Neonatal intensive care: communication and attachment

A Feasibility Study to Test the NICU Paternal Needs Inventory

BACKGROUND

There has been little research exploring paternal needs while experiencing a neonatal intensive care unit (NICU) stay. Some tools exist to measure paternal needs, but do not incorporate items to capture important information about how fathers cope with stress differently, and may have different needs. Therefore, an instrument is needed to measure and prioritize what needs are important to fathers to help facilitate the development of nursing interventions to help fathers cope with the NICU environment.

PURPOSE

The purpose of this study was to conduct a feasibility study before large-scale pilot testing the instrument, the NICU Paternal Needs Inventory (NPNI), so we could then determine what are the physical, emotional, and psychological needs of fathers.

METHODS

A nonexperimental, quantitative, and descriptive design was used to address the study's aims. Fathers were recruited from a level IV NICU and asked to complete an online survey (consisting of a demographic survey and the NPNI).

RESULTS

Needs rated 100% were knowing infant's progress, directions on caring for infant, flexible visitation, and assurance receiving the best care. The remainder showed a wide range of responses suggesting that needs of fathers are individual and varied.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Use of the NPNI to evaluate a father's unique and individual needs would allow for the nurse to develop father-specific, individualized interventions. Findings support that the NPNI is feasible to accomplish measuring fathers' needs, but a larger study is needed to test the reliability and validity of this tool.

Implementation of a Web Camera System in an Australian Neonatal Intensive Care Unit: Pre- and Postevaluation of the Parent and Staff Experience

Background

Admission to a neonatal intensive care unit (NICU) for prematurity or illness is necessary for approximately 20% of newborns in Australia, resulting in parent-infant separation. Web cameras in the NICU provide a virtual link for parents to remain remotely connected to their infant during admission. Web camera use is increasing; however, there is limited evidence on the impact of web cameras on parents, infants, and neonatal staff.

Objective

There were two objectives: (1) to determine the attitudes of parents and staff toward web cameras in the NICU and (2) to compare parental depression, anxiety, and stress levels using validated scales before and after web camera implementation in the NICU.

Methods

A pre- and postevaluation survey was administered before and after implementation of the NICVIEW camera system in a tertiary NICU in Sydney, Australia. The NICVIEW camera system provides secure real-time viewing of infants and can be accessed from any device with an internet connection. Surveys were administered to parents of inpatients and staff, and included open- and closed-ended questions and Likert scales. Survey questions aimed to determine parent and staff attitudes and use of web cameras before and after implementation. In addition, pre- and postimplementation parental levels of depression, anxiety, and stress, as measured by the 21-item version of the Depression Anxiety Stress Scale (DASS-21) and Parental Stressor Scale: Neonatal Intensive Care Unit, were recorded.

Results

In total, 94 parents and 109 staff members completed the pre- and postimplementation surveys. Post implementation, 43 of 44 (98%) parents supported web cameras, and 40 of 42 (95%) parents stated that they used web cameras. The most common reasons for support from parents included web cameras making parents feel more at ease, facilitating parent-infant bonding, increasing parental confidence in staff, and allowing others to see infants. There was no significant difference between the parental groups for the depression, anxiety, or stress scales measured by DASS-21. Staff support for web cameras increased significantly from 34 of 42 (81%) participants before to 64 of 67 (96%) participants after implementation (P=.01). Following implementation, there was a resolution in staff concerns about web cameras having an adverse impact on staff roles and privacy and security concerns.

Conclusions

Web camera use in a tertiary Australian NICU was strongly supported by parents and staff and may reduce parental stress, facilitate parent-infant bonding, and encourage positive parent-staff engagement. Web cameras are a feasible method of providing continuity of care for families and should be considered as a standard of care in similarly resourced settings.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

Mapping the Field in Stress, Anxiety, and Postpartum Depression in Mothers of Preterm Infants in Neonatal Intensive Care

Objective: The main aim of this study was to describe and conduct a bibliometric analysis of the state of research on stress, anxiety, and postpartum depression in mothers of preterm infants in the Neonatal Intensive Care Unit. Background: Women affected by premature births are particularly exposed to mental health difficulties in the postpartum period. The desire to comprehend and the growing interest in research on stress, anxiety, and postpartum depression in mothers of preterm infants in neonatal intensive care have led to a substantial rise in the number of documents in this field over the last years. Thus, it makes it vital to regularly review the state of knowledge on this phenomenon in order to identify progress and constraints, to stimulate reflection, and to encourage progress in future research. Method: This study examined 366 articles published in the Scopus database (1976–2020). Keyword analysis was also used to identify hot research trends to be developed in future studies. This study complies with the PRISMA-Scr guidelines for quality improvement research in the EQUATOR network. Results: Our results reveal that research in this field is in a period of high production and allows this flourishing body of work to be organized into different periods, highlighting the most important themes. In such a way, our research enriches the lively field by presenting a comprehensive understanding of the field. Discussion: The key contribution of this study is the development of a conceptual map of research on stress, anxiety, and postpartum depression in mothers of preterm infants in neonatal intensive care units.

Effects of parent-provider communication during infant hospitalization in the NICU on parents: A systematic review with meta-synthesis and narrative synthesis

OBJECTIVE

To synthesize and analyse the literature on the effects of parent-provider communication during infant hospitalization in the neonatal (intensive) care unit (NICU) on parent-related outcomes.

METHODS

Systematic review with meta-synthesis and narrative synthesis. Databases (PubMed, PsycINFO, Cochrane Library, CINAHL, Web of Science, Scopus) were searched in October/November 2019. Studies reporting, observing, or measuring parent-related effects of parent-provider communication in the NICU were included. Study quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs. Qualitative studies were meta-synthesized using deductive and inductive thematic analysis. Quantitative studies were analysed using narrative synthesis.

RESULTS

5586 records were identified; 77 were included, reporting on N = 6960 parents, N = 693 providers, and N = 300 NICUs. Analyses revealed five main (positive and negative) effects of parent-provider interaction on parents' (1) coping, (2) knowledge, (3) participation, (4) parenting, and (5) satisfaction. Communication interventions appeared impactful, particularly in reducing parental stress and anxiety. Findings confirm and refine the NICU Communication Framework.

CONCLUSIONS

Parent-provider communication is a crucial determinant for parental well-being and satisfaction with care, during and following infant hospitalization in the NICU. R. Practice Implications: Providers should particularly consider the impact on parents of their day-to-day interaction - the most occurring form of communication of all.

The functions of adequate communication in the neonatal care unit: A systematic review and meta-synthesis of qualitative research

OBJECTIVE

To assess the main functions of parent-provider communication in the neonatal (intensive) care unit (NICU) and determine what adequate communication entails according to both parents and health professionals.

METHODS

A systematic review and meta-synthesis of qualitative research. PubMed, Ebsco/PsycINFO, Wiley/Cochrane Library, Ebsco/CINAHL, Clarivate Analytics/Web of Science Core Collection, and Elsevier/Scopus were searched in October-November 2019 for records on interpersonal communication between parents and providers in neonatal care. Title/abstract screening and full-text analysis were conducted by multiple, independent coders. Data from included articles were analyzed using deductive and inductive thematic analysis.

RESULTS

43 records were included. Thematic analysis of data resulted in the development of the NICU Communication Framework, including four functions of communication (1. building/maintaining relationships, 2. exchanging information, 3. (sharing) decision-making, 4. enabling parent self-management) and five factors that contribute to adequate communication across these functions (topic, aims, location, route, design) and, thereby, to tailored parent-provider communication.

CONCLUSION

The NICU Communication Framework fits with the goals of Family Integrated Care to encourage parent participation in infants' care. This framework forms a first step towards the conceptualization of (adequate) communication in NICU settings.

PRACTICE IMPLICATIONS

Findings can be used to improve NICU communication in practice, in particular through the mnemonic TAILORED.

Mothers' voices and white noise on premature infants' physiological reactions in a neonatal intensive care unit: A multi-arm randomized controlled trial

BACKGROUND

A few positive effects of mothers' voice on physiological outcomes have been studied and limited studies have focused on the level of cortisol. In addition, white noise has recently been found to be beneficial for human sleep, but studies in premature infants were limited and no study has compared the effects of mothers' voice and white noise on premature infants.

OBJECTIVE

To examine the effects of mothers' voice and white noise on sleep-wake patterns, salivary cortisol levels, weight gain, heart rate, and oxygen saturation of premature infants in a neonatal intensive care unit (NICU).

METHODS

This was a three-group randomized controlled trial. A total of 103 medically stable premature infants in incubators were recruited from the NICU of a women's and children's hospital in China between March and December 2017 and were randomized into three groups: the mothers' voice group (n = 34), the white noise group (n = 34), and the routine care group (n = 35). Mothers' voice, white noise, and no voice were provided to the three groups for 20 min at a time, three times a day for four consecutive days. The sound levels of the mothers' voice and white noise were controlled between 50 and 55 dB. Sleep-wake patterns, salivary cortisol level, and weight were measured at pre-test and post-test whereas heart rate and oxygen saturation were measured every five-minute at 11am, 2pm, 5pm for four-consecutive days.

RESULTS

A group difference was found only in weight gain (p = 0.003), with weight gain in the white noise group being significantly higher than the mothers' voice group (Z=-3.447, p = 0.001). Significant declines in total sleep time and sleep efficiency and increases in wake time after sleep onset and average awakening time were only found in the routine-care group between the pre-test and post-test (p<0.05). No significant differences were found in the salivary cortisol levels, heart rates, and oxygen saturation levels among the three groups (p>0.05). A significant increase in oxygen saturation during the 20-min intervention was found in white noise group. Non-significant decreases in the heart rate during the 20-min intervention and salivary cortisol levels at post test were noted in all the three groups.

CONCLUSION

White noise is more useful for encouraging weight gain in preterm infants compared with mothers' voices. White noise might be introduced for use in the care of premature infants in NICUs, and more high-quality randomized controlled trials are needed to confirm these findings. Trial Registration No: ChiCTR-INR-17012755.

A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study

OBJECTIVES

The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) is a well-validated tool to assess different sources of stress in parents during the NICU hospitalization of their infant. The present meta-analytic study assessed the relative impact of different NICU-related sources of parental stress in a pool of studies conducted in a wide set of different countries. Also, differences in stress levels by parent gender and country, as well as the impact of infants' neonatal characteristics and clinical conditions were explored.

METHODS

Records were searched on PubMed, Scopus, and Web of Science (January 1993-December 2019). A purposive open search string was adopted: ["PSS:NICU"] OR ["PSS-NICU"] OR ["Parental Stressor Scale"]. A multiple random-effect meta-analysis was conducted on data from 53 studies extracted by independent coders.

RESULTS

Parental role alteration emerged as the greatest source of stress for both mothers and fathers. Mothers reported higher stress levels compared to fathers. A significant difference emerged only for the subscale related to sights and sounds physical stimuli. No significant effects of infants' neonatal characteristics (gestational age, birth weight) and clinical conditions (comorbidities) emerged. A marginal positive effect of NICU length of stay emerged on the global level of parents' stress.

CONCLUSIONS

The current meta-analysis underlines that parental stress related to NICU admission is a worldwide healthcare issue. Immediate and tailored support to parents after the birth of their at-risk infant should be prioritized to reduce parental stress and to promote mothers and fathers' emotional well-being and new-born neurodevelopmental outcomes.

Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines

Having a sick infant in the NICU can be quite stressful and overwhelming to parents. They require support and may have varied needs. A systematic review of qualitative and quantitative studies from 5 electronic databases (Ovid Medline, EMBASE, PsycINFO, CINAHL and Sociological Abstracts), covering January 2001 - March 2016 identified the needs and stressors of parents of term or near-term Infants in the NICU. Six articles addressed the needs and 14 identified the stressors of parents. Parents' most important need was for accurate and honest information. Needs focused around sensitive infant care and involvement in decision-making. The greatest stressor for parents was alteration to the parental role, followed by infant appearance. Fathers and parents of infants undergoing surgery are an under-researched population. Based on the evidence, enhancing staff-parent communication would better meet parental needs and reduce stressors. Our key recommendations highlight the need for family-centred and individualised care practices in the NICU.

Parental anxiety regarding premature infants and factors affecting parental concern

PURPOSE

Premature births have a great impact on the parents. The purpose of this study was to investigate the anxieties of parents of premature infants regarding infantile diseases and to help medical staff better communicate with parents of premature infants.

DESIGN AND METHODS

This study included premature infants <37 weeks of age who were admitted to the Neonatal Intensive Care Unit of Kosin University Gospel Hospital between August 1, 2017, and December 31, 2017. The eligible subjects included 51 premature infants with their 75 parents (45 mothers and 30 fathers) listed in the children's medical records. Parental anxieties regarding the infants were determined by retrospective interviews at various time points as follows: before and after the birth, on postnatal Days 3 and 7, before discharge, in the first week after discharge, and at "whenever" time point.

RESULTS

The highest parental anxiety during all time points was regarding the respiratory system of the premature infants. Parental concerns regarding the metabolic-endocrine system of their infants significantly correlated with the presence of maternal diabetes mellitus. Parental anxiety significantly differed depending on the use of resuscitation after birth. A statistically significant difference in parental anxiety was observed in relation to the birth weight before discharge. The premature infants with bronchopulmonary dysplasia showed a significant difference in the level of parental anxiety concerning the infant's illness in the first week after discharge.

CONCLUSIONS

The parents of the premature infants were greatly concerned about their infants' respiratory system. Careful prenatal counseling and support are needed for mothers with diabetes.

Needs of parents in a surgical neonatal intensive care unit

AIM

While there is evidence of parental needs in the neonatal intensive care unit (NICU), parents of newborns admitted for general surgery are an under-researched population. This study aimed to identify needs in parents of newborns admitted to the NICU for general surgery and whether health-care professionals meet these needs.

METHODS

This was a prospective cohort study of 111 parents (57% mothers) of newborns admitted to a surgical NICU for general surgery in Australia from January 2014 to September 2015. Parents completed the Neonatal Family Needs Inventory (NFNI), comprising 56 items in five subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge, as well as the Social Desirability Scale (SDS). Data were analysed using parametric and non-parametric techniques.

RESULTS

At both admission and discharge, parents rated Assurance (M = 3.8, standard deviation (SD) = 0.24) needs as the most important, followed by Proximity (M = 3.6, SD = 0.32) and Information (M = 3.5, SD = 0.38). Mothers rated Assurance significantly more important than fathers (P < 0.02). Overall, parents' most important needs were having questions answered honestly (M = 3.96, SD = 0.19), seeing their infant frequently and knowing about the medical treatment (both M = 3.95, SD = 0.23). The 10 most important needs were met for more than 96% of parents, with no evidence of response bias.

CONCLUSIONS

Reassurance is a priority need for parents in the surgical NICU. Mothers' and fathers' needs may be best met by practices based on family-centred, individualised care principles.

Infant Medical Trauma in the Neonatal Intensive Care Unit (IMTN): A Proposed Concept for Science and Practice

BACKGROUND

Trauma is an innately subjective experience ensuing from a deeply distressing event. Research has demonstrated that while the environment of the neonatal intensive care unit (NICU) is capable of providing extraordinary lifesaving measures following birth, the experience may be disruptive to several key aspects of early development, placing infants at risk for adverse behavioral, cognitive, and emotional outcomes.

PURPOSE

This article provides rationale for the concept of Infant Medical Trauma in the NICU (IMTN) as a means of describing this unique stress experience. A triad of cumulative early life NICU experiences (stress, parental separation, and pain) is proposed to influence an infant's swinging neurodevelopmental pendulum amid the potential outcomes of risk and resilience.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Creating language that describes the infant experience brings meaning and calls caregivers and parents to action to consider strategies that may improve long-term health. Actively seeking opportunities to decrease the allostatic load of at-risk infants may support an infant's pendulum to swing toward a path of resilience, thereby moderating his or her early life adverse experience.

The Needs of Parents of Preterm Infants in Iran and a Comparison With Those in Other Countries: A Systematic Review and Meta-Analysis

Context

Proper accountability to needs of preterm infants’ parents requires recognition of these needs and how they change in different conditions. The aim of this study was to assess the needs of parents of preterm infants in Iran, as compared to those in other regions in the world.

Evidence Acquisition

A search of Iranian databases (Iran Medex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) was conducted, with no time limitations, to 5 October 2014. Using standard tools, all quantitative studies that considering the parental needs of preterm infants and parental support were extracted. The STROBE checklist was used for the evaluation of the studies. Thirty-one studies were extracted in the qualitative evaluation, of which 17 were included in the meta-analysis. The variance between the studies was analyzed using tau-squared (Tau²) and review manager 5 software.

Results

The results obtained using the nurse-parent support tool (NPST) showed that mothers considered that all the fields of support were of great importance. The parental needs in Iran were similar to those of parents in other regions worldwide. However, the mean score for Iranian parents’ assessment of the support they received was 2.20 ± 0.06, whereas it was 3.84 ± 0.72 for other countries. The mean scores for parents’ assessment of the provision of emotional, informational appraisal, and instrumental support in Iran were 1.73 ± 0.06, 2.1 ± 0.06, 1.54 ± 0.6, and 3.44 ± 0.04, respectively, compared to 3.18 ± 1.34, 4.11 ± 0.5, 4.26 ± 0.18, and 4.51 ± 0.14, respectively, in other countries.

Conclusions

Parents always prefer the priorities of their babies to their individual needs. Given the lower scores for the parental assessment of received support in Iran, it is important to focus on these specific items in providing interventions to meet the needs of Iranian parents.

Metaethnographic Synthesis of Fathers' Experiences of the Neonatal Intensive Care Unit Environment During Hospitalization of Their Premature Infants

OBJECTIVE

To synthesize existing qualitative findings about fathers' experiences of the neonatal intensive care unit (NICU) environment.

DATA SOURCES

Relevant key terms including preterm, father, and NICU were used to search the databases of CINAHL Plus, Academic Search Premier, MEDLINE, and PsychInfo.

STUDY SELECTION

Only primary qualitative studies were included. Studies were excluded that did not focus on the NICU environment.

DATA EXTRACTION

Twenty-four studies were included. All authors critically appraised and extracted data relating to fathers' experiences in the NICU using an agreed data extraction form.

DATA SYNTHESIS

Findings were synthesized by translating the initial concepts and findings from an identified key paper into the data from the remaining 23 studies. Initially this was done separately by each author followed by further group discussion and synthesis. Emergent themes included Proximity, Parental Autonomy, Vulnerability, Communication and Exclusion, and Isolation.

CONCLUSIONS

The needs of fathers to interact and be involved with their infants' care was a prominent factor that enhanced their experiences in the NICU. Staff in the NICU can play a key role in facilitating this interaction through encouragement and reassurance.

Improved nurse-parent communication in neonatal intensive care unit: evaluation and adjustment of an implementation strategy

AIMS AND OBJECTIVES

To evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit.

BACKGROUND

Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication.

DESIGN

Qualitative and quantitative data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care.

METHODS

Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification.

RESULTS

Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders and nonguided-family-centred-care-trained nurses.

CONCLUSIONS

An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators.

RELEVANCE TO CLINICAL PRACTICE

Insights gained from our pioneering work might help nurses in a similar context to reach their goals of improving family-centred care.

The art of supporting families faced with neonatal transport

When newborns and their families are separated due to neonatal transport, it's critical to support families to ensure emotional and physical well-being of both babies and parents. Care providers at both sending and receiving facilities play an equally important role in providing education, information and support to families separated from newborns. A family-centered care approach in neonatal transport is truly a multidisciplinary, multiunit and multisystem approach.

Jordanian parental needs of critically ill infants in neonatal intensive care units

This descriptive correlational study was conducted to identify perceived parental needs of critically ill infants in Neonatal Intensive Care Units (NICUs). Jordanian parents who were visiting their infants admitted in NICU ( N = 170) composed the study sample. Participants completed the demographic data sheet and the NICU Family Needs Inventory. Findings showed that parents ranked assurance, information and proximity as the most important needs, while comfort and support were ranked the lowest. The primary concern of parents was to be assured and informed about the progress of their infant. In addition, the results indicated that the mother’s perceived needs for support, information and proximity were significantly more important than the father's. Accordingly, nurses should establish a rapport with family members and provide them with understandable and honest information. Furthermore, the provision of quality, holistic, family-centered nursing care that relies primarily on early and comprehensive needs assessment, which correlates with infants’ outcomes, is imperative.

Separation anxiety disorder increases among neonatal intensive care unit graduates

AIM

To evaluate whether separation anxiety disorder (SAD) develops in the later life of the infants, who were separated from their mothers in relation to being in neonatal intensive care unit (NICU).

METHODS

A group of 57 children, ages over 6 years old who were cared in NICU has been evaluated retrospectively by using the SAD diagnostic scale which is adapted according to DSM-IV. Another age and sex matched 50 children who admitted to the outpatient unit were selected as control group.

RESULTS

We found that the scores and incidence of SAD were increased among children who were cared in the NICU and both were correlated with the duration of stay in the NICU.

CONCLUSION

The NICU should be arranged to support the development of the baby. Families should be informed about the necessity of sustaining an early mother-infant interaction. By supporting mother-infant interaction, it will be provided that the baby will establish a more secure relation with his/her mother, develop more healthy and have less behavior problems in the future life.

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

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Anxiety levels of mothers whose infants have been cared for in unit level-I of a neonatal intensive care unit in Turkey

AIM

In most cases, admission of an infant to the intensive care unit is unexpected and is stressful for their mothers. The aim of this study is to examine factors affecting anxiety level of mothers whose infant is admitted to the neonatal intensive care unit.

BACKGROUND

Anxiety disorders figure among the most frequent psychiatric disorders in the population, and anxiety symptoms are among the most common.

DESIGN

A descriptive correlational design.

SETTING

Neonatal intensive care unit of Women's Health and Diseases, Education and Research Hospital in Turkey.

PARTICIPANTS

A total of 151 women who had an infant in NICU.

METHODS

A questionnaire form was used and included two instruments. The first measured characteristics of mothers and infants, and the second was the 'State-Trait Anxiety Inventory'.

RESULTS

Of the mothers, 33.8% were between the ages 25-29, 41.7% of the subjects had a primary education, 89.4% were housewives, 64.9% had social security and 58.9% of subjects had low family incomes. Of the 151 subjects, 75.5% had planned their pregnancy, and 41.7% were primiparas. It was determined that maternal age, education, income; planned pregnancy, having complications of pregnancy, receiving antenatal care, type of labour, gestational age of the infant at birth, reasons for hospitalisation of the infant and birth weight did not affect maternal anxiety levels. Maternal anxiety was significantly (p < 0.05) related to the infants' gender and duration of hospitalisation, with statistically significant differences.

RELEVANCE TO CLINICAL PRACTICE

Anxiety in mothers was significantly higher if their infant was a boy. This finding can be a result of mother's cultural and religious values. A better understanding of the psychosocial aspects such as cultural values and norms affecting maternal and child health of the perinatal period will contribute to improved health care and better outcomes. Nurses will be better prepared to assist mothers of babies in the NICU to cope with the experience through exploration of these aspects of the mother, infant and experience.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

Facilitating transitions. Nursing support for parents during the transfer of preterm infants between neonatal nurseries

AIMS AND OBJECTIVES

Transfers between neonatal units are significant transitional experiences for parents of preterm infants. The study aimed to investigate practices that nurses identify as supportive to parents during preterm infants' transfers. It explored the influence of organisational context on practice and what strategies nurses perceive would help them to provide supportive care.

BACKGROUND

Parents' experiences of neonatal nurseries, their stressors and needs have been well documented. The powerful position of nurses in influencing parenting experience is also recognised. However, nurses' understanding of the transfer process, their roles in supporting parents through this and the organisational context influencing practice have not been explored.

DESIGN AND METHODS

A focus group design was used composed of registered nurses from two neonatal units who met for a series of group interviews. Eleven registered nurses participated. They explored and critiqued their current practices and then established aims and strategies for practice development. A qualitative content analysis was conducted.

RESULTS

Participants identified validation, empowerment and communication as critical to effective practice. They identified a range of organisational dynamics, from logistical issues to nursing authority and scope of practice, as these influenced practice. They presented strategies for practice development, including staff education and the development of nurse practitioner roles.

RELEVANCE TO CLINICAL PRACTICE

This study explores nurses' understanding and insights into transitions for parents of preterm infants. It shows a congruence between nurses' perceptions of parents' experiences and needs and those reported by parents in previous studies. It articulates the way nurses practice in response to these perceptions, and the manner in which organisational dynamics influence their ability to facilitate transitions. The need to invest in transitions and invest in nurses to facilitate transitions is proposed, ultimately by increasing their clinical authority and autonomy.

Effective nurse parent communication: a study of parents' perceptions in the NICU environment

OBJECTIVE

This study examined mothers' and fathers' perceptions of effective and ineffective communication by nurses in the neonatal intensive care unit (NICU) environment, using communication accommodation theory (CAT) as the framework.

METHODS

Twenty mothers and 13 fathers participated in a semi-structured interview about their perceptions of effective and ineffective communication with nurses when their infant was in the NICU. The interviews were coded for using the CAT strategies.

RESULTS

Descriptions of effective and ineffective communication differed in terms of the strategies mentioned with effective communication about shared management of the interaction and appropriate support and reassurance by nurses. Ineffective communication was more about the interpretability strategy, particularly for fathers, and these interactions were seen as more intergroup. Mothers emphasised more being encouraged as equal partners in the care of their infant.

CONCLUSION

Effective communication by nurses was accommodative and more interpersonal while ineffective communication was generally under-accommodative and more intergroup.

PRACTICE IMPLICATIONS

The findings provide a framework for communication skills training for nurses that identifies both effective and ineffective communication strategies to use with mothers and fathers.

Stress in fathers of surgical neonatal intensive care unit babies

The purpose of this study was to identify and measure components of perceived stress in fathers of infants in a surgical neonatal intensive care unit (NICU). The Parent Stressor Scale: Infant Hospitalization (PSS:IH) was used to assess perceived stress in 22 fathers. Paternal stress was highest in the domains of "Parental Role Alteration" and "Infant Appearance and Behavior." "Sights and Sounds" did not appear to be associated with self-reported stress. This study demonstrates elevated levels of perceived stress among fathers of surgical NICU babies. Attention to fathers may be assisted by findings.

Families' needs when a child is long-term ill: A literature review with reference to nursing research

This article reports a literature review which draws together findings targeting families' needs when a child is long-term ill. The databases PubMed and CINHAL were searched from 1999 to 2003 during February 2004. The search terms were child health care, family caregivers, and needs and combinations of these. The search was limited to articles published in English and the Scandinavian languages. The analysis entailed a series of comparisons across articles focusing on major areas of inquiry and patterns of results. Various levels of needs are described, based on individual, family and social needs.

Mothers' experiences of having their newborn child in a neonatal intensive care unit

BACKGROUND

From birth the child has an ability to respond to the environment, which influences the interaction between mother and child. If this attachment is interrupted, the child's emotional development is negatively influenced. When the child needs care in a neonatal intensive care unit (NICU) it is difficult to establish contacts between mother and child. Separation from the child is found to be the most difficult aspect for mothers when their newborn child is hospitalized in a NICU.

AIM

The aim of this study was to describe mothers' experiences when their full-term newborn child was cared for in a NICU during the postpartum maternity care period.

METHOD

A phenomenological hermeneutic interview study was performed. Ten mothers were interviewed once, 6 months to 6 years after the experience.

RESULTS

The essence of the experience is understood as an alternation between two opposite concepts, exclusion and participation, with emphasis on exclusion. A feeling of exclusion dominates when the new mother feels a lack of interaction and a sense of not belonging to either the maternity care unit or the NICU. This has a negative effect on her maternal feelings. On the contrary, when a feeling of participation dominates, a continuous dialogue exists and the mother is cared for as a unique person with unique needs. This supports her maternal feelings in a positive direction. The implication of the result for nurses is that it is important to decrease mothers' experience of exclusion and to increase their feeling of participation when their child is cared for in a NICU. A return visit to the responsible nurse to go through the treatment and experiences should be offered to all parents whose child has been cared for in a NICU.

The relationship between maternal needs and priorities in a neonatal intensive care environment

AIM

The aim of this study was to investigate the nature and organization of maternal needs and priorities in a neonatal unit.

BACKGROUND

The relationship between maternal needs and priorities appears to be an under studied area in neonatal nursing.

METHODS

A quantitative survey was carried out based on 209 mothers with premature infants. Two self-assessment schedules were used: critical care maternal needs inventory (J. Leske, Heart and Lung 15, 27-42) and a ranking scale. The data were analysed with multivariate analysis.

FINDINGS

Data analysis revealed clear priorities in maternal needs. In particular the need for accurate infant related information was a priority for 93% of the mothers. Good communication practices with professionals were also valued. The mothers displayed altruistic behaviour, and self-related needs took second place. It is proposed that maternal needs demonstrate a hierarchical organization.

CONCLUSION

It is important for nurses to consider the individual needs of the mothers, simply because the satisfaction of these needs is essential for maternal well-being.