Parents' friends and families in neonatal intensive care units: A cross-national qualitative study on staff perceptions and experiences

AIMS AND OBJECTIVES

This study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs).

BACKGROUND

In NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these 'important others' can be present and involved.

DESIGN

This qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry.

METHODS

Seven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist.

RESULTS

The overarching theme showed that 'important others' were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised 'important others' as the parents' territory, but that 'important others'' presence and involvement needed to be negotiated with staff. Although the staff regarded 'important others' as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of 'important others' was an essential step forward in achieving family centred care.

CONCLUSIONS

The findings indicate that 'important others'' involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of 'important others'.

RELEVANCE TO CLINICAL PRACTICE

There is a need for more staff resources to enable and support the participation of 'important others'. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their 'important others'.

"When that understanding is there, you work much better together": the role of family in audiological rehabilitation for older adults

OBJECTIVE

This study aimed to explore the experiences and perceptions of adults with hearing impairment and family members regarding the role of family in audiological rehabilitation.

DESIGN

A qualitative descriptive methodology was used.

STUDY SAMPLE

A total of 37 people participated, 24 older adults with hearing impairment and 13 family members (11 spouses and 2 adult children). Four focus group interviews were conducted with the adults with hearing impairment, and 3 with family members.

RESULTS

Five key themes emerged from analysis of the transcripts: (1) knowledge and understanding of hearing impairment and treatment; (2) the role of family members in rehabilitation is complex and multifaceted; (3) audiologists have an influential role in facilitating family member involvement; (4) the role of communication in rehabilitation; and (5) outcomes of family member involvement. Importantly, although perceptions were generally very positive, there was some uncertainty about the role of family.

CONCLUSIONS

Audiologists have a key role in facilitating family involvement in audiological rehabilitation that is identified by adults with hearing impairment and their families. Although participants reported limited involvement in audiological rehabilitation currently, they identified potential for involvement in areas such as goal setting and decision-making.

Smiles behind the masks: A systematic review and narrative synthesis exploring how family members of seriously ill or dying patients are supported during infectious disease outbreaks

BACKGROUND

Infection control measures during infectious disease outbreaks can have significant impacts on seriously ill and dying patients, their family, the patient-family connection, coping, grief and bereavement.

AIM

To explore how family members of patients who are seriously ill or who die during infectious disease outbreaks are supported and cared for during serious illness, before and after patient death and the factors that influence family presence around the time of death.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

CINAHL, Medline, APA PsycInfo and Embase were searched from inception to June 2020. Forward and backward searching of included papers were also undertaken. Records were independently assessed against inclusion criteria. Included papers were assessed for quality, but none were excluded.

FINDINGS

Key findings from 14 papers include the importance of communication and information sharing, as well as new ways of using virtual communication. Restrictive visiting practices were understood, but the impact of these restrictions on family experience cannot be underestimated, causing distress and suffering. Consistent advice and information were critical, such as explaining personal protective equipment, which family found constraining and staff experienced as affecting interpersonal communication. Cultural expectations of family caregiving were challenged during infectious disease outbreaks.

CONCLUSION

Learning from previous infectious disease outbreaks about how family are supported can be translated to the current COVID-19 pandemic and future infectious disease outbreaks. Consistent, culturally sensitive and tailored plans should be clearly communicated to family members, including when any restrictions may be amended or additional supports provided when someone is dying.

Family involvement in the intensive care unit in four Nordic countries

BACKGROUND

Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement.

AIMS AND OBJECTIVES

To describe family involvement, communication practices and visiting policies in adult ICUs.

DESIGN

A cross-sectional survey.

METHOD

A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries.

RESULTS

The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments.

CONCLUSIONS

The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement.

Systematic review confirmed the benefits of early skin-to-skin contact but highlighted lack of studies on very and extremely preterm infants

AIM

We systematically reviewed the literature to identify the benefits of early skin-to-skin contact (SSC) for all gestational ages.

METHODS

The MEDLINE, Embase and CINAHL databases were searched for papers published in English from 1 January 1975 to 31 March 2020. Early SSC was defined as when the infant was placed directly onto the mother's chest within 180 min of birth. Two authors independently searched the databases, appraised study quality and extracted the study design and outcome data. The primary outcomes were the infants' physiological stability after birth: thermoregulation and stabilisation. The secondary outcomes were exclusive breastfeeding and mother-infant interaction.

RESULTS

We reviewed 30 studies that assessed the benefits of early SSC: 22 comprised term-born healthy infants and eight focused on preterm or ill infants. These included various gestational ages, birth methods and cultural backgrounds. The studies demonstrated that early SSC stabilised neonatal physiological parameters, promoted exclusive breastfeeding and supported bonding. Most of the data were from term and late preterm births.

CONCLUSION

This systematic review showed that early SSC could be beneficial. Further studies that focus on providing very and extremely preterm infants with SSC, and parental experiences, are needed to enable SSC to be adopted as routine practice.

Patients' and relatives' experiences of post-ICU everyday life: A qualitative study

BACKGROUND

As advancements in intensive care treatment have resulted in decreased mortality rates, more attention has been given to the experience of life after critical illness. Despite an increase in literature describing the physical, psychological, and cognitive health problems arising after critical illness, there is a shortage of research exploring the lifeworld of patients and relatives, including its internal and external interplay in everyday life. Addressing this is essential for gaining insights into the experience of everyday life and recovery after critical illness.

AIMS AND OBJECTIVES

To explore patients' and relatives' experiences of everyday life after critical illness.

DESIGN

Data were collected using semi-structured interviews with 7 relatives and 12 patients. Interviews were audiotaped and transcribed verbatim.

METHODS

Drawing on the phenomenological-hermeneutic tradition, data were analysed using Ricoeur's theory of interpretation, as described by Dreyer and Pedersen.

FINDINGS

The lifeworld of everyday life was disclosed in the theme "Finding oneself after critical illness," described as an overall comprehensive understanding. This theme was divided into the subthemes (a) redefining the self, (b) reintegrating with family, and (c) resuming everyday life, which followed the trajectory of the three phases: the known past, the uncertain present, and the unknown future.

CONCLUSION

Critical illness and physical, psychological, and cognitive health problems create new and emerging difficulties in patients' and relatives' experiences of everyday life after intensive care. These experiences affect their understanding of themselves, their families, and their ability to resume pre-intensive care unit everyday life.

IMPLICATIONS FOR PRACTICE

The study underlines the need to supplement the affirmed domains in post-intensive care syndrome with a social domain to enhance family-centred care within the intensive care unit and across sectoral borders. Additionally, it highlights the need to develop rehabilitation strategies aimed at patients' and relatives' multifactorial health problems.

Kangaroo position during neonatal ground ambulance transport: Parents' experiences

BACKGROUND

Kangaroo mother care including skin-to-skin care aims to overcome the negative effects of separating parents and infants and to increase the quality of care for infants and parents in need of neonatal care. In most cases where inter-hospital transport is needed, the infant is placed in a transport incubator, which increases the risk of separation due to ambulance service restrictions that imply that parents are not allowed to accompany these transport trips.

AIM

To illuminate parents' experiences of holding their infant in a kangaroo position during neonatal ground ambulance transport.

STUDY DESIGN

A qualitative design with an inductive approach.

METHODS

A total of 11 open interviews with Swedish parents were conducted two to seven days after their infant had been transferred in a kangaroo position between hospitals. The transcribed interviews were analysed using qualitative content analysis.

RESULTS

The emerged overarching category was "an uninterrupted closeness chain." The parents experienced that holding their infant during the transport extended the time they were close to their infant. Using the kangaroo position during ground ambulance transport also created a feeling of being important as a parent, as their participation during transport was appreciated. Parents' experiences were allocated into three categories: "Strengthen the feeling of being important as a parent," "promote security and create a positive environment for the baby" and "the professionals' attitude promotes security."

CONCLUSION AND RELEVANCE FOR CLINICAL PRACTICE

This knowledge about parents' experiences is important in the continued work to develop interventions that focus on promoting zero separation in neonatal care. Using kangaroo position in a safety harness during ambulance transport enhances zero separation and closeness. To encourage the implementation of kangaroo position during ambulance transport, further research is needed to address parents' experiences of zero separation during transport of infants to a higher level of care.

Measuring family-centred care practices in adult intensive care units: The EMPATHIC-F questionnaire

BACKGROUND

Engaging relatives in the care of critically ill patients is associated with better outcomes. It is crucial to empower relatives to provide feedback. Valid satisfaction instruments are essential to identify best practices and areas for improvement.

AIM

The aim of the study was to adapt the Spanish version of the EMpowerment of PArents in The Intensive Care-30 (EMPATHIC-30) questionnaire in adult intensive care units (ICUs) and psychometrically test the EMpowerment of PAtients in The Intensive Care-Family (EMPATHIC-F) questionnaire to measure family satisfaction.

DESIGN

This is a cross-sectional, prospective study conducted in two adult ICUs. Participants were relatives of patients who were discharged alive from the ICUs with an ICU length-of-stay >24 hours. The EMPATHIC-F questionnaire is divided into five domains that are related to the family-centred care principles. Responses are provided on a 6-point ordinal Likert scale, a score of >5 is considered acceptable.

RESULTS

Patients' relatives confirmed the adaptation of the instrument. A total of 262 relatives responded to the EMPATHIC-F questionnaire (97% response rate). The empirical structure of the instrument was established by confirmatory factor analysis confirming 30 statements within five theoretically conceptualized domains: information, care and treatment, family participation, organization, and professional attitude. On item level, two statements scored a mean below 5.0. Cronbach's α at the domain level was between .64 and .75. Congruent validity was adequate between the five domains and four general satisfaction items (r's .26-.54). The non-differential validity was confirmed with no significant effect size between three patients' demographic characteristics and the domains.

CONCLUSIONS

The EMPATHIC-F questionnaire is a reliable and valid quality performance indicator to measure the perceptions of family members in adult ICU settings.

RELEVANCE TO CLINICAL PRACTICE

The EMPATHIC-F questionnaire can be used to benchmark and provides a framework for standardized quality improvement towards the development of a family-centred care philosophy within adult ICUs.

What does a family who is "engaged" in early intervention look like? Perspectives of Australian speech-language pathologists

PURPOSE

To build a description of what engagement in early speech-language pathology intervention looks like, by exploring speech-language pathologists' (SLPs) perceptions of (1) what characteristics best describe families who are "engaged" in early speech-language pathology intervention and (2) which characteristics are most important for engagement.

METHOD

Group concept mapping, a participatory mixed-methods research approach, was used to represent the perspectives of Australian SLPs working with children aged 0-8 years and their families in early intervention. Using Concept Systems software, participants: (1) brainstormed responses to a focus question (n = 58); (2) grouped statements into categories (n = 34); and (3) rated the importance of each statement (n = 29).

RESULT

SLPs identified 108 characteristics of engagement in early speech-language pathology intervention, which were grouped into seven key concepts: (1) the family is reliable and ready for therapy; (2) the family has an open, honest relationship with the SLP; (3) the family actively participates and takes initiative; (4) the family works in partnership to plan and set goals together; (5) the family sees and celebrates progress; (6) the family invests in intervention at home; and (7) the family understands intervention and advocates for their child. All aspects of engagement were considered important by participants, with the family-SLP relationship and families continuing to invest in intervention at home being rated most highly.

CONCLUSION

Results present a picture of engagement which has been informed by stakeholders, and which goes beyond aspects of engagement which have previously been identified in the literature. Families who are engaged in early speech-language pathology intervention are actively invested and involved in intervention in various ways, both inside and outside the clinic room.

Young adults suffering from mental illness: Evaluation of the family-centred support conversation intervention from the perspective of mental healthcare professionals

AIMS AND OBJECTIVES

To explore how mental healthcare professionals' experience and evaluate the use of Family-Centred Support Conversation Intervention.

BACKGROUND

Mental health professionals working in the community mental health service provide treatment, care and support to young adults suffering from mental illness. Young adults suffering from mental illness are dependent on other family members and live close to the family. The Family-Centred Support Conversation promotes healing and alleviates the suffering of the family.

DESIGN AND METHODS

A qualitative explorative design was used. Individual interviews with health professionals (n = 13) were conducted in Norway and analysed using a phenomenographic approach. The COREQ checklist was used.

RESULTS

Three descriptive categories emerged: A new tool in the toolbox, the family as a conversational partner and Implementing the intervention, with seven conceptions. The mental health professionals had no previous routine for family support. The conversations helped them to structure the involvement of family members. Having the family as a conversational partner together with the patients was considered both somewhat new and rewarding but also challenging. The mental health professionals described a need to adjust the intervention.

CONCLUSIONS

The Family-Centred Support Conversation was described as a complement to care, as usual, structuring the involvement of families. The knowledge exchange between the families and the mental health professionals may create a context of changing beliefs, strengths and resources.

RELEVANCE TO CLINICAL PRACTICE

Clinical practice is challenged to work on establishing a mindset; whereby, the family is regarded as a resource with important skills and life experience. The family should be offered individualised support and follow-up, and FCSC may be a relevant intervention.

Delivery room cuddles for extremely preterm babies and parents: concept, practice, safety, parental feedback

Aim

Following extreme preterm birth, there has traditionally been felt an imperative to rush baby to the neonatal unit for ongoing intensive care. Immediate needs of parents to bond with their babies through direct early physical contact have often been overlooked; many weeks can pass before parents get to hold their babies for the first time. Recognition of the importance of early contact is growing. We aimed to review the safety and value of routinely practising delivery room cuddles for extremely preterm babies.

Methods

We reviewed delivery room cuddles in babies born <27 weeks’ gestation in our centre between 2006 and 2017 via case‐control. We also conducted a questionnaire survey of mothers who experienced a delivery room cuddle to gain their feedback and perspectives.

Results

We found no difference in age or temperatures on neonatal unit admission. There was no case of inadvertent extubation associated with cuddles. Parental feedback was very positive.

Conclusion

With appropriate safeguards, delivery room cuddles are feasible and achievable for extremely preterm babies irrespective of birth gestation. Facilitation of the cuddle is an early and very important family‐centred care practice which seems much appreciated by parents and which may improve bonding, lactation, and maternal mental health.

Speech language pathologists' responses to the rejection or abandonment of AAC systems

Purpose: This study aimed to explore the reported responses of speech-language pathologists (SLPs) to the rejection or abandonment of AAC systems for children with complex communication needs.Methods: Semi-structured in-depth interviews were conducted with 16 SLPs who worked with children with complex communication needs. Interviews were transcribed and coded using thematic analysis.Results: Four themes describing SLPs' responses were identified: (1) SLPs work with families; (2) SLPs respect families' wishes; (3) SLPs "push ahead" with AAC irrespective of families' wishes; and (4) SLPs reflect and acknowledge emotions.Conclusions: SLPs varied in the degree to which they remained family-centred and utilised clinical reflection following the rejection or abandonment of AAC systems for the children they worked with. SLPs also described experiencing a range of negative emotions following the rejection or abandonment of an AAC system, which could impact upon ongoing client care.Implications for RehabilitationIn this research SLPs reported variability in the degree to which they remained family-centred following the rejection or abandonment of an AAC system for the children they worked with.SLPs should reflect on their emotional responses to the rejection or abandonment of AAC systems by their clients.This research suggests that SLP services should consider monitoring the reflective practices of their clinicians to ensure ongoing clinical development and optimisation of client care.

Bridging the Gap: A Mixed Methods Study Investigating Caregiver Integration for People with Geriatric Syndrome

Introduction

Transitions of care between acute hospital and community settings are points of vulnerability for people with geriatric syndrome. Routinely including informal caregivers into the transition processes may mitigate risk. Guidance for operational aspects of caregiver inclusion is currently lacking in healthcare policy and fails to address the barriers faced by caregivers and healthcare professionals.

Methods

A questionnaire and a semi-structured interview were piloted with acute care physiotherapists who facilitate patient discharge into community settings. The questionnaire was analysed using summary statistics and interviews were thematically analysed by researchers, using NVivo 12 software.

Results

Questionnaire responses indicated mixed satisfaction with current caregiver integration by the multidisciplinary team. Four themes were shaped in the interviews: inconsistent caregiver engagement, individuals working in a system, an outdated model of care, and invisible care gaps.

Discussion

Feedback loops constructed from participant questionnaires and interview responses informed the identification of barriers and solutions. These are system wide and address automated integration, cultural shift, reimbursement models, and flexible structures to enhance informal caregiver participation. Future research is urgently required to translate, implement, and evaluate enhanced caregiver integration to ensure sustainable, person-centred healthcare delivery.

The impact of caring for children with posterior urethral valves

AIM

To investigate and describe factors contributing to the impact of caring for a child with posterior urethral valves and to determine the extent to which families view their care as family-centred, and whether this can affect the impact of care.

METHODS

A cross-sectional, survey-based study involving primary caregivers of children with posterior urethral valves. Caregivers completed the Impact on Family Scale (IOFS) and the Measure of Processes of Care (MPOC). Regression analyses were used to assess the relationship between child-related variables, demographic variables, MPOC and IOFS scores.

RESULTS

Thirty-one primary caregivers completed both questionnaires. Caregivers of children with moderate/severe chronic kidney disease (CKD) scored higher on the IOFS compared to those caring for children with mild CKD. Caregivers rated care received highly but reported lower scores in subscales related to information provision. Receiving less respectful and supportive care was significantly associated with lower IOFS scores.

CONCLUSION

The impact of caring for a child with posterior urethral valves is variable and is strongly determined by the severity of the associated CKD. Further research is required to show whether improving family centredness of care can reduce the impact of caring for children with posterior urethral valves.

Exploring the complexity of how families are engaged in early speech-language pathology intervention using video-reflexive ethnography

BACKGROUND

Despite being an important aspect of effective early intervention service delivery, 'engagement' has been inconsistently defined in paediatric healthcare. Previous research has identified that engagement in early speech-language pathology intervention is complex and multifaceted. However, more research is needed to understand the ways that different families may engage with intervention in different settings.

AIMS

To explore the complexity of engagement in early speech-language pathology intervention from the perspectives of both families and their speech-language pathologists (SLPs).

METHOD & PROCEDURES

Video-reflexive ethnography was used to explore engagement with 21 matched SLP-family dyads in early intervention services. Up to three intervention appointments for each participating family were video recorded. Short video segments were selected and played to participants during individual semi-structured interviews where participants were invited to reflect on the interactions captured (i.e., 'video-reflexive sessions'). Interview data were analysed using thematic analysis.

OUTCOMES & RESULTS

Results from the interview data were organized into one overarching theme 'Families may have "different levels of engagement"', and four individual themes that reflected how families engage differently in various aspects of intervention, including (1) attending sessions and coming into the room; (2) actively participating in sessions; (3) continuing to actively participate outside sessions; and (4) having open and honest communication with their SLPs.

CONCLUSIONS & IMPLICATIONS

Families may have different levels of engagement in various aspects of intervention, which contribute to their unique profile of engagement. Findings of this study prompt SLPs to move beyond using blanket statements about whether or not families are engaged, to instead describing in detail how families are uniquely engaged. What this paper adds What is already known on the subject In early speech-language pathology intervention, the term 'engagement' refers to (1) a complex, multifaceted state of families 'being engaged' in intervention both inside and outside sessions; and (2) a relational, co-constructed process where many families 'become engaged' in intervention as they work together with SLPs. Although research has acknowledged engagement may look different for each parent and family, little is known about how families are uniquely engaged in early speech pathology intervention in different settings. What this paper adds to existing knowledge This study is the first to explore engagement from the perspectives of both families and SLPs working together in intervention. Both groups of participants described the complexity of engagement in this setting and acknowledged that families engage differently in different aspects of intervention, which contribute to their unique profile of engagement. What are the potential or actual clinical implications of this work? Being able to identify potential indicators of engagement, such as the ones described in this study, provide opportunities for SLPs to take a reflexive approach to engaging with individual families, in line with principles of family-centred care. Findings of this study therefore prompt SLPs to reflect on how the families they work with are engaged in intervention, and to consider their own role in facilitating engagement. In addition, results highlight the importance of SLPs initiating open conversations with families themselves about how they would like to be engaged in intervention, and what support would be most beneficial to them.

Becoming an empowered parent. How do parents successfully take up their role as a collaborative partner in their child's specialist care?

The purpose of this article is to offer an improved understanding of how parents of children with long-term disabilities are empowered to successfully take up their role as decision-making partners in the design and delivery of the care of their child. The intention is to stimulate dialogue, encourage reflection and provide practical suggestions for health professionals working with children and their families. The reported findings are from a study which was guided by a constructivist grounded theory methodology. This involved an iterative process of repeated cycles of data collection and analysis, which comprised 12 semi-structured, in-depth interviews with 14 parents of children accessing paediatric services within a single National Health Service Trust. A novel model, explaining how the power im/balance and the perceived state of the therapeutic relationship influence how successfully a parent takes up their position in the collaborative partnership, is presented and discussed. It is suggested that by thoughtfully addressing the traditional hierarchy that exists within healthcare, health professionals might facilitate the development of a 'truly' therapeutic relationship, which can help promote parental empowerment.

Third-party disability in ongoing vestibular disorders through the lens of the ICF framework

OBJECTIVE

To identify presence and nature of Third-Party Disability experienced by Significant Others (SOs) of people with ongoing vestibular symptoms using the World Health Organisation International Classification of Functioning, Disability and Health (WHO-ICF) framework.

DESIGN

Qualitative semi-structured interviews were conducted and analysed by mapping transcripts to the WHO-ICF framework.

STUDY SAMPLE

Ten SOs of people with ongoing vestibular symptoms were interviewed. Maximum variation sampling was used.

RESULTS

Data mapped to 5 codes in the body functions component of the ICF, highlighting psychological impact on the SO and a broad range of negative emotions; 28 codes in the activities and participations component, showing impaired ability across several areas of the SO's life including social life, communication, general tasks and maintaining domestic balance; and 19 codes in the environmental factors component, highlighting the importance of supportive relationships and functioning health systems.

CONCLUSIONS

Third-Party Disability was identified, including psychological impacts on the SO, interruption to their daily lives and increased domestic responsibility. Health professionals may lessen disability by encouraging support networks and practicing family-centred care.

Perceived Impacts of Solution-Focused Coaching Training for Pediatric Rehabilitation Practitioners: A Qualitative Evaluation

AIMS

This qualitative evaluation study assessed perceived impacts of a solution-focused coaching (SFC) training rolled out in a Canadian pediatric rehabilitation hospital from the perspective of clinical service providers.

METHODS

Thirteen clinical service providers were interviewed six months after receiving 2-day SFC training. Participants retrospectively described perceived impacts of the training and benefits and challenges pertinent to the implementation of the SFC approach. Interview transcripts were transcribed verbatim and analyzed thematically.

RESULTS

SFC training was considered making a valuable addition to participants' toolbox, increasing their confidence in developing positive therapeutic alliance with clients, and enhancing their strengths-based orientation. The training was also seen improving team cohesion and promoting collaborative solution-finding among team members. Structural barriers such as time constraints, lack of continuous organizational support and clear expectations around the use of the SFC approach were reported as factors impeding effective clinical adaptation. The need for tailoring the SFC approach to unique service contexts was also reported.

CONCLUSIONS

Future SFC training initiatives should integrate a team-based approach and a culturally sensitive lens to help providers better assist clients in identifying their unique strengths. Follow-up training and continuous organizational support mechanisms will be vital for facilitating sustainable implementation after the initial training.

Peer support groups for families in Neonatology: Why and how to get started?

AIM

To describe the development of peer-to-peer support meetings between parents of children in neonatal intensive care unit (NICU) and veteran resource parents who had a previous NICU experience.

METHODS

The study had two steps: a needs assessment and a feasibility pilot study. Parental perspectives were investigated using mixed methods.

RESULTS

One hundred and fifty-three parents were participated. NICU parents (89%) wished to meet resource parents to discuss: their parental role, normalising their experience and emotions, adapting to their new reality, control, guilt, trust and coping. Practical aspects of the meetings were tested/finalised. Resource parent moderators reported that the presence of more than one moderator per meeting was essential. A checklist of topics to discuss was developed. Having a diversity of moderators (fathers, diagnoses other than prematurity, for example) was judged important. The name of the meeting had an impact on attendance: there were less participants when the word "support" was used. The best location (central, parents' kitchen) and optimal time/duration of meetings, selection of parent moderators and compensation were also determined.

CONCLUSION

Peer support meetings moderated by resource parents provide a unique and useful means to support NICU parents. Future investigations will explore whether these meetings will improve clinical outcomes.

Use of the Behaviour Change Wheel to design an intervention to improve the implementation of family-centred care in adult audiology services

OBJECTIVE

This study describes the development of an intervention to improve family-centred care in adult audiology services.

DESIGN

The Behaviour Change Wheel (BCW) was followed to develop the intervention. The BCW involves eight steps across three stages: (1) understanding the behaviour, (2) identifying intervention options, and (3) identifying content and implementation options.

STUDY SAMPLE

The data in Stage 1 comprised of 13 interviews with clinic staff. The research team drew on their own expertise and empirical research to complete Stages 2 and 3.

RESULTS

A two-phase, face-to-face intervention was developed to change clinic staff' behaviours to address two problem behaviours: (1) increase family member attendance to adult audiology appointments; and (2) increase family member involvement within appointments. Three target behaviours were chosen for the intervention to address the two problem behaviours. A variety of intervention functions and behaviour change techniques were incorporated into the intervention.

CONCLUSION

The BCW provided a useful framework for developing a whole-of-clinic intervention to increase family member attendance and involvement in adult audiology appointments. Recent research in social psychology has suggested that this type of family involvement and support in healthcare is a strong predictor of well-being for adult clients and their families.

'A blender without the lid on': Mealtime experiences of caregivers with a child with autism spectrum disorder in South Africa

Background

Evidence suggests that caregivers of children with autism spectrum disorder (ASD) and associated feeding difficulties have specific mealtime challenges in the home environment because of the limited interventions that are appropriate and responsive to the needs of the child as well as the family.

Objectives

To describe: (1) common feeding difficulties in children with ASD, (2) mealtime challenges for the caregiver and (3) mealtime strategies used by the caregiver.

Method

Forty caregivers were purposively sampled to participate in the study. Participants were recruited through ASD-specific schools in Johannesburg, South Africa. Participants completed an online questionnaire focusing on their mealtime experiences with their child with ASD.

Results

Findings from the data after thematic analysis indicated the multitude of challenges caregivers have when feeding their child with ASD as well as their individualised way of dealing with these difficulties.

Conclusion

The findings emphasised the importance of incorporating the family’s beliefs, values and needs into feeding management and highlight the importance of a holistic approach to intervention. The study also provided information about mealtime strategies that are being used in the home environment to support the child as well as the caregiver. This information can be used to inform management to improve therapeutic outcomes and feeding challenges in the home environment.

Parents' experiences of VOICE: A novel support programme in the NICU

Background

Admission of an infant to a neonatal intensive care unit (NICU) is often a stressful experience for parents and can be associated with feelings of inadequacy to fulfil the desirable parental role. The values, opportunities, integration, control, and evaluation (VOICE) programme was developed to engage parents in care, to decrease stress, and to increase empowerment.

Aim

To explore the experiences of parents regarding involvement in the VOICE programme during admission of their infant to the NICU.

Design

The VOICE programme includes at least five personal structured meetings between parents, nurses, and other health care professionals throughout the pathway from birth, NICU, and follow up. A qualitative design was adopted using semi‐structured interviews. Interviews with 13 parents of 11 infants born at <27 weeks' gestational age were conducted: nine mothers and two couples of father and mother. Thematic analysis was deployed.

Results

The findings have been described in one overarching theme: “parental empowerment.” Parents felt strengthened and were empowered in the development of their role as primary caretaker by the VOICE programme. The parental empowerment theme emerged from four related interpretive themes that were derived: (a) involvement in care, (b) personalized information and communication, (c) transition to a parental role, and (d) emotional support.

Conclusion

The VOICE programme can be a structured approach used to implement family support in a NICU to empower parents to become a partner in the care of their infant and feel confident.

Relevance to clinical practice

This study encourages health care professionals to provide parental support through a structured intervention programme, which contributes to the empowerment of parents in the NICU and encouraged them to participate in care and decision‐making.

Understanding Young People and Their Care Providers' Perceptions and Experiences of Integrated Care Within a Tertiary Paediatric Hospital Setting, Using Interpretive Phenomenological Analysis

Introduction:

Benefits of integrated care include improved health outcomes and more satisfaction with experiences of care for consumers. For children and young people with chronic and complex health conditions, their care may be fragmented due to the multitude of healthcare providers involved. This paper describes the experiences of integrated care in a paediatric tertiary hospital.

Theory and methods:

Using an Interpretive Phenomenological Analysis approach, semi-structured interviews were conducted with children and young people, their parents and healthcare providers to explore stakeholders’ integrated care experiences.

Results:

Nineteen interviews were completed (6 children and young people, 7 parents and 6 healthcare providers) and transcribed verbatim. Two recurrent themes were applicable across the three cohorts: ‘agency and empowerment’ and ‘impact of organisational systems, supports and structures’.

Discussion and conclusion:

Stakeholders’ experiences of integrated care highlighted the need to examine the discrepancies between healthcare strategies, policies and service delivery within a complex, and often inflexible organisational structure. Power imbalance and family agency (including directly with children and young people) needs to be addressed to support the implementation of integrated care.

Improving mealtimes for paediatric intensive care children and families: A quality improvement initiative

BACKGROUND

Many critically ill children can be fed orally at some point during their paediatric intensive care (PICU) stay, but reduced appetite and other factors may impact their intake. At home, oral feeding is usually delivered by parents, so involving parents more actively during mealtimes in the PICU may contribute to improved patient/family satisfaction.

AIM

To assess the impact of a new "room service" initiative involving parents on mealtime quality and on both family and health care professional (HCP) satisfaction.

METHODS

A prospective, single-centre, before-and-after intervention study was designed as part of a PICU quality-of-care improvement programme in 2013 to 2016. Two questionnaires assessing oral nutrition practices and family/HCP overall satisfaction were disseminated among the parents of critically ill children capable of oral feeding during their PICU admission and among the whole PICU HCP team (nurses, nurse assistants, and medical doctors). Categorical variables were compared using the chi-square test, and Likert scales were compared between groups with the Mann-Whitney-Wilcoxon test.

RESULTS

the pre-intervention surveys were completed by 97 of 130 (75%) HCPs and 52 families and the post-intervention surveys by 74 of 130 (57%) HCPs and 54 families. After the intervention, a marked improvement was observed in the overall quality of meal service rating by both HCPs and families (medians and IQR: 5 (5-7) to 7 (7, 8) and 6 (6-8) to 8 (7-9), respectively; P < .01) and also in parents' involvement; in children's, families', and HCP satisfaction; in meal-dedicated facilities and equipment; and in perception that oral nutrition is an important aspect of PICU care.

CONCLUSIONS

Implementation of an improved "room service" initiative in the PICU was feasible and improved the perceived quality of care and satisfaction around oral feeding. This family-centred care initiative can be integrated in an overall quality improvement strategy.

Systematic review of family engagement interventions in neonatal, paediatric, and adult ICUs

AIMS AND OBJECTIVES

The purpose of this systematic review was to evaluate interventions that have been used to engage families in direct care activities (active family engagement) in adult, paediatric, and neonatal intensive care unit (ICU) settings.

BACKGROUND

Family engagement is universally advocated across ICU populations and practice settings; however, appraisal of the active family engagement intervention literature remains limited.

SEARCH STRATEGY

Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were searched for family interventions that involved direct care of the patient to enhance the psychological, physical, or emotional well-being of the patient or family in neonatal, paediatric, or adult ICUs.

INCLUSION/EXCLUSION CRITERIA

Studies were included if an active family engagement intervention was evaluated. Studies were excluded if they were not published in English or reported non-interventional research.

RESULTS

A total of 6210 abstracts were screened and 19 studies were included. Most studies were of low to moderate quality and were conducted in neonatal ICUs within the United States. Intervention dosage and frequency varied widely across studies. The interventions focused on developmental care (neonatal ICU) and involved families in basic patient care. Family member outcomes measured included satisfaction, stress, family-centred care, confidence, anxiety, and depression. Most studies found improvements in one or more outcomes.

CONCLUSIONS

There is a paucity of literature about active family engagement interventions, especially in adult and paediatric populations. The optimal dosage and frequency of family engagement interventions remains unknown. Our systematic review found that data are limited on the relationship between family engagement and patient outcomes, and provides a timely appraisal to guide future research.

RELEVANCE TO CLINICAL PRACTICE

Further research on the efficacy of family engagement interventions is warranted. The translation of active family engagement interventions into clinical practice should also be supported.