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Ahlqvist-Björkroth S, Axelin A, Lehtonen L. Close Collaboration with Parents-Implementation and effectiveness. Acta Paediatr 2024. [PMID: 38514910 DOI: 10.1111/apa.17210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/23/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
AIM There has been a need to develop programs to facilitate family-centered care. This paper describes the content of a program called Close Collaboration with Parents, its implementation, and research on its effectiveness. METHODS The program is a systematic training with a focus on staff communication and observation skills and skills to support parenting. The primary implementation strategy is mentoring. Staff engage in bedside practices and reflections with mentors covering all four phases of the program. The effects of this unit-wide program have been evaluated using a pre-post study design, a qualitative study design, and a register-based study design. RESULTS The program has been successfully implemented in 26 units so far. Our research has shown that the training benefits infants, parents, staff, and healthcare organisations. Specifically, family-centered care practices improved after the program, the parents' presence and parent-infant skin-to-skin contact increased, infant growth improved and the length of hospital stays shortened. The mothers' depressive symptoms decreased in the long term. CONCLUSION We have described an educational program for the multidisciplinary staff of a neonatal intensive care unit, Close Collaboration with Parents. The program has changed hospital care cultures for the benefit of infants, parents, staff, and even the healthcare organisation.
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Affiliation(s)
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
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2
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Itoshima R, Tuura K, Toome L, Varendi H, Saik P, Axelin A, Lehtonen L, Ahlqvist-Björkroth S. Depressive symptoms in mothers of preterm infants before and during COVID-19 restrictions in neonatal intensive care units. Acta Paediatr 2023; 112:2164-2171. [PMID: 37354112 DOI: 10.1111/apa.16886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/26/2023]
Abstract
AIM Little is known about the specific restriction measures used in intensive care units (NICUs) during the COVID-19 pandemic and their impact on parental well-being. Hence, this study aimed to assess the association between restriction measures and mothers' post-partum depressive symptoms. METHODS This comparative cohort study included mothers who gave birth before 35 weeks of gestation in Estonia. The outcome measure was mothers' post-partum depressive symptoms at the time of infant discharge, evaluated using the Edinburgh Postnatal Depression Scale (EPDS). In addition to the pandemic itself, the number of restriction measures in the NICUs was analysed as a potential explanatory factor for depressive symptoms. RESULTS The study included 55 mothers before the pandemic in 2018-2019 and 54 mothers during the COVID-19 pandemic in 2021. No significant difference was found in the median EPDS scores between the cohorts: 7.0 [interquartile range (IQR): 4.0-12.0] and 8.0 (IQR: 5.0-12.8) respectively. The number of restriction measures was not associated with mothers' EPDS scores in either unadjusted or adjusted models. CONCLUSION The COVID-19 pandemic or the number of restriction measures used in Estonian NICUs did not associate with mothers' post = partum depressive symptoms.
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Affiliation(s)
- Ryo Itoshima
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Division of Neonatology, Nagano Children's Hospital, Azumino, Japan
| | - Kirsi Tuura
- Department of Psychology and Language Pathology, University of Turku, Turku, Finland
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia
| | - Heili Varendi
- Neonatal Unit, Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Pille Saik
- Department of Neonatology, West-Tallinn Central Hospital, Tallinn, Estonia
| | - Anna Axelin
- Department of Nursing Science, 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
| | - Sari Ahlqvist-Björkroth
- Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychology and Language Pathology, University of Turku, Turku, Finland
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3
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Franck LS, Axelin A, Van Veenendaal NR, Bacchini F. Improving Neonatal Intensive Care Unit Quality and Safety with Family-Centered Care. Clin Perinatol 2023; 50:449-472. [PMID: 37201991 DOI: 10.1016/j.clp.2023.01.007] [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: 05/20/2023]
Abstract
There is strong evidence that family-centered care (FCC) improves the health and safety of infants and families in neonatal settings. In this review, we highlight the importance of common, evidence-based quality improvement (QI) methodology applied to FCC and the imperative to engage in partnership with neonatal intensive care unit (NICU) families. To further optimize NICU care, families should be included as essential team members in all NICU QI activities, not only FCC QI activities. Recommendations are provided for building inclusive FCC QI teams, assessing FCC, creating culture change, supporting health-care practitioners and working with parent-led organizations.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, N411F, Box 0606, San Francisco, CA 94143, USA.
| | - Anna Axelin
- Department of Nursing Science, University of Turku, 20014 University of Turku, Finland. https://twitter.com/AnnaAxelin
| | - Nicole R Van Veenendaal
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. https://twitter.com/nicolevan_vee
| | - Fabiana Bacchini
- Canadian Premature Babies Foundation, 4225-B Dundas Street West, Etobicoke, ON M8X 1Y3, Canada. https://twitter.com/fabianabacchini
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Mohd Shukri NH, Senjaya O, Zainudin Z, Mohamed M, Syed Abdullah FI. The Associations of Breastfeeding and Postnatal Experiences With Postpartum Depression Among Mothers of Hospitalized Infants in Tertiary Hospitals. Cureus 2022; 14:e29425. [PMID: 36299949 PMCID: PMC9586844 DOI: 10.7759/cureus.29425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Postpartum depression has been linked to undesirable outcomes for mother-infant dyads, interfering with childcare and breastfeeding practices. This study aimed to determine the prevalence of depressive symptoms among mothers during the postpartum period and its association with breastfeeding and postpartum experiences. Methodology This cross-sectional study involved mothers of hospitalized infants (n = 219) at two tertiary hospitals in Klang Valley, Malaysia. Mothers were screened for postpartum depression using the Edinburgh Postnatal Depression Scale with a cut-off of ≥12 for positive screening for depression. Mothers were asked to complete questionnaires on breastfeeding experience, which included breastfeeding self-efficacy and challenges. The questionnaires also collected information on postnatal experiences, including birth outcomes, anxiety and stress levels, and social support. Multiple linear regression was used to ascertain the association of postpartum depression levels with breastfeeding and postnatal experiences. Results Overall, 30% of mothers in this study screened positive for depression. Based on multiple linear regression, a higher score of postpartum depression was significantly associated with unpleasant breastfeeding and postnatal experiences reflected by increased scores of anxiety and stress, lower infant birth weight, increased breastfeeding problems, and lower level of social support (p < 0.005). Conclusions Maternal emotions, birth outcomes, breastfeeding issues, and social support were associated with postpartum depression. Efforts should be made to increase maternal support, and screening for maternal depression during infant hospital stays should be encouraged.
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5
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Ranaei V, Kalroozi F, Sadeghi M, Yarmohammadi S, Haglund K, Mehrabi N. Effect of educational intervention on improving nurse's general health in military hospitals of Iran: a quasi-experimental study. BMC Nurs 2022; 21:254. [PMID: 36096821 PMCID: PMC9467669 DOI: 10.1186/s12912-022-01032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Nursing in military hospitals affects their general health. Educational interventions can help to maintain the general health of nurses. This study aimed to evaluate the effect of an educational intervention to improve the general health of nurses in military hospitals. Methods In this quasi-experimental study, 146 nurses working in military hospitals in Tehran, Iran in 2021 were included in the study. The one-month educational intervention included videos, pamphlets, and motivational messages about promoting general health. General health questionnaire with 28 items (GHQ28) was study tool. The allocation of nurses to groups was not random, it was based on personal interest. Frequency (percentage), and mean (standard deviation) were used to describe, and the chi-square test, Fisher’s exact test, independent and paired t-test were used for data analysis. All analyzes were performed in SPSS 24 software with a significance level of 5%. Results A total of 146 nurses participated in the study, most of them were in the age group of 30 to 40 years (64 people, 43.8%), and 76.7% (112 people) of them were women. The results of the independent sample t-test showed after the intervention, general health scores in the intervention group had a significant decrease compared to the control (p < 0.001) (change in intervention group = -31.1, V.S change in control = 0.55). The results of paired t-test showed that only in the intervention group, the value of the general health score and its dimensions were significantly different (p < 0.001). Conclusions The educational intervention performed well and decreased the score of the general health of military nurses. Given that these positive effects may be temporary, it is necessary to design and perform educational interventions over a longer period.
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Affiliation(s)
- Vahid Ranaei
- Researcher, Department of Health Information Technology, Faculty of Paramedicine, AJA University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kalroozi
- Assistant Professor in Pediatric Nursing Department, Faculty of Nursing, AJA University of Medical Sciences, Shariati St, Kaj St, Tehran, Iran
| | - Mojtaba Sadeghi
- Faculty Member of Department of Health Information Technology, AJA University of Medical Science, Tehran, Iran
| | - Soudabeh Yarmohammadi
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kristin Haglund
- College of Nursing, Marquette University, Milwaukee, WI, USA
| | - Nahid Mehrabi
- Assistant Professor in Health Information Management, Paramedical School AJA University of Medical Sciences, Fathemi St, Etemad zadhe St, Tehran, Iran.
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Thürlimann E, Verweij L, Naef R. The Implementation of Evidence-Informed Family Nursing Practices: A Scoping Review of Strategies, Contextual Determinants, and Outcomes. JOURNAL OF FAMILY NURSING 2022; 28:258-276. [PMID: 35707895 PMCID: PMC9280703 DOI: 10.1177/10748407221099655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
There is a lack of knowledge about the successful implementation of family nursing practices. This scoping review maps current knowledge about the implementation of evidence-informed family nursing practices across settings and populations. A systematic search (CINAHL, PubMed, Medline) identified 24 publications, published between 2010 and 2020. We found nurses' implementation experience to be one of disruption, learning, and moving to new ways of practicing. The implementation resulted in benefits to families and self but was marked by fluctuation and partial integration of evidence-informed family nursing practices into care delivery. Uptake was shaped by various contextual determinants, with barriers mainly at the team and organizational levels. We identified low-quality, tentative evidence that capacity-building strategies coupled with dissemination-educational strategies may enable family nursing practice skills and increase the quality of family care. More rigorous research is needed to build further knowledge about effective implementation. Future implementation endeavors should utilize the evolving knowledge base in family nursing and tailor implementation strategies to contextual barriers.
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Affiliation(s)
- Eva Thürlimann
- University of Zurich, Institute for Implementation Science in Health Care, Switzerland
| | - Lotte Verweij
- University of Zurich, Institute for Implementation Science in Health Care, Switzerland
- University Hospital Zurich, Center of Clinical Nursing Science, Switzerland
| | - Rahel Naef
- University of Zurich, Institute for Implementation Science in Health Care, Switzerland
- University Hospital Zurich, Center of Clinical Nursing Science, Switzerland
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7
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Lehtonen L, Lilliesköld S, De Coen K, Toome L, Gimeno A, Caballero S, Tameliene R, Laroche S, Retpap J, Grundt H, Van Hoestenberghe MR, Skene C, Pape B, Axelin A. Parent-infant closeness after preterm birth and depressive symptoms: A longitudinal study. Front Psychol 2022; 13:906531. [PMID: 36237668 PMCID: PMC9551610 DOI: 10.3389/fpsyg.2022.906531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022] Open
Abstract
Background Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents. Methods This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents’ presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14 days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4 months corrected age of the infant. Results The study included 684 mothers and 574 fathers. The median presence was 469 min (Q1 258 and Q3 1,087) per 24 h for the mothers and 259 min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4 months, respectively. Parents’ presence and depressive symptoms varied greatly between the units. Parents’ presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted). Conclusion No association was found between the duration of parent-infant closeness in the neonatal unit and parents’ depressive symptoms. The beneficial effects of family-centered care on parents’ depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents’ depression after NICU stay.
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Affiliation(s)
- Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland,Department of Clinical Medicine, University of Turku, Turku, Finland,*Correspondence: Liisa Lehtonen,
| | - Siri Lilliesköld
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Kris De Coen
- Department of Neonatal Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children’s Hospital, Tallinn, Estonia
| | - Ana Gimeno
- Neonatal Intensive Care Unit, La Fe Hospital, Valencia, Spain
| | - Sylvia Caballero
- Department of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rasa Tameliene
- Department of Neonatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Sabine Laroche
- Neonatal Intensive Care Unit, University Hospital Antwerp, Antwerp, Belgium,University of Antwerp, Antwerp, Belgium
| | | | - Hege Grundt
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | | | - Caryl Skene
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Bernd Pape
- Turku Clinical Research Center, Turku University Hospital, Turku, Finland,School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland,Department of Women’s and Children’s Health, University of Uppsala, Uppsala, Sweden
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8
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Ahlqvist‐Björkroth S, Axelin A, Setänen S, Huhtala M, Korja R, Pape B, Lehtonen L. Fewer maternal depression symptoms after the Close Collaboration with Parents intervention: Two-year follow-up. Acta Paediatr 2022; 111:1160-1166. [PMID: 35181919 PMCID: PMC9305419 DOI: 10.1111/apa.16303] [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: 12/23/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Abstract
Aim To test whether the implementation of the Close Collaboration with Parents intervention at a neonatal intensive care unit (NICU) decreases depression symptoms of mothers up to two years after the delivery of preterm infants. Methods We used a non‐equivalent two‐group design, comparing mothers of very low birthweight infants in the same NICU before (2001–2006) and after (2011–215) the intervention. The unit carried out the educational intervention (2009–2012) that was targeted at its healthcare team and aimed to improve their skills to collaborate with parents. Maternal depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) six months and two years after the expected birth date of the infant. Results We found a median difference of 2.56 (95% CI from 1.64 to 3.48) in EPDS at the two‐year follow‐up between the pre‐intervention and post‐intervention groups, p < 0.001. Furthermore, we found no interaction between measurement time‐points and group, implying that the intervention effect on maternal depression symptoms was similar at the six‐month and two‐year time‐points. Conclusion The intervention seems to have long‐term preventive effects on maternal depressive symptoms. This effect is of clinical significance as prolonged maternal depression associates with adverse child outcomes.
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Affiliation(s)
| | - Anna Axelin
- Department of Nursing Science University of Turku Turku Finland
| | - Sirkku Setänen
- Department of Clinical Medicine/Division of Pediatrics University of Turku Turku Finland
| | - Mira Huhtala
- Department of Oncology and Radiotherapy Turku University Hospital Turku Finland
| | - Riikka Korja
- Department of psychology and language pathology University of Turku Turku Finland
| | - Bernd Pape
- Turku Clinical Research Center Turku University Hospital and School of Technology and Innovations University of Vaasa Turku Finland
| | - Liisa Lehtonen
- Department of Clinical Medicine/Division of Pediatrics University of Turku Turku Finland
- Department of Pediatrics and Adolescent Medicine Division of Neonatology Turku University Hospital Turku Finland
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Kimkool P, Huang S, Gibbs D, Banerjee J, Deierl A. Cuddling very and extremely preterm babies in the delivery room is a positive and normal experience for mothers after the birth. Acta Paediatr 2022; 111:952-960. [PMID: 34971010 DOI: 10.1111/apa.16241] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/20/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
Abstract
AIM Extremely preterm infants are separated from their mothers immediately after birth and not placed skin-to-skin in routine neonatal intensive care unit settings. Visual and physical contact in the delivery room as a first cuddle potentially can facilitate early parent-infant interaction and reduce the trauma of separation. Our aim in this study was to explore mothers' experience of delivery room cuddle by collecting qualitative feedback via emotional mapping. METHODS Six mothers experiencing delivery room cuddle had been recruited (GA of their babies 24 + 5-29 + 0 weeks, birth weight 540-1019 g). Using a descriptive qualitative approach, semi-structured interviews were performed with six mothers following consent via Zoom or phone between September 2020 and March 2021. Interviews were transcribed using AI Otter and then analysed using thematic analysis. RESULTS Analysis of the participants' experiences revealed five themes: fears and hopes around delivery; the moment of delivery-recognising uncertainty; reclaiming normalcy; forming connections; and the journey ahead as an empowered parent. CONCLUSION All mothers reported positive emotions about the cuddle with their baby. They highlighted that this physical contact was often the only positive and 'normal' birth experience they had from the time of delivery.
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Affiliation(s)
- Parisut Kimkool
- Neonatal Unit Imperial College Healthcare NHS Trust London UK
| | - Shirley Huang
- Neonatal Unit Imperial College Healthcare NHS Trust London UK
| | | | - Jayanta Banerjee
- Neonatal Unit Imperial College Healthcare NHS Trust London UK
- Institute of Reproductive and Developmental Biology Imperial College London UK
| | - Aniko Deierl
- Neonatal Unit Imperial College Healthcare NHS Trust London UK
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10
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Lemmon ME, Glass HC, Shellhaas RA, Barks MC, Bansal S, Annis D, Guerriero JL, Pilon B, Wusthoff CJ, Chang T, Soul JS, Chu CJ, Thomas C, Massey SL, Abend NS, Rau S, Rogers EE, Franck LS. Family-Centered Care for Children and Families Impacted by Neonatal Seizures: Advice From Parents. Pediatr Neurol 2021; 124:26-32. [PMID: 34509000 PMCID: PMC8523194 DOI: 10.1016/j.pediatrneurol.2021.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parents of neonates with seizures are at risk of mental health symptoms due to the impact of illness on family life, prognostic uncertainty, and the emotional toll of hospitalization. A family-centered approach is the preferred model to mitigate these challenges. We aimed to identify strategies to promote family-centered care through an analysis of parent-offered advice to clinicians caring for neonates with seizures. METHODS This prospective, observational, and multicenter (Neonatal Seizure Registry) study enrolled parents of neonates with acute symptomatic seizures. Parents completed surveys about family well-being at 12, 18, and 24 months corrected gestational age. Parents were asked open-ended questions eliciting their advice to clinicians caring for neonates with seizures. Responses were analyzed using a conventional content analysis approach. RESULTS Among the 310 parents who completed surveys, 118 (38%) shared advice for clinicians. These parents were predominantly mothers (n = 103, 87%). Three overarching themes were identified. (1) Communicate information effectively: parents appreciate when clinicians offer transparent and balanced information in an accessible way. (2) Understand and validate parent experience: parents value clinicians who display empathy, compassion, and a commitment to parent-partnered clinical care. (3) Providesupportand resources: parents benefit from emotional support, education, connection with peers, and help navigating the health care system. CONCLUSIONS Parents caring for neonates with seizures appreciate a family-centered approach in health care encounters, including skilled communication, understanding and validation of the parent experience, and provision of support and resources. Future interventions should focus on building structures to reinforce these priorities.
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Affiliation(s)
- Monica E. Lemmon
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA,Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Hannah C. Glass
- Departments of Neurology and Pediatrics, UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, California, USA,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Renée A. Shellhaas
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Carol Barks
- Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA
| | - Simran Bansal
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dana Annis
- NSR Parent Partner, Children’s National Hospital, Washington, DC, USA
| | - Jennifer L. Guerriero
- NSR Parent Partner, Children’s Hospital Boston, Boston, MA, USA,Dana Farber Cancer Institute
| | | | | | - Taeun Chang
- Department of Neurology, Children’s National Hospital, George Washington University School of Medicine, Washington, DC, USA
| | - Janet S. Soul
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA,Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shavonne L. Massey
- Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicholas S. Abend
- Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie Rau
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth E. Rogers
- Departments of Neurology and Pediatrics, UCSF Benioff Children’s Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Linda S. Franck
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
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11
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Upadhyaya S, Sourander A, Luntamo T, Matinolli HM, Chudal R, Hinkka-Yli-Salomäki S, Filatova S, Cheslack-Postava K, Sucksdorff M, Gissler M, Brown AS, Lehtonen L. Preterm Birth Is Associated With Depression From Childhood to Early Adulthood. J Am Acad Child Adolesc Psychiatry 2021; 60:1127-1136. [PMID: 33068750 DOI: 10.1016/j.jaac.2020.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/14/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There have been inconsistent findings on the associations among prematurity, poor fetal growth, and depression. We examined the associations among gestational age, poor fetal growth, and depression in individuals aged 5 to 25 years. METHOD We identified 37,682 case subjects based on International Classification of Diseases, Ninth Revision code 2961 and International Classification of Diseases, Tenth Revision codes F32.0-F32.9 and F33.0-F33.9 from the Care Register for Health Care, and 148,795 matched controls from the Finnish Central Population Register. Conditional logistic regression examined the associations between gestational age by each gestational week, poor fetal growth, and depression. The associations were adjusted for parental age and psychopathology, paternal immigrant status, maternal substance abuse, depression, number of previous births, marital status, socio-economic status, smoking during pregnancy, and the infant's birthplace. RESULTS In the adjusted models, increased risk of depression was found in children born ≤25 weeks (adjusted odds ratio [aOR] 1.89, 95% CI 1.08-3.31), at 26 weeks (aOR 2.62, 95% CI 1.49-4.61), at 27 weeks (aOR 1.93, 95% CI 1.05-3.53), and ≥42 weeks (aOR 1.11, 95% CI 1.05-1.19). In girls, extremely preterm birth was associated with depression diagnosed at 5 to 12 years (aOR 2.70, 95% CI 1.83-3.98) and 13 to 18 years (aOR 2.97, 95% CI 1.84-4.78). In boys, postterm birth (≥42 weeks) was associated with depression diagnosed at 19 to 25 years (aOR 1.28, 95% CI 1.07-1.54). Poor fetal growth was associated with an increased risk of depression in full-term infants (aOR 1.06, 95% CI 1.03-1.10) and postterm infants (aOR 1.24, 95% CI 1.08-1.43). CONCLUSION Preterm birth before 28 weeks of gestation appeared to play a role in the development of childhood depression. Smaller effects were also seen in postterm births, especially in boys.
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Affiliation(s)
| | - Andre Sourander
- University of Turku, Finland; Turku University Hospital, Finland; Columbia University, New York.
| | | | - Hanna-Maria Matinolli
- University of Turku, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | | | - Mika Gissler
- University of Turku, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland; Karolinska Institute, Stockholm, Sweden
| | | | - Liisa Lehtonen
- University of Turku, Finland; Turku University Hospital, Finland
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van Veenendaal NR, Auxier JN, van der Schoor SRD, Franck LS, Stelwagen MA, de Groof F, van Goudoever JB, Eekhout IE, de Vet HCW, Axelin A, van Kempen AAMW. Development and psychometric evaluation of the CO-PARTNER tool for collaboration and parent participation in neonatal care. PLoS One 2021; 16:e0252074. [PMID: 34106929 PMCID: PMC8189480 DOI: 10.1371/journal.pone.0252074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Active parent participation in neonatal care and collaboration between parents and professionals during infant hospitalization in the neonatal intensive care unit (NICU) is beneficial for infants and their parents. A tool is needed to support parents and to study the effects and implementation of parent-partnered models of neonatal care. METHODS We developed and psychometrically evaluated a tool measuring active parent participation and collaboration in neonatal care within six domains: Daily Care, Medical Care, Acquiring Information, Parent Advocacy, Time Spent with Infant and Closeness and Comforting the Infant. Items were generated in focus group discussions and in-depth interviews with professionals and parents. The tool was completed at NICU-discharge by 306 parents (174 mothers and 132 fathers) of preterm infants. Subsequently, we studied structural validity with confirmatory factor analysis (CFA), construct validity, using the Average Variance Extracted and Heterotrait-Monotrait ratio of correlations, and hypothesis testing with correlations and univariate linear regression. For internal consistency we calculated composite reliability (CR). We performed multiple imputations by chained equations for missing data. RESULTS A 31 item tool for parent participation and collaboration in neonatal care was developed. CFA revealed high factor loadings of items within each domain. Internal consistency was 0.558 to 0.938. Convergent validity and discriminant validity were strong. Higher scores correlated with less parent depressive symptoms (r = -0.141, 95%CI -0.240; -0.029, p = 0.0141), less impaired parent-infant bonding (r = -0.196, 95%CI -0.302; -0.056, p<0.0001), higher parent self-efficacy (r = 0.228, 95%CI 0.117; 0.332, p<0.0001), and higher parent satisfaction (r = 0.197, 95%CI 0.090; 0.308, p = 0.001). Parents in a family integrated care model had higher scores than in standard care (beta 6.020, 95%CI 4.144; 7.895, p<0.0001) and mothers scored higher than fathers (beta 2.103,95%CI 0.084; 4.121, p = 0.041). CONCLUSION The CO-PARTNER tool explicitly measures parents' participation and collaboration with professionals in neonatal care incorporating their unique roles in care provision, leadership, and connection to their infant. The tool consists of 31 items within six domains with good face, content, construct and structural validity.
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics and Neonatology, OLVG, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | - Linda S. Franck
- School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | | | - Femke de Groof
- Department of Neonatology, NoordWest Ziekenhuis Groep, Alkmaar, The Netherlands
| | - Johannes B. van Goudoever
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Henrica C. W. de Vet
- Department of Epidemiology & Data Science, Location VU Medical Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anna Axelin
- Department of Nursing Science, The University of Turku, Turku, Finland
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Abstract
PURPOSE OF REVIEW Postpartum depression (PPD) negatively impacts caregivers, infants, siblings, and entire families. Mothers with infants admitted to the neonatal intensive care unit (NICU) face additional risk for PPD, coupled with risk factors extending beyond a NICU admision. The novelty of this review is the focus on maternal PPD for mothers with infants admitted to the NICU. Interventions aimed at limiting and preventing PPD in this population include: prenatal and postpartum depression screening, PPD symptom awareness and monitoring, and trauma-informed care. RECENT FINDINGS PPD, the most frequent complication of childbirth, affects approximately 10-15% of mothers worldwide. Prevalence rates increase to 40% for mothers whose infant is admitted to the NICU. PPD can affect maternal and child health across the life course and predispose future generations to a myriad of developmental, psychosocial, and physical challenges. Prevalence rates are higher for racial and ethnic minorities, immigrant and refugee populations, and mothers in rural locations. Trauma-informed care is suggested at individual and organizational levels, leading to better care for those with and without previous trauma exposure. SUMMARY Increasing PPD symptom awareness, screening for PPD, and connections with resources should begin during prenatal visits. Care teams should discuss barriers to resources for mothers, children, and families to improve access and support.
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He FB, Axelin A, Ahlqvist-Björkroth S, Raiskila S, Löyttyniemi E, Lehtonen L. Effectiveness of the Close Collaboration with Parents intervention on parent-infant closeness in NICU. BMC Pediatr 2021; 21:28. [PMID: 33430816 PMCID: PMC7798198 DOI: 10.1186/s12887-020-02474-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parent-infant closeness during hospital care of newborns has many benefits for both infants and parents. We developed an educational intervention for neonatal staff, Close Collaboration with Parents, to increase parent-infant closeness during hospital care. The aim of this study was to evaluate the effectiveness of the intervention on parent-infant closeness in nine hospitals in Finland. METHODS Parents of hospitalized infants were recruited in the hospitals during 3-month periods before and after the Close Collaboration with Parents intervention. The data were collected using daily Closeness diaries. Mothers and fathers separately filled in the time they spent in the hospital and the time of skin-to-skin contact with their infant during each hospital care day until discharge. Statistical analyses were done using a linear model with covariates. RESULTS Diaries were kept before and after the intervention by a total of 170 and 129 mothers and 126 and 84 fathers, respectively. Either parent was present on average 453 min per day before the intervention and 620 min after the intervention in the neonatal unit. In the adjusted model, the increase was 99 min per day (p = 0.0007). The infants were in skin-to-skin contact on average 76 min per day before the intervention and 114 min after the intervention. In the adjusted model, skin-to-skin contact increased by 24 min per day (p = 0.0405). CONCLUSION The Close Collaboration with Parents intervention increased parents' presence and skin-to-skin contact in nine hospitals. This study suggests that parent-infant closeness may be one mediating factor explaining benefits of parenting interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT04635150 . Retrospectively registered.
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Affiliation(s)
- Felix B He
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
- University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Simo Raiskila
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | | | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
- University of Turku, Turku, Finland.
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15
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Pisoni C, Provenzi L, Moncecchi M, Caporali C, Naboni C, Stronati M, Montirosso R, Borgatti R, Orcesi S. Early parenting intervention promotes 24-month psychomotor development in preterm children. Acta Paediatr 2021; 110:101-108. [PMID: 32392381 DOI: 10.1111/apa.15345] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
AIM Although parenting is key to promoting healthy development of at-risk preterm infants, parents have often restricted access to neonatal intensive care units (NICUs). This study aimed to assess the effect of an early parenting intervention on the psychomotor outcome in preterm children at 24 months of corrected age. METHODS Forty-two preterm children and their parents were consecutively recruited at a level III NICU in Northern Italy and randomly allocated to early intervention (two educational peer-group sessions and four individual infant observation sessions) or care as usual (no educational or infant observation sessions). During NICU stay, parents provided information on daily holding and skin-to-skin. Psychomotor development was measured at 24 months of corrected age using the Griffith Mental Development Scales. RESULTS There were no significant differences in socio-demographic and clinical variables between early intervention (n = 21; 13 females) and care as usual (n = 21; 12 females) groups. At 24 months of corrected age, children in the early intervention arm had greater scores for global psychomotor development as well as for Hearing-Speech and Personal-Social sub-scales, compared to those in the care as usual group. CONCLUSION The present NICU parenting intervention was found to be associated with better psychomotor outcomes in preterm children at 24-month age. The effects were especially evident for domains related to language and socio-emotional functioning. Results are promising and should be retested with more heterogeneous and representative preterm sample.
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Affiliation(s)
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Michela Moncecchi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Camilla Caporali
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Cecilia Naboni
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | | | - Rosario Montirosso
- 0‐3 Center for the at‐Risk Infant Scientific Institute IRCCS E. Medea Lecco Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Sciences University of Pavia Pavia Italy
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16
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Axelin A, Raiskila S, Lehtonen L. The Development of Data Collection Tools to Measure Parent-Infant Closeness and Family-Centered Care in NICUs. Worldviews Evid Based Nurs 2020; 17:448-456. [PMID: 33210818 PMCID: PMC7756210 DOI: 10.1111/wvn.12475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
Background Preterm and sick infants benefit from parent–infant closeness and family‐centered care (FCC) in neonatal intensive care units (NICUs). Prospective and feasible tools are needed to measure these care practices to facilitate their implementation. Aims To describe the development process of three prospective data collection tools that measure parent–infant closeness and the quality of FCC. Methods Data collection tools were developed in an iterative process consisting of three development cycles. Feedback was gathered from parents, staff, and researchers. The first stages of development focused on the content validity, appropriate scaling, and optimization of the response rate of these tools. Results The study included parents of 490 infants and the nurses working at bedside in 15 NICUs in six countries. The Parent‐Infant Closeness Diary was developed to measure the daily duration of parental presence, holding, and skin‐to‐skin contact. The optimal duration for daily diaries was 14 consecutive days to maintain a good response rate. Parents provided reliable documentation of parent–infant closeness. Digital FCC tools covering the nine aspects of FCC for parents and nurses were developed to measure the quality of FCC. Participants provided answers on a 7‐point Likert scale. Parents’ response rates remained >50% for approximately 1 month, and the nurses’ mean response rate was 55% (39%–87%) for the 3‐month study period. Linking Evidence to Action These new tools provide prospective daily information to aid the implementation of parent–infant closeness and the quality of FCC in NICU in different countries. They can be used to study and evaluate the implementation of these clinical practices NICUs in an international context.
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Affiliation(s)
- Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Simo Raiskila
- Department of Clinical Medicine, Pediatrics, Turku University Hospital, University of Turku, Turku, Finland.,Department of Paediatrics and Adolescent Medicine, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Clinical Medicine, Pediatrics, Turku University Hospital, University of Turku, Turku, Finland.,Department of Paediatrics and Adolescent Medicine, University of Turku, Turku, Finland
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Lehtonen L, Lee SK, Kusuda S, Lui K, Norman M, Bassler D, Håkansson S, Vento M, Darlow BA, Adams M, Puglia M, Isayama T, Noguchi A, Morisaki N, Helenius K, Reichman B, Shah PS. Family Rooms in Neonatal Intensive Care Units and Neonatal Outcomes: An International Survey and Linked Cohort Study. J Pediatr 2020; 226:112-117.e4. [PMID: 32525041 DOI: 10.1016/j.jpeds.2020.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the proportion of neonatal intensive care units with facilities supporting parental presence in their infants' rooms throughout the 24-hour day (ie, infant-parent rooms) in high-income countries and to analyze the association of this with outcomes of extremely preterm infants. STUDY DESIGN In this survey and linked cohort study, we analyzed unit design and facilities for parents in 10 neonatal networks of 11 countries. We compared the composite outcome of mortality or major morbidity, length of stay, and individual morbidities between neonates admitted to units with and without infant-parent rooms by linking survey responses to patient data from 2015 for neonates of less than 29 weeks of gestation. RESULTS Of 331 units, 13.3% (44/331) provided infant-parent rooms. Patient-level data were available for 4662 infants admitted to 159 units in 7 networks; 28% of the infants were cared for in units with infant-parent rooms. Neonates from units with infant-parent rooms had lower odds of mortality or major morbidity (aOR, 0.76; 95% CI, 0.64-0.89), including lower odds of sepsis and bronchopulmonary dysplasia, than those from units without infant-parent rooms. The adjusted mean length of stay was 3.4 days shorter (95%, CI -4.7 to -3.1) in the units with infant-parent rooms. CONCLUSIONS The majority of units in high-income countries lack facilities to support parents' presence in their infants' rooms 24 hours per day. The availability vs absence of infant-parent rooms was associated with lower odds of composite outcome of mortality or major morbidity and a shorter length of stay.
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Affiliation(s)
- Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital; and Department of Clinical Medicine, University of Turku, Turku, Finland.
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Departments of Pediatrics and Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Maternal-infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Satoshi Kusuda
- Neonatal Research Network of Japan, Kyorin University, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Lui
- Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, Australia
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Maximo Vento
- Division of Neonatology and Health Research Institute of La Fe University Hospital, Valencia, Spain
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monia Puglia
- Unit of Epidemiology, Regional Health Agency, Florence, Italy
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naho Morisaki
- Neonatal Research Network Japan, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital; and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Maternal-infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Holdren S, Fair C, Lehtonen L. A qualitative cross-cultural analysis of NICU care culture and infant feeding in Finland and the U.S. BMC Pregnancy Childbirth 2019; 19:345. [PMID: 31601193 PMCID: PMC6785867 DOI: 10.1186/s12884-019-2505-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/12/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The benefits of family-centered care for the health and well-being of preterm infants and their families include increased parent-infant closeness, improved lactation, and positive mental health outcomes; however, it is known that the extent to which family-centered care is adopted varies by unit. This study aimed to understand how differences in neonatal care culture in two units in Finland and the U.S. were translated to parents' infant feeding experiences in the hope of improving relationally focused feeding practices in both locations. METHODS This qualitative, cross-sectional study utilized narrative methodologies to understand the lived experiences of 15 families hospitalized in a tertiary neonatal intensive care unit in Finland (n = 8) and the U. S (n = 7). RESULTS A global theme of lactation as a means or an end showed that lactation and infant feeding were framed differently in each location. The three supporting themes that explain families' perceptions of their transition to parenthood, support as a family unit, and experience with lactation include: universal early postnatal challenges; culture and space-dependent nursing support; and controlled or empowering breastfeeding experiences. CONCLUSIONS Care culture plays a large role in framing all infant caring activities, including lactation and infant feeding. This study found that in the unit in Finland, breastfeeding was one method to achieve closeness with an infant, while in the unit in the U.S., pumping was only an end to promote infant nutritional health. Therefore, breastfeeding coupled with closeness was found to be supportive of a salutogenic, or health-promoting, care approach for the whole family.
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Affiliation(s)
- Sarah Holdren
- Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Cynthia Fair
- Public Health Studies & Department Chair, Elon University Department of Public Health Studies, Elon, North Carolina USA
| | - Liisa Lehtonen
- Department of Pediatrics, Neonatology & Professor of Pediatrics, Turku University Hospital, Turku, Finland
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19
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Toivonen M, Lehtonen L, Ahlqvist-Björkroth S, Axelin A. Key factors supporting implementation of a training program for neonatal family- centered care - a qualitative study. BMC Health Serv Res 2019; 19:394. [PMID: 31217007 PMCID: PMC6585011 DOI: 10.1186/s12913-019-4256-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 06/13/2019] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Mirka Toivonen
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
| | - Liisa Lehtonen
- Faculty of Medicine, University of Turku, Turku, Finland.,Hospital District of Southwest Finland, Department of Pediatrics Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521, Turku, Finland
| | - Sari Ahlqvist-Björkroth
- Department of Psychology and Speech-Language Pathology, Faculty of Social Sciences, University of Turku, FI-20014, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, FI-20014, Turku, Finland
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Screening for postpartum depression: obligation and opportunity for pediatricians to improve the lives of children. Pediatr Res 2019; 85:923-924. [PMID: 30862959 DOI: 10.1038/s41390-019-0373-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 11/08/2022]
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