Integrative Review of Technology to Support Communication With Parents of Infants in the NICU

Examining technology use and mental health among parents with newborns in the intensive care unit during the COVID-19 pandemic: A cross-sectional study

Objectives

To investigate the relationship between pandemic-related stressors, mental health, and technology use among parents of hospitalized infants during the COVID-19 pandemic.

Methods

A cross-sectional study of 47 participants who had an infant in the Neonatal Intensive Care Unit (NICU) during the pandemic was completed. Participants ranked several statements on a Likert scale to assess mental health, technology use, and COVID-19-related stress during their infant's stay in the NICU.

Results

Mental health wellness scores were negatively associated with COVID-19-related stress (rs - 0.40, p = .015). The most prevalent stressor was hospital visitation restriction. Higher COVID-19-related stress was associated with greater use of text and video chat [(rs0.35, p = 0.016) and (rs0.33, p = .025)]. Enjoyment of technology use and access to technology were positively associated with higher mental health wellness scores [(rs0.42, p = .003) and (rs0.38, p = .009)].

Conclusions

Social uses of technology were valuable in a cohort of parents with infants hospitalized during the COVID-19 pandemic.

Innovation

Technology is a tool that can help parents cope with the stress of having a hospitalized infant. Digital literacy and technology access should be promoted in the post-pandemic landscape to help parents of infants in the NICU attain more benefit from these resources.

Psychological distress in the neonatal intensive care unit: a meta-review

INTRODUCTION

Parental psychological distress (PD) (anxiety, depression, stress and post-traumatic stress syndrome) can adversely affect parents' own physical and mental health as well as their children's long-term health and development. Numerous studies have addressed PD in mothers of infants admitted to NICU, with interventions proposed, but few have addressed the impact on fathers or other family members. The present review examined systematic reviews that addressed PD in NICU and potential interventions.

METHODS

A meta-review was performed by searching various databases between 2000 and May 2024.

RESULTS

Fifty-four studies were included. The incidence of maternal PD varied depending on the screening tool used (13-93%), as did paternal PD (0.08-46%). The incidence of PD in sexual, racial and gender minorities, siblings, grandparents and those in lower-middle income countries is not known. Numerous screening tools were used with a wide variety of cut-off values. Various intervention programmes were evaluated and showed contradictory evidence regarding their effect on PD.

DISCUSSION

Routine screening should be implemented together with a combination of interventional programmes, specifically family-centred interventions. More research is required for PD in siblings, sexual and gender minority parents as well as parents living in low middle income countries.

IMPACT STATEMENT

Psychological distress is high in NICU, affecting parents and siblings. Maternal psychological distress may have long lasting effects on infant health and differs from that of fathers, who require as much attention as mothers Little is known about emotional stress in siblings and sex and gender minority group peoples Few interventions showed conclusive effectiveness in reducing psychological distress with combination interventions showing more effectiveness than single interventions.

Relationship Between Frequency of Remote Visitation and Postpartum Depression in Mothers of Hospitalized Neonates During the COVID-19 Pandemic

OBJECTIVE

To explore the relationship between symptoms of postpartum depression and the number of remote visitations among mothers of infants in the NICU.

DESIGN

Retrospective cohort study.

SETTING

NICU in a medical university in Iwate, Japan.

PARTICIPANTS

A total of 89 mothers of infants who spent more than 1 month in the NICU from June 2021 to December 2022.

METHODS

Participants completed the Edinburgh Postnatal Depression Scale (EPDS) at 4 days and 1 month after birth. We used a one-way analysis of variance with Tukey-Kramer or Games-Howell post hoc tests to examine differences in postpartum depression among three groups based on the frequency of remote visitation: frequent visitation, rare visitation, or no visitation.

RESULTS

Of the 89 mothers, 41 scored 9 points or higher on the EPDS conducted 4 days after birth; among them, 14 did not visit, 13 rarely visited, and 14 frequently visited the NICU remotely through a web camera. The rare visitation group had significantly higher EPDS scores 1 month after birth (M = 9.7, SD = 5.2) than the frequent (M = 5.3, SD = 3.7) and no visitation (M = 5.1, SD = 4.2) groups (p < .05). The rare visitation group demonstrated lower improvement on the EPDS than the frequent and no visitation groups (nonsignificant).

CONCLUSION

It is unclear whether remote visitation reduces symptoms of postpartum depression; however, the frequency of remote visitation could be assessed to identify at-risk mothers in need of social support.

Experiences of healthcare professionals, patients and families with video calls to stimulate patient- and family-centred care during hospitalization: A scoping review

AIM

To synthesize the literature on the experiences of patients, families and healthcare professionals with video calls during hospital admission. Second, to investigate facilitators and barriers of implementation of video calls in hospital wards.

DESIGN

Scoping review.

METHODS

PubMed, CINAHL and Google Scholar were searched for relevant publications in the period between 2011 and 2023. Publications were selected if they focused on experiences of patients, families or healthcare professionals with video calls between patients and their families; or between families of hospitalized patients and healthcare professionals. Quantitative and qualitative data were summarized in data charting forms.

RESULTS

Forty-three studies were included. Patients and families were satisfied with video calls as it facilitated daily communication. Family members felt more engaged and felt they could provide support to their loved ones during admission. Healthcare professionals experienced video calls as an effective way to communicate when in-person visits were not allowed. However, they felt that video calls were emotionally difficult as it was hard to provide support at distance and to use communication skills effectively. Assigning local champions and training of healthcare professionals were identified as facilitators for implementation. Technical issues and increased workload were mentioned as main barriers.

CONCLUSION

Patients, families and healthcare professionals consider video calls as a good alternative when in-person visits are not allowed. Healthcare professionals experience more hesitation towards video calls during admission, as it increases perceived workload. In addition, they are uncertain whether video calls are as effective as in-person conservations.

IMPLICATIONS FOR THE CLINICAL PRACTICE

When implementing video calls in hospital wards, policymakers and healthcare professionals should select strategies that address the positive aspects of family involvement at distance and the use of digital communication skills.

PATIENT CONTRIBUTION

No patient or public contribution.

The Impact of Video Calling Between Preterm Infants and Their Mothers on the Physiological Parameters of Infants and Mother-Infant Bonding

PURPOSE

This study aimed to determine the effect of video calling between preterm infants treated in the neonatal intensive care unit (NICU) and their mothers on the physiological parameters of infants and mother-infant bonding.

BACKGROUND

Preterm infants need prolonged treatment in the NICU, and their families may have difficulty seeing their babies during this treatment process.

METHODS

This is a prospective, randomized-controlled, experimental study. The study sample consisted of 75 preterm infants and their mothers. The data were collected using a maternal introductory information form, a preterm infant introductory information form, a preterm infant physiological parameters follow-up form, and the Mother-Infant Bonding Scale (MIBS). The study included 3 study groups: the video call group, the video call with lullaby group, and the control group. Video calls between preterm infants and their mothers were made through Zoom for 5 to 10 minutes daily for 7 days. The mothers filled out the MIBS online before and on the 7th and 30th days of the study.

RESULTS

Preterm infants in the video call and the video call with lullaby groups had higher MIBS mean scores on the 7th and 30th days of the study than their pretest MIBS scores. Preterm infants in the video call and the video call with lullaby groups had statistically significantly higher MIBS mean scores on the seventh day of the study than those in the control group. At the end of the 7-day study period, there was an improvement in the physiological parameters of preterm infants in the video call group and the video call with lullaby group compared with those in the control group, and this relationship was statistically significant.

CONCLUSIONS

In conclusion, the implementation of video calls between mothers and preterm infants in NICUs had a healing effect on the physiological parameters of preterm infants and increased mother-infant bonding.

A preliminary study of the effectiveness of video visitation on depression and stress in mothers with preterm infants during the pandemic

BACKGROUND AND PURPOSE

Parents of preterm infants experience anxiety and stress in the neonatal intensive care unit (NICU). Visitation restrictions due to COVID-19 have increased maternal pressure and limited bonding opportunities. Little research exists in Taiwan on using video conferencing as a solution. This study investigates depression and stress levels in mothers of preterm infants and evaluates the effectiveness of video visitation during NICU restrictions.

METHODS

This study adopts a cross-sectional design and a qualitative survey. Mothers of premature infants were recruited and they participated in the study. Interventions for video visits were scheduled on the third day of admission to the NICU (T1) and during the second week of the study (T2). After each video visit, participants completed an online survey. The study's online survey used structured questionnaires including demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Parental Stress Scale (PSS): Infant Hospitalization (IH).

RESULTS

A total of 51 mothers of preterm infants participated in the study. During the T1 and T2 periods, single mothers with lower educational levels and those aged below 30 experienced depression and high levels of stress. Lower birth weight and gestational age were associated with maternal depression. Video visitation intervention led to a significant decrease in depression scores (EPDS, T1: 11.3 ± 5.5 vs. T2: 10.1 ± 5.2, p = 0.039). Positive correlations were observed between EPDS and PSS: IH scores (p < 0 .005).

CONCLUSION

Video visitation intervention can reduce maternal depression in mothers with preterm infants. Since it is practical, video visitation may be applied even after the pandemic.

Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit

OBJECTIVE

 This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit.

STUDY DESIGN

 Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and "in effect" unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively.

RESULTS

 Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03).

CONCLUSION

 Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further.

KEY POINTS

· Virtual visitation technology can bridge the distance gap for families of hospitalized infants.. · Utilization of virtual technology is affected by socioeconomic factors and seasonal unit visitation restrictions.. · Factors influencing disparities in access and utilization of virtual technology need to be investigated further..

Nurse-mother communication and support: Perceptions of mothers in neonatal units

Introduction

Having a hospitalized neonate is a stressful experience for parents, especially mothers. Thus, in recent years, a paradigm shift occurred in the neonatal units, focusing on the needs of parents and supporting them in addition to caring for neonates. The aim of this study was to evaluate the nurse-mother communication and support in neonatal units in Bushehr, Iran.

Method

This descriptive cross-sectional study was performed in neonatal units of 6 hospitals in Bushehr, Iran, in 2022. Using the census method, all eligible mothers who met the inclusion criteria were included in this study. Data collection tools included demographic information form, nurse-parent support tool and nurse-parent communication questionnaire. The collected data were analyzed by SPSS version 24 using descriptive statistics, independent t-test, one-way ANOVA and Pearson correlation test.

Results

The total mean score of nurse-parent support tool was 3.72 ± 0.72 and the total mean score of nurse-parent communication questionnaire was 59/27 ± 12/82. Caregiving support had the highest mean score (4.07 ± 73 0.73) and emotional support had the lowest (3.42 ± 91 0.91). Also, a statistically significant difference was seen between the admitted unit variable and the mean score of nurse-mother communication and support. Additionally, there was a statistically significant difference between the mechanical ventilation status of the neonate and the mean score of nurse-mother support. A significant positive correlation was seen between the neonatal gestational age and the mean score of nurse-mother communication.

Conclusions

The total mean score of nurse-parent support and communication was moderate. Therefore, nursing support and communication need to be improved. Planning is needed to enhance the role of neonatal nurses and strengthen their support and communication skills in line with the family-centered care approach.

Nonface-to-Face Visitation to Restrict Patient Visits for Infection Control: Integrative Review

BACKGROUND

In the COVID-19 pandemic, a visit restriction policy for patients has been implemented in medical institutions worldwide and visits are being made using alternative communication technologies. This shift has also required the use of platforms to prevent negative consequences of these restrictions.

OBJECTIVE

The purpose of this review was to comprehensively explore nonface-to-face visits as an alternative during infection prevention and to synthesize the scientific evidence of their benefits and disadvantages.

METHODS

A comprehensive search was conducted via the PubMed, Embase, CINAHL, Cochrane, and Web of Science electronic databases; unpublished trials in the clinical trials register ClinicalTrials.gov; and Virginia Henderson International Nursing Library up to September 10, 2021. The search query was developed according to the guidelines of the Peer Review of Electronic Search Strategies and included keywords on the topics of telemedicine and visitation restrictions. The inclusion criteria were a nonface-to-face modality using telemedicine with family in a hospital setting, experimental and observational studies, and articles written in English. The exclusion criteria were inaccessible in full text, not related to patient or family involvement, mainly focused on the study protocol, or only discussing the pros and cons of telemedicine.

RESULTS

Overall, patients' families experienced emotional distress due to restrictions on face-to-face visits. Nonface-to-face virtual visits compensating for these restrictions had a positive effect on reducing the risk of infection to the patient and the family. This further encouraged psychological and physical recovery and decreased psychological distress. However, nonface-to-face virtual technology could not replace the existence of actual families, and technical problems with networks and devices are reported as limitations.

CONCLUSIONS

Ensuring the availability of technology and educating on the same in alignment with the characteristics of patients and their families, nonface-to-face virtual visits need to show more potential as an effective patient-centered treatment strategy based on more research and advanced practice.

Building Connections with Families: Implementation of a Video-Messaging Service in the Neonatal Intensive Care Unit

BACKGROUND

Family involvement is vital to optimize the care of infants in the neonatal intensive care unit (NICU). Various technologies have been used to support communication with parents in the NICU. The purpose of this study was to evaluate the parent and staff experience and perception of the use of a cloud-based video-messaging service in our NICU.

METHODS

This study was a single center observational study conducted at Mount Sinai Hospital, Toronto, Canada. Following the implementation of a video-messaging service, parent and staff surveys were distributed to evaluate their experience and perception.

RESULTS

Parent responses were positive with respect to how the service helped them feel: closer to their infant (100%) and reassured about their infant's care (100%). Nursing staff responses indicated that they perceived a benefit to parents (100%) and to their building a relationship with families (79%). However, they also identified time constraints (85%) and the use of the technology hardware (24%) as challenges.

CONCLUSIONS

The use of an asynchronous video-messaging service was perceived as beneficial to both parents and staff in the NICU. Complaints pertained to the impact of the technology on nursing workflow and the difficulty using the hardware provided for use of the service.

A Customized Triggers Program: A Children's Hospital's Experience in Improving Trigger Usability

BACKGROUND

Despite the growth of patient safety programs across the United States, errors and adverse events remain a source of patient harm. Many hospitals rely on retrospective voluntary reporting systems; however, there are opportunities to improve patient safety using novel tools like trigger programs.

METHODS

Children's National Hospital developed a unique pediatric triggers program that offers customized, near real-time reports of potential safety events. Our team defined a measure to quantify clinical utility of triggers, termed "trigger signal," as the percentage of cases that represent true adverse or near-miss events (numerator) per total triggers activated (denominator). Our key driver diagram focused on unifying the program structure, increasing data analytics, promoting organizational awareness, and supporting multidisciplinary end user engagement. Using the model for improvement, we aimed to double overall trigger signal from 8% to 16% and sustain for 12 months.

RESULTS

The trigger signal increased from 8% to 41% and sustained during the coronavirus disease 2019 pandemic. A balancing measure of time to implement a new trigger decreased. Key interventions to increase trigger signal were change in the program structure, increasing stakeholder engagement, and development of self-service reports for end users.

CONCLUSIONS

Children's National Hospital's triggers program highlights successful evolution of an iterative, customized approach to increase clinical utility that hospitals can implement to impact real-time patient care. This triggers program requires an iterative, customized approach rather than a "1-size-fits-all," static paradigm to add a new dimension to current patient safety programs.

Comparison of Parental In-Person Visitation and Webcam Usage Patterns at a Single-Center Neonatal Intensive Care Unit

Purpose

Barriers to parents visiting the neonatal intensive care unit (NICU) in person for infant bonding include socioeconomic status, distance from NICU, and having children at home. Use of NICU bedside webcam can increase access to parent-infant interaction. This study aimed to describe the pattern of webcam logins by parents, relationship of logins to in-person visitation, and maternal factors affecting usage.

Methods

In this retrospective cohort study, data pertaining to parental webcam logins and in-person visitation, maternal screening for depression, anxiety, and stress, and family sociodemographics were collected from medical records. Relationships between chart variables and webcam or in-person visitation were measured using Pearson's correlation coefficient and Mann-Whitney U test, as applicable. Login data were obtained from weeks 2 through 5 of NICU stay of the infant, while depression, anxiety, and stress scores were obtained in the second week as standard procedure by a dedicated NICU social worker.

Results

A total of 59 mother-baby dyads were included. Percentage of days visited and webcam logins decreased from week 2 to week 5. A higher rate of webcam login was documented for all parents on days they did not visit in person. Parents who lived ≥15 miles away (P=0.004) and those with government insurance (P=0.01) visited in person significantly less, although webcam logins showed no difference between groups. One negative correlation was found between percentage of in-person visits and DASS-21 depression score (P=0.03), but no such correlation was seen with webcam logins.

Conclusions

Parents utilized NICU webcams to connect with their infants when unable to be at the bedside. Webcam use reduced visitation disparities known to be exacerbated by insurance status, home-to-hospital distance, and psychological distress.

NeoConnect: The Design, Implementation, and Impact of a Virtual Family-Centered NICU Program

BACKGROUND

Familial involvement in the neonatal intensive care unit (NICU) reduces parental stress and strengthens parental-infant bonding. However, parents often face barriers to in-person visitation. The coronavirus disease-2019 COVID-19 pandemic has exacerbated limitations to parental bedside presence.

OBJECTIVE

To design, implement, and evaluate a technology-based program to connect NICU babies with their families during the COVID-19 pandemic.

METHODS

We created NeoConnect at our level IV NICU, which included parental audio recordings and video chats between parents and their babies. Parental and NICU staff input on NeoConnect was gathered via preimplementation surveys. Inaugural families and staff members completed a postparticipation survey.

RESULTS

Prior to implementation, all parents who were surveyed (n = 24) wished they could be more involved in their baby's care. In the first 3 months of NeoConnect, 48 families participated in the audio recording project and 14 families participated in the video chat initiative. Following implementation, 85% of surveyed staff (28/33) reported that the patients became calmer when listening to their parents' recorded voice and 100% of surveyed parents (6/6) reported that video chats reduced their stress level.

CONCLUSION

Harnessing technology as a tool to increase parental involvement in the NICU is feasible and beneficial for NICU patients and their families.

Improving Communication with Parents in the NICU during the COVID-19 Pandemic, a Study and Review of the Literature

BACKGROUND

Communication with parents of sick premature and term infants in the NICU is complicated and challenging. Multiple efforts have been made to improve it, including the introduction of new electronic-based measures.

AIM

We aimed to study the influence of implementation of a new communication technology on parents' satisfaction with care in the NICU during the COVID-19 pandemic.

METHODS

Infants were video-recorded in their incubators or cots without being disturbed. These short films, with voice updates on the infant's condition, were sent on a daily basis to their parents via a WhatsApp application.

RESULTS

Parents who chose to join the new communication project (study group) were older, and their infants were more premature. Parents were satisfied with this new communication modality. Satisfaction scores in both study and control groups were high, but not significantly different.

CONCLUSIONS

Although the implementation of the new communication project was successful, we could not demonstrate significant improvement in satisfaction scores that were high in study and control groups, reflecting baseline high satisfaction. Further studies are needed employing other assessment tools in order to evaluate other aspects of parents' satisfaction with new modalities of communication introduced to the NICU, and their effects on parents' bonding with their infants.

Percepção dos pais sobre as práticas de educação em saúde na Unidade Neonatal

Resumo Objetivo analisar a percepção dos pais sobre as práticas de educação em saúde desenvolvidas pelos enfermeiros na Unidade Neonatal que facilitaram a aquisição de competências parentais para uma tomada de decisão fundamentada. Método estudo exploratório e descritivo, com abordagem qualitativa. Participaram 13 pais com filhos internados, pela primeira vez, em uma Unidade Neonatal portuguesa. Os dados foram colhidos entre fevereiro e agosto de 2020, por meio de grupos focais, processados no software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires, através da Classificação Hierárquica Descendente e da Análise de Similitude. Resultados da Classificação Hierárquica Descendente, emergiram quatro classes: “Necessidades de informação”, “Lacunas na informação”, “Disponibilidade para informar”; “Práticas facilitadoras da educação em saúde”. Conclusão e implicações para a prática os pais consideraram como práticas facilitadoras da educação em saúde a tecnologia digital aliada à disponibilidade dos enfermeiros para informar e explicar, bem como propiciar um ambiente empático e informal. Tal resultado pode subsidiar o desenvolvimento de intervenções de enfermagem de educação em saúde para pais na Unidade Neonatal, com recurso à tecnologia digital.

Impact of the COVID-19 pandemic on developmental care practices for infants born preterm

OBJECTIVES

To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm.

METHODS

We analyzed electronic medical record data from 129 infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n = 67) and the analogous period in 2019 (n = 62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates.

RESULTS

Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p = 0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p = 0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p = 0.001). In 2020, developmental care activities were 5 min shorter, on average, than in 2019, p = 0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies.

CONCLUSIONS

The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.

Improving Care in Neonatal Intensive Units During the COVID-19 Pandemic: A Survey on Electronic Health Communication

BACKGROUND

A novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started spreading through Italy and the world from February 2020, and the pandemic threatened the family-centred care (FCC) model used in the neonatal intensive care unit (NICU). Teleconferences and video calls were employed to keep parents in contact with their babies. This study aimed to evaluate satisfaction and stress levels between parents in the telematic family-centred care group (T-FCC) versus the FCC group and the no Family-Centred Care (N-FCC) group. Methods A prospective cohort pilot study was carried out from April to May 2020. A parental stressor scale and the NICU satisfaction questionnaire were administered to parents at the time of discharge of their newborns. Parents in T-FCC group could see their newborns via video calls, while those in the FCC and N-FCC groups were extracted from our previously published database. Results Parents in the T-FCC group were more satisfied and less stressed than those in the N-FCC group. Experiences of the mothers and fathers in the T-FCC group were similar. However, the FCC group showed the best results. Conclusion The T-FCC group showed satisfaction with the quality of information received about their babies and felt that their privacy was considered and respected by the medical staff. Parents were also less stressed because they could monitor what happens to the baby through a video, however, they could not intervene if there was a problem. Data support the use of video calls to improve insight into clinical conditions and communication between doctors, nurses, and parents during the pandemic.

Parental Perspectives on the Postpartum Bonding Experience after Neonatal Intensive Care Unit Transfer to a Referral Hospital

OBJECTIVE

The aim of this study is to describe the postpartum bonding experience of parents whose newborns were transferred to a referral hospital while their mothers remained at the delivery hospital.

STUDY DESIGN

A total of 18 semi-structured interviews conducted with mothers within 2 weeks of birth were completed. Thematic analysis was performed.

RESULT

In total, 72% of mothers were unable to hold their newborns, and mothers spent a median of 15 minutes with their newborn prior to transfer. Thematic analysis revealed five themes: three barriers to bonding (medical, hospital, and family barriers) and two themes of interventions that helped promote bonding (parent and hospital-initiated interventions). Using technology such as bedside cameras, recording of heart beats, and video chatting on rounds were extremely popular.

CONCLUSION

Parents identified multiple barriers to maternal-infant bonding and suggested several parent-focused and hospital-focused interventions to enhance bonding. Strategies that address barriers should be used to help parents promote bonding during separation from their newborns.

KEY POINTS

· Transfer to referral neonatal intensive care units interrupts bonding.. · Interviews reveal multiple barriers to bonding.. · Interventions can be parent or hospital initiated.. · Technology is playing a growing role..

Maternal Stress, Depression, and Attachment in the Neonatal Intensive Care Unit Before and During the COVID Pandemic: An Exploratory Study

The main aim of the present study was to investigate the effects of the COVID-19 pandemic on the mothers' postnatal depression, stress, and attachment during their stay in the Neonatal Intensive Care Unit (NICU). Twenty mothers of very premature infants born before 32weeks of gestational age were recruited at the Geneva University Hospital between January 2018 and February 2020 before the COVID-19 pandemic started. Mothers were screened for postnatal depression after their preterm infant's birth (Edinburgh Postnatal Depression Scale, EPDS), then for stress (Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU), and attachment (Maternal Postnatal Attachment Scale, MPAS) at infant's term-equivalent age. Data were compared with 14 mothers recruited between November 2020 and June 2021 during the COVID-19 pandemic. No significant differences were found in the scores for depression, stress, and attachment between the two groups. However, a non-statistically significant trend showed a general increase of depression symptoms in mothers during the COVID-19 pandemic, which significantly correlated to the attachment and stress scores. Moreover, the PSS:NICU Sights and Sounds score was significantly positively correlated with EPDS scores and negatively with the MPAS score only in the During-COVID group. To conclude, we discussed a possible dampened effect of the several protective family-based actions that have been adopted in the Geneva University Hospital during the health crisis, and we discussed the most appropriate interventions to support parents in this traumatic period during the COVID-19 pandemic.

Healthcare professionals' sense of coherence of parental involvement in neonatal intensive care units: A framework synthesis

Family-centered care is recognized as the gold standard in pediatric healthcare practice. However, despite the acknowledgment of its benefits and importance, inconsistent and questionable implementation persists in neonatal intensive care units (NICUs) without a consolidated understanding of healthcare professionals' experiences. Therefore, this review aims to explore and consolidate healthcare professionals' perspectives on parental participation in the NICU. A systematic review of qualitative studies was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven electronic databases were searched from their respective dates of inception until December 30, 2020. Twenty-eight studies were included in this review. The analysis was conducted via a framework synthesis approach using Antonovsky's Sense of Coherence theory. Three over-arching themes, guided by Antonovsky's Sense of Coherence theory emerged: (1) "Comprehensibility of parental involvement in family-centered care," (2) "Manageability of parental involvement in care and decision-making," and (3) "Meaningfulness of parental involvement in shared decision-making in neonatal care," with nine corresponding subthemes. Healthcare professionals had mixed views of parental involvement, recognizing the benefits attributed to infants and parents, but were greatly hindered by organizational, environmental, and personal obstacles that weakened their sense of coherence in coping with the situation, making them feel unconfident and unprepared to involve parents in care. To cope, more integrated and formalized support was required. Organizational, environmental, and policy changes, as well as psychological support, were strategies identified to enhance healthcare professionals' sense of coherence, and consequently, their ability to cope.

Engaging and supporting families in the Neonatal intensive care unit with telehealth platforms

The utilization of telehealth in the Neonatal Intensive Care Unit (NICU) has the potential to better support families during their infant's time in the hospital. Due to the stressful nature of a NICU admission, parents are at increased risk for anxiety. The expanding use of web camera and videoconferencing technologies will allow families to bond and connect with their infant through remote baby viewing. These technologies are also in place during their hospitalization and allow families the opportunity to connect directly with their care team to build trusting relationships and work on a mutual care plan. Telehealth platforms can continue to aid families post discharge to ensure that transition of care to their child's primary care provider is seamless. With telehealth programs taking root in multiple, longitudinal aspects of NICU care, the hope is to promote the foundations of patient and family-centered care and provide our families with the support they deserve.

Family Presence for Critically Ill Patients During a Pandemic

Family engagement is a key component of high-quality critical care, with known benefits for patients, care teams, and family members themselves. The COVID-19 pandemic led to rapid enactment of prohibitions or restrictions on visitation that now persist, particularly for patients with COVID-19. Reevaluation of these policies in response to advances in knowledge and resources since the early pandemic is critical because COVID-19 will continue to be a public health threat for months to years, and future pandemics are likely. This article reviews rationales and evidence for restricting or permitting family members' physical presence and provides broad guidance for health care systems to develop and implement policies that maximize benefit and minimize risk of family visitation during COVID-19 and future similar public health crises.

Family integrated care: Supporting parents as primary caregivers in the neonatal intensive care unit

Family integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy; important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.

Supporting Breastfeeding in 2021 and Beyond-Lessons from the Pandemic

The COVID-19 pandemic has affected maternal and infant health globally both directly from infection with the SARS-CoV-2 virus and indirectly from changes in health care resulting from social, economic, and health care policies unique to each country. The developing countries have to share the disproportionate burden on maternal and infant health. In this review, we discuss the uncertainties resulting from SARS-CoV-2 infection in pregnancy, vertical transmission of the virus, and its effects on breastfeeding of the newborn. The problems of families and communities caring for mothers with COVID-19 and its impact on breastfeeding in newborns are discussed. The challenges posed by the pandemic have forced us to think and devise innovative solutions, including telemedicine help for antenatal counseling, breastfeeding education, and lactation support. Optimal utilization of resources and technology to find creative solutions at the individual and the community level will help in facilitating maternal-infant bonding soon after birth. Appropriate health care policies to support pregnant and lactating mothers will go a long way in meeting healthy child development goals.

Promoting infant mental health in the neonatal intensive care unit (NICU): A review of nurturing factors and interventions for NICU infant-parent relationships

Premature and medically vulnerable infants experience early and sometimes prolonged separation from their parents, intrusive and unnatural environments, painful and distressing procedures, difficulties with physiological regulation, increased biological and neurological vulnerabilities, and grow up to have higher rates of neurocognitive and psychosocial difficulties. Parents of infants born prematurely or with medical vulnerabilities, in turn, experience significant distress and are a psychiatrically vulnerable population, with very high rates of depression, anxiety, and posttraumatic stress disorder. The combination of these factors cause significant challenges for some of these infants and parents in developing an early optimal relationship and connection. Given the critical importance of early relationships with main caregivers for infant mental health and long-term developmental outcomes, we review various targets of intervention to promote healthy infant and parent mental health and bonding thereby facilitating an optimal infant-parent relationship in the NICU population.

The Collateral Impact of COVID-19 Emergency on Neonatal Intensive Care Units and Family-Centered Care: Challenges and Opportunities

The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staff facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices.

Impact of the COVID-19 pandemic on developmental care practices for infants born preterm

OBJECTIVES

To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm delivered by both families and clinical staff.

METHODS

We analyzed electronic medical record data from infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to May 31, 2020) and the analogous period in 2019. Our final sample consisted of 52 infants ( n =27, 2019 cohort; n =25, 2020 cohort). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for GA at start of study period.

RESULTS

Results indicated that families of infants in the 2020 cohort visited less frequently (47% of available days) than those in the 2019 cohort (97%; p =0.001). Infants received developmental care activities less frequently in the 2020 cohort (3.51 vs. 4.72 activities per day; p =0.04), with a lower number of minutes per day (99.91 vs. 145.14; p =0.04) and a shorter duration per instance (23.41 vs. 29.65; p =0.03). Similar reductions occurred in both family- and staff-delivered developmental care activities.

CONCLUSIONS

The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.

Neonatal nursing in the COVID-19 pandemic: can we improve the future?

The current 2019 coronavirus disease (COVID-19) is the world's largest and most pervasive public health emergency in more than one hundred years. Although neonatal units have not been at the epicentre of the current health crisis, they have also been forced to adopt contingency plans with the aim of protecting hospitalised neonates, their families, and professionals. Neonatal units have been forced to alter the neonatal care framework based on promoting neurodevelopment and family-centred care. The peak of the pandemic is falling in most countries, but COVID-19 infection is not eradicated and there is uncertainty about new outbreaks. It is time to reflect about better strategies to preserve the rights and excellence of care for newborns and their families. This column will highlight the changes that have occurred in neonatal units, and their impact on neonatal care and families. It is a time for critical reflection on nursing practice.

Remote Parent Participation in Intensive Care Unit Rounds

Although most pediatric intensive care units invite parents to participate in daily rounds, many families face barriers preventing them from being physically present on rounds. Telehealth for remote parent participation on daily rounds offers one solution to this problem. However, barriers threaten the implementation and sustainability of such programs. Highly reliable, user-friendly telehealth technologies coupled with adequate human resources to address logistical challenges and clinical champions to affect culture change are key. Further research is needed to better quantify the impact of such programs on patient and parent outcomes and to convince hospital leadership to invest in telehealth solutions.

In-Hospital Telehealth Supports Care for Neonatal Patients in Strict Isolation

The aim of this study is to determine the feasibility of "in-hospital" inpatient telemedicine within a children's referral hospital to facilitate inpatient care activities such as interprofessional rounding and the provision of supportive services such as lactation consultations to pediatric patients in strict isolation. To test the feasibility of in-hospital video telemedicine, a dedicated telemedicine device was set up in the patient's room. This device and the accompanying Bluetooth stethoscope were used by the health care team located just outside the room for inpatient rounding and consultations from supportive services. Video telemedicine facilitated inpatient care and interactions with support services, reducing the number of health care providers with potential exposure to infection and decreasing personal protective equipment use. In the setting of strict isolation for highly infectious viral illness, telemedicine can be used for inpatient care activities such as interprofessional rounding and provision of supportive services. KEY POINTS: · Telehealth supports patient care in isolation.. · Telehealth reduced health care provider exposures.. · Telehealth conserves personal protective equipment..

The Impact of Web-Cameras on Parent-Infant Attachment in the Neonatal Intensive Care Unit

PROBLEM

The introduction of web-cameras in neonatal intensive care units (NICUs) has made it possible for parents to see their sick or premature infant when they cannot be close to them due to prolonged hospital admissions. However, there is a paucity of research into the impact of this technology on the wellbeing of families. A systematic review was conducted to identify previous research and suggest avenues for future inquiry.

ELIGIBILITY CRITERIA

Research studies written in English that investigated the impact of web-cameras on parent-infant attachment in the NICU were sought for inclusion. However, due to the dearth of studies focused on this question, the eligibility criteria were extended to include any study that assessed the impact of web-camera use on mechanisms that impact attachment quality, such as bonding, anxiety, stress, and depression.

RESULTS

A total of 152 articles were identified. After duplicates and other non-suitable articles were removed, three studies met eligibility criteria for review.

CONCLUSION

There are promising indications that the use of web-cameras in the NICU enhances parent-infant attachment by strengthening parents' feelings of closeness to their infants, increasing parental responsiveness and reducing parental stress and anxiety. However, while the overall effects appear to be positive, negative impacts affecting a small proportion of parents were identified. This highlights the need to identify who is most likely to benefit from web-camera technology and who requires alternative supports.

IMPLICATIONS

Web-cameras are a useful adjunct to methods of family-centred care, however, more research is needed to optimise their use and minimise potential harm.

Mothers' Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care

BACKGROUND

Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown.

PURPOSE

The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago.

METHODS

In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant's birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis.

RESULTS

Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother-nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving.

IMPLICATIONS FOR PRACTICE

Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance.

IMPLICATIONS FOR RESEARCH

Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers.

Visitation restrictions: is it right and how do we support families in the NICU during COVID-19?

Although the COVID-19 pandemic has largely not clinically affected infants in neonatal intensive care units around the globe, it has affected how care is provided. Most hospitals, including their NICUs, have significantly reduced parental and family visitation privileges. From an ethical perspective, this restriction of parental visitation in settings where infectious risk is difficult to understand. No matter what the right thing to do is, NICUs are currently having to support families of their patients via different mechanisms. In this perspective, we discuss ways NICUs can support parents and families when they are home and when they are in the NICU as well as provide infants the support needed when family members are not able to visit.

Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes

In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.

Technology-Enhanced Consultations in Diabetes, Cancer, and Heart Failure: Protocol for the Qualitative Analysis of Remote Consultations (QuARC) Project

BACKGROUND

Remote videoconsulting is promoted by policy makers as a way of delivering health care efficiently to an aging population with rising rates of chronic illness. As a radically new service model, it brings operational and interactional challenges in using digital technologies. In-depth research on this dynamic is needed before remote consultations are introduced more widely.

OBJECTIVE

The objective of this study will be to identify and analyze the communication strategies through which remote consultations are accomplished and to guide patients and clinicians to improve the communicative quality of remote consultations.

METHODS

In previous research, we collected and analyzed two separate datasets of remote consultations in a National Institute for Health Research-funded study of clinics in East London using Skype and a Wellcome Trust-funded study of specialist community heart failure teams in Oxford using Skype or FaceTime. The Qualitative Analysis of Remote Consultations (QuARC) study will combine datasets and undertake detailed interactional microanalysis of up to 40 remote consultations undertaken by senior and junior doctors and nurse specialists, including consultations with adults with diabetes, women who have diabetes during pregnancy, people consulting for postoperative cancer surgery and community-based patients having routine heart failure reviews along with up to 25 comparable face-to-face consultations. Drawing on established techniques (eg, conversation analysis), analysis will examine the contextual features in remote consultations (eg, restricted visual field) combined with close analysis of different modes of communication (eg, speech, gesture, and gaze).

RESULTS

Our findings will address the current gap in knowledge about how technology shapes the fine detail of communication in remote consultations. Alongside academic outputs, findings will inform the coproduction of information and guidance about communication strategies to support successful remote consultations.

CONCLUSIONS

Identifying the communication strategies through which remote consultations are accomplished and producing guidance for patients and clinicians about how to use this kind of technology successfully in consultations is an important and timely goal because roll out of remote consultations is planned across the National Health Service.

REGISTERED REPORT IDENTIFIER

RR1-10.2196/10913.