1
|
Mahwasane T, Netshisaulu KG, Malwela TN, Maputle MS. Support needs of parents with preterm infants at resource-limited neonatal units in Limpopo province: A qualitative study. Curationis 2023; 46:e1-e8. [PMID: 37916665 PMCID: PMC10623485 DOI: 10.4102/curationis.v46i1.2409] [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: 09/09/2022] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Preterm birth is often unexpected and life-threatening for the baby and/or the mother. When admitted to the hospital, midwives need to provide informational, instrumental, psycho-cultural and emotional support to enhance post-discharge care. OBJECTIVES This study aimed to explore and describe the support provided to parents of preterm infants in preparing for post-discharge care. The study was conducted in three district hospitals in the Mopani district, South Africa. METHOD A qualitative approach wherein explorative, descriptive and contextual designs were used. A non-probability, convenience sampling was used to select 23 midwives who were working in the maternity unit for at least 2 years. Data were collected through in-depth individual semi-structured interviews until data saturation was reached. The data were analysed through Tesch's open coding method. Trustworthiness was ensured through credibility, transferability and confirmability. Ethical principles adhered to were: informed consent, beneficence, right to self-determination, confidentiality and anonymity. RESULTS The findings revealed that parents need informational, instrumental direct supervision, and psycho-cultural and emotional support during preparation for discharge. CONCLUSION Parents were unsure of their ability to care for the preterm infants after discharge and manage their own needs. The provision of informational, instrumental, psycho-cultural and emotional support needs would play a vital role in their ability to cope with their parental roles and the relationship with their infant.Contribution: The support provided to parents could build parental confidence and act as an integral part of neonatal follow-up programmes.
Collapse
Affiliation(s)
- Thendo Mahwasane
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou.
| | | | | | | |
Collapse
|
2
|
Ohnstad MO, Stensvold HJ, Pripp AH, Tvedt CR, Jelsness-Jørgensen LP, Astrup H, Eriksen BH, Lunnay ML, Mreihil K, Pedersen T, Rettedal SI, Selberg TR, Solberg R, Støen R, Rønnestad AE. Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks. Front Pediatr 2023; 11:1090701. [PMID: 37009293 PMCID: PMC10064049 DOI: 10.3389/fped.2023.1090701] [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: 11/05/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Objective The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant's first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.
Collapse
Affiliation(s)
- Mari Oma Ohnstad
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Christine Raaen Tvedt
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health and Welfare, Østfold University College, Halden, Norway
- Department of Internal Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Henriette Astrup
- Department of Pediatric and Adolescent Medicine, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mai Linn Lunnay
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Khalaf Mreihil
- Department of Pediatrics and Adolescence Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Tanja Pedersen
- Neonatal Intensive Care Unit, Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Siren Irene Rettedal
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terje Reidar Selberg
- Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Rønnaug Solberg
- Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Støen
- Department of Neonatology, St Olavs - Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild Erland Rønnestad
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Research Group for Clinical Neonatal Medicine and Epidemiology, Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
3
|
Mahwasane T, Maputle MS, Simane-Netshisaulu KG, Malwela T. Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa. Ann Glob Health 2020; 86:10. [PMID: 32064228 PMCID: PMC7006596 DOI: 10.5334/aogh.2555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life. Purpose The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa. Methods Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method. Findings Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision. Conclusion Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.
Collapse
|
4
|
Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit. Adv Neonatal Care 2018; 18:E13-E20. [PMID: 30299284 DOI: 10.1097/anc.0000000000000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care. PURPOSE To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions. METHODS A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis. RESULTS Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses. IMPLICATIONS FOR PRACTICE This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support. IMPLICATIONS FOR RESEARCH Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.
Collapse
|
5
|
Rocha G, Soares P, Gonçalves A, Silva AI, Almeida D, Figueiredo S, Pissarra S, Costa S, Soares H, Flôr-de-Lima F, Guimarães H. Respiratory Care for the Ventilated Neonate. Can Respir J 2018; 2018:7472964. [PMID: 30186538 PMCID: PMC6110042 DOI: 10.1155/2018/7472964] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/12/2018] [Indexed: 11/19/2022] Open
Abstract
Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn's lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.
Collapse
Affiliation(s)
- Gustavo Rocha
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Américo Gonçalves
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Ana Isabel Silva
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Porto, Portugal
| | - Diana Almeida
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Sara Figueiredo
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
| | - Susana Pissarra
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Costa
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Soares
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Filipa Flôr-de-Lima
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hercília Guimarães
- Department of Neonatology, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
6
|
Onu CC, Kanbar LJ, Shalish W, Brown KA, Sant'Anna GM, Kearney RE, Precup D. A semi-Markov chain approach to modeling respiratory patterns prior to extubation in preterm infants. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2022-2026. [PMID: 29060293 DOI: 10.1109/embc.2017.8037249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
After birth, extremely preterm infants often require specialized respiratory management in the form of invasive mechanical ventilation (IMV). Protracted IMV is associated with detrimental outcomes and morbidities. Premature extubation, on the other hand, would necessitate reintubation which is risky, technically challenging and could further lead to lung injury or disease. We present an approach to modeling respiratory patterns of infants who succeeded extubation and those who required reintubation which relies on Markov models. We compare the use of traditional Markov chains to semi-Markov models which emphasize cross-pattern transitions and timing information, and to multi-chain Markov models which can concisely represent non-stationarity in respiratory behavior over time. The models we developed expose specific, unique similarities as well as vital differences between the two populations.
Collapse
|
7
|
Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes. Adv Neonatal Care 2016; 16:379-389. [PMID: 27275531 DOI: 10.1097/anc.0000000000000314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. PURPOSE To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. METHODS This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. FINDINGS Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. IMPLICATIONS FOR PRACTICE Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. IMPLICATIONS FOR RESEARCH Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.
Collapse
|