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Itoshima R, Ojasalo V, Lehtonen L. Impact of discharge criteria on the length of stay in preterm infants: A retrospective study in Japan and Finland. Early Hum Dev 2024; 193:106016. [PMID: 38663141 DOI: 10.1016/j.earlhumdev.2024.106016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To shorten the hospital stay in preterm infants, it is important to understand the factors extending the length of stay. AIMS To understand how different discharge criteria affect the length of stay in preterm infants. STUDY DESIGN A retrospective comparison study. SUBJECTS Preterm infants born at 28 to 31 gestational weeks in 2020-2021 in a Level IV NICU in Japan (n = 22) and a Level III NICU in Finland (n = 49). OUTCOME MEASURES We compared the most common last discharge criteria and the postmenstrual age (PMA) between the two NICUs. The potential extending effects of each discharge criterion on the length of stay were also evaluated. The discharge criteria were classified into six categories: temperature, respiration, feeding, examination, weight limit, and family readiness. RESULTS The PMA at discharge was significantly higher in Japan than in Finland: median 40.7 (interquartile range 39.9-41.3) vs. 37.9 (36.9-39.0) weeks; r = 0.58; p < 0.001. The most common last discharge criterion was the family criterion in Japan (n = 19; 86 %) and the respiration criterion in Finland (n = 43; 88 %). In Japan, the length of stay was extended by 7.9 (standard deviation [SD] 7.0) days due to a lack of family readiness for discharge and 8.7 (SD 8.7) days due to not having discharged home with a feeding tube as a common practice. CONCLUSIONS The length of stay of preterm infants in Japan could be notably reduced by supporting the parents' earlier readiness for discharge and allowing tube feeding at home.
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Affiliation(s)
- Ryo Itoshima
- Department of Clinical Medicine, University of Turku, Turku, Finland; Division of Neonatology, Nagano Children's Hospital, Azumino, Japan; Life Science Research Center, Nagano Children's Hospital, Azumino, Japan.
| | - Venla Ojasalo
- Department of Clinical Medicine, University of Turku, Turku, Finland; Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland; InFLAMES Research Flagship Center, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
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Bakker L, Jackson B, Miles A. The Impact of Physical and Environment Factors on Parental Presence for Oral Feeding in New Zealand Neonatal Intensive Care Units. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:166-182. [PMID: 38083855 DOI: 10.1177/19375867231216517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
AIM To identify physical environmental factors influencing family involvement in feeding in New Zealand neonatal units. BACKGROUND Infant oral feeding development is critical for both short-term feeding skills and longer term neurodevelopmental outcomes. The neonatal environment is well-known as challenging for neuroprotection due to negative sensory exposure. The impact of environmental factors on oral feeding in New Zealand (NZ) neonatal units is currently unexplored, and knowledge of this could allow for evidence-based unit design. METHODS Focused ethnography at five neonatal units, a national survey of NZ neonatal professionals (n = 102), and five focus groups were carried out. Current oral feeding practice, and beliefs, experiences, and opinions of unit staff and family about these practices were explored. Data were analyzed using qualitative content analysis. RESULTS Units were providing the best experience to families that they could with the resources they had available. Lack of physical space, lack of privacy, limited on-site accommodation for families, and lack of coordination between maternity and neonatal services were identified as impacting on family's comfort and sense of homeliness on the unit. Unit staff used furniture, screens, and external accommodation providers to support families where they could. CONCLUSIONS The physical design of neonatal units in New Zealand provides barriers to family's spending time privately developing oral feeding. Solutions are proposed to increase the size of bedspaces, provide single-family rooms, create greater on-site family accommodation options, combine maternity and neonatal healthcare, and improve family comfort and therefore connection with their infant.
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Affiliation(s)
- Lise Bakker
- Child Development Service, Palmerston North, New Zealand
- Te Whatu Ora Health New Zealand | Te Pae Hauora O Ruahine O Tararua Midcentral, New Zealand
| | - Bianca Jackson
- School of Psychology, The University of Auckland, New Zealand
| | - Anna Miles
- School of Psychology, The University of Auckland, New Zealand
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Shuman CJ, Morgan M, Vance A. Integrating Neonatal Intensive Care Into a Family Birth Center: Describing the Integrated NICU (I-NIC). J Perinat Neonatal Nurs 2023:00005237-990000000-00019. [PMID: 37773333 DOI: 10.1097/jpn.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Parent-infant separation resulting from admission to a neonatal intensive care unit (NICU) is often reported as the most challenging and distressing experience for parents. Aiming to mitigate the stress of parent-infant separation, a new neonatal care model was designed to integrate NIC with delivery and postpartum care. Yet, little is known about the model and its implementation. METHODS Using a qualitative descriptive design with field observations, we describe the characteristics of an integrated-neonatal intensive care (I-NIC) model and examined perceptions of clinical staff (n = 8) and parents (n = 3). RESULTS The physical layout of the I-NIC rooms required additional oxygen and suction columns and new signage to specify them as NICU-equipped. Other NICU-related equipment was mobile, thus moved into rooms when necessary. Nurses were cross-trained in labor/delivery, postpartum, neonatal care; however, nurses primarily worked within their specific area of expertise. Clinician and parent perceptions of the model were notably positive, reporting decreased anxiety related to separation, increased ability for chest feeding and skin-to-skin care, and improved interdisciplinary care. CONCLUSION Future work is needed to understand implementation of the model in other settings, with specific attention to unit architecture, level of NICU care services, patient census, and staff and patient outcomes.
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Affiliation(s)
- Clayton J Shuman
- Department of Systems, Populations, and Leadership, University of Michigan, Ann Arbor (Dr Shuman and Ms Morgan); and Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance)
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McDonald R, Moloney W. Improving the Implementation of Family-Centered Care Within the Neonatal Care Unit: Empowering Parents to Participate in Infant Care. J Perinat Neonatal Nurs 2023; 37:242-251. [PMID: 37494692 DOI: 10.1097/jpn.0000000000000738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND Internationally, approximately 15 million babies are born prematurely every year. In New Zealand, 1 neonatal ward may care for 1000 infants annually. Family-centered care (FCC) is a philosophy used in neonates to enhance positive outcomes for infants, parents, and staff by recognizing the strengths and needs of infants and their families. OBJECTIVE This research assessed how a neonatal environment could be improved to ensure parents feel welcomed and empowered to participate in their infant's care. PARTICIPANTS Survey data from 67 health professionals and 51 parents of infants who received neonatal care for more than 7 days. Four in-depth interviews with parents and 5 with health professionals. METHODS A mixed-methods research design was used. Phase 1 collected quantitative data using the Family-Centered Care Questionnaire. Phase 2 composed of face-to-face interviews with health professionals and parents. RESULTS Implementing FCC practices to improve health outcomes for infants, parents, and staff is important. Recommendations for improvement were formulated from the themes. CONCLUSION The perspectives of parents and health professionals have enabled the development of recommendations to improve the implementation of FCC practice in the neonatal environment. These may lead to better parental experience and improved infant health outcomes.
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Affiliation(s)
- Rebecca McDonald
- Kidz First Neonatal Care, Middlemore Hospital, Auckland, New Zealand (Ms McDonald); and University of Auckland, Auckland, New Zealand (Dr Moloney)
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Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open 2023; 13:e068932. [PMID: 37147093 PMCID: PMC10163491 DOI: 10.1136/bmjopen-2022-068932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022. ELIGIBILITY CRITERIA Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. CONCLUSIONS The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness. PROSPERO REGISTRATION NUMBER CRD42022311689.
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Affiliation(s)
| | | | | | | | - Rachel Ashton
- Ashton Editorial Consulting, London, UK
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Wayne Smith
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Andi Orlowski
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Faez N, Hmami F, Kojmane W, Atmani S. Developmentally supportive care in neonatology: Correlational study of the knowledge and declared practices of professionals. Ann Med Surg (Lond) 2022; 84:104928. [PMID: 36582915 PMCID: PMC9793219 DOI: 10.1016/j.amsu.2022.104928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/29/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
•Developmental Care contributes to improving the quality of neonatal life.•Professionals must develop multidisciplinary approaches to clinical practice.•This research identified a low level of knowledge and practice in Developmental Care.•Significant correlations were detected between clinical practice and knowledge.•The implementation of Developmental Care seems to be a priority.
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Affiliation(s)
- Naima Faez
- Faculty of Science and Technology, Sidi Mohamed Ben Abdelah University, Fez, Morocco,Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Sidi Mohamed Ben Abdelah University, Fez, Morocco,Corresponding author. Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Faculty of Science and Technology / Sidi Mohamed Ben Abdelah University, Fez, 30000, Morocco.
| | - Fouzia Hmami
- Neonatology and Intensive Care Unit. Hassan II University Hospital, Mother and Child Department, General Pediatrics, Fez, Morocco,Human Pathology, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy / sidi Mohamed Ben Abdelah University, Fez, Morocco
| | - Widade Kojmane
- Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Sidi Mohamed Ben Abdelah University, Fez, Morocco,Neonatology and Intensive Care Unit. Hassan II University Hospital, Mother and Child Department, General Pediatrics, Fez, Morocco
| | - Samir Atmani
- Laboratory of Epidemiology and Research in Health Science, Faculty of Medicine and Pharmacy / Sidi Mohamed Ben Abdelah University, Fez, Morocco,Medico-surgical Unit of Pediatric Cardiology. Pediatric Cardiac Catheterization. Hassan II University Hospital, Mother and Child Department, General Pediatrics and Pediatric Cardiology, Fez, Morocco
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Kainiemi E, Flacking R, Lehtonen L, Pasanen M, Axelin A. Psychometric Properties of an Instrument to Measure the Quality of Family-Centered Care in NICUs. J Obstet Gynecol Neonatal Nurs 2022; 51:461-472. [PMID: 35598704 DOI: 10.1016/j.jogn.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine the psychometric properties of the Digi Family-Centered Care-Parent Version (DigiFCC-P), which was developed to measure parents' perceptions of family-centered care (FCC) in NICUs. DESIGN Cross-sectional psychometric study. SETTING Twenty-three NICUs in 15 countries in Europe, Canada, and Australia. PARTICIPANTS Mothers (n = 565) and fathers (n = 406) of preterm infants hospitalized in NICUs. METHODS Participants reported their perceptions of the quality of FCC during their infants' hospitalizations by answering one DigiFCC-P question delivered to their mobile phones every evening. Nine questions rotated in random order. Participants responded on a 7-point Likert scale. We evaluated the instrument's internal consistency, construct and concurrent validity, and sensitivity. RESULTS The internal consistency of the DigiFCC-P was satisfactory; the Cronbach's alpha coefficient was .74 (95% confidence interval [.71, .77]), and all the corrected item-total correlations were greater than .30. We identified that the items formed two factors, support from staff and the parent's active participation, and observed no strong item cross-loadings on the two factors. We discovered some items with weak interitem correlations, and the two factors explained 35.2% of the variance. Scores on the DigiFCC-P and Family-Centered Care Questionnaire were significantly correlated (r = .59, p < .001) and supported the convergent validity of the instrument. In addition, changes were discovered in the participants' ratings over time, which indicated that the instrument was sensitive to detect changes in their evaluations. CONCLUSION The psychometric testing of the DigiFCC-P provided initial support for the convergent validity and reliability of the instrument. The instrument was also sensitive in detecting changes in the evaluations of FCC over time. However, there is a need for further development of the content validity of the instrument.
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