Parental and staff experiences of restricted parental presence on a Neonatal Intensive Care Unit during COVID-19

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

AIM

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

DESIGN

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

METHODS

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

DATA SOURCES

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS

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

IMPACT

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

FINDINGS

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

IMPACT

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

No change in mother's own milk provision and breastfeeding rates in preterm infants during the COVID-19 pandemic

AIM

The aim of the study was to evaluate the duration of mother's own milk (MOM) provision to preterm very low-birth weight (VLBW, <1500 g) infants during the COVID-19 pandemic. We hypothesised that COVID-19 restrictions would reduce the duration of MOM provision.

METHODS

This retrospective study compared VLBW infants born at the Berlin university hospital during the pandemic (15 March 2020 to 14 March 2021, n = 108) with infants born in the pre-pandemic year (01 January 2019 to 31 January 2019, n = 121). We calculated the duration of MOM provision and analysed factors associated with its early cessation.

RESULTS

During the pandemic, the rate of primiparous mothers increased from 29% to 44% while the distribution of all other parental and infants' characteristics remained similar. There were no differences in the median duration of MOM provision (47 vs. 51 days), feeding type (MOM 67% vs. 65%) and breastfeeding rates at discharge (exclusive, 8% vs. 13%; partial 69% vs. 60%). Cox proportional hazard analysis revealed smoking during pregnancy and parental school education consistently as independent risk factors for early cessation of MOM provision.

CONCLUSION

Supply of MOM for VLBW infants can be upheld also during pandemic restrictions.

The impact of restrictions to visiting in paediatric intensive care during the COVID-19 pandemic

BACKGROUND

Restrictions to hospital visiting were mandated during the COVID-19 pandemic, with variability in the degree of restriction imposed. At times, paediatric intensive care units (ICU) restricted visiting to one parent/carer. Views of parents/carers and ICU staff about changes in the visiting policy are not well understood.

STUDY DESIGN

This is a Service evaluation involving questionnaire survey incorporating rating scales and free-text comments. Inner-city specialist children's hospital. Parents/carers of children on ICU between December 2020-March 2021 and staff who were working on ICU during May-June 2021. Parents and staff on ICU were invited to complete a questionnaire focusing on their experience of being or working on ICU. Quantitative data were analysed descriptively and free-text comments were thematically analysed.

RESULTS

Completed questionnaires were received from 81/103 (79%) parents/carers and 217/550 (39%) staff. The majority of parents (n = 60;77%) and staff (n = 191;89%) understood the need for the one-parent visiting policy but acknowledged it was a source of considerable stress. More staff than parents agreed it was appropriate other relatives/friends visiting was not permitted (Z = 3.715;p < .001). There was no association between parents' satisfaction with their child's care and views about the visiting policy. However, staff were more likely to report an impact on their ability to deliver family centred care if they disagreed with the policy.

CONCLUSION

The COVID-19 visiting policy had a clear impact on parents and staff. In the event of any future threat to open-access visiting to children in hospital, the potentially damaging effect on children, parents, and staff must be considered.

RELEVANCE TO CLINICAL PRACTICE

Visiting policies need to take account of parents being partners in their child's care, rather than purely visitors to the unit where their child is being cared for. Visiting for two carers should always be facilitated, including during a crisis such as a pandemic.

Rescinding evidence-based care and practices during the initial COVID-19 outbreak in the United States: a qualitative study of the experiences of lactation support providers

Background

The COVID-19 pandemic disrupted healthcare systems and services including along the childbearing continuum. The aim of this study was to explore the experiences and perceptions of professional lactation support providers who cared for breastfeeding families during the early months of the pandemic (March 2020 - August 2020) in the United States.

Design/methods

We conducted a qualitative survey among active lactation support providers in the United States. Eligible participants spoke English, were Certified Lactation Counselors who maintained an active certification and who provided lactation care and services prior to and after the onset of the COVID-19 pandemic. Participants were recruited via email from the national database of Certified Lactation Counselors obtained from the national certification body. All ten Health and Human Service regions of the United States were included. Demographic data was collected on each respondent. Qualitative survey responses were analyzed thematically following the framework method.

Findings

Six-hundred and seventy-four (674) Certified Lactation Counselors responded to the survey from June to July of 2022. Their responses fell within the overarching theme of rescinding evidence-based care and practices that had been in place prior to the pandemic. Affected care practices included the insertion of limits on access to care and insinuating stigma and bias based on COVID-19 status. Irregular appointment schedules and staffing shortages also affected care. Participants reported that separation of the mother and their infant became the norm. Decisions made by management seemed to be grounded in fear and uncertainty, rather than on the evidence-based principles that had been in place prior to the pandemic.

Conclusion

A lack of coordination, consistency and support, along with fear of the unknown, troubled lactation support providers and impacted their ability to provide evidence-based care and to maintain access to care for all families. The findings of the survey and analysis underscore the importance of adequately preparing for future public health crises by determining how evidence-based care and practices can be preserved in emergent situations.

'They could not see our eyes, they cannot see our faces, they do not know who we are and that is hard': a qualitative interview study with staff caring for children and families in a UK specialist children's hospital during the COVID-19 pandemic

OBJECTIVES

Despite lower rates of illness, morbidity and mortality associated with SARS-CoV-2 infection in children during the COVID-19 pandemic, their health and well-being has been significantly impacted. Emerging evidence indicates that this includes experiences of hospital-based care for them and their families. As part of a series of multisite research studies to undertake a rapid appraisal of perceptions of hospital staff, working during the pandemic, our study focused on clinical and non-clinical staff perceptions of the impact of COVID-19 on aspects of care delivery, preparedness and staffing specific to a specialist children's hospital.

DESIGN

Qualitative study using a qualitative rapid appraisal design. Hospital staff participated in a telephone interview. We used a semistructured interview guide, and recorded and transcribed all interviews. Rapid Research Evaluation and Appraisal Lab Rapid Assessment Procedure sheets were used to share data; team-based analysis was facilitated using a framework approach.

SETTING

Specialist children's hospital in London, UK.

PARTICIPANTS

Thirty-six staff representing a range of roles within the hospital: 19 (53%) nurses, 7 (19%) medical staff and 10 (28%) other staff groups (including radiographers, managers, play staff, schoolteachers, domestic and portering staff and social workers).

RESULTS

Three overarching themes relating to staff perceptions of the impact on children and families were identified, each containing subthemes: (1) same hospital but different for everyone, (2) families paid the price and (3) the digital world. They illustrated that providing care and treatment for children and families changed profoundly during the pandemic, particularly during lockdown periods. Adaptations to deliver clinical care, play, schooling and other therapies online were rapidly put into action; however, benefits were not universal or always inclusive.

CONCLUSIONS

The disruption to a central principle of children's hospital care-the presence and involvement of families-was of critical concern to staff, suggesting a need for the specific impact of COVID-19 on children's services to be accounted for.

A Concept Analysis of Family Presence During COVID-19

BACKGROUND

In 2020, the COVID-19 pandemic required health care organizations throughout the United States to implement strict visitor restriction policies to mitigate the spread of the virus. These policy changes had a direct impact on family presence (FP) in hospital settings.

PURPOSE

The aim of this study was to conduct a concept analysis of FP during the COVID-19 pandemic.

METHODS

Walker and Avant's 8-step method was used.

RESULTS

Four defining attributes of FP during COVID-19 were derived based on a review of the literature: being there or with, seeing is believing, during challenging times, and subjective advocates. The COVID-19 pandemic was the main antecedent of the concept. The consequences and empirical referents were discussed. Model, borderline, and contrary cases were developed.

CONCLUSION

This concept analysis provided an understanding of the concept of FP during COVID-19, which is imperative to optimizing patient care outcomes, as literature identified a support person or system as an extension of the care team that facilitates successful care management. Whether by advocating for their patients to have a support person present during team rounds, or by stepping in as the patient's main support system in the absence of family, nurses must find a way to do what is best for their patients even during the unprecedented times of a global pandemic.

Experiences of Mothers of Preterm Infants in the Neonatal Intensive Care Unit During the COVID-19 Pandemic

BACKGROUND

The neonatal intensive care unit (NICU) stay following the birth of a preterm infant can be stressful and traumatic for families. During the COVID-19 pandemic, the NICU environment changed precipitously as infection control and visitor restriction measures were implemented.

PURPOSE

Our study aimed to examine the impact of the pandemic policies on the experiences of mothers of preterm infants during their stay in the NICU.

METHODS

Semistructured interviews were conducted with mothers of preterm infants hospitalized in a Canadian tertiary-level NICU. Informed by interpretive description methodology, interview content was transcribed and analyzed using a thematic analysis approach. The identified themes were validated, clarified, or refined using investigator triangulation.

RESULTS

Nine English-speaking mothers, aged 28 to 40 years, were interviewed. Four themes emerged from the analysis of their experiences: (1) disrupted family dynamic, support, and bonding; (2) physical and emotional isolation; (3) negative psychological impact compounded by added concerns, maternal role change, and survival mode mentality; and (4) positive aspects of the pandemic management measures.

IMPLICATIONS FOR PRACTICE

During the pandemic, the way that care was provided in the NICU changed. This study helps to explore how neonatal clinicians can foster individual and organizational resilience to keep patients and families at the center of care, even when the healthcare system is under intense stress.

IMPLICATIONS FOR RESEARCH

: Our results show that these changes heightened mothers' distress, but also had a modest positive impact. Further research about long-term consequences of pandemic policies on the mother and preterm infant after NICU discharge is warranted.

Sociodemographic factors affecting depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic

Purpose

This study aimed to determine the sociodemographic factors affecting the depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during the COVID-19 pandemic.

Design

and Methods: This descriptive cross-sectional study was conducted between March and October 2021. The sample consisted of 93 parents. Data were collected using a descriptive questionnaire, the Depression Anxiety Stress Scale (DASS- 42), and Coping Style Scale (CSS).

Results

Participants had mean DASS "depression," "anxiety," and "stress" subscale scores of 13.69 ± 8.86, 12.11 ± 8.37, and 19.09 ± 9.24, respectively. They had mean CSS "self-confident," "optimistic," "helpless," "submissive coping," and "seeking of social support" subscale scores of 2.71 ± 0.65, 2.57 ± 0.59, 2.29 ± 0.62, 2.25 ± 0.49, and 2.38 ± 0.52, respectively. Fathers had lower mean CSS "helpless" and "submissive" subscale scores than mothers. Participants who were briefed about their babies' condition by nurses had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with higher education had lower mean CSS "helpless" and "submissive" subscale scores than others. Participants with spouses with bachelor's or higher degrees had a higher median CSS "optimistic" subscale score than those with literate spouses or spouses with primary school degrees. Participants who were worried about the "no visitors" policy had a lower median CSS "self-confident" subscale score than those who were not.

Conclusions

Parents who are not allowed to see their babies due to the "no visitors" policy during the COVID-19 pandemic experience more psychosocial problems. Though not a result of the present study, the "no visitors" policy seems to affect the mother-infant attachment adversely.

Practice implications

Healthcare professionals should brief parents about what a neonatal intensive care unit is like. They should also warn them that they may not be too happy about how their baby looks before seeing them. Therefore, they should use therapeutic communication techniques to talk to them and explain the situation in a way they can understand. Moreover, they should provide parents with psychological empowerment training programs to help them adopt active coping strategies to deal with challenges in times of crisis.

Psychosocial Difficulties Experienced By Parents Of Babies Treated In A Neonatal Intensive Care Unit During The Coronavirus Pandemic

AIM

This study had two objectives: (1) to investigate the psychosocial difficulties experienced by parents of babies treated in a neonatal intensive care unit during the coronavirus pandemic and (2) to determine parent-infant attachment.

MATERIALS AND METHODS

This study adopted phenomenology, a qualitative research design in order to answer the research questions design. The sample consisted of 20 parents of babies treated in the neonatal intensive care unit (NICU) of a City Hospital in Turkey between July and August 2021. Participation was voluntary. Data were collected using a sociodemographic characteristics questionnaire and a semi-structured qualitative interview form. Each participant was interviewed face to face. Each interview was recorded and transcribed. The data were analyzed using content analysis.

RESULTS

Participants had a mean age of 32.2 ± 3.61 years and at least secondary school degrees. Babies were admitted to the NICU for congenital anomalies (n = 3) or preterm birth (n = 7). Participants experienced anxiety, worry, and loneliness and produced less milk because they could not see and touch their babies. Their greatest source of support was their spouses.

CONCLUSION

Parents of babies treated in the NICU during the COVID-19 pandemic experience anxiety, sadness, unhappiness, and loneliness. The preventive measures against the pandemic affect parents psychosocially. Healthcare professionals should plan and implement care practices and establish effective communication with parents to identify their physiological, psychological, and social needs and help them produce breastmilk and bond with their babies.

Parental perceptions on the impact of visiting restrictions during COVID-19 in a tertiary neonatal intensive care unit

AIM

During the first wave of coronavirus disease 2019 (COVID-19), visiting guidelines in neonatal units changed to maintain the health and safety of staff, neonates, and families. In the neonatal intensive care unit/special care nursery (NICU/SCN), restrictions were placed on parental contact and extended family excluded. Our team was interested in evaluating the effect of these restrictions on parental stress and discharge confidence.

METHODS

A prospective descriptive study utilising survey methodology was undertaken. The survey was developed and previously used by the NICU research group to evaluate parental knowledge and understanding, parental role, communication, and parental stress (admission/discharge). We have also included a section regarding COVID19 visiting restrictions (ETH.2020.LRE.00124). The survey used a five-level Likert scale. Statistical analysis was completed using SPSS version 21.

RESULTS

Notably, 33 surveys were returned. Results showed visiting restrictions reduced social contact between partners 26/33 (84%), with their other children 14/16 (87.5%) and extended family 28/33 (84.8%). Parents indicated that they had high levels of confidence in understanding their babies' medical needs (78-93%) and gaining hands-on experience caring for their baby (87-100%). However, 11/33 (33%) of parents reported concerns with discharge processes and gaining consistent information as challenges during their baby's admission. Notably, 17/33 (51.5) stated their NICU/SCN experience had been very to extremely stressful. Parents openly described how the restrictions had affected their mental/emotional health identifying the need to treat parents as one unit, and a gap in the psychological support available for families.

CONCLUSION

Support services and consistency of communication with NICU/SCN families need to be enhanced and prioritised during periods of restrictions, especially peri-discharge.

Provision of mother's own milk for preterm infants during the COVID-19 pandemic: Differential effect of insurance

Mother-infant dyads faced many challenges during the COVID-19 pandemic; however, the impact was different depending on socio-economic determinants. This study aims to investigate the impact of the COVID-19 pandemic on maternal provision of mother's own milk (MOM) at neonatal intensive care unit (NICU) discharge among preterm infants. We hypothesized that fewer infants would be discharged home on any MOM during the pandemic period compared to a pre-pandemic period. This is a retrospective analysis of infants born <34 weeks' gestation admitted to the Women and Infant's Hospital NICU. Infants born pre-pandemic (1/1/2019 to 2/29/2020) were compared to infants born during the pandemic (3/1/2020 to 4/30/2021). Maternal and neonatal variables were analyzed by group. The primary outcome was provision of MOM (defined as feeding exclusively MOM, or a combination of MOM and formula) at NICU discharge. Analyses were performed for time periods, and multivariable regression analyses were run for the total cohort and by insurance type. Analysis included 268 infants born pre-pandemic and 262 infants born during the pandemic. Pandemic group mothers vs. pre-pandemic were less likely to be single (27%, 63/233 vs. 38%, 93/243; p = 0.01) and more likely to have a diagnosis of chorioamnionitis (16%, 38/236 vs. 7%, 17/243; p = 0.002). Rates of public insurance were similar (55% pre-pandemic and 50% pandemic). There was no significant change in provision of MOM between time periods. In multivariable analysis, public insurance decreased the odds of MOM at discharge for the entire study period (aOR 0.31, 95% CI: 0.19-0.50; p = 0.0001). On analysis by insurance type, rates of MOM increased from 77% pre-pandemic to 88% during the pandemic (p = 0.03) for mothers with private insurance and remained unchanged for mothers with public insurance (52% pre-pandemic and 53% pandemic; p = 0.86). Mothers with private insurance had twice the odds (aOR 2.02, 95% CI: 1.02-3.97; p = 0.04) of providing MOM during the pandemic vs. pre-pandemic. For those with public insurance, the odds for any MOM provision during the pandemic were unchanged (aOR 0.95, 95% CI: 0.5-1.7; p = 0.86). These differences may be related to health care disparities requiring additional exploration of risk factors and the need for equitable opportunities for all mother-infant dyads.

Parental and staff experiences of restricted parental presence on a Neonatal Intensive Care Unit during COVID-19

Aim

The COVID‐19 pandemic had a significant impact on parental presence in the Neonatal Intensive Care Unit (NICU) during the first wave. The NICU team at the Rosie Hospital, Cambridge, endeavoured to explore the impact on parent and staff experiences of supporting parents throughout the period when visiting was restricted, between 13th August and 11th September 2020.

Methods

Bespoke surveys were designed following the first lockdown to gather information on the impact on staff and parents. The questions were developed in the context of initial observations and conversations with staff and parents.

Results

The findings of this study have illustrated the extent of the restrictions on parental wellbeing and mood, with the restrictions having had an adverse effect on these. In addition, the findings illustrate the adverse effect that the parents reported due to the restricted presence in terms of their babies’ wellbeing, parent‐infant bonding, partners’ wellbeing, parental confidence, the ability to breastfeed confidently and parents’ access to the medical teams.

Conclusion

The findings of this study have a number of clinical implications for parents and staff. Namely, the data supported the decision not to close NICU again during the second and third waves.