[Developmental centered care. Situation in Spanish neonatal units]

Modifications in family centered developmental care and in neonatal intensive care during the COVID-19 pandemic in a hospital in Spain: A qualitative study

INTRODUCTION

Family centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC.

OBJECTIVES

To understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19.

METHODS

A qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses' narratives and discourses.

RESULTS

Three open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality.

CONCLUSIONS

The nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

Spanish adaptation and validation of the empowerment of parents in the intensive care-neonatology (EMPATHIC-N) questionnaire

INTRODUCTION

Parental satisfaction is rarely measured in the neonatal intensive care unit due to a lack of specific assessment tools. The Empowerment of Parents in The Intensive Care-Neonatology (EMPATHIC-N) questionnaire is an instrument to assess satisfaction in relation to family-centred care that has been validated in several countries, but not Spain.

OBJECTIVES

To perform the translation and cultural adaptation of the EMPATHIC-N to Spanish followed by its validation for the purpose of assessing satisfaction in parents with children admitted to the neonatal intensive care unit.

MATERIAL AND METHODS

The questionnaire first underwent forward and backward translation and transcultural adaptation by a panel of experts through a standardized process based on the Delphi method, followed by a pilot study in 8 parents and then a cross-sectional study in the neonatal intensive care unit of a tertiary care hospital to assess the reliability and converging validity of the Spanish version.

RESULTS

The study proved the comprehensibility, validity, feasibility, applicability and usefulness of the Spanish version of the EMPATHIC-N in the field of paediatric health after being evaluated by 19 professionals and 60 parents. The content validity was found to be excellent (0.93). The reliability and convergent validity of the Spanish version of the EMPHATIC-N was analysed in a sample of 65 completed questionnaires. The Cronbach α for each domain was greater than 0.7, indicating a high internal consistency. We assessed validity by analysing the correlation of the 5 domains with the with the 4 general satisfaction items. The validity was found to be adequate (rs, 0.4-0.76; P < .01).

CONCLUSIONS

The Spanish version of the EMPATHIC-N questionnaire is a comprehensible, useful, valid and reliable instrument to measure satisfaction in the parents of children admitted to neonatal care units.

Exploring Public Perceptions of Dental Care Affordability in the United States: A Mixed Method Analysis via Twitter

BACKGROUND

Dental care expenses are reported to present higher financial barriers than any other type of health care service in the United States. Social media platforms such as Twitter have become a source of public health communication and surveillance. Previous studies have demonstrated the usefulness of Twitter in exploring public opinion on aspects of dental care. To date, no studies have leveraged Twitter to examine public sentiments regarding dental care affordability in the U.S.

OBJECTIVE

The aim of this study was to understand public perceptions of dental care affordability in the U.S. on the social media site, Twitter.

METHODS

Tweets posted between September 1, 2017 and September 30, 2021 were collected using the Snscrape application. Query terms were selected a priori to represent dentistry and financial aspects associated with dental treatment. Data were analyzed qualitatively using both deductive and inductive approaches. Ten percent of all included tweets were coded to identify prominent themes and subthemes. The entire sample of included tweets were then independently coded into the thematic categories. Quantitative data analyses included: geographic distribution of tweets by state; volume analysis of tweets over time; distribution of tweets by content theme.

RESULTS

A final sample of 5,314 tweets were included in the study. Thematic analysis identified the following prominent themes: 1) general sentiments (1614 tweets, 30.4%); 2) delaying or forgoing dental care (1190 tweets, 22.4%); 3) payment strategies (1019 tweets, 19.2%); 4) insurance (767 tweets, 14.4%); and 5) policy statements (724 tweets, 13.6%). Geographic distributions of tweets established California, Texas, Florida, New York as the states with the most tweets. A word cloud revealed that "insurance", "need", and "work" were the most frequently used words. Qualitative analysis revealed barriers faced by individuals to accessing dental care, strategies taken to cope with dental pain, and public perceptions on aspects of dental care policy. The volume and thematic trends of tweets corresponded to relevant societal events: The Coronavirus disease 2019 (COVID-19) pandemic and debates on healthcare policy resulting from the election of President Joseph R. Biden.

CONCLUSIONS

Findings illustrate the real-time sentiment of social media users toward the cost of dental treatment and suggest shortcomings in funding that may be representative of greater systemic failures in the provision of dental care. Thus, this study provides insights for policy makers and dental professionals who strive to increase access to dental care.

The Impact of a Preterm Baby Arrival in a Family: A Descriptive Cross-Sectional Pilot Study

BACKGROUND

The rate of premature births is increasing every day, with an estimated 15 million premature babies born worldwide each year. When a child is born prematurely, he or she is transferred to a Neonatal Intensive Care Unit (NICU), requiring special care on an ongoing basis. The admission of the newborn to these units can negatively affect the family routine as it generates changes and requires adaptation to new roles.

OBJECTIVES

The objective of the present study was to understand the effect of the arrival of a premature baby on the family, based on the parents' perception.

METHODS

A cross-sectional descriptive observational study conducted by means of a self-administered online ad-hoc questionnaire which collected information related to the situation of the relatives of premature infants in the region of Extremadura (Spain). The questionnaire consisted of a total of 35 questions, divided into three sections: 'family environment', 'stay in hospital' and 'return home'.

RESULTS

Among the 53 responses obtained from fathers and mothers, 44 were from mothers. 53.6% of the respondents felt a delay in the acquisition of their parental role and 86.8% were afraid for their baby. During hospital stay, most of the parents had to modify their routines (94.3%), 69.8% suffered from sleep disturbances, 84.9% changed their eating habits and 88.5% referred to loss of time for themselves. Once at home, the time it took to recover their family normality ranged from 4 to 11 months, while 84.9% of respondents neglected their personal appearance and more than half had to give up or reduce their working hours.

CONCLUSION

The arrival of a premature baby has a strong impact on the parents' family environment, altering their daily routines and occupations both in hospital and at home. If preterm care programmes take into account these possible occupational imbalances, it will not only meet the needs of the parents but also provide family-centred care.

Eight principles for newborn care in neonatal units: Findings from a national survey

AIM

To assess, at national level, the implementation of eight principles for infant- and family-centred developmental care (IFCDC) in neonatal units. A European expert group established eight 'Principles of care' in 2018 that define neurodevelopmental and family-centred care.

METHODS

The implementation of each principle was assessed by a survey sent to level-III Spanish units. A principle was considered to be implemented if all answers to the principle-associated questions were positive.

RESULTS

The response rate was 84.5% (65/77). No unit had implemented eight principles. Principle 1 (free parental access) was implemented in 21.5% of the centres; Principle 2 (psychological support) 40%; Principle 3 (pain management) 7.7%; Principle 4 (environmental influences) 29%; Principle 5 (postural support) 84.6%; Principle 6 (kangaroo-care) 67.7%; Principle 7 (breastfeeding) 23% and Principle 8 (sleep protection) in 46%. In units attending ≥50 very low birth weight (VLBW) infants, four or more principles had been implemented in 31% vs 13% <50 VLBW neonates (odds ratio 3.0 CI 95% 0.9-10.1, P .07).

CONCLUSION

The principle with the highest implementation was related to newborn body positioning. Pain management was the principle with lowest implementation. More principles for IFCDC tend to be implemented in units providing care for a higher number of VLBW infants.

Reduction of visual and auditory stimuli to reduce pain during venipuncture in premature infants. Study protocol for a randomized controlled trial

AIM

To evaluate the efficacy of the reduction of visual and auditory stimuli on pain during venipuncture in premature newborns of 32-36 weeks of gestation.

DESIGN

Open, randomized, non-blind parallel clinical trial.

METHOD

Study to take place at the neonatal intensive care unit of a University Hospital in 2019-2021. Fifty-six recently born babies between 32-36 weeks of gestation will participate. The dependent variable is the level of pain determined using the premature infant pain profile instrument. The intervention will be assigned randomly using the random.org software. Data analysis will be carried out using the IBM SPSS v.25 software assuming a level of significance of 5%.

DISCUSSION

The evidence for the efficacy of reducing sensory stimulation and its effect on pain in minor procedures has not been studied in depth. There are no studies that evaluate the reduction of visual and auditory stimuli in a combined way.

IMPACT

It is easy to incorporate the reduction of visual and auditory stimuli into nursing practice. The results of this study could have a direct impact on clinical practice. Trial registered at clinicaltrials.gov: NCT04041635.

Quality of attachment in infants less than 1500g or less than 32weeks. Related factors

BACKGROUND

Prematurity carries a high risk of mortality and sequelae, altering the bonding process and leading to repercussions in terms of attachment.

OBJECTIVE

To assess the type of attachment in children under 32weeks' gestational age (GA) or below 1500g, in hospitals where development-centred care has been implemented and to study the association between various types of attachment and certain neonatal and family characteristics.

METHOD

Children <1500g or <32weeks GA who were born or admitted before 48h of life to one of two hospitals in Madrid between January and December 2012 were candidates for the study. The type of attachment was assessed through the strange situation procedure (SSP). Attachment was classified according to three types: secure (B), avoidant (A), or resistant/ambivalent (C). Insecure attachment was considered to be A+C. Children were assessed at a corrected age of 2years using the Bayley III Scales and SSP. Data on the characteristics of the parents and children were collected.

RESULTS

A total of 59% (117/199) of the children <1500g or <32weeks GA born in 2012 in the two study hospitals were able to be evaluated. Secure attachment was found in 64% (75/117), avoidant attachment in 12.8% (15/117), and resistant/ambivalent in 23.1% (27/117). The children with secure attachment had a score of 107.6±16 in the cognitive area of the Bayley's Scale versus 98.8±18.8 in those with insecure attachment (p 0.007). Frequency of secure attachment at ≤26weeks GA was 23% (3/13) versus 69% (72/104) in children >26weeks GA (p 0.003).

CONCLUSIONS

Nearly two-thirds of the children studied presented secure attachment, which was associated with better cognitive development. The frequency of secure attachment is lower in the children born more preterm.