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Schmid SV, Arnold C, Jaisli S, Bubl B, Harju E, Kidszun A. Parents' and neonatal healthcare professionals' views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study. BMC Pediatr 2024; 24:268. [PMID: 38658901 PMCID: PMC11040849 DOI: 10.1186/s12887-024-04758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Parent and infant separation in the neonatal unit is associated with adverse health outcomes. Family-integrated care has several advantages and the potential to reduce these adverse outcomes but requires parental presence. This study aimed to explore the views of parents and neonatal healthcare professionals (nHCPs) on barriers and facilitators to parental presence in a Swiss neonatal unit and to identify possible differences between nHCPs and parents, and between mothers and fathers. METHODS Data were collected through semi-structured interviews with parents and focus group discussions with nHCPs. Inductive content analysis was used to identify barriers and facilitators to parental presence in the neonatal unit. RESULTS Twenty parents (10 mothers and 10 fathers) and 21 nHCPs (10 nurses and 11 physicians) participated in the study. Parents and nHCPs experienced barriers and facilitators related to: (1) Structural factors of the institution, such as infrastructure or travel and distance to the neonatal unit. (2) Organization and time management of parental presence, daily activities, and work. (3) Resources, which include factors related to the legal situation, support services, family, and friends. (4) Physical and psychological aspects, such as pain, which mainly affected mothers, and aspects of emotional distress, which affected both parents. Self-care was an important physical and psychological facilitator. (5) Parent-professional interaction. Parental presence was influenced by communication, relationship, and interaction in infant care; and (6) Cultural aspects and language. Some perspectives differed between mothers and fathers, while the overall views of parents and nHCPs provided complementary rather than conflicting insights. Using visit plans to support the organization, educating nHCPs in knowledge skills and available resources to improve encouragement and information to parents, strengthening parent self-care, and improving nHCPs' attitudes towards parental presence were seen as possible improvements. CONCLUSIONS Multifactorial barriers and facilitators determine parental presence and experience in the neonatal unit. Parents and nHCPs made specific recommendations to improve parental presence.
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Affiliation(s)
- Stephanie Vanessa Schmid
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6002, Switzerland
| | - Christine Arnold
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland.
| | - Sophie Jaisli
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
| | - Benedikt Bubl
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
| | - Erika Harju
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Lucerne, 6002, Switzerland
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, 8401, Switzerland
| | - André Kidszun
- Division of Neonatology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
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Solís-García G, Cambra-Rufino L, Piris Borregas S, Carrasco Pérez A, López Maestro M, De la Cruz Bértolo J, Moral Pumarega MT, Pallás Alonso CR. Architectural design, facilities and family participation in neonatal units in Spain: A multicentre study. Acta Paediatr 2024; 113:716-721. [PMID: 38186235 DOI: 10.1111/apa.17085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
AIM The architecture of neonatal units plays a key role in developmental strategies and preterm outcomes. The aim was to evaluate the design of Spanish neonatal units and its impact on the participation of parents in neonatal care. METHODS A web-based survey was sent to all level III Spanish neonatal units, including questions about hospital data, architectural design, facilities and family participation. RESULTS The study included 63 units. Most units (87%) had part or all the intensive care patients located in open bay units, while 54% had at least one individual patient cubicle. Single family rooms, defined as those including enough space and furniture for family members to stay with the infant without restrictions, were available in 8 units (13%). Eighteen units (29%) had a structured programme of family education. Units with single family rooms were more likely to have parental participation in rounds (p < 0.01), safety protocols (p = 0.02), oxygen management (p < 0.01) and nasogastric tube feeding (p = 0.02), as well as to allow siblings to participate in kangaroo care (p < 0.01). CONCLUSION Widely variable architectural designs and policies were found in Spanish neonatal units. The presence of single family rooms may have impacted the participation of parents in neonatal care.
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Affiliation(s)
| | - Laura Cambra-Rufino
- Departamento de Construcción y Tecnología Arquitectónicas, Escuela Técnica Superior de Arquitectura de la Universidad Politécnica de Madrid, Madrid, Spain
| | - Salvador Piris Borregas
- Neonatology Division, Hospital Universitario 12 de Octubre, Madrid, Spain
- i+12 Biomedical Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Carmen Rosa Pallás Alonso
- Neonatology Division, Hospital Universitario 12 de Octubre, Madrid, Spain
- i+12 Biomedical Institute, Hospital Universitario 12 de Octubre, Madrid, Spain
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Petersen M, Nordlund HL, Koreska M, Brødsgaard A. Bridging the gap between healthcare sectors: Facilitating the transition from NICU to the municipality and home for families with premature infants. J SPEC PEDIATR NURS 2024; 29:e12426. [PMID: 38615233 DOI: 10.1111/jspn.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE The transition from hospital to home can be challenging for parents of prematurely born infants. The aim of this ethnographic study was to describe a multidisciplinary and cross-sectoral discharge conference for families with premature infants transitioning from a neonatal intensive care unit to municipal healthcare services. DESIGN AND METHODS An ethnographically/anthropologically inspired qualitative design was adopted. We conducted four participant observations of multidisciplinary and cross-sectoral discharge conferences and 12 semistructured interviews with four neonatologists, four nurses, and four health visitors who had attended one of the conferences. Salient themes were generated by two-part analysis consisting of a thematic analysis followed by Turner's ritual analysis. RESULTS This study illustrated how multidisciplinary and cross-sectoral discharge conferences improved the quality of care for premature infants and their families in their transition process which was perceived as complex. These conferences contributed to promoting a sense of coherence and continuity of care. The healthcare professionals experienced that this event may be characterized as a ritual, which created structures that promoted cross-sectoral cooperation and communication while increasing interdisciplinary knowledge sharing. Thus, the conferences triggered a sense that the participants were building bridges to unite healthcare sectors, ensuring a holistic and coordinated approach to meet the unique needs of the infants and their families. IMPLICATIONS FOR PRACTICE This study presented a unique holistic and family-centered approach to constructing multidisciplinary and cross-sectoral discharge conferences that seemed to underpin the quality of interdisciplinary and health-related knowledge sharing and establish a crucial starting point for early interventions, preventive measures, and health-promoting efforts. Hopefully, our findings will encourage others to rethink the discharge conference as a transitional ritual that may potentially bridge the gap between healthcare sectors. Specifically, our findings contribute to the mounting body of knowledge of family-centered care by showing how healthcare professionals may-in a meaningful and tangible manner-operate, develop, and implement this somewhat elusive theoretical foundation in their clinical practice.
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Affiliation(s)
- Mette Petersen
- Department of Paediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | | | - Mai Koreska
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | - Anne Brødsgaard
- Department of Paediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
- Department of Public Health, Nursing and Health Care, University of Aarhus, Aarhus, Denmark
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Weber A, Bakas T, Schulman-Green D, Voos KC, Rice JB, Bailey R, Reigel A, Oudat Q, Holmes M, Tubbs-Cooley HL, Kaplan HC. Family Management Skills Reported by Parents of Preterm Infants in the NICU Using the Self- and Family Management Framework (SFMF). Adv Neonatal Care 2024; 24:119-131. [PMID: 38127650 PMCID: PMC10978294 DOI: 10.1097/anc.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Across the globe, family-integrated care (FICare) has become an evidence-based standard in which parents deliver the majority of infant care in the neonatal intensive care unit (NICU). Because of extensive barriers to parent presence, adaptations to FICare may be required for successful implementation. Family management theory may provide structure to the Parent Education of FICare and help nurses guide parents' skill development as equal care members. PURPOSE To identify family management skills employed by NICU parents using the Self- and Family Management Framework (SFMF). METHODS We conducted secondary analyses of qualitative interview data from NICU parents (n = 17) who shared their experiences of using family management skills to care for their infant. We categorized skills according to 3 main self- and family management processes: Focusing on Infant Illness Needs; Activating Resources; and Living With Infant Illness. RESULTS Parents reported several family management skills currently identified in the SFMF, as well as new skills such as conflict management, power brokerage, and addressing resources related to social determinants of health. Parent activation of resources was critical to sustaining parent focus on the infant's illness needs. IMPLICATIONS FOR PRACTICE AND RESEARCH By teaching skills that parents reported as helping them manage infant care, neonatal nurses may better facilitate parent integration into the care team. Future researchers can incorporate the skills identified in this study into the design of family management interventions that facilitate FICare implementation in the United States.
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Affiliation(s)
- Ashley Weber
- Author Affiliations: University of Cincinnati College of Nursing, Cincinnati, Ohio (Drs Weber and Bakas and Mr Oudat); New York University Rory Meyers College of Nursing, New York City, New York (Dr Schulman-Green); Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Voos, Mr Bailey, and Mss Reigel and Holmes); Rainbow Babies and Children's Hospital, Cleveland, Ohio (Dr Rice); The Ohio State University, Columbus, Ohio (Dr Tubbs-Cooley); and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Dr Kaplan)
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Hoeben H, Obermann-Borst SA, Stelwagen MA, van Kempen AAMW, van Goudoever JB, van der Schoor SRD, van Veenendaal NR. 'Not a goal, but a given': Neonatal care participation through parents' perspective, a cross-sectional study. Acta Paediatr 2024. [PMID: 38436526 DOI: 10.1111/apa.17179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
AIM To explore parents' perspectives regarding participation in neonatal care, with focus on the family integrated care (FICare) model utilised as a tool to enhance parent-infant closeness. Additionally, we describe experiences in different architectural settings. METHODS An online survey, categorised by four FICare pillars, was distributed through social media to parents of newborns hospitalised to Dutch neonatal wards between 2015 and 2020. Quantitative findings were summarised using descriptive statistics, while open-ended responses were thematically analysed. RESULTS Among the 344 respondents (98% mothers), most reported feeling involved in care (315/340). However, 79% also felt separated from their infant (265/337). Irrespective of architectural settings, parents reported incomplete implementation of FICare pillars: 14% was invited to educational sessions (parent education), 51% discussed family-specific care plans (staff education), 21% was facilitated in connecting with veteran parents (psychosocial support) and 22% received couplet-care (environment). Although 65% of parents were invited to attend clinical rounds, 32% actively participated in decision making. Thematic analysis revealed fundamentals for feeling welcome on the ward, peer-to-peer support, psychosocial support and participation in clinical rounds. CONCLUSION Overall, parents expressed satisfaction with participation in neonatal care. However, structural implementation of FICare lacks. Regardless of architecture, expanding parent participation beyond presence requires attention.
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Affiliation(s)
- Hannah Hoeben
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, The Netherlands
- Emma Children's Hospital Department of Pediatrics, Amsterdam UMC, University of Amsterdam, VU University, Amsterdam, The Netherlands
| | | | | | | | - Johannes B van Goudoever
- Emma Children's Hospital Department of Pediatrics, Amsterdam UMC, University of Amsterdam, VU University, Amsterdam, The Netherlands
| | - Sophie R D van der Schoor
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, The Netherlands
- Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nicole R van Veenendaal
- Department of Pediatrics/Neonatology, OLVG, Amsterdam, The Netherlands
- Emma Children's Hospital Department of Pediatrics, Amsterdam UMC, University of Amsterdam, VU University, Amsterdam, The Netherlands
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Arwehed S, Axelin A, Björklund LJ, Thernström Blomqvist Y, Heiring C, Jonsson B, Klingenberg C, Metsäranta M, Ågren J, Lehtonen L. Nordic survey showed wide variation in discharge practices for very preterm infants. Acta Paediatr 2024; 113:48-55. [PMID: 37540833 DOI: 10.1111/apa.16934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/06/2023]
Abstract
AIM We aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units. METHODS Medical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments. RESULTS We received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay. CONCLUSION Discharge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.
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Affiliation(s)
- Sofia Arwehed
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Anna Axelin
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Lars J Björklund
- Department of Clinical Sciences, Lund, Paediatrics, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Christian Heiring
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Baldvin Jonsson
- Department of Women's and Children's Health, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marjo Metsäranta
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital (HUH), Helsinki, Finland
| | - Johan Ågren
- Department of Women's and Children's Health, Uppsala University and Uppsala University Hospital, Uppsala, Sweden
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University, Hospital and University of Turku, Turku, Finland
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Franck LS, Hodgson C, Gay CL, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Mobile-Enhanced Family-Integrated Care for Preterm Infants: Nurse and Physician Views About Implementation. Adv Neonatal Care 2023; 23:565-574. [PMID: 37948639 DOI: 10.1097/anc.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND The mobile-enhanced family-integrated care (mFICare) model addresses inconsistencies in family-centered care (FCC) delivery, with an evidence-based bundle of staff training, parent participation in rounds, parent classes, parent peer mentors, expanded role for parents in infant caregiving, and a parent-designed app. PURPOSE Our aim was to explore the views of neonatal intensive care unit (NICU) nurses and physicians about mFICare implementation, including what worked well and what could be improved. METHODS As part of a larger study to compare mFICare with FCC, we invited registered nurses, nurse practitioners, and fellow and attending physicians at the 3 study sites to participate in a survey about mFICare implementation. Data were analyzed with descriptive statistics and thematic analysis. RESULTS The majority of the 182 respondents with experience delivering mFICare positively rated parent-led rounds, parent classes, parent skills acquisition, and the nurse-family relationship resulting from participation in mFICare. Respondents were less familiar or neutral regarding the parent peer mentor and app components of mFICare. Most respondents agreed that the mFICare program improved parent empowerment, and they shared suggestions for optimizing implementation. Physicians experienced more challenges with parent participation in rounds than nurses. Three themes emerged from the free-text data related to emotional support for parents, communication between staff and parents, and the unique experiences of families receiving mFICare. IMPLICATIONS FOR PRACTICE AND RESEARCH The mFICare program was overall acceptable to nurses and physicians, and areas for improvement were identified. With implementation refinement, mFICare can become a sustainable model to enhance delivery of FCC in NICUs.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF) (Drs Franck, Hodgson, and Gay); Intensive Care Nursery (Ms Bisgaard) and Division of Neonatology, UCSF Benioff Children's Hospital, San Francisco, California (Dr Sun); Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, California (Dr Joe); NICU and Pediatrics, Community Regional Medical Center, Fresno, California (Dr Cormier); and Will's Way Foundation, Chicago, Illinois (Ms Lothe)
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Klemming S, Lilliesköld S, Arwehed S, Jonas W, Lehtonen L, Westrup B. Mother-newborn couplet care: Nordic country experiences of organization, models and practice. J Perinatol 2023; 43:17-25. [PMID: 38086962 PMCID: PMC10716037 DOI: 10.1038/s41372-023-01812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023]
Abstract
Mother-Newborn Couplet Care is a concept and is defined as the provision of care for a sick or preterm newborn in close proximity to and coupled with the care for the mother from the birth of the infant and for as long as the mother needs hospital care. This concept of care requires system change in both obstetrics and pediatrics in terms of the planning and organization of care, equipment and design of units. Accordingly, strong leadership setting clear goals and emphasizing a culture of cohesive care, supported by targeted education and training is crucial to ensure high-quality care of all mother-newborn dyads without separation. We describe various organizational models of Mother-Newborn Couplet Care used in Sweden and Finland and implementation processes. We envision a future where newborns and mothers are always together, irrespective of medical needs, and form an inseparable center around which healthcare services and providers are organized.
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Affiliation(s)
- Stina Klemming
- Lund-Malmö NIDCAP Training and Research Center, Department of Neonatology, Skåne University Hospital, Lund, Sweden.
| | - Siri Lilliesköld
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren's Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sofia Arwehed
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Neonatology, Uppsala University Hospital, Uppsala, Sweden
| | - Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Liisa Lehtonen
- Faculty of Medicine, University of Turku, Turku, Finland
- Department of Pediatrics and Adolescence Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Björn Westrup
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Hoeben H, Alferink MT, van Kempen AAMW, van Goudoever JB, van Veenendaal NR, van der Schoor SRD. Collaborating to Improve Neonatal Care: ParentAl Participation on the NEonatal Ward-Study Protocol of the neoPARTNER Study. Children (Basel) 2023; 10:1482. [PMID: 37761442 PMCID: PMC10527908 DOI: 10.3390/children10091482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
Parents are often appointed a passive role in the care for their hospitalised child. In the family-integrated care (FICare) model, parental involvement in neonatal care is emulated. Parental participation in medical rounds, or family-centred rounds (FCR), forms a key element. A paucity remains of randomised trials assessing the outcomes of FCR (embedded in FICare) in families and neonates, and outcomes on an organisational level are relatively unexplored. Likewise, biological mechanisms through which a potential effect may be exerted are lacking robust evidence. Ten level two Dutch neonatal wards are involved in this stepped-wedge cluster-randomised trial FCR (embedded in FICare) by one common implementation strategy. Parents of infants hospitalised for at least 7 days are eligible for inclusion. The primary outcome is parental stress (PSS:NICU) at discharge. Secondary outcomes include parental, neonatal, healthcare professional and organisational outcomes. Biomarkers of stress will be analysed in parent-infant dyads. With a practical approach and broad outcome set, this study aims to obtain evidence on the possible (mechanistic) effect of FCR (as part of FICare) on parents, infants, healthcare professionals and organisations. The practical approach provides (experiences of) FICare material adjusted to the Dutch setting, available for other hospitals after the study.
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Affiliation(s)
- Hannah Hoeben
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Milène T. Alferink
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Anne A. M. W. van Kempen
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
| | - Johannes B. van Goudoever
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Nicole R. van Veenendaal
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Sophie R. D. van der Schoor
- Department of Paediatrics/Neonatology, OLVG, 1091 AC Amsterdam, The Netherlands; (H.H.); (M.T.A.); (A.A.M.W.v.K.); (N.R.v.V.)
- Department of Neonatology, Wilhelmina Children’s Hospital, 3508 AB Utrecht, The Netherlands
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Spence CM, Stuyvenberg CL, Kane AE, Burnsed J, Dusing SC. Parent Experiences in the NICU and Transition to Home. Int J Environ Res Public Health 2023; 20:6050. [PMID: 37297654 PMCID: PMC10252259 DOI: 10.3390/ijerph20116050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Families (n = 12) with infants born at <29 weeks gestation shared their experiences while in the NICU and transitioning home. Parents were interviewed 6-8 weeks after NICU discharge, including some during the acute phase of the COVID-19 pandemic. Findings regarding the parent experience in the NICU were focused around challenges navigating parent-infant separation, social isolation, communication difficulties, limited knowledge of preterm infants, mental health challenges. Parents also discussed supports that were present and supports they wished were present, as well as the impact of COVID-19 on their experiences. In the transition to home, primary experiences included the sudden nature of the transition, anxiety around discharge preparation, and the loss of the support from nursing staff. During the first few weeks at home, parents expressed joy and anxiety, particularly around feeding. The COVID-19 pandemic limited emotional, informational, and physical support to parents and resulted in limited mutual support from other parents of infants in the NICU. Parents of preterm infants in the NICU present with multiple stressors, rendering attending to parental mental health crucial. NICU staff need to address logistical barriers and familial priorities impacting communication and parent-infant bonding. Providing multiple opportunities for communication, participating in caretaking activities, and meeting other families can be important sources of support and knowledge for parents of very preterm infants.
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Affiliation(s)
- Christine M. Spence
- Department of Counseling and Special Education, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Corri L. Stuyvenberg
- Rehabilitation Science Graduate Program, Medical School, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Audrey E. Kane
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Jennifer Burnsed
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, USA;
| | - Stacey C. Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90033, USA;
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Franck LS, Axelin A, Van Veenendaal NR, Bacchini F. Improving Neonatal Intensive Care Unit Quality and Safety with Family-Centered Care. Clin Perinatol 2023; 50:449-472. [PMID: 37201991 DOI: 10.1016/j.clp.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
There is strong evidence that family-centered care (FCC) improves the health and safety of infants and families in neonatal settings. In this review, we highlight the importance of common, evidence-based quality improvement (QI) methodology applied to FCC and the imperative to engage in partnership with neonatal intensive care unit (NICU) families. To further optimize NICU care, families should be included as essential team members in all NICU QI activities, not only FCC QI activities. Recommendations are provided for building inclusive FCC QI teams, assessing FCC, creating culture change, supporting health-care practitioners and working with parent-led organizations.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, N411F, Box 0606, San Francisco, CA 94143, USA.
| | - Anna Axelin
- Department of Nursing Science, University of Turku, 20014 University of Turku, Finland. https://twitter.com/AnnaAxelin
| | - Nicole R Van Veenendaal
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. https://twitter.com/nicolevan_vee
| | - Fabiana Bacchini
- Canadian Premature Babies Foundation, 4225-B Dundas Street West, Etobicoke, ON M8X 1Y3, Canada. https://twitter.com/fabianabacchini
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Darmstadt GL, Mader S, Edmond K. The needs of children born preterm are too often overlooked - Authors' reply. Lancet 2023; 401:1156-1157. [PMID: 37030886 DOI: 10.1016/s0140-6736(23)00243-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 04/10/2023]
Affiliation(s)
- Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Silke Mader
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Karen Edmond
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva 1211, Switzerland.
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