Design, Implementation, and Early Outcome Indicators of a New Family-Integrated Neonatal Unit

The Effect of Simulation Training on Enhancing Nursing Students' Perceptions to Incorporate Patients' Families Into Treatment Plans: A Randomized Experimental Study

INTRODUCTION

As clinical placement in bachelor's nursing programs becomes increasingly difficult, simulation is becoming increasingly common to enhance learning. Blended learning incorporating simulation videos provides students with the opportunity to observe and learn from exemplary practices while bridging the gap between theoretical knowledge and its practical application. This study aimed to investigate the effect of simulation training on enhancing nursing students' perception of integrating patient's families' assessments into their treatment plan.

METHODS

A quantitative, experimental research design was used, with a control (56) and intervention group (67) from levels 7 and 8 senior nursing students at King Saud Bin Abdulaziz University for Health Sciences, College of Nursing, Jeddah, assigned randomly to each group. The tool consists of three sections: personal information, a Van Gelderen family rubric, and a role-play survey. The validity and reliability of the tools were confirmed by the original developer. In the current study, the reported Cronbach's alpha was 95%.

RESULTS

A total of 123 students participated in the study. Their ages ranged between 19 and 23 years and 23 years and above, with a mean age of 21.3 ± 1.3 among the control group and 22.2 ± 1.1 among the experimental group. There was an improvement in the mean scores in the post-training phase compared to the pre-training phase in the experimental group, with a statistically significant difference at p < 0.05. However, there were no significant differences noted between the control and experimental groups in the pre-training phase compared to the statistically significant difference noted between the two groups in the post-training phase.

CONCLUSION AND RECOMMENDATIONS

The findings of the study indicated that the utilization of scenario-based standardized patient-simulated exercises, guided by dedicated faculty and accompanied by reflective debriefing exercises, proved to be an effective approach for bridging the gap between theoretical knowledge and its application in clinical practice. Therefore, the study prompts curriculum revisions to incorporate family assessment into nursing practices, as well as evidence-based strategies, such as learning activities that use standardized patient or high-fidelity simulation technology to address and possibly reduce the theory-practice gap for graduates when entering clinical practice.

Engagement of Families in the Care of Hospitalized Pediatric Patients: A Scoping Review

This scoping review was conducted to examine the range, nature, and extent of the published family engagement literature specific to the pediatric acute care setting to highlight future research and practice development opportunities. Included studies (N = 247) revealed global relevance. Engagement strategies ranged from more passive such as allowing/encouraging families to be present at the bedside to more active strategies aimed at promoting mutual and reciprocal nurse-patient interactions. Family engagement is distinguished by a mutually beneficial partnership of families with health care team members and care organizations. Future research in the area of family engagement in pediatric nursing should focus on determining the core engaging health professional behaviors and engaged parent outcomes; extending the knowledge base related to mutually beneficial partnerships between families and health care teams; developing effectiveness studies to determine the optimal engaging actions by teams to achieve parent engagement; and measuring the influence of engagement on parent and infant/child outcomes.

Assessment of feasibility and acceptability of family-centered care implemented at a neonatal intensive care unit in India

Background

A family-centered care (FCC) parent participation program that ensures an infant is not separated from parents against their will was developed for the caring of their small or sick newborn at a neonatal intensive care unit (NICU) in Delhi, India. Healthcare provider sensitization training directed at psychosocial and tangible support and an audio-visual training tool for parent-attendants were developed that included: 1) handwashing, infection prevention, protocol for entry; 2) developmentally supportive care, breastfeeding, expression of breastmilk and assisted feeding; 3) kangaroo mother care; and 4) preparation for discharge and care at home. The study aimed to examine the feasibility and acceptability of the FCC model in a NICU in India.

Methods

A prospective cohort design collected quantitative data on each parent-attendant/infant dyad at enrollment, during the NICU stay, and at discharge. Feasibility of the FCC program was measured by assessing the participation of parent-attendants and healthcare providers, and whether training components were implemented as intended. Acceptability was measured by the proportion of parent-attendants who participated in the trainings and their ability to accurately complete program activities.

Results

Of 395 NICU admissions during the study period, eligible participants included 333 parent-attendant/infant dyads, 24 doctors, and 21 nurses. Of the 1242 planned parent-attendant training sessions, 939 (75.6%) were held, indicating that program fidelity was high, and the majority of trainings were implemented as intended. While 50% of parent-attendants completed all 4 FCC training sessions, 95% completed sessions 1 and 2; 60% of the total participating parent-attendants completed session 3, and 75% completed session 4. Compliance rates were over 96% for 5 of 10 FCC parent-attendant activities, and 60 to 78% for the remaining 5 activities.

Conclusions

FCC was feasible to implement in this setting and was acceptable to participating parent-attendants and healthcare providers. Parents participated in trainings conducted by NICU providers and engaged in essential care to their infants in the NICU. A standard care approach and behavior norms for healthcare providers directed psychosocial and tangible support to parent-attendants so that a child is not separated from his or her parents against their will while receiving advanced care in the NICU.

Integration of Maternity and Neonatal Care to Empower Parents

OBJECTIVE

To describe the transition from a traditional hospital design with separate maternity and neonatal departments to a design in which maternity and neonatal health care infrastructures are integrated to empower parents.

DESIGN

A descriptive, qualitative analysis.

SETTING

A mother and child center in a teaching hospital in Amsterdam.

PARTICIPANTS

Six staff members who were involved in the transition.

METHODS

We analyzed the content of all relevant policy reports and other related documents that were produced during the transition from April 2010 to October 2014. This content was supplemented with in-depth, semistructured interviews with the six participants. We used thematic analysis and Bravo et al.'s model of patient empowerment to analyze the documents and the qualitative interview data.

RESULTS

We identified eight themes. At the health care system level, the four themes were Joint Vision and Goal, Integration of Three Wards Into One With Single-Family Rooms, Reorganization of the Health Care Team, and New Equipment. At the health care provider level, the three themes were Training for Extension of Professional Goals, Intensified Coaching for Parents, and Implementing Patient Centeredness. The single theme at the patient level was Opinions and Experiences of Parents.

CONCLUSION

We found a good fit between the new design and Bravo et al.'s model of patient empowerment. Challenges that remain include the adaptation of staff training programs and further development of the infrastructure in collaboration with staff and parents. The experiences of parents and staff members will be evaluated in future studies.

Key factors supporting implementation of a training program for neonatal family- centered care - a qualitative study

Background

Traditionally, the care of infants in neonatal care units has been professionally centered, paying less attention to family support. In recent years, many interventions have been developed to improve family-centered care and thereby parent and infant outcomes. Understanding the key factors of implementation of these interventions would help improve clinical practice. The aim of this study was to describe the staff’s perceptions of the implementation of the Close Collaboration with Parents Training Program and to identify the barriers and facilitators of the implementation.

Methods

A descriptive qualitative interview study was conducted in eight neonatal intensive care units in Finland. Nineteen unit managers and 32 nurses were interviewed after their unit had finished the 1.5-year training program. Data were analyzed using thematic content analysis.

Results

Key factors facilitating the implementation of the training program were multidisciplinary commitment and the staff’s motivation to change their professional role to work as the parents’ facilitator. Observable benefits promoted the implementation, as well as experiential learning as a facilitation method. The role of mentor was remarkable as a facilitator. In addition, contextual elements such as support from leadership and proper timing were important.

Conclusions

Implementation of family-centered care is facilitated by staff who is prepared to accept parents as partners and adopt a new professional role. Enough time for preparation, readiness for the change, solid support from the leadership, and a multidisciplinary approach are needed as well. Mentoring was found to be one of the key factors facilitating the change.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4256-1) contains supplementary material, which is available to authorized users.

Self-assessment of family inclusion in institutional policies and practices: nursing team perspective

Abstract Objective: To compare the evaluation carried out by the nursing teams of pediatric and maternal-infant with adult patient wards on the inclusion of families in institutional policies and practices. Method: A cross-sectional and descriptive study carried out in a university hospital with 148 professionals from the nursing team of the maternal and pediatric units and 43 from adult units. The data were analyzed by the program Statistical Package for the Social Sciences 22, using the chi-square test and Fisher's exact test. Results: The groups presented distinct perceptions about the differentiation between families and visitors in policies and practices; similar perceptions related to the policies and practices are not favorable to the presence of siblings and children, and to the non-inclusion of the families in aspects related to daily care. Conclusion and Implications for Practice: The perception of nursing teams indicates that families are not included in institutional policies and practices. The results of an organizational self-assessment about families' inclusion subsidize a way to improve organizational policies and practices, making it possible to draw up an action plan to implementing Patient and Family Centered Care at the institutional level.

Communicating with parents in neonatal intensive care units: The impact on parental stress

OBJECTIVE

To analyse stress in parents whose infants with very low birth weight have just concluded high-level care in a Neonatal Intensive Care Unit (NICU). More specifically, we aimed 1) to identify groups of parents in the NICU who are particularly at risk of experiencing stress, and 2) to explore the effects of clinical staffś communication on parental stress.

METHODS

Our multi-center-study evaluated views from 1277 parents about care for 923 infants in 66 German NICUs. Answers were linked with separately evaluated medical outcomes of the infants. Separate generalised mixed models estimated the influence of personal, medical and communication-related characteristics on specific parental stress.

RESULTS

Parents of a younger age and those of infants with severe prognoses were more likely to experience stress. While empathetic communication as one aspect of staffś communication was shown as appropriate in reducing parental stress, an initial introduction and the quantity of information were only slightly associated with lower levels of stress.

CONCLUSION

Results provide evidence for the need to involve parents empathetically from the beginning of their child's stay in the NICU.

PRACTICE IMPLICATIONS

Staff in the NICU should communicate empathetically and help to reduce stress in parents particularly at risk.