Transition from NICU to Home: Are the Parents Ready to Manage Any Emergency? An Evidence-Based Project

The availability and delivery of culturally responsive Australian Aboriginal infant resuscitation education programmes: a structured literature review

AIM

To critically appraise the literature to determine availability and identify the cultural responsiveness of infant resuscitation education for Aboriginal and Torres Strait Islander populations.

BACKGROUND

Despite overall reductions in infant mortality in the last two decades, Aboriginal people have some of the highest rates of infant mortality of any developed nation. One of the key factors that has attributed to improvements in infant mortality rates is parent and carer education around risk factors and actions of first responders. Identifying gaps in the current basic first-aid initiatives available to Aboriginal communities may contribute to developing resources to contribute to reductions in Aboriginal neonatal mortality rates.

METHOD

The review used key terms and Boolean operators across an 11-month time frame searching for research articles utilising the databases of CINAHL, Scopus, Ovid Emcare, Informit, Pubmed and Proquest. After review, 39 articles met the inclusion criteria, 25 articles were discarded due to irrelevant material and 14 articles were included in the structured literature review. The search process was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Articles were assessed for validity and inclusion using the Critical Appraisal Skills Program checklist.

RESULTS

Research literature relating to First Nation community-based CPR and first-aid education programmes in Canada, USA, India, UK and Europe, Asia and Africa were identified; however, none pertaining specifically to CPR and first-aid education in Australian Aboriginal communities were found.

DISCUSSION

Despite the lack of research evidence relating to infant cardiopulmonary resuscitation (CPR) education for Australian Aboriginal populations, the reviewed studies noted the importance of culturally responsive education designed in collaboration with First Nation peoples, using novel ways of teaching CPR, that align with the language, culture and needs of the communities it is intended for.

CONCLUSION

Further research is required to create a framework for the delivery of culturally responsive infant resuscitation education for Australian Aboriginal parents and communities.

Impact of emergency management in a simulated home environment for caregivers of children who are tracheostomy dependent

PURPOSE

Children who are tracheostomy dependent require comprehensive caregiver preparation for safe hospital-to-home transition. Although a structured discharge education program successfully trained caregivers to provide routine daily tracheostomy care, emergency response training was limited, lacking realistic experiences. Initiation of simulated emergency training for caregivers indicated performance confusion related to tracheostomy cardiopulmonary resuscitation (CPR). This study evaluated the effectiveness of an evidence-based tracheostomy CPR education intervention via caregiver participation in a high-fidelity simulation of a home-based emergency scenario on the performance of essential behaviors, comfort, and satisfaction.

DESIGN AND METHODS

The study utilized a prospective descriptive pre- and post interventional design; 44 caregivers of children who were tracheostomy dependent participated. All caregiver participants completed: video- and instructor-assisted specialized tracheostomy CPR class, high-fidelity simulation performance of a home-based emergency (respiratory failure with cardiac arrest), postsimulation video debriefing, performance assessment with an objective scoring rubric, and pre- and post simulation surveys on levels of comfort and satisfaction.

RESULTS

On the performance of essential emergency management behaviors, 86.4% of caregivers performed all four behaviors, but only 36.4% performed these essential behaviors in order. Post simulation caregiver comfort with emergency management significantly increased from pre simulation (p = .001). All caregivers were satisfied with this training and would recommend simulation of home-based emergencies for all caregivers. Qualitative feedback from caregivers revealed themes of gratitude and the importance of hands-on practice with guided debriefing/feedback. Study power was 0.98.

PRACTICE IMPLICATIONS

Objective evaluation of caregiver performance demonstrated specialized tracheostomy CPR education prepared caregivers to respond in a home emergency. Caregivers viewed simulation as an opportunity to gain hands-on experience and improve emergency responses. It may be beneficial for other similar programs to include specialized tracheostomy CPR and emergency scenario simulation in their discharge education protocols and subsequently compare this program to other similar programs to establish best practice guidelines.

Teaching Infant Cardiopulmonary Resuscitation to Caregivers in the Emergency Department

OBJECTIVES

Infant cardiopulmonary resuscitation (CPR) has been taught to caregivers of infants in inpatient settings. There are no studies to date that look at teaching infant CPR in the emergency department (ED). Using a framework of cognitive load theory, we compared teaching infant CPR to caregivers in a pediatric ED versus an inpatient setting.

METHODS

Knowledge tests, 1-minute infant CPR performances on a Resusci Baby QCPR (Laerdal) manikin, and self-reported questionnaires were completed before and after caregivers were self-taught infant CPR using Infant CPR Anytime kits. The proportions of chest compression depth and rate that met quality standards from the American Heart Association's Basic Life Support program were measured.

RESULTS

Seventy-four caregivers participated. Mean knowledge scores (out of a total score of 15) increased in both settings (ED preintervention: Mean (M) = 4.53 [SD = 1.97]; ED postintervention: M = 10.47 [SD = 2.90], P < 0.001; inpatient preintervention: M = 4.83 (SD = 2.08); inpatient postintervention: M = 10.61 [SD = 2.79], P < 0.001). Improvement in the proportion of chest compression that met high quality standards for depth increased in the inpatient group only. Neither groups had improvements in compression rates. There were no statistically significant differences in the difficulty of learning CPR, frequency of interruptions/distractions, or difficulty staying concentrated in learning CPR between the 2 settings.

CONCLUSIONS

Caregivers in the ED and inpatient settings after a self-instructional infant CPR kit did not demonstrate adequate infant CPR performance. However, both groups gained infant CPR knowledge. Differences in cognitive loads between the 2 settings were not significant.

Transition From the Neonatal Intensive Care Unit to Home: A Concept Analysis

BACKGROUND

A successful transition from the neonatal intensive care unit to home is fundamental for the long-term health and well-being of preterm infants; however, the process parents' experience during their transition home is poorly understood. An improved understanding of this concept will allow nurses to offer families comprehensive and collaborative discharge preparation.

PURPOSE

To describe the defining attributes, antecedents, and consequences for the concept of transition in the context of the neonatal intensive care unit to home.

METHODS

Databases, MEDLINE, CINAHL, PsycINFO, and EMBASE were searched for articles containing "transition" in combination with "neonatal intensive care unit" or variants of these terms. The Walker and Avant method was used for this concept analysis.

RESULTS

The defining attributes of transition in the context of the neonatal intensive care unit to home are "mix of emotions," "uncertainty," and "coming into parenthood." The principal antecedent is "hospital discharge preparation" and consequences include "feeding and medical needs," "family life changes," and "parental confidence."

IMPLICATIONS FOR PRACTICE

Gradually increasing parents' participation in their infant's care and forming a partnership and collaborative plan with families will help ease the uncertainty parents experience during their transition home.

IMPLICATIONS FOR RESEARCH

Further investigation is needed to determine how best to provide emotional support for parents during their transition home and to explore a feasible option for neonatal nurses to follow up with parents after hospital discharge.

Can parental simulation improve neonatal CPR performance? A pilot study

Basic life support training and instruction is recommended for parents of premature infants discharged from the hospital. In order to assess the short-term efficacy of basic life support simulation, in addition to the institutional training, a prospective single-blinded randomized interventional study was performed. The study group received, besides the institutional training, an additional simulation training. The control group had only traditional training. A test assessment was followed approximately a week later and evaluated by two investigators. Fifty parents participated. Nineteen (38%) were in the study group. The study group showed a significant improvement in all the parameters assessed.Conclusion: The addition of a simulation encounter before discharge may improve short-term parental performance of basic life support. What is Known: • Parents of newborns at risk receive institutional training in basic life support. • The retention of knowledge from this training is a point of concern for parents. What is New: • A single simulation encounter for parents improved resuscitation performance. • Simulation for parents may be an important and useful tool to improve the efficacy of basic life support training.

Barriers to Transition to Home From the Neonatal Intensive Care Unit: A Qualitative Perspectives of Parents and Healthcare Providers

The objective of this study was to explore the challenges faced by parents of former neonatal intensive care unit (NICU) patients in transitioning home from parents' and healthcare providers' perspective. We conducted semistructured individual and group interviews with parents of former NICU patients and healthcare providers. Themes from the individual interviews framed the group interviews' contents. The group interviews were recorded and transcribed, and thematic analysis was performed to identify themes. We conducted individual and group interviews with 16 parents and 33 inpatient and outpatient providers from November 2017 to June 2018. Individual interview participants identified several barriers experienced by parents when transitioning their infant home from the NICU including parental involvement and engagement during NICU stay and during the discharge process. Further exploration within group interviews revealed opportunities to improve discharge communication and processes, standardization of parental education that was lacking due to NICU resource constraints, support for parents' emotional state, and use of technology for infant care in the home. Parents of NICU patients face serious emotional, logistical, and knowledge challenges when transitioning their infant home from the NICU. Understanding and mitigating the challenges of transitioning infants from NICU to home require multistakeholder input from both parents and providers.