1
|
Kabajassi O, Reiter A, Tagoola A, Kenya-Mugisha N, O'Brien K, Wiens MO, Feeley N, Duby J. Facilitators and constraints to family integrated care in low-resource settings informed the adaptation in Uganda. Acta Paediatr 2024; 113:1845-1851. [PMID: 38411347 DOI: 10.1111/apa.17182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
AIM Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda. METHODS Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints. RESULTS Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers. CONCLUSION Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.
Collapse
Affiliation(s)
| | - Anna Reiter
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | | | | | - Karel O'Brien
- Department of Paediatrics, Sinai Health System, Toronto, Ontario, Canada
| | - Matthew O Wiens
- Walimu, Kampala, Uganda
- Centre for International Child Health, BC Children's & Women's Hospital, Vancouver, British Columbia, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Québec, Canada
- Centre for Nursing Research, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
| | - Jessica Duby
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| |
Collapse
|
2
|
Broden EG, Boyden JY, Keller S, James R, Mooney-Doyle K. Who, What, Where, and How? The State of Family Science in Pediatric Palliative Care. J Pain Symptom Manage 2024:S0885-3924(24)00844-3. [PMID: 38992396 DOI: 10.1016/j.jpainsymman.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
CONTEXT Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health. OBJECTIVES Explore and describe the family-level impact of pediatric serious illness. METHODS We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction. RESULTS We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities. CONCLUSION The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families.
Collapse
Affiliation(s)
- Elizabeth G Broden
- Yale National Clinician Scholars Program (E.G.B.), Yale University, New Haven, CT; School of Public Health (E.G.B.), Yale University, New Haven, CT.
| | - Jackelyn Y Boyden
- Department of Family and Community Health (J.Y.B.), School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics (J.Y.B.), Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan Keller
- Research Library (S.K.M.), Children's National Hospital, Washington, DC
| | - Richard James
- Nemours Children's Health (R.J.M.), Wilmington, DE; Fontan Outcomes Network
| | - Kim Mooney-Doyle
- Department of Family and Community Health (K.M-D.), School of Nursing, University of Maryland, Baltimore, MD
| |
Collapse
|
3
|
Alqarawi N, Alhalal E. Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study. J Pediatr Nurs 2024; 77:172-179. [PMID: 38522211 DOI: 10.1016/j.pedn.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care. DESIGN AND METHODS A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model. RESULTS The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000). CONCLUSIONS Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care. PRACTICAL IMPLICATIONS The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.
Collapse
Affiliation(s)
- Nada Alqarawi
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia; College of Nursing, King Saud University, Riyadh, Saudi Arabia.
| | - Eman Alhalal
- Community and mental health nursing, Nursing college, King Saud University Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Harlow AB, Ledbetter L, Brandon DH. Parental presence, participation, and engagement in paediatric hospital care: A conceptual delineation. J Adv Nurs 2024; 80:2758-2771. [PMID: 38037504 DOI: 10.1111/jan.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
AIM To delineate between the concepts of parental presence, participation, and engagement in paediatric hospital care. DESIGN The concepts' uses in the literature were analysed to determine attributes, influences, and relationships. METHODS Delineations of each concept are established and conceptual definitions are proposed following Morses' methods. DATA SOURCES MEDLINE (PubMed); CINAHL, PsycINFO, Sociology Source Ultimate (EBSCOhost); Embase, Scopus (Elsevier); Google Scholar. Search dates October 2021, February 2023. RESULTS Multinational publications dated 1991-2023 revealed these concepts represent a range of parental behaviours, beliefs, and actions, which are not always perceptible to nurses, but which are important in family-integrated care delivery. Parental presence is the state of a parent being physically and/or emotionally with their child. Parental participation reflects parents' performing caregiving activities with or without nurses. Parental engagement is a parents' state of emotional involvement in their child's health and the ways they act on their child's behalf. CONCLUSION These concepts' manifestations are important to parental role attainment but may be inadequately understood and considered by healthcare providers. IMPLICATIONS Nurses have influence over parents' parental presence, participation, and engagement in their child's care but need support from healthcare institutions to ensure equitable family-integrated care delivery. IMPACT Problem: Lack of clear definition among these concepts results in incomplete and at times inequitable family-integrated care delivery. FINDINGS Parental presence is an antecedent to parental participation, and parental presence and participation are elements of parental engagement. The concepts interact to influence one another. IMPACT Hospitalized children, their families, nurses, and researchers will benefit through a better understanding of the concepts' attributes, interactions, and implications for enhanced family-integrated care delivery.
Collapse
Affiliation(s)
| | - Leila Ledbetter
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Debra H Brandon
- Duke University School of Nursing, Durham, North Carolina, USA
| |
Collapse
|
5
|
Barnes S, Macdonald I, Rahmaty Z, de Goumoëns V, Grandjean C, Jaques C, Ramelet AS. Effectiveness and family experiences of interventions promoting partnerships between families and pediatric and neonatal intensive care units: a mixed methods systematic review. JBI Evid Synth 2024; 22:1208-1261. [PMID: 38505961 PMCID: PMC11230661 DOI: 10.11124/jbies-23-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The objective of this mixed methods review was to examine the effectiveness and family experiences of interventions promoting partnerships between families and the multidisciplinary health care team in pediatric and neonatal intensive care units. INTRODUCTION Hospitalization of infants and children in neonatal intensive care units and pediatric intensive care units has a significant effect on their families, including increased stress, anxiety, and depression. Available evidence syntheses focused on specific family-centered care, but not on partnership, which is another aspect that may improve families' outcomes and experiences. INCLUSION CRITERIA This review considered studies that focused on effectiveness or family experiences of interventions by health professionals in partnership with families of infants or children hospitalized in an intensive care unit. For the quantitative component of the review, the type of intervention was a partnership between the health care team and the family, and focused on outcomes of stress, anxiety, depression, quality of life, attachment, or satisfaction with family-centered care. For the qualitative component, the phenomenon of interest was family experiences of interventions that included collaboration and partnering with the health care team in the pediatric or neonatal intensive care unit. Quantitative, qualitative, and mixed methods studies, published from 2000 to August 2022 in English or French, were eligible for inclusion. METHODS The JBI methodology for convergent segregated mixed methods systematic reviews was followed using the standardized JBI critical appraisal and data extraction tools. Ten databases were searched in December 2019 and again in August 2022. Study selection, critical appraisal, and data extraction were performed by 2 reviewers independently. Findings of quantitative studies were statistically pooled through meta-analysis and those that could not be pooled were reported narratively. Qualitative studies were pooled through meta-synthesis. RESULTS This review included 6 qualitative and 42 quantitative studies. The methodological quality varied, and all studies were included regardless of methodological quality. Meta-analyses showed improvements in anxiety, satisfaction with family-centered care, and stress, yet no conclusive effects in attachment and depression. These results should be interpreted with caution due to high heterogeneity. Qualitative analysis resulted in 2 synthesized findings: "Interventions that incorporate partnerships between families and the health care team can improve the family's experience and capacity to care for the child" and "Having a child in intensive care can be an experience of significant impact for families." Integration of quantitative and qualitative evidence revealed some congruence between findings; however, the paucity of qualitative evidence minimized the depth of this integration. CONCLUSIONS Partnership interventions can have a positive impact on parents of children in intensive care units, with improvements reported in stress, anxiety, and satisfaction with family-centered care. REVIEW REGISTRATION PROSPERO CRD42019137834. SUPPLEMENTAL DIGITAL CONTENT A Chinese-language version of the abstract of this review is available at http://links.lww.com/SRX/A50 . A French-language version of the abstract of this review is available at http://links.lww.com/SRX/A51 .
Collapse
Affiliation(s)
- Shannon Barnes
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Ibo Macdonald
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Zahra Rahmaty
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Véronique de Goumoëns
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Chantal Grandjean
- Pediatric Intensive Care Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Cécile Jaques
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| |
Collapse
|
6
|
Franco Fuenmayor ME, Fawcett A, Schwartz KE, Horner S, Balasundaram M, Burke BL, Bean KA, Russell LN, Simonton E, Machut KZ, Fry JT. Understanding family-centered care in the NICU: a scoping review protocol. JBI Evid Synth 2024; 22:1379-1386. [PMID: 38385497 DOI: 10.11124/jbies-23-00252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This scoping review will aim to identify and categorize the definitions of neonatal intensive care unit (NICU) family-centered care (FCC) and its associated concepts. It also aims to identify and categorize the practices and interventions that comprise NICU FCC, and catalog the metrics used to evaluate NICU FCC. INTRODUCTION FCC has been identified as an important element of care for neonates and infants admitted to the NICU, and there is clear evidence that the incorporation of families in care improves clinical outcomes. However, FCC has been linked to numerous associated terms and concepts and lacks a unifying definition or framework, thus limiting the ability to categorize, prioritize, and identify practices and interventions to optimize both institutional approaches for individual centers and for the field at large. INCLUSION CRITERIA Studies that include or apply at least one FCC concept or its associated terms will be considered eligible for inclusion. Studies not related exclusively to the NICU will be excluded. METHODS The review will follow the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Several electronic databases and sources of gray literature will be searched from 1992 to the present day. The review will include only full-text studies in English and will be independently screened by a minimum of 2 authors. Data will be extracted using a modified JBI data extraction tool and presented using narrative summaries; concept mapping; and categorization of practices, interventions, and metrics.
Collapse
Affiliation(s)
- Maria E Franco Fuenmayor
- Department of Pediatrics, Division of Neonatology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea Fawcett
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical and Organizational Development, Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine E Schwartz
- Division of Neonatal-Perinatal Medicine, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Susan Horner
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Malathi Balasundaram
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Barbara Lawlor Burke
- Patient Family Experience Department, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine A Bean
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Laura N Russell
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jessica T Fry
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
Tiryaki Ö, Çınar N, Caner İ. The effect of family integrated care on preparing parents with premature infants hospitalized in the neonatal intensive care unit for discharge. J Perinatol 2024; 44:1014-1021. [PMID: 38499753 PMCID: PMC11226394 DOI: 10.1038/s41372-024-01931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE The study was designed as a randomized controlled experimental trial to determine the effect of the Family Integrated Care (FICare) model on the readiness of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) for discharge and home care of the infants. STUDY DESIGN Parents in the intervention group received FICare, and parents in the control group received standard care. RESULTS The total mean score of the mothers and fathers in the intervention group regarding readiness for discharge and home care was higher than that of the control group, and a significant difference was observed. A statistically significant difference was found in terms of discharge weight, the day of first enteral feeding, and first breast milk. CONCLUSION The FICare model was observed to enhance the readiness of mothers and fathers for discharge and home care and positively affect the infant's weight gain, the status of breastfeeding and the continuation of nutrition. CLINICAL TRIAL REGISTRATION Registered on ClinicalTrials.gov (Identifiers: NCT04478162 Unique Protocol ID: 16214662/050.01.04/14) on 17/07/2020.
Collapse
Affiliation(s)
- Öznur Tiryaki
- Department of Midwifery, Faculty of Health Science, Sakarya University, Sakarya, Turkey.
| | - Nursan Çınar
- Department of Pediatric Nursing, Faculty of Health Science, Sakarya University, Sakarya, Turkey
| | - İbrahim Caner
- Faculty of Medicine, Division of Neonatology, Department of Pediatrics, Sakarya University, Sakarya, Turkey
| |
Collapse
|
8
|
Alqarawi N, Alhalal E. Factors affecting family-centered care practice by nurses: A systematic review. J Pediatr Nurs 2024; 78:158-171. [PMID: 38944912 DOI: 10.1016/j.pedn.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/26/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE This study presents a systematic review of the obstacles to and enablers of family-centered care (FCC) implementation by nurses. FCC, which has demonstrated beneficial outcomes, is regarded as a crucial quality measure in certain pediatric units. However, not all nurses incorporate FCC into their practice. DESIGN AND METHODS A systematic review was conducted from January to June 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Various medical subject heading keywords and terms were used to search electronic databases, with the aim of synthesizing and evaluating the results. RESULTS Twenty-three articles were identified for review. Most of these studies were carried out in Western countries. They revealed several facilitators and obstacles to FCC implementation by nurses when caring for sick children. Some of these factors are linked to the personal attributes of the nurses, while others are associated with the characteristics of the families and the healthcare system itself. CONCLUSION Nurses face multi-level barriers that hinder their ability to implement FCC practice. This systematic review identifies the need to leverage nurses' attributes, foster effective nurse-client relationships, and promote organizational changes. PRACTICE IMPLICATIONS Nurses need to comprehend and work toward altering the factors that influence the delivery of FCC. The findings of this review can be used by healthcare organization leaders and policymakers to customize interventions and allocate resources to promote FCC practice. Further research in diverse cultural contexts is needed to examine the cause-and-effect relationship concerning the influence of the identified barriers and facilitators on FCC practice. In addition, experimental studies are required to evaluate the effectiveness of evidence-based interventions on FCC practice by nurses.
Collapse
Affiliation(s)
- Nada Alqarawi
- Department of Community, Psychiatric and Mental Health Nursing, College of Nursing, Qassim University, Buraydah, Saudi Arabia; College of Nursing, King Saud University, Riyadh, Saudi Arabia.
| | - Eman Alhalal
- Community and mental health nursing, Nursing college, King Saud University Riyadh, Saudi Arabia.
| |
Collapse
|
9
|
Nematifard T, Arsalani N, Nourozi Tabrizi K, Fallahi-Khoshknab M, Borimnejad L. Improvement of family-centered care in the pediatric rehabilitation ward: a participatory action research. Front Pediatr 2024; 12:1325235. [PMID: 38978840 PMCID: PMC11228933 DOI: 10.3389/fped.2024.1325235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/02/2024] [Indexed: 07/10/2024] Open
Abstract
Background and aim The improved life expectancy of children with disability in recent years has led to their increased request for using lifelong rehabilitation services. Family-centered care (FCC) is a model with potential positive effects on the rehabilitation of children with disability. The present study aimed at improving FCC in the pediatric rehabilitation ward. Methods This participatory action research was conducted in 2021-2023 in the pediatric rehabilitation ward of a hospital in Tehran, Iran. Participants were 16 rehabilitation staff and 48 mothers recruited via convenient and purposive sampling methods. Data were collected using semi-structured interviews, focus group discussions, and the 20-item and the 27-item Measures of the Processes Of Care (MPOC). Data were analyzed using qualitative content analysis as well as the Kolmogorov-Smirnov and the Wilcoxon's tests. Findings The major barrier to the implementation of FCC was staff and family limited knowledge about the importance and the benefits of FCC and the best facilitator to change was improvement of their knowledge. Therefore, an action plan based on staff and family education was designed and implemented. Participants' positive experiences of the plan were improvement of satisfaction, knowledge, collaboration, and coordination in care and their negative experiences were educational problems and dissatisfaction with the ward atmosphere. The strengths of the plan were adequate number of staff, long enough hospital stay of children, chronic course of disability, and mothers' previous experiences. Its weaknesses were the long course of a single action plan cycle, exclusive focus on education, and the high risk of plan termination after the study. The practical problems of the study were also small physical space of the ward, transfer of some trained staff to other wards, and child discharge from the hospital. Conclusion Staff and family limited knowledge about the importance and the benefits of FCC is a major barrier to effective FCC. Continuous education as well as family and staff collaboration may improve FCC in pediatric rehabilitation ward.
Collapse
Affiliation(s)
- Taban Nematifard
- Nursing and Midwifery Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Narges Arsalani
- Iranian Research Center on Aging, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kian Nourozi Tabrizi
- Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Leili Borimnejad
- Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Guez-Barber D, Pilon B. Parental impact during and after neonatal intensive care admission. Semin Perinatol 2024:151926. [PMID: 38964994 DOI: 10.1016/j.semperi.2024.151926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Parents play a pivotal role in neurodevelopmental outcomes of their children in the neonatal intensive care unit (NICU) and beyond. Integration of parents in clinical care and research is synergistic. Engaged parents yield more comprehensive clinical care and more robust and meaningful research products. Subsequently, successful clinical and research efforts improve outcomes for children. We review strategies for parental integration into NICU clinical care and research, including parental involvement in therapeutic interventions and neurodevelopmental care, and effective communication strategies for clinicians and researchers. We discuss challenges in neonatal trials and emphasize the need for building a culture of research, collaborative partnerships with patient advocacy organizations, and ongoing support beyond the NICU. Overall, we call for recognizing and fostering the impactful role of parents as teammates with clinicians and researchers in optimizing neurodevelopmental outcomes in the NICU and beyond.
Collapse
Affiliation(s)
- Danielle Guez-Barber
- Instructor, Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - Betsy Pilon
- Executive Director, Hope for HIE, West Bloomfield, MI 48325, USA
| |
Collapse
|
11
|
de Vos C, de Vos W, Widemann-Grolig A, van Wyk L, Sidler D, Goussard P. Parent experiences of the esophageal atresia journey during the early post-natal period: results from a support group perspective. Eur J Pediatr 2024:10.1007/s00431-024-05640-1. [PMID: 38864876 DOI: 10.1007/s00431-024-05640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 04/17/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
Surgically repaired esophageal atresia (EA) is associated with chronic esophageal and respiratory morbidity that require ongoing management. The care of chronically ill children can exert considerable stress on parents, thereby potentially affecting their mental well-being. In response to this, disease-specific support groups have emerged with the aim to bring together individuals facing similar challenges, facilitating the exchange of experiences within a nurturing environment, and providing essential emotional support. In the context of this international collaborative study, we investigated the role played by EA-specific support groups in promoting the emotional well-being of EA families. An anonymous online survey was distributed through a network comprising 12 international EA support groups affiliated with the Federation of Esophageal Atresia and Tracheoesophageal Fistula (EAT) during May and August of 2022. In the study, 96 parents from 23 different countries completed the survey. Fifty-six percent indicated a lack of interaction with other EA families during the initial diagnosis, with 91% expressing the belief that such contact would have been beneficial. Participants exhibited a unanimous recognition of the critical role played by disease-specific support groups in navigating the emotional journey associated with EA.Conclusion: The findings of this global survey align with existing literature, reaffirming the beneficial impact of disease-specific support groups tailored for EA patients and their families on their emotional well-being. These groups provide a valuable platform for the exchange of personal experiences and narratives, delivering advantages to both those who share their stories and those who receive this valuable information.
Collapse
Affiliation(s)
- Corné de Vos
- Division of Pediatric Surgery, Tygerberg Hospital, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, PO Box 19063, Tygerberg, 7505, South Africa.
- Esophageal Atresia Global Support Groups (EAT), Sommerrainstrasse 61, 70374, Stuttgart, Germany.
- Department of Pediatrics and Child Health, Tygerberg Hospital, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, PO Box 241, Tygerberg, 8000, South Africa.
| | - Werner de Vos
- Division of Surgery, Stellenbosch University, Francie Van Zijl Drive, PO Box 241, Cape Town, 8000, South Africa
- Esophageal Atresia Global Support Groups (EAT), Sommerrainstrasse 61, 70374, Stuttgart, Germany
| | - Anke Widemann-Grolig
- Esophageal Atresia Global Support Groups (EAT), Sommerrainstrasse 61, 70374, Stuttgart, Germany
| | - Lizelle van Wyk
- Department of Pediatrics and Child Health, Tygerberg Hospital, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, PO Box 241, Tygerberg, 8000, South Africa
| | - Daniel Sidler
- Center for Medical Ethics and Law, Faculty of Health and Sciences, Stellenbosch University, Tygerberg Campus, Tygerberg, 8000, South Africa
| | - Pierre Goussard
- Department of Pediatrics and Child Health, Tygerberg Hospital, Stellenbosch University and Tygerberg Hospital, Francie Van Zijl Drive, PO Box 241, Tygerberg, 8000, South Africa
| |
Collapse
|
12
|
Zuccotti G, Marsilio M, Fiori L, Erba P, Destro F, Zamana C, Folgori L, Mandelli A, Braghieri D, Guglielmetti C, Pisarra M, Magnani L, Infante G, Dilillo D, Fabiano V, Carlucci P, Zoia E, Pelizzo G, Calcaterra V. Leveraging User-Friendly Mobile Medical Devices to Facilitate Early Hospital Discharges in a Pediatric Setting: A Randomized Trial Study Protocol. CHILDREN (BASEL, SWITZERLAND) 2024; 11:683. [PMID: 38929262 PMCID: PMC11201467 DOI: 10.3390/children11060683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Mobile technology is increasingly prevalent in healthcare, serving various purposes, including remote health monitoring and patient self-management, which could prove beneficial to early hospital discharges. AIMS This study investigates the transitional care program experience facilitating early discharges in a pediatric setting through the use of an easy-to-use mobile medical device (TytoCare™, TytoCare Ltd., Natanya, Israel). OUTCOMES This study aims to assess the effectiveness of telehomecare in achieving complete resolution of diseases without readmission, compare the length of stay between intervention and standard care groups, and gather user and professional experiences. METHODS A randomized open-label, controlled pilot study enrolled 102 children, randomly assigned to the telehomecare (TELE) group (n = 51, adopting early hospital discharge with continued home monitoring) or the standard-of-care (STAND) group (n = 51). Primary outcomes include complete disease resolution without readmission. Secondary objectives include recording a shorter length of stay in the intervention group. Surveys on user and professional experiences were conducted. A group of 51 children declining telemedicine services (NO-TELE) was also included. RESULTS In the TELE group, 100% of children achieved complete disease resolution without readmission, with a median duration of stay of 4 days, significantly shorter than the 7 days in the STAND group (p = 0.01). The telemedicine system demonstrated efficient performance and high satisfaction levels. The NO-TELE group showed no significant differences in demographics or digital technology competence. Perceived benefits of telemedicine included time and cost savings, reduced hospital stays, and technology utility and usability. CONCLUSIONS This study demonstrates that user-friendly mobile medical devices effectively facilitate early hospital discharges in a pediatric setting. These devices serve as a bridge between home and hospital, optimizing care pathways.
Collapse
Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Marta Marsilio
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Laura Fiori
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Paola Erba
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Francesca Destro
- Pediatric Surgery Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (C.Z.)
| | - Costantino Zamana
- Pediatric Surgery Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (C.Z.)
| | - Laura Folgori
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Anna Mandelli
- Intensive Care Unit, Buzzi Children’s Hospital, 20154 Milan, Italy; (A.M.); (E.Z.)
| | - Davide Braghieri
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Martina Pisarra
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Letizia Magnani
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Gabriele Infante
- Department of Economics, Management and Quantitative Methods, University of Milan, 20122 Milan, Italy; (M.M.); (C.G.); (M.P.); (L.M.); (G.I.)
| | - Dario Dilillo
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Valentina Fabiano
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Patrizia Carlucci
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
| | - Elena Zoia
- Intensive Care Unit, Buzzi Children’s Hospital, 20154 Milan, Italy; (A.M.); (E.Z.)
| | - Gloria Pelizzo
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy; (D.B.); (V.F.); (G.P.)
- Pediatric Surgery Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (F.D.); (C.Z.)
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy; (L.F.); (P.E.); (L.F.); (D.D.); (P.C.); (V.C.)
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| |
Collapse
|
13
|
Darilek U, Finley E, McGrath J. A Narrative Review of NICU Implementation of Evidence-Based Early Relational Health Interventions. Adv Neonatal Care 2024; 24:253-267. [PMID: 38815279 DOI: 10.1097/anc.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Early relational health (ERH) interventions in the neonatal intensive care unit (NICU) buffer infants from toxic stress effects. Implementation science (IS) can guide successful uptake of evidence-based practice (EBP) ERH interventions. It is unknown if implementors of ERH interventions currently use the resources of IS to improve implementation. PURPOSE A narrative review of recent literature on implementation of ERH EBPs was completed to understand (a) which ERH interventions are currently being implemented in NICUs globally, (b) whether clinical implementors of ERH interventions have adopted the resources of IS, (c) existence of implementation gaps, and (d) implementation outcomes of ERH interventions in contemporary literature. DATA SOURCES Scopus, PubMed, and CINHAL were searched for original research regarding implementation of dyadic ERH interventions using key words related to IS and ERH. STUDY SELECTION For inclusion, ERH EBPs had to have been implemented exclusively in NICU settings, contained data addressing an IS domain, printed in English within the last 5 years. Twenty-four studies met inclusion criteria. DATA EXTRACTION Studies were distilled for intervention, IS domains addressed, location, aims, design, sample, and outcomes. RESULTS Eleven ERH interventions were described in the literature. Few studies utilized the resources of IS, indicating variable degrees of success in implementation. Discussions of implementation cost were notably missing. IMPLICATIONS FOR PRACTICE AND RESEARCH Implementors of ERH interventions appear to be largely unfamiliar with IS resources. More work is needed to reach clinicians with the tools and resources of IS to improve implementation outcomes.
Collapse
Affiliation(s)
- Umber Darilek
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr Darilek); Departments of Medicine and Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr Finley); Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Finley); and School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Dr McGrath)
| | | | | |
Collapse
|
14
|
Yinger OS, Jones A, Fallin-Bennett K, Gibbs C, Farr RH. Family-Centered Care for LGBTQ+ Parents of Infants in the Neonatal Intensive Care Unit: An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:615. [PMID: 38929195 PMCID: PMC11201882 DOI: 10.3390/children11060615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Having an infant in the Neonatal Intensive Care Unit (NICU) can disrupt parent well-being, the transition to parenthood, and the typical trajectories of infant and child health. For lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority identity (LGBTQ+) parents, this stress may be compounded by health disparities and fear of stigma and discrimination; however, research is lacking about LGBTQ+ parents of infants in the NICU. OBJECTIVES The purpose of this integrative review was to better understand the experiences of LGBTQ+ parents of NICU infants, with a focus on experiences of stigma and discrimination, sources of strength and resilience, and provision of family-centered care. METHOD We searched EBSCOHost, ProQuest, Web of Science, and Google Scholar between 30 May 2023 and 18 September 2023 for empirical studies published in English in peer-reviewed scholarly journals in which LGBTQ+ parents shared their experiences with having infants admitted to the NICU. RESULTS We identified six articles that met inclusion criteria, all of which were qualitative studies that included 12-14 LGBTQ+ parents of NICU infants. CONCLUSIONS LGBTQ+ parents in all studies reported instances of perceived stigma and discrimination while their infants were in the NICU, whereas parents in two studies mentioned strength and resilience, and parents in three studies described elements of family-centered care. There is a need for rigorous research on family-centered NICU care that includes questions about sources of strength and resilience in addition to challenges. We propose that future researchers use community engaged methods to center perspectives of LGBTQ+ parents.
Collapse
Affiliation(s)
- Olivia Swedberg Yinger
- School of Music, College of Fine Arts, University of Kentucky, Lexington, KY 40506, USA;
| | - Aubrey Jones
- College of Social Work, University of Kentucky, Lexington, KY 40506, USA;
| | - Keisa Fallin-Bennett
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY 40536, USA;
| | - Chelsea Gibbs
- School of Music, College of Fine Arts, University of Kentucky, Lexington, KY 40506, USA;
| | - Rachel H. Farr
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY 40506, USA;
| |
Collapse
|
15
|
Blagdon A, Smith D, Bramfield T, Soraisham A, Mehrem AA. Evaluation of family and staff experiences with virtual rounding and bedside presence in a tertiary neonatal intensive care unit during the COVID-19 pandemic. J Telemed Telecare 2024; 30:681-695. [PMID: 35350925 PMCID: PMC8968438 DOI: 10.1177/1357633x221081294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/21/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The COVID-19 pandemic-related visitation restrictions started in March 2020 in Alberta, Canada. In the Neonatal Intensive Care Unit, we implemented a Virtual Communications initiative to allow parents to continue to be present with their infants, attend daily rounds, and communicate with the medical team. The purpose of this survey study was to describe our approach and evaluate the experience for families and staff. METHODS The study surveys consisted of 13-18 questions directed toward understanding staff and family experience with the process and emotional impact using Likert scale and open-ended questions. The study team reviewed results and implemented changes in real time. Analysis was mixed quantitative and qualitative design, with descriptive data organized into themes. RESULTS Twenty-six surveys were completed by 16 staff (62%) and 10 parents (38%). About 50% to 100% of respondents agreed or strongly agreed with statements addressing the quality and value of the virtual sessions. Staff identified challenges with slow devices and need for awareness and education. Both staff and parents expressed gratitude for the initiative and an overall positive experience. DISCUSSION Offering Virtual Rounds and Bedside Presence in the Neonatal Intensive Care Unit is a well-received and feasible alternative to in-person presence that allows parents to stay involved and connected to their infants. Families have a better understanding of their babies' clinical status and plans with an overall positive experience.
Collapse
Affiliation(s)
- Ashley Blagdon
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dani Smith
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Tara Bramfield
- Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Amuchou Soraisham
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| |
Collapse
|
16
|
Çimke S, Yıldırım Gürkan D, Polat S. Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis. J Pediatr Nurs 2024; 76:199-206. [PMID: 38479074 DOI: 10.1016/j.pedn.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children. MATERIALS AND METHODS The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps. RESULTS A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS. CONCLUSION The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered. PRACTICAL IMPLICATIONS Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.
Collapse
Affiliation(s)
- Sevim Çimke
- Faculty of Health Sciences, Yozgat Bozok University, Turkey.
| | | | - Sevinç Polat
- Faculty of Health Sciences, Yozgat Bozok University, Turkey
| |
Collapse
|
17
|
Razdan S, Hedli LC, Sigurdson K, Profit J, Morton CH. Disparity drivers, potential solutions, and the role of a health equity dashboard in the neonatal intensive care unit: a qualitative study. J Perinatol 2024; 44:659-664. [PMID: 38155228 DOI: 10.1038/s41372-023-01856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Racial/ethnic disparities are well-described in the neonatal intensive care unit (NICU). We explored expert opinion on their etiology, potential solutions, and the ability of health equity dashboards to meaningfully capture NICU disparities. STUDY DESIGN We conducted 12 qualitative semi-structured interviews, purposively selecting a diverse group of neonatal experts. We used grounded theory to develop codes, shape interviews, and conduct analysis. RESULT We identified three sources of disparity: interpersonal bias, care process and institutional barriers, and social determinants of health, particularly as they affect parental engagement in the NICU. Proposed solutions included racial/cultural concordance, bolstering hospital-based resources, and policy interventions. Health equity dashboards were viewed as useful but limited, because clinical metrics do not account for many of the aforementioned sources of disparities. CONCLUSION Equity dashboards serve as a motivational starting point for quality improvement; future iterations may require novel, qualitative data sources to identify underlying etiologies of NICU disparities.
Collapse
Affiliation(s)
- Sheila Razdan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura C Hedli
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Krista Sigurdson
- School of Journalism, Writing, and Media, University of British Columbia, Kelowna, BC, Canada
| | - Jochen Profit
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine H Morton
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
18
|
Ullsten A, Campbell-Yeo M, Eriksson M. Parent-led neonatal pain management-a narrative review and update of research and practices. FRONTIERS IN PAIN RESEARCH 2024; 5:1375868. [PMID: 38689885 PMCID: PMC11058235 DOI: 10.3389/fpain.2024.1375868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills. Methods In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research. Results Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change. Conclusion Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.
Collapse
Affiliation(s)
- Alexandra Ullsten
- Center for Clinical Research and Education, Region Värmland, Karlstad, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- MOM-LINC Lab, IWK Health Halifax, Halifax, NS, Canada
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
19
|
Lee J. Neonatal family-centered care: evidence and practice models. Clin Exp Pediatr 2024; 67:171-177. [PMID: 37321589 PMCID: PMC10990654 DOI: 10.3345/cep.2023.00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
Although advances in neonatology have reduced the mortality rate of high-risk infants, sick newborns or pre-mature infants undergo more intensive monitoring, pain-ful procedures, and lengthy hospitalization, leading to pro-longed separation from their parents. In recent decades, the importance of parent-infant closeness early in life has become more apparent, especially in preterm infants who are prone to neurodevelopmental deficits. There is an increasing body of evidence regarding the benefits of family-centered care (FCC) in neonatal intensive care units. Key aspects related to neonatal FCC include the parents' presence in the ward and their participation in infants' daily care and decision-making processes. In addition, an environment that supports a private and comfortable space for each family member and infant, such as a single-family room, should be provided. To successfully implement FCC in neonatal intensive care units, the culture of care and hospital policies should be changed to successfully implement FCC in neonatal intensive care units, and appropriate training for medical staff is also required.
Collapse
Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
20
|
Feeley N, Kabajaasi O, Kenya-Mugisha N, Tagoola A, O'Brien K, Duby J. Benefits and Challenges of Implementing an Adaptation of Family Integrated Care in a Ugandan Setting. Adv Neonatal Care 2024; 24:172-180. [PMID: 38547483 DOI: 10.1097/anc.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Family Integrated Care (FICare) integrates parents as partners in neonatal intensive care unit care. Our team adapted and implemented this approach in a Ugandan unit for hospitalized neonates. PURPOSE This qualitative descriptive study examined the perceptions of mothers and healthcare professionals (HCPs) of the benefits and challenges of this new approach to care. METHODS Fifty-one mothers of hospitalized neonates born weighing greater than 2000 g participated in the program. They were taught to assess neonate danger signs, feeding, and weight. After discharge, a subsample (n = 15) participated in focus groups to explore benefits and challenges of their participation in care. Interviews with 8 HCPs were also conducted for the same purpose. Transcripts from focus groups and interviews were analyzed using inductive content analysis to describe the benefits and challenges from the perspectives of mothers and HCPs. RESULTS For mothers a benefit was decreased stress. Both mothers and HCPs reported that the knowledge and skills mothers acquired were a benefit as was their ability to apply these to the care of their neonate. Improved relations between mothers and HCPs were described, characterized by greater exchange of information and HCPs' attentiveness to mothers' assessments. Mothers felt ready for discharge and used their knowledge at home. HCPs noted a decrease in their workload. Challenges included the need for mothers to overcome fears about performing the tasks, their own well-being and literacy skills, and access to equipment. IMPLICATIONS FOR PRACTICE Mothers' participation in their neonates' care can have benefits for them and their neonate.
Collapse
Affiliation(s)
- Nancy Feeley
- Centre for Nursing Research, Jewish General Hospital & Lady Davis Institute for Medical Research, CIUSSS West-Central Montreal & Ingram School of Nursing, McGill University, Montreal, Québec, Canada (Dr Feeley); Walimu, Kampala, Uganda (Ms Kabajaasi and Dr Kenya-Mugisha); Department of Pediatrics, Jinja Regional Referral Hospital, Jinja, Uganda (Dr Tagoola); Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada (Dr O'Brien); and Department of Pediatrics, McGill University, Montreal, Québec, Canada (Dr Duby)
| | | | | | | | | | | |
Collapse
|
21
|
Horner S. Impact of Parent Presence and Engagement on Stress in NICU Infants. Adv Neonatal Care 2024; 24:132-140. [PMID: 38547480 DOI: 10.1097/anc.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Infants in neonatal intensive care units (NICUs) are exposed to frequent stressors that impact their neurodevelopmental outcomes. Parent presence and engagement are considered critical to improving infant outcomes, yet associations between cumulative NICU parent presence, engagement, and infant stress are infrequently examined. PURPOSE To examine associations between NICU infant stress and the amount (hours per week) or frequency (days per week) of parent presence and skin-to-skin care (SSC). METHODS A secondary analysis of a data set representing 78 NICU families was conducted. Infant acuity was measured using Neonatal Medical Index (NMI) scores. Parent presence and SSC data were collected from electronic medical records. Infant stress was measured using resting salivary cortisol levels collected at NICU discharge (median = 33 days of life). RESULTS More cumulative SSC was associated with lower discharge cortisol in NICU infants for SSC measured in hours per week (P = .03) or days per week (P = .05). Cumulative parent presence was not significantly associated with infant cortisol at discharge. Hierarchical regression analyses examining timing of parent presence supported a model including admission cortisol, NMI score, and parent presence during weeks 1 to 4 of life for explaining infant stress at discharge (R2 = 0.44, P = .004). Analyses examining timing of SSC supported a model including admission cortisol, NMI score, and frequency of SSC during week 1 for explaining infant stress at discharge (R2 = 0.21, P = .04). IMPLICATIONS FOR PRACTICE AND RESEARCH Early, frequent SSC to mitigate stress in NICU infants was supported. Results suggested that timing of parent presence impacts NICU infant stress; however, additional study is recommended.
Collapse
Affiliation(s)
- Susan Horner
- Author Affiliations: Loyola University Chicago, Chicago, Illinois; and Ann & Robert H. Lurie Children's Hospital, Lombard, Illinois
| |
Collapse
|
22
|
Sagaser A, Pilon B, Goeller A, Lemmon M, Craig AK. Parent Experience of Hypoxic-Ischemic Encephalopathy and Hypothermia: A Call for Trauma Informed Care. Am J Perinatol 2024; 41:586-593. [PMID: 35026852 PMCID: PMC9276837 DOI: 10.1055/a-1739-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Therapeutic hypothermia (TH) is the standard treatment for hypoxic-ischemic encephalopathy (HIE). We surveyed parents of infants treated with TH about their experiences of communication and parental involvement in the neonatal intensive care unit (NICU). STUDY DESIGN A 29-question anonymous survey was posted on a parent support (web site: https://www.hopeforhie.org ) and sent to members via e-mail. Responses from open-ended questions were analyzed using thematic analysis. RESULTS A total of 165 respondents completed the survey and 108 (66%) infants were treated with TH. 79 (48%) respondents were dissatisfied/neutral regarding the quality of communication in the NICU, whereas 127 (77%) were satisfied/greatly satisfied with the quality of parental involvement in the NICU. Six themes were identified as follows: (1) setting for communication: parents preferred face to face meetings with clinicians; (2) content and clarity of language: parents valued clear language (use of layman's terms) and being explicitly told the medical diagnosis of HIE; (3) immediate and longitudinal emotional support: parents required support from clinicians to process the trauma of the birth experience and hypothermia treatment; (4) clinician time and scheduling: parents valued the ability to join rounds and other major conversations about infant care; (5) valuing the parent role: parents desired being actively involved in rounds, care times, and decision-making; (6) physical presence and touch: parents valued being physically present and touching their baby; this presence was limited by the novel coronavirus disease 2019 (COVID-19)-related restrictions. CONCLUSION We highlight stakeholder views on parent involvement and parent-clinician communication in the NICU and note significant overlap with principles of trauma informed care: safety (physical and psychological), trustworthiness and transparency, peer support, collaboration and mutuality, empowerment, and voice and choice. We propose that a greater understanding and implementation of these principles may allow the medical team to more effectively communicate with and involve parents in the care of infants with HIE in the NICU. KEY POINTS · Parents of infants with HIE experience trauma both from the birth and the hypothermia treatment.. · Transparent communication and encouraging parental involvement can ameliorate this trauma..
Collapse
Affiliation(s)
- Anna Sagaser
- Department of Pediatrics, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA
| | | | | | - Monica Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexa K. Craig
- Department of Pediatrics, Division of Pediatric Neurology, Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA
| |
Collapse
|
23
|
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] [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.
Collapse
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
| |
Collapse
|
24
|
Aita M, De Clifford‐Faugère G, Laporte G, Colson S, Feeley N. Nurses' perceptions about neonatal intensive care units providing family-centered care are associated with skin-to-skin contact implementation. Pediatr Investig 2024; 8:61-65. [PMID: 38516142 PMCID: PMC10951481 DOI: 10.1002/ped4.12402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/08/2023] [Indexed: 03/23/2024] Open
Affiliation(s)
- Marilyn Aita
- Faculty of NursingUniversité de MontréalMontrealCanada
- CHU Sainte‐Justine Research CentreMontrealCanada
- Quebec Network on Nursing Intervention ResearchMontrealCanada
| | | | - Geneviève Laporte
- Faculty of NursingUniversité de MontréalMontrealCanada
- CHU Sainte‐Justine Research CentreMontrealCanada
| | - Sébastien Colson
- Quebec Network on Nursing Intervention ResearchMontrealCanada
- Faculty of Medical and Paramedical SciencesCEReSSAix‐Marseille UniversitéMarseilleFrance
| | - Nancy Feeley
- Quebec Network on Nursing Intervention ResearchMontrealCanada
- Ingram School of NursingMcGill UniversityMontrealCanada
- Centre for Nursing Research and Lady Davis InstituteJewish General HospitalMontrealCanada
| |
Collapse
|
25
|
Ventura Expósito L, Arreciado Marañón A, Gomà Tous M, Ferrerons Sánchez M, Zuriguel-Pérez E. Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey. J Clin Nurs 2024. [PMID: 38323664 DOI: 10.1111/jocn.17062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
AIMS AND OBJECTIVES (I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model. BACKGROUND Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. DESIGN Observational, descriptive, cross-sectional study. METHODS Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. RESULTS A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. CONCLUSIONS The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. RELEVANCE TO CLINICAL PRACTICE The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.
Collapse
Affiliation(s)
- Laia Ventura Expósito
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona. Cerdanyola del Vallès, Barcelona, Spain
- Vall Hebron Barcelona University Hospital (HUVH), Barcelona, Spain
- Multidisciplinary Nursing Research Group, Vall d' Hebron Research Institute (VHIR), Barcelona, Spain
| | - Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Cerdanyola del Vallès, Campus Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), Barcelona, Spain
| | | | - Mercè Ferrerons Sánchez
- Vall Hebron Barcelona University Hospital (HUVH), Barcelona, Spain
- Multidisciplinary Nursing Research Group, Vall d' Hebron Research Institute (VHIR), Barcelona, Spain
| | - Esperanza Zuriguel-Pérez
- Multidisciplinary Nursing Research Group, Vall d' Hebron Research Institute (VHIR), Barcelona, Spain
- Department of Knowledge Management and Evaluation, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
26
|
Raj M. Organizational and Policy Challenges and Priorities for Integrating Family Care Partners Into the Healthcare Team. Adv Health Care Manag 2024; 22:231-237. [PMID: 38262018 DOI: 10.1108/s1474-823120240000022011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Family care partners are significantly involved in healthcare tasks in order to support adult relatives. Yet, unlike pediatric models of care where caregivers of children are formally integrated into healthcare teams, care partners of adults are rarely engaged in a formal, structured, or consistent manner. Their inclusion in the healthcare team is critical to their capacity to continue supporting their relative. A meaningful dialogue between policy and healthcare management is required to identify feasible and effective ways of engaging family care partners in healthcare teams.
Collapse
|
27
|
Uveges MK, Hamilton JB, Pados BF, Thayer WM, Hinds PS, Nolan MT. Being a "Good Parent" to a NICU Infant With a Major Congenital Anomaly. Adv Neonatal Care 2024; 24:14-26. [PMID: 38232327 DOI: 10.1097/anc.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND In the United States, up to one-third of infants with a congenital anomaly require neonatal intensive care unit (NICU) hospitalization. Parents of these infants may have different decision-making priorities, which may be influenced by the timing of the infant's diagnosis. PURPOSE (1) To compare the ranked importance of decision-making beliefs for parents of infants who received a prenatal versus postnatal congenital diagnosis and (2) explore how parents describe their decision-making beliefs. METHODS A cross-sectional, sequential mixed-methods pilot design was applied to collect quantitative data using the Good Parent Ranking Exercise and further explore parents' decision-making beliefs through qualitative interviews. Maximum difference scaling/hierarchical Bayes estimation and content analysis were used to analyze the quantitative and qualitative data, respectively. RESULTS Forty mothers completed the Good Parent Ranking Exercise and 20 mothers completed qualitative interviews. Four of the top 5 ranked parenting beliefs were shared by mothers in the prenatal and postnatal groups. Mothers in the postnatal group ranked "focusing on my child's quality of life" higher. Qualitative interviews revealed that previously identified decision-making beliefs were consistent in this NICU parent population, with 1 additional belief identified. Mixed-methods analysis revealed high concordance between the prenatal and postnatal groups. IMPLICATIONS FOR PRACTICE NICU nurses need to know that decision-making beliefs for parents who receive a prenatal versus postnatal congenital diagnosis, while largely similar, may have differences. IMPLICATIONS FOR RESEARCH Future research should explore decision-making beliefs in demographically diverse parent groups (ie, fathers, partnered vs nonpartnered couples) and effective strategies for promoting NICU parents' decision-making beliefs.
Collapse
Affiliation(s)
- Melissa K Uveges
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Uveges); Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Hamilton); Infant Feeding Care, Wellesley Hills, Massachusetts (Dr Pados); School of Nursing, Johns Hopkins University, Baltimore, Maryland (Mr Thayer); Children's National Health System, Washington, District of Columbia (Dr Hinds); Department of Pediatrics, The George Washington University, Washington, District of Columbia (Dr Hinds); and Conway School of Nursing, The Catholic University of America, Washington, District of Columbia (Dr Nolan)
| | | | | | | | | | | |
Collapse
|
28
|
Rodrigues SM, Bounds DT, Terry J, Pinto MD, Shin S, Burton CW. Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children. Issues Ment Health Nurs 2024; 45:142-151. [PMID: 37699105 DOI: 10.1080/01612840.2023.2250000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.
Collapse
Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Dawn T Bounds
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Jennifer Terry
- Department of Gender & Sexuality Studies, University of California, Irvine, California, USA
| | - Melissa D Pinto
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Sanghyuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | | |
Collapse
|
29
|
Abukari AS, Schmollgruber S. Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study. Nurs Crit Care 2024. [PMID: 38228405 DOI: 10.1111/nicc.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. AIM To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. DESIGN The study employed a descriptive qualitative design. METHODS The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. RESULTS Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. CONCLUSION The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. RELEVANCE TO CLINICAL PRACTICE Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.
Collapse
Affiliation(s)
- Alhassan Sibdow Abukari
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
- Department of General Nursing, School of Nursing, Wisconsin International University College, Accra, Ghana
| | - Shelley Schmollgruber
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| |
Collapse
|
30
|
Oh WO, Lee A, Heo YJ. Transition in the Context of Parental Participation in Caring for Infants in Neonatal Intensive Care Units: An Evolutionary Concept Analysis. ANS Adv Nurs Sci 2024; 47:43-58. [PMID: 36656124 DOI: 10.1097/ans.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
While participating in the care for a baby in a neonatal intensive care unit, parents experience a transition in which they adapt to changes and reconstruct their roles and identities. However, there is no clear explanation for this concept of transition. The purpose of this study was to clarify this concept using Rodgers' evolutionary approach. The identified attributes of the concept were a process of learning, repeated undulating emotions, balancing a caring relationship with nurses, and embracing new roles and responsibilities. The findings can provide a knowledge base for future research aimed at enhancing nurses' understanding of transition and promoting parental participation.
Collapse
Affiliation(s)
- Won-Oak Oh
- College of Nursing, Korea University, Seoul, South Korea (Drs Oh and Heo); and College of Nursing, Yonsei University, Seoul, South Korea (Dr Lee)
| | | | | |
Collapse
|
31
|
Sturrock S, Sadoo S, Nanyunja C, Le Doare K. Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations. Res Rep Trop Med 2023; 14:121-134. [PMID: 38116466 PMCID: PMC10728307 DOI: 10.2147/rrtm.s410785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.
Collapse
Affiliation(s)
- Sarah Sturrock
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
| | - Samantha Sadoo
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Nanyunja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George’s, University of London, London, UK
- UK Health Security Agency, Salisbury, UK
- Makerere University, Johns Hopkins University, Kampala, Uganda
| |
Collapse
|
32
|
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] [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.
Collapse
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)
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Veldhorst C, Luijmes A, Kef S, Vervloed MPJ, Steenbergen B. Scoping review: quality of life of siblings of children who are deaf and hard of hearing, have a vision or motor impairment. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1227698. [PMID: 38035184 PMCID: PMC10682732 DOI: 10.3389/fresc.2023.1227698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023]
Abstract
This study identified the current state of knowledge about the Quality of Life (QoL) of siblings of children who are deaf and hard of hearing (DHH), have a vision impairment (VI) or motor impairment (MI). Additionally, factors associated with individual variation in QoL were examined. A scoping review was performed using PsycInfo, ERIC, Web of Science, and CINAHL. Empirical studies with siblings (age 0-18 years) of children who are DHH, have a VI or MI that investigate the QoL of siblings were included. A total of 1746 studies were identified of which 11 met the inclusion criteria. The results showed that QoL has different interpretations and various measurement tools are used. The findings showed both positive and negative outcomes for the QoL of siblings. For example, family cohesion was found as a positive consequence. A negative consequence could be a higher score on problem behavior. Personal and parental characteristics such as age and parental availability were two main factors related to individual variation in QoL. Insight in the factors related to individual variation may help researchers to consider the research perspective. In addition, healthcare providers can use the information to be either aware or intervene on specific factors that are related to the QoL of the children who are DHH, have a VI or MI and their siblings.
Collapse
Affiliation(s)
- Carlijn Veldhorst
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Anna Luijmes
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Sabina Kef
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | | | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| |
Collapse
|
34
|
Jaramillo M. Holistic nursing can improve family engagement. Nursing 2023; 53:37-39. [PMID: 37856299 DOI: 10.1097/01.nurse.0000978864.81948.c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
ABSTRACT Family engagement is relevant to patient outcomes and ensures patient efficacy, support, and quality of life. Such engagement is facilitated by holistic nursing methods. This article discusses the importance of and barriers to family engagement and practical strategies for its implementation.
Collapse
|
35
|
Pricoco R, Mayer-Huber S, Paulick J, Benstetter F, Zeller M, Keller M. Impact of a family-centred clinical care programme on short-term outcomes of very low-birth weight infants. Acta Paediatr 2023; 112:2368-2377. [PMID: 37551158 DOI: 10.1111/apa.16944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
AIM We evaluated the effects of a family-centred clinical care pathway and case management programme on short-term clinical outcome in a cohort of very low-birth weight (VLBW) infants. METHODS The programme, named NeoPAss, was developed at the Department of Neonatology Children's hospital Passau in 2013. Short-term outcomes of infants were compared to matched controls from the Bavarian neonatology surveillance database before (n = 111; 2008-2012) and after implementation (n = 170; 2014-2017). RESULTS After implementation the rate of late-onset sepsis was significantly lower (2.5% vs. 10.7%, p = 0.005) and the length of stay was significantly shorter (VLBW 28 to 31 weeks' gestational age (GA) 47.5 vs. 53.1 days, p = 0.047; <28 weeks' GA 79.4 vs. 91.9 days, p = 0.007) in the intervention group compared to controls. Infants were discharged with significantly lower weight (mean 2351 vs. 2539 g, p = 0.013). There was no statistically significant difference in the rate of intraventricular haemorrhage (3.7% vs. 8.2%), necrotizing enterocolitis (0.6% vs. 1.9%) and bronchopulmonary dysplasia (0% vs. 6.9%). CONCLUSION Our data confirm that of other studies demonstrating a beneficial effect of family-centred care programmes and provides evidence that structured parental involvement is not associated with increased risk of infection in a VLBW cohort.
Collapse
Affiliation(s)
- Rafael Pricoco
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Johannes Paulick
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Michael Zeller
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
- Kinderklinik Dritter Orden, Passau, Germany
| | - Matthias Keller
- Department of Pediatrics, Technical University of Munich, School of Medicine, Munich, Germany
- Kinderklinik Dritter Orden, Passau, Germany
| |
Collapse
|
36
|
Simbar M, Kiani Z, Nazarpour S, Babaei F. Development and validation of the code of ethics for midwives in Iran. BMC Med Ethics 2023; 24:76. [PMID: 37794351 PMCID: PMC10548606 DOI: 10.1186/s12910-023-00963-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Considering ethical issues in midwifery care is essential for improving the quality of health services and the client's satisfaction. This study aimed to develop and validate the code of ethics for Midwives in Iran (ICEM). MATERIALS AND METHODS This was a mixed sequential study that was performed in three phases including a qualitative study, a review, and the content validity assessment. The first phase was a qualitative study with a content analysis approach. The data were collected by conducting in-depth semi-structured individual interviews with 14 midwifery and ethics experts. The purposive sampling method was used to recruit the participants and sampling continued until data saturation. The data were analyzed using the conventional content analysis described by Graneheim and Lundman. Lincoln and Guba's criteria were used to confirm the trustworthiness of the data. Then, a narrative review of the selected national and international codes of ethics for Midwives was performed to complete the items of the ICEM. For validity assessment, the face and content validity of the items of ICEM was assessed by 15 experts to calculate the content validity ratio (CVR) and index (CVI). RESULTS Fourteen experts were interviewed in the qualitative phase, and 207 codes were extracted from a content analysis which were categorized into 23 sub-categories and 6 main categories. The extracted codes were considered as the items for ICEM that were completed by a review of the selected national and international code of ethics for Midwives. The content validity and ratio assessment of the items demonstrated an average CVI = 0.92 and CVR = 0.85. Then, the final version of ICEM was developed with 92 items in 6 domains about; 1) "professional Commitments" with 30 items; 2) "providing midwifery services to the client and her companions" with 26 items; 3) "relationship with colleagues" with 11 items; 4) "herself" with 6 items; 5) "education and research" with 8 items; and, 6) "management" with 11 items. CONCLUSION ICEM was prepared with 92 items in six sections that facilitate its use for midwives who are working in the different fields of care, counseling, education, research, and management. In this new version of the ICEM, the items related to recent social-, scientific, and technical improvements were considered for providing ethical midwifery care.
Collapse
Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Nazarpour
- Department of Midwifery, Chalous Branch, Islamic Azad University, Chalous, Iran
| | - Farah Babaei
- Department of Midwifery, Deputy of Curative Affairs, Ministry of Health, Education and Treatment, Tehran, Iran
| |
Collapse
|
37
|
Simbar M, Kiani Z, Nazarpour S, Babaei F. Development and validation of the code of ethics for midwives in Iran. BMC Med Ethics 2023; 24:76. [DOI: https:/doi.org/10.1186/s12910-023-00963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
Abstract
Background
Considering ethical issues in midwifery care is essential for improving the quality of health services and the client's satisfaction. This study aimed to develop and validate the code of ethics for Midwives in Iran (ICEM).
Materials and methods
This was a mixed sequential study that was performed in three phases including a qualitative study, a review, and the content validity assessment. The first phase was a qualitative study with a content analysis approach. The data were collected by conducting in-depth semi-structured individual interviews with 14 midwifery and ethics experts. The purposive sampling method was used to recruit the participants and sampling continued until data saturation. The data were analyzed using the conventional content analysis described by Graneheim and Lundman. Lincoln and Guba’s criteria were used to confirm the trustworthiness of the data. Then, a narrative review of the selected national and international codes of ethics for Midwives was performed to complete the items of the ICEM. For validity assessment, the face and content validity of the items of ICEM was assessed by 15 experts to calculate the content validity ratio (CVR) and index (CVI).
Results
Fourteen experts were interviewed in the qualitative phase, and 207 codes were extracted from a content analysis which were categorized into 23 sub-categories and 6 main categories. The extracted codes were considered as the items for ICEM that were completed by a review of the selected national and international code of ethics for Midwives. The content validity and ratio assessment of the items demonstrated an average CVI = 0.92 and CVR = 0.85. Then, the final version of ICEM was developed with 92 items in 6 domains about; 1) "professional Commitments" with 30 items; 2) "providing midwifery services to the client and her companions” with 26 items; 3) “relationship with colleagues" with 11 items; 4) “herself” with 6 items; 5) “education and research” with 8 items; and, 6) “management” with 11 items.
Conclusion
ICEM was prepared with 92 items in six sections that facilitate its use for midwives who are working in the different fields of care, counseling, education, research, and management. In this new version of the ICEM, the items related to recent social-, scientific, and technical improvements were considered for providing ethical midwifery care.
Collapse
|
38
|
Shuman CJ, Morgan M, Vance A. Integrating Neonatal Intensive Care Into a Family Birth Center: Describing the Integrated NICU (I-NIC). J Perinat Neonatal Nurs 2023:00005237-990000000-00019. [PMID: 37773333 DOI: 10.1097/jpn.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Parent-infant separation resulting from admission to a neonatal intensive care unit (NICU) is often reported as the most challenging and distressing experience for parents. Aiming to mitigate the stress of parent-infant separation, a new neonatal care model was designed to integrate NIC with delivery and postpartum care. Yet, little is known about the model and its implementation. METHODS Using a qualitative descriptive design with field observations, we describe the characteristics of an integrated-neonatal intensive care (I-NIC) model and examined perceptions of clinical staff (n = 8) and parents (n = 3). RESULTS The physical layout of the I-NIC rooms required additional oxygen and suction columns and new signage to specify them as NICU-equipped. Other NICU-related equipment was mobile, thus moved into rooms when necessary. Nurses were cross-trained in labor/delivery, postpartum, neonatal care; however, nurses primarily worked within their specific area of expertise. Clinician and parent perceptions of the model were notably positive, reporting decreased anxiety related to separation, increased ability for chest feeding and skin-to-skin care, and improved interdisciplinary care. CONCLUSION Future work is needed to understand implementation of the model in other settings, with specific attention to unit architecture, level of NICU care services, patient census, and staff and patient outcomes.
Collapse
Affiliation(s)
- Clayton J Shuman
- Department of Systems, Populations, and Leadership, University of Michigan, Ann Arbor (Dr Shuman and Ms Morgan); and Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance)
| | | | | |
Collapse
|
39
|
Juncker HG, Naninck EFG, van Keulen BJ, Harinck JE, Schipper L, Lucassen PJ, van Goudoever JB, de Rooij SR, Korosi A. Maternal stress is associated with higher protein-bound amino acid concentrations in human milk. Front Nutr 2023; 10:1165764. [PMID: 37743929 PMCID: PMC10513938 DOI: 10.3389/fnut.2023.1165764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/10/2023] [Indexed: 09/26/2023] Open
Abstract
Background Maternal stress in the postpartum period affects not only the mother but also her newborn child, who is at increased risk of developing metabolic and mental disorders later in life. The mechanisms by which stress is transmitted to the infant are not yet fully understood. Human milk (HM) is a potential candidate as maternal stress affects various components of HM, e.g., fat and immunoglobulin concentrations. To date, it is unknown whether maternal stress also affects the amino acids (AAs) in HM, even though this nutrient is of extreme importance to child health and development. This study aimed to investigate whether and how maternal stress is associated with the AA composition of HM. Methods In this observational cohort study (Amsterdam, The Netherlands), lactating women were recruited in two study groups: a high-stress (HS) group; women whose child was hospitalized (n = 24), and a control (CTL) group; women who gave birth to a healthy child (n = 73). HM was collected three times a day, on postpartum days 10, 17, and 24. Perceived psychological stress was measured using validated questionnaires, while biological stress measures were based on hair, saliva, and HM cortisol concentrations. HM protein-bound and free AAs were analyzed by liquid chromatography and compared between groups. Results Maternal perceived stress scores were higher in the HS group (p < 0.01). The concentrations of protein-bound AAs in HM were higher in the HS group compared to the CTL group (p = 0.028) and were positively associated with HM cortisol concentrations (p = 0.024). The concentrations of free AAs did not differ between study groups and were unrelated to cortisol concentrations. Conclusion Findings from this prospective cohort study suggest that maternal stress in the postpartum period is associated with an altered human milk amino acid composition, which could play a role in the transmission of maternal stress effects to her child. The physiological implications of these stress-induced changes for infant development await future research.
Collapse
Affiliation(s)
- Hannah G. Juncker
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Eva F. G. Naninck
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Britt J. van Keulen
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Jolinda E. Harinck
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Paul J. Lucassen
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes B. van Goudoever
- Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Susanne R. de Rooij
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam, Netherlands
| | - Aniko Korosi
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
40
|
Neshat H, Hassankhani H, Jabraeili M, Negarandeh R. Organisational challenges of pain management in neonatal intensive care unit: a qualitative study. BMJ Open 2023; 13:e072695. [PMID: 37669843 PMCID: PMC10481740 DOI: 10.1136/bmjopen-2023-072695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES Despite credible evidence, optimal neonates' pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing challenges vary depending on the context, and investigating them can help to improve the quality of care. The study aimed to explore organisational challenges to neonates' pain management in the NICU. METHODS This qualitative study included 31 nurses and physicians in the NICU of Children's Hospital, Tabriz, Iran. Data collection was done through individual and focus group interviews. For data analysis, we used conventional content analysis. RESULTS The identified challenges included organisational culture (poor interprofessional collaboration and low parental participation), organisational structure (lack of unified approach in relieving pain and limited supervision for pain management) and organisational resources (lack of time due to high workload and inadequate educational programmes). CONCLUSIONS Many organisational factors consistently affect neonatal pain management. Adopting some approaches to enhance the cooperation of treatment team members, holding educational programmes, proper organisational supervision and implementing a unified neonatal-based pain management programme could improve neonatal pain management.
Collapse
Affiliation(s)
- Hanieh Neshat
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Hadi Hassankhani
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mahnaz Jabraeili
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Reza Negarandeh
- Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| |
Collapse
|
41
|
Ding L, Chen Y, Zhang W, Song J, Yao X, Wan Y, Huang R. Effect of family integrated care on breastfeeding of preterm infants: A scoping review. Nurs Open 2023; 10:5950-5960. [PMID: 37306324 PMCID: PMC10416000 DOI: 10.1002/nop2.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
AIMS The aims are to describe the key components of family integrated care intervention for preterm infants in the neonatal intensive care unit (NICU) and assess the impact on breastfeeding outcomes for those infants. DESIGN A scoping review. METHODS We conducted a systematic study search based on the databases, including PubMed, Scopus, Cochrane, Web of Science, MEDLINE, CINAHL, CNKI and Wanfang Database in December 2022. The search time ranged from database establishment to 31 December 2022. Papers by manual searching were also listed on the references. We adopted Joanna Briggs Institute Reviewer's Manual methodology and followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to conduct the review. Two independent reviewers filtered the papers, extracted data and synthesized the findings. A table was used to extract data and synthesize results. RESULTS After systematic searching, 11 articles that implemented family integrated care (FIcare) were finally included in this scoping review. By analysing the implementation of this nursing model, we identified seven main components: NICU staff training, parent education, parent participation in infants' care, parent involvement in medical plans, peer support, NICU environmental support and mobile app for parents. Based on the extracted breastfeeding data, this scoping review concludes that family integrated care shows a positive effect on increasing breastfeeding rates at discharge. Through this scoping review, we find that family integrated care is feasible and it can support breastfeeding of preterm infants. Further studies will be needed to provide more evidence that family integrated care could facilitate breastfeeding of preterm infants. IMPACT This scoping review provides evidence for the positive role of family integrated care on breastfeeding outcomes. The analysis may contribute to the implementation of family integrated care. NO PATIENT OR PUBLIC CONTRIBUTION No further public or patient contribution was made in view of the review-based nature of the research.
Collapse
Affiliation(s)
- Lijing Ding
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yanli Chen
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Wenyan Zhang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Jianqi Song
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiao Yao
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Yue Wan
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Rong Huang
- Nursing Department, Shanghai First Maternity and Infant Hospital, School of MedicineTongji UniversityShanghaiChina
| |
Collapse
|
42
|
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, SWITZERLAND) 2023; 10:1482. [PMID: 37761442 PMCID: PMC10527908 DOI: 10.3390/children10091482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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.
Collapse
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
| | | |
Collapse
|
43
|
de Souza DM, Fernandes RDF, Costa CTDS, Borghi CA, Rossato LM. From theory to practice: the inclusion of hospitalized children's families in painful procedures. Rev Esc Enferm USP 2023; 57:e20230152. [PMID: 37624383 PMCID: PMC10453425 DOI: 10.1590/1980-220x-reeusp-2023-0152en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To understand nursing team professionals' strategies to include the family in painful procedures performed on hospitalized children. METHOD An exploratory-descriptive, qualitative study, carried out with nursing professionals. Data were collected through semi-structured interviews, guided by a script of topics, transcribed and submitted to thematic content analysis, in the light of Symbolic Interactionism, discussed considering the Family-Centered Care philosophy assumptions. RESULTS Two central categories emerged, "Theoretical perspective: the family as a care agent in painful procedures" and "Practical perspective: experiences, challenges and strategies in painful procedures for family inclusion", with their respective subcategories. CONCLUSION Nursing professionals have theoretical knowledge about family inclusion in painful procedures based on the assumptions: Family-Centered Care: dignity and respect; information sharing; joint participation; and family collaboration. However, knowledge is not applied in clinical practice; consequence of the interaction between beliefs and attitudes unfavorable to family presence.
Collapse
Affiliation(s)
- Danton Matheus de Souza
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | | | | | | | - Lisabelle Mariano Rossato
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
| |
Collapse
|
44
|
Yu M, Zhu S. Effects of family centered nursing model on children with primary nephrotic syndrome: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34601. [PMID: 37603508 PMCID: PMC10443777 DOI: 10.1097/md.0000000000034601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Family-centered nursing model has been widely used in the care of children patients, but there is still a lack of research on the care of children with primary nephrotic syndrome (PNS). Therefore, the aim of this study was to comprehensively evaluate the effects of family-centered nursing on children with PNS. METHODS The electronic databases included China National Knowledge Internet, Wanfang Data Knowledge Service Platform, VIP, PubMed, Web of Science, Cochrane Library, and Embase, were searched to collect randomized controlled trials on family-centered nursing model in the treatment of children with PNS. Fixed effect models or fixed effect models were used to analyze the outcomes. The primary outcomes were length of hospital stay and nursing satisfaction, and the second outcomes were quality of life (QoL) and behavioral problems. RESULTS A total of 12 studies involving 996 pediatric patients were included, of which 500 children received family centered care and 496 children received routine care. The results showed that family centered nursing model could significantly improve the QoL of children with PNS (P < .05), increase the nursing satisfaction of family members (P < .0001, SMD = 7.37, 95%CI = 4.15-13.08), reduce the time of hospitalization (P < .0001, standard mean difference [SMD] = -2.30, 95%CI = -2.57 to -2.03), and decrease the scores of psychosomatic disorders and impulsivity hyperactivity in children with PNS (P < .0001, SMD = -3.13, 95%CI = -4.12 to -2.15; P < .0001, SMD = -3.29, 95%CI = -4.29 to -2.28). However, there was no significant statistical difference in the impact on the scores of conduct problems, learning problems, anxiety, and hyperactivity (P > .05). CONCLUSION Family-centered nursing model can improve the QoL of children with PNS, increase the nursing satisfaction of family members and reduce the length of hospital stay, but further research need to verify its impact on behavioral problems.
Collapse
Affiliation(s)
- Miaolei Yu
- The Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuzhen Zhu
- The Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
45
|
Franck LS, Gay CL, Hoffmann TJ, Kriz RM, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs. BMC Pediatr 2023; 23:396. [PMID: 37563722 PMCID: PMC10413600 DOI: 10.1186/s12887-023-04211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms. METHOD This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches. RESULTS 178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes. CONCLUSION Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.
Collapse
Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA.
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, UCSF, San Francisco, CA, USA
| | - Rebecca M Kriz
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Diana M Cormier
- NICU and Pediatrics, Community Regional Medical Center, Fresno, CA, USA
| | - Priscilla Joe
- Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | | | - Yao Sun
- Division of Neonatology, Department of Pediatrics, UCSF, San Francisco, CA, USA
| |
Collapse
|
46
|
Stein Duker LI, Kwon J, Richter M, Pineda R. Feasibility of wearable sensors in the NICU: Psychophysiological measures of parental stress. Early Hum Dev 2023; 183:105814. [PMID: 37429198 PMCID: PMC11062485 DOI: 10.1016/j.earlhumdev.2023.105814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Parents report elevated stress during their infant's NICU hospitalization. Real-time measures may improve our understanding of parental stress in the NICU. AIM Examine the feasibility of wearable sensors to describe parental stress in the NICU. STUDY DESIGN In this prospective feasibility study of 12 parent-infant dyads, parents wore an Empatica E4 wristband to measure psychophysiological stress via electrodermal activity (EDA) during sensory interventions (holding, massage, reading, touch, etc) with their babies. Baseline and intervention periods were delineated during which concurrent monitoring and clinical observations of infant behavior and environmental factors were recorded. Feasibility was assessed by investigating recruitment/enrollment, retention/adherence, acceptability, sensor usability, and changes in EDA waveforms based on potential stressors. For the latter, independent samples t-tests and ANOVA were used to examine differences in EDA from baseline to intervention, and the impact of environmental and infant factors on parent stress were visually analyzed against EDA waveforms. RESULTS Wearable sensor use in the NICU appeared feasible as assessed by all methods. Preliminary data analysis indicated that overall parent EDA levels during parent-infant interactions were low, and engagement in sensory intervention(s) led to a non-significant increase in parental EDA, measured by both skin conductance levels and non-specific skin conductance responses. Three main patterns of EDA emerged: a temporary increase in EDA at the beginning of the intervention followed by a decrease and plateau, a plateau in EDA from baseline to intervention, and a gradual rise in EDA throughout intervention. Specific environmental and infant factors, such as infant stress and health care providers entering the room, appeared to impact parent stress levels. CONCLUSION Although these preliminary findings provide support for use of EDA in the NICU, future studies are needed.
Collapse
Affiliation(s)
- Leah I Stein Duker
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jenny Kwon
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Marinthea Richter
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA; Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
47
|
Schuler R, Woitschitzky L, Eiben C, Beck J, Jägers A, Windhorst A, Kampschulte B, Petzinger J, Waitz M, Kilsdonk MORV, Neubauer BA, Zimmer KP, Ehrhardt H, Brosig B, Mihatsch WA. Multidimensional assessment of infant, parent and staff outcomes during a family centered care enhancement project in a tertiary neonatal intensive care unit: study protocol of a longitudinal cohort study. BMC Pediatr 2023; 23:344. [PMID: 37420180 PMCID: PMC10326953 DOI: 10.1186/s12887-023-04165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The therapeutic advances and progress in the care for preterm infants have enabled the regular survival of very immature infants. However, the high burden of lifelong sequelae following premature delivery constitutes an ongoing challenge. Regardless of premature delivery, parental mental health and a healthy parent-child relationship were identified as essential prerogatives for normal infant development. Family centered care (FCC) supports preterm infants and their families by respecting the particular developmental, social and emotional needs in the Neonatal Intensive Care Unit. Due to the large variations in concepts and goals of different FCC initiatives, scientific data on the benefits of FCC for the infant and family outcome are sparse and its effects on the clinical team need to be elaborated. METHODS This prospective single centre longitudinal cohort study enrols preterm infants ≤ 32 + 0 weeks of gestation and/or birthweight ≤ 1500 g and their parents at the neonatal department of the Giessen University Hospital, Giessen, Germany. Following a baseline period, the rollout of additional FCC elements is executed following a stepwise 6-months approach that covers the NICU environment, staff training, parental education and psychosocial support for parents. Recruitment is scheduled over a 5.5. year period from October 2020 to March 2026. The primary outcome is corrected gestational age at discharge. Secondary infant outcomes include neonatal morbidities, growth, and psychomotor development up to 24 months. Parental outcome measures are directed towards parental skills and satisfaction, parent-infant-interaction and mental health. Staff issues are elaborated with particular focus on the item workplace satisfaction. Quality improvement steps are monitored using the Plan- Do- Study- Act cycle method and outcome measures cover the infant, the parents and the medical team. The parallel data collection enables to study the interrelation between these three important areas of research. Sample size calculation was based on the primary outcome. DISCUSSION It is scientifically impossible to allocate improvements in outcome measures to individual enhancement steps of FCC that constitutes a continuous change in NICU culture and attitudes covering diverse areas of change. Therefore, our trial is designed to allocate childhood, parental and staff outcome measures during the stepwise changes introduced by a FCC intervention program. TRIAL REGISTRATION Clinicaltrials.gov, trial registration number NCT05286983, date of registration 03/18/2022, retrospectively registered, http://clinicaltrials.gov .
Collapse
Affiliation(s)
- Rahel Schuler
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany.
| | - Lea Woitschitzky
- Department of Psychosomatic Medicine, Justus-Liebig-University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Carola Eiben
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Judith Beck
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Alena Jägers
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Anita Windhorst
- Institute of Medical Informatics, Justus -Liebig -University, 35392, Giessen, Germany
| | - Birgit Kampschulte
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Jutta Petzinger
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Markus Waitz
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | | | - Bernd A Neubauer
- Department of Neuropediatrics, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus- Liebig- University, Feulgenstrasse 12, 35392, Giessen, Germany
- Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Burkhard Brosig
- Department of Psychosomatic Medicine, Justus-Liebig-University, Feulgenstrasse 12, 35392, Giessen, Germany
| | - Walter A Mihatsch
- Department of Pediatrics, University of Ulm, Ulm, Germany
- University of Applied Sciences, Neu Ulm, Germany
| |
Collapse
|
48
|
Haeusslein L, Gano D, Gay CL, Kriz RM, Bisgaard R, Vega M, Cormier DM, Joe P, Walker V, Kim JH, Lin C, Sun Y, Franck LS. Relationship between social support and post-discharge mental health symptoms in mothers of preterm infants. J Reprod Infant Psychol 2023; 41:260-274. [PMID: 34587850 PMCID: PMC8960471 DOI: 10.1080/02646838.2021.1984404] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Social support is associated with decreased symptoms of postpartum mood and anxiety disorders (PMAD) in mothers of healthy infants, but less is known about social support and PMADs in mothers with preterm infants. The purpose of this study was to examine the relationship between social support and symptoms of PMADs reported by mothers in the months following hospital discharge of their preterm infant. METHODS Mothers of infants less than 33 weeks gestational age were enrolled from neonatal intensive care units (NICU) at 6 sites. Mothers completed PMAD measures of depression, anxiety and post-traumatic stress approximately 3 months following their infant's discharge. Multivariable regression was used to evaluate relationships between social support and PMAD measures. RESULTS Of 129 mothers, 1 in 5 reported clinically significant PMAD symptoms of: depression (24%), anxiety (19%), and post-traumatic stress (20%). Social support was strongly inversely associated with all 3 PMADs. Social support explained between 21% and 26% of the variance in depression, anxiety and post-traumatic stress symptoms. CONCLUSION Increased social support may buffer PMAD symptoms in mothers of preterm infants after discharge. Research is needed to determine effective screening and interventions aimed at promoting social support for all parents during and following their infant's hospitalisation.
Collapse
Affiliation(s)
- Laurel Haeusslein
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Dawn Gano
- Department of Neurology and Pediatrics, UCSF
| | - Caryl L. Gay
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca M. Kriz
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children’s Hospital, San Francisco
| | - Myrna Vega
- Intensive Care Nursery, UCSF Benioff Children’s Hospital, San Francisco
| | | | - Priscilla Joe
- Division of Neonatology, UCSF Benioff Children’s Hospital, Oakland
| | - Valencia Walker
- Department of Pediatrics, Division of Neonatology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jae H. Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children’s Hospital Medical Center
| | - Carol Lin
- Division of Neonatology, Kaiser Permanente Santa Clara
| | - Yao Sun
- Division of Neonatology, UCSF Benioff Children’s Hospital, San Francisco
| | - Linda S. Franck
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
49
|
Razdan S, Hedli L, Sigurdson K, Profit J, Morton C. Disparities and Equity Dashboards in the Neonatal Intensive Care Unit: A Qualitative Study of Expert Perspectives. RESEARCH SQUARE 2023:rs.3.rs-3002217. [PMID: 37461712 PMCID: PMC10350244 DOI: 10.21203/rs.3.rs-3002217/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Objective Racial/ethnic disparities are well-described in the neonatal intensive care unit (NICU). We explore expert opinion on their root causes, potential solutions, and the ability of health equity dashboards to meaningfully address NICU disparities. Study Design We conducted 12 qualitative semi-structured interviews, purposively selecting a diverse group of neonatal experts. We used grounded theory to develop codes, shape interviews, and conduct analysis. Result Participants identified three sources of disparity: interpersonal bias, care process barriers, and social determinants of health, particularly as they affect parental engagement in the NICU. Proposed solutions included racial/cultural concordance, bolstering hospital-based resources, and policy interventions. Health equity dashboards were viewed as useful but limited because clinical metrics do not account for many of the aforementioned sources of disparities. Conclusion Equity dashboards serve as a motivational starting point for quality improvement; future iterations may require novel, qualitative data sources to identify underlying etiologies of NICU disparities.
Collapse
|
50
|
Ottosen M, Eloi H, Lyons M. Engaging patients as teachers in a baccaulaureate nursing reproductive health care course: A qualitative study. NURSE EDUCATION TODAY 2023; 128:105859. [PMID: 37348405 DOI: 10.1016/j.nedt.2023.105859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/01/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Teaching nursing students about the principles and practical application of person-centered care is an essential yet challenging component of nursing education. Integrating patients as teachers to share their personal stories of maternity care can elicit positive outcomes toward students achieving course objectives. OBJECTIVES To determine how the educational experience of having patients as teachers in the classroom could influence students' awareness of patients' perceptions of their maternity care, delivering person-centered care and the roles of nursing in their future practice. DESIGN Retrospective qualitative study of student reflections. SETTINGS Reproductive health course within a BSN program. PARTICIPANTS Ninety-nine second semester BSN student reflections. METHODS Two course faculty and a qualitative nurse researcher conducted a thematic content analysis of written student reflections. RESULTS Three primary themes emerged from the students' reflections of hearing patient and family advisors describe their maternity experiences: 1) awareness of the impact of nursing practice on patient and family well-being, 2) awareness of personal biases and emotions about difficulties in maternity care, and 3) appreciation to hear from patients directly as part of didactic coursework. CONCLUSIONS Including patients as teachers is an enhanced method to aid nursing students in understanding the humanistic and impactful roles of nursing in the clinical setting.
Collapse
Affiliation(s)
- Madelene Ottosen
- Department of Graduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 681, Houston, TX 77030, United States of America.
| | - Hildreth Eloi
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 787, Houston, TX 77030, United States of America.
| | - Mandi Lyons
- Department of Undergraduate Studies, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 764, Houston, TX 77030, United States of America.
| |
Collapse
|