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Grunberg VA, Presciutti A, Vranceanu AM, Lerou PH. Parental Self-Efficacy and Personal Time Help Explain Impact of Parent-Staff Interactions on Parental Distress and Bonding in the Neonatal Intensive Care Unit. J Pediatr 2024; 276:114300. [PMID: 39278533 DOI: 10.1016/j.jpeds.2024.114300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/29/2024] [Accepted: 09/09/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVES To identify factors that help explain associations between parent-staff interactions and: (1) parental depression, anxiety, and post-traumatic stress; and (2) parent-child bonding in the neonatal intensive care unit. STUDY DESIGN Our cross-sectional mixed methods survey investigated the ways in which parental-staff interactions relate to parental distress and parent-child bonding. Parents with babies in the neonatal intensive care unit (n = 165) completed validated measures and open-ended questions about their experiences with staff. Using a sequential explanatory approach, we examined: (1) whether and how parental self-efficacy and personal time mediated parent-staff interactions on distress and bonding; and (2) parental written accounts of experiences with staff. RESULTS Multiple mediation analyses revealed that parent-staff interactions exhibited an: (1) indirect effect on parental depression (b = -0.05, SE = 0.02, CI [-0.10, -0.01]), anxiety (b = -0.08, SE = 0.04, CI [-0.16, -0.02]), and parent-child bonding (b = -0.26, SE = 0.08, CI [-0.43, -0.11]) through parental self-efficacy; and (2) indirect effect on parental post-traumatic stress (b = -0.08, SE = 0.04, CI [-0.17, -0.00], completely standardized indirect effect = -0.06) through parental personal time. Thematic analyses revealed that emotional and instructional support from staff helped build parental self-efficacy. Trust with staff helped parents feel comfortable leaving the bedside and engage in basic needs (eg, eat, sleep). CONCLUSIONS Family-staff dynamics are the foundation for high quality family-centered care. Staff who empower parents to participate in care, engage in parenting tasks, and take care of themselves may reduce their distress and improve relationships among staff, parents, and babies.
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Affiliation(s)
- Victoria A Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Mass General Brigham, Boston, MA; Harvard Medical School, Boston, MA; Division of Newborn Medicine, Mass General Brigham, Boston, MA.
| | - Alex Presciutti
- Center for Health Outcomes and Interdisciplinary Research, Mass General Brigham, Boston, MA; Harvard Medical School, Boston, MA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Mass General Brigham, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul H Lerou
- Harvard Medical School, Boston, MA; Division of Newborn Medicine, Mass General Brigham, Boston, MA
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Guttmann KF, Raviv GN, Fortney CA, Ramirez M, Smith CB. Parent Perspectives on Communication Quality in the Neonatal Intensive Care Unit. Adv Neonatal Care 2024; 24:382-388. [PMID: 38975667 PMCID: PMC11334642 DOI: 10.1097/anc.0000000000001178] [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: 07/09/2024]
Abstract
BACKGROUND Though prior literature has demonstrated that communication in the Neonatal Intensive Care Unit (NICU) needs to be improved, in-depth descriptions of parents' views of NICU communication are lacking. PURPOSE We sought (1) to explore parent perceptions of communication in the NICU and (2) to understand parents' communication needs and preferences. METHODS We conducted in-depth semi-structured cognitive interviews utilizing concurrent probes with parents of 10 patients in our urban level IV Neonatal Intensive Care Unit over a period of 4 months (July 2021-October 2021). Interview questions were derived from the Quality of Communication scale. We conducted thematic analysis of interview transcripts modeled after work by Braun and Clarke. RESULTS Four overarching themes were identified: Strengths, Challenges, People, and Coping Strategies. Parents reported a range of communication quality in the NICU. Results revealed that the first 48 hours of NICU hospitalization represent a period of vulnerability and uncertainty for parents. Parents value clear yet hopeful communication about a baby's clinical status and expected course. IMPLICATIONS FOR PRACTICE AND RESEARCH We hope that the concrete findings from this study can both inform practice in the NICU now and influence practice guidelines to include such components as emphasis on the first 48 hours, desire for proactive information sharing, and the importance of including hope.
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Affiliation(s)
- Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Guttmann and Ms Raviv); The Ohio State University College of Nursing Martha S. Pitzer Center for Women, Children, and Youth, Columbus, Ohio (Dr Fortney); Research Division, Hebrew Home at Riverdale, Riverdale, New York, USA (Dr Ramirez); Division of Hematology and Medical Oncology, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith); Brookdale Department of Geriatrics and Palliative Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA (Dr Smith and Dr Guttmann)
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Marino LV, Collaḉo N, Coyne S, Leppan M, Ridgeway S, Bharucha T, Cochrane C, Fandinga C, Palframan K, Rees L, Osman A, Johnson MJ, Hurley-Wallace A, Darlington ASE. The Development of a Communication Tool to Aid Parent-Centered Communication between Parents and Healthcare Professionals: A Quality Improvement Project. Healthcare (Basel) 2023; 11:2706. [PMID: 37893780 PMCID: PMC10606263 DOI: 10.3390/healthcare11202706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Good communication is central to good healthcare. As a result of poor communication between parents and healthcare professionals (HCPs) in clinical settings, this study aimed to address this problem by developing a communication tool to empower parents and act as a prompt for HCPs to talk about the child's care and gather information at the point of admission to hospital about what is important to families, therefore supporting patient-centered communication. A design thinking process was used to develop a physical copy of Chloe's card and evaluate its use. Design thinking is a problem-solving approach, which uses an empathetic lens to integrate viewpoints of different stakeholders throughout the process of creating solutions. Design thinking involves five processes: (1) empathise-including a literature review and data synthesis, (2) define-by completing semi-structured interviews with parents about their experience of communication and HCPs perceptions of parent's experience of communication, (3) ideate-iterate the design of Chloe's card with parents and HCPs, (4) prototype-develop the design of Chloe's card, and (5) test-pilot test in clinical practice. Results from this initial study suggest that a small hand-held card, with emoticons and a place to write concerns, was acceptable to parents and feasible to use in clinical practice. Parents do not always feel heard by HCPs and a tool such as Chloe's card may help facilitate sharing of information about matters important to them and their child. However, some HCPs felt the need for a communication tool undermined their clinical skills. Feedback from HCP participants suggests that the idea of Chloe's card was acceptable and perceived as potentially being useful in clinical practice. Further work is required, as part of a larger study, to further refine this communication tool, identify those parents who would benefit most from Chloe's card, as well as to further refine the HCP process prior to implementing it into clinical settings. It was noted future iterations would benefit from a digital version linked with a child's electronic record, as well as multi-language versions and information for parents.
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Affiliation(s)
- Luise V Marino
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nicole Collaḉo
- School of Health Sciences, Southampton University, Southampton SO17 1BJ, UK
| | | | | | | | - Tara Bharucha
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Colette Cochrane
- Paediatric Cardiology, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Catarina Fandinga
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Karla Palframan
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Leanne Rees
- Department of Dietetics/Speech Language Therapy, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Ahmed Osman
- Paediatric Intensive Care, Southampton Children's Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Mark J Johnson
- Neonatal Medicine, Princess Anne Hospital, University Southampton Hospital NHS Foundation Trust, Southampton SO16 6YD, UK
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Del Castanhel F, Burg LB, Maia Nogueira L, Rodrigues de Oliveira Filho G, Grosseman S. Adaptation of the Quality of Communication Questionnaire for Family Members and Its Validity Evidence for Use in Brazil. Am J Hosp Palliat Care 2023; 40:401-408. [PMID: 35595713 DOI: 10.1177/10499091221102583] [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: 11/17/2022] Open
Abstract
Assessment of communication between physicians and patients' family members is essential to improving healthcare quality. To adapt the Quality of Communication Questionnaire (QoC) for family members and to analyze its validity evidence for use in Brazil. Data were collected between 2017 and 2019, with family members of patients in intensive care (IC) and palliative care (PC) from five public hospitals in the South Brazil. The QoC was adapted for family members for use in Brazil, and its cross-cultural adaptation was carried out. The clarity and cultural appropriateness of the pre-final version were evaluated by 30 family members of patients in IC. The final version was responded by 198 family members of patients. All items were considered clear, and appropriate to Brazilian culture. The goodness of fit index for proposed model had CFI 0.96 (CI95%: 0.94 - 0.98), TLI 0.95 (CI95%: 0.92 - 0.97), RMSEA 0.07 (CI90%: 0.06 - 0.08), and χ2/df 2.18. Cronbach's alpha coefficient (α) among family members of patients in PC was 0.88 for the general communication (first subscale) and 0.80 for the end-of-life communication (second subscale). However, among family members of patients in IC, α was 0.86 for the first subscale and only 0.53 for the second subscale. The QoC for family members and its cross-cultural adaptation were carried out successfully. It has strong validity evidence among those with loved ones in PC, but only the QoC general communication subscale has strong validity evidence among those with loved ones in IC.
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Affiliation(s)
- Flávia Del Castanhel
- Asthma and Airways Inflamation Research Center (NUPAIVA), 28117Federal University of Santa Catarina, Univeristy Hospital Professor Polydoro Ernani de São Thiago, Florianópolis, Brazil
| | - Luciana B Burg
- Federal University of Santa Catarina Univeristy Hospital Professor Polydoro Ernani de São Thiago, Florianópolis, Brazil
| | - Leonardo Maia Nogueira
- Center of Exact Sciences and Technology, 74391Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | - Suely Grosseman
- Pediatrics Department and in the Medical Science Postgraduation Program, Federal University of Santa Catarina, Florianópolis, Brazil.,Master in Teaching in Health Sciences, Faculdades Pequeno Príncipe, Curitiba, Brazil
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Sidek SM, Marup S, Zolkefli Y. Nurses' view of the nature of the support given to parents in the neonatal intensive care unit. BELITUNG NURSING JOURNAL 2021; 7:522-528. [PMID: 37497293 PMCID: PMC10367982 DOI: 10.33546/bnj.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/11/2021] [Accepted: 09/22/2021] [Indexed: 07/28/2023] Open
Abstract
Background Most parents of Neonatal intensive care unit (NICU) babies often expressed dissatisfaction with the nursing care in NICU because of their unaddressed needs, resulting in emotional strain. This raises an essential question of how NICU nurses provide support for the parents. However, this can be relatively challenging in the NICU setting. Objective To explore nurses' views on the nature of parental support provided in NICU settings in Brunei Darussalam. Methods This study employed a qualitative research approach conducted in 2020. Ten nurses were individually interviewed in semi-structured interviews. The data were analysed using thematic analysis. Results Three broad themes were identified, namely: (1) Emotional and informational support (2) Keeping the support going (3) Seeking help from others. The data provide insights into how nurses provide emotional and informational support to parents in the NICU setting. Challenges were encountered in providing support and were addressed through the involvement of the doctors and emotional support continuity by nursing colleagues. Conclusion This paper describes two critical supports given to the parents in the NICU setting and the challenges that underline these supports and proposes strategies used by nurses to help the parents. The balance needed between work demand and parental support is highlighted. In order to give more robust parental support, ongoing interactions with doctors and nursing colleagues are required.
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Affiliation(s)
- Syazwana Mohd. Sidek
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
| | | | - Yusrita Zolkefli
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
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Miller JJ, Serwint JR, Boss RD. Clinician-family relationships may impact neonatal intensive care: clinicians' perspectives. J Perinatol 2021; 41:2208-2216. [PMID: 34091604 PMCID: PMC8178652 DOI: 10.1038/s41372-021-01120-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Collaborative clinician-family relationships are necessary for the delivery of successful patient- and family-centered care (PFCC) in the NICU. Challenging clinician-family relationships may undermine such collaboration and the potential impacts on patient care are unknown. STUDY DESIGN Consistent caregivers were surveyed to describe their relationships and collaboration with families of infants hospitalized ≥ 28 days. Medical record review collected infant and family characteristics hypothesized to impact relationships. Mixed methods analysis was performed. RESULTS Clinicians completed 243 surveys representing 77 families. Clinicians reported low collaboration with families who were not at the bedside and/or did not speak English. Clinicians perceived most clinician-family relationships impact the infant's hospital course. Negative impacts included communication challenges, mistrust or frustration with the team and disruptions to patient care. CONCLUSION This study identifies features of clinician-family relationships that may negatively impact an infant's NICU stay. Targeting supports for these families is necessary to achieve effective PFCC.
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van den Hoogen A, Eijsermans R, Ockhuijsen HDL, Jenken F, Oude Maatman SM, Jongmans MJ, Verhage L, van der Net J, Latour JM. Parents' experiences of VOICE: A novel support programme in the NICU. Nurs Crit Care 2020; 26:201-208. [PMID: 33124117 PMCID: PMC8246858 DOI: 10.1111/nicc.12569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
Background Admission of an infant to a neonatal intensive care unit (NICU) is often a stressful experience for parents and can be associated with feelings of inadequacy to fulfil the desirable parental role. The values, opportunities, integration, control, and evaluation (VOICE) programme was developed to engage parents in care, to decrease stress, and to increase empowerment. Aim To explore the experiences of parents regarding involvement in the VOICE programme during admission of their infant to the NICU. Design The VOICE programme includes at least five personal structured meetings between parents, nurses, and other health care professionals throughout the pathway from birth, NICU, and follow up. A qualitative design was adopted using semi‐structured interviews. Interviews with 13 parents of 11 infants born at <27 weeks' gestational age were conducted: nine mothers and two couples of father and mother. Thematic analysis was deployed. Results The findings have been described in one overarching theme: “parental empowerment.” Parents felt strengthened and were empowered in the development of their role as primary caretaker by the VOICE programme. The parental empowerment theme emerged from four related interpretive themes that were derived: (a) involvement in care, (b) personalized information and communication, (c) transition to a parental role, and (d) emotional support. Conclusion The VOICE programme can be a structured approach used to implement family support in a NICU to empower parents to become a partner in the care of their infant and feel confident. Relevance to clinical practice This study encourages health care professionals to provide parental support through a structured intervention programme, which contributes to the empowerment of parents in the NICU and encouraged them to participate in care and decision‐making.
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Affiliation(s)
- Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rian Eijsermans
- Centre for Child Development Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henriette D L Ockhuijsen
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Floor Jenken
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sabine M Oude Maatman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marian J Jongmans
- Department of Education and Pedagogy, Utrecht University, Utrecht, The Netherlands
| | - Lianne Verhage
- Centre for Child Development Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Janjaap van der Net
- Centre for Child Development Exercise and Physical Literacy, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
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Santos ADS, Rodrigues LDN, Andrade KC, Santos MSND, Viana MCA, Chaves EMC. Construction and validation of an educational technology for mother-child bond in the neonatal intensive care unit. Rev Bras Enferm 2020; 73:e20190083. [DOI: 10.1590/0034-7167-2019-0083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/09/2019] [Indexed: 12/25/2022] Open
Abstract
ABSTRACT Objectives: to describe the process of construction and validation of an educational booklet to promote bonding between mothers and newborns in a Neonatal Intensive Care Unit. Methods: methodological study developed through data collection in the literature and with the target audience; construction of the booklet; qualification of the material through validation by judges (health and communication experts/designer) and assessment by the target audience (mothers of at-risk newborns). Data were analyzed descriptively. Results: booklet content was validated, obtaining an overall Content Validity Index of 0.92. Appearance was rated “Superior” with 80% percentage. Mothers performed an assessment with 100% agreement between the items. Conclusions: the booklet was validated in all domains assessed and can be used by mothers with children hospitalized in the Neonatal Unit.
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Rusalen F, Cavicchiolo ME, Lago P, Salvadori S, Benini F. Perinatal palliative care: a dedicated care pathway. BMJ Support Palliat Care 2019; 11:329-334. [PMID: 31324614 DOI: 10.1136/bmjspcare-2019-001849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Ensure access to perinatal palliative care (PnPC) to all eligible fetuses/infants/parents. DESIGN During 12 meetings in 2016, a multidisciplinary work-group (WG) performed literature review (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method was applied), including the ethical and legal references, in order to propose shared care pathway. SETTING Maternal-Infant Department of Padua's University Hospital. PATIENTS PnPC eligible population has been divided into three main groups: extremely preterm newborns (first group), newborns with prenatal/postnatal diagnosis of life-limiting and/or life-threatening disease and poor prognosis (second group) and newborns for whom a shift to PnPC is appropriate after the initial intensive care (third group). INTERVENTIONS The multidisciplinary WG has shared care pathway for these three groups and defined roles and responsibilities. MAIN OUTCOME MEASURES Prenatal and postnatal management, symptom's treatment, end-of-life care. RESULTS The best care setting and the best practice for PnPC have been defined, as well as the indications for family support, corpse management and postmortem counselling, as well suggestion for conflicts' mediation. CONCLUSIONS PnPC represents an emerging field within the paediatric palliative care and calls for the development of dedicated shared pathways, in order to ensure accessibility and quality of care to this specific population of newborns.
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Affiliation(s)
- Francesca Rusalen
- Woman's and Child's Department, Pediatric Pain and Palliative Care Service, University of Padua, Padova, Italy
| | - Maria Elena Cavicchiolo
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padova, Veneto, Italy
| | - Paola Lago
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padova, Veneto, Italy
| | - Sabrina Salvadori
- Woman's and Child's Department, Neonatal Intensive Care Unit, University of Padua, Padova, Veneto, Italy
| | - Franca Benini
- Woman's and Child's Department, Pediatric Pain and Palliative Care Service, University of Padua, Padova, Italy
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Ahlqvist-Björkroth S. Communication between healthcare professionals and parents is a key factor in involving parents in neonatal intensive care. Acta Paediatr 2018; 107:12-13. [PMID: 29068078 DOI: 10.1111/apa.14111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sari Ahlqvist-Björkroth
- Department of Psychology and Speech-Language Pathology; Faculty of Social Sciences; University of Turku; Turku Finland
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