mothers' sense of control and connection with the infant. SFRs were also associated with Changing the norms of interactions with nurses and other mothers, which created challenges in the desired quantity and quality of interactions for mothers and nurses. Nurses in the SFR nursery also reported Enhanced interactions, including improved confidentiality and personalized communication. Mothers in the OB nursery reported more supportive mothering actions from nurses than mothers in the SFR nursery. Both mothers and nurses in the OB nursery also talked about Our nursery community, which captured the value of having other nurses and mothers in the rooms.

CONCLUSION

Mothers and nurses perceived that the SFR nursery enhanced privacy and maternal closeness for mothers compared to the OB nursery. However, the SFR nursery design presented challenges to some interactions of value to nurses and mothers.

A life uncertain - My baby's vulnerability: Mothers' lived experience of connection with their preterm infants in a Botswana neonatal intensive care unit

BACKGROUND

Preterm and low-birth weight infants are often separated from their mothers when admitted to neonatal units for stabilisation of body temperature and technological support.

OBJECTIVES

The aim of the study was to explore and describe the lived experiences of mothers regarding care of their hospitalised preterm infants in a neonatal unit in a public hospital in Gaborone, Botswana.

METHOD

This study utilised a qualitative exploratory and descriptive phenomenological study design. Mothers of hospitalised preterm infants were purposefully selected, with whom there was extensive engagement. Two in-depth interviews were conducted with each participant (P).

RESULTS

Mothers were shocked by the sudden birth of a preterm infant and found the neonatal environment intimidating. This increased their fear and anxiety and delayed development of a relationship with their infants. Support from staff, other mothers in the neonatal unit and family members enabled the mothers to overcome their fear and to develop an emotional connection with their infants.

CONCLUSION

On-going supportive communication with the mothers by healthcare professionals promotes their confidence and competence in caring for their preterm infants, which in turn promotes mother-infant attachment.

Development and Evaluation of a Peer Support Program for Parents Facing Perinatal Loss

The purpose of this program evaluation was to understand the perspectives of peer parents and parents receiving support within a peer support program for perinatal bereavement at a midsized hospital within the midwestern United States. To document participants' perceptions of the program, a focus group was conducted with peer parents, and surveys were completed by both peer parents and parents receiving support. In this article we review our model of a peer support program for perinatal bereavement and report on parents' evaluation of the program. Recommendations through which other organizations can develop peer support programs for parents who have experienced a perinatal loss are provided.

Recommendations for peer-to-peer support for NICU parents

Peer-to-peer support provided by 'veteran' neonatal intensive care unit (NICU) parents to those with current NICU babies is a legitimate and unique form of support that can complement or supplement, but not replace, services provided by professional NICU staff. Peer support can be delivered through hospital- or community-based programs that offer one-to-one in-person or telephone matches, or support groups that meet in-person or via the Internet. Issues in program development, volunteer training and program operation are discussed. Recommendations for offering peer support to all NICU parents as an integral component of family-centered care and comprehensive family support are presented.

Art-Based Occupation Group Reduces Parent Anxiety in the Neonatal Intensive Care Unit: A Mixed-Methods Study

OBJECTIVE. We examined whether an art-based occupation group using scrapbooking in the neonatal intensive care unit (NICU) would reduce parent stress, operationalized as anxiety. We also wanted to understand the parents’ lived experience of the group.

METHOD. Forty parents from a Level 3 NICU in a large metropolitan hospital participated. We administered the State–Trait Anxiety Inventory preactivity and postactivity along with a brief interview.

RESULTS. The decline in parents’ mean state anxiety (12.7 points, SD = 11.8; p < .0001) was clinically significant. The decline in mean trait anxiety (2.6 points, SD = 5.2; p = .0036) was statistically significant but not clinically meaningful. Parents said that participation offered distraction and engagement, pleasure, relaxation, a sense of hope, and an opportunity to share.

CONCLUSION. An art-based occupation group using scrapbooking was an effective brief intervention to reduce parent anxiety in the neonatal intensive care unit; parent interviews suggested that participation has broad clinical implications for parent well-being.

Integrating a sense of coherence into the neonatal environment

BACKGROUND

Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes.

DISCUSSION

In this paper we present a new perspective to neonatal care based on Aaron Antonovksy's Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed.

SUMMARY

Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned.

Implementing family-integrated care in the NICU: a parent education and support program

The purpose of this study was to develop, implement, and evaluate a parent education and support program that enhances family-integrated care in a Canadian neonatal intensive care unit (NICU). A total of 39 mothers of infants born at 35 or fewer weeks' gestation were enrolled in the pilot program. We examined the development, implementation, and qualitative assessment of the education component of a family-integrated care program. We enrolled in groups of 4 or 5, the study mothers agreed to attend daily educational sessions, provide care for their infants for at least 8 hours daily, and participate in medical rounds. The educational sessions were provided by staff and veteran parents to assist parents' development of confidence in providing caregiving skills and assuming the role of a primary caregiver for their infants as they moved closer to discharge. Effectiveness of the program was evaluated through anecdotal feedback and a formal evaluation process at discharge. The results indicated that the mothers were provided with the tools to parent their infants in the NICU, recognize their own strengths, increase their problem-solving strategies, and emotionally prepare them to take their infant home. Feedback from the participants provided direction to adapt the program to provide optimal parent support and education. Parental education is a valued and vital component of family-integrated care in the NICU.

Neonatal family care for 24 hours per day: effects on maternal confidence and breast-feeding

In family care (FC) program for neonatal intensive care units (NICUs), parents are encouraged to reside together with their infant for 24 hours a day to actively be involved in the care. The aim of this study was to assess the impact of FC on maternal confidence and breast-feeding. Maternal confidence and rate of breast-feeding were assessed in 31 mothers offered FC that included special family rooms in the NICU, and in 30 mothers from a comparable NICU providing traditional care without such facilities. One week prior to hospital discharge, mothers in the FC group felt better informed regarding nursing issues and had more confidence in interpretation of the infants regarding feeding issues and in caregiving without staff attendance (P < .05). They also reported a higher level of empowerment (P < .05). Three months after discharge, the mothers in the FC group had a higher self-reported skill level for interpretation of the infant's signals and knowledge about breast-feeding (P < .05). Despite similar rate of breast-feeding at discharge, more infants in the FC group were breastfed 3 months after discharge (P < .05). An FC program in the NICU promoted better maternal confidence during the hospital stay and 3 months after discharge compared with traditional care.

The POPPY study: developing a model of family-centred care for neonatal units

BACKGROUND

The concept of family-centred care in neonatal practice has become increasingly recognised internationally. The underlying philosophy puts parents and the family at the centre of health care and promotes "individualised, flexible care."

AIMS

To develop the first international model of family-centred care based on strong parental collaboration in the synthesis of robust research evidence to generate the philosophy, principles, model, and indicators for implementation. METHODS AND SYNTHESIS: Seven key steps were followed to develop the POPPY model of care collaboratively with parents. Step 1 drew on the POPPY systematic review to identify effective interventions. Step 2 drew on the POPPY qualitative study to identify good parent experiences. Step 3 identified the philosophy and principles of the POPPY model of care. Step 4 identified the key stages of the POPPY model of care. Step 5 populated the POPPY model of care with data from steps 1 and 2. Step 6 developed the indicators of family-centred care; and Step 7 undertook some initial testing with parents and practitioners.

RESULTS

Seven key stages of the parents' journey through their neonatal unit experience were identified and formed the architecture of the POPPY model of care. These include: before admission to the unit, admission, early days, growing and developing, transfers between units and between levels of care, preparing for discharge, and transition to home and at home. A philosophy, a set of principles to underpin the model, and a set of indicators to guide implementation in neonatal units were developed.

CONCLUSION

The POPPY model of family-centred care provides the first robust, collaboratively developed, parent-centred model, which can be implemented to deliver high quality care to parents of preterm infants.

IMPLICATIONS

Implementing the POPPY model could help neonatal units to develop parent-focused services which better meet parents' needs for information, communication and support, key elements of family-centred care.

Support like a walking stick: parent-buddy matching for language and culture in the NICU

PURPOSE

(1) To explore the experience of non-English-speaking mothers with preterm, very low birth weight (VLBW) infants (,1,500 g); and (2) to examine mothers' assessment of a peer support program matching them with linguistically and culturally similar parent-buddies.

DESIGN

An exploratory, qualitative analysis based on grounded theory.

SAMPLE

A convenience sample of eight mothers from four of the most prevalent non-English-speaking cultures (Spanish, Portuguese, Chinese, and Tamil) in an urban Canadian-teaching hospital.

MAIN OUTCOME VARIABLE

Non-Anglophone mothers' experience and support in the NICU.

RESULTS

Study mothers experienced intense role disequilibrium during the unanticipated crisis of preterm birth of a VLBW infant; situational crises owing to the high-tech NI CU environment and their infant's condition; and developmental crises with feelings of loss, guilt, helplessness, and anxiety. Language barriers compounded the difficulties. Parent-buddies helped non-English-speaking mothers mobilize their strengths. Culture and language are important determinants of service satisfaction for non-English-speaking mothers. Linguistically congruent parent-to-parent matching increases access to service.

A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants

Background and objective The birth of a preterm infant can be an overwhelming experience of guilt, fear and helplessness for parents. Provision of interventions to support and engage parents in the care of their infant may improve outcomes for both the parents and the infant. The objective of this systematic review is to identify and map out effective interventions for communication with, supporting and providing information for parents of preterm infants. Design Systematic searches were conducted in the electronic databases Medline, Embase, PsychINFO, the Cochrane library, the Cumulative Index to Nursing and Allied Health Literature, Midwives Information and Resource Service, Health Management Information Consortium, and Health Management and Information Service. Hand-searching of reference lists and journals was conducted. Studies were included if they provided parent-reported outcomes of interventions relating to information, communication and/or support for parents of preterm infants prior to the birth, during care at the neonatal intensive care unit and after going home with their preterm infant. Titles and abstracts were read for relevance, and papers judged to meet inclusion criteria were included. Papers were data-extracted, their quality was assessed, and a narrative summary was conducted in line with the York Centre for Reviews and Dissemination guidelines. Studies reviewed Of the 72 papers identified, 19 papers were randomised controlled trials, 16 were cohort or quasi-experimental studies, and 37 were non-intervention studies. Results Interventions for supporting, communicating with, and providing information to parents that have had a premature infant are reported. Parents report feeling supported through individualised developmental and behavioural care programmes, through being taught behavioural assessment scales, and through breastfeeding, kangaroo-care and baby-massage programmes. Parents also felt supported through organised support groups and through provision of an environment where parents can meet and support each other. Parental stress may be reduced through individual developmental care programmes, psychotherapy, interventions that teach emotional coping skills and active problem-solving, and journal writing. Evidence reports the importance of preparing parents for the neonatal unit through the neonatal tour, and the importance of good communication throughout the infant admission phase and after discharge home. Providing individual web-based information about the infant, recording doctor-patient consultations and provision of an information binder may also improve communication with parents. The importance of thorough discharge planning throughout the infant's admission phase and the importance of home-support programmes are also reported. Conclusion The paper reports evidence of interventions that help support, communicate with and inform parents who have had a premature infant throughout the admission phase of the infant, discharge and return home. The level of evidence reported is mixed, and this should be taken into account when developing policy. A summary of interventions from the available evidence is reported.

Information behaviour of parents of children admitted to a neonatal intensive care unit: Constructing a conceptual framework

This article explores the concepts 'information behaviour' and 'illness trajectory' at the neonatal intensive care unit (NICU). On the basis of literature review and exploratory interviews with neonatologists and head nurses of Belgian NICUs a conceptual framework is presented. The 'information behaviour' of parents of infants admitted to a NICU is analytically divided into five dimensions: ways of getting information; interpersonal information sources; time-related issues; location of information transfer; and content of information. The conceptual framework equally takes the 'illness trajectory' into account. Following Corbin and Strauss the illness trajectory at a NICU is analysed in three sub-trajectories: disease course; healthcare trajectory; and sickness trajectory. By combining the respective categories of information behaviour and illness trajectory, an analytical tool is presented under the form of a classification matrix for scrutinizing the mediating role of the illness trajectory on the information behaviour of parents of infants admitted to a NICU.

Psychosocial parental support programs and short-term clinical outcomes in extremely low-birth-weight infants

OBJECTIVE

To describe the association between an individualized psychosocial parental support (PPS) program and short-term clinical outcomes of extremely low-birth-weight (ELBW) infants admitted to the neonatal intensive care unit (NICU).

METHODS

Medical records of ELBW infants (<1000 g) hospitalized in the NICU at Miami Children's Hospital between July 2006 and June 2008 were reviewed. Outborn infants admitted during their first 72 h of life and discharged home were included. Parents were divided in two groups according to their participation status in the PPS program. Neonatal outcomes in both groups were compared.

RESULTS

Forty-one infants were included (n = 41). Mean gestational age was 26.7±2 weeks, and birth weight was 860±125 g. Median length of stay (LOS) was 96 days (quartile range: 76-112 days). PPS was provided to 33.3% of these infants' parents. The median LOS in the PPS group was significantly lower than in control group (86 vs. 99 days; p < 0.05). No other differences in short-term neonatal outcomes were found.

CONCLUSIONS

The addition of individualized psychosocial parent support programs to standard care in the NICU may reduce LOS in surviving infants discharged home. Further larger and randomized prospective studies are needed.

Family-centered pediatric nursing care: state of the science

The purposes of this article were to summarize the development of family-centered pediatric care, review the current state of nursing research in this area, and recommend directions for future study. A literature review of 30 nursing research studies between 1995 and 2006 was conducted. Results revealed that evidence of consistent provision of family-centered pediatric care is lacking. Many areas of research remain undeveloped, but there is a solid foundation for moving forward in conducting research focused on assisting nurses in implementing this basic philosophy of practice in all settings and situations in which children receive health care.

Information needs of parents of children admitted to a neonatal intensive care unit: a review of the literature (1990-2008)

OBJECTIVE

This literature review focuses on information and communication needs of parents of children admitted to the NICU and on their use of information sources in the illness trajectories at NICU.

METHODS

Literature search in 4 electronic databases (Ovid Medline, PsycINFO, CINAHL and Sociological Abstracts), covering 1990-March 2008.

RESULTS

The seventy-eight included articles revealed that NICU parents have high information needs. The illness trajectory mediates parental information needs and induces a changing pattern in information use and information needs. Most attention is paid to the prenatal and acute phases, while information behaviour in sudden events and later phases receives limited attention.

CONCLUSIONS

In-depth studies on information needs and corresponding use of information sources are lacking. More longitudinal studies are needed, taking the illness trajectory into account and investigating the determinants and outcomes of the information and communication needs of NICU parents.

PRACTICE IMPLICATIONS

Healthcare professionals should adapt their information provision along the illness trajectory. The development of guidelines of information provision during the illness trajectory at NICU would support all professionals.

Parenting in the neonatal intensive care unit

OBJECTIVE

A systematic review of the literature was conducted to answer the following 2 questions: (a) What are the needs of parents who have infants in the neonatal intensive care unit? (b) What behaviors support parents with an infant in the neonatal intensive care unit?

DATA SOURCES

Using the search terms "parents or parenting" and the "neonatal intensive care unit," computer library databases including Medline and CINAHL were searched for qualitative and quantitative studies. Only research published in English between 1998 and 2008 was included in the review.

STUDY SELECTION

Based on the inclusion criteria, 60 studies were selected.

DATA EXTRACTION

Study contents were analyzed with the 2 research questions in mind.

DATA SYNTHESIS

Existing research was organized into 1 of 3 tables based on the question answered. Nineteen articles addressed the first question, 24 addressed the second, and 17 addressed both.

CONCLUSIONS

Six needs were identified for parents who had an infant in the neonatal intensive care unit: (a) accurate information and inclusion in the infant's care, (b) vigilant watching-over and protecting the infant, (c) contact with the infant, (d) being positively perceived by the nursery staff, (e) individualized care, and (f) a therapeutic relationship with the nursing staff. Four nursing behaviors were identified to assist parents in meeting these needs: (a) emotional support, (b) parent empowerment, (c) a welcoming environment with supportive unit policies, and (d) parent education with an opportunity to practice new skills through guided participation.

Fathers' experiences in the neonatal intensive care unit: a search for control

OBJECTIVE

This qualitative study aimed at understanding the experiences of fathers of very ill neonates in the NICU.

METHODS

Sixteen fathers of very ill and/or very preterm infants who had been in the NICU for >30 days were interviewed by a male physician. Fathers were asked about their level of comfort with or concerns about staff communication regarding their infant, about accessing information, and about more general perceptions of their experience in the neonatal intensive care unit. Interviews were audiotaped and transcribed for analysis. Coding used content analysis with construction of themes by 3 researchers.

RESULTS

The overarching theme for fathers was a sense of lack of control. Their world view, as a "backdrop" theme, provided context for all of the themes. Four other interrelated subthemes were identified, including information; communication, particularly with the health care team; fathers' various roles; and external activities. Fathers reported that relationships with friends/family/health care team, receiving information consistently, and receiving short written materials on common conditions were ways of giving them support. The fathers said that speaking to a male physician was a positive and useful experience.

CONCLUSIONS

Fathers experience a sense of lack of control when they have an extremely ill infant in the NICU. Specific activities help fathers regain a sense of control and help them fulfill their various roles of protectors, fathers, partners, and breadwinners. Understanding these experiences helps the health care team offer targeted supports for fathers in the NICU.