Partnerships with families: a foundation to support them in difficult times

Do parents get what they want during bad news delivery in NICU?

OBJECTIVES

Little is known about parents' preferences in breaking bad news (BBN) in neonatology. The study was aimed at comparing parents' experiences with their first BBN discussion with a neonatologist/pediatric surgeon to their personal preferences.

METHODS

We conducted a quantitative survey amongst 54 parents of hospitalized preterm or term infants with severe diseases in two medium-size and one small German neonatal units. Parents answered self-rated questions on how they perceived BBN during their infant's hospital stay, asking for procedure and perception of BBN, their preferences and satisfaction with BBN.

RESULTS

Overall satisfaction with BBN was moderate to high (median (min-max): 8 (1-10) on a 1-10-Likert scale). A compassionate way of disclosure correlated highest with overall satisfaction with BBN. Thorough transmission of information in an easy to understand manner emerged as another crucial point and correlated significantly to satisfaction with BBN, too. The study revealed that it was highly important for parents, that physicians had good knowledge of the infant and the course of his/her disease, which was only met in a minority of cases. Moreover, there was a major discrepancy between expected and observed professional competence of the delivering physicians. Additionally, physicians did not set aside sufficient time for BBN and parents reported a lack of transporting assurance and hope.

CONCLUSIONS

In BBN physicians should draw greatest attention to ensure understanding in parents, with good knowledge of child and disease and sufficient time in a trustworthy manner. Physicians should focus on transporting competence, trust and gentleness.

Parent experiences of communication with healthcare professionals in neonatal intensive care units: a qualitative systematic review protocol

The objectives of this review are to explore parents' experiences of communication with healthcare professionals and to identify the meaningfulness of communication to parents in the neonatal intensive care unit (NICU).More specifically, the objectives are to identify.

Parental Perceptions of Body Mass Index Notification: A Qualitative Study

BACKGROUND

There is a worldwide epidemic of obesity in children. To address obesity in children, emphasis must be on factors within family, school, and community environments. Although most parents and school officials are aware of the problem of overweight children, there are few data available to guide decision making about the acceptability of school-based body mass index (BMI) screening and referral programs. Parental insight is essential to determine the efficiency and effectiveness of BMI notification.

METHODS

The purpose of this qualitative study was to explore the perceptions of parents whose school-age children received a BMI referral letter stating their child is overweight. Purposeful convenience sampling was used to obtain 21 parents. Semistructured interviews were used to collect the data.

RESULTS

Eight themes and corresponding subthemes emerged. The themes regarding parental perceptions were feelings about receiving the letter, causes of obesity, capabilities, barriers, role modeling, primary care provider response, school's role, and health screening process.

CONCLUSIONS

The findings of this study can serve as the foundation and provide guidance for parents, schools, healthcare professionals, and communities when attempting to implement changes and programs to combat the epidemic of childhood obesity.

Family-centered rounds in the neonatal intensive care unit

Promotion of family-centered care is common in neonatal intensive care units (NICUs) across the nation. Yet, true collaboration and shared decision-making with families in the care of their baby is not the standard of care. Family-centered rounds can provide the opportunity for this level of collaboration, but care must be taken to overcome barriers to family-centered rounds.

An integrative review of parent satisfaction with care provided in the neonatal intensive care unit

OBJECTIVE

To synthesize findings from the published empirical literature on parent satisfaction with care provided in the neonatal intensive care unit (NICU).

DATA SOURCES

Electronic databases including CINAHL, Medline, Embase, PsycInfo, Sociological Abstracts, the Cochrane Library, and the Campbell Library were searched for relevant research dating from January 1990 to the beginning of October 2011. The reference lists of all studies were reviewed and the personal files of the authors were also searched for relevant studies.

STUDY SELECTION

Twelve studies (nine quantitative descriptive, two qualitative descriptive, and one mixed methods) were identified that met the review inclusion criteria. Only studies written in English were selected.

DATA EXTRACTION

Whittemore and Knafl's methodology for integrative reviews guided the data extraction and subsequent analysis. Studies meeting the review inclusion criteria were analyzed sequentially. Data were extracted and organized under the following headings: author, year, and country; study purpose and design; sample size and setting; study variables and data collection; study findings; and limitations.

DATA SYNTHESIS

Studies examining parent satisfaction with the care provided in the NICU were synthesized under four main themes: (a) parents' degree of satisfaction with care, (b) factors associated with parents' satisfaction with care, (c) elements of care parents view as important, and (d) discrepancies between parent expectations and actual ratings of care.

CONCLUSIONS

The vast majority of parents were highly satisfied with the care they and their infants received in the NICU. However, other evidence points to less-than-optimal NICU care that is not meeting parents' expectations. These findings provide some direction as to what is important and satisfying to parents whose children must reside in the NICU. However, given the quality and dearth of the evidence, gaps remain in our understanding, and additional, more rigorous research is needed.

Developing nurse/parent relationships in the NICU through negotiated partnership

OBJECTIVE

To explore parents' experience and satisfaction with care in the Neonatal Intensive Care Unit (NICU).

DESIGN

Qualitative design using an interpretive description method.

SETTING

A tertiary-level care 69-bed NICU.

PARTICIPANTS

Ten parents (nine mothers and one father) were interviewed.

METHOD

Parents were interviewed in person or via telephone, either following or close to discharge. Interviews were recorded, transcribed, and then analyzed using an evolving coding guide.

RESULTS

All parents indicated that the relationship they developed with the bedside nurse was the most significant factor affecting their satisfaction with their NICU experience. All parents described nursing actions of perceptive engagement, cautious guidance, and subtle presence, which facilitated the development of this relationship. Further analysis of the data revealed that parents portrayed nurses in ideal nurse/parent interactions as fulfilling the roles of teacher, guardian, and facilitator.

CONCLUSION

Developing a collaborative and effective nurse/parent relationship is the most significant factor affecting parents' satisfaction with their NICU experience. Providing nursing care in a manner that optimizes consistency and continuity of care facilitates the ability of both parties to develop this relationship.

Using evidence to improve care for the vulnerable neonatal population

The facilitation of evidence-based practice (EBP) in the clinical setting is important to ensure patients receive the best care possible. This article highlights changes in open visitation and feeding readiness practices that occurred in a Magnet-designated facility neonatal ICU. The examples demonstrate ways to bring evidence to the bedside within an environment that supports EBP at all levels of nursing leadership.

Transition to home from the newborn intensive care unit: applying the principles of family-centered care to the discharge process

Increasingly newborn intensive care units (NICUs) are embracing family-centered care principles. Family-centered newborn intensive care requires that families are welcomed as partners in caregiving and decision making. Traditionally, discharge planning has been done without significant family involvement. In fact, parent participation in caregiving may still be limited until discharge is imminent. By increasing parental involvement in caregiving throughout hospitalization and working with families to facilitate the discharge process, parents may emerge from the NICU experience with increased competence and confidence in infant caregiving. This article reviews common discharge practices and processes in the NICU and offers strategies to assist nurses in integrating a family-centered approach into discharge planning.