1
|
Duffy N, Hickey L, Treyvaud K, Delany C. 360-degree phenomenology: A qualitative approach to exploring the infant experience of hospitalisation in neonatal intensive care. Early Hum Dev 2024; 190:105963. [PMID: 38377880 DOI: 10.1016/j.earlhumdev.2024.105963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024]
Abstract
This paper describes the development and justification of a qualitative methodology aimed at exploring the infant's personal experience of hospitalisation in the neonatal intensive care unit (NICU). We begin by briefly reviewing existing methods for documenting and recording infant experiences. These methods focus on the clinical needs of the infant predominantly through quantifiable medical outcome data. Research understanding their experience of receiving clinical care is lacking. By exploring newborn infant behaviour, cues, and communication strategies we assert the infant as a capable participant in neonatal research. We then describe the methodology and methods which we have named 360-degree phenomenology that draws directly from the capabilities and knowledge of the infants themselves. We propose this methodology will address the gap in the literature by enabling a rich and comprehensive overview of the early life experiences of infants hospitalised in NICU.
Collapse
Affiliation(s)
- Natalie Duffy
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Medical Education, University of Melbourne, Melbourne, Australia.
| | - Leah Hickey
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Karli Treyvaud
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia; Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Delany
- Department of Medical Education, University of Melbourne, Melbourne, Australia; Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
2
|
Malin KJ, Vittner D, Darilek U, McGlothen-Bell K, Crawford A, Koerner R, Pados BF, Cartagena D, McGrath JM, Vance AJ. Application of the Adverse Childhood Experiences Framework to the NICU. Adv Neonatal Care 2024; 24:4-13. [PMID: 38061194 PMCID: PMC11317928 DOI: 10.1097/anc.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families. PURPOSE Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment. METHODS An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed. RESULTS NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU. IMPLICATIONS FOR PRACTICE AND RESEARCH Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.
Collapse
Affiliation(s)
- Kathryn J Malin
- College of Nursing, Marquette University, Milwaukee, Wisconsin (Dr Malin); Children's Wisconsin, Milwaukee (Dr Malin); Egan School of Nursing & Health Studies, Fairfield University, Fairfield, Connecticut (Dr Vittner); Department of Pediatrics (Dr Darilek) and School of Nursing (Drs McGlothen-Bell, Crawford, and McGrath), The University of Texas Health Science Center at San Antonio; University of Florida, Gainesville (Dr Koerner); Infant Feeding Care, Wellesley, Massachusetts (Dr Pados); School of Nursing, Old Dominion University, Norfolk, Virginia (Dr Cartagena); and Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan (Dr Vance)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Kutahyalioglu NS, Scafide KN. Effects of family-centered care on bonding: A systematic review. J Child Health Care 2023; 27:721-737. [PMID: 35430900 DOI: 10.1177/13674935221085799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most critically ill neonates require constant monitoring, continuous care, and supervision. However, distance created by admission and prolonged stay in a neonatal intensive care unit (NICU) may contribute to a delay in parent-infant bonding. This review aimed to determine how family-centered care (FCC) in the NICU affects parental bonding with critically ill infants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform a systematic search of the literature within the following four electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, and Web of Science. The search was conducted through July/August 2020. Research quality was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Grading Scale. Out of 816 articles identified through literature search, 16 of the studies met our inclusion criteria. The majority of the studies (n = 14) found FCC interventions resulted in a significant increase in parental bonding. Results showed evidence practicing FCC in the NICU setting supports early parent-infant bonding. Nurses should consider implementing evidence-based FCC strategies into practice, such as allowing parents unrestricted access to their infants. More rigorous research with larger samples is recommended. More studies are also needed focusing on father-infant dyads and mother-father-infant triads.
Collapse
Affiliation(s)
- Nesibe S Kutahyalioglu
- Fazil Boyner Faculty of Health Sciences, Kastamonu University, Kastamonu, Karabuk, Turkey
| | - Katherine N Scafide
- College of Health and Human Services, George Mason University, Fairfax, VA, USA
| |
Collapse
|
4
|
Varty D, Minhas K, Gillis S, Rourke S. Skin-to-Skin Therapy on High-Frequency Jet Ventilation: A Trauma-Informed Best Practice. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:175-182. [PMID: 37781345 PMCID: PMC10540160 DOI: 10.29390/001c.84446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/06/2023] [Indexed: 10/03/2023]
Abstract
Objective To mitigate trauma for infants on high-frequency jet ventilation by decreasing exposure to noise and facilitating skin-to-skin therapy. Design Key drivers were identified, and we designed and implemented equipment and processes through a series of interventions. A mixed methods evaluation was used. Retrospective chart reviews assessed safety (unplanned extubation) and stability parameters. Semi-structured interviews were conducted to understand parent and staff experiences. Results Stability parameters demonstrated safe skin-to-skin therapy. Data from the interviews showed that parents and staff experiences focused on safety, connection and healing. Conclusion Implementing safe processes to support skin-to-skin therapy during high-frequency jet ventilation is possible. We hope other units will be encouraged to examine their current practices for infants on high-frequency jet ventilation to help mitigate trauma for infants and parents while enhancing staff satisfaction.
Collapse
Affiliation(s)
- Dallyce Varty
- Neonatal Intensive Care Unit Royal Columbian Hospital
- Fraser Health Authority
| | - Kuljit Minhas
- Fraser Health Authority
- Respiratory Therapy Royal Columbian Hospital
| | - Sarah Gillis
- Fraser Health Authority
- Perinatal Royal Columbian Hospital
| | - Sarah Rourke
- Maternal, Infant, Child, Youth Program Fraser Health Authority
| |
Collapse
|
5
|
Malin KJ, Gondwe KW, Fial AV, Moore R, Conley Y, White-Traut R, Griffith T. Scoping Review of Early Toxic Stress and Epigenetic Alterations in the Neonatal Intensive Care Unit. Nurs Res 2023; 72:218-228. [PMID: 37084322 PMCID: PMC10278559 DOI: 10.1097/nnr.0000000000000652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
BACKGROUND Preterm infants are uniquely vulnerable to early toxic stress exposure while in the neonatal intensive care unit (NICU) and also being at risk for suboptimal neurodevelopmental outcomes. However, the complex biological mechanisms responsible for variations in preterm infants' neurodevelopmental outcomes because of early toxic stress exposure in the NICU remain unknown. Innovative preterm behavioral epigenetics research offers a possible mechanism and describes how early toxic stress exposure may lead to epigenetic alterations, potentially affecting short- and long-term outcomes. OBJECTIVE The aim of this study was to review the relationships between early toxic stress exposures in the NICU and epigenetic alterations in preterm infants. The measurement of early toxic stress exposure in the NICU and effect of epigenetic alterations on neurodevelopmental outcomes in preterm infants were also examined. METHODS We conducted a scoping review of the literature published between January 2011 and December 2021 using databases PubMed, CINAHL, Cochrance Library, PsycINFO, and Web of Science. Primary data-based research that examined epigenetics, stress, and preterm infants or NICU were included. RESULTS A total of 13 articles from nine studies were included. DNA methylations of six specific genes were studied in relation to early toxic stress exposure in the NICU: SLC6A4, SLC6A3, OPRMI, NR3C1, HSD11B2, and PLAGL1. These genes are responsible for regulating serotonin, dopamine, and cortisol. Poorer neurodevelopmental outcomes were associated with alterations in DNA methylation of SLC6A4, NR3C1, and HSD11B2. Measurements of early toxic stress exposure in the NICU were inconsistent among the studies. DISCUSSION Epigenetic alterations secondary to early toxic stress exposures in the NICU may be associated with future neurodevelopmental outcomes in preterm infants. Common data elements of toxic stress exposure in preterm infants are needed. Identification of the epigenome and mechanisms by which early toxic stress exposure leads to epigenetic alterations in this vulnerable population will provide evidence to design and test individualized intervention.
Collapse
|
6
|
Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101568. [PMID: 36291504 PMCID: PMC9600280 DOI: 10.3390/children9101568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.
Collapse
|
7
|
Micro-preemie Parents' Perceptions of Trauma-Informed Developmental Neuroprotective Care and Nursing Support. Adv Neonatal Care 2022; 22:422-431. [PMID: 34966055 DOI: 10.1097/anc.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preterm birth is traumatic for both the infant and parents. Trauma-informed developmental neuroprotective care (TIDNC) may positively influence the outcomes for micro-preemie infants (infants born before 26 weeks' gestation) as well as support parents in crisis. PURPOSE To explore how TIDNC influences micro-preemie parents' perceptions of nursing care and support. METHODS A descriptive cross-sectional study was conducted at a 56-bed level III neonatal intensive care unit (NICU). A convenience sample of micro-preemie parents (n = 16, 46%) completed the Nurse Parent Support Tool (NPST) questionnaire, which included 2 open-ended questions. RESULTS These parents scored high scores on the NPST (mean = 4.62 ± 0.24), indicating most parents felt support from the nursing staff and perceived individualized family-centered high-quality nursing care. Subscale scores were higher than all previous studies. Parents perceived high levels of support most of the time to almost always. Although 4 themes were closely associated with the subscales, the fifth theme, Praise has not been previously documented. Parents were grateful for nurses who provided compassionate care and support during one of the most difficult times of their lives. IMPLICATIONS FOR PRACTICE TIDNC encourages robust nurse-parent authentic caring relationships, which are foundational to the parents' perceptions of nursing care and support. These relationships, built on mutual trust, respect, and genuine listening, appear to foster an exceptionally high degree of support. IMPLICATIONS FOR RESEARCH More research is needed to examine how unit culture, characteristics of nurses, parents, and infants as well as infant outcomes influence micro-preemie parents' perception of care and further explore the nature of support.
Collapse
|
8
|
D’Agata AL, Kelly M, Green CE, Sullivan MC. Molding influences of prematurity: Interviews with adults born preterm. Early Hum Dev 2022; 166:105542. [PMID: 35085882 PMCID: PMC9186092 DOI: 10.1016/j.earlhumdev.2022.105542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tremendous medical advancements over the last several decades have supported the survival of younger and sicker newborns. Substantial quantitative research exists about health and developmental outcomes following preterm birth, however, limited published literature has explored what this experience means to the survivors. AIM The purpose was to describe, interpret and understand how adults born preterm perceive prematurity to have affected their lives. STUDY DESIGN Qualitative thematic analysis. METHODS Semi-structured interviews were conducted with 33 adults born preterm from the RHODĒ Study, a longitudinal preterm birth cohort. A cross-section of participants with high and low early life medical and environmental risk was interviewed. Data were analyzed using a constructionist method of latent theme analysis. RESULTS From the data, 3 themes were identified: 1) My parents call me their miracle, 2) It's not a big deal, I'm the same as everyone else, 3) I've overcome a lot. Themes represent a continuum of experience, from positive to neutral to negative. Common life experiences of family, education, friends, and health are subthemes that help to illuminate how participants assign meaning to their prematurity. Meaning was linked to how typical or not participants perceive their health, learning and friends compared to peers. CONCLUSION Perceptions about prematurity and adversity are influenced by the ways parents and families represent prematurity in shared stories and actions. These findings should inform future research with adult survivors of prematurity. Participants identified ongoing need for support and advocacy, particularly from healthcare and education communities.
Collapse
Affiliation(s)
- Amy L. D’Agata
- University of Rhode Island, College of Nursing, 350 Eddy Street, Providence, RI 02903, United States of America,Corresponding author at: University of Rhode Island, Rhode Island Nursing Education Center, 350 Eddy Street, Providence, RI 02903, United States of America. (A.L. D’Agata)
| | - Michelle Kelly
- University of Rhode Island, College of Nursing, 350 Eddy Street, Providence, RI 02903, United States of America,Villanova University, Fitzpatrick College of Nursing, 800 E. Lancaster Avenue, Villanova, PA 19085, United States of America
| | - Carol E. Green
- Department of Family Medicine, Brown University, Alpert School of Medicine, 111 Brewster Street, Pawtucket, RI 02860, United States of America
| | - Mary C. Sullivan
- University of Rhode Island, College of Nursing, 350 Eddy Street, Providence, RI 02903, United States of America
| |
Collapse
|
9
|
LaRonde MP, Connor JA, Cerrato B, Chiloyan A, Lisanti AJ. Individualized Family-Centered Developmental Care for Infants With Congenital Heart Disease in the Intensive Care Unit. Am J Crit Care 2022; 31:e10-e19. [PMID: 34972853 DOI: 10.4037/ajcc2022124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Individualized family-centered developmental care (IFDC) is considered the standard of care for premature/medically fragile newborns and their families in intensive care units (ICUs). Such care for infants with congenital heart disease (CHD) varies. OBJECTIVE The Consortium for Congenital Cardiac Care- Measurement of Nursing Practice (C4-MNP) was surveyed to determine the state of IFDC for infants younger than 6 months with CHD in ICUs. METHODS An electronic survey was disseminated to 1 nurse at each participating center. The survey included questions on IFDC-related nursing practice, organized in 4 sections: demographics, nursing practice, interdisciplinary practice, and parent support. Data were summarized by using descriptive statistics. Differences in IFDC practices and IFDC-related education were assessed, and practices were compared across 3 clinical scenarios of varying infant acuity by using the χ2 test. RESULTS The response rate was 66% (25 centers). Most respondents (72%) did not have IFDC guidelines; 63% incorporated IFDC interventions and 67% documented IFDC practices. Only 29% reported that their ICU had a neurodevelopmental team. Significant differences were reported across the 3 clinical scenarios for 11 of 14 IFDC practices. Skin-to-skin holding was provided least often across all levels of acuity. Nurse education related to IFDC was associated with more use of IFDC (P < .05). CONCLUSION Practices related to IFDC vary among ICUs. Opportunities exist to develop IFDC guidelines for infants with CHD to inform clinical practice and nurse education. Next steps include convening a C4-MNP group to develop guidelines and implement IFDC initiatives for collaborative evaluation.
Collapse
Affiliation(s)
- Meena P. LaRonde
- Meena P. LaRonde is a staff nurse III, Cardiovascular Intensive Care Unit, Boston Children’s Hospital, Boston, Massachusetts
| | - Jean A. Connor
- Jean A. Connor is the director of nursing research, Cardiovascular and Critical Care Patient Services, Boston Children’s Hospital and an assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Cerrato
- Benjamin Cerrato is a project coordinator, Cardiovascular and Critical Care Patient Services, Boston Children’s Hospital
| | - Araz Chiloyan
- Araz Chiloyan is a quality improvement consultant, Department of Cardiology, Boston Children’s Hospital
| | - Amy Jo Lisanti
- Amy Jo Lisanti is a research assistant professor at the University of Pennsylvania School of Nursing, Department of Family and Community Health and a primary investigator at the Research Institute and Children’s Hospital of Philadelphia
| |
Collapse
|
10
|
Ståhlberg T, Upadhyaya S, Polo-Kantola P, Khanal P, Luntamo T, Hinkka-Yli-Salomäki S, Sourander A. Associations Between Delivery Modes, Birth Outcomes and Offspring Anxiety Disorders in a Population-Based Birth Cohort of Children and Adolescents. Front Psychiatry 2022; 13:917299. [PMID: 35911234 PMCID: PMC9326080 DOI: 10.3389/fpsyt.2022.917299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Mode of delivery and well-being markers for newborn infants have been associated with later psychiatric problems in children and adolescents. However, only few studies have examined the association between birth outcomes and anxiety disorders and the results have been contradictory. METHODS This study was a Finnish population-based register study, which comprised 22,181 children and adolescents with anxiety disorders and 74,726 controls. Three national registers were used to collect the data on exposures, confounders and outcomes. Mode of delivery, the 1-min Apgar score, umbilical artery pH and neonatal monitoring were studied as exposure variables for anxiety disorders and for specific anxiety disorders. Conditional logistic regression was used to examine these associations. RESULTS Unplanned and planned cesarean sections increased the odds for anxiety disorders in children and adolescents (adjusted OR 1.08, 95% CI 1.02-1.15 and aOR 1.12, 95% CI 1.05-1.19, respectively). After an additional adjustment for maternal diagnoses, unplanned cesarean sections remained statistically significant (aOR 1.11, 95% CI 1.04-1.18). For specific anxiety disorders, planned cesarean sections and the need for neonatal monitoring increased the odds for specific phobia (aOR 1.21, 95% CI 1.01-1.44 and aOR 1.28, 95% CI 1.07-1.52, respectively). CONCLUSIONS Birth by cesarean section increased the odds for later anxiety disorders in children and adolescents and unplanned cesarean sections showed an independent association. Further studies are needed to examine the mechanisms behind these associations.
Collapse
Affiliation(s)
- Tiia Ståhlberg
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Subina Upadhyaya
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Prakash Khanal
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Terhi Luntamo
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | | | - Andre Sourander
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| |
Collapse
|
11
|
Power NM, North N, Leonard AL, Bonaconsa C, Coetzee M. A scoping review of mother-child separation in clinical paediatric settings. J Child Health Care 2021; 25:534-548. [PMID: 33035074 DOI: 10.1177/1367493520966415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is increasing evidence to suggest that autonomic regulation of hospitalised infants is affected by separation from their mother. This review explored the extent of the evidence relating to the impact of separation on infants and children and aimed to identify suitable measures of the impact of mother-child separation. We conducted a scoping review of seven databases using the main search terms 'physiological', 'psychological', 'infant/child', 'maternal separation' and 'hospital'. Thirty-four articles containing data relevant to the effects of mother-child separation on either member of the pair were included. Findings highlight the central importance of the mother's presence in mediating the stressful effects of hospitalisation on her child. The majority of articles reported on psychological effects of separation on mothers of infants or on younger children. We identified no articles reporting on physiological effects on the older child or mothers of older children or psychological effects on mothers of older children. Only nine articles used validated tools to measure the effects of separation. There is a need for more evidence, based on validated measurement, about the psychological effects of separation on the child, particularly the older child, and on the physiological effects of separation on the mother-child pair during hospitalisation.
Collapse
Affiliation(s)
- Nina M Power
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, 37716University of Cape Town, South Africa
| | - Natasha North
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, 37716University of Cape Town, South Africa
| | - Angela L Leonard
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, 37716University of Cape Town, South Africa
| | - Candice Bonaconsa
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, 37716University of Cape Town, South Africa
| | - Minette Coetzee
- The Harry Crossley Children's Nursing Development Unit, Department of Paediatrics and Child Health, 37716University of Cape Town, South Africa
| |
Collapse
|
12
|
Individualized Family-Centered Developmental Care: A Model for High-Quality Care. J Perinat Neonatal Nurs 2021; 35:294-297. [PMID: 34726644 DOI: 10.1097/jpn.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Ceylan SS, Keskin Z, Yavaş Z, Özdemir H, Tosun G, Güner E, İzci A. Developing the Scale of Parental Participation in Care: Neonatal Intensive Care Unit and Examining the Scale's Psychometric Properties. Intensive Crit Care Nurs 2021; 65:103037. [PMID: 33773901 DOI: 10.1016/j.iccn.2021.103037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to develop the Scale of Parental Participation in Care: Neonatal Intensive Care Unit and to examine the Scale's psychometric properties. METHODS The draft scale' items were created through relevant literature reviews, focus group interviews with nurses, and content validity evaluations by experts. Study data were collected in the neonatal intensive care unit of a public hospital in Turkey from June 2019 to February 2020. The study participants were comprised of 205 parents with an infant in the neonatal intensive care unit. The Scale's content validity and construct validity were evaluated to determine the validity of the scale. Cronbach's alpha coefficient, item-total score correlations, and intraclass correlation were calculated to evaluate the Scale's reliability. RESULTS Content validity index values of the draft form of the scale ranged from 0.93 to 1.00. The final scale consisted of 18 items. From the exploratory factor analysis, it was found that the scale structure comprised a single factor that accounted for 51.92% of the total variance. Concerning the reliability of the Scale, it was calculated that Cronbach's alpha level was 0.93; item total correlations ranged from 0.48 to 0.78; intraclass correlation level was 1.000. CONCLUSION It was found that the Parental Participation in Care Scale: Neonatal Intensive Care Unit was valid and reliable in this sample.
Collapse
Affiliation(s)
- Sibel Serap Ceylan
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey.
| | - Züleyha Keskin
- Neonatal Intensive Care Unit, Denizli State Hospital, Denizli, Turkey
| | - Zekiye Yavaş
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Hilal Özdemir
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Gülseren Tosun
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Elmas Güner
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| | - Aysun İzci
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
| |
Collapse
|
14
|
Duffy N, Hickey L, Treyvaud K, Delany C. The lived experiences of critically ill infants hospitalised in neonatal intensive care: A scoping review. Early Hum Dev 2020; 151:105244. [PMID: 33130369 DOI: 10.1016/j.earlhumdev.2020.105244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neonatal intensive care saves lives, but the environment in which this occurs is complex and has been shown to negatively disrupt some aspects of an infant's early development. Identifying these negative effects has relied on measuring physiological and behavioural responses. Little research has sought to understand and learn from what an individual infant can communicate about their lived experience. AIM To examine what is known of the lived experiences of infants hospitalised in neonatal intensive care. STUDY DESIGN A scoping review using the revised Arksey and O'Malley framework was undertaken. Relevant studies, exploring an infant's experience of hospitalisation were identified through a comprehensive, systematic literature search. RESULTS 4955 articles were retrieved, 88 full texts reviewed, and 23 studies included. We identified no studies that assessed the experience from the infant's perspective. The infant experience was explored using quantitative methodology, characterising, and describing the experience in measurable physiological, behavioural, and neurodevelopmental terms or through the lens of medical outcomes. The environment is described as too loud and too bright and infants are exposed to high levels of medical handling, impacting on physiology, behaviour, sleep, feeding, and both short- and longer-term outcomes. CONCLUSION The studies captured in this review focused on quantitative, measurable outcomes as a proxy for the experience as it might be felt, interpreted, and processed by an infant. Medical focus has been crucial to advance the field of neonatology, but the review highlights an important gap; the need to explore and better understand the infant's experience through their eyes.
Collapse
Affiliation(s)
- Natalie Duffy
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Medical Education, University of Melbourne, Melbourne, Australia.
| | - Leah Hickey
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Karli Treyvaud
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Psychology and Counselling, La Trobe University, Melbourne, Australia; Neonatal Services, Royal Women's Hospital, Melbourne, Australia; Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Delany
- Department of Medical Education, University of Melbourne, Melbourne, Australia; Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|
15
|
Groer MW, Miller EM, D'Agata A, Ho TTB, Dutra SV, Yoo JY, Yee AL, Gilbert JA, Dishaw LJ. Contributors to Dysbiosis in Very-Low-Birth-Weight Infants. J Obstet Gynecol Neonatal Nurs 2020; 49:232-242. [PMID: 32247727 DOI: 10.1016/j.jogn.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 02/08/2023] Open
Abstract
The objective of this commentary was to analyze the causes and outcomes of gut microbiome dysbiosis in preterm infants who are born at very low birth weight (VLBW). The intrauterine development of VLBW infants is interrupted abruptly with preterm birth and followed by extrauterine, health-threatening conditions and sequelae. These infants develop intestinal microbial dysbiosis characterized by low diversity, an overall reduction in beneficial and/or commensal bacteria, and enrichment of opportunistic pathogens of the Gammaproteobacteria class. The origin of VLBW infant dysbiosis is not well understood and is likely the result of a combination of immaturity and medical care. We propose that these factors interact to produce inflammation in the gut, which further perpetuates dysbiosis. Understanding the sources of dysbiosis could result in interventions to reduce gut inflammation, decrease enteric pathology, and improve health outcomes for these vulnerable infants.
Collapse
|
16
|
McGowan EC, Vohr BR. Impact of Nonmedical Factors on Neurobehavior and Language Outcomes of Preterm Infants. Neoreviews 2019; 20:e372-e384. [PMID: 31261104 DOI: 10.1542/neo.20-7-e372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Preterm infants are at increased risk for adverse neurodevelopmental outcomes. The impact of maternal, NICU, and social environmental factors on early neurobehavior and language outcomes of preterm infants is recognized. There is a need for health care professionals to have a clear understanding of the importance of facilitating positive mother-infant relationships, and to address not only the infant's sensory and language environment, but also focus on adverse maternal mental health and social adversities to optimize infant outcomes.
Collapse
Affiliation(s)
- Elisabeth C McGowan
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Warren Alpert Medical School of Brown University, and Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
| |
Collapse
|
17
|
Eliades C. Mitigating Infant Medical Trauma in the NICU: Skin-to-Skin Contact as a Trauma-Informed, Age-Appropriate Best Practice. Neonatal Netw 2019; 37:343-350. [PMID: 30567883 DOI: 10.1891/0730-0832.37.6.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infant medical trauma in the NICU is associated with serious and lasting consequences. Skin-to-skin contact (SSC) of infants with their parents is a nursing intervention that provides significant benefits and can mitigate the negative consequences of the infant's traumatic experiences in the NICU. The purpose of this article is to explain how SSC aligns with the concept of trauma-informed age-appropriate care (TIAAC) in the NICU. The evidence supporting SSC will be reviewed and discussed using TIAAC as a framework. SSC is an effective and evidence-based care strategy that reduces the infant's traumatic NICU experiences by improving parental proximity, attachment, and lactation; decreasing stress and pain; improving physiologic stability; supporting sleep; and enhancing neurologic outcomes.
Collapse
|
18
|
D’Agata AL, Roberts MB, Ashmeade T, Dutra SVO, Kane B, Groer MW. Novel method of measuring chronic stress for preterm infants: Skin cortisol. Psychoneuroendocrinology 2019; 102:204-211. [PMID: 30583244 PMCID: PMC6420357 DOI: 10.1016/j.psyneuen.2018.12.223] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Infants who begin life in the medicalized environment of the neonatal intensive care unit (NICU) do so under stressful conditions. Environmental exposures are often abrasive to vulnerable infants, while invasive and noninvasive lifesaving interventions provide additional pain and/or stress. The most commonly selected biomarker to measure stress is cortisol. The skin is the barrier between the external environment and communicates with our neurological, endocrine and immune regulatory networks. To examine if skin cortisol may be a reliable biomarker of stress, NICU stress exposure and repeated measurements of skin cortisol in very preterm infants were examined retrospectively during the first 6 weeks of life. The temporal relationship between skin cortisol and NICU stress exposure was also analyzed. MATERIALS AND METHODS Participants included 82 preterm infants born weighing less than 1500 g, admitted to a level III NICU, with a mean gestational age of 28.5 weeks. Infants were studied from birth through 6 weeks of life. NICU stress data was collected using the Neonatal Infant Stressor Scale. Skin samples were collected using d-squame tape as soon after birth as possible and every two weeks thereafter. RESULTS On average, infants experienced approximately 43 stressful events per day during the first 6 weeks of life in the NICU. Stress level and cortisol reactivity varied by gestation age. Higher stress resulted in higher cortisol for infant >28 weeks; lower stress scores were associated with higher stress for infants <28 weeks. Stress exposure during 7 days prior to cortisol sampling yielded the highest AUC for the 2 groups. A statistically significant interaction was identified between gestational age and stress exposure during the previous 7 days (p < 0.01). CONCLUSION This is the first study to demonstrate skin cortisol as a preterm infant biomarker of chronic stress exposure. For infants with appropriate skin maturation, this non-invasive sampling method provides several benefits. Importantly, this method may be less intrusive and disruptive for preterm infants.
Collapse
Affiliation(s)
- Amy L. D’Agata
- College of Nursing, University of South Florida, 12912 USF Health Drive, Tampa, FL, USA,College of Nursing, University of Rhode Island, 39 Butterfield Rd., Kingston, RI, USA
| | - Mary B. Roberts
- College of Nursing, University of Rhode Island, 39 Butterfield Rd., Kingston, RI, USA,Center for Primary Care & Prevention, Care New England Medical Group, Primary Care & Specialty Services, 111 Brewster St., Pawtucket, RI, USA
| | - Terri Ashmeade
- Morsani College of Medicine, 12910 Bruce B. Downs Blvd, Tampa, FL, USA
| | | | - Bradley Kane
- College of Nursing, University of South Florida, 12912 USF Health Drive, Tampa, FL, USA
| | - Maureen W. Groer
- College of Nursing, University of South Florida, 12912 USF Health Drive, Tampa, FL, USA
| |
Collapse
|
19
|
Weber A, Harrison TM. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. Nurs Outlook 2019; 67:169-189. [PMID: 30611546 PMCID: PMC6450772 DOI: 10.1016/j.outlook.2018.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023]
Abstract
In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.
Collapse
Affiliation(s)
- Ashley Weber
- University of Cincinnati College of Nursing, 310 Proctor Hall, 3110 Vine St, Cincinnati, OH 45221, USA
| | - Tondi M. Harrison
- The Ohio State University, Newton Hall, College of Nursing, 1585 Neil Avenue, Columbus OH, 43210 USA
| |
Collapse
|
20
|
D'Agata AL, Wu J, Welandawe MKV, Dutra SVO, Kane B, Groer MW. Effects of early life NICU stress on the developing gut microbiome. Dev Psychobiol 2019; 61:650-660. [PMID: 30697700 DOI: 10.1002/dev.21826] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 02/06/2023]
Abstract
Succession of gut microbial community structure for newborns is highly influenced by early life factors. Many preterm infants cared for in the NICU are exposed to parent-infant separation, stress, and pain from medical care procedures. The purpose of the study was to investigate the impact of early life stress on the trajectory of gut microbial structure. Stool samples from very preterm infants were collected weekly for 6 weeks. NICU stress exposure data were collected daily for 6 weeks. V4 region of the 16S rRNA gene was amplified by PCR and sequenced. Zero-inflated beta regression model with random effects was used to assess the impact of stress on gut microbiome trajectories. Week of sampling was significant for Escherichia, Staphylococcus, Enterococcus, Bifidobacterium, Proteus, Streptococcus, Clostridium butyricum, and Clostridium perfringens. Antibiotic usage was significant for Proteus, Citrobacter, and C. perfringens. Gender was significant for Proteus. Stress exposure occurring 1 and 2 weeks prior to sampling had a significant effect on Proteus and Veillonella. NICU stress exposure had a significant effect on Proteus and Veillonella. An overall dominance of Gammaproteobacteria was found. Findings suggest early life NICU stress may significantly influence the developing gut microbiome, which is important to NICU practice and future microbiome research.
Collapse
Affiliation(s)
- Amy L D'Agata
- College of Nursing, University of Rhode Island, Kingston, Rhode Island.,College of Nursing, University of South Florida, Tampa, Florida
| | - Jing Wu
- Computer Science and Statistics, University of Rhode Island, Kingston, Rhode Island
| | | | - Samia V O Dutra
- College of Nursing, University of South Florida, Tampa, Florida
| | - Bradley Kane
- College of Nursing, University of South Florida, Tampa, Florida
| | - Maureen W Groer
- College of Nursing, University of South Florida, Tampa, Florida
| |
Collapse
|
21
|
American Academy of Nursing on policy: Reducing preterm births in the United States: Maternal infant health, child, adolescent and family, and women's health expert panels (August 13, 2018). Nurs Outlook 2018; 66:499-504. [PMID: 30497578 DOI: 10.1016/j.outlook.2018.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
22
|
Coughlin McNeil M. Take Care and Care Well. Can J Nurs Res 2017; 49:43-45. [PMID: 28841055 DOI: 10.1177/0844562117701599] [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: 11/16/2022] Open
Abstract
Evidence-based practice supports the patient care process by integrating patient values and preferences with clinician expertise and the best available evidence. This approach to patient care focuses on quality and safety with the aim of improving patient outcomes. Despite its obvious value, healthcare professionals struggle to integrate evidence-based best practices into their clinical practice.
Collapse
|
23
|
D'Agata AL, Walsh S, Vittner D, Cong X, McGrath JM, Young EE. FKBP5genotype and early life stress exposure predict neurobehavioral outcomes for preterm infants. Dev Psychobiol 2017; 59:410-418. [DOI: 10.1002/dev.21507] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Amy L. D'Agata
- School of Nursing; University of Connecticut; Storrs Connecticut
- College of Nursing; University of South Florida; Tampa Florida
| | - Stephen Walsh
- School of Nursing; University of Connecticut; Storrs Connecticut
| | - Dorothy Vittner
- School of Nursing; University of Connecticut; Storrs Connecticut
- Division of Quality Management; Connecticut Department of Developmental Services; Hartford Connecticut
| | - Xiaomei Cong
- School of Nursing; University of Connecticut; Storrs Connecticut
| | - Jacqueline M. McGrath
- School of Nursing; University of Connecticut; Storrs Connecticut
- Connecticut Children's Medical Center; Hartford Connecticut
| | - Erin E. Young
- School of Nursing; University of Connecticut; Storrs Connecticut
- Institute for Systems Genomics; University of Connecticut; Storrs Connecticut
- School of Medicine, Genetics and Genome Sciences; University of Connecticut; Farmington Connecticut
| |
Collapse
|
24
|
Neurobiological Consequences of Early Painful Experience: Basic Science Findings and Implications for Evidence-Based Practice. J Perinat Neonatal Nurs 2017; 31:178-185. [PMID: 28437310 DOI: 10.1097/jpn.0000000000000258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As healthcare teams have worked to improve infant survival rates, the management of painful events experienced by these hospitalized neonates has increased and yet pain management remains highly variable between healthcare institutions. At the same time, emerging evidence suggests that these early painful experiences may alter the trajectory of development for pain-processing pathways both peripherally and centrally. This concise review highlights findings from both the basic and clinical science literature supporting the hypothesis that early painful experiences can have long-lasting negative effects on biological, psychological, and socioemotional functions. Implications for pain management in neonates and considerations for evidence-based practice change are discussed.
Collapse
|
25
|
A Framework of Complex Adaptive Systems: Parents As Partners in the Neonatal Intensive Care Unit. ANS Adv Nurs Sci 2016; 39:244-56. [PMID: 27490880 DOI: 10.1097/ans.0000000000000127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Advances in neonatal care are allowing for increased infant survival; however, neurodevelopmental complications continue. Using a complex adaptive system framework, a broad analysis of the network of agents most influential to vulnerable infants in the neonatal intensive care unit (NICU) is presented: parent, nurse, and organization. By exploring these interconnected relationships and the emergent behaviors, a model of care that increases parental caregiving in the NICU is proposed. Supportive parent caregiving early in an infant's NICU stay has the potential for more sensitive caregiving and enhanced opportunities for attachment, perhaps positively impacting neurodevelopment.
Collapse
|