Enhancing person-centred communication in NICU: a comparative thematic analysis

Strategies to improve interpersonal communication along the continuum of maternal and newborn care: A scoping review and narrative synthesis

Effective interpersonal communication is essential to provide respectful and quality maternal and newborn care (MNC). This scoping review mapped, categorized, and analysed strategies implemented to improve interpersonal communication within MNC up to 42 days after birth. Twelve bibliographic databases were searched for quantitative and qualitative studies that evaluated interventions to improve interpersonal communication between health workers and women, their partners or newborns' families. Eligible studies were published in English between January 1st 2000 and July 1st 2020. In addition, communication studies in reproduction related domains in sexual and reproductive health and rights were included. Data extracted included study design, study population, and details of the communication intervention. Communication strategies were analysed and categorized based on existing conceptualizations of communication goals and interpersonal communication processes. A total of 138 articles were included. These reported on 128 strategies to improve interpersonal communication and were conducted in Europe and North America (n = 85), Sub-Saharan Africa (n = 12), Australia and New Zealand (n = 10), Central and Southern Asia (n = 9), Latin America and the Caribbean (n = 6), Northern Africa and Western Asia (n = 4) and Eastern and South-Eastern Asia (n = 2). Strategies addressed three communication goals: facilitating exchange of information (n = 97), creating a good interpersonal relationship (n = 57), and/or enabling the inclusion of women and partners in the decision making (n = 41). Two main approaches to strengthen interpersonal communication were identified: training health workers (n = 74) and using tools (n = 63). Narrative analysis of these interventions led to an update of an existing communication framework. The categorization of different forms of interpersonal communication strategy can inform the design, implementation and evaluation of communication improvement strategies. While most interventions focused on information provision, incorporating other communication goals (building a relationship, inclusion of women and partners in decision making) could further improve the experience of care for women, their partners and the families of newborns.

Impact of the person-centred intervention guided self-determination across healthcare settings-An integrated review

AIM

To review the evidence of the existing literature on the impact of guided self-determination across methodologies in different healthcare settings.

METHODS

An integrated five-stage review.

RESULTS

Forty-five eligible papers were included. Guided self-determination was applied in full- or small-scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention-deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self-determination reduces disease-related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets-appreciated but challenging tool to prompt insights and person-specific knowledge, (4) New person-specific knowledge enables person-centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice-a decision from above, (2) A new role-unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person-centred approach.

CONCLUSION

Overall, guided self-determination proved to have a great impact on patient important outcomes and was useful and well-accepted by the majority of patients and healthcare professionals. Albeit guided self-determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self-determination to enhance adoption and sustainability in clinical practice.

Home Immunization with Palivizumab-A Randomized Pilot Study Describing Safety Aspects and Parents' Preferences

Among prematurely born infants and newborns with chronic conditions, a respiratory syncytial virus (RSV) infection may cause (re-)admission and later respiratory complications. Therapeutic protection is possible with monthly injections of a specific monoclonal antibody, palivizumab, during RSV season. Standard care is giving up to five injections in clinic-based settings. Immunization at home could be an alternative to standard care for vulnerable infants to reduce the number of revisits and associated risk of RSV infection. The aim of this randomized pilot trial was to evaluate safety aspects and explore parents' preferences of home versus hospital immunization with palivizumab during one RSV season. Immediate adverse events (AEs) were observed and registered by a pediatric specialist nurse. Late-onset AEs were reported by parents. Parents' perceptions were collected through a questionnaire and analyzed using content analysis. The study population consisted of 43 infants in 38 families. No immediate AEs occurred. Three late-onset AEs were reported in two infants in the intervention group. Three categories emerged in the content analysis: (1) protect and watch over the infant, (2) optimal health and well-being for the whole family, and (3) avoid suffering for the infant. The study results show that home immunization with palivizumab is feasible if safety aspects are considered and that parental involvement in the choice of place for immunization after a neonatal intensive care experience can be important.

Improving Communication with Parents in the NICU during the COVID-19 Pandemic, a Study and Review of the Literature

BACKGROUND

Communication with parents of sick premature and term infants in the NICU is complicated and challenging. Multiple efforts have been made to improve it, including the introduction of new electronic-based measures.

AIM

We aimed to study the influence of implementation of a new communication technology on parents' satisfaction with care in the NICU during the COVID-19 pandemic.

METHODS

Infants were video-recorded in their incubators or cots without being disturbed. These short films, with voice updates on the infant's condition, were sent on a daily basis to their parents via a WhatsApp application.

RESULTS

Parents who chose to join the new communication project (study group) were older, and their infants were more premature. Parents were satisfied with this new communication modality. Satisfaction scores in both study and control groups were high, but not significantly different.

CONCLUSIONS

Although the implementation of the new communication project was successful, we could not demonstrate significant improvement in satisfaction scores that were high in study and control groups, reflecting baseline high satisfaction. Further studies are needed employing other assessment tools in order to evaluate other aspects of parents' satisfaction with new modalities of communication introduced to the NICU, and their effects on parents' bonding with their infants.

Family-centred care change during COVID-19

BACKGROUND

Family-centred care (FCC) is an approach to promote family and health care provider partnership. This has been incorporated into neonatal intensive care units (NICUs) worldwide. However, FCC in low resource health settings, such as Thailand, is challenging and further impacted by coronavirus disease 2019 (COVID-19).

AIMS

To evaluate FCC innovations to improve respect, collaboration and support in a Thai NICU.

STUDY DESIGN

A quasi-experimental study was conducted in an NICU in southern Thailand. Pre-implementation was prior to COVID-19, and parental and staff perceptions of FCC were measured via Perceptions of Family Centred Care-Parent (PFCC-P) and -Staff (PFCC-S) survey. The FCC innovations were developed by stakeholders based on the COVID-19 restrictions, pre-survey results, parents' and clinicians' interviews and integrative review, then implemented via a flowchart. Post-implementation evaluation was via repeated surveys. Comparisons were made pre-and post-implementation, with Mann-Whitney U-test statistics for parents and Wilcoxon's Rank Sum for staff.

RESULTS

A total of 185 (85 pre; 100 post) parents and 20 (pre and post; paired group) health care professionals participated. Because of COVID-19, many planned interventions were unfeasible, however, other innovations achieved (e.g., structured telephone updates, information booklet revision). There was an increase in parents' perception of respect ([median] 2.50-3.50), collaboration (2.33-3.33) and support (2.60-3.60) domains and overall (2.50-3.43; p < .001; 95% CI: 2.93-3.11). Interdisciplinary professionals' perception of FCC did not significantly change pre-and post-implementation/COVID-19 pandemic for respect (3.00-2.92), collaboration (3.22-3.33), support (3.20-3.20) and overall (3.15-3.20; 95% CI: 3.10-3.25).

CONCLUSION

Despite the challenges of COVID-19 restricting NICU access, the provision of FCC was maintained and even improved.

RELEVANCE TO CLINICAL PRACTICE

Further research is necessary to develop FCC practice innovations associated with communication, across diverse health care systems and resources.

Applying communication skills in the provision of family-centred care: a reflective account

Providing family-centred care is fundamental to children's nursing and requires the development of therapeutic relationships with parents, notably parents of children who are acutely unwell. Gaining parents' trust and engaging them in their child's care involves the use of optimal verbal and non-verbal communication techniques. Children's nursing students need to develop skills and confidence in using these techniques. This article is a reflective account by a children's nursing student on how communication concepts and techniques learned at university can be applied to practice. The student had undertaken a theoretical and practical communication module during which she had been introduced to techniques such as active listening and the SURETY model shortly before starting a practice placement in an acute care setting. Here she uses the 'What?, So what?, Now what?' framework to reflect on and learn from her placement. The article demonstrates how complementing theoretical knowledge with experiential learning, and combining this with reflection on action, can enhance students' confidence to deliver family-centred care.

Effects of parent-provider communication during infant hospitalization in the NICU on parents: A systematic review with meta-synthesis and narrative synthesis

OBJECTIVE

To synthesize and analyse the literature on the effects of parent-provider communication during infant hospitalization in the neonatal (intensive) care unit (NICU) on parent-related outcomes.

METHODS

Systematic review with meta-synthesis and narrative synthesis. Databases (PubMed, PsycINFO, Cochrane Library, CINAHL, Web of Science, Scopus) were searched in October/November 2019. Studies reporting, observing, or measuring parent-related effects of parent-provider communication in the NICU were included. Study quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs. Qualitative studies were meta-synthesized using deductive and inductive thematic analysis. Quantitative studies were analysed using narrative synthesis.

RESULTS

5586 records were identified; 77 were included, reporting on N = 6960 parents, N = 693 providers, and N = 300 NICUs. Analyses revealed five main (positive and negative) effects of parent-provider interaction on parents' (1) coping, (2) knowledge, (3) participation, (4) parenting, and (5) satisfaction. Communication interventions appeared impactful, particularly in reducing parental stress and anxiety. Findings confirm and refine the NICU Communication Framework.

CONCLUSIONS

Parent-provider communication is a crucial determinant for parental well-being and satisfaction with care, during and following infant hospitalization in the NICU. R. Practice Implications: Providers should particularly consider the impact on parents of their day-to-day interaction - the most occurring form of communication of all.

The functions of adequate communication in the neonatal care unit: A systematic review and meta-synthesis of qualitative research

OBJECTIVE

To assess the main functions of parent-provider communication in the neonatal (intensive) care unit (NICU) and determine what adequate communication entails according to both parents and health professionals.

METHODS

A systematic review and meta-synthesis of qualitative research. PubMed, Ebsco/PsycINFO, Wiley/Cochrane Library, Ebsco/CINAHL, Clarivate Analytics/Web of Science Core Collection, and Elsevier/Scopus were searched in October-November 2019 for records on interpersonal communication between parents and providers in neonatal care. Title/abstract screening and full-text analysis were conducted by multiple, independent coders. Data from included articles were analyzed using deductive and inductive thematic analysis.

RESULTS

43 records were included. Thematic analysis of data resulted in the development of the NICU Communication Framework, including four functions of communication (1. building/maintaining relationships, 2. exchanging information, 3. (sharing) decision-making, 4. enabling parent self-management) and five factors that contribute to adequate communication across these functions (topic, aims, location, route, design) and, thereby, to tailored parent-provider communication.

CONCLUSION

The NICU Communication Framework fits with the goals of Family Integrated Care to encourage parent participation in infants' care. This framework forms a first step towards the conceptualization of (adequate) communication in NICU settings.

PRACTICE IMPLICATIONS

Findings can be used to improve NICU communication in practice, in particular through the mnemonic TAILORED.

Identification of the Range of Nursing Skills Used to Provide Social Support for Mothers of Preterm Infants in Neonatal Intensive Care

Background

Hospitalization of preterm infants in neonatal intensive care units (NICUs) is a stressful experience for parents. Iranian NICUs do not have specified levels of care, nor do they integrate supportive methods of parent support such as family-centered care approaches. This study investigated the range and types of neonatal nursing support, as perceived by mothers of preterm infants, and its association with mothers' satisfaction with infant care in the NICU.

Methods

This is a descriptive, correlational study of mothers of preterm infants who were hospitalized in three different NICUs in Iran. A convenience sampling method was used. Data were collected using three questionnaires that identified (i) demographic information; (ii) social support available; and (iii) parent satisfaction with infant care.

Results

Mothers (N = 110) generally rated the support from nurses as being moderate. Correlation analysis identified a moderate association of neonatal nurse social support domains for affirmational (r = 0.44) and concrete aid (r = 0.41), a moderately strong association for affectional support (r = 0.64), and total social support (r = 0.60) with mothers' satisfaction.

Conclusion

There were positive associations between social support from nurses and mothers' satisfaction with the care of their infants. Therefore, planning to promote and create opportunities for neonatal nurses to support mothers in NICU is important to promote increased maternal satisfaction in infant care.

Parents' experiences of family health conversations after having a child in need of neonatal intensive care

BACKGROUND

When a newborn child requires neonatal intensive care, it is often the beginning of a journey of stress and worry for the parents. Such situations could cause difficulties in problem-solving and communication within the family and result in decreased family functioning. Studies have shown that nurse-led interventions in the form of Family Health Conversations promote family's well-being and functioning and strengthen their relationships. However, this model has not previous been used and evaluated with families who have a child in need of neonatal intensive care.

AIM

To describe parents' experiences of participating in Family Health Conversations after having a child in need of neonatal intensive care.

METHOD

Family interviews were conducted with 12 families from three neonatal intensive care units in southern Sweden, six months after a Family Health Conversations intervention. Data were analysed using qualitative content analysis.

FINDINGS

The parents experienced the Family Health Conversations as an opportunity to co-create a comprehensive picture of what had happened after their child was born. Parents shared their experiences of the Family Health Conversations in terms of feeling validated and strengthened as individuals, as a couple, and as a family. They found the conversations to be supportive to their well-being and to processing experiences and becoming equipped for the future. The parents reported that it was valuable to talk with conversational leaders who had knowledge in neonatal care and who thereby understood what the parents were talking about. This provided a different type of support compared with other conversational contacts.

CONCLUSION

These results highlight the importance of having an early onset of family conversations in order to help the parents to cope with their challenges and improve their well-being.

Using parent metaphors for learning about the neonatal care experience: An interpretive perspective

This study focuses on how metaphors are used by parents who have had a premature baby to describe their neonatal care experience and how these can contribute to empathic learning of health professionals. In health, metaphors are commonly used to communicate and explain difficult topics. When patients tell their story, metaphor can be a means of expression from which we can learn about their experience of illness or hospitalisation. Limited research exits on how metaphor can improve our understanding of parent's emotional experience in neonatal care and subsequently inform education in this field. Employing narrative inquiry within an interpretive, constructivist paradigm, 20 narrative interviews with 23 parents of premature babies were analysed using a process of metaphor identification. Findings revealed common metaphors used to describe experience. Metaphor clusters used by parents in order of frequency were journeying, altered reality, darkness, breaking, connections, fighting, salvation and being on the edge. Parents widely used compelling and emotive metaphors to describe and express both difficult and challenging times as well as progression forward. Metaphors serve as a powerful way for health professionals to learn about the emotional experiences of parents and potentially enhance their empathic understanding.

About me as a person not only the disease - piloting Guided Self-Determination in an outpatient endometriosis setting

INTRODUCTION

Endometriosis is a chronic disease affecting 5-10% of women in the reproductive age. Despite surgical and medical treatment, many women struggle with pain, infertility, sexual dysfunction, depression, distress and reduced workability, affecting their overall quality of life. The usual follow-up procedures may not support the women's self-management of this condition. Therefore, person-centred empowerment-based approaches are needed.

AIM

To assess if the implementation of the Guided Self-Determination method targeted women with complex endometriosis appeared feasible and supported self-management.

METHODS

Guided Self-Determination was offered to 10 out-patients with complex endometriosis. Each of the women had five conversations based on prefilled disease-specific reflection sheets. A qualitative evaluation was conducted in 2016-2017 covering semi-structured, telephone interviews and focus group interviews, which were analysed using thematic analysis. Additionally, we assessed if the women changed the self-reported questionnaires, Endometriosis Health Profile 30 and the Patient Activation Measure from before and after the conversations.

RESULTS

We identified four themes: feeling alone with the disease; establishing a meaningful relationship with healthcare professionals in a traditional hospital setting; person-specific knowledge facilitated new behaviours and; accepting a chronic condition - the beginning of a process. All dimensions of the Endometriosis Health Profile 30 and the Patient Activation Measure appeared to improve at two weeks and so did almost all the dimensions of Endometriosis Health Profile 30 after 1 year.

CONCLUSIONS

The implementation of the Guided Self-Determination method appeared feasible and the women developed self-management skills in relation to endometriosis and its symptoms. This was achieved by increasing insight into their needs and behaviours and gaining new knowledge about the disease itself. The before-and-after assessment suggested benefit of the intervention, but this should be further tested in a randomised trial.

Breaking out of your comfort zone: an archival research on epistemology in inclusive education pedagogy for Industry 4.0

Purpose

As skills need to be changed in a dynamic learning environment, employability depends not just on what people already know but on how well they learn, apply and adapt breaking out their comfort zone. This study explores how students from all backgrounds and teachers can engage with inclusive education without discrimination through pedagogy. The research provides a platform through implication for other international readers of developing countries to implement pedagogies of the Indian context.

Design/methodology/approach

This archival research focuses on the topical literature to scrutinize efficient ways to elevate the realization of all learners in inclusive settings. What inclusive pedagogy teaching approaches, focusing on the key competences and sustains learning which are effectual in elevating the academic success of all novices.

Findings

Educators need to develop their skills and competency by breaking their comfort zone, and individual recital of every faculty affiliate is a decisive feature in accomplishing quality for inclusive education. An education institution also needs to provide passable facilities to academicians and students in order to adapt and utilize technology efficiently without any discrimination. This is an important method of assisting educators to recognize and investigate using this epistemology in new innovative inclusive teaching pedagogy with technologies in industry 4.0.

Research limitations/implications

The study momentarily suggests an innovative pedagogy approach for stakeholders and users to be adapted in current digital arena.

Originality/value

Review of the concepts can provide valuable pointers for policy makers in other jurisdictions contemplating inclusive education. The issues that are dealt with relate to how all students with and without disability can be engaged in a classroom without discrimination, and development is incentivized using Information and Communication Technology (ICT) in teaching pedagogy.

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.

[The Relationship between Parental Stress and Nurses' Communication as Perceived by Parents of High-risk Newborns]

PURPOSE

This study aimed to characterize the relationship between parental stress and nurses' communication as perceived by parents of high-risk newborns in a neonatal intensive care unit (NICU).

METHODS

The participants were 54 parents of high-risk newborns in a NICU. Data were collected from January to March 2018. Parental stress and parents' perceptions of nurses' communication ability and styles were measured using a questionnaire.

RESULTS

The average scores for parental stress and nurses' communication ability were 3.39 and 4.38 respectively, on a 5-point scale. Parents most commonly reported that nurses showed a friendly communication style, followed by informative and authoritative styles. Mothers and fathers reported significantly different levels of parental stress. Parental stress showed a negative correlation with nurses' perceived verbal communication ability. Higher scores for nurses' verbal communication ability and for friendly and informative communication styles were associated with lower parental stress induced by the environment, the baby's appearance and behaviors, and treatments in the NICU.

CONCLUSION

The findings of this study suggest that nurses need to offer proper information for parents and to support parents by encouraging them to express their emotions of stress and by providing parents with therapeutic communication and opportunities to participate in care.

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.

Parents' experiences of neonatal transfer. A meta-study of qualitative research 2000-2017

Transfers of critically ill neonates are frequent phenomena. Even though parents' participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents' experiences of neonatal transfer is lacking. This paper describes a meta-study addressing qualitative research about parents' experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological issues of qualitative studies concerning parents' experiences of neonatal transfer over the course of this meta-study (2000-2017). Meta-theory and meta-method analyses showed that caring, transition, and family-centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta-data-analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified 'wavering and wandering' as a metaphoric representation of the parents' experiences. The findings add knowledge about meta-study as an approach for comprehensive qualitative research and point at the value of meta-theory and meta-method analyses.

Parent-Infant Closeness, Parents' Participation, and Nursing Support in Single-Family Room and Open Bay NICUs

This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.

Transition from hospital to home: Parents' perception of their preparation and readiness for discharge with their preterm infant

AIMS AND OBJECTIVES

To explore the experiences of parents with babies born between 28-32 weeks' gestation during transition through the neonatal intensive care unit and discharge to home.

BACKGROUND

Following birth of a preterm baby, parents undergo a momentous journey through the neonatal intensive care unit prior to their arrival home. The complexity of the journey varies on the degree of prematurity and problems faced by each baby. The neonatal intensive care unit environment has many stressors and facilitating education to assist parents to feel ready for discharge can be challenging for all health professionals.

DESIGN

Qualitative descriptive design.

METHODS

The project included two phases, pre- and postdischarge, to capture the experiences of 20 couples (40 parents), whilst their baby was a neonatal intensive care unit inpatient and then after discharge. Face-to-face interviews, an online survey and telephone interviews were employed to gather parent's experiences. Constant comparative analysis was used to identify commonalities between experiences. Recruitment and data collection occurred from October 2014-February 2015.

RESULTS/FINDINGS

Overlapping themes from both phases revealed three overarching concepts: effective parent staff communication; feeling informed and involved; and being prepared to go home.

CONCLUSION

Our findings can be used to develop strategies to improve the neonatal intensive care unit stay and discharge experience for parents. Proposed strategies would be to improve information transfer, promote parental contact with the multidisciplinary team, encourage input from fathers to identify their needs and facilitate parental involvement according to individual needs within families.

RELEVANCE TO CLINICAL PRACTICE

Providing information to parents during their time in hospital, in a consistent and timely manner is an essential component of their preparation when transitioning to home.

The use of short message services (SMS) to provide medical updating to parents in the NICU

OBJECTIVE

Premature delivery and prolonged hospitalization of infants in the neonatal intensive care unit (NICU) are very stressful for parents. As technology has advanced, short message services (SMS) have been used increasingly in the medical disciplines. To date, the use of SMS for updating patients and families regarding medical information has not been reported. We implemented the SMS technique to daily update the parents regarding the health status of their preterm infant. The objective of this study was to evaluate the use of SMS technology and to assess its impact on the parents and the nursing staff.

STUDY DESIGN

Parents and nurses completed questionnaires at two time periods: pre-SMS implementation (pre-SMSi) and post-SMS implementation (post-SMSi). The parent questionnaires included statements about medical information delivery, communication and trust between parents and medical staff, parental anxiety and overall satisfaction. The nurse questionnaires included statements about the expected and actual impact on their workload.

RESULTS

Comparison of the parents' responses at the two time periods indicated that in the post-SMSi time period, they felt that the physician was more available when needed (P=0.002), they were more comfortable about approaching the physician (P=0.001) and more satisfied with the medical information provided by the staff (P=0.03). In the post-SMSi period, 78.1% of the nurses noted that the SMS communication is a convenient and user-friendly method.

CONCLUSIONS

SMS updating is an easy and user-friendly technology that enriches the modalities of information delivery to parents of hospitalized preterm infants. It is a complementary and useful tool for encouraging and improving personal communication between parents and medical staff and should be considered part of quality improvement in health care.

Pathways to emotional closeness in neonatal units - a cross-national qualitative study

BACKGROUND

Research shows evidence for the importance of physical and emotional closeness for the infant, the parent and the infant-parent dyad. Less is known about how, when and why parents experience emotional closeness to their infants in a neonatal unit (NU), which was the aim of this study.

METHODS

A qualitative study using a salutogenic approach to focus on positive health and wellbeing was undertaken in three NUs: one in Sweden, England and Finland. An 'emotional closeness' form was devised, which asked parents to describe moments/situations when, how and why they had felt emotionally close to their infant. Data for 23 parents of preterm infants were analyzed using thematic networks analysis.

RESULTS

A global theme of 'pathways for emotional closeness' emerged from the data set. This concept related to how emotional, physical, cognitive and social influences led to feelings of emotional closeness between parents and their infants. The five underpinning organising themes relate to the: Embodied recognition through the power of physical closeness; Reassurance of, and contributing to, infant wellness; Understanding the present and the past; Feeling engaged in the day to day and Spending time and bonding as a family.

CONCLUSION

These findings generate important insights into why, how and when parents feel emotionally close. This knowledge contributes to an increased awareness of how to support parents of premature infants to form positive and loving relationships with their infants. Health care staff should create a climate where parents' emotions and their emotional journey are individually supported.

Relational Communications Strategies to Support Family-Centered Neonatal Intensive Care

The philosophy of family-centered care in neonatal intensive care units is intended to facilitate parental involvement, shared decision-making, and improved outcomes for infants and families. To support family-centered care, there are multiple interventions with different components and associated outcomes that have been described in the research literature. This evidence leaves many unanswered questions about how best to implement and evaluate strategies to enhance family-centered care. This article provides a brief overview of interventions designed to support family-centered care in neonatal intensive care units and offers an evidence-informed staff education strategy to enhance family-centered care. The evidence-informed relational communications strategies of circular pattern diagrams, questioning, and commendations are described, along with specific examples of how nurses can use them in in their day-to-day practice in neonatal intensive care units.

A person-centered intervention targeting the psychosocial needs of gynecological cancer survivors: a randomized clinical trial

PURPOSE

We investigated the effect of a person-centered intervention consisting of two to four nurse-led conversations using guided self-determination tailored to gynecologic cancer (GSD-GYN-C) on gynecological cancer survivors' quality of life (QOL), impact of cancer, distress, anxiety, depression, self-esteem, and self-reported ability to monitor and respond to symptoms of recurrence.

METHODS

We randomly assigned 165 gynecological cancer survivors to usual care (UC) plus GSD-GYN-C or UC alone. Self-reported QOL-cancer survivor (QOL-CS) total score and subscale scores on physical, psychological, social, and spiritual well-being were assessed before randomization and at 3 and 9 months after randomization using t tests. Bonferroni and Pipper corrections were applied for multiple testing adjustments.

RESULTS

At 9 months, the GSD-GYN-C plus UC group scored significantly higher on the QOL-CS total scale (P = 0.02) and on the QOL-CS physical well-being subscale (P = 0.01), compared to women receiving UC alone. After adjusting for baseline scores, only the difference in the physical well-being subscale was statistically significant. No other measured outcomes differed between the intervention and control groups after baseline adjustment.

CONCLUSION

We observed higher physical well-being 9 months after randomization in the GSD-GYN-C group, as compared to women receiving usual care.

IMPLICATIONS FOR CANCER SURVIVORS

The results suggest that the person-centered intervention GSD-GYN-C may improve physical well-being in gynecological cancer survivors. However, further testing is needed.

Recommendations for involving the family in developmental care of the NICU baby

Family involvement is a key to realize the potential for long-lasting positive effects on physical, cognitive and psychosocial development of all babies, including those in the neonatal intensive care unit (NICU). Family-centered developmental care (FCDC) recognizes the family as vital members of the NICU health-care team. As such, families are integrated into decision-making processes and are collaborators in their baby's care. Through standardized use of FCDC principles in the NICU, a foundation is constructed to enhance the family's lifelong relationship with their child and optimize development of the baby. Recommendations are made for supporting parental roles as caregivers of their babies in the NICU, supporting NICU staff participation in FCDC and creating NICU policies that support this type of care. These recommendations are designed to meet the basic human needs of all babies, the special needs of hospitalized babies and the needs of families who are coping with the crisis of having a baby in the NICU.

Improved nurse-parent communication in neonatal intensive care unit: evaluation and adjustment of an implementation strategy

AIMS AND OBJECTIVES

To evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit.

BACKGROUND

Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication.

DESIGN

Qualitative and quantitative data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care.

METHODS

Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification.

RESULTS

Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders and nonguided-family-centred-care-trained nurses.

CONCLUSIONS

An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators.

RELEVANCE TO CLINICAL PRACTICE

Insights gained from our pioneering work might help nurses in a similar context to reach their goals of improving family-centred care.