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Orr E, Ballantyne M, Gonzalez A, Jack SM. Providers' perspectives of the neonatal intensive care unit context and care provision for adolescent parents: an interpretive description. BMC Pregnancy Childbirth 2023; 23:259. [PMID: 37069591 PMCID: PMC10107570 DOI: 10.1186/s12884-023-05553-1] [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: 07/28/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The neonatal intensive care unit (NICU) is a complex care environment, with the NICU patient population among the most vulnerable in a hospital setting. Adolescent parents are a unique group within the broader NICU parent population and admission of their infant to the NICU contributes to an already complex situation as adolescent pregnancy and parenting is often associated with a range of psychosocial challenges. How the NICU care context influences care provision for adolescent parents is a significant gap in the NICU parenting and support discourse. Therefore, this study aimed to explore health and social care providers' perspectives of the NICU care context and how providers perceive the context as influencing the experiences of adolescent parents in the NICU. METHODS This was a qualitative, interpretive description study design. In-depth interviews were conducted with providers, including nurses and social workers, caring for adolescent parents in the NICU. Data was collected between December 2019 and November 2020. Data were analyzed concurrently with data collection. Constant comparison, analytic memos, and iterative diagramming techniques were used to challenge developing analytic patterns. RESULTS Providers (n = 23) described how the unit context influenced care provision as well as experiences for adolescent parents. We learned that having a baby in the NICU was perceived by providers as a traumatic experience for parents - impacting attachment, parenting confidence and competence, and mental health. Environmental factors - such as privacy and time - and perceptions that adolescent parents are treated differently in the NICU were also seen as influencing this overall experience. CONCLUSIONS Providers involved in the care of adolescent parents in the neonatal intensive care unit described the distinctiveness of this group within the broader parent population and how quality of care may be impacted by contextual factors as well as experiences of age-related stigma. Further understanding of NICU experiences from the parents' perspectives are warranted. Findings highlight opportunities for strengthened interprofessional collaboration and trauma- and violence-informed care strategies within the neonatal intensive care environment to mitigate the potential negative influence of this experience and improve care for adolescent parents.
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Affiliation(s)
- Elizabeth Orr
- Department of Nursing, Brock University, Faculty of Applied Health Sciences, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada.
| | - Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Younge T, Jacobs M, Tuchman L, Streisand R, Soghier L, Fratantoni K. Sociodemographic risk factors, parental stress and social support in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2023; 108:165-169. [PMID: 36805477 DOI: 10.1136/archdischild-2022-324119] [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: 03/09/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Investigate relationships among neonatal intensive care unit (NICU) parent demographics, reported stress and social support. DESIGN Cross-sectional observation. SETTING Tertiary referral NICU in Mid-Atlantic USA. PATIENTS Parents (n=300) in the Giving Parents Support trial at enrolment. MEASURES Psychometric scales measured general stress, parental stress, NICU stress and social support. Demographic variables included education level, health insurance type, race, relationship status, age and gender. Length of stay was used to control for illness severity. Associations and potential modifying effects were evaluated using linear regression. RESULTS Having less than a college degree (b=-2.52, SE=0.91) and female parent gender (b=-3.42, SE=1.47) were associated with lower parental stress scores. Older age in years was associated with higher parental stress scores (b=0.21, SE=0.07) but lower NICU stress scores (b=-0.01, SE=0.01). Greater social support scores were associated with lower scores of general (b=-2.76, SE=0.39) and parental stress (b=-1.71, SE=0.47). Less than a college degree (b=-0.26, SE=0.11), Medicaid insurance (b=-0.43, SE=0.11) and black race (b=-0.56, SE=0.12) were associated with decreased social support scores. Level of social support modified the relationship between education and parental stress, with higher social support decreasing education-based differences in parental stress scores (p=0.049). CONCLUSION Sociodemographic risk factors may not infer stress or risk in the anticipated direction. Practice and future research should focus on identifying and supporting NICU families at high risk for stress and low support. TRIAL REGISTRATION NUMBER NCT02643472.
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Affiliation(s)
- Tamiko Younge
- Division of Neonatology, Children's National Hospital, Washington, DC, USA
| | - Marni Jacobs
- Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, USA.,Department of OBGYN & Reproductive Sciences, UCSD, La Jolla, California, USA
| | - Lisa Tuchman
- Division of Adolescent and Young Adult Medicine, Children's National Hospital, Washington, DC, USA
| | - Randi Streisand
- Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC, USA
| | - Lamia Soghier
- Division of Neonatology, Children's National Hospital, Washington, DC, USA
| | - Karen Fratantoni
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA
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Orr E, Ballantyne M, Gonzalez A, Jack SM. Mobilizing Forward: An Interpretive Description of Supporting Successful Neonatal Intensive Care Unit-To-Home Transitions for Adolescent Parents. QUALITATIVE HEALTH RESEARCH 2022; 32:831-846. [PMID: 35316117 PMCID: PMC9152603 DOI: 10.1177/10497323221079785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pregnancy and parenting in adolescence and the transition home following the hospitalization of an infant in the neonatal intensive care unit (NICU) are two relatively complex phenomena; and whilst each have been consistently explored within the relevant literature, little is understood about the care required when they intersect. Using interpretive description methodology to guide our exploration, we conducted semi-structured interviews with 23 expert providers caring for adolescent parents involved in NICU-to-home transitions to describe this process in their practice. Findings suggest that supporting successful NICU-to-home transitions for adolescent parents relied strongly on understanding the impact of the NICU experience, establishing therapeutic relationships and facilitating supportive partnerships between the NICU and parents as well as the NICU and supportive services post-discharge. Findings highlight the opportunity for more integrated models of care within the NICU and extending into the community to address the complex biopsychosocial care needs of this parent population.
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Affiliation(s)
- Elizabeth Orr
- Department of Nursing, Brock University Faculty of Applied Health
Science, St. Catharines, Ontario, Canada
| | - Marilyn Ballantyne
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Holland Bloorview Kids Rehabilitation
Hospital, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural
Neurosciences, McMaster University, Hamilton, Ontario, Canada
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The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis' Transitions Theory Applied. ANS Adv Nurs Sci 2020; 43:349-359. [PMID: 33136587 DOI: 10.1097/ans.0000000000000299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Quality care for individuals and families during periods of transition is one of the major issues facing health care systems and providers today. The transition-home from the neonatal intensive care unit (NICU) as experienced by adolescent mothers is poorly understood-placing young mothers and their infants at risk of poor outcomes following NICU discharge. Meleis' Transitions Theory offers a unique theoretical perspective for understanding this transition experience and also serves to highlight the complexity of the NICU-to-home transition for this population of young mothers that is not currently elucidated in the literature.
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The influence of anemia on maternal and neonatal outcomes in adolescent pregnant. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.393143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fullerton BS, Velazco CS, Sparks EA, Morrow KA, Edwards EM, Soll RF, Modi BP, Horbar JD, Jaksic T. Contemporary Outcomes of Infants with Gastroschisis in North America: A Multicenter Cohort Study. J Pediatr 2017; 188:192-197.e6. [PMID: 28712519 DOI: 10.1016/j.jpeds.2017.06.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/13/2017] [Accepted: 06/06/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To quantify outcomes and analyze factors predictive of morbidity and mortality in infants with gastroschisis. STUDY DESIGN Clinical data regarding neonates with gastroschisis born between 2009 and 2014 were prospectively collected at 175 North American centers. Multivariate regression was used to assess risk factors for mortality and length of stay (LOS). RESULTS Gastroschisis was diagnosed in 4420 neonates with median birth weight 2410 g (IQR 2105-2747). Survival (discharge home or alive in hospital at 1 year) was 97.8% with a 37 day median LOS (IQR 27-59). Sepsis, defined by positive blood or cerebrospinal fluid culture, was the only significant independent predictor of mortality (P = .04). Significant independent determinants of LOS and the percentage of neonates affected were as follows: bowel resection (9.8%, P < .0001), sepsis (8.6%, P < .0001), presence of other congenital anomalies (7.6%, including 5.8% with intestinal atresias, P < .0001), necrotizing enterocolitis (4.5%, P < .0001), and small for gestational age (37.3%, P = .0006). Abdominal surgery in addition to gastroschisis repair occurred in 22.3%, with 6.4% receiving gastrostomy or jejunostomy tubes and 6.3% requiring ostomy creation. At discharge, 57.0% were less than the 10th percentile weight for age. The mode of delivery (52.4% cesarean delivery) was not associated with any differences in outcome. CONCLUSIONS Although neonates with gastroschisis have excellent overall survival they remain at risk for death from sepsis, prolonged hospitalization, multiple abdominal operations, and malnutrition at discharge. Outcomes appear unaffected by the use of cesarean delivery. Further opportunities for quality improvement include sepsis prevention and enhanced nutritional support.
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Affiliation(s)
- Brenna S Fullerton
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
| | - Cristine S Velazco
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Eric A Sparks
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT; University of Vermont, Burlington, VT
| | - Roger F Soll
- Vermont Oxford Network, Burlington, VT; University of Vermont, Burlington, VT
| | - Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT; University of Vermont, Burlington, VT
| | - Tom Jaksic
- Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
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Abstract
Neonatologists receive highly varied and largely inadequate training to acquire and maintain communication and palliative care skills. Neonatology fellows often need to give distressing news to families and frequently face unique communication challenges. While several approaches to teaching these skills exist, practice opportunities through simulation and role play will likely provide the most effective learning.
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Affiliation(s)
- Natalia Henner
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E, Chicago Ave, Box 36, Chicago, IL 60611-2605.
| | - Renee D Boss
- Division of Neonatology, Johns Hopkins School of Medicine, Berman Institute of Bioethics, Baltimore, MD
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Soliman SE, Ulster A, MacDonald H, VandenHoven C, Toi A, Hèon E, Gallie B. Psychosocial determinants for treatment decisions in familial retinoblastoma. Ophthalmic Genet 2017; 38:392-394. [DOI: 10.1080/13816810.2016.1227458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sameh E. Soliman
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Alissa Ulster
- Department of Social Work, The Hospital For Sick Children, Toronto, Ontario, Canada
| | - Heather MacDonald
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cynthia VandenHoven
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ants Toi
- Department of Medical Imaging, Mt. Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Elise Hèon
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Brenda Gallie
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Departments of Medical Biophysics and Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
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Rossman B, Meier PP, Janes JE, Lawrence C, Patel AL. Human Milk Provision Experiences, Goals, and Outcomes for Teen Mothers with Low-Birth-Weight Infants in the Neonatal Intensive Care Unit. Breastfeed Med 2017; 12:351-358. [PMID: 28557525 PMCID: PMC5512322 DOI: 10.1089/bfm.2017.0035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Breastfeeding rates are virtually unknown for teen mothers whose low-birth-weight (LBW; <2500 gm) infants are hospitalized in the neonatal intensive care unit (NICU). The objective was to examine the infant feeding experiences, goals, and outcomes of teen mothers of LBW infants. METHODS We conducted a multimethod study using a qualitative research design, survey, and infant medical records. The primary data source was individual interviews conducted with teen mothers of LBW infants hospitalized in a tertiary NICU. Content analysis and descriptive statistics were used for data analysis. RESULTS All 15 teen mothers (12 black, 3 Hispanic) wanted what was best for their infants and initiated lactation by breast pump. However, maintaining lactation was challenging and the following barriers were identified: fear of being judged; body image issues; influence of the maternal grandmother; and disorganized thought processes about combining pumping with returning to school or work. Despite these barriers, 50% of the teen mothers met their goals for human milk provision at NICU discharge. CONCLUSION Most of the teen mothers' lactation barriers reflected their adolescent developmental stage. Potential interventions are identified and include focus groups with teen mothers and maternal grandmothers and lactation support by NICU-based teen breastfeeding peer counselors.
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Affiliation(s)
| | - Paula P Meier
- 2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois.,3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
| | - Judy E Janes
- 2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois
| | - Christie Lawrence
- 1 Rush University College of Nursing , Chicago, Illinois.,2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois
| | - Aloka L Patel
- 2 Department of Pediatrics, Rush University Children's Hospital , Chicago, Illinois.,3 Department of Pediatrics, Rush University Medical Center , Chicago, Illinois
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von Hauff P, Long K, Taylor B, van Manen MA. Antenatal consultation for parents whose child may require admission to neonatal intensive care: a focus group study for media design. BMC Pregnancy Childbirth 2016; 16:103. [PMID: 27180192 PMCID: PMC4867091 DOI: 10.1186/s12884-016-0898-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For parents whose child may require admission to a neonatal intensive care unit (NICU), the antenatal consultation is often their first point of contact with the child's medical team. Consultation challenges health professionals, as parents may be anxious, overwhelmed, or even exhausted by what is and what might occur. Despite consultation being a common practice, there is a paucity of research on how to support practitioners and parents. The purpose of this study was to gain insights into important relational aspects of antenatal consultation that may be used to spur the development of media to support consultation. METHODS Focus group, as a data collection method, was employed to gather insights about antenatal consultation from a total of 50 hospital staff and 17 NICU parents from a large urban NICU program in western Canada. Qualitative content analysis was applied to the obtained materials to explicate themes that may serve as necessary understandings for media design. RESULTS Participating hospital staff and parents expressed their desire for a good antenatal consultation with comments grouped under the following themes: supporting the building of a caring relation; sharing information in conversation; and, preparing for what is to come. CONCLUSIONS To support the emerging relations of baby, parent, and hospital staff, a good antenatal consultation needs to convey care, understanding, and empathy; create possibilities for open and genuine conversations; and, foster the buildings of respect, confidence, and trust.
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Affiliation(s)
| | - Karen Long
- Northern Alberta Neonatal Program, Edmonton, AB, Canada
| | | | - Michael A van Manen
- University of Alberta, Edmonton, AB, Canada.
- Northern Alberta Neonatal Program, Edmonton, AB, Canada.
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