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Zores C, Gibier C, Haumesser L, Meyer N, Poirot S, Briot C, Langlet C, Dillenseger L, Kuhn P. Evaluation of a new tool - "Step by step with my baby" - to support parental involvement in the care of preterm infants. Arch Pediatr 2024; 31:306-314. [PMID: 38653616 DOI: 10.1016/j.arcped.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/24/2023] [Accepted: 11/26/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIMS Parental guidance is essential for supporting parental involvement, maintaining the quality and safety of infant care, and limiting parental stress. The efficiency of a new tool to support parental empowerment - "Step by step with my baby" - was evaluated. The perception of this tool by parents and nurses was studied. METHODS This was a prospective, observational study conducted from September 2019 to December 2020 at a level-3 neonatal center. A total of 79 newborns (<33 weeks of gestational age or small for gestational age), 84 parents, and 94 nurses were included. The new tool that was evaluated is in the form of a drawing of flowers to be colored according to the parents' ability to care for their newborn. Six domains were explored and given a score (total of 35 points) according to the parents' ability to care for each item: behavior, skin-to-skin contact, carrying, oral and tube feeding, and routine care. The use and relevance of this tool were evaluated by parents and caregivers. RESULTS At a mean of 19 days of life, parents required caregiver support regardless of the skill domain (6/35). After 26 days, the mean score increased to 19.4 (p < 0.05). Parents felt autonomous in changing diapers and monitoring temperature but always required help for skin-to-skin contact, carrying, and feeding with or without a tube. The progression was not affected by the presence of siblings, the distance from home, and staying in the parental hospital room. For 67 % of the parents, the tool gave them a better understanding of their newborn and helped them be more confident (69 %) without feeling judged (81 %). These feelings were upheld by nurses. CONCLUSIONS This tool was efficient for evaluating parents' autonomy and helped them take ownership of the care provided.
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Affiliation(s)
- Claire Zores
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France; INCI, UPR 3231, CNRS/ université de Strasbourg, 67000 Strasbourg, Alsace, France.
| | - Corisande Gibier
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Lucile Haumesser
- CHU Strasbourg, Service d'information médicale-biostatistique - Santé Publique 67000 Strasbourg, Alsace, France
| | - Nicolas Meyer
- CHU Strasbourg, Service d'information médicale-biostatistique - Santé Publique 67000 Strasbourg, Alsace, France
| | - Stéphanie Poirot
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Caroline Briot
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Claire Langlet
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Laurence Dillenseger
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France
| | - Pierre Kuhn
- CHU Strasbourg, Médecine et Réanimation du nouveau-né, Service de Pédiatrie 2, Pôle médico chirurgical Pédiatrique de Hautepierre, Avenue Molière, 67091 Strasbourg, France; INCI, UPR 3231, CNRS/ université de Strasbourg, 67000 Strasbourg, Alsace, France
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Stern-Delfils A, Leray I, Caeymaex L, Dicky O, Akrich M, Reynaud A, Bouvard C, Evrard A, Sizun J, Tscherning C, Kuhn P. Father's perceptions and care involvement for their very preterm infants at French neonatal intensive care units. Front Psychiatry 2023; 14:1229141. [PMID: 38034931 PMCID: PMC10687630 DOI: 10.3389/fpsyt.2023.1229141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives We aimed to evaluate (1) fathers' perceptions and care involvement for their very premature infants and their views of the hospitalization period based on parental reports and (2) their evolution over time. Methods We used an online parental survey to assess answers from parents of very preterm infants who were successfully discharged from French neonatal units. We analysed answers from February 2014 to January 2019 to an anonymous internet-based survey from the GREEN committee of the French Neonatal Society. Responses were compared for period 1 (P1, 1998 to 2013) and period 2 (P2, 2014 to 2019). Results We analyzed 2,483 surveys, 124 (5%) from fathers and 2,359 (95%) from mothers. At birth, 1,845 (80%) fathers were present in the hospital, but only 879 (38%) were near the mother. The presence of fathers in the NICU increased from P1 to P2 (34.5% vs. 43.1%, p = 0.03). Nearly two thirds of fathers accompanied their infants during transfer to the NICU (1,204 fathers, 60.6%). Fathers and mothers had similar perceptions regarding relationships with caregivers and skin-to-skin contact with their infants. However, more fathers than mothers felt welcome in the NICU and in care involvement regarding requests for their wishes when they met their infant (79% vs. 60%, p = 0.02) and in the presentation of the NICU (91% vs. 76%; p = 0.03). Mothers and fathers significantly differed in the caring procedures they performed (p = 0.01), procedures they did not perform but wanted to perform (p < 0.001), and procedures they did not perform and did not want to perform (p < 0.01). Conclusion Most fathers were present at the births of their very preterm infants, but fewer fathers were near the mother at this time. Less than two thirds of fathers accompanied their infants to the NICU. There should be further changes to better meet the specific needs of the fathers of infants requiring care in the NICU. Continuing assessment with an online questionnaire may be useful to monitor changes over time in father's involvement in NICUs.
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Affiliation(s)
| | - Isabelle Leray
- Department of Neonatology, University Hospital of Strasbourg, Strasbourg, France
| | - Laurence Caeymaex
- NICU, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Centre d’Etudes Discours Images Textes Ecrits Communication (CEDITEC), Paris Est Créteil University, Créteil, France
| | - Odile Dicky
- NICU, University Hospital, Toulouse, France
- U1027 INSERM, Paul Sabatier University, Toulouse, France
| | - Madeleine Akrich
- Collectif inter-associatif autour de la naissance (CIANE), Paris, France
| | | | | | - Anne Evrard
- Collectif inter-associatif autour de la naissance (CIANE), Paris, France
| | | | - Charlotte Tscherning
- NICU, University Hospital, Toulouse, France
- U1027 INSERM, Paul Sabatier University, Toulouse, France
- NICU, Sidra Medicine Hospital, Well Cornell University Hospital, Doha, Qatar
- Center for Pathophysiology Toulouse-Purpan (CPTP), Inserm Unviversity of Toulouse, Toulouse, France
| | - Pierre Kuhn
- Department of Neonatology, University Hospital of Strasbourg, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR, Strasbourg University, Strasbourg, France
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
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Linnér A, Blomqvist YT, Jonsson K, Lilliesköld S, Norman M. Parental Experiences of Neonatal Care: A Nationwide Study on Determinants of Excellence. Neonatology 2023; 121:46-55. [PMID: 37844545 PMCID: PMC10836739 DOI: 10.1159/000533900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/25/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Infant- and family-centered developmental care can reduce adverse outcomes in both infants and parents. Parents' experiences of the care and staff treatment remain to be evaluated. METHODS Parents of infants admitted to neonatal units in Sweden from July 2020 to May 2022 responded to a questionnaire with standardized questions about in-hospital care. Exposures were hospital, gestational age, length of hospital stay, unit level, and bed density. The proportions of parents rating aspects of neonatal care as excellent, defined as five on a Likert scale, and the determinants of excellence were described. The results were benchmarked with ratings in adult somatic care. RESULTS A total of 4,475/13,108 (34%) parents responded. The ratings of excellent care varied by question from 65% to 90%. The largest variation in excellence between neonatal units (range 43-80%) was found for "participation and involvement." The proportion of excellence was significantly lower among parents of extremely preterm infants. Confidence in the staff was lower in parents of extremely preterm infants than in parents of term infants (56% vs. 83%). Longer hospital stays affected the experience of neonatal care adversely, whereas level of care and bed density were overall unrelated to the parental experience. Parents in neonatal care rated the care as excellent to a higher extent than patients cared for in adult medicine. CONCLUSION A majority of parents rated neonatal care in Sweden as excellent. The less frequent ratings of excellence among parents of extremely preterm infants indicate that more could be done to optimize parental involvement and support.
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Affiliation(s)
- Agnes Linnér
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kristina Jonsson
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Siri Lilliesköld
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
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Passini L, Le Bouedec S, Dassieu G, Reynaud A, Jung C, Keller ML, Lefebvre A, Katty T, Baleyte JM, Layese R, Audureau E, Caeymaex L. Error disclosure in neonatal intensive care: a multicentre, prospective, observational study. BMJ Qual Saf 2023; 32:589-599. [PMID: 36918264 DOI: 10.1136/bmjqs-2022-015247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 03/16/2023]
Abstract
IMPORTANCE Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied. OBJECTIVE To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure. DESIGN Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested. SETTING 10 NICUs in France with a 20-month follow-up, starting November 2015. PARTICIPANTS n=1019 patients with NICU stay ≥2 days with ≥1 error. EXPOSURE Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure. MAIN OUTCOME AND MEASURES Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure. RESULTS Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence. CONCLUSION AND RELEVANCE In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant. TRIAL REGISTRATION NUMBER NCT02598609.
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Affiliation(s)
- Loïc Passini
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Gilles Dassieu
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Marie-Laurence Keller
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Aline Lefebvre
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR 3571 CNRS, University Paris Diderot, Paris, France
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Therese Katty
- Health Law Manager, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Jean-Marc Baleyte
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| | - Richard Layese
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Etienne Audureau
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
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Belgodère L, Pougheon Bertrand D, Jaulent MC, Rabeharisoa V, Janssens W, Rollason V, Barbot J, Vernant JP, Oualikene Gonin W, Maison P, Ankri J. Patient and public involvement in the benefit-risk assessment and decision concerning health products: position of the Scientific Advisory Board of the French National Agency for Medicines and Health Products Safety (ANSM). BMJ Glob Health 2023; 8:bmjgh-2023-011966. [PMID: 37208125 DOI: 10.1136/bmjgh-2023-011966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
| | - Dominique Pougheon Bertrand
- Laboratoire Educations et Promotion de la santé, LEPS, UR 3412, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Marie Christine Jaulent
- INSERM, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé, LIMICS, Sorbonne Université, Paris, France
| | - Vololona Rabeharisoa
- Centre de sociologie de l'innovation, UMR CNRS i3 (9217), Mines Paris - PSL, Paris, France
| | - Walter Janssens
- Federal Agency for Medicines and Health Products, Brussel, Belgium
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Janine Barbot
- Centre d'étude des mouvements sociaux (CNRS-EHESS 8044, INSERM 1276), INSERM, Paris, France
| | - Jean Paul Vernant
- Service Hématologie, Hôpital Universitaire Pitié Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
| | | | - Patrick Maison
- Délégation scientifique, ANSM, Saint-Denis, France
- EA 7379, Faculté de Santé, Université Paris-Est Créteil Val de Marne, Creteil, France
| | - Joel Ankri
- Inserm U1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Universite Versailles Saint-Quentin-en-Yvelines UFR de Medecine, Montigny-Le-Bretonneux, France
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Li L, Ji F, Wang Y, Wang L, Yu L, Wu X, Lyu T, Dou Y, Cao Y, Hu XJ. The clinical experience of early skin-to-skin contact combined with non-nutritive comfort sucking in mothers of preterm infants: a qualitative study. BMC Pregnancy Childbirth 2023; 23:281. [PMID: 37095429 PMCID: PMC10123578 DOI: 10.1186/s12884-023-05581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND In most areas of China, mothers typically do not participate in early care of preterm infants in NICU. This study aims to examine the early experience of mothers of preterm infants participating in skin-to-skin contact combined with non-nutritive comfort sucking in China. METHODS This qualitative research study used one-on-one, face-to-face, semi-structured in-depth interviews. Eighteen mothers who participated in early skin-to-skin contact combined with non-nutritive comfort sucking were interviewed in the NICU of a tertiary children's hospital in Shanghai between July and December 2020. Their experiences were analyzed using the inductive topic analysis method. RESULTS Five themes about skin-to-skin contact combined with non-nutritive comfort sucking were identified, including alleviation of maternal anxiety and fear during mother infant separation, reshaping the maternal role, promotion of active breast pumping, enhances the mother's willingness to actively breast feed and building the maternal confidence in baby care. CONCLUSION Skin-to-skin contact combined with non-nutritive comfort sucking in the NICU can not only enhance the identity and responsibility of the mother's role, but also provide non-nutritive sucking experience for promoting the establishment of oral feeding in preterm infants.
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Affiliation(s)
- Liling Li
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Futing Ji
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Yuejue Wang
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Li Wang
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Ling Yu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Xi Wu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Tianchan Lyu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Yalan Dou
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Yun Cao
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China
| | - Xiao-Jing Hu
- Children's Hospital of Fudan University, the National Children's Medical Center, 399 Wan Yuan Road, Shanghai, 201102, People's Republic of China.
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases(2018RU002), Chinese Academy of Medical Sciences , Beijing, China.
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Barriers to Kangaroo Care in the NICU: A Qualitative Study Analyzing Parent Survey Responses. Adv Neonatal Care 2022; 22:261-269. [PMID: 34054009 DOI: 10.1097/anc.0000000000000907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored. PURPOSE To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC. METHODS This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services. RESULTS Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance. IMPLICATIONS FOR PRACTICE AND RESEARCH The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.
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