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Akkaş N, Geçkil E. Family-Centered Care Scale in Neonatal Intensive Care Unit (FCCS-NICU): Development and psychometrics evaluation. J Pediatr Nurs 2023; 72:168-176. [PMID: 36517315 DOI: 10.1016/j.pedn.2022.11.031] [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: 05/25/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The study was conducted to develop FCC Scale in Neonatal Intensive Care Units (FCCS-NICU) and to test its validity and reliability. METHODS This methodological study was conducted with 484 mothers whose neonates were hospitalized in the NICU of four different hospitals in Konya, Turkey. Data were collected with the mother and neonate information form and FCCS-NICU, and analyzed with Items Analysis, Cronbach's alpha, Exploratory Factor Analysis, and Confirmatory Factor Analysis tests. RESULTS A 48-item pool was created for the draft FCCS-NICU based on the family-centered care model. The Content Validity Index of the scale was found to be popular opinion 0.95. In the Exploratory Factor Analysis, a four-factor structure with 29 items emerged. These four factors explained 53.23% of the total variance. The subscales were named dignity and respect (7 items), information sharing (9 items), participation in care (5 items), and collaboration with the family (8 items). The parallel form correlation coefficient was 0.80, the test-retest correlation coefficient was 0.76 (p < .001). The Cronbach's Alpha was found 0.94 for a total scale. The Confirmatory factor analysis confirmed the four-factor structure. CONCLUSIONS We provide a valid and reliable scale to evaluate FCC and associated factors in NICU. FCCS-NICU can be used as a tool in descriptive research to assess FCC and identify associated factors. PRACTICE IMPLICATION It can be used as a tool in experimental studies to develop FCC.
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Affiliation(s)
- Neslihan Akkaş
- Neonatal Intensive Care Unit of Konya City Hospital, Konya, Turkey
| | - Emine Geçkil
- Department of Pediatric Nursing, Nursing Faculty, Necmettin Erbakan University, Konya, Turkey.
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Zanoni P, Scime NV, Benzies K, McNeil DA, Mrklas K. Facilitators and barriers to implementation of Alberta family integrated care (FICare) in level II neonatal intensive care units: a qualitative process evaluation substudy of a multicentre cluster-randomised controlled trial using the consolidated framework for implementation research. BMJ Open 2021; 11:e054938. [PMID: 34663673 PMCID: PMC8524282 DOI: 10.1136/bmjopen-2021-054938] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the barriers and facilitators to implementing Alberta Family Integrated Care (AB-FICare [2019 Benzies]), a model of care for integrating parents into level II neonatal intensive care units (NICUs) care teams, from the perspective of healthcare providers (HCP) and hospital administrators. DESIGN Qualitative process evaluation substudy. SETTING Ten level II NICUs in six cities across Alberta, Canada. PARTICIPANTS HCP and hospital administrators (n=32) who were involved in the cluster-randomised controlled trial of AB-FICare in level II NICUs. METHODS Post-implementation semi-structured interviews were conducted via phone or in-person. The Consolidated Framework for Implementation Research was used to develop interview guides, code transcripts and analyse data. RESULTS Key facilitators to implementation of AB-FICare included (1) a receptive implementation climate, (2) compatibility of the intervention with individual and organisational practices, (3) available resources and access to knowledge and information for HCP and hospital administrators, (4) engagement of key stakeholders across the organisation, (5) engagement of and outcomes for intervention participants, and (6) reflecting and evaluating on implementation progress and patient and family outcomes. Barriers were (1) design quality and packaging of the intervention, (2) relative priority of AB-FICare in relation to other initiatives, and (3) learning climate within the organisation. Mixed influences on implementation depending on contextual factors were coded to eight constructs: intervention source, cost, peer pressure, external policy and incentives, staff needs and resources, structural characteristics, organisational incentives and rewards, and knowledge, beliefs and attitudes. CONCLUSIONS The characteristics of an organisation and the implementation process had largely positive influences, which can be leveraged for implementation of AB-FICare in the NICU. We recommend site-specific consultations to mitigate barriers and assess how swing factors might impact implementation given the local context, with the goal that strategies can be put in place to manage their influence on implementation. TRIAL REGISTRATION NUMBER NCT02879799.
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Affiliation(s)
- Pilar Zanoni
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Deborah A McNeil
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Kelly Mrklas
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Clinical Excellence, Alberta Health Services, Calgary, Alberta, Canada
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Effects of single family room architecture on parent-infant closeness and family centered care in neonatal environments-a single-center pre-post study. J Perinatol 2021; 41:2244-2251. [PMID: 34230604 PMCID: PMC8440171 DOI: 10.1038/s41372-021-01137-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/23/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of a single family room architecture in a neonatal intensive care unit (SFR-NICU) on parents' presence, parent-infant skin-to-skin contact (SSC) and the quality of family centered care. STUDY DESIGN Two cohorts of parents of preterm infants were compared: those in the unit before and after the move to SFR-NICU. The parents used daily diaries to report their presence and SSC, and they responded to daily text message questions about the quality of family centered care. RESULTS Parents spent more time in the SFR-NICU, but no significant change was found in SSC. Parents rated the quality of family centered care highly in both unit architectures, without a change in rating after the move. CONCLUSION The SFR-NICU increased parents' presence but not SSC. The change in architecture did not affect parents' evaluations of the quality of family centered care, which was already highly rated before the move.
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Çelik K, Asena M, İpek MŞ. The trends in the usage of breast milk in neonatal intensive care setting. Pediatr Int 2020; 62:1064-1072. [PMID: 32315473 DOI: 10.1111/ped.14263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many interventions have been designed to increase breast milk (BM) consumption among preterm and critical-term infants in neonatal units. The aim of this study was to determine the trends in the usage of BM in a neonatal unit and the risk factors for insufficient breast-milk feeding at discharge. METHODS This retrospective study included newborn infants who hospitalized in the neonatal unit during two periods in different years, a 15-month period in 2012-2013 and in 2017-2018. The primary outcomes were the availability of BM within 24 h after delivery and the status of infant feeding at discharge. RESULTS During two periods of the study, a total of 3,018 infants were included in the study. The rate of BM expression within the first 24 h after delivery was 92.9%, and it was found that the first period of the study, caesarean section delivery, very low birth weight, being first-time mother, and young maternal age were each independently associated with the delayed initiation of BM expression (P < 0.05). At discharge, 87.6% of the infants had been feeding with BM. Multiple births, the delayed initiation of BM expression, and the length of hospital stay were associated with inadequate BM feeding at discharge (P < 0.001). CONCLUSION This study showed that interventions supporting BM feeding, which have recently been carried out, made improvements to the initiation of BM expression among mothers whose babies were admitted to the neonatal unit, and in the rate of BM feeding among infants at discharge.
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Affiliation(s)
- Kıymet Çelik
- Division of Neonatology, Department of Pediatrics, University of Health Science Gaziyaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Muhammed Asena
- Department of Pediatrics, University of Health Science Gaziyaşargil Education and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Şah İpek
- Division of Neonatology, Department of Pediatrics, Memorial Dicle Hospital, Diyarbakir, Turkey
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Vetcho S, Cooke M, Ullman AJ. Family-Centred Care in Dedicated Neonatal Units: An Integrative Review of International Perspectives. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jnn.2019.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Oude Maatman SM, Bohlin K, Lilliesköld S, Garberg HT, Uitewaal-Poslawky I, Kars MC, van den Hoogen A. Factors Influencing Implementation of Family-Centered Care in a Neonatal Intensive Care Unit. Front Pediatr 2020; 8:222. [PMID: 32435628 PMCID: PMC7219204 DOI: 10.3389/fped.2020.00222] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Approximately 10% of all births worldwide are preterm. Often these infants are admitted at a Neonatal Intensive Care Unit (NICU). The NICU environment with periods of unnatural light, noise and repeated disturbances is very stressful for infants admitted to the NICU. In addition separation of parents causes stress for both infant and parents. A way to support and include parents in the care for their infants is Family-Centered Care (FCC). FCC is an approach of planning, delivery and evaluation of healthcare, based on a partnership between healthcare professionals and families of patients. Parents of infants who were admitted to an FCC unit were less stressed compared to parents at a Standard Care unit. Aim: Although FCC is beneficial to families and patients, implementation can be challenging. Therefore it is important to know which factors can contribute or withhold the implementation of FCC. This study explored factors that influence implementation of FCC in NICU's according to healthcare professionals that work in a NICU with the concept FCC. Method: A descriptive generic qualitative design with semi-structured interviews and inductive thematic analyses was used. This international multi-center study was conducted in three hospitals in three European countries: Sweden, Norway, and The Netherlands. Results: Seven neonatal care nurses, one nurse assistant, five neonatologists, and three managers participated in this study. Four aspects were identified, when analyzing the data, namely: Behavioral change in staff, Family needs, Environment, and Communication. Most important is that almost all healthcare professionals described that the mind-set of the professional influences the implementation of FCC. Conclusion: The mind-set of healthcare professionals in seeing parents as primary caregiver influences the way FCC is practiced and how parents are involved in the care for their infant.
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Affiliation(s)
- Sabine M Oude Maatman
- Department Woman and Baby, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Kajsa Bohlin
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Siri Lilliesköld
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Marijke C Kars
- Clinical Health Science, Utrecht University, Utrecht, Netherlands
| | - Agnes van den Hoogen
- Department Woman and Baby, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.,Clinical Health Science, Utrecht University, Utrecht, Netherlands
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David Vainberg L, Vardi A, Jacoby R. The Experiences of Parents of Children Undergoing Surgery for Congenital Heart Defects: A Holistic Model of Care. Front Psychol 2019; 10:2666. [PMID: 31827455 PMCID: PMC6890854 DOI: 10.3389/fpsyg.2019.02666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/12/2019] [Indexed: 12/02/2022] Open
Abstract
The present article is based on a qualitative study focusing on parents of children born with congenital heart defects (CHDs) and hospitalized in the children's intensive care unit post-surgery. Our aim was to explore parents' subjective experiences as primary caregivers. Ten semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis according to the instructions of Smith and Osborn. Our analysis yielded eight categories which were grouped into four themes and two main superordinate themes: (1) dialectical tension between positive and negative experiences; and (2) fluctuations between the inner and the outer world. The two superordinate themes intersect such that parents report positive as well as negative experiences within both their inner and outer worlds. Based on our analysis, we found that the experience of having a child undergo surgery for a CHD can be regarded as a chaotic period characterized by uncertainty, confusion, and helplessness. It is therefore no surprise that many parents display negative psychological outcomes which extend beyond the period of hospitalization and may also affect their future parenting and coping. However, within this chaotic and stressful situation, parents had occasional supportive experiences which decreased their emotional distress and isolation and helped them throughout this difficult period. We thus conclude that the support offered to parents during the hospitalization period should be increased by trying to minimize their negative experiences and strengthen their inner coping abilities. These changes cannot be implemented without also addressing the needs of the medical staff in their role as caregivers. Therefore, we propose a holistic model of care which supports both parents as caregivers of children undergoing surgery for CHD and the medical staff involved in their care.
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Affiliation(s)
| | - Amir Vardi
- Pediatric Cardiac Intensive Care, The Edmond and Lilly Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Rebecca Jacoby
- Medical Psychology Graduate Program, Stress, Hope and Cope Lab, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
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Palmquist AEL, Holdren SM, Fair CD. "It was all taken away": Lactation, embodiment, and resistance among mothers caring for their very-low-birth-weight infants in the neonatal intensive care unit. Soc Sci Med 2019; 244:112648. [PMID: 31707144 DOI: 10.1016/j.socscimed.2019.112648] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
The prevalence of infants born before 37 weeks of gestation continues to rise in the United States. Advances in neonatology have led to improved survival rates among preterm infants, including those born at a very-low-birth-weight (VLBW). Exclusive human milk feeding is a therapeutic intervention for VLBW preterm infants, and mothers are encouraged to provide their own milk. Yet, it is well-established that mothers and infants may face extraordinarily complicated lactation and infant feeding challenges in NICU settings, many of which emanate from birth trauma. The purpose of this study is to gain a deeper understanding of the ways in which the hyper-medicalized management of preterm birth and infant feeding in NICU environments affect mothers' postpartum health and well-being. Seventeen mothers of VLBW preterm infants were interviewed August 2016-June 2017 within three years of their infant's NICU discharge about their feeding decisions and experiences. Narrative analysis yielded five themes: (1) the physical and emotional trauma of giving birth prematurely impacted mothers' lactation experiences; (2) separation from their infants intensified mothers' suffering and disrupted lactation; (3) mothers experienced being marginalized in their infant's NICU care; (4) mothers practiced embodied forms of resistance to cope with both trauma and marginalization; and (5) skilled support was central to mothers' positive lactation experiences in the NICU. We draw upon feminist theory in the anthropology of reproduction to examine the fundamental hierarchies of power in U.S. neonatal critical care systems that fracture mothers' interembodied relationships to their newborns, exacerbate lactation failure, and engender traumatic postpartum neglect. Moreover, we theorize mothers' expressions of suffering in the context of preterm birth and lactation insufficiency as idioms of distress engendered by the violence of neglectful care. Narrative inquiry is instrumental to designing structural transformations in the systems of care available to mothers of preterm infants who are admitted to a NICU.
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Affiliation(s)
- Aunchalee E L Palmquist
- University of North Carolina at Chapel Hill, Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, CB-7445, Gillings School of Global Public Health, Chapel Hill, NC, 27599, USA.
| | - Sarah M Holdren
- Columbia University, School of Professional Studies, New York, NY, 10027, USA
| | - Cynthia D Fair
- Watts-Thompson Distinguished Professor & Chair, Public Health Studies and Human Service Studies, Elon University, Elon, NC, 27244, USA
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Holdren S, Fair C, Lehtonen L. A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S. BMC Pregnancy Childbirth 2019; 19:345. [PMID: 31601193 PMCID: PMC6785867 DOI: 10.1186/s12884-019-2505-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/12/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The benefits of family-centered care for the health and well-being of preterm infants and their families include increased parent-infant closeness, improved lactation, and positive mental health outcomes; however, it is known that the extent to which family-centered care is adopted varies by unit. This study aimed to understand how differences in neonatal care culture in two units in Finland and the U.S. were translated to parents' infant feeding experiences in the hope of improving relationally focused feeding practices in both locations. METHODS This qualitative, cross-sectional study utilized narrative methodologies to understand the lived experiences of 15 families hospitalized in a tertiary neonatal intensive care unit in Finland (n = 8) and the U. S (n = 7). RESULTS A global theme of lactation as a means or an end showed that lactation and infant feeding were framed differently in each location. The three supporting themes that explain families' perceptions of their transition to parenthood, support as a family unit, and experience with lactation include: universal early postnatal challenges; culture and space-dependent nursing support; and controlled or empowering breastfeeding experiences. CONCLUSIONS Care culture plays a large role in framing all infant caring activities, including lactation and infant feeding. This study found that in the unit in Finland, breastfeeding was one method to achieve closeness with an infant, while in the unit in the U.S., pumping was only an end to promote infant nutritional health. Therefore, breastfeeding coupled with closeness was found to be supportive of a salutogenic, or health-promoting, care approach for the whole family.
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Affiliation(s)
- Sarah Holdren
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Cynthia Fair
- Public Health Studies & Department Chair, Elon University Department of Public Health Studies, Elon, North Carolina USA
| | - Liisa Lehtonen
- Department of Pediatrics, Neonatology & Professor of Pediatrics, Turku University Hospital, Turku, Finland
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10
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Lundqvist P, Weis J, Sivberg B. Parents’ journey caring for a preterm infant until discharge from hospital‐based neonatal home care—A challenging process to cope with. J Clin Nurs 2019; 28:2966-2978. [DOI: 10.1111/jocn.14891] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/16/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Pia Lundqvist
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
| | - Janne Weis
- Neonatal Department and the Research Unit for Women’s and Children’s Health Copenhagen University Hospital Copenhagen Denmark
| | - Bengt Sivberg
- Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
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O'Callaghan N, Dee A, Philip RK. Evidence-based design for neonatal units: a systematic review. Matern Health Neonatol Perinatol 2019; 5:6. [PMID: 31061714 PMCID: PMC6492317 DOI: 10.1186/s40748-019-0101-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022] Open
Abstract
Evidence-based design (EBD) of hospitals could significantly improve patient safety and make patient, staff and family environments healthier. This systematic review aims to determine which neonatal intensive care unit design features lead to improved neonatal, parental and staff outcomes. Medline, CINAHL, Web of Science Citation Index and Cochrane Central Register of Controlled Trials Registry, were searched in January 2017. Using combinations of the relevant key words, review was performed following the recommended guidelines for reporting systematic reviews. English language limitation was applied and term limited to 2006–2016. Included studies were assigned a grade based upon their level of evidence and critically appraised using defined tools. Data were not synthesized for meta-analysis due to nature of literature reviewed and heterogeneity. Three thousand five hundred ninety-two titles were screened with 43 full-texts assessed for eligibility. Twenty nine studies were deemed eligible for inclusion. These included 19 cohort studies, two qualitative studies, seven cross-sectional studies, and one randomised control trial. Grey literature search from guidelines, and repositories yielded an additional 10 guidelines. ‘Single family room’ (SFR) design for neonatal units is recommended. An optimally designed neonatal unit has many possible health implications, including improved breastfeeding, infection and noise control, reduced length of stay, hospitalisation rates and potentially improved neonatal morbidity and mortality. High quality, family centred care (FCC) in neonatology could be assisted through well grounded, future proofed and technology enabled design concepts that have the potential to impact upon early life development.
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Affiliation(s)
- N O'Callaghan
- Mid-West Department of Public Health, HSE, Limerick, Ireland
| | - A Dee
- Mid-West Department of Public Health, HSE, Limerick, Ireland
| | - R K Philip
- 2Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland.,3University Maternity Hospital Limerick (UMHL), Limerick, V94 C566 Ireland
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12
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The health care system is making ‘too much noise’ to provide family-centred care in neonatal intensive care units: Perspectives of health care providers and hospital administrators. Intensive Crit Care Nurs 2019; 50:44-53. [DOI: 10.1016/j.iccn.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/19/2018] [Accepted: 05/02/2018] [Indexed: 01/08/2023]
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13
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Academy News. Neonatal Netw 2018; 37:254-259. [PMID: 30567925 DOI: 10.1891/0730-0832.37.4.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Broom M, Kecskes Z, Kildea S, Gardner A. Exploring the Impact of a Dual Occupancy Neonatal Intensive Care Unit on Staff Workflow, Activity, and Their Perceptions. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 12:44-54. [PMID: 29925276 DOI: 10.1177/1937586718779360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2012, a tertiary neonatal intensive care unit (NICU) transitioned from an open plan (OP) to a dual occupancy (DO) NICU. The DO design aimed to provide a developmental appropriate, family-centered environment for neonates and their families. During planning, staff questioned the impact DO would have on staff workflow and activity. To explore the impact of changing from an OP to a DO NICU, a prospective longitudinal study was undertaken from 2011 to 2014, using observational, time and motion, and surveys methods. Main outcome measures included distance walked by staff, minutes of staff activity, and staff perceptions of the DO design. Results highlighted no significant difference in the distances clinical nurses walked nor time spent providing direct clinical care, whereas technical support staff walked further than other staff in both designs. Staff perceived the DO design created a developmentally appropriate, family-centered environment that facilitated communication and collaboration between staff and families. Staff described the main challenges of the DO design such as effective staff communication, gaining educational opportunities, and the isolation of staff and families compared to the OP design. Our study provides new evidence that DO provides an improved developmentally environment and has similar positive benefits to single-family room for neonates and families. Such design may reduce the larger floor plan's impact on staff walking distance and work practices. Challenges of staff transition can be minimized by planning and leadership throughout the development and move to a new design.
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Affiliation(s)
| | | | - Sue Kildea
- 3 University of Queensland (UQ) School of Nursing and Midwifery and Mater Health Service, Brisbane, Australia
| | - Anne Gardner
- 1 Australian Catholic University, Barton, Australia
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Staff Nurse Perceptions of Open-Pod and Single Family Room NICU Designs on Work Environment and Patient Care. Adv Neonatal Care 2018; 18:189-198. [PMID: 29794838 DOI: 10.1097/anc.0000000000000493] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal intensive care units have historically been constructed as open units or multiple-bed bays, but since the 1990s, the trend has been toward single family room (SFR) units. The SFR design has been found to promote family-centered care and to improve patient outcomes and safety. The impact of the SFR design NICU on staff, however, has been mixed. PURPOSE The purposes of this study were to compare staff nurse perceptions of their work environments in an open-pod versus an SFR NICU and to compare staff nurse perceptions of the impact of 2 NICU designs on the care they provide for patients/families. METHODS/SEARCH STRATEGY A prospective cohort study was conducted. Questionnaires were completed at 6 months premove and again at 3, 9, and 15 months postmove. A series of 1-way analyses of variance were conducted to compare each group in each of the 8 domains. Open-ended questions were evaluated using thematic analysis. FINDINGS/RESULTS The SFR design is favorable in relation to environmental quality and control of primary workspace, privacy and interruption, unit features supporting individual work, and unit features supporting teamwork; the open-pod design is preferable in relation to walking. IMPLICATIONS FOR PRACTICE Incorporating design features that decrease staff isolation and walking and ensuring both patient and staff safety and security are important considerations. IMPLICATIONS FOR RESEARCH Further study is needed on unit design at a microlevel including headwall design and human milk mixing areas, as well as on workflow processes.
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Coombs M, Puntillo KA, Franck LS, Scruth EA, Harvey MA, Swoboda SM, Davidson JE. Implementing the SCCM Family-Centered Care Guidelines in Critical Care Nursing Practice. AACN Adv Crit Care 2018; 28:138-147. [PMID: 28592473 DOI: 10.4037/aacnacc2017766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Family-centered care is an important component of holistic nursing practice, particularly in critical care, where the impact on families of admitted patients can be physiologically and psychologically burdensome. Family-centered care guidelines, developed by an international group of nursing, medical, and academic experts for the American College of Critical Care Medicine/Society of Critical Care Medicine, explore the evidence base in 5 key areas of family-centered care. Evidence in each of the guideline areas is outlined and recommendations are made about how critical care nurses can use this information in family-centered care practice.
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Affiliation(s)
- Maureen Coombs
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Kathleen A Puntillo
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Linda S Franck
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Elizabeth A Scruth
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Maurene A Harvey
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Sandra M Swoboda
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
| | - Judy E Davidson
- Maureen Coombs is Professor, Clinical Nursing, The Graduate School of Nursing Midwifery and Health, Victoria University, Wellington, New Zealand . Kathleen A. Puntillo is Professor Emeritus and Research Scientist, Department of Physiological Nursing, University of California, San Francisco, California. Linda S. Franck is Jack and Elaine Koehn Endowed Chair in Pediatric Nursing, Department of Family Health Care Nursing, University of California, San Francisco, California. Elizabeth A. Scruth is Clinical Practice Consultant, Regional Quality and Regulatory Services, Kaiser Permanente, Oakland, California. Maurene A. Harvey is a Critical Care Educator and Consultant, Lake Tahoe, Nevada. Sandra M. Swoboda is Research Program Coordinator/Simulation Educator, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland. Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California San Diego Health, San Diego, California
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Broom M, Parsons G, Carlisle H, Kecskes Z, Thibeau S. Exploring Parental and Staff Perceptions of the Family-Integrated Care Model: A Qualitative Focus Group Study. Adv Neonatal Care 2017; 17:E12-E19. [PMID: 29083997 DOI: 10.1097/anc.0000000000000443] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Family-integrated care (FICare) is an innovative model of care developed at Mount Sinai Hospital, Canada, to better integrate parents into the team caring for their infant in the neonatal intensive care unit (NICU). The effects of FICare on neonatal outcomes and parental anxiety were assessed in an international multicenter randomized trial. As an Australian regional level 3 NICU that was randomized to the intervention group, we aimed to explore parent and staff perceptions of the FICare program in our dual occupancy NICU. SUBJECTS AND DESIGN This qualitative study took place in a level 3 NICU with 5 parent participants and 8 staff participants, using a post implementation review design. METHODS Parents and staff perceptions of FICare were explored through focus group methodology. Thematic content analysis was done on focus group transcripts. RESULTS Parents and staff perceived the FICare program to have had a positive impact on parental confidence and role attainment and thought that FICare improved parent-to-parent and parent-to-staff communication. Staff reported that nurses working with families in the program performed less hands-on care and spent more time educating and supporting parents. IMPLICATIONS FOR PRACTICE FICare may change current NICU practice through integrating and accepting parents as active members of the infant's care team. In addition, nurse's roles may transition from bedside carer to care coordinator, educating and supporting parents during their journey through the NICU. IMPLICATIONS FOR RESEARCH Further research is needed to assess the long-term impact of FICare on neonates, parents, and staff.
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Maastrup R, Weis J, Engsig AB, Johannsen KL, Zoffmann V. ‘Now she has become my daughter’: parents’ early experiences of skin-to-skin contact with extremely preterm infants. Scand J Caring Sci 2017; 32:545-553. [DOI: 10.1111/scs.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Janne Weis
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Anne B. Engsig
- Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - Vibeke Zoffmann
- The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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Using Qualitative Research to Inform Development of Professional Guidelines: A Case Study of the Society of Critical Care Medicine Family-Centered Care Guidelines. Crit Care Med 2017; 45:1352-1358. [PMID: 28598866 DOI: 10.1097/ccm.0000000000002523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore the importance, challenges, and opportunities using qualitative research to enhance development of clinical practice guidelines, using recent guidelines for family-centered care in the ICU as an example. METHODS In developing the Society of Critical Care Medicine guidelines for family-centered care in the neonatal ICU, PICU, and adult ICU, we developed an innovative adaptation of the Grading of Recommendations, Assessments, Development and Evaluations approach to explicitly incorporate qualitative research. Using Grading of Recommendations, Assessments, Development and Evaluations and the Council of Medical Specialty Societies principles, we conducted a systematic review of qualitative research to establish family-centered domains and outcomes. Thematic analyses were undertaken on study findings and used to support Population, Intervention, Comparison, Outcome question development. RESULTS We identified and employed three approaches using qualitative research in these guidelines. First, previously published qualitative research was used to identify important domains for the Population, Intervention, Comparison, Outcome questions. Second, this qualitative research was used to identify and prioritize key outcomes to be evaluated. Finally, we used qualitative methods, member checking with patients and families, to validate the process and outcome of the guideline development. CONCLUSIONS In this, a novel report, we provide direction for standardizing the use of qualitative evidence in future guidelines. Recommendations are made to incorporate qualitative literature review and appraisal, include qualitative methodologists in guideline taskforce teams, and develop training for evaluation of qualitative research into guideline development procedures. Effective methods of involving patients and families as members of guideline development represent opportunities for future work.
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Doede M, Trinkoff AM, Gurses AP. Neonatal Intensive Care Unit Layout and Nurses’ Work. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017. [DOI: 10.1177/1937586717713734] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neonatal intensive care units (NICUs) remain one of the few areas in hospitals that still use an open bay (OPBY) design for patient stays greater than 24 hr, housing multiple infants, staff, and families in one large room. This creates high noise levels, contributes to the spread of infection, and affords families little privacy. These problems have given rise to the single-family room NICU. This represents a significant change in the care environment for nurses. This literature review answers the question: When compared to OPBY layout, how does a single family room layout impact neonatal nurses’ work? Thirteen studies published between 2006 and 2015 were located. Many studies reported both positive and negative effects on nurses’ work and were therefore sorted by their cited advantages and disadvantages. Advantages included improved quality of the physical environment; improved quality of patient care; improved parent interaction; and improvements in nurse job satisfaction, stress, and burnout. Disadvantages included decreased interaction among the NICU patient care team, increased nurse workload, decreased visibility on the unit, and difficult interactions with family. This review suggests that single-family room NICUs introduce a complex situation in which trade-offs occur for nurses, most prominently the trade-off between visibility and privacy. Additionally, the literature is clear on what elements of nurses’ work are impacted, but how the built environment influences these elements, and how these elements interact during nurses’ work, is not as well understood. The current level of research and directions for future research are also discussed.
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Affiliation(s)
- Megan Doede
- University of Maryland School of Nursing, Baltimore, MD, USA
| | | | - Ayse P. Gurses
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sherman TI, Moya F, Simmons PD, Kurtz D, Shaffer TH. Parental preferences regarding administration of an animal-derived versus a synthetic medication to newborn infants. J Neonatal Perinatal Med 2017; 9:7-14. [PMID: 27002267 DOI: 10.3233/npm-16915062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM We examined the perceptions of parents with regard to animal-derived versus synthetic medications of comparable efficacy. We hypothesized that this issue is a concern in neonatal care and that the perceptions of parents from one geographical location would be similar to those of another. METHODS A survey was distributed to parents of neonates admitted to a neonatal intensive care unit of a southeastern hospital. RESULTS Of 153 parents surveyed, 150 (98%) responded. More mothers than fathers completed the surveys (113 vs. 34). Fifty-six percent of participants indicated a college or higher education; 40% had an income of $51,000/yr or higher. Thirty-four percent of parents had concerns about animal-derived medications, 41% preferred a synthetic medication of equivalent efficacy, and 69% would like to be informed if a medication was animal-derived. CONCLUSION Parents have concerns about exposing neonates to animal-derived medication and wish to be informed if an animal-derived medication is being considered.
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Affiliation(s)
| | - Fernando Moya
- Betty Cameron Women & Children's Hospital, Wilmington, NC, USA
| | - Phillip D Simmons
- Biostatistics and Data Management, Discovery Laboratories, Inc., Warrington, PA, USA
| | | | - Thomas H Shaffer
- Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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Transition to a New Neonatal Intensive Care Unit: Positive Effects on Staff Working Environment and How the Physical Environment Facilitates Family-Centered Care. J Perinat Neonatal Nurs 2017; 31:75-85. [PMID: 28121762 DOI: 10.1097/jpn.0000000000000232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To optimize family-centered care and the staff working environment, the physical care environment should be designed to meet the needs of the infants, their families, and staff. It is important to evaluate the effects of a purpose-built neonatal ward on staff perceptions of job strain, the psychosocial climate, and the appropriateness of the physical environment. This study collected information from staff at a neonatal intensive care unit (NICU), before and after the ward was relocated to a new NICU. Effects were measured using the following variables: job strain, person-centered climate and appropriateness-of-the-physical-environment questionnaires. Data were analyzed using repeated-measures generalized estimating equations and factor analysis. After staff began to work in the new NICU, their job strain significantly increased. At the 2-year follow-up, staff stress levels had returned to preintervention levels. Participating staff perceived the purpose-built neonatal ward as being a significantly more appropriate physical environment for family-centered care of the infants and their families. The staff also perceived the psychosocial climate of the new NICU as significantly more person-centered in terms of having a more homey, comfortable, and everyday ambience and thus experienced as being more supportive. An NICU built according to recommended standards optimized the physical care environment for family-centered care and increased the staff working climate.
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A qualitative exploration of oncology nurses’ family assessment practices in Denmark and Australia. Support Care Cancer 2016; 25:559-566. [DOI: 10.1007/s00520-016-3438-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/02/2016] [Indexed: 10/20/2022]
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Hadian Shirazi Z, Sharif F, Rakhshan M, Pishva N, Jahanpour F. Lived Experience of Caregivers of Family-Centered Care in the Neonatal Intensive Care Unit: "Evocation of Being at Home". IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e3960. [PMID: 28203324 PMCID: PMC5294931 DOI: 10.5812/ijp.3960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 03/08/2016] [Accepted: 03/17/2016] [Indexed: 11/16/2022]
Abstract
Background In recent decades, family-centered care (FCC) has come to be known, accepted, and reported as the best care strategy for admitted children and their families. However, in spite of the increasing application of this approach, the experiences of the caregivers have not yet been studied. Objectives The present study aimed at the description and interpretation of the FCC experience in two neonatal intensive care units (NICU) at Shiraz University of Medical Sciences. Methods This study was conducted through the hermeneutic phenomenological approach. Semi-structured interviews were conducted with 17 professional and familial caregivers, and their interactions were observed in three work shifts. The interviews were audiotaped and transcribed verbatim. After observations, field notes were also written. Finally, the data were analyzed through van Manen’s methodology. Results One of the essential themes that emerged in this study was the “evocation of being at home” among familial and even professional caregivers. This theme had three subthemes: i.e., “meta-family interaction,” “comprehensive support,” and “reconstruction of a normal family.” Accordingly, FCC eliminated borders between professional and non-professional caregivers and built close relationships among them in the NICU. It also provided for the needs of neonates, their families, and even professional caregivers through perceived and received support. Conclusions Parents of the neonates admitted to the NICU experience hard moments. They not only play the role of primary caregivers, but they also receive the care. Focusing on the different meanings of this care from the caregivers’ points of view and having managers provide certain requirements can guarantee the establishment of comprehensive care for clients and proper support for the staff in this unit.
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Affiliation(s)
- Zahra Hadian Shirazi
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Farkhondeh Sharif
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Farkhondeh Sharif, Community Based Psychiatric Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-713647425051, Fax: +98-7136474252, E-mail:
| | - Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Narjes Pishva
- Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Faezeh Jahanpour
- School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, IR Iran
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Determining the Psychometric Properties of the Turkish Version of the Nurse-Parent Support Tool and the Stress Levels of Parents of Premature Infants Hospitalized in the Neonatal Intensive Care Unit. CLIN NURSE SPEC 2016; 30:E1-10. [DOI: 10.1097/nur.0000000000000204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Coyne I. Families and health-care professionals' perspectives and expectations of family-centred care: hidden expectations and unclear roles. Health Expect 2015; 18:796-808. [PMID: 23800327 PMCID: PMC5060842 DOI: 10.1111/hex.12104] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Family-centred care (FCC) is viewed as a pivotal concept in the provision of high-quality nursing care for children and their families, yet implementation continues to be problematic worldwide. This research investigated how FCC was enacted from families and nurses' perspectives. DESIGN Descriptive qualitative approach using elements of analysis from grounded theory method. Data were collected though individual interviews with 18 children aged 7-16 years, their parents (n = 18) and 18 nurses from two children's hospital and one children's unit in a large general hospital in Ireland. RESULTS Four key themes were identified: expectations; relying on parents' help; working out roles; and barriers to FCC. Nurses wholeheartedly endorsed FCC because of the benefits for families and their reliance on parents' contribution to the workload. There was minimal evidence of collaboration or negotiation of roles which resulted in parents feeling stressed or abandoned. Nurses cited busy workload, under-staffing and inappropriate documentation as key factors which resulted in over-reliance on parents and hindered their efforts to negotiate and work alongside parents. CONCLUSIONS Families are willing to help in their child's care but they require clear guidance, information and support from nurses. Hidden expectations and unclear roles are stressful for families. Nurses need skills training, adequate resources and managerial support to meet families' needs appropriately, to establish true collaboration and to deliver optimal family-centred care.
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Affiliation(s)
- Imelda Coyne
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
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Broom M, Gardner A, Kecskes Z, Kildea S. How can we help staff transition to a new NICU design? ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jnn.2015.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Involving parents in managing their child's long-term condition-a concept synthesis of family-centered care and partnership-in-care. J Pediatr Nurs 2015; 30:143-59. [PMID: 25458112 DOI: 10.1016/j.pedn.2014.10.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED BACKGROUNG: Fostering effective engagement, collaboration and empowerment are central to supporting parents caring for children with long-term conditions. METHODS A concept synthesis was undertaken to identify the shared antecedents and attributes underpinning models of family-centered care and partnership-in-care. RESULTS Thirty studies were reviewed; antecedents of models related to unclear roles, entrenched professional practices, and lack of guidelines supporting their implementation; with central attributes being building trust, listening to parent concerns and valuing parents' knowledge of their child. CONCLUSION The key attributes are outlined in a practical framework of involvement which may promote parent-professional collaboration for families of children with long-term conditions.
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Nichols A. The impact of the clinical environment on family centred care in the neonatal unit: A qualitative investigation. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jnn.2014.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, Kyhnaeb A, Svarer I, Hallström I. Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: the results of a national cohort study with high breastfeeding initiation rates. PLoS One 2014; 9:e108208. [PMID: 25251690 PMCID: PMC4177123 DOI: 10.1371/journal.pone.0108208] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
Background and Aim Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. Methods The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24–36 weeks. Results Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4–2.8) and 1.2 days (95% CI 0.1–2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1–7.0) later establishment of exclusive breastfeeding. Conclusion Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- * E-mail:
| | - Bo Moelholm Hansen
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section of Nursing, University of Aarhus, Aarhus, Denmark
| | - Susanne Norby Bojesen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Karin Hallum
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Viborg Regional Hospital, Viborg, Denmark
| | - Annemi Frandsen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Paediatric Department, Holbaek University Hospital, Holbaek, Denmark
| | - Anne Kyhnaeb
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Inge Svarer
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs, Copenhagen, Denmark
- Department of Neonatology, Odense University Hospital, Odense, Denmark
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Nichols A, Manzi S. Physical space and its impact on waste management in the neonatal care setting. J Infect Prev 2014; 15:134-138. [PMID: 28989373 DOI: 10.1177/1757177414531632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2014] [Indexed: 11/15/2022] Open
Abstract
This paper reports an investigation intended to obtain some understanding of how the working environment might influence the practice and knowledge of those involved in the management of healthcare waste. The National Health Service (NHS) has a continuing waste problem, and the way it manages waste harms the environment and consumes resources. It has been estimated that the carbon footprint of the NHS in England is approximately 20 million tons of CO2e. It has been suggested that better waste segregation could lead to more effective recycling, saving up to 42,000 tonnes of CO2. This qualitative study employed non-participant observation and semi-structured interviews. The interviews were carried out with the key informants within the participating neonatal intensive care unit. Findings from this study indicate that space and the physical arrangement of the environment are significant and influential factors in clinical practice. Where the clinical environment is not supportive, poor infection control and waste management practice is likely to occur. However, proximity of staff caused by a lack of physical space might facilitate situated learning and a collective development of knowledge in practice. The implementation of sustainable waste management practices would be more likely to succeed in an environment that facilitates correct waste segregation.
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Affiliation(s)
- Andrew Nichols
- Faculty of Health & Human Sciences, University of Plymouth, UK
| | - Sean Manzi
- Faculty of Health & Human Sciences, University of Plymouth, UK
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Maastrup R, Hansen BM, Kronborg H, Bojesen SN, Hallum K, Frandsen A, Kyhnaeb A, Svarer I, Hallström I. Factors associated with exclusive breastfeeding of preterm infants. Results from a prospective national cohort study. PLoS One 2014; 9:e89077. [PMID: 24586513 PMCID: PMC3929624 DOI: 10.1371/journal.pone.0089077] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/15/2014] [Indexed: 12/02/2022] Open
Abstract
Background and Aim Evidence-based knowledge of how to guide the mothers of preterm infants in breastfeeding establishment is contradictive or sparse. The aim was to investigate the associations between pre-specified clinical practices for facilitating breastfeeding, and exclusive breastfeeding at discharge as well as adequate duration thereof. Methods A prospective survey based on questionnaires was conducted with a Danish national cohort, comprised of 1,221 mothers and their 1,488 preterm infants with a gestational age of 24–36 weeks. Adjusted for covariates, the pre-specified clinical practices were analysed by multiple logistic regression analyses. Results At discharge 68% of the preterm infants were exclusively breastfed and 17% partially. Test-weighing the infant, and minimizing the use of a pacifier, showed a protective effect to exclusive breastfeeding at discharge (OR 0.6 (95% CI 0.4–0.8) and 0.4 (95% CI 0.3–0.6), respectively). The use of nipple shields (OR 2.3 (95% CI 1.6–3.2)) and the initiation of breast milk expression later than 48 hours postpartum (OR 4.9 (95% CI 1.9–12.6)) were associated with failure of exclusive breastfeeding at discharge. The clinical practices associated with an inadequate breastfeeding duration were the initiation of breast milk expression at 12–24 hours (OR 1.6 (95% CI 1.0–2.4)) and 24–48 hours (OR 1.8 (95% CI 1.0–3.1)) vs. before six hours postpartum, and the use of nipple shields (OR 1.4 (95% CI 1.1–1.9)). Conclusion Early initiation of breast milk pumping before 12 hours postpartum may increase breastfeeding rates, and it seems that the use of nipple shields should be restricted. The use of test-weighing and minimizing the use of a pacifier may promote the establishment of exclusive breastfeeding, but more research is needed regarding adequate support to the mother when test-weighing is ceased, as more of these mothers ceased exclusive breastfeeding at an early stage after discharge.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs at Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- * E-mail:
| | - Bo Moelholm Hansen
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section of Nursing, University of Aarhus, Aarhus, Denmark
| | - Susanne Norby Bojesen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Karin Hallum
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Viborg Regional Hospital, Viborg, Denmark
| | - Annemi Frandsen
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Paediatric Department, Holbaek University Hospital, Holbaek, Denmark
| | - Anne Kyhnaeb
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Inge Svarer
- Danish National Panel of Experts on Breastfeeding Infants with Special Needs
- Department of Neonatology, Odense University Hospital, Odense, Denmark
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Coyne I, Murphy M, Costello T, O'Neill C, Donnellan C. A survey of nurses' practices and perceptions of family-centered care in Ireland. JOURNAL OF FAMILY NURSING 2013; 19:469-488. [PMID: 24108266 DOI: 10.1177/1074840713508224] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Family-centered care (FCC) is a philosophy of care that recognizes the family's central role in the child's life and in the delivery of care. We used a survey design to investigate the practices and perceptions of nurses toward FCC in Ireland. Data were obtained from 250 nurses in seven hospitals using the Family-Centered Care Questionnaire-Revised (FCCQ-R). Findings indicated that nurses' practices were significantly different from their perceptions of FCC. Nurses with dual registration (children and adult) had significantly lower mean scores on the total current (practice) scale than the other registration subgroups. Nurses with a baccalaureate or a higher academic qualification had higher mean scores than nurses who held a certificate-level qualification on the total necessary (perception) scale, which assessed the activities perceived to be necessary for FCC. Findings showed that nurses support FCC but perceive the design of the health care system and parent-professional collaboration as barriers to FCC practice.
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Broom M, Brady B, Kecskes Z, Kildea S. World Café Methodology engages stakeholders in designing a Neonatal Intensive Care Unit. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.jnn.2012.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Haiek LN. Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations. J Hum Lact 2013; 29:300-9. [PMID: 23727630 DOI: 10.1177/0890334413489775] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.
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Affiliation(s)
- Kerstin H Nyqvist
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden.
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Heinemann AB, Hellström-Westas L, Hedberg Nyqvist K. Factors affecting parents' presence with their extremely preterm infants in a neonatal intensive care room. Acta Paediatr 2013; 102:695-702. [PMID: 23590800 DOI: 10.1111/apa.12267] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/11/2013] [Indexed: 12/21/2022]
Abstract
AIM To describe parents' experiences of factors that influenced their stay with their extremely preterm infants in a neonatal intensive care unit (NICU). METHODS This study has a qualitative descriptive design based on semistructured interviews conducted with seven mothers and six fathers. RESULTS Opportunities to stay overnight together with their infant facilitated parental presence, and opportunities for taking over their infant's care empowered the parents in their parental role and increased their motivation to stay. Kangaroo mother care helped them to feel in control and feel needed, which increased their presence. High levels of illumination and noise rendered it difficult for parents to sleep and stay overnight with the infant. Low staffing levels limited their use of kangaroo mother care when they had to wait for assistance to transfer the infant from the incubator. Several participants perceived the performance of painful procedures on their child as stressful and as an obstacle to their presence. CONCLUSION Kangaroo mother care and active involvement in the infant's care gave parents a sense of control and strengthened their motivation to be with their infant. High levels of noise and illumination and a dismissive staff attitude were obstacles to parents' presence.
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Affiliation(s)
- Ann-Britt Heinemann
- Neonatal Intensive Care Unit; University Children's Hospital; Uppsala; Sweden
| | | | - Kerstin Hedberg Nyqvist
- Department of Women's and Children's Health, Pediatrics; University Hospital; Uppsala; Sweden
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Thomson G, Moran VH, Axelin A, Dykes F, Flacking R. Integrating a sense of coherence into the neonatal environment. BMC Pediatr 2013; 13:84. [PMID: 23697687 PMCID: PMC3663664 DOI: 10.1186/1471-2431-13-84] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/15/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes. DISCUSSION In this paper we present a new perspective to neonatal care based on Aaron Antonovksy's Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed. SUMMARY Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned.
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Affiliation(s)
- Gill Thomson
- Maternal and Infant Nutrition and Nurture (MAINN), University of Central Lancashire, Preston PR1 2HE, UK.
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Bailey SM, Hendricks-Muñoz KD, Mally P. Parental influence on clinical management during neonatal intensive care: a survey of US neonatologists. J Matern Fetal Neonatal Med 2013; 26:1239-44. [PMID: 23414460 DOI: 10.3109/14767058.2013.776531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Family-centered care (FCC), which includes involving parents in conversations about medical management, is increasingly employed in the neonatal intensive care unit (NICU). Our aim was to determine which care decisions are discussed by neonatologists with families most frequently and the percentage of clinicians influenced by such conversations. METHODS Anonymous web-based survey provided to 2137 neonatologists assessing information sharing and parental involvement. RESULTS Thousand and two neonatologists responded in which 893 fully completed the surveys. 88% practice FCC. Topics most frequently discussed with parents were blood transfusion, steroids for lung disease and patent ductus arteriosus (PDA) surgery, each being reported and discussed by more than 90% of respondents. Many therapies, including aminoglycoisdes, total parenteral nutrition, and phototherapy, were discussed with parents by far fewer clinicians. Additionally, parents had most influence on clinicians in two categories, blood transfusion and steroids, with more than 70% reporting that their practice was influenced by parental opinion if communicated. For some topics, such as PDA surgery and central line placement, conversations impacted few clinicians. CONCLUSIONS FCC appears to have an impact on NICU clinical decision-making processes, some more than others. Further investigation in this area may provide information on how to best communicate with families and run effective, efficient FCC rounds.
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Affiliation(s)
- Sean M Bailey
- Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NYU Langone Medical Center, Bellevue Hospital, New York, NY 10016, USA.
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Nichols A, Grose J, Bennallick M, Richardson J. Sustainable healthcare waste management: a qualitative investigation of its feasibility within a county in the south west of England. J Infect Prev 2012. [DOI: 10.1177/1757177412471411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper aims to investigate the possibility of safely and lawfully employing a sustainable reduce, reuse, recycle philosophy in the management of waste within healthcare settings. Climate change presents significant threats to our wellbeing on a global scale and provides a new challenge for healthcare organisations. As the United Kingdom’s biggest public sector employer, the National Health Service has enormous power to mitigate the impact of climate change by implementing sustainable practices. One area in which sustainable practices could be employed is within healthcare waste management. The investigation used a qualitative approach using semi-structured interviews with 20 participants responsible for the safe management of healthcare waste in an English county. Interviews indicated that topics such as knowledge, the environment, finance and legislation influence attitudes and behaviour in healthcare waste management. Participants were clear that from financial and environmental perspectives an aim to reduce, reuse and recycle waste in health care was desirable. Attempts to implement sustainable healthcare waste management practices, informed by a sustainable waste management philosophy are desirable both financially and environmentally. Research is needed to explore behaviour, attitudes, learning, knowledge and the role of the environment in healthcare waste management.
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Affiliation(s)
- Andrew Nichols
- Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK
| | - Jane Grose
- Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK
| | - Maria Bennallick
- Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK
| | - Janet Richardson
- Faculty of Health, Education and Society, University of Plymouth, Plymouth, UK
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Feeley N, Waitzer E, Sherrard K, Boisvert L, Zelkowitz P. Fathers’ perceptions of the barriers and facilitators to their involvement with their newborn hospitalised in the neonatal intensive care unit. J Clin Nurs 2012. [DOI: 10.1111/j.1365-2702.2012.04231.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nyqvist KH, Häggkvist AP, Hansen MN, Kylberg E, Frandsen AL, Maastrup R, Ezeonodo A, Hannula L, Koskinen K, Haiek LN. Expansion of the ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations for three guiding principles. J Hum Lact 2012; 28:289-96. [PMID: 22674967 DOI: 10.1177/0890334412441862] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care.
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Maastrup R, Bojesen SN, Kronborg H, Hallström I. Breastfeeding support in neonatal intensive care: a national survey. J Hum Lact 2012; 28:370-9. [PMID: 22674965 DOI: 10.1177/0890334412440846] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of breastfeeding of preterm infants is affected by the support provided at the hospital and in the neonatal intensive care unit (NICU). However, policies and guidelines promoting breastfeeding vary both nationally and internationally. OBJECTIVES The aim of this survey was to describe breastfeeding support in Danish NICUs, where approximately 98% of mothers initiate lactation. METHODS A national survey of all 19 Danish NICUs was conducted in 2009. Four NICUs were at designated Baby-Friendly hospitals, and 5 had a lactation consultant. In all NICUs, it was possible for some parents to stay overnight; 2 units had short restrictions on parents' presence. Five NICUs had integrated postpartum care for mothers. Breastfeeding policies, written guidelines, and systematic breastfeeding training for the staff were common in most NICUs. Seventeen NICUs recommended starting breast milk expression within 6 hours after birth, and mothers were encouraged to double pump. Most NICUs aimed to initiate skin-to-skin contact the first time the parents were in the NICU, and daily skin-to-skin contact was estimated to last for 2-4 hours in 63% and 4-8 hours in 37% of the units. The use of bottle-feeding was restricted. CONCLUSIONS The Danish NICUs described the support of breastfeeding as a high priority, which was reflected in the recommended policies for breast milk pumping, skin-to-skin contact, and the parents' presence in the NICU, as well as in the restricted use of bottle-feeding. However, support varied between units, and not all units supported optimal breastfeeding.
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Affiliation(s)
- Ragnhild Maastrup
- Knowledge Centre for Breastfeeding Infants with Special Needs, Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
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Impact of the design of neonatal intensive care units on neonates, staff, and families: a systematic literature review. J Perinat Neonatal Nurs 2012; 26:260-6; quiz 267-8. [PMID: 22843008 DOI: 10.1097/jpn.0b013e318261ca1d] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Newborn intensive care is for critically ill newborns requiring constant and continuous care and supervision. The survival rates of critically ill infants and hospitalization in neonatal intensive care units (NICUs) have improved over the past 2 decades because of technological advances in neonatology. The design of NICUs may also have implications for the health of babies, parents, and staff. It is important therefore to articulate the design features of NICU that are associated with improved outcomes. The aim of this study was to explore the main features of the NICU design and to determine the advantages and limitations of the designs in terms of outcomes for babies, parents, and staff, predominately nurses. A systematic review of English-language, peer-reviewed articles was conducted for a period of 10 years, up to January 2011. Four online library databases and a number of relevant professional Web sites were searched using key words. There were 2 main designs of NICUs: open bay and single-family room. The open-bay environment develops communication and interaction with medical staff and nurses and has the ability to monitor multiple infants simultaneously. The single-family rooms were deemed superior for patient care and parent satisfaction. Key factors associated with improved outcomes included increased privacy, increased parental involvement in patient care, assistance with infection control, noise control, improved sleep, decreased length of hospital stay, and reduced rehospitalization. The design of NICUs has implications for babies, parents, and staff. An understanding of the positive design features needs to be considered by health service planners, managers, and those who design such specialized units.
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Cockcroft S. How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care? ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jnn.2011.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Coyne I, O’Neill C, Murphy M, Costello T, O’Shea R. What does family-centred care mean to nurses and how do they think it could be enhanced in practice. J Adv Nurs 2011; 67:2561-73. [DOI: 10.1111/j.1365-2648.2011.05768.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Patient- and family-centered care is not a new concept, but it has garnered increased interest and support during the last decade. While most healthcare providers are excellent at providing clinical care, the practice of addressing the myriad other patient and family needs requires a conscious and collaborative effort. Though the staff of hospitals and other patient settings across the country have achieved various degrees of successful implementation of patient- and family-centered care initiatives, the success has not been universal. An objective evaluation of patient- and family-centered initiatives is needed. However, underdeveloped evaluation processes should not prevent the implementation of best practices that already have shown demonstrable success.
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