Nurses' narratives on termination of primary nursing relationship with parents in neonatal intensive care

Primary nursing in the intensive care unit

Background: Primary nursing (Process Responsible Nursing; PRN) is a nursing organization model, practiced in intensive care units (ICUs), but implementation is challenging. This paper focuses on the qualitative process analysis of the development and implementation of PRN in an ICU at a German university hospital. Aims: Aim was to record the perception of changes in nursing practice due to the introduction of PRN and obtain information on implementation and further optimization perceived by nurses. Method: A qualitative process analysis was done. Data collection took place at three defined times (immediately before implementation and 6 and 12 months after) and each included a focus group interview (FG) and a 5-day ICU ward process analysis (WA) in the form of participant observation. The analysis of FG and WA was carried out according to Kuckartz's content-structuring qualitative content analysis. Findings: The main categories communication, care planning and integration of patients and relatives in care and 13 subcategories with a cross-sectional category could be identified. Positive effects of PRN were found, particularly concerning relatives. The optimization potential included handover, visit appointments, the documentation system and adjustments to the visiting times. Conclusion: The qualitative analysis was able to show changes during the introduction of PRN, e.g. in communication and care planning, but also challenges like visit appointments or the documentation system in nursing practice.

Enhancing Lactation Support in the NICU During the COVID-19 Pandemic by Implementing a Primary Care Model

Objective

Meet the needs for additional lactation support in the NICU during the Covid-19 pandemic due to restriction in visitors, hours, and other stressors impacting the Mother and infant dyad.

Method

During the Covid-19 pandemic, a large southeast U.S. research hospital implemented a new model of providing Lactation Consultation in a Level IV NICU. The Primary Care nursing model utilized in the NICU focuses on the infant and mother's individual needs and assists in the development of a caring and supportive environment.

Results

The response to the Primary Care Lactation Consultant has well received and has resulted in the early identification of any Lactation concerns. Parents are reassured, knowing whom to contact with questions. The Lactation Consultant can set mutually agreed upon goals with the mother and include input from the other family members and the healthcare team.

Conclusions

In the future, the model and outcomes of Primary Care by Lactation Consultants in the NICU will focus on additional study and evaluation. In the interim, the parents at this facility have benefited from the family-centered care that focuses on the infant and parents.

Beziehungsarbeit in der ambulanten Kinderkrankenpflege - Eine phänomenologische Untersuchung des Spannungsfeldes von Nähe und Distanz

Relationship-work in outpatient pediatric nursing - a phenomenological study of the field of tension of proximity and distance Abstract. Background: Outpatient pediatric nursing makes it possible to care for seriously ill children in the environment of their families. Professional caregivers are facing specific challenges because of their work within the family and the 1:1 care. Objective: The study asks about experiencing the tension between proximity and distance of caregivers in outpatient pediatric nursing. Methods: Nine narrative interviews with pediatric nurses in the outpatient setting were conducted which were then analyzed following Spichiger und Prakke's approach of interpretative phenomenology. Results: Thus the main topics "Outpatient pediatric nursing as a special nursing setting", "Adaptation to the family system", "Proximity and distance as criteria of professionalism", "Proximity and distance as constant tightrope walk", "Handling stressful situations" and "Time factor as an essential component of the relationship structure" could be identified to describe the phenomenon. Conclusion: Creating awareness for the specifics of this particular field of practice already during the training phase and when entering an outpatient nursery service can help to prepare them for their assignment. Caregivers should be given the space to talk about the relationship-work with the patients, in order to enable reflection of their professional role. A clear idea of that role with regards to who has to fulfill which tasks and issues of responsibilities seems to be helpful. Perhaps the term proximity and distance does not represent the pertinent poles of the relationship between nurses and caregivers.

Caring for indigenous families in the neonatal intensive care unit

Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non-Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health-seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two-Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self-identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma-informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families.

Intraprofessional Excellence in Nursing: Collaborative Strategies for Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a growing public health concern, one that costs the health care system $190-$720 million each year. Recently, state-level perinatal quality collaborative groups have disseminated NAS action plans: customizable frameworks aimed to assist health care systems in identifying, evaluating, treating, and coordinating discharge services for neonates with NAS. Hospital-based neonatal nursing quality improvement teams, including neonatal nurse practitioners (NNPs), neonatal clinical nurse specialists (CNSs), and clinical neonatal nurses, by virtue of their collective academic, administrative, and practical years of experience, are ideally positioned to develop, implement, and evaluate NAS care bundles. The article's purpose is to discuss key elements of an NAS care bundle using the framework of the Perinatal Quality Collaborative of North Carolina NAS action plan as an exemplar. Discussion of evidence-based and nursing-driven metrics will be followed by a discussion of the emerging concept of an inpatient-to-outpatient transitional care NAS management model.

Creating stories for learning about the neonatal care experience through the eyes of student nurses: An interpretive, narrative study

BACKGROUND

Storytelling is an increasingly well recognised and valued platform to learn about the human experience within healthcare. Little is known however about how stories can enhance understanding in neonatal care, a specialised field offering rich opportunities for learning. This study focuses on the creation of stories based on the experiences of student nurses to inform teaching and learning strategies in the neonatal field.

OBJECTIVES

The study aimed to create stories from the narratives of student nurses working within the neonatal field and identify what key themes for learning emerged in order to develop a storytelling resource to share experiences with their peers.

DESIGN

An interpretive, constructivist approach was used to collect, analyse and create stories from student nurse's experiences, in line with narrative inquiry.

PARTICIPANTS

Six pre-registration children's nursing students were selected by purposive sampling.

SETTINGS

Interviews were undertaken within six weeks following placement completion in an agreed location.

METHODS

Narratives were obtained by semi-structured interviews. Narrative analysis and core story creation was undertaken to construct stories and key learning themes emerged which provided the pedagogical basis for subsequent digital resource development.

FINDINGS

Key themes emerged relating to the insight and observances of student nurses and the neonatal journey they had experienced, including the nature of neonatal care, experiences of the neonate and parents, the environment and their own learning transition. Preliminary peer evaluation of the storytelling resource revealed storytelling as an interesting and novel approach to teaching & learning, learning from ones' peers, preparation for practice and a valuable insight into a new specialist area.

CONCLUSIONS

The study has value to teaching and learning by enabling an appreciation of how narrative can be used to portray the experiences of learners. Findings also support an approach to analysing narrative to create stories for learning and inform subsequent digital resource development.