Positive Touch and massage in the neonatal unit: a British approach

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

Background

Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored.

Objectives

The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare?

Materials and methods

A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice.

Results

Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships.

Conclusion

There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships.

Implications

In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.

The Effect of Educational Program for New Mothers about Infant Abdominal Massage and Foot Reflexology for Decreasing Colic at Najran City

As part of an emerging movement in complementary therapy, the practice of infant foot reflexology and abdominal massage is gaining widespread acceptance as a therapeutic approach to the relief of infantile colic. The objective of the current research is to offer an evaluation of knowledge, attitudes and practice amongst new mothers in relation to infant massage and reflexology. Specifically, the intention is to apply any insights gained to the establishment of appropriate educational programmes in line with the requirements of new mothers. This is to be achieved through the appraisal of any perceived improvements in the knowledge, attitudes and practices of new mothers following the completion of any programme. A quasi-experimental design is adopted in this research and applied in the setting of the outpatient clinic at the University Hospital in Najran, Saudi Arabia. A convenience sample, comprising sixty-two new mothers, all of whom have infants ranging in age from one month to four months. All the infants experience colic. The first instrument employed in this research comprises a structured interview wherein interviewees are presented with a two-part sheet. Section one is devoted to the obtaining of socio-demographic data regarding the mothers and the infants, whilst section two consists of a questionnaire devoted to gauging the level of knowledge of new mothers. The second research instrument is an observation checklist aimed at evaluating the practical skills of new mothers, whereas the third research tool employed in this study is a Likert scale which judges the attitudes of new mothers toward foot reflexology and abdominal massage. The findings of the research reveal that most new mothers demonstrated improvements to their attitudes, knowledge, and practice following the programme. Specifically, there was found to be statistically significant correlation between the age, educational level, and work experience of new mothers and their scores for attitudes, knowledge, and practices. Hence, it was possible to conclude that educational programmes for new mothers can augment their knowledge, refine their practices and improve their attitudes in respect of abdominal massage and foot reflexology as a means of treating colic in infants. Thus, the authors recommend that educational programmes constitute a significant means by which abdominal massage and foot reflexology can be promoted as a therapy for the treatment of colic.

Early intervention program for very low birth weight preterm infants and their parents: a study protocol

BACKGROUND

Preterm infants are high risk for delayed neurodevelopment. The main goal is to develop a program of early intervention for very preterm infants that allows families to apply it continuously at home, and quantify the results of early parental stimulation on improvement of cognition and motor skills.

METHODS

Randomized clinical Trial including inborn preterm infants with gestational age less than 32 weeks or birth weight less than 1500 g at 48 h after birth. Eligible for begin the intervention up to 7 days after birth. Study Protocol approved by the Brazilian national Committee of ethics in Research and by the institutional ethics committee. Intervention group (IG): skin-to skin care by mother (kangaroo care) plus tactile-kinesthetic stimulation by mothers from randomization until hospital discharge when they receive a program of early intervention with 10 parents' orientation and a total of 10 home visits independently of the standard evaluation and care that will be performed. Systematic early intervention program will be according to developmental milestones, anticipating in a month evolutionary step acquisition of motor and / or cognitive expected for corrected age. Active comparator with a Conventional Group (CG): standard care according to the routine care of the NICU and their needs in the follow up program. Neurodevelopment outcome with blinded evaluations in both groups between 12 and 18 months by Bayley Scales of Infant and Toddler Development third edition and Alberta Motor Infant scale will be performed. All evaluations will be conducted in the presence of parents or caregivers in a safe room for the child move around during the evaluation.

DISCUSSION

If we can show that a continuous and global early intervention at home performed by low income families is better than the standard care for very preterm infants, this kind of program may be applied elsewhere in the world. We received grants by Bill and Melinda Gates Foundation, DECIT, Cnpq and Health Ministry. Grand Challenges Brazil: All Children Thriving.

TRIAL REGISTRATION

The study was restrospectively registered in ClinicalTrials.gov . in July 15 2016 ( NCT02835612 ).

Effects of Gentle Human Touch and Field Massage on Urine Cortisol Level in Premature Infants: A Randomized, Controlled Clinical Trial

Introduction: Hospitalization in neonatal intensive care unit may leads to many stresses for premature infants. Since premature infants cannot properly process stressors, identifying interventions that reduce the stress level for them is seems necessary. The aim of present study was to compare the effects of Field massage and Gentle Human Touch (GHT) techniques on the urine level of cortisol, as an indicator of stress in preterm infants.

Methods: This randomized, controlled clinical trial was carried out in Al-Zahra hospital, Tabriz. A total of 84 premature infants were randomly assigned into three groups. First groups were touched by their mothers three times a day (15 minutes in each session) for 5 days by GHT technique. The second group was received 15 minutes Field massage with sunflower oil three times a day by their mothers for 5 days. The third group received routine care. In all groups, 24-hours urine samples were collected in the first and sixth day after the intervention and analyzed for cortisol level. Data were analyzed by SPSS software.

Results: There were significant differences between mean of changes in cortisol level between GHT and control groups and Field massage and control groups (0.026).

Conclusion: Although the massage with Field technique resulted in a significant reduction in blood cortisol level, but the GHT technique have also a similar effect. So, both methods are recommended for decreasing of stress in preterm infants.

The effects of massage therapy on physical growth and gastrointestinal function in premature infants: A pilot study

To promote the growth and development of premature infants, effective and tender care is required in neonatal intensive care units (NICUs). The purpose of this study was to test the potential effects of massage therapy on increasing physical growth and promoting gastrointestinal function in premature infants. Twenty subjects were divided into two groups in the NICU of one general hospital located in South Korea. The experimental group (n = 10) were given massage therapy and the control group (n = 10) received routine care. Massage therapy was performed twice daily for 14 days, for 15 minutes per session. In the physical growth, height and chest circumference were significantly increased in the experimental group. In assessing gastrointestinal function, frequency of pre-feed gastric residual was significantly decreased and numbers of bowel movements were significantly increased in the experimental group. This study showed massage therapy has the potential effects on increasing physical growth and gastrointestinal function in premature infants. The massage in the NICU might be utilized as a part of developmental care, but more research needs to be done. NICU nurses need to be trained in massage therapy techniques to provide more effective clinical care for premature infants.

The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial

Introduction: Pregnancy can be associated with different psychological problems such as depression and anxiety. These problems are often neglected and left untreated. This study aimed to examine the effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women. Methods: A convenient sample of 80 pregnant women were selected. Participants were randomly allocated to either the experimental or the control groups. Participants in the experimental group received mindfulness-integrated cognitive behavior therapy while women in the control group only received routine prenatal care services. A demographic questionnaire, the Edinburgh Postnatal Depression Scale, and the Beck Anxiety Inventory were used for data collection. Descriptive statistics measures such as frequency, mean, and standard deviation as well as the repeated-measures analysis of variance test were used for data analysis. Results: After the study intervention, the mean scores of anxiety and depression in the experimental group were significantly lower than the control group. Conclusion: Mindfulness-integrated cognitive behavior therapy can significantly alleviate pregnant women's depression and anxiety. So implementation of this method alongside with other prenatal care services is recommended.

Effect of olive oil massage on weight gain in preterm infants: A randomized controlled clinical trial

Background:

Despite the fact that effect of massage with or without oil on the baby's weight gain is not clear, but recent studies have shown that massage with essential oils make lipid absorption through the skin. The aim of this study was to evaluate the effect of olive oil massage on weight gain in preterm infants.

Materials and Methods:

This study was a single-blind, randomized controlled clinical trial. In this study, infants who met inclusion criteria for the study were divided into two groups by using random numbers table. Newborns in intervention group were under massage for 10 days and 3 times for 15 min daily; the mother of these newborns had been trained already using olive oil. Moreover, the infants of the control group were under massaging without oil same as the above-mentioned method. Researchers weighed babies daily during 10 days and recorded it at the checklist. Data from the study were reviewed and analyzed by descriptive statistics and repeated measure test using the statistical software SPSS/13.

Results:

This study showed that the neonatal weight gain in the infants with the oil massage was 21 g daily in average, whereas the increase in infant massage without oil was 7 g. This difference was statistically significant (P < 0.001).

Conclusion:

Considering the positive effect of infant massage on weight gain in premature infants with olive oil, it is recommended that nurses use oil in infant massage in the neonatal units.

Emprego de soluções adocicadas no alívio da dor neonatal em recém-nascido prematuro: uma revisão integrativa

As experiências dolorosas repetida em recém-nascidos podem ter efeito a curto e a longo prazo, especialmente nos prematuros. Como uma medida de alívio da dor, tem sido recomendado o uso de soluções adocicadas em procedimentos dolorosos. Este estudo objetiva avaliar as evidências do efeito da sacarose e da glicose oral no alívio da dor aguda em recém-nascidos prematuros. Realizou-se uma revisão integrativa, nas bases de dados MEDLINE e LILACS, no período de 2005 a 2010, foram selecionados oito artigos. A análise destes revelou o efeito analgésico da glicose e da sacarose em procedimentos agudos. Nenhum efeito colateral foi encontrado nos recém-nascidos que receberam a glicose/sacarose. Ressalta-se a importância do uso da escala de avaliação da dor que mais se identifique com a população predominante nas unidades neonatais, que seja de fácil aplicação e manuseio pelos profissionais de saúde.

Exploring the Role of Touch in the First Year of Life: Mothers' Perspectives of Tactile Interactions with Their Infants

Introduction:

Touch is a basic instinctual interaction between a parent and his or her infant and has a vital role in the infant's early development. Parents provide a variety of tactile stimulation while addressing their infant's daily care routines. This paper reports on research findings, exploring the nature of this tactile interaction and how it is influenced by personal and contextual factors.

Method:

A qualitative study, employing a phenomenological approach, was conducted to explore the experiential nature of tactile interaction. Data were collected from six mothers of typically developing infants through single semi-structured interviews, and analysed thematically. Credibility and trustworthiness were addressed throughout the research process through peer checking, an audit trail and the completion of a reflexive diary.

Findings:

The mothers described the importance of tactile interaction as a medium through which to bond with their infant and also discussed the influence that the infant's development has on this dyadic relationship. Personal and contextual factors were identified as affecting engagement in tactile interaction.

Conclusion:

Based on these findings, recommendations are made for occupational therapists who work with infants. The consideration of personal and contextual factors that influence mother-infant tactile interaction will contribute to a family-centred approach to therapy and support the achievement of best practice in this area.

Massage therapy improves neurodevelopment outcome at two years corrected age for very low birth weight infants

BACKGROUND

Long term effects of massage therapy in very preterm newborns infants are still to be described. Few studies evaluated neurodevelopment just at six months, and included late preterm infants.

OBJECTIVE

To study the effect of massage therapy on neurodevelopment of very low birth weight infants at two years corrected age.

STUDY DESIGN

Newborns with birth weight between >or= 750 and <or= 1500 g and gestational age <or= 32 weeks were randomly assigned to massage therapy by mothers plus skin-to-skin care (Intervention Group) or just skin-to-skin care (Control Group) during their hospital stay. Growth and neurodevelopment outcome were evaluated at 2 years corrected age.

RESULTS

We followed 73 newborns (35 in Intervention Group, and 38 in Control Group). Both groups were similar in neonatal data. Growth at 2 years corrected age was similar in both groups. Intervention Group had borderline higher Psychomotor Development Index and significantly higher Mental Development Index scores than Control Group.

CONCLUSIONS

We suggest that massage therapy by mothers combined to skin-to-skin care during neonatal hospital stay improves neurodevelopment outcome at 2 years corrected age.

Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates

OBJECTIVE

To study the effect of maternal massage therapy on hospital stay in very-low-birth-weight infants who were already submitted to skin-to-skin care.

STUDY DESIGN

A randomized study was performed including infants of birth weight >or=750 and <or=1500 g and gestational age <or=32 weeks. The exclusion criteria were as follows: death before completing 48 h and presence of major malformations. Neonates were divided into intervention group (IG) (standard care plus maternal massage) and control group (CG). Anthropometric data were always verified by a person blind to the group to which the newborn belonged. Maternal massage was performed four times a day on the face and limbs. Passive exercises of upper and lower limbs were also done by the mothers.

RESULT

A total of 104 newborns were included, 52 in each group. Both groups were similar in gestational age (IG: 29.7+/-1.6; CG: 29.4+/-1.6 weeks), birth weight (IG: 1186+/-194; CG: 1156+/-198 g), gender, number of small-for-gestational-age infants, SNAPPE-II, deaths, gains in weight, length and head circumference. Incidence of late-onset sepsis was significantly lower in the intervention group (IG: 10.8%, n=5; CG: 38.3%, n=18; P=0.005). IG was discharged from the hospital 7 days before CG (IG: 42, confidence interval (CI) 95%: 38 to 46; CG: 49, CI 95%: 42 to 56), and presented 1.85 hazard ratio (CI 95%: 1.09 to 3.13; P=0.023) for early discharge.

CONCLUSION

Maternal massage therapy in very-low-birth-weight infants decreases the length of hospital stay and the incidence of late-onset neonatal sepsis.

Implementing potentially better practices to support the neurodevelopment of infants in the NICU

OBJECTIVE

The purpose of the Vermont Oxford Neonatal Quality Improvement Collaborative 2005 was to explore improvements related to the physical environment of the newborn intensive care unit (NICU) in order to optimize the neurodevelopmental outcome of newborns.

STUDY DESIGN

Five centers were involved in a focus group examining NICU environmental design and its impact on the neurodevelopmental outcome of the neonate. Using an evidence-based approach, the group identified 16 potentially better care practices. This article describes the implementation approaches for some of these practices. The practice areas include tactile stimulation, providing early exposure to mother's scent, minimizing exposure to noxious odors, developing a system for noise assessment of the NICU acoustic environment, minimizing ambient noise in the infants environment, and preservation of sleep.

RESULT

Approaches to implementation were center specific. Optimizing neurodevelopment of the newborn was the desired goal, but this outcome is difficult to measure with a limited number of subjects over a short study period. Many of the changes although intuitively beneficial are difficult to measure. Education of all participants was considered essential to the process of implementation.

CONCLUSION

The process of collaborative quality improvement is useful in identifying ways to optimize the physical environment of the NICU to improve the neurodevelopmental outcome of the neonate.

Salivary cortisol and mood and pain profiles during skin-to-skin care for an unselected group of mothers and infants in neonatal intensive care

OBJECTIVES

Mother-infant separation after birth is a well-known source of stress. Parents and preterm infants in neonatal intensive care are separated immediately after birth. Skin-to-skin care is 1 possible method to reduce the separation-dependent stress. The aim of the present study was to investigate how skin-to-skin care influences stress for the mother and the infant in neonatal intensive care.

METHODS

Seventeen mother-infant pairs were included at their first and fourth skin-to-skin care. The infants were 25 to 33 weeks' gestational age, with birth weights ranging from 495 to 2590 g. In mothers, salivary cortisol, heart rate, mood scale, and stress measured on a visual analog scale (VAS) were analyzed. In infants, salivary cortisol and heart rate were analyzed, and because pain is one facet of stress, 2 different pain scales were used.

RESULTS

In mothers, the skin-to-skin care decreased salivary cortisol (32%), heart rate (7%), and VAS (89%), whereas mood increased (6%). Before the fourth skin-to-skin care, mothers rated less stress on VAS, and salivary cortisol and heart rate improved faster. The infants' cortisol either increased or decreased. Their heart rates and pain scores decreased during skin-to-skin care.

CONCLUSIONS

Our results lend additional support to the value of skin-to-skin care in neonatal intensive care. Variable stress responses in preterm infants favor the need for individualized care. The mothers' need for support seem to be more pronounced in the first skin-to-skin session as our results show a higher degree of stress as compared with later skin-to-skin care.