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Urbina T, Balasundaram M, Coughlin M, Sorrells K, Toney-Noland C, Day C. The Why and How of Family-Centered Care. Neoreviews 2024; 25:e393-e400. [PMID: 38945966 DOI: 10.1542/neo.25-7-e393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 07/02/2024]
Abstract
Although the Accreditation Council for Graduate Medical Education states that neonatal-perinatal medicine fellows must demonstrate an understanding of the emotional impact of admission to the NICU on a family, few curricula are in place to teach this important competency. Family-centered care (FCC) in the NICU is an approach to health care that focuses on decreasing mental and emotional trauma for families while empowering them to reclaim their role as caregivers. FCC is deeply rooted in trauma-informed care and is crucial during transition periods throughout the NICU admission. In this article, we provide a review of FCC and trauma-informed care and how to use these approaches at different stages during an infant's hospitalization. We also discuss parent support networks and how to integrate FCC into an existing NICU practice.
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Affiliation(s)
- Theresa Urbina
- Department of Pediatrics, Uniformed Services University of Health Services, Bethesda, MD
| | - Malathi Balasundaram
- Division of Neonatology, Department of Pediatrics, Stanford Medicine Children's Health, Standford, CA
| | | | | | | | - Colby Day
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
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2
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Lechner BE, Kukora SK, Hawes K. Equity, inclusion and cultural humility: contemporizing the neonatal intensive care unit family-centered care model. J Perinatol 2024; 44:760-766. [PMID: 38532086 DOI: 10.1038/s41372-024-01949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/29/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Existing NICU family centered care models lack the key elements of equity, inclusion and cultural humility. These models were conceived to support families during the stressful life event of an infant's NICU admission. Their development, however, occurred prior to recognition of the medical field's systematic shortcomings in providing equitable care and their impact on outcome disparities for marginalized communities; thus, they do not include cultural or equitable healthcare considerations. Given the significant neonatal care inequities for marginalized groups, incorporating the experience of these patients in a targeted manner into family centered care frameworks is of critical importance to ensure culturally humble and thus more just and equitable treatment. Here, we review past approaches to NICU family centered care and propose a novel, updated framework which integrates culturally humble care into the NICU family centered care framework.
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Affiliation(s)
- Beatrice E Lechner
- Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI, USA.
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Stephanie K Kukora
- Division of Neonatology and Bioethics Center, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics and Department of Medical Humanities and Bioethics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Katheleen Hawes
- Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI, USA
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
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3
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Nist MD, Spurlock EJ, Pickler RH. Barriers and Facilitators of Parent Presence in the Neonatal Intensive Care Unit. MCN Am J Matern Child Nurs 2024; 49:137-144. [PMID: 38240753 DOI: 10.1097/nmc.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE The purpose of this study was to describe system-level and personal factors influencing parent presence in the neonatal intensive care unit (NICU) and identify differences in factors by sociodemographic characteristics. STUDY DESIGN AND METHODS In a cross-sectional national survey study using social media recruitment, participants rated the frequency of 13 potential barriers and 12 potential facilitators using a 5-point Likert scale. Experiences of discrimination and parent-staff engagement were also measured. RESULTS Valid responses were analyzed from 152 participants. Uncomfortable facilities and home responsibilities were the most highly reported system-level and personal barriers, respectively. Encouragement to participate in caregiving and social support were the most highly reported system-level and personal facilitators, respectively. Participants reported low to moderate levels of discrimination and moderate levels of parent-staff engagement. Latent class analysis revealed three sociodemographic clusters. Differences in barriers, facilitators, discrimination, and engagement were found among clusters. CLINICAL IMPLICATIONS NICU facilities are uncomfortable and may discourage parent presence. Allowing support persons to accompany parents, providing comfortable facilities, and engaging parents in caregiving may promote greater parent presence and improved parent and child outcomes. Studies of potential bias toward parents with lower education and income and effects on parent presence and infant outcomes are needed.
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Bogetz JF, Oslin E, O’Donnell M, Barton KS, Yi-Frazier JP, Watson RS, Rosenberg AR. Meaning-Making Among Parents of Children With Severe Neurologic Impairment in the PICU. Pediatrics 2024; 153:e2023064361. [PMID: 38529567 PMCID: PMC10979294 DOI: 10.1542/peds.2023-064361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Parents and family caregivers of children with severe neurologic impairment (SNI) experience many stressors, especially during their child's critical illness. This study aimed to examine parent experiences around the time of their child's PICU care to explore ways parents make meaning in relation to these stressors. METHODS This qualitative study of data from a single center in the United States followed Consolidated Criteria for Reporting Qualitative Research guidelines. One to one semistructured interviews queried parents' psychosocial well-being around the time of their child's PICU care. Eligible participants had a child with an SNI condition for >3 months admitted to the PICU for >24 hours with an expected length of stay >1 week. RESULTS Data were analyzed by a research team with expertise in palliative care, psychology, critical care, and qualitative methods. Fifteen family caregivers of 15 children participated. Children were a median of 8 years old (interquartile range 4-11.5) and 80% (n = 12) had congenital/genetic conditions. Parent/family caregivers were a median age of 39 years old (interquartile range 36-42.5); 20% (n = 3) self-identified as fathers and 47% (n = 7) as having to a minority racial background. Parents discussed ongoing meaning-making that occurred through domains of comprehension and purpose, and themes of understanding of other people and the world around them. Subthemes focused on appreciation/acceptance, adaptability/accountability, valuing all lives, and learning/teaching about their child. CONCLUSIONS Meaning-making may be an opportunity for support in the PICU among parents/family caregivers of children with SNI.
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Affiliation(s)
- Jori F. Bogetz
- Divisions of Bioethics and Palliative Care
- Treuman Katz Center for Bioethics
| | | | | | - Krysta S. Barton
- Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Seattle Children’s Research Institute; Seattle, Washington
| | | | - R. Scott Watson
- Division of Critical Care, Department of Pediatrics, University of Washington School of Medicine; Seattle, Washington
| | - Abby R. Rosenberg
- Division of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute; Department of Pediatrics, Boston Children’s Hospital; Department of Pediatrics, Harvard Medical School; Boston, Massachusetts
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Vance AJ, Farmer ML, D'Agata A, Moore T, Esser M, Fortney CA. NANN Membership Recommendations: Opportunities to Advance Racial Equity Within the Organization. Adv Neonatal Care 2024; 24:71-77. [PMID: 37703135 DOI: 10.1097/anc.0000000000001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Neonatal care has advanced significantly in recent years, yet racial health inequities persist in the neonatal intensive care unit (NICU), with infants from racial and ethnic minority groups less likely to receive recommended treatment. Healthcare providers acknowledge that there are steps that can be taken to increase knowledge and awareness regarding health inequities. PURPOSE To better understand current health equity-related initiatives in the neonatal community and solicit feedback from National Association of Neonatal Nurses (NANN) membership about advancing racial equity within the organization. METHODS A cross-sectional survey was conducted in January 2021. The anonymous, onetime survey was distributed to active NANN members via SurveyMonkey and included questions related to racial equity initiatives, recommendations, and demographics. Data analysis was conducted using an exploratory approach using descriptive statistics, and thematic analysis was used to summarize responses to open-ended questions. RESULTS There were 325 members who completed the full survey, of whom were White (83%), female (96%), staff nurses (42%), and those with more than 16 years of experience (69%), and most (69%) were familiar with NANN's racial equity position statement. Recommendations were summarized into the following themes: (1) research, (2) education, (3) workforce diversity, (4) communication, (5) scholarships, (6) resources, and (7) community outreach. IMPLICATIONS FOR PRACTICE AND RESEARCH NANN members offered clear and actionable recommendations to advance health equity within the neonatal community and organization, which included offering more diversity, inclusion, and equity education at the annual conferences, in ANC articles, and newsletters, and the creation of scholarships or reduced membership fees to encourage diverse enrollment in the organization.
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Affiliation(s)
- Ashlee J Vance
- Henry Ford Health, Detroit, Michigan (Dr Vance); Marietta Neonatology, Marietta, Georgia (Dr Farmer); The Univeristy of Rhode Island College of Nursing, Kingston, Rhode Island (Dr D'Agata); Univeristy of Nebraska Medical Center College of Nursing, Omaha, Nebraska (Dr Moore); Alverno College School of Nursing and Health Professions, Milwaukee, Wisconsin (Dr Esser); and The Ohio State University College of Nursing, Columbus, Ohio (Dr Fortney)
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Pirrello J, Sorin G, Dahan S, Michel F, Dany L, Tosello B. Analysis of communication and logistic processes in neonatal intensive care unit. BMC Pediatr 2022; 22:137. [PMID: 35291967 PMCID: PMC8922841 DOI: 10.1186/s12887-022-03209-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In neonatology, parents play a central role as guarantors of the new-born's autonomy. Notifying parents about their infant's status in neonatal critical care is an integral part of the care. However, conveying this information can be very difficult for physicians and the neonatal medical team. The objective of this work is to assess the dimensions and dynamic processes of critical care communications in neonatal intensive care in order to enhance the development of theoretical and applied knowledge of these discussions. METHODS This qualitative, descriptive study was conducted on critical care new-borns less than 28 days-old who were hospitalized in a neonatal intensive care unit. Verbatim communications with the parents were recorded using a dictaphone. RESULTS The verbatim information had five themes: (a) critical care, (b) establishing the doctor-patient relationship, (c) assistance in decision making, (d) Socio-affective and (e) socio-symbolic dimensions. Our recordings underscored both the necessity of communication skills and the obligation to communicate effectively. Analysis of the dynamics of the communication process, according to the categories of delivering difficult information, showed few significant differences. CONCLUSION Physician training needs to include how to effectively communicate to parents to optimize their participation and cooperation in managing their care.
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Affiliation(s)
- J Pirrello
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.,Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France
| | - G Sorin
- Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France
| | - S Dahan
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - F Michel
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.,Pediatric Intensive Care Unit, Hôpital de la Timone, Assistance-Publique des Hôpitaux de Marseille, 13005, Marseille, France
| | - L Dany
- Aix Marseille University, LPS, Aix-en-Provence, France.,Service of Medical Oncology, Hôpital de la Timone, Assistance-Publique des Hôpitaux de Marseille, 13005, Marseille, France
| | - B Tosello
- Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France. .,Department of Neonatal Medicine, North Hospital, Assistance-Publique des Hôpitaux de Marseille, 13015, Marseille, France.
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Klawetter S, Cetin N, Ilea P, McEvoy C, Dukhovny D, Saxton SN, Rincon M, Rodriguez-JenKins J, Nicolaidis C. "All these people saved her life, but she needs me too": Understanding and responding to parental mental health in the NICU. J Perinatol 2022; 42:1496-1503. [PMID: 35705639 PMCID: PMC9199311 DOI: 10.1038/s41372-022-01426-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the mental health needs of parents of infants in a neonatal intensive care unit (NICU), as well as barriers and solutions to meeting these needs. DESIGN Qualitative interviews conducted with parents and staff (n = 15) from a level IV NICU in the Northwestern United States. Thematic analysis completed using an inductive approach, at a semantic level. RESULTS (1) Information and mental health needs change over time, (2) Staff-parent relationships buffer trauma and distress, (3) Lack of continuity of care impacts response to mental health concerns, (4) NICU has a critical role in addressing parental mental health. CONCLUSION Mental health support should be embedded and tailored to the NICU trajectory, with special attention to the discharge transition, parents living in rural areas, and non-English-speaking parents. Research should address structural factors that may impact mental health such as integration of wholistic services, language barriers, and staff capacity.
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Affiliation(s)
- Susanne Klawetter
- School of Social Work, Portland State University, Portland, OR, USA.
| | - Nazan Cetin
- grid.262075.40000 0001 1087 1481School of Social Work, Portland State University, Portland, OR USA
| | - Passion Ilea
- grid.262075.40000 0001 1087 1481School of Social Work, Portland State University, Portland, OR USA
| | - Cindy McEvoy
- grid.5288.70000 0000 9758 5690Department of Pediatrics, Oregon Health & Science University, Portland, OR USA
| | - Dmitry Dukhovny
- grid.5288.70000 0000 9758 5690Department of Pediatrics, Oregon Health & Science University, Portland, OR USA
| | - Sage N. Saxton
- grid.5288.70000 0000 9758 5690Department of Pediatrics, Oregon Health & Science University, Portland, OR USA
| | - Monica Rincon
- grid.5288.70000 0000 9758 5690Department of OBGYN—Maternal Fetal Medicine Division, Oregon Health & Science University, Portland, OR USA
| | | | - Christina Nicolaidis
- grid.262075.40000 0001 1087 1481School of Social Work, Portland State University, Portland, OR USA ,grid.5288.70000 0000 9758 5690Department of Medicine, Oregon Health & Science University, Portland, OR USA
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Berwick A, Taylor K, Tumin D, Peedin L. Parental presence after significant procedures and medical events in the neonatal intensive care unit. J Matern Fetal Neonatal Med 2021; 35:8476-8481. [PMID: 34582283 DOI: 10.1080/14767058.2021.1980535] [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: 10/20/2022]
Abstract
PURPOSE Very low birth weight (VLBW) and extremely preterm (EPT) infants typically experience multiple significant medical events, while in the neonatal intensive care unit (NICU), we aimed to identify how major medical and procedural events were associated with parental presence in this patient population. MATERIALS AND METHODS We retrospectively identified VLBW/EPT neonates at a single center and determined parental presence in the first 60 days of hospitalization based on routine documentation in the electronic medical record. The presence on each day was regressed on medical events and procedures occurring within the previous day using mixed-effects logistic regression. RESULTS The analysis included 174 infants contributing 8750 days (observations), including 6061 days (69%) with parental presence, and 607 days (7%) with major medical events or procedures. The occurrence of a medical event or procedure within the past day increased the odds of parental presence by 28% (odds ratio: 1.28; 95% confidence interval: 1.04, 1.57; p = .018). Further analysis found this association was limited to severe (versus moderate) events and procedures, and was absent when considering events over the past week (versus the past day). CONCLUSIONS Major medical events or procedures are associated with increased parental presence in the NICU. Future studies are needed to determine how interventions around the time of major medical events can support parental presence in the NICU and involvement in the child's care.
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Affiliation(s)
- Alexander Berwick
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
| | - Katherine Taylor
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
| | - Dmitry Tumin
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Leslie Peedin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA.,Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
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