Parents' and neonatal healthcare professionals' views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study

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.

Clinical, serological and epidemiological features of hepatitis A in León, Nicaragua

Background and Objectives

To monitor and document the endemicity and disease burden of acute hepatitis A in the area of an ongoing vaccine effectiveness study in León, Nicaragua.

Methods

At community health centres in León, all children, adolescents and young adults presenting with jaundice and/or other clinical signs of hepatitis were offered free serologic screening (hepatitis A, B and C) and blood tests for liver enzymes and bilirubin. Clinical and socioeconomic data were collected with a structured questionnaire. Diagnosis of acute hepatitis A was confirmed by anti-HAV IgM testing. Using logistic regression we compared the characteristics and living conditions of acute hepatitis A cases with those of non-cases.

Results

Of 557 eligible subjects enrolled between May 2006 and March 2010, 315 (56.6%) were diagnosed with hepatitis A, 80.6% of them ≤10 years and five >18 years of age. No severe cases were encountered. Apart from jaundice (95.6%) and other signs of hepatitis A (fever, pale stool, dark urine, nausea, vomiting, anorexia), two thirds of patients had moderately raised liver enzymes. Cases occurred throughout the year, with highest incidences from August to March. Poor sanitary conditions and crowding were the main risk factors.

Conclusions

In the study area, hepatitis A is still highly endemic in young and school age children living in low socioeconomic conditions. There are, however, first indications that the endemicity level is shifting from high to high-intermediate.