Assessment of family needs in neonatal intensive care units

A rounding system to enhance patient, parent, and neonatal nurse interactions and promote patient safety

Comfort rounds, an approach to assessing and meeting the needs of patients and families in a neonatal intensive care unit (NICU), was created based on nursing rounds. The purpose of comfort rounds is to provide information to parents and assess and enhance the neonate's comfort and safety. I describe a comfort rounds process that was implemented through presentations, huddles, and discussions and was validated through parent comments, employee documentation, and an increase in patient satisfaction scores.

Parents' expectations of staff in the early bonding process with their premature babies in the intensive care setting: a qualitative multicenter study with 60 parents

BACKGROUND

During the first weeks of hospitalization, premature babies and their parents encounter difficulties in establishing early bonds and interactions. Only a few studies have explored what caregivers can do to meet parents' needs in relation to these interactions and help optimize them. This study sought to explore parents' perception of these first interactions and to identify the actions of caregivers that help or hinder its development.

METHODS

Prospective study, qualitative discourse analysis of 60 face-to-face interviews conducted with 30 mothers and 30 fathers of infants born before 32 weeks of gestation (mean ± SD: 27 ± 2 weeks of gestational age), during their child's stay in one out of three NICUs in France. Interviews explored parental experience, from before birth up to the first month of life.

RESULTS

Data analysis uncovered two main themes, which were independent of parents' geographical or cultural origin but differed between mothers and fathers. First, fathers described the bond with their child as composed more of words and looks and involving distance, while mothers experienced the bond more physically. Secondly, two aspects of the caregivers' influence were decisive: nurses' caring attitude towards baby and parents, and their communication with parents, which reduced stress and made interactions with the baby possible. This communication appeared to be the locus of a supportive and fulfilling encounter between parents and caregivers that reinforced parents' perception of a developing bond.

CONCLUSIONS

At birth and during the first weeks in the NICU, the creation of a bond between mothers and fathers and their premature baby is rooted in their relationship with the caregivers. Nurses' caring attitude and regular communication adapted to specific needs are perceived by parents as necessary preconditions for parents' interaction and development of a bond with their baby. These results might allow NICU staff to provide better support to parents and facilitate the emergence of a feeling of parenthood.

Pilot study of experiences and needs of 111 fathers of very low birth weight infants in a neonatal intensive care unit

OBJECTIVE

To study the experiences and needs of the fathers of very low birth weight (VLBW, <1500 g) infants in a neonatal intensive care unit (NICU).

STUDY DESIGN

An anonymous self-report questionnaire was administered to fathers of VLBW infants born between Jan 1, 2008 and December 31, 2009 at two tertiary NICUs.

RESULT

A total of 111 of 273 fathers responded to the questionnaire. Responses to a variety of items, including self-perception, parenting attitudes, confidence, emotional pressure to satisfaction and self-efficacy as a parent were similar for the fathers of this survey and previous results for mothers of VLBW infants. Fathers judged direct bedside support by the NICU team as sufficient. However, 54.4% of fathers reported missing nonbedside interventions such as VLBW father-specific baby care courses, seminars or workshops, and platforms or chatrooms on the internet.

CONCLUSION

Bedside support of fathers, accomplished by the NICU team, could be complemented by additional father-specific non-bedside support, such as peer-education measures or interactive mass media.

Jordanian parental needs of critically ill infants in neonatal intensive care units

This descriptive correlational study was conducted to identify perceived parental needs of critically ill infants in Neonatal Intensive Care Units (NICUs). Jordanian parents who were visiting their infants admitted in NICU ( N = 170) composed the study sample. Participants completed the demographic data sheet and the NICU Family Needs Inventory. Findings showed that parents ranked assurance, information and proximity as the most important needs, while comfort and support were ranked the lowest. The primary concern of parents was to be assured and informed about the progress of their infant. In addition, the results indicated that the mother’s perceived needs for support, information and proximity were significantly more important than the father's. Accordingly, nurses should establish a rapport with family members and provide them with understandable and honest information. Furthermore, the provision of quality, holistic, family-centered nursing care that relies primarily on early and comprehensive needs assessment, which correlates with infants’ outcomes, is imperative.

Development and validation of a neonatal intensive care parent satisfaction instrument

OBJECTIVE

To develop and test the psychometric properties of the EMPATHIC-N (EMpowerment of PArents in THe Intensive Care-Neonatology) questionnaire measuring parent satisfaction.

DESIGN

A psychometric study testing the reliability and validity of a parent satisfaction questionnaire by applying confirmatory factor analysis including standardized factor loadings and subsequently Cronbach's α reliability estimates across time, congruent validity, and nondifferential validity testing.

SETTING

A 30-bed neonatal intensive care unit in a university hospital.

PATIENTS

Two cohorts with a total of 441 parents whose child was admitted to the neonatal intensive care unit, January to December 2009.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In the first cohort, 220 of 339 (65%) parents responded; in the second cohort, 59 of 102 (58%) parents responded. Structural equation modeling and confirmatory factor analysis resulted in a sufficient model fit of 57 statements within five domains: Information, Care & Treatment, Organization, Parental Participation, and Professional Attitude. Standardized factor loading of these statements were between 0.58 and 0.91. Reliability measures, Cronbach's α, of the domains ranged from 0.82 to 0.95. Reliability across time showed no evidence of statistically significant differences between the domains. Congruent validity was confirmed by a good correlation (p = .01) between the domains and four general satisfaction questions. Nondifferential validity showed no significant effect sizes between the infants' characteristics and the domains, except between ventilated infants and parent participation statements and infants ≥30 wks gestational age and organizational statements.

CONCLUSIONS

The EMPATHIC-N questionnaire is a valid quality performance indicator to measure the delivered care as perceived by parents.

Enfermagem e a relação com as mães de neonatos em Unidade de Terapia Intensiva Neonatal

As relações estabelecidas com a enfermagem frente à experiência do nascimento prematuro de um filho influencia a vivência da mulher. O objetivo deste estudo foi delinear a relação entre a equipe de enfermagem e as mães com bebês internados na Unidade de Terapia Intensiva Neonatal, apresentada em artigos publicados entre 2005 e 2010. Foram utilizadas as bases de dados CINAHL, MEDLINE e LILACS, com estudos publicados entre 2005 e 2010 com os descritores: Neonatal Nursing, Premature, Mothers and Nursing Care, totalizando 21 artigos organizados nas categorias: Fases Enfrentadas pelos Pais durante a Estadia do Bebê na UTIN; Relação entre Enfermeira e Mãe; Suporte da Enfermagem; Descuidado na Relação entre Enfermeira e Mãe e Ações de Educação em Saúde. Os estudos apontam a necessidade das mães por suporte o que inclui apoio emocional, envolvimento nos cuidados ao bebê, disponibilidade para estar e conversar.

Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role

AIM

This article is a report on a descriptive study of fathers’ experiences of providing their preterm infants with Kangaroo Mother Care.

BACKGROUND

During neonatal intensive care, fathers describe the incubator as a barrier and the separation from their infant as stressful. Fathers consider it important to be close to the infant, and performing Kangaroo Mother Care makes them feel an important participant in their infants' care.

METHOD

Individual interviews conducted in 2009 with seven fathers who performed Kangaroo Mother Care were analysed using qualitative content analysis.

RESULTS

The fathers' opportunity for being close to their infants facilitated attainment of their paternal role in the neonatal intensive care unit. Kangaroo Mother Care allowed them to feel in control and that they were doing something good for their infant, although the infant's care could be demanding and stressful. As active agents in their infant's care, some fathers stayed with the infant during the whole hospital stay, others were at the neonatal intensive care unit all day long. Despite the un-wished-for situation, they adapted to their predicament and spent as much time as possible with their infants.

CONCLUSION

Fathers' opportunities for Kangaroo Mother Care helped them to attain their paternal role and to cope with the unexpected situation. The physical environment and conflicting staff statements influenced their opportunity for, and experience of, caring for their preterm infants.

Family-provider alliance program in intensive care units

This nonrandomized controlled study evaluated the effects of Family-Provider Alliance Program on nurses' perception of therapeutic alliance, job satisfaction, and quality of care. A total of 275 nurses were included in the study: 206 nurses in the ICUs participated in the Program and 69 in the control group did not. Mean postinterventional Kim Alliance Scale-Provider score was improved not only in the experimental group (+0.87; p = .01), but also in the control group (+1.37; p = .016). However, Empowerment subscale mean score was improved in the experimental group alone (+0.34; p = .006). Hierarchical multiple regression analyses indicated that family-nurse therapeutic alliance explained 7.2% and 11.4% of the variance in nurses' job satisfaction and perceived quality of care, respectively. The Program was marginally effective in improving nurses' perception of family empowerment. The quality of family-nurse therapeutic alliance predicted small to moderate fractions of the variance in nurses' job satisfaction and perceived quality of care.