Implementing a Parent Education Program in the Special Care Nursery

'It turned my life upside down': Parents' emotional experience of the transition with their preterm infant from birth to discharge Home-A qualitative study

BACKGROUND

A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis' Transition Theory, parents might experience emotional change initiated by critical events during this transition.

OBJECTIVES

The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better.

METHODS

This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis.

RESULTS

The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents' experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge.

CONCLUSIONS

Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents' critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.

Breastfeeding a Premature Baby During the Covid-19 Pandemic in Perinatology: An Exploration of Mothers' Experiences

This study was conducted to explore the meaning of mothers' experiences of breastfeeding premature babies while being treated in the perinatology room during the COVID-19 pandemic. A descriptive phenomenological design was used in this study to describe the meaning of mothers' experiences. In-depth interviews were conducted with 11 mothers. The analysis of transcribed data resulted in three themes: (1) The pandemic has made it difficult for me to meet my baby, (2) Breastfeeding is not easy, and (3) I am a breast milk pumper. The breastfeeding experience of having a premature baby and being cared for by perinatology during a pandemic is full of challenges and limited support. The results of this study suggest that a review of the current regulations be carried out, and the staff be given continuing lactation education to strengthen breastfeeding support to mothers with premature babies.

Evaluating the Implementation of the Online HUG Your Baby Course "Roadmap to Breastfeeding Success" for Nevada WIC Professionals

Lack of knowledge on the impact of infant development and behavior on breastfeeding affects both professionals and the clients they serve. Continuing education for Nevada WIC professionals with the online HUG Your Baby course Roadmap to Breastfeeding Success was implemented. This two-hour online course teaches about baby's development from birth to one year in relation to the breastfeeding journey. Tests and self-report surveys were used to evaluate these objectives pre- and post-intervention. Results showed significant improvement in knowledge about infant behavior and development, confidence in identifying and responding to infant behavior, and the positive integration of HUG resources into the professionals' work.

Increasing Parent Satisfaction With Discharge Planning: An Improvement Project Using Technology in a Level 3 NICU

BACKGROUND

Neonatal intensive care unit (NICU) families are often overwhelmed by the discharge process. Their anxiety can inhibit learning and contribute to poor infant outcomes and increased healthcare utilization after discharge. Quality of the discharge teaching is the strongest predictor of discharge readiness, so NICUs must develop excellent discharge preparation programs.

PURPOSE

This improvement project enhances NICU discharge preparedness by providing consistent, early discharge teaching using technology as a supplemental resource and raises parental satisfaction with the process.

METHODS

Neonatal intensive care unit staff and former NICU parents developed a task force to create technology-based discharge education content. The content was originally uploaded to an e-book and later transferred to the electronic health record inpatient portal. Families were able to view discharge teaching content at their own convenience and pace and review topics as needed with the NICU staff. Postdischarge follow-up phone calls provided insight into parental reaction to the new education format.

RESULTS

Parent satisfaction top-box scores, reflecting the highest rating in the "Prepared for Discharge" category of the patient satisfaction survey, improved from a baseline of 47% in 2017 to 70% in 2019. Overwhelmingly, 92% of families highly rated the tablet-based discharge teaching during postdischarge phone calls.

IMPLICATIONS FOR PRACTICE

A comprehensive, consistent, and early discharge program using technology can lead to more effective and efficient NICU discharge education and improved parent satisfaction.

IMPLICATIONS FOR RESEARCH

Further studies are needed to generalize hospital-based inpatient portal teaching as an additional resource for parental education in the NICU.

Prenatal education program decreases postpartum depression and increases maternal confidence: A longitudinal quasi-experimental study in urban Japan

BACKGROUND

Mothers in urban Japan are at high risk for postpartum depression. Previous research indicates that parents who understand their baby's behavior may have lower risks for postpartum depression. HUG Your Baby helps parents understand their baby's behavior.

AIM

The purpose of this longitudinal study was to determine whether mothers receiving prenatal HUG Your Baby teaching would have better outcomes than a control group with respect to postpartum depression and related factors.

METHODS

Pregnant women, after thirty weeks' gestation, were recruited to either the intervention or the control group. The intervention group received HUG Your Baby education, which teaches how to recognize and respond to a baby's behavior. The control group received a leaflet and regular, prenatal treatment. Participants completed the Edinburgh Postnatal Depression Scale, Karitane Parenting Confidence Scale, and three other scales at one and three months, postpartum. Questions about knowledge of baby's behavior was administered prenatally, and at one and three months, postpartum.

FINDINGS

Data derived from 221 mothers (Control 100, Intervention 121) were included in the analysis. Researchers found significant differences regarding postpartum depression at one and three months and parenting confidence at one month. Scores were favorable for the intervention group.

CONCLUSIONS

The HUG Your Baby program has a positive impact on preventing postpartum depression and increasing parenting confidence. It warrants wider implementation and evaluation in prenatal programs.

Randomized clinical trial investigating the effect of consistent, developmentally-appropriate, and evidence-based multisensory exposures in the NICU

OBJECTIVE

Evaluate the effect of a manualized multisensory program, applied across NICU hospitalization, on infant and parent outcomes.

STUDY DESIGN

Seventy parent-infant dyads (born ≤32 weeks gestation) in a Level IV NICU were randomized at birth to the multisensory program or standard-of-care. Parents in the multisensory group administered prespecified amounts of age-appropriate, evidence-based sensory interventions to their infants each day during NICU hospitalization according to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program.

RESULTS

Infants who received the SENSE program had more lethargy on the NICU Network Neurobehavioral Scale (NNNS) (p = 0.05), even after controlling for medical and social risk (p = 0.043), and had higher Communication scores on the Ages and Stages Questionnaire (p = 0.04) at 1-year corrected age, but this relationship failed to reach significance after controlling for medical and social risk (p = 0.12).

CONCLUSION

The SENSE program shows promise for improving outcomes, but more research with larger sample sizes is needed.

Exploring Informational Needs of Parents of Children with Intestinal Failure: A Thematic Analysis

PURPOSE

Information seeking has been observed to be important for the coping and empowerment of parents of children with rare diseases. This study was conducted to understand the education needs of families of children with pediatric intestinal failure (IF) and how technology might be effectively leveraged to address these needs.

DESIGN AND METHODS

A qualitative methodology using thematic analysis was utilized. Purposeful sampling was adopted to recruit 10 parents/caregivers of children with IF. Participants participated in a 1:1 semi-structured interview. Interviews were recorded, transcribed and themes identified through open and focused coding.

RESULTS

Four themes emerged: (1) reliable electronic or printed information resources relevant to their child's unique needs were lacking; (2) an educational program with in-person and hands-on learning was preferred for transition to home; (3) practical and relatable information was valued over medical knowledge as children's needs evolved; and (4) creation of electronic resources would be useful for information seeking and sharing.

CONCLUSION

To cope with the responsibilities of caring for a child with IF, participants sought information beyond what they received. Participants preferred a blended approach of care team discussions and electronic tools for receiving knowledge and skills. Parents' connections with other caregivers was important for practical day-to-day management information, as well as supporting their well-being.

PRACTICE IMPLICATIONS

Development and implementation of accessible digital resources with emphasis on practical information is required. Beyond medical and practical informational needs, building resilience and supporting psychologic needs for parents/caregivers of children with IF emerged as important needs to address.

Protocol for implementation of an evidence based parentally administered intervention for preterm infants

BACKGROUND

Multi-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents' interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants' behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs.

METHODS

The study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers' individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining.

DISCUSSION

This study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs.

TRIAL REGISTRATION

ClinicalTrials.gov registration number NCT04555590 , Registered on 8/19/2020.

Psychometric Properties of the Teachers’ Sense of Efficacy Scale for Chinese Special Education Teachers

Teacher self-efficacy plays an important role in special education; yet, the literature on the measurement of teacher self-efficacy in this field is limited. This study investigated the psychometric properties of the Teachers’ Sense of Efficacy Scale with a sample of Chinese special education teachers ( N = 401, 24.19% male). Confirmatory factor analysis indicated that the Chinese special educational version of the Teacher's Sense of Efficacy Scale (CS-TSES), modified from the Asian model by Ruan, J., Nie, Y., Hong, J., Monobe, G., Zheng, G., Kambara, H., & You, S. (2015). Cross-cultural validation of teachers’ sense of efficacy scale in three Asian countries. Journal of Psychoeducational Assessment, 33(8), 769-779, showed an excellent fit. Additionally, correlations were observed between the results of the CS-TSES and both the Multidimensional Scale of Perceived Social Support and the Satisfaction with Life Scale, providing criterion-related validity. In sum, the findings indicated that the TSES is applicable to special education teachers in the Chinese context.