1
|
Mann PC, Stansfield BK. Optimal presence: enhancing parent integration to maximize neurodevelopmental outcomes in preterm infants. Pediatr Res 2024:10.1038/s41390-024-03491-y. [PMID: 39147904 DOI: 10.1038/s41390-024-03491-y] [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] [Received: 03/13/2024] [Revised: 07/29/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
Preterm birth disrupts the natural progression of events in the parent-infant relationship and bestows many of the typical parent responsibilities to the clinical care team. In turn, the neonatal intensive care environment (NICU) introduces obstacles to parents that would not otherwise be encountered and forces parents to adapt to this artificial environment as they seek to bond with and care for their newborn. Facilitating parent presence at the bedside and incorporating them into the care of their preterm infant is critical for lessening the immediate burden to both the parent and offspring while also ensuring the best possible outcome for preterm infants. In this review, we explore the impact that parents exert on the neurodevelopmental outcome of preterm infants and identify several barriers and facilitators to parent presence.
Collapse
Affiliation(s)
- Paul C Mann
- Department of Pediatrics, Augusta University, Augusta, GA, USA
| | | |
Collapse
|
2
|
Mariani I, Vuillard CLJ, Bua J, Girardelli M, Lazzerini M. Family-centred care interventions in neonatal intensive care units: a scoping review of randomised controlled trials providing a menu of interventions, outcomes and measurement methods. BMJ Paediatr Open 2024; 8:e002537. [PMID: 39106991 DOI: 10.1136/bmjpo-2024-002537] [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: 01/31/2024] [Accepted: 07/12/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Benefits of different types of family-centred care (FCC) interventions in neonatal intensive care units (NICUs) have been reported. However, a comprehensive review of existing FCC intervention studies was lacking. OBJECTIVE This review aimed at synthesising the characteristics of FCC interventions, related outcomes and measurement methods in randomised controlled trials (RCTs) in NICU, and providing menus of options to favour implementation and further research. METHODS We searched PubMed, EMBASE, Web of Science and the Cochrane Library up to 31 January 2022. Interventions were mapped according to five categories as defined by a previous Cochrane review. We described outcome types, measurement populations, measurement methods and timelines. Subgroup analyses were also performed. RESULTS Out of 6583 studies identified, 146 met eligibility criteria. Overall, 52 (35.6%) RCTs tested more than one category of intervention, with a large variety of combinations, with the most frequent category of intervention being the educational (138 RCTs, 94.5%). We identified a total of 77 different intervention packages, and RCTs comparing the same interventions were lacking. The 146 RCTs reported on 425 different outcomes, classified in 13 major categories with parental mental health (61 RCTs, 41.8% of total RCTs) being the most frequent category in parents, and neurobehavioural/developmental outcomes being the most frequent category in newborns (62 RCTs, 42.5%). For several categories of outcomes almost every RCT used a different measurement method. Educational interventions targeting specifically staff, fathers, siblings and other family members were lacking or poorly described. Only one RCT measured outcomes in health workers, two in siblings and none considered other family members. CONCLUSIONS A large variety of interventions, outcomes and measurement methods were used in FCC studies in NICU. The derived menus of options should be helpful for researchers and policy makers to identify interventions most suitable in each setting and to further standardise research methods.
Collapse
Affiliation(s)
- Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | | | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Martina Girardelli
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
- London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
3
|
Lazzerini M, Bua J, Vuillard CLJ, Squillaci D, Tumminelli C, Panunzi S, Girardelli M, Mariani I. Characteristics of intervention studies on family-centred care in neonatal intensive care units: a scoping review of randomised controlled trials. BMJ Paediatr Open 2024; 8:e002469. [PMID: 39103175 DOI: 10.1136/bmjpo-2023-002469] [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: 12/20/2023] [Accepted: 02/10/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Different definitions of family-centred care (FCC) exist in the newborn setting, and many FCC interventions have been tested, while a comprehensive review synthesising characteristics of existing intervention studies is still lacking. OBJECTIVE This review aims at summarising the characteristics of randomised controlled trials (RCTs) on FCC interventions in neonatal intensive care units. METHODS We searched PubMed, Embase, Web of Science and the Cochrane Library up to 31 January 2022, and reference lists of included studies and other reviews. Interventions were grouped into five categories according to a previous Cochrane review: (1) family support, (2) educational, (3) communication, (4) environmental interventions and (5) family-centred policies. Subgroup analyses by time period (RCTs published before vs after 2016) and by country income (based on the World Bank Classification) were conducted. RESULTS Out of 6583 retrieved studies, 146 RCTs met the eligibility criteria, with 53 (36.3%) RCTs published after 2016. Overall, 118 (80.8%) RCTs were conducted in high-income countries, 28 (19.1%) in middle-income countries and none in low-income countries. Only two RCTs were multicountry. Although mothers were the most frequent caregiver involved, fathers were included in 41 RCTs (28.1%). Very few studies were conducted in at-term babies (nine RCTs); siblings (two RCTs) and other family members (two RCTs), maternity care units (two RCTs). The role of health professionals was unclear in 65 (44.5%) RCTs. A large variety of intervention combinations was tested, with 52 (35.6%) RCTs testing more than 1 category of interventions, and 24 (16.4%) RCTs including all 5 categories. CONCLUSION There is a large and rising number of RCTs on FCC interventions in neonatal intensive care units, with specific research gaps. The large variety of FCC interventions, their high complexity, the need to tailor them to the local context and major gaps in implementation suggest that implementation research is the current priority.
Collapse
Affiliation(s)
- Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
- Maternal Adolescent Reproductive and Child Health Care Centre, Faculty of Epidemiology and Population Health, LSHTM, London, UK
| | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Domenica Squillaci
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristina Tumminelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Silvia Panunzi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Martina Girardelli
- Department of Paediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| |
Collapse
|
4
|
Persson C, Ericson J, Eriksson M, Salari R, Flacking R. Quality of couple relationship and associated factors in parents of NICU-cared infants during the first year after birth. J Perinatol 2024:10.1038/s41372-024-02076-1. [PMID: 39097668 DOI: 10.1038/s41372-024-02076-1] [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] [Received: 12/22/2023] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE To describe factors associated with quality of couple relationships among parents of infants cared for in neonatal intensive care units (NICUs) 1 year after birth and examine the trajectory of the relationship quality compared to parents from maternity units (MUs). STUDY DESIGN Longitudinally comparative cohort design. Parents answered surveys during the first year after discharge about the couple relationship, social support, and depressive symptoms. RESULTS Better social support and a hospital stay of 7-14 days were positively associated with the couple relationship in NICU mothers, whereas not having slept together with the partner and infant during hospitalization were negatively associated. Depressive symptoms were negatively associated with the relationship among NICU fathers. There were no differences in trajectory of the relationship quality between NICU and MU parents. CONCLUSION To strengthen couple relationships, it could be important to improve social support, facilitate space and time for support, and enable togetherness during hospitalization.
Collapse
Affiliation(s)
- Christine Persson
- School of Health and Welfare, Dalarna University, Falun, Sweden.
- Centre for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden.
| | - Jenny Ericson
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Raziye Salari
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Renée Flacking
- School of Health and Welfare, Dalarna University, Falun, Sweden
| |
Collapse
|
5
|
Stern-Delfils A, Leray I, Caeymaex L, Dicky O, Akrich M, Reynaud A, Bouvard C, Evrard A, Sizun J, Tscherning C, Kuhn P. Father's perceptions and care involvement for their very preterm infants at French neonatal intensive care units. Front Psychiatry 2023; 14:1229141. [PMID: 38034931 PMCID: PMC10687630 DOI: 10.3389/fpsyt.2023.1229141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives We aimed to evaluate (1) fathers' perceptions and care involvement for their very premature infants and their views of the hospitalization period based on parental reports and (2) their evolution over time. Methods We used an online parental survey to assess answers from parents of very preterm infants who were successfully discharged from French neonatal units. We analysed answers from February 2014 to January 2019 to an anonymous internet-based survey from the GREEN committee of the French Neonatal Society. Responses were compared for period 1 (P1, 1998 to 2013) and period 2 (P2, 2014 to 2019). Results We analyzed 2,483 surveys, 124 (5%) from fathers and 2,359 (95%) from mothers. At birth, 1,845 (80%) fathers were present in the hospital, but only 879 (38%) were near the mother. The presence of fathers in the NICU increased from P1 to P2 (34.5% vs. 43.1%, p = 0.03). Nearly two thirds of fathers accompanied their infants during transfer to the NICU (1,204 fathers, 60.6%). Fathers and mothers had similar perceptions regarding relationships with caregivers and skin-to-skin contact with their infants. However, more fathers than mothers felt welcome in the NICU and in care involvement regarding requests for their wishes when they met their infant (79% vs. 60%, p = 0.02) and in the presentation of the NICU (91% vs. 76%; p = 0.03). Mothers and fathers significantly differed in the caring procedures they performed (p = 0.01), procedures they did not perform but wanted to perform (p < 0.001), and procedures they did not perform and did not want to perform (p < 0.01). Conclusion Most fathers were present at the births of their very preterm infants, but fewer fathers were near the mother at this time. Less than two thirds of fathers accompanied their infants to the NICU. There should be further changes to better meet the specific needs of the fathers of infants requiring care in the NICU. Continuing assessment with an online questionnaire may be useful to monitor changes over time in father's involvement in NICUs.
Collapse
Affiliation(s)
| | - Isabelle Leray
- Department of Neonatology, University Hospital of Strasbourg, Strasbourg, France
| | - Laurence Caeymaex
- NICU, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Centre d’Etudes Discours Images Textes Ecrits Communication (CEDITEC), Paris Est Créteil University, Créteil, France
| | - Odile Dicky
- NICU, University Hospital, Toulouse, France
- U1027 INSERM, Paul Sabatier University, Toulouse, France
| | - Madeleine Akrich
- Collectif inter-associatif autour de la naissance (CIANE), Paris, France
| | | | | | - Anne Evrard
- Collectif inter-associatif autour de la naissance (CIANE), Paris, France
| | | | - Charlotte Tscherning
- NICU, University Hospital, Toulouse, France
- U1027 INSERM, Paul Sabatier University, Toulouse, France
- NICU, Sidra Medicine Hospital, Well Cornell University Hospital, Doha, Qatar
- Center for Pathophysiology Toulouse-Purpan (CPTP), Inserm Unviversity of Toulouse, Toulouse, France
| | - Pierre Kuhn
- Department of Neonatology, University Hospital of Strasbourg, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR, Strasbourg University, Strasbourg, France
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | | |
Collapse
|
6
|
Bergerat M, De Saint Blanquat L, Milesi C, Grimaud M, Le Bourgeois F, Renolleau S, Pouletty M, Oualha M, Leteurtre S, Recher M, Béranger A. Visiting Policies and Parental Presence During PICU Admission: A Survey in French Units. Pediatr Crit Care Med 2023; 24:e498-e504. [PMID: 37219957 DOI: 10.1097/pcc.0000000000003284] [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] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To describe the policies about parent visiting and involvement in care during admission to French PICUs. DESIGN A structured questionnaire was emailed to the chief of each of 35 French PICUs. Data about visiting policies, involvement in care, evolution of policies, and general characteristics were collected from April 2021 to May 2021. A descriptive analysis was conducted. SETTING Thirty-five PICUs in France. PATIENTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty-nine of 35 (83%) PICUs replied. Twenty-four-hour access for parents was reported for all PICUs responding. Other allowed visitors were grandparents (21/29, 72%) and siblings (19/29, 66%) with professional support. Simultaneous visits were restricted to two visitors in 83% (24/29) of PICUs. Family presence was always permitted during medical rounds for 20 of 29 (69%) PICUs. Most of the units rarely or never allowed parental presence during the most invasive procedures, such as central venous catheter placement (18/29, 62%) and intubation (22/29, 76%). CONCLUSIONS Unrestricted access to the PICU, for both parents, was available in all responding French units. There were, however, restrictions on the number of visitors and the presence of other family members at the bedside. Moreover, permission for parental presence during care procedures was heterogenous, and mainly restricted. National guidelines and educational programs are needed to support family wishes and promote acceptance by healthcare providers in French PICUs.
Collapse
Affiliation(s)
- Manon Bergerat
- Réanimation et surveillance continue medico-chirurgicales pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Laure De Saint Blanquat
- Réanimation et surveillance continue medico-chirurgicales pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Christophe Milesi
- Réanimation pédiatrique, Centre Hospitalier Régional Universitaire Montpellier, Montpellier, France
| | - Marion Grimaud
- Réanimation et surveillance continue medico-chirurgicales pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Fleur Le Bourgeois
- Réanimation médico-chirurgicale pédiatrique, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Sylvain Renolleau
- Réanimation et surveillance continue medico-chirurgicales pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Marie Pouletty
- Réanimation et surveillance continue medico-chirurgicales pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Mehdi Oualha
- Réanimation et surveillance continue medico-chirurgicales pédiatriques, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
- EA7323 pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Université de Paris, Paris, France
| | - Stéphane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Agathe Béranger
- EA7323 pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Université de Paris, Paris, France
- Réanimation chirurgicale cardiaque pédiatrique, AP-HP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| |
Collapse
|
7
|
Passini L, Le Bouedec S, Dassieu G, Reynaud A, Jung C, Keller ML, Lefebvre A, Katty T, Baleyte JM, Layese R, Audureau E, Caeymaex L. Error disclosure in neonatal intensive care: a multicentre, prospective, observational study. BMJ Qual Saf 2023; 32:589-599. [PMID: 36918264 DOI: 10.1136/bmjqs-2022-015247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 03/16/2023]
Abstract
IMPORTANCE Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied. OBJECTIVE To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure. DESIGN Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested. SETTING 10 NICUs in France with a 20-month follow-up, starting November 2015. PARTICIPANTS n=1019 patients with NICU stay ≥2 days with ≥1 error. EXPOSURE Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure. MAIN OUTCOME AND MEASURES Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure. RESULTS Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence. CONCLUSION AND RELEVANCE In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant. TRIAL REGISTRATION NUMBER NCT02598609.
Collapse
Affiliation(s)
- Loïc Passini
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Gilles Dassieu
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Marie-Laurence Keller
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Aline Lefebvre
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR 3571 CNRS, University Paris Diderot, Paris, France
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Therese Katty
- Health Law Manager, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Jean-Marc Baleyte
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| | - Richard Layese
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Etienne Audureau
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| |
Collapse
|
8
|
Hua W, Zhou J, Wang L, Li C, Zheng Q, Yuwen W, Jiang L. 'It turned my life upside down': Parents' emotional experience of the transition with their preterm infant from birth to discharge Home-A qualitative study. Aust Crit Care 2023; 36:679-686. [PMID: 36464525 DOI: 10.1016/j.aucc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis' Transition Theory, parents might experience emotional change initiated by critical events during this transition. OBJECTIVES The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better. METHODS This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis. RESULTS The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents' experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge. CONCLUSIONS Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents' critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.
Collapse
Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Jingxin Zhou
- Department of Neonatology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai, 200092, PR China
| | - Liying Wang
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Chenxing Li
- Department of Psychology, University of Washington, 3920 15th Ave NE, Seattle, WA, 98195, USA
| | - Qiaomu Zheng
- Shanghai Jiao Tong University School of Nursing, 227 Chongqing Road, Shanghai, 200025, PR China
| | - Weichao Yuwen
- School of Nursing and Healthcare Leadership, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, 200092, Shanghai, PR China.
| |
Collapse
|
9
|
How to support fathers of preterm infants in early parenthood - An integrative review. J Pediatr Nurs 2022; 67:e38-e47. [PMID: 36335065 DOI: 10.1016/j.pedn.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/04/2022]
Abstract
PROBLEM Preterm birth is a stressful event. Paternal experiences of having a preterm infant indicate a need for tailored support. However, it is unclear which interventions work best. This review presents the evidence on existing healthcare interventions to support fathers of preterm infants in early parenthood, how effective they are and paternal experiences with the interventions. ELIGIBILITY CRITERIA The integrative review process of Whittemore and Knafl was used to guide the study. A structured and comprehensive literature search was conducted in PubMed (MEDLINE), Embase, CINAHL, PsycInfo, Cochrane, Scopus, Web of Science, SweMed+, and Proquest Dissertation & Thesis Global. SAMPLE A total of 18 qualitative and quantitative studies were included in the review. The Mixed Methods Appraisal Tool was used to assess quality. RESULTS Three overall themes were identified in the analysis: 1) Skin-to-skin contact supported interaction between infant and father, 2) information impacted paternal experiences of stress, anxiety, and development of fatherhood, 3) fathers' relationships with the nurses oscillated between conflict and assistance. CONCLUSIONS Our findings show that targeted interventions could support father-infant interaction and reduce stress among fathers of preterm infants. IMPLICATIONS Fathers of preterm infants rely on nurses to support their engagement in early parenthood, while nurses facilitate the interventions that engage the fathers. It is also essential to develop a culture within the neonatal intensive care unit that encourages the presence of fathers and enhances educational nursing strategies for supporting fathers of preterm infants during early parenthood.
Collapse
|
10
|
Rossi Jelidi M, Vandenbroucke V, Martinet M, Rioual R, Borradori Tolsa C, Sizonenko S, E Pfister R. ["Illustrated guide for the observation of the sensory-motor behavior of the preterm newborn"]. SOINS. PEDIATRIE, PUERICULTURE 2022; 43:39-45. [PMID: 36207123 DOI: 10.1016/j.spp.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Developmental care is defined by a personalized approach to the premature child. Observation of sensory-motor behavior is a key part of this approach and requires specific training and the use of observation tools. This study analyzes the use of an illustrated guide during the observation and evaluation of the sensory-motor behavior of the premature baby; this didactic contribution constitutes a real added value for the professionals, allowing the elaboration of a care project.
Collapse
Affiliation(s)
| | | | | | - Roxane Rioual
- Hôpitaux universitaires de Genève, rue Willy-Donzé 6, CH-1211 Genève 14, Suisse.
| | | | - Stéphane Sizonenko
- Hôpitaux universitaires de Genève, rue Willy-Donzé 6, CH-1211 Genève 14, Suisse
| | - Riccardo E Pfister
- Hôpitaux universitaires de Genève, rue Willy-Donzé 6, CH-1211 Genève 14, Suisse
| |
Collapse
|
11
|
Tavella RA, Vignol FS, Favero RF, da Silveira TB, Dos Santos M, Garcia EM, da Silva Júnior FMR. DNA damage in Brazilian newborns admitted to NICUs - association with maternal and neonatal outcomes. MUTATION RESEARCH. GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 881:503521. [PMID: 36031333 DOI: 10.1016/j.mrgentox.2022.503521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Growing evidence suggests that early-life events can predispose the newborn to a variety of health problems in postnatal life, which can lead to the need for specialized care in the neonatal intensive care unit (NICU). These events may be caused by factors intrinsically related to the mother (i.e., lifestyle, socioeconomic conditions), and this interplay between maternal exposure factors and negative outcomes in the neonate can be efficiently monitored through effect biomarkers, such as DNA damage. Thus, the present study aimed to evaluate the DNA damage and the maternal and neonatal factors associated with the genotoxic outcome using newborns admitted to the NICUs of three hospitals located in the extreme south of Brazil. A total of 81 newborns were evaluated. DNA damage was assessed using the comet assay, and according to the result obtained for the evaluated parameters (tail length, % of tail DNA and tail moment). The investigation of associated factors was performed using the bivariate and multivariate Poisson regression analysis. As a result, we observed that the tail moment was the most sensitive parameter to detect differences between variables and genetic outcomes in newborns from NICU. Birthweight and the presence of respiratory diseases were associated with greater risks of DNA damage. Furthermore, the variables family income, sex, head circumference, preterm, birthweight and the presence of respiratory and/or infectious diseases showed a significant statistical difference regarding the groups with and without DNA damage (based on the median of the parameter). While the results of this study will serve as the basis for investigating genetic damage, we encourage that similar studies should be conducted elsewhere in order to confirm these and other outcomes as associated factors with DNA damage in newborns.
Collapse
Affiliation(s)
- Ronan Adler Tavella
- Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá, 102, Centro, Rio Grande, RS, 96203-900, Brazil
| | - Flavia Saraçol Vignol
- Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá, 102, Centro, Rio Grande, RS, 96203-900, Brazil
| | - Rafael Frizzo Favero
- Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá, 102, Centro, Rio Grande, RS, 96203-900, Brazil
| | - Tatiane Britto da Silveira
- Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá, 102, Centro, Rio Grande, RS, 96203-900, Brazil
| | - Marina Dos Santos
- Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá, 102, Centro, Rio Grande, RS, 96203-900, Brazil
| | - Edariane Menestrino Garcia
- Universidade Federal do Rio Grande - FURG, Rua Visconde de Paranaguá, 102, Centro, Rio Grande, RS, 96203-900, Brazil
| | | |
Collapse
|
12
|
Linnér A, Lilliesköld S, Jonas W, Skiöld B. Initiation and duration of skin-to-skin contact for extremely and very preterm infants: A register study. Acta Paediatr 2022; 111:1715-1721. [PMID: 35642385 DOI: 10.1111/apa.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/24/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
AIM This study sought to describe how skin-to-skin contact between extremely and very preterm infants and their parents is practised in Swedish neonatal units. METHODS Data from the Swedish Neonatal Quality Register from 2020 to 2021 were extracted to analyse initiation time and daily duration of skin-to-skin contact in different gestational ages and regions. RESULTS Of the 1475 infants in the cohort, mean (range) gestational age was 28 weeks (22-31), and mean (range) birthweight was 1205 g (360-2810). For extremely preterm infants (<28 weeks), median (interquartile range) skin-to-skin contact initiation time was at 88 postnatal hours (48-156) and 5% had skin-to-skin contact on the first day. For very preterm infants (<32 weeks), the corresponding numbers were 14 h (4-36) and 34%. Median (interquartile range) daily skin-to-skin contact duration for the entire cohort during the first day, first three and seven days and the remaining hospital stay was 0 (0-0), 0.7 (0-2.7), 1.6 (0.4-3.6) and 4.4 (3.0-6.1) h, respectively. CONCLUSION A minority of extremely and very preterm infants were exposed to skin-to-skin contact on the first postnatal day. Daily duration during the first week of life amounted to less than two hours. Initiation time and daily duration varied among gestational ages.
Collapse
Affiliation(s)
- Agnes Linnér
- Department of Women’s and Children’s Health, Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
| | - Siri Lilliesköld
- Department of Women’s and Children’s Health, Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
| | - Wibke Jonas
- Department of Women’s and Children’s Health, Karolinska Institutet Stockholm Sweden
- Faculty of Health University of Applied Sciences Bielefeld Germany
| | - Béatrice Skiöld
- Department of Women’s and Children’s Health, Karolinska Institutet Stockholm Sweden
- Neonatal Unit Karolinska University Hospital Stockholm Sweden
| |
Collapse
|
13
|
Artese C, Ferrari F, Perugi S, Cavicchioli P, Paterlini G, Mosca F. Surveying family access: kangaroo mother care and breastfeeding policies across NICUs in Italy. Ital J Pediatr 2021; 47:231. [PMID: 34857018 PMCID: PMC8638249 DOI: 10.1186/s13052-021-01164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies on the application of developmental care initiatives in Italian NICUs are rather scarce. We aimed to assess parental access to the NICUs and facilities offered to the family members and to test "the state of art" regarding kangaroo mother care (KMC) and breastfeeding policies in level III Italian NICUs. METHODS A questionnaire both in paper and in electronic format was sent to all 106 Italian level III NICUs; 86 NICUs (i.e., 80% of NICUs) were completed and returned. The collected data were analysed. In addition, a comparison between the 2017 survey results and those of two previous surveys conducted from 2001 to 2006 was performed. RESULTS In total, 53 NICUs (62%) reported 24-h open access for both parents (vs. 35% in 2001 and 32% in 2006). Parents were requested to temporarily leave the unit during shift changes, emergencies and medical rounds in 55 NICUs (64%). Some parental amenities, such as an armchair next to the crib (81 units (94%)), a room for pumping milk and a waiting room, were common, but others, such as family rooms (19 units (22%)) and adjoining accommodation (30 units (35%)), were not. KMC was practised in 81 (94%) units, but in 72 (62%), i.e., the majority of units, KMC was limited to specific times. In 11 (13%) NICUs, KMC was not offered to the father. The average duration of a KMC session, based on unit staff estimation, was longer in 24-h access NICUs than in limited-access NICUs. KMC documentation in medical records was reported in only 59% of questionnaires. Breastfeeding was successful in a small proportion of preterm infants staying in the NICU. CONCLUSION The number of 24-h access NICUs doubled over a period of 13 years. Some basic family facilities, such as a dedicated kitchen, rooms with dedicated beds and showers for the parents, remain uncommon. KMC and breastfeeding have become routine practices; however, the frequency and duration of KMC sessions reported by NICU professionals still do not meet the WHO recommendations.
Collapse
Affiliation(s)
- Claudia Artese
- Neonatology and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Fabrizio Ferrari
- Neonatology and Neonatal Intensive Care Unit, University of Modena and Reggio Emilia Hospital, Via del Pozzo 71, 41125, Modena, Italy.
| | - Silvia Perugi
- Neonatology and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Paola Cavicchioli
- Neonatal Intensive Care Unit, Hospital "Dell'Angelo" Venezia Mestre, Venice, Italy
| | - Giuseppe Paterlini
- Department of Mother's and Child' Health, Neonatology and Neonatal Intensive Care Unit, Poliambulanza Foundation Hospital Institute, Brescia, Italy
| | - Fabio Mosca
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, University of Milan, IRCCS Cà Granda Ospedale Maggiore Foundation, University Hospital, Milan, Italy
| |
Collapse
|
14
|
Flacking R, Haslund-Thomsen H, Jónsdóttir R, Poropudas S, Axelin A. Parents' friends and families in neonatal intensive care units: A cross-national qualitative study on staff perceptions and experiences. J Clin Nurs 2021; 31:3120-3129. [PMID: 34816522 DOI: 10.1111/jocn.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs). BACKGROUND In NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these 'important others' can be present and involved. DESIGN This qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry. METHODS Seven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist. RESULTS The overarching theme showed that 'important others' were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised 'important others' as the parents' territory, but that 'important others'' presence and involvement needed to be negotiated with staff. Although the staff regarded 'important others' as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of 'important others' was an essential step forward in achieving family centred care. CONCLUSIONS The findings indicate that 'important others'' involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of 'important others'. RELEVANCE TO CLINICAL PRACTICE There is a need for more staff resources to enable and support the participation of 'important others'. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their 'important others'.
Collapse
Affiliation(s)
- Renée Flacking
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Helle Haslund-Thomsen
- Paediatric Research Unit, Clinical Nursing Research Unit, Aalborg University Hospital, Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Rakel Jónsdóttir
- Neonatal Intensive Care Unit, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sini Poropudas
- Department of Nursing Science, University of Turku, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, University of Turku, Turku, Finland
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Filippa M, Saliba S, Esseily R, Gratier M, Grandjean D, Kuhn P. Systematic review shows the benefits of involving the fathers of preterm infants in early interventions in neonatal intensive care units. Acta Paediatr 2021; 110:2509-2520. [PMID: 34053115 PMCID: PMC8453504 DOI: 10.1111/apa.15961] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
Aim This review identifies interventions involving the fathers of preterm infants that have been tested in neonatal intensive care units (NICU). It examines their effects on the fathers and infants and highlights any differences between fathers and mothers who took part in the same interventions. Methods A systematic search was performed in English from 1995 to 1 September 2020, using the CINAHL, Cochrane Central Register of Controlled Trials, Embase, PubMed and PsycINFO databases. We examined 14 peer‐reviewed studies that investigated NICU interventions involving 478 fathers, whose 511 infants were born before 37 weeks of gestation. These included empirical studies with clinical outcomes. Results Studies on fathers' interventions in NICUs were limited and mainly restricted to basic skin‐to‐skin contact or tactile interventions. The interventions had similar general positive effects on mothers and fathers when it came to infant physiological and behavioural reactions. There was also evidence of a positive effect on the fathers, including their mental health. Conclusion Including fathers as active partners in the care of their preterm newborn infants produced good outcomes for both of them. Further research is needed to develop new, multimodal and interactive interventions that provide fathers with positive contact with their preterm infants.
Collapse
Affiliation(s)
- Manuela Filippa
- Neuroscience of Emotion and Affective Dynamics Lab Swiss Center for Affective Sciences and Faculty of Psychology and Educational Sciences University of Geneva Geneva Switzerland
- Division of Development and Growth Department of Pediatrics Geneva University Hospitals Geneva Switzerland
| | - Sahar Saliba
- Department of Psychomotor Therapy Faculty of Public Health Lebanese University Beirut Lebanon
| | - Rana Esseily
- Ethology, Cognition and Development Laboratory UPL University of Paris Nanterre Nanterre France
| | - Maya Gratier
- Ethology, Cognition and Development Laboratory UPL University of Paris Nanterre Nanterre France
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics Lab Swiss Center for Affective Sciences and Faculty of Psychology and Educational Sciences University of Geneva Geneva Switzerland
| | - Pierre Kuhn
- Department of Neonatal Medicine Hautepierre Hospital University Hospital, University of Strasbourg Strasbourg France
- Centre National de la Recherche Scientifique and University of StrasbourgInstitut des Neurosciences Cellulaires et Intégratives Strasbourg France
| |
Collapse
|
17
|
González-Gil MT, Alcolea-Cosín MT, Pérez-García S, Luna-Castaño P, Torrent-Vela S, Piqueras-Rodríguez P, Gil-Domínguez S, Alonso-Lloret F, Belda-Holfheinz S, Sánchez-Díaz JI, Espinosa-Bayal MÁ. Children's visits to the paediatric intensive care unit from the nurses' experience. ENFERMERIA INTENSIVA 2021; 32:133-144. [PMID: 34391734 DOI: 10.1016/j.enfie.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/01/2020] [Indexed: 10/20/2022]
Abstract
BACKGROUND Family process disruption is one of the main consequences of the hospitalization of a critically ill child in a Paediatric Intensive Care Unit (PICU). Children's visits to PICU may help improve family coping. However, this is not standard practice and nurses' experiences in facilitating children's visits to units where it is encouraged is unknown. AIM To explore nurses' experience related to promoting the visits of siblings to PICU. METHODS An interpretative phenomenological study was carried out through in-depth interviews in two PICUs belonging to third level public hospitals in Madrid. Twelve nurses with more than two years of experience in PICU were interviewed. They were all were working in PICU during the study. Furthermore, a PICU psychologist with an experience of four years was interviewed and this was considered shadowed data. Data analysis followed a thematic discourse analysis. RESULTS Nurses' experience of facilitating children's visits to PICU can be condensed into four themes: emerging demand for visits, progressive preparation, decision-making through common consensus and creating intimate spaces. CONCLUSIONS The experience of nurses in facilitating visits is mainly in response to the demand of families going through prolonged hospitalisation or end-of-life situations. The role of the nurse is one of accompaniment, recognising the major role of parents in the preparation of children and in developing the visit. Nurses feel insecure and lack resources for emotional support and demand action protocols to guide intervention and decision making.
Collapse
Affiliation(s)
- M T González-Gil
- Departamento de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
| | - M T Alcolea-Cosín
- Departamento de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - S Pérez-García
- Unidad de Apoyo a la Investigación en Enfermería, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - P Luna-Castaño
- Enfermería de Investigación, Hospital Universitario de la Paz, Madrid, Spain
| | - S Torrent-Vela
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - P Piqueras-Rodríguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario de la Paz, Madrid, Spain
| | - S Gil-Domínguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - F Alonso-Lloret
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - S Belda-Holfheinz
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - J I Sánchez-Díaz
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - M Á Espinosa-Bayal
- Departamento de Psicología Evolutiva y Educación, Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
18
|
La visita infantil a la unidad de cuidados intensivos pediátricos desde la experiencia de las enfermeras. ENFERMERÍA INTENSIVA 2021. [DOI: 10.1016/j.enfi.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Chandebois L, Nogue E, Bouschbacher C, Durand S, Masson F, Mesnage R, Nagot N, Cambonie G. Dissemination of newborn behavior observation skills after Newborn Individualized Developmental Care and Assessment Program (NIDCAP) implementation. Nurs Open 2021; 8:3547-3557. [PMID: 33956404 PMCID: PMC8510744 DOI: 10.1002/nop2.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/06/2021] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To assess nurses’ ability to observe newborn behaviour after in situ training provided by caregivers with advanced practice certification in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Design Prospective observational study. Methods Twelve nurses viewed 20‐min films showing the behaviour of 10 premature newborns before, during and after the usual caregiving. The behaviour was rated on an observation sheet with 88 items distributed into six systems. The responses were compared to the reference ratings established by two professionals certified for this programme. Results Despite less accurate observations during care and for some components, the nurses generally showed a satisfactory ability to observe newborn behaviour after training by NIDCAP expert professionals. The dissemination of observation skills among caregivers may result in an improved quality of patient care and better communication among professionals in a department of neonatology.
Collapse
Affiliation(s)
- Laurence Chandebois
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Catherine Bouschbacher
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Sabine Durand
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Florence Masson
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Renaud Mesnage
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France
| | - Nicolas Nagot
- Clinical Research and Epidemiology Unit, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France.,Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
| |
Collapse
|
20
|
Dicky O, Kuhn P, Akrich M, Reynaud A, Caeymaex L, Tscherning C. Emotional responses of parents participating for the first time in caregiving for their baby in a neonatal unit. Paediatr Perinat Epidemiol 2021; 35:227-235. [PMID: 33029809 DOI: 10.1111/ppe.12718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parents of term and preterm infants hospitalised at birth experience a stressful situation. They are considered as primary caregivers in neonatal units and are encouraged to participate in their child's care. OBJECTIVES The aim of our study was to analyse the feelings of parents participating for the first time in caregiving for their baby admitted at birth in a neonatal unit in France and to compare the feelings reported by parents of term and preterm infants. METHODS An online survey was created in 2014 for parents who had a baby hospitalised at birth. We analysed parents' responses to this open-ended question: "How did you feel when you participated in caregiving for your baby for the first time?" using a qualitative discourse analysis by two analysts. Themes were identified and coded. RESULTS Between February 2014 and March 2018, 1603 parents of preterm infants and 239 parents of term infants responded to this open-ended question. Twenty-five per cent of parents expressed positive feelings exclusively (confidence, ease, joy, pride, feeling supported by healthcare professionals, by their family and feeling of being a parent), 41% expressed negative feelings exclusively (stress, fear, feeling of being judged, frustration, anger, uselessness and clumsiness) and 34% expressed mixed feelings (both positive and negative). Parents of term infants expressed less frequent feelings of stress and fear than parents of preterm infants: with a relative risk (RR) of 0.69, 95% confidence interval (CI) 0.56, 0.87. Parents of term babies more frequently expressed feelings of frustration: RR 2.40 (95% CI 1.33, 4.32). CONCLUSIONS Infant- and Family-Centred Developmental Care supportive programmes are recommended within neonatal units in order to improve the experience of parents participating in caregiving for their baby hospitalised at birth.
Collapse
Affiliation(s)
- Odile Dicky
- NICU, University Hospital, Toulouse, France.,U1027 INSERM, Paul Sabatier University, Toulouse, France
| | - Pierre Kuhn
- NICU, University Hospital, Strasbourg, France.,Cellular and Integrative Neuroscience Institute, CNRS, Paris, France
| | - Madeleine Akrich
- Collectif inter-associatif autour de la naissance (CIANE), Paris, France
| | | | - Laurence Caeymaex
- NICU, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Centre d'Etudes Discours Images Textes Ecrits Communication (CEDITEC), Paris Est Créteil University, Créteil, France
| | - Charlotte Tscherning
- NICU, University Hospital, Toulouse, France.,U1027 INSERM, Paul Sabatier University, Toulouse, France.,NICU, Sidra Medecine Hospital, Well Cornell University Hospital, Doha, Qatar.,Center for Pathophysiology Toulouse-Purpan (CPTP), Inserm Unviversity of Toulouse, Toulouse, France
| | | |
Collapse
|
21
|
Artese C, Paterlini G, Mascheroni E, Montirosso R. Barriers and Facilitators to Conducting Kangaroo Mother Care in Italian Neonatal Intensive Care Units. J Pediatr Nurs 2021; 57:e68-e73. [PMID: 33189484 DOI: 10.1016/j.pedn.2020.10.028] [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: 07/16/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This work aimed to investigate obstacles and facilitators for carrying out Kangaroo Mother Care (KMC) across Italian NICUs. DESIGN AND METHODS A survey that investigated Unit's characteristics, policies toward parents and KMC practice and policies was carried out. Data from 86 NICUs (80.4%) was collected. Descriptive statistics and Multiple Regression Models were computed. RESULTS Eighty-one NICUs provided KMC. These NICUs had a less restricted parental access policies (chi2 = 7.373, p = .007). More than the 70% of the units did not have adequate facilities for parents. KMC daily length was positively predicted (R2 = 0.18, F = 7.91, p = .001) by repeated sessions and documentation of KMC. CONCLUSION The implementation of KMC is characterized by different barriers and facilitators that determine the parent's possibility to provide KMC. Structural factors (e.g., adequate space and facilities) can support families in providing KMC. A unique result of this survey is that KMC documentation on medical records appears critical for improving its practice. PRACTICE IMPLICATIONS Although most of the Italian units provide KMC as a routine practice, improving its practical support would be beneficial to its implementation. A more formalized approach to KMC may strengthen staff habits to consider KMC like a standard care treatment.
Collapse
Affiliation(s)
- Claudia Artese
- SOD Neonatology and Neonatal Intensive Care Unit, Careggi Hospital-University, Italy
| | - Giuseppe Paterlini
- Department of Mother's and Child's Health, Neonatology and Neonatal Intensive Care Unit, Poliambulanza Foundation Hospital Institute, Italy
| | - Eleonora Mascheroni
- 0-3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy.
| | - Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
| | | |
Collapse
|
22
|
Hua W, Wang L, Li C, Simoni JM, Yuwen W, Jiang L. Understanding preparation for preterm infant discharge from parents' and healthcare providers' perspectives: Challenges and opportunities. J Adv Nurs 2020; 77:1379-1390. [PMID: 33249653 DOI: 10.1111/jan.14676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/03/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
AIM To describe the facilitating/inhibiting factors of preparation for preterm infant discharge and recommendations for increasing discharge readiness from parents' and healthcare providers' perspectives based on Meleis's Transitions Theory. DESIGN A qualitative cross-sectional descriptive design. METHODS We selected a purposive sample of 17 parents (9 fathers and 8 mothers) and 13 healthcare providers (10 nurses and 3 clinicians) from the neonatal intensive care unit of a tertiary hospital in Eastern China. Data were collected between May -July 2018. Data from audio-recorded semi-structured individual interviews were coded with content analysis both inductively and deductively. RESULTS The analyses yielded four themes: personal conditions, community conditions, nursing therapeutics, and patterns of response. Parents and healthcare providers had unique opinions about the themes. CONCLUSION Meleis's Transitions Theory seems to be an applicable and practicable framework for understanding the discharge preparation of parents with preterm infants and may be used to help healthcare providers to develop appropriate interventions on discharge preparation practice. IMPACT To address the lack of discharge readiness of preterm infants in China and countries with a similar clinical context, healthcare providers should help parents play a more active role to promote their engagement in discharge preparation. In a wider global community, healthcare providers should consider parents' personal conditions and their practical needs in performing discharge preparation.
Collapse
Affiliation(s)
- Wenzhe Hua
- Shanghai Jiao Tong University School of Nursing, Shanghai, PR China
| | - Liying Wang
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Weichao Yuwen
- School of Nursing and Healthcare Leadership, University of Washington, Tacoma, WA, USA
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| |
Collapse
|
23
|
Ozawa M. Commentary: Interprofessional Collaboration and Involvement of Parents in the Management of Painful Procedures in Newborns. Front Pediatr 2020; 8:599759. [PMID: 33224910 PMCID: PMC7674607 DOI: 10.3389/fped.2020.599759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mio Ozawa
- Division of Nursing Sciences, Graduate School of Biomedical & Health Sciences, University of Hiroshima, Hiroshima, Japan
| |
Collapse
|
24
|
Ponthier L, Ensuque P, Guigonis V, Bedu A, Bahans C, Teynie F, Medrel-Lacorre S. Parental presence during painful or invasive procedures in neonatology: A survey of healthcare professionals. Arch Pediatr 2020; 27:362-367. [PMID: 32891481 DOI: 10.1016/j.arcped.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/25/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Newborns in neonatology are exposed to invasive and painful procedures. The absence of parents during procedures revealed significantly high pain scores. OBJECTIVE The aim of this study was to assess practices regarding the role of parents during painful and invasive procedures. METHODS This was a prospective, observational, multicenter study in France in which 471 caregivers participated. Professional practices regarding the role of parents during painful procedures on their child were assessed. Univariate and multivariate analyses were performed to identify factors associated with parental presence during painful procedures. RESULTS Parental presence was most often allowed during capillary blood sampling, nasogastric tube insertions, and vein punctures, whereas it was mostly restricted during central line insertions, extubations, lumbar punctures, and intubations. However, we found discrepancies depending on the type of facility and caregiver seniority. CONCLUSION An important variability in practices concerning the role of parents during painful and invasive procedures on their child was reported.
Collapse
Affiliation(s)
- L Ponthier
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France.
| | - P Ensuque
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - V Guigonis
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - A Bedu
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - C Bahans
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - F Teynie
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| | - S Medrel-Lacorre
- Universitary hospital, 8, avenue Dominique-Larrey 87000 Limoges, France
| |
Collapse
|
25
|
Upadhyaya S, Chudal R, Luntamo T, Hinkka‐Yli‐Salomäki S, Sucksdorff M, Lehtonen L, Sourander A. Perinatal risk factors and reactive attachment disorder: A nationwide population-based study. Acta Paediatr 2020; 109:1603-1611. [PMID: 31899934 DOI: 10.1111/apa.15156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To examine the association between several perinatal and obstetric risk factors and reactive attachment disorder in children diagnosed in specialised services. METHODS In this nested case-control study, 614 cases with reactive attachment disorder and 2423 controls matched with age and sex were identified from Finnish national registers. Conditional logistic regression was used to examine the association between a number of perinatal risk factors and reactive attachment disorder. RESULTS In the adjusted analysis, a low birthweight of <2500 g was associated with an increased odds of reactive attachment disorder, with an odds ratio (OR) of 1.96 and 95% confidence interval (CI) of 1.17, 3.30 and a birthweight of 4000-4499 grams was associated with decreased odds OR 0.49 (95% CI 0.31, 0.75). The odds for being diagnosed with reactive attachment disorder increased with a gestational age of <32 weeks OR 3.72 (95% CI 1.52, 9.10), induced labour OR 1.34 (95% CI 1.03, 1.75) and monitoring in a neonatal intensive care unit (NICU) OR 1.67 (95% CI 1.09, 2.55). CONCLUSION We found associations between low birthweight, preterm birth, NICU admission and reactive attachment disorder. The findings add to the current literature on the understanding of the development of reactive attachment disorder in children.
Collapse
Affiliation(s)
- Subina Upadhyaya
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Roshan Chudal
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Terhi Luntamo
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | | | - Minna Sucksdorff
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
| | - Liisa Lehtonen
- Department of Paediatrics Turku University Hospital Turku Finland
- Department of Paediatrics University of Turku Turku Finland
| | - Andre Sourander
- Department of Child Psychiatry Research Centre for Child Psychiatry University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital Turku Finland
- INVEST Research Flagship University of Turku Turku Finland
| |
Collapse
|
26
|
Lopez-Maestro M, De la Cruz J, Perapoch‐Lopez J, Gimeno‐Navarro A, Vazquez‐Roman S, Alonso‐Diaz C, Muñoz‐Amat B, Morales‐Betancourt C, Soriano‐Ramos M, Pallas‐Alonso C. Eight principles for newborn care in neonatal units: Findings from a national survey. Acta Paediatr 2020; 109:1361-1368. [PMID: 31799756 DOI: 10.1111/apa.15121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
AIM To assess, at national level, the implementation of eight principles for infant- and family-centred developmental care (IFCDC) in neonatal units. A European expert group established eight 'Principles of care' in 2018 that define neurodevelopmental and family-centred care. METHODS The implementation of each principle was assessed by a survey sent to level-III Spanish units. A principle was considered to be implemented if all answers to the principle-associated questions were positive. RESULTS The response rate was 84.5% (65/77). No unit had implemented eight principles. Principle 1 (free parental access) was implemented in 21.5% of the centres; Principle 2 (psychological support) 40%; Principle 3 (pain management) 7.7%; Principle 4 (environmental influences) 29%; Principle 5 (postural support) 84.6%; Principle 6 (kangaroo-care) 67.7%; Principle 7 (breastfeeding) 23% and Principle 8 (sleep protection) in 46%. In units attending ≥50 very low birth weight (VLBW) infants, four or more principles had been implemented in 31% vs 13% <50 VLBW neonates (odds ratio 3.0 CI 95% 0.9-10.1, P .07). CONCLUSION The principle with the highest implementation was related to newborn body positioning. Pain management was the principle with lowest implementation. More principles for IFCDC tend to be implemented in units providing care for a higher number of VLBW infants.
Collapse
Affiliation(s)
| | - Javier De la Cruz
- Healthcare Research Institute (IMAS12) Hospital Universitario 12 de Octubre, Servicio Madrileño de Salud (SERMAS-H12O) Madrid Spain
| | | | - Ana Gimeno‐Navarro
- Division of Neonatology Hospital Universitari i Politecnic La Fe Valencia Spain
| | - Sara Vazquez‐Roman
- Division of Neonatology Hospital Universitario 12 de Octubre Madrid Spain
| | - Clara Alonso‐Diaz
- Division of Neonatology Hospital Universitario 12 de Octubre Madrid Spain
| | - Bárbara Muñoz‐Amat
- Division of Neonatology Hospital Universitario 12 de Octubre Madrid Spain
| | | | | | - Carmen Pallas‐Alonso
- Division of Neonatology Instituto de Investigación i+12 Hospital Universitario 12 de OctubreUniversidad Complutense Madrid Spain
| |
Collapse
|
27
|
Yu X, Zhang J, Yuan L. Chinese Parents' Lived Experiences of having Preterm Infants in NICU: A Qualitative Study. J Pediatr Nurs 2020; 50:e48-e54. [PMID: 31787470 DOI: 10.1016/j.pedn.2019.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/11/2019] [Accepted: 11/09/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore Chinese parents' experiences and expectations of having preterm infants in a Chinese neonatal intensive care unit. DESIGN AND METHODS A qualitative descriptive design with semi-structured interviews was used to describe the experiences and expectations of parents of preterm infants in a neonatal intensive care unit in the central region of China. Purposive sampling was adopted to recruit parents (n = 15) of preterm infants and data were collected by face-to-face interviews from January to May 2018. Themes were identified by thematic analysis. This study followed the consolidated criteria for reporting qualitative research (COREQ). RESULTS Five themes emerged from the analysis: (1) mixed emotional experiences; (2) separation from the infants; (3) perceived incompetence in taking care of preterm infants; (4) obtained support through various sources; (5) desired more from healthcare professionals. CONCLUSIONS Parents experienced additional emotional burdens due to separation from their infants as well as a lack of an effective approach to their associated needs. While NICU staff adopted several strategies to help parents cope with their infant hospitalization, these parents still expected to receive more support from healthcare providers to meet their needs. PRACTICE IMPLICATIONS Healthcare providers should be more aware of parents' various needs in neonatal intensive care units and of their important role as constant caregivers. Hospital-based neonatal care should be specifically designed to supply positive support and necessary strategies for parents to strengthen their confidence in parenting infants.
Collapse
Affiliation(s)
- Xiaoyan Yu
- School of Health Sciences, Wuhan University, Wuhan, China; Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Zhang
- School of Health Sciences, Wuhan University, Wuhan, China.
| | - Lu Yuan
- Wuhan Medical Care Center for Women and Children, Wuhan, China
| |
Collapse
|
28
|
Carvalho SC, Facio BC, Souza BFD, Abreu-D'Agostini FCPD, Leite AM, Wernet M. Maternal care in the preterm child's family context: A comprehensive look towards the sibling. Rev Bras Enferm 2019; 72:50-57. [PMID: 31851234 DOI: 10.1590/0034-7167-2017-0780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/30/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze maternal care for siblings of preterm babies hospitalized in the neonatal intensive care unit. METHOD Qualitative research using symbolic interactionism as a theoretical reference and narrative research as a methodological reference. Ten mothers were surveyed through semi-structured interviews. RESULTS Three thematic units emerged from the analysis of data: "social support in the sharing of child care"; "promotion of adaptation to the arrival of a sibling" and "maternal feelings and coping". FINAL CONSIDERATIONS Care for the premature child's sibling is developed under mothers' physical distance from him/her, justified by the need to remain close to the premature child due to risks and fragility related to the condition.
Collapse
Affiliation(s)
| | | | | | | | | | - Monika Wernet
- Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil
| |
Collapse
|
29
|
Flacking R, Breili C, Eriksson M. Facilities for presence and provision of support to parents and significant others in neonatal units. Acta Paediatr 2019; 108:2186-2191. [PMID: 31350769 PMCID: PMC6899771 DOI: 10.1111/apa.14948] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/13/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022]
Abstract
AIM To describe parental facilities for staying in neonatal units, visiting policies and access to emotional support during hospitalisation. METHODS A cross-sectional design was used in which a survey was presented to all neonatal units in Sweden; 34 out of 38 units participated (89%). RESULTS The findings showed that in 50% of the units, parents could stay 24/7 for the infant's entire hospital stay. In 32% of the units, siblings could stay the night with their parents. Units had policies on restrictions for visits by siblings (80%), grandparents (59%), friends and relatives (71%). All units offered counselling to parents, and some units offered peer-to-peer groups (24%), diaries (35%), relaxation techniques (6%) or Internet parental forums (6%). All units enabled parents to be at home with their infant and to visit the unit for check-ups (35%) or to have staff visits at home (65%). CONCLUSION Facilities for parents to stay with their infant during hospitalisation and to have significant others visit are good, but there is room for improvement. During the transitional phase to being at home, parents are facilitated in being at home before the infant is discharged and are supported by the unit, which must be considered beneficial for parents.
Collapse
Affiliation(s)
- Renée Flacking
- School of Education, Health and Social Studies Dalarna University Falun Sweden
| | - Christine Breili
- School of Education, Health and Social Studies Dalarna University Falun Sweden
- Centre for Clinical Research Dalarna Falun Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences Örebro University Örebro Sweden
| |
Collapse
|
30
|
Brødsgaard A, Pedersen JT, Larsen P, Weis J. Parents' and nurses' experiences of partnership in neonatal intensive care units: A qualitative review and meta‐synthesis. J Clin Nurs 2019; 28:3117-3139. [DOI: 10.1111/jocn.14920] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/22/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Brødsgaard
- Department of Pediatrics and Adolecent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
- Department of Public Health, Section for Nursing University of Aarhus Aarhus Denmark
| | | | - Palle Larsen
- Department of Nursing University College Lillebaelt Svendborg Denmark
| | - Janne Weis
- Department of Neonatology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| |
Collapse
|
31
|
Lundqvist P, Weis J, Sivberg B. Parents’ journey caring for a preterm infant until discharge from hospital‐based neonatal home care—A challenging process to cope with. J Clin Nurs 2019; 28:2966-2978. [DOI: 10.1111/jocn.14891] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/16/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Pia Lundqvist
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
| | - Janne Weis
- Neonatal Department and the Research Unit for Women’s and Children’s Health Copenhagen University Hospital Copenhagen Denmark
| | - Bengt Sivberg
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
| |
Collapse
|
32
|
Filippa M, Poisbeau P, Mairesse J, Monaci MG, Baud O, Hüppi P, Grandjean D, Kuhn P. Pain, Parental Involvement, and Oxytocin in the Neonatal Intensive Care Unit. Front Psychol 2019; 10:715. [PMID: 31001173 PMCID: PMC6454868 DOI: 10.3389/fpsyg.2019.00715] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/14/2019] [Indexed: 12/16/2022] Open
Abstract
Preterm infants (PTI) typically experience many painful and stressful procedures or events during their first weeks of life in a neonatal intensive care unit, and these can profoundly impact subsequent brain development and function. Several protective interventions during this sensitive period stimulate the oxytocin system, reduce pain and stress, and improve brain development. This review provides an overview of the environmental risk factors experienced by PTI during hospitalization, with a focus on the effects of pain, and early maternal separation. We also describe the long-term adverse effects of the simultaneous experiences of pain and maternal separation, and the potential beneficial effects of maternal vocalizations, parental contact, and several related processes, which appear to be mediated by the oxytocin system.
Collapse
Affiliation(s)
- Manuela Filippa
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology and Educational Sciences, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Department of Social Sciences, University of Valle d'Aosta, Aosta, Italy
| | - Pierrick Poisbeau
- Centre National de la Recherche Scientifique, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France
| | - Jérôme Mairesse
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland
| | | | - Olivier Baud
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland.,Service de Médecine et Réanimation Néonatale, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Petra Hüppi
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology and Educational Sciences, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Pierre Kuhn
- Centre National de la Recherche Scientifique, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France.,Service de Médecine et Réanimation Néonatale, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| |
Collapse
|
33
|
Warren I, Mat-Ali E, Green M, Nyathi D. Evaluation of the Family and Infant Neurodevelopmental Education (FINE) programme in the UK. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jnn.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
34
|
Cuttini M, Croci I, Toome L, Rodrigues C, Wilson E, Bonet M, Gadzinowski J, Di Lallo D, Herich LC, Zeitlin J. Breastfeeding outcomes in European NICUs: impact of parental visiting policies. Arch Dis Child Fetal Neonatal Ed 2019; 104:F151-F158. [PMID: 29954880 DOI: 10.1136/archdischild-2017-314723] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The documented benefits of maternal milk for very preterm infants have raised interest in hospital policies that promote breastfeeding. We investigated the hypothesis that more liberal parental policies are associated with increased breastfeeding at discharge from the neonatal unit. DESIGN Prospective area-based cohort study. SETTING Neonatal intensive care units (NICUs) in 19 regions of 11 European countries. PATIENTS All very preterm infants discharged alive in participating regions in 2011-2012 after spending >70% of their hospital stay in the same NICU (n=4407). MAIN OUTCOME MEASURES We assessed four feeding outcomes at hospital discharge: any and exclusive maternal milk feeding, independent of feeding method; any and exclusive direct breastfeeding, defined as sucking at the breast. We computed a neonatal unit Parental Presence Score (PPS) based on policies regarding parental visiting in the intensive care area (range 1-10, with higher values indicating more liberal policies), and we used multivariable multilevel modified Poisson regression analysis to assess the relation between unit PPS and outcomes. RESULTS Policies regarding visiting hours, duration of visits and possibility for parents to stay during medical rounds and spend the night in unit differed within and across countries. After adjustment for potential confounders, infants cared for in units with liberal parental policies (PPS≥7) were about twofold significantly more likely to be discharged with exclusive maternal milk feeding and exclusive direct breastfeeding. CONCLUSION Unit policies promoting parental presence and involvement in care may increase the likelihood of successful breastfeeding at discharge for very preterm infants.
Collapse
Affiliation(s)
- Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ileana Croci
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia.,Department of Pediatrics, University of Tartu, Tartu, Estonia
| | - Carina Rodrigues
- EPI Unit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Emilija Wilson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mercedes Bonet
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Inserm UMR 1153, Paris, France.,Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Janusz Gadzinowski
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Domenico Di Lallo
- Hospital Network Planning and Research Area, Lazio Regional Health Authority, Rome, Italy
| | - Lena Carolin Herich
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Inserm UMR 1153, Paris, France
| | | |
Collapse
|
35
|
Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran. J Pediatr Nurs 2019; 45:e79-e88. [PMID: 30630639 DOI: 10.1016/j.pedn.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 12/29/2018] [Accepted: 12/29/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides comprehensive newborn focused family-centered care in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to investigate nurses' and physicians' experiences of implementing the NIDCAP model to optimize its implementation for both caregivers, infants, and families in the NICU. DESIGN & METHODS A purposes sample of 11 nurses and four physicians participated in this qualitative study. Data were collected by face-to-face and semi-structured interviews and analysis were guided by principles of thematic analysis as per Graneheim and Lundman (2004). RESULTS Six themes and 20 sub-themes were constructed during data analysis. These included; NIDCAP as a milestone, Helping to rebuild the core of the family, Caregiver excellence, Realism towards the feasibility of NIDCAP, Proper managerial position of NIDCAP specialists in the health system, and Caring for the caregiver. CONCLUSIONS The findings of this study highlight how NIDCAP provides a comprehensive and effective care model for premature infants, with the goal to promote neonatal growth and development while also facilitating the self-efficacy of caregivers. Implementation of the NIDCAP model requires attention to be paid to social context, infrastructure, adjustment of the program according to the facilities and resources of each country, and the needs of caregivers. PRACTICE IMPLICATIONS Health care resources are required to sustain NIDCAP specialists and a favorable environment as the necessary conditions for its multidimensional application across NICU units around the world.
Collapse
|
36
|
Ding X, Zhu L, Zhang R, Wang L, Wang TT, Latour JM. Effects of family-centred care interventions on preterm infants and parents in neonatal intensive care units: A systematic review and meta-analysis of randomised controlled trials. Aust Crit Care 2019; 32:63-75. [PMID: 30554939 DOI: 10.1016/j.aucc.2018.10.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/27/2018] [Accepted: 10/28/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The objective of this study was to review English and Chinese randomised controlled trials (RCTs) to determine the effects of family-centred care (FCC) interventions on preterm infants' and parental outcomes in the neonatal intensive care units and to conduct a meta-analysis. REVIEW METHOD USED Systematic review and meta-analysis. DATA SOURCES Medline, CINAHL, Embase, PsycINFO, BNI, and AMED and the Chinese databases CNKI and Wanfang Data were searched in April 2017 and updated in August 2018. REVIEW METHODS Only RCTs were included. Participants were preterm infants ≤37 weeks gestational age and parents. Interventions were related to FCC, and outcome measures were infant and parent clinical outcomes. Included studies were assessed for risk of bias using Cochrane Manual 5.1.0. Meta-analyses used mean differences (MDs), standardised mean differences (SMDs), or odds ratio (OR), followed by 95% confidence interval (CI). Heterogeneity was tested with Cochran's Q chi-squared test, tau-squared test, and inconsistency index (I2). RESULTS Nineteen studies (10 from English and 9 from Chinese databases) were included; meta-analysis included 15 studies (7 English and 8 Chinese RCTs). Meta-analysis showed significant improvements in weight gain (7 studies: MD, 4.57; 95% CI, 2.80-6.34; P < 0.001; I2 94%); readmission (3 studies: OR, 0.23; 95% CI, 0.10-0.52; P < 0.001; I2 = 0%); parent satisfaction (5 studies: OR, 11.20; 95% CI, 4.76-26.34; p < 0.001; I2 = 0%); skills of parents (4 studies: SMD, 2.57; 95% CI, 2.19-2.96; P < 0.001; I2 = 53%); knowledge of parents (4 studies: SMD, 2.74; 95% CI, 2.47-3.00; P < 0.001; I2 = 0%); parental anxiety at follow-up (3 studies: SMD, -0.19; 95% CI, -0.28 to -0.09; P < 0.001; I2 = 0%); parent depression at follow-up (2 studies: SMD, 0.37; 95% CI, -0.63 to -0.12; P = 0.004; I2 = 44%); and parental stress (3 studies: MD, -0.20; 95% CI, -0.26 to -0.13; P < 0.001; I2 = 0%). No statistical differences were observed in neurobehavioural development (3 studies) and hospital length of stay (7 studies). CONCLUSIONS FCC interventions can improve weight gain and readmission in preterm infants as well as parent satisfaction, knowledge, and skills, and possibly long-term anxiety, depression, and stress. Developing standardised outcome sets for testing family-centred care interventions is recommended.
Collapse
Affiliation(s)
- Xiang Ding
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Lihui Zhu
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Rong Zhang
- Neonatal Intensive Care Unit, Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Li Wang
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China.
| | - Ting-Ting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, People's Republic of China.
| | - Jos M Latour
- Department of Nursing, Hunan Children's Hospital, Changsha, Hunan Province, People's Republic of China; School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.
| |
Collapse
|
37
|
Jannes C, Miedaner F, Langhammer K, Enke C, Göpel W, Kribs A, Nitzsche A, Riedel R, Woopen C, Kuntz L, Roth B. Increased parental satisfaction by unrestricted visiting hours and developmentally supportive care in NICUs - results of a German multicenter study. J Matern Fetal Neonatal Med 2018; 33:1874-1880. [PMID: 32216530 DOI: 10.1080/14767058.2018.1532499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: This study aims to provide insights into the impact of organizational family-centered care characteristics at German neonatal intensive care units (NICUs) on the satisfaction of parents of very low birthweight (VLBW) infants.Materials and methods: Using multilevel modeling, this study analyzed whether organizational characteristics of NICUs fostering parent-infant interaction (by way of the existence of a recreation room, possibility of rooming in, existence of unrestricted visiting hours for parents, existence of parental classes, and the connection to parent associations as well as the existence of standards on developmentally supportive care) increase the satisfaction of parents after the infants' high-intensive care phase within the NICU.Results: Nine hundred and twenty-three VLBW infants from 66 NICUs in Germany born between May and October 2013 were enrolled in this multicenter study. We retrieved 1493 questionnaires completed by 1277 parents. The existence of unrestricted visiting hours (adjusted odds ratio (AOR): 1.967; 95% CI [1.118, 3.459]) and standardized procedures for developmentally supportive care (AOR: 1.775; 95% CI [1.166, 2.704]) were positively associated with parental satisfaction.Conclusions: Fostering the parent-infant interaction through the provision of developmentally supportive care and unrestricted visiting hours for parents whose infants are hospitalized within an NICU significantly contributes to the satisfaction of parents.
Collapse
Affiliation(s)
- Christiane Jannes
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Felix Miedaner
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Kristina Langhammer
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| | - Christian Enke
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Angela Kribs
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| | - Anika Nitzsche
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Rainer Riedel
- Institute for Medical Economics and Health Services Research, Rheinische Fachhochschule Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne; and Research Unit Ethics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany
| | - Bernhard Roth
- Department of Business Administration and Healthcare Management, University of Cologne, Cologne, Germany.,Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University Clinic Cologne, Cologne, Germany
| |
Collapse
|
38
|
Axelin A, Outinen J, Lainema K, Lehtonen L, Franck LS. Neonatologists can impede or support parents' participation in decision-making during medical rounds in neonatal intensive care units. Acta Paediatr 2018; 107:2100-2108. [PMID: 29723925 DOI: 10.1111/apa.14386] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/23/2018] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
Abstract
AIM We explored the dynamics of neonatologist-parent communication and decision-making during medical rounds in a level three neonatal intensive care unit. METHODS This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013 to 2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23 + 5 to 40 + 1 weeks, and the parents were aged 24-47. The neonatologists and parents were interviewed separately after the rounds. RESULTS Four patterns of interaction emerged. The collaborative pattern was most consistent, with the ideal of shared decision-making, as the parents' preferences were genuinely and visibly integrated into the treatment decisions. In the neonatologist-led interactional pattern, the decision-making process was only somewhat inclusive of the parents' observations and preferences. The remaining two patterns, emergency and disconnected, were characterised by a paternalistic decision-making model where the parents' observations and preferences had minimal to no influence on the communication or decision-making. CONCLUSION The neonatologists played a central role in facilitating parental participation and their interaction during medical rounds were characterised by the level of parent participation in decision-making.
Collapse
Affiliation(s)
- Anna Axelin
- Department of Nursing Science; University of Turku; Turku Finland
| | - Jyri Outinen
- Department of Pediatrics; Turku University Hospital and University of Turku; Turku Finland
| | - Kirsi Lainema
- Organization and Management; Turku School of Economics; University of Turku; Turku Finland
| | - Liisa Lehtonen
- Department of Pediatrics; Turku University Hospital and University of Turku; Turku Finland
| | - Linda S. Franck
- Department of Family Health Care Nursing; University of California; San Francisco CA USA
| |
Collapse
|
39
|
Maastrup R, Haiek LN. Compliance with the "Baby-friendly Hospital Initiative for Neonatal Wards" in 36 countries. MATERNAL AND CHILD NUTRITION 2018; 15:e12690. [PMID: 30198645 PMCID: PMC6586157 DOI: 10.1111/mcn.12690] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/23/2018] [Accepted: 08/31/2018] [Indexed: 12/02/2022]
Abstract
In 2012, the Baby‐friendly Hospital Initiative for Neonatal Wards (Neo‐BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross‐sectional survey aimed to measure compliance on a global level with the Neo‐BFHI's expanded Ten Steps to successful breastfeeding and three Guiding Principles in neonatal wards. In 2017, the Neo‐BFHI Self‐Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country, and international levels. A total of 917 neonatal wards from 36 low‐, middle‐, and high‐income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Step 3 (antenatal information) and Step 7 (rooming‐in) had the lowest scores, 63 and 67, respectively. High‐income countries had significantly higher scores for Guiding Principles 2 (family‐centered care), Step 4 (skin‐to‐skin contact), and Step 5. Neonatal wards in hospitals ever‐designated Baby‐friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo‐BFHI designation. Currently, Neo‐BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby‐friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.
Collapse
Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Quebec, Canada.,McGill University, Department of Family Medicine, Montreal, Quebec, Canada.,St. Mary's Hospital, St. Mary's Research Centre, Montreal, Quebec, Canada
| | | |
Collapse
|
40
|
He SW, Xiong YE, Zhu LH, Lv B, Gao XR, Xiong H, Wang H, Shi HR, Latour JM. Impact of family integrated care on infants' clinical outcomes in two children's hospitals in China: a pre-post intervention study. Ital J Pediatr 2018; 44:65. [PMID: 29871689 PMCID: PMC5989344 DOI: 10.1186/s13052-018-0506-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/28/2018] [Indexed: 12/29/2022] Open
Abstract
Background Most Neonatal Intensive Care Units (NICUs) in China have restricted visiting policies for parents. This also implicates that parents are not involved in the care of their infant. Family Integrated Care (FIC), empowering parents in direct care delivery and decisions, is becoming the standard in NICUs in many countries and can improve quality-of-life and health outcomes of preterm infants. The aim of this study was to evaluate the impact of a FIC intervention on the clinical outcomes of preterm infants with Bronchopulmonary Dysplasia (BPD). Methods A pre-post intervention study was conducted at NICUs in two Chinese children’s hospitals. Infants with BPD were included: pre-intervention group (n = 134) from December 2015 to September 2016, post-intervention (FIC) group (n = 115) and their parents from October 2016 to June 2017. NICU nurses were trained between July and September 2016 to deliver the FIC intervention, including parent education and support. Parents had to be present and care for their infant minimal three hours a day. The infants’ outcome measures were length-of-stay, breastfeeding, weight gain, respiratory and oxygen support, and parent hospital expenses. Results Compared with control group (n = 134), the FIC group (n = 115) had significantly increased breastfeeding rates (83% versus 71%, p = 0.030), breastfeeding time (31 days versus 19 days, p < 0.001), enteral nutrition time (50 days versus 34 days, p < 0.001), weight gain (29 g/day versus 23 g/day, p = 0.002), and significantly lower respiratory support time (16 days versus 25 days, p < 0.001). Oxygen Exposure Time decreased but not significant (39 days versus 41 days p = 0.393). Parents hospital expenses in local Chinese RMB currency was not significant (84 K versus 88 K, p = 0.391). Conclusion The results of our study suggests that FIC is feasible in two Chinese NICUs and might improve clinical outcomes of preterm infants with BPD. Further research is needed to include all infants admitted to NICUs and should include parent reported outcome measures. Our study may help other NICUs with limited parental access to implement FIC to enhance parental empowerment and involvement in the care of their infant.
Collapse
Affiliation(s)
- Shi-Wen He
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China.,Hunan University of Traditional Chinese Medicine, Xueshi Rd, Changsha, Hunan, China
| | - Yue-E Xiong
- Division of Neonatal Medicine, Hunan Children's Hospital, Ziyuan Rd, Changsha, 41007 Hunan Province, China
| | - Li-Hui Zhu
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China.
| | - Bo Lv
- Division of Neonatal Medicine, Hunan Children's Hospital, Ziyuan Rd, Changsha, 41007 Hunan Province, China
| | - Xi-Rong Gao
- Division of Neonatal Medicine, Hunan Children's Hospital, Ziyuan Rd, Changsha, 41007 Hunan Province, China
| | - Hua Xiong
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China
| | - Huan Wang
- Nursing Department, Maternal and Child Health Hospital of Guiyang Province, Ruijinnan Rd, Guiyang, Guizhou, China
| | - Hua-Rong Shi
- Nursing Department, Maternal and Child Health Hospital of Guiyang Province, Ruijinnan Rd, Guiyang, Guizhou, China
| | - Jos M Latour
- Nursing Department, Hunan Children's Hospital, Ziyuan Rd, Changsha, 410007 Hunan Province, China.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| |
Collapse
|
41
|
Garne Holm K, Brødsgaard A, Zachariassen G, Smith AC, Clemensen J. Parent perspectives of neonatal tele-homecare: A qualitative study. J Telemed Telecare 2018; 25:221-229. [PMID: 29792079 DOI: 10.1177/1357633x18765059] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Neonatal homecare for preterm infants is a method of supporting families and monitoring infant growth in the home setting. Telehealth may be used to deliver specialist neonatal care remotely, using online communication methods. This study explored parental experiences with neonatal tele-homecare (NTH). METHODS Semi-structured interviews were conducted with 49 parents whose preterm infants had received NTH from a neonatal intensive care unit (NICU) in Denmark. Interview transcripts were analysed using Malterud's systematic text condensation. RESULTS Parents experienced NTH as a personalised method for linking to specialist staff in the NICU. NTH promoted the parent's role as the primary care provider, further strengthening the parent-infant relationship. DISCUSSION From the perspective of parents with preterm infants requiring specialist care, NTH is a useful method of supporting families in the home. Telehealth provides effective communication links with NICU specialists and encourages family-centred care.
Collapse
Affiliation(s)
- Kristina Garne Holm
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anne Brødsgaard
- 3 Department of Pediatrics, Copenhagen University Hospital Amager Hvidovre, Capital Region of Denmark, Denmark.,4 Department of Nursing Science, Faculty of Public Health, Aarhus University, Denmark
| | - Gitte Zachariassen
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Anthony C Smith
- 5 Centre for Online Health, University of Queensland, Brisbane, Australia
| | - Jane Clemensen
- 1 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,2 Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,6 Centre of Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
42
|
Dall'Oglio I, Mascolo R, Gawronski O, Tiozzo E, Portanova A, Ragni A, Alvaro R, Rocco G, Latour JM. A systematic review of instruments for assessing parent satisfaction with family-centred care in neonatal intensive care units. Acta Paediatr 2018; 107:391-402. [PMID: 29239021 DOI: 10.1111/apa.14186] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/27/2017] [Accepted: 12/06/2017] [Indexed: 12/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Immacolata Dall'Oglio
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Rachele Mascolo
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Orsola Gawronski
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Emanuela Tiozzo
- Professional Development; Continuing Education and Nursing Research Service; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Anna Portanova
- Department of Medical and Surgical Neonatology; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Angela Ragni
- Department of Medical and Surgical Neonatology; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention; University of Rome Tor Vergata; Rome Italy
| | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship of IPASVI Rome Nursing College; Rome Italy
| | - Jos M. Latour
- School of Nursing and Midwifery; Faculty of Health and Human Sciences; Plymouth University; Plymouth UK
| |
Collapse
|
43
|
Abstract
Global pandemics, such as H1N1, are a major risk for neonatal patients. We surveyed U.K. tertiary and district neonatal units about visiting and infection control policies relating to viral respiratory infections. There was marked variation with visiting policies, tertiary units being more restrictive. Isolation, screening, and outbreak management of infected babies was highly variable posing a risk in future pandemics.
Collapse
|
44
|
Provenzi L, Scotto di Minico G, Giorda R, Montirosso R. Telomere Length in Preterm Infants: A Promising Biomarker of Early Adversity and Care in the Neonatal Intensive Care Unit? Front Endocrinol (Lausanne) 2017; 8:295. [PMID: 29163364 PMCID: PMC5671586 DOI: 10.3389/fendo.2017.00295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Preterm infants present an immature neurobehavioral profile at birth, even in absence of severe brain injuries and perinatal complications. As such, they require a long-lasting hospitalization in the Neonatal Intensive Care Unit (NICU), which is thought to grant at-risk newborns' survival, but still entails a number of physical, painful, and socio-emotional stressors. Hence, preterm birth and NICU stay represent an early adverse experience, which has been linked to detrimental consequences for neurological, neuro-endocrinal, behavioral, and socio-emotional development, as well as to disease later in life. Recent advances in the behavioral epigenetic field are helping us to unveil the potential mechanisms through which early NICU-related stress may lead to negative developmental outcomes. From this perspective, telomere regulation might be a key programming mechanism. Telomeres are the terminal portion of chromosomes and are known to get shorter with age. Moreover, telomere length (TL) is affected by the exposure to stress during early development. As such, TL might be an innovative biomarker of early adverse exposures in young infants and children. Unfortunately, there is paucity of studies investigating TL in populations of preterm infants and its association with known NICU-related stressors remains unexplored. In the present paper, the potential relevance of TL for research and clinical work with preterm infants will be underlined in the light of recent contributions linking progressive telomere shortening and early exposure to adverse experiences and stressful environments in humans. Finally, insights will be provided to guide clinically relevant translational research on TL in the field of VPT birth and NICU stay.
Collapse
Affiliation(s)
- Livio Provenzi
- 0–3 Center for the At-Risk Infant, Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | | | - Roberto Giorda
- Molecular Biology Laboratory, Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Rosario Montirosso
- 0–3 Center for the At-Risk Infant, Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| |
Collapse
|
45
|
Maastrup R, Weis J, Engsig AB, Johannsen KL, Zoffmann V. ‘Now she has become my daughter’: parents’ early experiences of skin-to-skin contact with extremely preterm infants. Scand J Caring Sci 2017; 32:545-553. [DOI: 10.1111/scs.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Janne Weis
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Anne B. Engsig
- Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - Vibeke Zoffmann
- The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| |
Collapse
|
46
|
Treherne SC, Feeley N, Charbonneau L, Axelin A. Parents' Perspectives of Closeness and Separation With Their Preterm Infants in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 46:737-747. [PMID: 28802557 DOI: 10.1016/j.jogn.2017.07.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To discover parents' perceptions of closeness to and separation from their preterm infants in the NICU. DESIGN Qualitative descriptive. SETTING Urban Level III NICU. PARTICIPANTS Twenty parents of preterm infants in the NICU. METHODS After ethics approval, data were collected with a smartphone application created for this study. Parents recorded their descriptions of moments of closeness and separation over a 24-hour period in the NICU. Data were transcribed verbatim and content was analyzed. RESULTS Five themes related to parents' perceptions of closeness and separation were identified: Having a role as a parent: Feeling autonomous and making decisions; Providing for and getting to know the infant: Feeding, holding, and interacting; Support from staff; Reluctantly leaving the infant's bedside; and NICU environment. CONCLUSION Autonomy is a key element of a parent's perception of closeness. Staff in the NICU can facilitate autonomy by involving parents in the care of their preterm infants as much as possible to reinforce the parental role. Parents described leaving their infants' bedsides as very difficult.
Collapse
|
47
|
Wilson E, Edstedt Bonamy AK, Bonet M, Toome L, Rodrigues C, Howell EA, Cuttini M, Zeitlin J. Room for improvement in breast milk feeding after very preterm birth in Europe: Results from the EPICE cohort. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28714111 DOI: 10.1111/mcn.12485] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 12/01/2022]
Abstract
Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence-based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36-80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU.
Collapse
Affiliation(s)
- Emilija Wilson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Anna-Karin Edstedt Bonamy
- Department of Women's and Children's Health, and Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mercedes Bonet
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé) and Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Liis Toome
- Department of Neonates and Infants, Tallinn Children's Hospital, Tallinn, and University of Tartu, Tartu, Estonia
| | | | - Elizabeth A Howell
- Departments of Population Health Science & Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Jennifer Zeitlin
- INSERM, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Centre for Epidemiology and Biostatistics (U1153), Paris-Descartes University, Paris, France
| | | |
Collapse
|
48
|
Thébaud V, Lecorguillé M, Roué JM, Sizun J. Healthcare professional perceptions of family-centred rounds in French NICUs: a cross-sectional study. BMJ Open 2017; 7:e013313. [PMID: 28674126 PMCID: PMC5734206 DOI: 10.1136/bmjopen-2016-013313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the perceptions of healthcare professionals (HCPs) regarding parental presence at medical rounds in French neonatal intensive care units (NICUs). We hypothesised that HCPs would perceive barriers against allowing parental participation in round discussions. METHODS This cross-sectional study approached 304 HCPs from three groups; group 1: French professionals that attended an annual French-speaking meeting of the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP); group 2: NICU professionals from a tertiary care academic hospital in western France; and group 3: paediatric residents from six French universities. We invited all HCPs to complete a questionnaire about medical round practices and their perceptions towards parent participation in family-centred rounds (FCRs). RESULTS Of the 176 (58%) questionnaires returned, 159 were included in the analysis. The majority of medical rounds took place at the bedside for groups 1 and 3 (68%, 95% CI 54 to 80 and 71%, 95% CI 56 to 84, respectively) and in a conference room for group 2 (65%, 95% CI 51 to 78). Overall, respondents positively perceived FCR for themselves, parents and students. However, most respondents agreed with the following claims: 'Parental attendance at medical rounds prevents some discussions between health professionals' (66%, 95% CI 57 to 73), 'FCR increases round durations' (63%,95% CI 55 to 71) and 'Some decisions made during medical rounds may be stressful for parents' (51%, 95% CI 42 to 59). Nevertheless, responses varied significantly according to NIDCAP training and NICU experience and consequently group 1 displayed a significantly more positive attitude than other groups (p<0.001); they expressed less concern about potentially inhibiting discussions between HCPs (p<0.001), the feasibility (p=0.02) and prolonged round durations (p<0.001). Several difficulties and facilitators of FCR implementation were variously reported, but all groups agreed that routine workload was an important difficulty and that medical leadership would be an important facilitator. CONCLUSION French HCPs expressed rather positive perceptions towards parental presence in NICU rounds. However, some concerns need to be addressed.
Collapse
Affiliation(s)
- Véronique Thébaud
- Faculté de Médecine et Sciences de la Santé, LIEN (EA4685), Université de Brest, Brest, France
| | | | - Jean-Michel Roué
- Faculté de Médecine et Sciences de la Santé, LIEN (EA4685), Université de Brest, Brest, France
- Pôle de la Femme, de la Mère et de l'Enfant, CHU Brest, Brest, France
| | - Jacques Sizun
- Faculté de Médecine et Sciences de la Santé, LIEN (EA4685), Université de Brest, Brest, France
- Pôle de la Femme, de la Mère et de l'Enfant, CHU Brest, Brest, France
| |
Collapse
|
49
|
Roué JM, Kuhn P, Lopez Maestro M, Maastrup RA, Mitanchez D, Westrup B, Sizun J. Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2017; 102:F364-F368. [PMID: 28420745 DOI: 10.1136/archdischild-2016-312180] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/18/2017] [Accepted: 02/22/2017] [Indexed: 12/30/2022]
Abstract
Despite the recent improvements in perinatal medical care leading to an increase in survival rates, adverse neurodevelopmental outcomes occur more frequently in preterm and/or high-risk infants. Medical risk factors for neurodevelopmental delays like male gender or intrauterine growth restriction and family sociocultural characteristics have been identified. Significant data have provided evidence of the detrimental impact of overhelming environmental sensory inputs, such as pain and stress, on the developing human brain and strategies aimed at preventing this impact. These strategies, such as free parental access or sleep protection, could be considered 'principles of care'. Implementation of these principles do not require additional research due to the body of evidence. We review the scientific evidence for these principles here.
Collapse
Affiliation(s)
| | - Pierre Kuhn
- Department of Neonatal Medicine, University Hospital of Strasbourg, Strasbourg, France
| | | | | | - Delphine Mitanchez
- Division of Neonatology, Department of Perinatology, Hopital Armand-Trousseau, Paris, France
| | - Björn Westrup
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jacques Sizun
- Department of Neonatal Medicine, CHRU de Brest, Brest, France
| |
Collapse
|
50
|
Rallying the Troops: How Sharing Knowledge With Grandparents Supports the Family of the Preterm Infant in Neonatal Intensive Care Unit. Adv Neonatal Care 2017; 17:E1-E10. [PMID: 27902505 DOI: 10.1097/anc.0000000000000360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research concludes that there is a need for educational programs for grandmothers, as well as networking opportunities; educational programs for other extended family members have long been sought by parents, relatives, and nurses in neonatal intensive care unit. PURPOSE To describe the effect of having premature infants' extended families participating in family-centered care (FCC) groups in the neonatal intensive care unit. An intervention based on dialogue, including topics as own reactions, general knowledge about the premature infants, parenthood, and how the extended families can support the new families during hospitalization and after discharge. METHODS A qualitative content analysis of 2 focus group interviews involving 16 purposefully sampled extended family members, who had participated in 1½ hours of FCC group interventions. FINDINGS The overall theme was: Accepting the individuality of the infant and providing the family with realistic expectations for the future. This theme emerged during the analysis of 4 categories: knowledge sharing, same basis for understanding, access to the immediate family, and competent supporting role. The interrelationship between the categories also emerged, surprisingly, during the analysis. IMPLICATIONS FOR PRACTICE Extended family members should be recognized as an essential part of the new family's life from the time of the premature infant's admission to neonatal intensive care unit. Family-centered care group interventions should be integrated into ward practice and policy. IMPLICATIONS FOR RESEARCH The study reinforces the need for further research, utilizing both qualitative and quantitative methods, into age and ethnicity aspects of FCC group interventions. There is also a need to compare the new parents' perceived level of stress and support from the FCC group intervention in relation to participating and nonparticipating extended families.
Collapse
|