Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study

Nordic survey showed wide variation in discharge practices for very preterm infants

AIM

We aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units.

METHODS

Medical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments.

RESULTS

We received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay.

CONCLUSION

Discharge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.

Diversity of Parent Emotions and Physician Responses During End-of-Life Conversations

BACKGROUND AND OBJECTIVES

To provide support to parents of critically ill children, it is important that physicians adequately respond to parents' emotions. In this study, we investigated emotions expressed by parents, physicians' responses to these expressions, and parents' emotions after the physicians' responses in conversations in which crucial decisions regarding the child's life-sustaining treatment had to be made.

METHODS

Forty-nine audio-recorded conversations between parents of 12 critically ill children and physicians working in the neonatal and pediatric intensive care units of 3 Dutch university medical centers were coded and analyzed by using a qualitative inductive approach.

RESULTS

Forty-six physicians and 22 parents of 12 children participated. In all 49 conversations, parents expressed a broad range of emotions, often intertwining, including anxiety, anger, devotion, grief, relief, hope, and guilt. Both implicit and explicit expressions of anxiety were prevalent. Physicians predominantly responded to parental emotions with cognition-oriented approaches, thereby limiting opportunities for parents. This appeared to intensify parents' expressions of anger and protectiveness, although their anxiety remained under the surface. In response to more tangible emotional expressions, for instance, grief when the child's death was imminent, physicians provided parents helpful support in both affect- and cognition-oriented ways.

CONCLUSIONS

Our findings illustrate the diversity of emotions expressed by parents during end-of-life conversations. Moreover, they offer insight into the more and less helpful ways in which physicians may respond to these emotions. More training is needed to help physicians in recognizing parents' emotions, particularly implicit expressions of anxiety, and to choose helpful combinations of responses.

Unmet Parental Mental Health Service Needs in Neonatal Follow-Up Programs: Parent and Service Provider Perspectives

Parental mental health services in neonatal follow-up programs (NFUPs) are lacking though needed. This study aimed to determine (1) the unmet mental health needs of parents and (2) the parent and provider perspectives on barriers and opportunities to increase mental health service access. Study 1: Parents in a central Canadian NFUP (N = 49) completed a mixed-method online survey (analyzed descriptively and by content analysis) to elucidate their mental health, related service use, barriers to service use, and service preferences. Study 2: Virtual focus groups with NFUP service providers (N = 5) were run to inform service improvements (analyzed by reflexive thematic analysis). The results show that parents endorsed a 2-4 times higher prevalence of clinically significant depression (59.2%), anxiety (51.0%), and PTSD (26.5%) than the general postpartum population. Most parents were not using mental health services (55.1%) due to resource insecurity among parents (e.g., time, cost) and the organization (e.g., staffing, training, referrals). Consolidating parents' and service providers' perspectives revealed four opportunities for service improvements: bridging services, mental health screening, online psychoeducation, and peer support. Findings clarify how a central Canadian NFUP can address parental mental health in ways that are desired by parents and feasible for service providers.

Perception and Educational Needs of Developmentally Supportive Care At-Home for Parents of Pre-Term Newborns

After discharge from neonatal intensive care units (NICUs), the parents of pre-term newborns have to provide developmentally supportive care (DSC) to their children; thus, educational support for parents is essential. This study aimed to explore the lived experiences of parents providing DSC to their children born as pre-term newborns at home and to investigate their parenting-related needs. This study included 10 mothers who were identified through theoretical sampling. In-depth interviews were conducted for data collection. For data analysis, grounded theory was used according to Corbin and Strauss's process. The mother's perception and educational needs were characterized by the phenomena "Coexistence of familiarity and unfamiliarity" and "Desire for expert support". Causal conditions include the "Incomplete education system" and "Gap between expectations and reality". Contextual conditions include the "Fear of developmental disability" and "Lack of good evaluation criteria". Intervening conditions include the "Difficulty in obtaining useful information". Action/interaction strategies include the "Active information seeking" and "Continuing to provide DSC". The consequences were the "Needs for professional educational support". The core category was the "Parenting routine that continues without awareness" and "Hope to establish parenting system supported by multidisciplinary experts". These results may provide the preliminary evidence base for suitable educational programs and for developing a social support system for parents.

Parent experiences of a remote patient monitoring program enabling early discharge from the neonatal intensive care unit with nasogastric tube feeding

BACKGROUND

This exploratory study examined parents' experiences with "Growing at Home" (G@H), a remote patient monitoring program for stable infants discharged from the Neonatal Intensive Care Unit (NICU) with continued need for nasogastric tube feeding.

METHODS

We used classical content analysis to identify and refine emergent themes from 13 semi-structured key informant interviews.

RESULTS

The primary emergent theme was the desire to return to normalcy, which was expressed as a primary motivator for participating in G@H. Parents reported G@H assisted them in transitioning from the NICU's highly medicalized setting to establishing a new normal with incorporation of their infant into their lives and families. Parental preparation is important, as some parents experienced challenges that indicate the program may not be suitable for all families.

CONCLUSIONS

Parental experiences offer insight into benefits and challenges of early discharge from the NICU and highlight opportunities to support families beginning in the NICU and as they transition home.

Risk factors for hospital readmission among infants with prolonged neonatal intensive care stays

OBJECTIVE

To assess risk factors associated with 30-day hospital readmission after a prolonged neonatal intensive care stay.

STUDY DESIGN

Retrospective analysis of 57,035 infants discharged >14 days from the NICU between 2013 and 2016. Primary outcome was 30-day, all-cause hospital readmission. Adjusted likelihood of readmission accounting for demographic and clinical characteristics, including chronic conditions was also estimated.

RESULTS

The 30-day readmission rate was 10.7%. Respiratory problems accounted for most (31.0%) readmissions. In multivariable analysis, shunted hydrocephalus [OR 2.2 (95%CI 1.8-2.7)], gastrostomy tube [OR 2.0 (95%CI 1.8-2.3)], tracheostomy [OR 1.5 (95%CI 1.2-1.8)], and use of public insurance [OR 1.3 (95%CI 1.2-1.4)] had the highest likelihood of readmission. Adjusted hospital readmission rates varied significantly (p < 0.001) across hospitals.

CONCLUSIONS

The likelihood of hospital readmission was highest for infants with indwelling medical devices and public insurance. These findings will inform future initiatives to reduce readmission for high risk infants with medical and social complexity.

Psychiatric Symptoms, Posttraumatic Growth, and Life Satisfaction Among Parents of Seriously Ill Infants: A Prospective Case-Controlled Study

We evaluated psychiatric symptoms, posttraumatic growth, and life satisfaction among the parents (n = 34) of newborns (n = 17) requiring therapeutic hypothermia or urgent surgery (interest group). Our control group included 60 parents of healthy newborns (n = 30). The first surveys were completed soon after diagnosis or delivery and the follow-up surveys 1 year later (participation rate 88% in the interest group and 70% in the control group). General stress was common in both groups but was more prevalent in the interest group as were depressive symptoms, too. Anxiety was more common in the interest group, although it showed a decrease from the baseline in both groups. Life satisfaction had an inverse correlation with all measures of psychiatric symptoms, and it was lower in the interest group in the early stage, but similar at 12 months due to the slight decline in the control group. Mothers in the interest group had more anxiety and depressive symptoms than fathers in the early stage. Mothers had more traumatic distress than fathers at both time points. Half of the parents experienced substantial posttraumatic growth at 12 months. In conclusion, the serious illness of an infant substantially affects the well-being of the parents in the early stages of illness and one year after the illness.

Exploring Adjustment and Parent-Infant Relations in Mothers of Premature Infants: Thematic Analysis Using a Multisensory Approach

Objective

The aim of the study was to explore mothers’ experiences of having an infant born prematurely (28–32 weeks gestation). In particular, the study aimed to explore the developing parent–infant relationship 12–30 months since birth and the developing parental identity during hospitalization and discharge.

Methods

Twelve mothers, aged between 22 and 43, participated in the semi-structured interviews. The mean age of infants was 19 months. Interviews comprised open-ended questions and visual stimuli consisting of photographs brought by participants, word selection, and card sorting techniques. Data were analyzed using Braun and Clarke’s thematic analysis (Braun & Clarke, 2013).

Results

Three themes arose from a clustering of 10 subthemes: (a) Emotional Impact, (b) Searching for Parent Identity, and (c) Moving Beyond Adversity. Participants expressed experiencing heightened emotional distress during the time of their infants’ birth and hospitalization and initially not feeling like parents. Their parental identity strengthened as they became more involved in the care of their infant and began to accept the situation. Participants described parenting their premature infants differently compared with parents of full-term infants, and described adjusting to this difference over time.

Conclusions

The findings highlight the emotional experience and adjustment of mothers of premature infants, from hospital and postdischarge. The need for psycho-educational interventions postdischarge and parent-partnered models during hospitalization is discussed. In addition, the study demonstrates the use of integrating visual stimuli in qualitative data collection procedures, to elicit further meaning and interaction from participants with the interview process.

A qualitative study of recorded telephone support calls with mothers of preterm infants: Expressing both positive and negative feelings

AIM

To describe the structure and content of telephone support calls between mothers of preterm infants and support team members after hospital discharge.

DESIGN

This is a qualitative study.

METHODS

Data consisted of 19 recordings of telephone calls that occurred between March 2013 and December 2015. The calls were made by support team members to mothers within two weeks of discharge from the neonatal unit. Analyses were performed using content analysis.

RESULTS

One category referred to what the support team members said that facilitated or did not facilitate the conversation. It was found that the support team members managed to have conversations that were tailored to the mother's current needs and conversations where the focus was on what the support team members thought was important. A second category referred to the topics the mothers talked about and that the mothers expressed both negative and positive feelings.

Knowledge of mothers and fathers' experiences of the early in-home care of premature infants supported by video consultations with a neonatal nurse

Aim

To gain in-depth knowledge of mothers’ and fathers’ experiences of the whole trajectory of an early in-home care programme supported by video consultations with a neonatal nurse.

Design

A qualitative interview study.

Methods

Data were collected through dyadic semi-structured interviews with mothers and fathers participating in virtual early in-home care programmes and were subjected to inductive content analysis.

Findings

The mothers and fathers were anxious about mastering the care of their premature infants at the start of the early in-home care phase but gradually developed confidence by the completion of the early in-home care programme. Being at home during the early in-home care programme gave the mothers and fathers an opportunity to test their decision making concerning the care of the infant while having the ability to obtain support from nurses when needed.

Conclusion

Our findings indicate that the trajectory of early in-home care programmes combined with video consultations contributes to parents’ increased confidence as mothers and fathers.

Trial registration

Clinical trial registration: REG-113-2014 and SJ-431.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00572-9.

Video consultation as nursing practice during early in-home care for premature infants and families viewed from the families' homes'

AIM

This study examined how communication between nurses and families in video consultations in a neonatal early in-home care program unfolded in the context of parents' homes.

DESIGN

A qualitative study based on focused observations supported by audio-recorded video consultations.

METHODS

The data were collected through nine video consultations between nurses and families in an early in-home care program. The transcribed material was examined using inductive content analysis.

FINDINGS

The analyses revealed the following themes: "Setting the scene," "Weight as a point of reference" and "The pros and cons of technology." The video consultations unfolded in a relaxed atmosphere, but also as one-way communication dominated by nurses, with the infant's weight as the focus. The study finds that a focus on training in video communication is needed to take full advantage of video consultations' potential.

Association between neonatal homecare for preterm infants and incidence of severe postpartum depression in mothers

BACKGROUND

Understanding the association between neonatal homecare and postpartum depression could contribute to the design of evidence-based interventions to prevent postpartum depression. We aimed to determine whether the change from inpatient stays in neonatal intensive care units to offering neonatal homecare was associated with a reduced incidence rate of severe postpartum depression among mothers who gave birth prematurely.

METHODS

We conducted a register-based population-wide study of all mothers who gave birth prematurely 1994-2017 to live-born infants and spent at least one night in the Neonatal Intensive Care Unit. We performed an interrupted time series analysis to investigate the incidence rate ratio of severe postpartum depression before and after the implementation of neonatal homecare. Neonatal homecare was implemented between 1994 and 2016.

RESULTS

The total population consisted of 46,456 mothers and the median age was 30 years and interquartile range of 27-34 years. Overall 4.5 % of the mothers were diagnosed with severe postpartum depression. Prior to neonatal homecare no change in the incidence of severe postpartum depression was found; (incidence rate ratio=1.01 [95 % confidence interval: 0.97-1.05] every half year, p=0.69). The implementation was associated with a level change with an incidence rate ratio reduction of 23 % (incidence rate ratio=0.77 [95 % confidence interval: 0.64-0.93], p=0.007).

LIMITATIONS

Limitations include potential underdiagnosis in early periods, lack of randomization, and different periods of implementation of neonatal homecare.

CONCLUSIONS

We found a possible association between the implementation of neonatal homecare and a 23 % reduced incidence rate of severe postpartum depression among mothers of preterm infants.

Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial

Introduction

Early in-home care is increasingly being used in Scandinavian countries for clinically stable premature infants. Due to challenges with travel and hospital resources, alternative ways to support parents during early in-home care are being considered. The aim of this study was to test whether the proportion of mothers exclusively breastfeeding, parental confidence and mother–infant interaction increased after early in-home care with premature infants, and to compare the outcomes of in-home care involving the use of video communication and a mobile application with those of in-home care involving in-hospital consultations.

Methods

This study was conducted in four neonatal wards offering premature infant in-home care in Denmark. Premature infants were randomised using 1:1 block randomisation. During early in-home care, families had planned consultations two to three times a week, during which they received support from nurses: the intervention group had video consultations, while the control group had in-hospital consultations.

Results

The proportion of exclusively breastfeeding mothers at discharge was 66.7% in the intervention group vs 66% in the control group and decreased to 49.4% vs 55%, respectively, 1 month after discharge. No significant improvements were found in the intervention group compared with the control group. In the intervention group, some video consultations were changed to telephone consultations due to problems with the video function, or to in-hospital consultations due to infants’ requirement for medical services. No significant differences in secondary outcomes were observed.

Discussion

The study showed similar breastfeeding proportions at discharge. No unfavourable effects of video consultation compared with in-hospital consultation were found, indicating that video consultation could be a viable option and an important supplement during early in-home care.

Trial registration

ClinicalTrials.gov ID: NCT02581800.

Supporting families on their journey towards a normal everyday life - facilitating partnership in an early discharge program for families with premature infants

PURPOSE

Several Danish neonatal intensive care units (NICUs) offer the possibility of an early discharge program (EDP) for families with premature infants, when the infant reaches the gestational age ≥ 34 weeks and a weight ≥ 1,500 g. The purpose of this study is to explore how the partnership with these families can be facilitated by the nurse based on the principles of the framework of family centered care (FCC).

DESIGN AND METHODS

The study was conducted as an ethnographic inquiry inspired by Spradley and based on participant observation of 12 contacts between nurse and family, one informal and three formal interviews with nurses in the EDP-unit of a Danish NICU.

RESULTS

This study illustrates how EDP-nurses facilitate a partnership with the families enrolled in EDP by using a range of complex strategies to adjust their care to the family's changing needs, while acknowledging the family's way of being. The partnership typically develops in three phases: "Settling in EDP," "Thriving in EDP," and "Leaving the EDP nest." The EDP-nurses have a clear understanding of whether a partnership is well functioning or challenging and they play a unique role by facilitating a partnership that supports the family on the journey towards a normal everyday life.

PRACTICE IMPLICATIONS

The knowledge unraveled in this study may prove helpful for training future EDP-nurses in the neonatal field of FCC, when improving the quality of an existing EDP or developing a new EDP based on the principles of FCC.

Facilities for presence and provision of support to parents and significant others in neonatal units

AIM

To describe parental facilities for staying in neonatal units, visiting policies and access to emotional support during hospitalisation.

METHODS

A cross-sectional design was used in which a survey was presented to all neonatal units in Sweden; 34 out of 38 units participated (89%).

RESULTS

The findings showed that in 50% of the units, parents could stay 24/7 for the infant's entire hospital stay. In 32% of the units, siblings could stay the night with their parents. Units had policies on restrictions for visits by siblings (80%), grandparents (59%), friends and relatives (71%). All units offered counselling to parents, and some units offered peer-to-peer groups (24%), diaries (35%), relaxation techniques (6%) or Internet parental forums (6%). All units enabled parents to be at home with their infant and to visit the unit for check-ups (35%) or to have staff visits at home (65%).

CONCLUSION

Facilities for parents to stay with their infant during hospitalisation and to have significant others visit are good, but there is room for improvement. During the transitional phase to being at home, parents are facilitated in being at home before the infant is discharged and are supported by the unit, which must be considered beneficial for parents.

Integrative Review of Parents' Perspectives of the Nursing Role in Neonatal Family-Centered Care

OBJECTIVES

To identify the perceptions of mothers and fathers of newborns admitted to NICUs regarding the role of neonatal nurses in the provision of family-centered care and how neonatal nurses were able to interpret and meet parents' needs.

DATA SOURCES

We conducted literature searches in the CINAHL, MEDLINE, Embase, PsycINFO, Dissertations and Theses Global, and Maternity and Infant Care databases.

STUDY SELECTION

Articles on qualitative and quantitative studies were selected if they were published in English from 2009 to 2018; they were set in countries with similar health care resources in Australasia, Canada, Europe, Scandinavia, the United Kingdom, and the United States; and the data were collected from parents. We identified 31 studies for analysis.

DATA EXTRACTION

We used the thematic analysis method of Braun and Clarke to extract data elements that were grouped and coded into themes and subthemes.

DATA SYNTHESIS

Through ongoing iterative analysis, we generated six themes from the 18 subthemes that in combination presented the experiences of parents in the context of family-centered care provided by neonatal nurses: Process of Becoming a Parent, Neonatal NursesSupportingParents, Infant Safety, Communication, Barriers to Parenting, and Parenting Inhibited by Neonatal Nurses.

CONCLUSION

The six themes reflected the contribution made by neonatal nurses to family-centered care in the NICU. The parents' perspectives of nurses were mostly positive, but some negative aspects attributed to nurses identified in earlier studies persisted.

Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care

Introduction

Neonatal homecare (NH) can be used to provide parents the opportunity of bringing cardiopulmonary-stable preterm infants home for tube feeding and the establishment of breastfeeding supported by neonatal nurses visiting the home. However, home visits can be challenging for hospitals covering large regions, and, therefore, regular neonatal hospital care has remained the first choice in Denmark. As an alternative to home visits, telehealth may be used to deliver NH. Thus, neonatal tele-homecare (NTH) was developed. Positive infant outcomes and the optimization of family-centred care have been described, but the costs of telehealth in the context of NH remain unknown. This study aims to assess the costs of NTH compared to regular neonatal hospital care, from the health service perspective.

Methods

The cost analysis was based on an observational study of NTH in Denmark (run from November 2015 to December 2016) and followed the Consolidated Health Economic Evaluation Reporting Standards. The intervention group were the families of preterm infants receiving NTH ( n = 96). The control group comprised a historic cohort of families with preterm infants, receiving standard care in the neonatal intensive care unit (NICU) ( n = 278). NTH infants and the historical group were categorized according to gestational age at birth at/under and over 32 weeks. The outcomes were NTH resource utilization, in-NICU hospital bed days, re-admissions and total costs on average per infant. The time horizon was from birth to discharge.

Results

The costs of NTH resource utilization were, on average, €695 per infant, and the total costs per infant, on average, were €12,200 and €4200 for infants at/under and over 32 weeks, respectively. The corresponding costs of the control group were €14,300 and €4400. The difference in total costs showed statistical significance for the group of infants under 32 weeks ( p < 0.001).

Discussion

The cost analysis showed that NTH was less costly compared to regular hospital care, especially for infants born with gestational age at/under 32 weeks. NTH is an appropriate model of care for preterm infants and their families, is clinically effective and less expensive than similar services delivered in the hospital.

Parent Empowerment in Pediatric Healthcare Settings: A Systematic Review of Observational Studies

BACKGROUND

Parent empowerment is often an expressed goal in clinical pediatrics and in pediatric research, but the antecedents and consequences of parent empowerment are not well established.

OBJECTIVE

The objective of this systematic review was to synthesize potential antecedents and consequences of parent empowerment in healthcare settings.

ELIGIBILITY CRITERIA

The inclusion criteria were (1) studies with results about parent empowerment in the context of children's healthcare or healthcare providers; and (2) qualitative studies, observational studies, and systematic reviews of such studies.

INFORMATION SOURCES

We searched the databases of PubMed, Web of Science, and Google Scholar (2006-2017) and reference lists.

INCLUDED STUDIES

Forty-four articles met the inclusion criteria.

SYNTHESIS OF RESULTS

We identified six themes within consequences of empowerment: increased parent involvement in daily care, improved symptom management, enhanced informational needs and tools, increased involvement in care decisions, increased advocacy for child, and engagement in empowering others. Six themes summarizing antecedents of empowerment also emerged: parent-provider relationships, processes of care, experiences with medical care, experiences with community services, receiving informational/emotional support, and building personal capacity and narrative. We synthesized these findings into a conceptual model to guide future intervention development and evaluation.

STRENGTHS AND LIMITATIONS OF EVIDENCE

Non-English articles were excluded.

INTERPRETATION

Parent empowerment may enhance parent involvement in daily care and care decisions, improve child symptoms, enhance informational needs and skills, and increase advocacy and altruistic behaviors. Parent empowerment may be promoted by the parent-provider relationship and care processes, finding the right fit of medical and community services, and attention to the cognitive and emotional needs of parents.

CLINICAL REGISTRATION NO

PROSPERO 2017:CRD42017059478.

Experiences of Mothers of Extremely Preterm Infants after Hospital Discharge

PURPOSE

The purpose of this study was to describe and understand the experiences of mothers of extremely preterm infants during the first twelve months at home following discharge from a neonatal intensive care unit.

DESIGN AND METHODS

A qualitative, interpretative approach using Gadamer's philosophical hermeneutics was carried out. One focus group and fifteen in-depth, semi-structured interviews were conducted twelve months after hospital discharge. Responses were recorded, transcribed and analyzed using computer-assisted qualitative data analysis.

RESULTS

The study´s participants were twenty women. The following themes emerged from the data analysis: 1) 'The journey home: the discharge process', which included the sub-themes 'escaping the hospital environment: between desire and fear' and 'preparing parents for hospital discharge: practice and formal support'; and 2) 'The difficulty of living with an extremely preterm infant', including the sub-themes 'the challenge of an unexpected form of childcare', 'overprotection of and bond with a child with special needs' and 'disturbance in the social/familiar setting: when a mother becomes a nurse'.

CONCLUSIONS

The process of hospital discharge and the first months at home are difficult. The birth and care of an extremely preterm infant affect the mothers' quality of life as well as their family and social life. Practice and early discharge programmes can make the discharge process easier.

PRACTICE IMPLICATIONS

The knowledge and understanding of the experience of mothers of extremely preterm infants in the first months at home after hospital discharge could help healthcare professionals to develop educational strategies and counselling interventions in accordance with the mothers' needs.

Understanding parents' emotional experiences for neonatal education: A narrative, interpretive approach

AIMS AND OBJECTIVES

To explore the emotional experiences of parents who have had premature babies to inform and educate neonatal nurses and health professionals in this field.

BACKGROUND

Parents find the neonatal unit a daunting and unfamiliar place leading to anxiety, uncertainty and fear about the future of their baby. Parents have significant emotional needs in relation to assisting them to cope with their neonatal experience. In line with a family-centred approach to neonatal education, it is essential to teach health professionals about the emotional impact of neonatal care based on an appreciation of the parent experience.

DESIGN

A narrative-based, interpretive approach was undertaken in line with constructivist learning theory.

METHODS

Twenty narrative interviews took place, with a total of 23 parents of premature babies. Following core story creation to create coherent stories from the raw transcripts, thematic analysis of the narrative constructs using the principles of Braun and Clarke's, International Journal of Qualitative Studies on Health and Well-Being, 2014, 9, 1, framework was undertaken. The study methods were compliant with the consolidated criteria for reporting qualitative research (COREQ).

FINDINGS

Thematic analysis revealed key themes relating to the following: parents' emotions through the whole neonatal experience, feelings towards the baby, the environment, the staff and the transitions through the different phases of neonatal care. Both negative and positive experiences were reported.

CONCLUSION

Understanding the emotional experience from the parent's perspective, following birth of their premature baby, informs empathic, family-centred teaching and learning within the neonatal education arena.

RELEVANCE TO CLINICAL PRACTICE

Students and health professionals alike can learn what is important in the delivery of care that addresses the emotional needs of parents and families. Educators can use narratives and key messages from parents, both negative and positive, to teach family-centred principles to nurses and health professionals as a core component of a narrative curricula and potentially to enhance empathy.

Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care

OBJECTIVE

Neonatal tele-homecare implies that parents of clinically stable preterm infants can manage tube feeding and establishment of oral feeding in the home. Support is provided from the neonatal intensive care unit (NICU) through a telehealth service. The aim of this study was to compare growth and breastfeeding rates amongst infants being managed in the NICU (conventional care) and by neonatal tele-homecare.

METHODS

A total of 96 preterm infants with tube feeding requirements participated in the observational study of neonatal tele-homecare. Retrospective data in 278 preterm infants receiving standard care in the same neonatal intensive care unit prior to implementation of neonatal tele-homecare were used for comparison. Rates of breastfeeding and growth were monitored during neonatal tele-homecare. Infant weights were converted to standard deviation weight-for-age z-scores based on a reference.

RESULTS

There was no significant difference in rates of exclusive breastfeeding between the neonatal tele-homecare infants and the controls. Among the very preterm singleton infants more neonatal tele-homecare infants were exclusively breastfed at discharge compared to the controls (p = 0.04). There was no significant difference in median weight for age z-scores at discharge.

CONCLUSION

This study demonstrates that neonatal tele-homecare may be an appropriate model of care for the management of preterm infants outside of the hospital environment; with the added benefit of higher rates of breastfeeding at time of discharge for very preterm infants.

Understanding the Effects of Neonatal Early Discharge on Parents: A Literature Review

A neonatal early discharge (NED) program is a supported process where preterm infants leave hospital before they have established full sucking feeds and are gavage fed by their parents while they transition to breast- and/or bottle-feeds. While there is some evidence in the literature describing the outcomes of this process for preterm infants, there is even more limited evidence of the effects and outcomes of these NED programs on parents. The objective of this study was to summarize and critically appraise the literature regarding the effects of NED on parents. A literature search was conducted for English language publications since 2007 using MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, and Google Scholar. A total of 20 primary articles met the inclusion criteria for the review. An integrative thematic synthesis identified 4 themes: establishing parenting skills/confidence; bonding with the newborn; psychological distress; and the need for support and resources. Findings suggest that parents have various concerns regarding discharge from the neonatal unit and therefore support from healthcare professionals and family plays a crucial role during the experience. There were also various external factors such as socioeconomic status and cultural differences that impact on parents differently, and it is therefore challenging to draw definite conclusions. This warrants further research in the area.

Stress From the Neonatal Intensive Care Unit to Home: Paternal and Maternal Cortisol Rhythms in Parents of Premature Infants

To examine cortisol diurnal rhythms over the transition from the critical care setting to home for fathers and mothers of very low-birth-weight infants, including how cortisol is associated with psychosocial stress and parenting sense of competence. This cohort study in a level III neonatal intensive care unit and the general community had 86 parents complete salivary collection and self-reported psychosocial measures. Salivary samples were collected 3 times a day on the day before discharge, and on 3 subsequent days at home. Self-report measures included the Perceived Stress Scale and the Parenting Sense of Competence Scale, which measure parenting satisfaction. Fathers showed increased physiologic stress over the transition home, reflected by flattening of slopes, lower wakeup, and higher bedtime cortisol. Mothers reporting increases in perceived stress over the transition home had higher bedtime cortisol, suggesting a link between higher perceived stress and higher physiologic stress. Results were significant after controlling for breastfeeding, insurance status, and gestational age. This study examined a physiologic marker of stress in parents with very low-birth-weight infants, finding sex disparities in diurnal cortisol patterns during the transition from neonatal intensive care unit to the community. Fathers may be especially susceptible to stressors during this transition.

Healthcare Professionals' Views on Parental Participation in the Neonatal Intensive Care Units

PURPOSE

To examine the associations between age, gender, and profession in relation to the perceived importance of parental participation in Neonatal Intensive Care Units.

DESIGN AND METHODS

A quantitative cross-sectional design was used. Participants were recruited consecutively from all 40 existing NICU units in Sweden. A total of 443 healthcare professionals (372 nurses and 71 physicians) participated in the study. Participants completed the Swedish version of the Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N) questionnaire. Data were analyzed using multiple regression analyses.

RESULTS

The findings indicated that profession and age, but not gender, had an overall perceived importance on how nurses and physicians rated specific aspects of parental participation in NICUs.

CONCLUSIONS

Being a nurse, compared to a physician, was associated with an increase in overall perceived importance of parental participation in NICUs. These differences may affect and may be crucial for how parents take a part in the care of their infant and also for how they adapt to the parental role.

PRACTICE IMPLICATIONS

Nurses and physicians require education and training that support parental participation based on age and their different roles, rather than simply conveying information about the technical medical aspects of NICU care. For a sustainable outcome all team members should be invited to discuss cases from their perspectives.

Parent perspectives of neonatal tele-homecare: A qualitative study

INTRODUCTION

Neonatal homecare for preterm infants is a method of supporting families and monitoring infant growth in the home setting. Telehealth may be used to deliver specialist neonatal care remotely, using online communication methods. This study explored parental experiences with neonatal tele-homecare (NTH).

METHODS

Semi-structured interviews were conducted with 49 parents whose preterm infants had received NTH from a neonatal intensive care unit (NICU) in Denmark. Interview transcripts were analysed using Malterud's systematic text condensation.

RESULTS

Parents experienced NTH as a personalised method for linking to specialist staff in the NICU. NTH promoted the parent's role as the primary care provider, further strengthening the parent-infant relationship.

DISCUSSION

From the perspective of parents with preterm infants requiring specialist care, NTH is a useful method of supporting families in the home. Telehealth provides effective communication links with NICU specialists and encourages family-centred care.

PARENTALIDADE DE PAIS DE RECÉM-NASCIDOS HOSPITALIZADOS POR SÍFILIS CONGÊNITA À LUZ DA TEORIA DAS TRANSIÇÕES

RESUMO Objetivo: compreender a vivência de transições na parentalidade de pais que tiveram um filho recém-nascido hospitalizado por sífilis congênita. Método: estudo qualitativo realizado com treze mães e quatro pais de recém-nascidos hospitalizados por sífilis congênita, no alojamento conjunto e unidade neonatal de um hospital universitário do Rio de Janeiro, entre setembro de 2014 e maio de 2015, utilizando o método Narrativa de Vida e a análise temática. Resultados: no tema “descobrir-se mãe/pai de um filho recém-nascido com sífilis congênita e o impacto do diagnóstico na construção da parentalidade” verificou-se que os pais tinham a consciencialização de que o filho poderia ser hospitalizado por sífilis congênita, emergindo a culpa pela transmissão vertical da sífilis e o medo de sofrer estigmas. No tema “vivência de transições na parentalidade em face da hospitalização do filho com sífilis congênita”, identificou-se que a parentalidade foi uma experiência considerada boa, feliz e de superação, todavia a hospitalização do filho desencadeou sofrimento e estresse. O apoio dos familiares e os cuidados da enfermagem foram aspectos facilitadores da transição na parentalidade, que proporcionaram aos pais novos conhecimentos e reformulação de suas identidades. Conclusão: constatou-se que os enfermeiros têm um papel essencial no cuidar de pais que vivenciam transições na parentalidade devido à hospitalização do filho por sífilis congênita, fortalecendo o vínculo mãe-pai-recém-nascido, empoderando os pais para o cuidado parental e para prevenir a reinfecção da sífilis.

Participatory design methods for the development of a clinical telehealth service for neonatal homecare

Objectives:

Neonatal homecare delivered during home visits by neonatal nurses is a common method for supporting families of preterm infants following discharge. Telehealth has been introduced for the provision of neonatal homecare, resulting in positive feedback from parents of preterm infants. While the benefits are beginning to be realised, widespread uptake of telehealth has been limited due to a range of logistical challenges. Understanding user requirements is important when planning and developing a clinical telehealth service. We therefore used participatory design to develop a clinical telehealth service for neonatal homecare.

Methods:

The study adopted a participatory design approach to engage users in the development and design of a new telehealth service. Participatory design embraces qualitative research methods. Creative and technical workshops were conducted as part of the study. Tests of the telehealth service were conducted in the neonatal unit. Participants in this study were former and current parents of preterm infants eligible for neonatal homecare, and clinical staff (medical and nursing) from the neonatal unit. Preterm infants accompanied their parents.

Results:

Based on the results obtained during the workshops and subsequent testing, we developed an application (app), which was integrated into the medical record at the neonatal unit. The app was used to initiate videoconferences and chat messages between the family at home and the neonatal unit, and to share information regarding infant growth and well-being.

Conclusion:

Results obtained from the workshops and testing demonstrated the importance of involving users when developing new telehealth applications. The workshops helped identify the challenges associated with delivery of the service, and helped instruct the design of a new telehealth service for neonatal homecare based on the needs of parents and clinical staff.

DEVIR CUIDADORA DE PREMATURO E OS DISPOSITIVOS CONSTITUINTES DA CONTINUIDADE DA ATENÇÃO PÓS-ALTA

RESUMO Objetivo: analisar os dispositivos constituintes da continuidade da atenção ao prematuro e como as cuidadoras vivenciam a atenção pós-alta ao prematuro extremo. Método: estudo qualitativo, desenvolvido de junho a outubro de 2013, com coleta de dados utilizando a história oral temática, com dez cuidadoras, e construção de narrativas que foram analisadas, baseadas no referencial de Deleuze e Guatarri. Resultados: o devir cuidadora de prematuro é uma trajetória de produções de subjetividades, na qual se identificam encontros, inseguranças, fé, evasão do trabalho e adaptação. Os resultados apontam que a atenção ao prematuro deve incorporar práticas cuidadoras capazes de potencializar a produção da vida, o que implica uma discursividade não orientada dos profissionais, exclusivamente por uma ausência de doença, mas que considera os projetos existenciais das cuidadoras. Conclusão: a continuidade da atenção acontece com diferentes arranjos assistenciais. Contudo, o protagonismo da cuidadora mostrou-se capaz de disparar agenciamentos e é um dispositivo potente para a continuidade da atenção.

Multicentre randomised study of the effect and experience of an early inhome programme (PreHomeCare) for preterm infants using video consultation and smartphone applications compared with inhospital consultations: protocol of the PreHomeCare study

INTRODUCTION

Although premature infants and their parents are discharged earlier to inhomecare programmes, how to optimally support parents during this transition remains unknown. The aim of this study is to compare the effects of early inhomecare (PreHomeCare) including video consultations and mobile applications with those of inhospital consultations regarding breast feeding, parental confidence and parent-infant interactions.

METHODS AND ANALYSIS

A randomised controlled intervention study will be conducted in four neonatal departments offering PreHomeCare (ie, premature infant inhomecare) in Denmark. Parents of hospitalised premature infants who fulfil the inclusion criteria for PreHomeCare will be randomised during hospitalisation to either the intervention (n=80) or control group (n=80) using 1:1 block randomisation. During PreHomeCare, the intervention group will receive a smartphone application with a video system and an infant scale, and the control group will receive usual care (ie, hospital consultations). Additionally, both groups will have planned nurse consultations two to three times a week: the intervention group through video consultations and the control group through inhospital consultations. Data collection will occur at inclusion/baseline, at the end of PreHomeCare and 1 month after discharge using questionnaires and hospital records. The primary outcome is the proportion of exclusively breastfed infants 1 month after discharge/end of PreHomeCare, the secondary outcomes are parent-infant interactions measured by the Mother and baby interaction scale and family confidence in caring for infants measured by the Karitane Parenting Confidence Scale. The process evaluation will consist of two qualitative studies: a field study and an interview study. Data collection will initially involve field observations of three scheduled video consultations with six families from the intervention group. These families will also be interviewed 1 month after PreHomeCare has ended.

ETHICS AND DISSEMINATION

The project has been approved by the Regional Ethics Committee and the Danish Data Protection Agency.

TRIAL REGISTRATION NUMBER

NCT02581800.

Factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit: a qualitative study

AIM

The aim of this study was to explore factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit.

BACKGROUND

Transition to motherhood often causes significant issues in terms of adaptation to the role of motherhood. The main factors leading to parental stress, especially in the neonatal intensive care unit, have shown that the greatest source of stress is the loss of women's role as mothers.

DESIGN

It was a qualitative study with content analysis approach.

METHODS

Semi-structured in-depth interviews were used for data collection. Interviews were conducted with 17 mothers of preterm infants (under 36 weeks) who had been hospitalized for at least one week in the neonatal intensive care unit. Purposive sampling with maximum diversity was used to recruit mothers in Kermanshah province (west of Iran). Data was collected during 2013-2014. Interviews were recorded and transcribed verbatim. Data were analysed using conventional content analysis.

FINDINGS

Explanation of the mothers' perspective towards factors affecting adaptation to the role of motherhood led to two main categories of individual factors (emotional distress, self-efficacy, interaction and alienation) and social factors (support, prejudice).

CONCLUSION

Adaptation to the role of motherhood can be promoted through supporting mothers of preterm infants, empowering them and increasing their self-efficacy, to eliminate negative factors and emotions.

Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design

Background

For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored.

Objective

To identify parental needs when wanting to provide neonatal home care supported by telemedicine.

Methods

The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively.

Results

Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a “bell cord” to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition.

Conclusions

Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine.

A preterm lifeline: Early discharge programme based on family-centred care

PURPOSE

To present an Early Discharge Programme model for preterm infants based on family-centred care, and to describe its impact on the infants and families.

DESIGN AND METHODS

Methods included longitudinal growth assessments of 218 premature infants and a qualitative synthesis of two focus group interviews with 15 parents.

RESULTS

The main finding was the experience of "parents in control with lifeline to neonatal intensive care unit" based on five syntheses.

PRACTICE IMPLICATIONS

An early discharge programme based on family-centred care has been implemented and integrated into our neonatal intensive care unit that could be implemented by other hospitals.

Post-discharge symptoms following fast-track colonic cancer surgery: a phenomenological hermeneutic study

OBJECTIVE

To obtain knowledge of patients' experiences of postoperative symptoms during the initial two weeks following fast-track colonic cancer surgery.

METHOD

Semi-structured in-depth interviews with seven colonic cancer patients two weeks post hospital discharge. Analysis was performed using a phenomenological hermeneutical approach.

RESULTS

During the first two weeks after discharge the patients experienced unfamiliar symptoms that affected their everyday lives. Despite distressing symptoms, they applied a "wait-and-see" strategy, and only reacted when symptoms became intolerable. The patients failed to report their unfamiliar symptoms during hospital nurse follow-up telephone call. While waiting for the final histology patients suffered loss of sleep and chaotic thinking, and experienced ambiguity of hoping for the best and expecting the worst.

CONCLUSION

Although fast-track surgery programmes lead to shorter hospitalisation and improved physical performance, post-colonic surgery patients experience various symptoms after discharge. Healthcare professionals need to address symptoms that might have immediate and long-term consequences on patients' everyday life. Follow-up studies are encouraged to explore the patient perspective to identify the needs of individual patients after hospital discharge.