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Broden EG, Boyden JY, Keller S, James R, Mooney-Doyle K. Who, What, Where, and How? The State of Family Science in Pediatric Palliative Care. J Pain Symptom Manage 2024:S0885-3924(24)00844-3. [PMID: 38992396 DOI: 10.1016/j.jpainsymman.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
CONTEXT Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health. OBJECTIVES Explore and describe the family-level impact of pediatric serious illness. METHODS We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction. RESULTS We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities. CONCLUSION The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families.
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Affiliation(s)
- Elizabeth G Broden
- Yale National Clinician Scholars Program (E.G.B.), Yale University, New Haven, CT; School of Public Health (E.G.B.), Yale University, New Haven, CT.
| | - Jackelyn Y Boyden
- Department of Family and Community Health (J.Y.B.), School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics (J.Y.B.), Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan Keller
- Research Library (S.K.M.), Children's National Hospital, Washington, DC
| | - Richard James
- Nemours Children's Health (R.J.M.), Wilmington, DE; Fontan Outcomes Network
| | - Kim Mooney-Doyle
- Department of Family and Community Health (K.M-D.), School of Nursing, University of Maryland, Baltimore, MD
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Rodrigues SM, Shin SS, Pinto MD, Bounds DT, Terry J, Burton CW. Parenting Expectations, NICU Experiences, and Maternal Psychological Outcomes: An Exploratory Mixed-Methods Study. Adv Neonatal Care 2024; 24:195-207. [PMID: 38215024 DOI: 10.1097/anc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
BACKGROUND Infant neonatal intensive care unit (NICU) hospitalization increases maternal risk for psychological distress. However, no universal screening standards exist and predicting maternal risk remains challenging. Reconceptualizing maternal distress in relation to differences between parenting expectations and NICU experiences may illuminate commonalities across a range of experiences. PURPOSE This study explored parenting expectation-experience differences (EEDs) among NICU mothers and assessed correlations between EED scores and psychological outcomes 1 to 5 years post-NICU hospitalization. METHODS A 3-phase explanatory sequential mixed-methods design was used. Pearson's correlation coefficients were used to measure relationships between EED scores and maternal psychological outcomes. Reflexive thematic analysis of one-on-one, semi-structured interviews contextualized EED scores. RESULTS Most participants (92.9%) reported negative EED scores, indicating NICU experiences fell short of parenting expectations. Significant inverse correlations were found between EED scores and maternal outcomes, including depression ( r = -0.25, P < .01), anxiety ( r = -0.25, P < .01) and posttraumatic stress disorder symptoms ( r = -0.41, P < .001), and perceived parenting self-efficacy ( r = -0.28, P < .01). Major qualitative themes included unexpected versus prepared, lost parenting experiences, and surviving and thriving. Data synthesis contextualized EED scores and revealed key differences in meaning ascribed to unmet parenting expectations. IMPLICATIONS FOR PRACTICE AND RESEARCH Preparing mothers for infant NICU hospitalization and creating a NICU parenting environment, which better supports mothers and their engagement in parenting tasks, may help to reduce differences between parenting expectations and NICU experiences. Further research is needed to elucidate the impacts of parenting EEDs in this population.
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Affiliation(s)
- Sarah M Rodrigues
- Author Affiliations: Sue & Bill Gross School of Nursing, University of California, Irvine (Drs Rodrigues, Shin, Pinto, and Bounds); Department of Gender & Sexuality Studies, University of California, Irvine (Dr Terry); and School of Nursing, University of Nevada, Las Vegas (Dr Burton)
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Rodrigues SM, Bounds DT, Terry J, Pinto MD, Shin S, Burton CW. Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children. Issues Ment Health Nurs 2024; 45:142-151. [PMID: 37699105 DOI: 10.1080/01612840.2023.2250000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.
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Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Dawn T Bounds
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Jennifer Terry
- Department of Gender & Sexuality Studies, University of California, Irvine, California, USA
| | - Melissa D Pinto
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Sanghyuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
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Boni L, Gradellini C, Miari M, Cocconi P, Montorsi A, Capone R, Costi S, Di Leo S, Puglisi C, Ghirotto L. How parents and health professionals experience prematurity in an Italian neonatal intensive care: A grounded theory study. J Pediatr Nurs 2022; 67:e172-e179. [PMID: 35987669 DOI: 10.1016/j.pedn.2022.07.020] [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: 03/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to explore prematurity as a psycho-social process from the point of view of both parents and healthcare professionals. DESIGN AND METHODS We conducted a Grounded Theory study through semi-structured interviews. Participants were from an Italian Neonatal Intensive Care Unit, including parents of premature children, and health professionals. Interviews were analyzed according to Grounded Theory coding strategies, to hypothesize a theoretical model. RESULTS On one side, behaviors, emotions, and feelings of parental couples; on the other one, the activities and reactions of professionals have been interpreted in a four-phase negotiated process: 1) the initial breakup; 2) the floating family; 3) the event processing; 4) the reconstruction of a new family. CONCLUSIONS Managing prematurity is a negotiated process which could be better managed through a family-centered approach as fundamental in neonatal and pediatric services. Being open in listening, coherent in the given answers, and knowing the entire process and story of being suddenly parents of a premature child can make the difference in the future definition of a new family. PRACTICE IMPLICATIONS Perinatal care would benefit from the following suggested practical implications: i) reducing feelings of separation and solitude by integrating diverse professionals around the family systems; ii) expediting prematurity-related changes through peer-support during hospitalization and attention to rooms' organization; iii) enhancing information exchange between all professionals involved in the care of dyads/parents and new-borns, starting since the pregnancy and continuing after the child's birth by implementing multidisciplinary meetings or appropriate care pathways.
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Affiliation(s)
- Laura Boni
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, via Giovanni Amendola 2, 42122 Reggio Emilia, Italy
| | - Cinzia Gradellini
- Qualitative Research Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia; Nursing Course, University of Modena and Reggio Emilia, Italy.
| | - Monica Miari
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | | | - Annalisa Montorsi
- Ospedale Sassuolo SpA, via Francesco Ruini 2, 41049 Sassuolo, Modena, Italy
| | - Roberto Capone
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Stefania Costi
- Neonatal Intensive Care Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Silvia Di Leo
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Chiara Puglisi
- Reserach Unit, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Luca Ghirotto
- Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
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Adcock A, Cram F, Edmonds L, Lawton B. He Tamariki Kokoti Tau: Whānau of preterm Māori infants (pēpi) reflect on their journeys from birth to first birthday. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2090390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Anna Adcock
- Te Tātai Hauora o Hine National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | | | - Liza Edmonds
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand
- Department of Women’s and Children’s, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Beverley Lawton
- Te Tātai Hauora o Hine National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Wellington, Aotearoa New Zealand
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Azeez S, Obst KL, Due C, Oxlad M, Middleton P. Overwhelming and unjust: A qualitative study of fathers' experiences of grief following neonatal death. DEATH STUDIES 2022; 46:1443-1454. [PMID: 35107411 DOI: 10.1080/07481187.2022.2030431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Limited research has examined the grief experiences of fathers following neonatal death. Using a qualitative research design, ten fathers were interviewed, and thematic analysis resulted in three overarching themes: 'A complicated grief experience: Neonatal death is highly emotional', 'Grief is multidimensional' and 'Sense of injustice'. Overall, results showed that grief was a multidimensional experience for fathers, with expressions of grief including strong feelings of anger and guilt and the manifestation of grief in physical symptoms. In addition, the findings also indicated a sense of injustice that contributed to the disenfranchisement of grief for fathers. The results of this study contribute to developing a better understanding of the grief that fathers experience following neonatal death, and can inform improvements in healthcare practices after the death of a baby in the neonatal period, including father-specific programs and adequate provision of information.
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Affiliation(s)
- Shazleen Azeez
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Melissa Oxlad
- School of Psychology, University of Adelaide, Adelaide, South Australia
| | - Philippa Middleton
- South Australian Health and Medical Research Institute, Adelaide, South Australia
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Kidane S, Shamebo SD, Ntaganda E, Petroze RT, McNatt Z, Wong R, Rabideau M. Exploring the lived experiences of parents caring for infants with gastroschisis in Rwanda: The untold story. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000439. [PMID: 36962402 PMCID: PMC10021215 DOI: 10.1371/journal.pgph.0000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/21/2022] [Indexed: 11/19/2022]
Abstract
Pediatric surgery is a crucial pillar of health equity but is often not prioritized in the global health agenda, especially in low-and middle-income countries. Gastroschisis (GS) is a type of structural congenital anomaly that can be treated through surgical interventions. In Rwanda, neonatal surgical care is only available in one hospital. The experience of parents of children born with gastroschisis has not been previously studied in Rwanda. The objective of this study was to explore the lived experiences of parents of children diagnosed with GS in Rwanda. A qualitative study using a semi-structured interview guide was conducted. Parents who had children with gastroschisis and were discharged alive from the hospital in Rwanda were interviewed by trained data collectors, from May to July 2021. Data were transcribed, translated, and then coded using a structured code-book. Thematic analysis was conducted with the use of Dedoose software. Sixteen parents participated in the study. Five themes emerged from the data. They were: "GS diagnosis had a significant emotional impact on the parents", "Parents were content with the life-saving medical care provided for their children despite some dissatisfaction due to the delayed initiation of care and shortage of medications", "GS care was accompanied by financial challenges", "support systems were important coping mechanisms" and "the impact of GS care extended into the post-discharge period". Having a newborn with GS was an emotional journey. The lack of pre-knowledge about the condition created a shock to the parents. Parents found support from their faith and other parents with similar experiences. The experiences with the care received were mostly positive. The overall financial burden incurred from the medical treatment and indirect costs was high and extended beyond the hospital stay. Strengthening prenatal and hospital services, providing peer, spiritual and financial support could enhance the parents' experience.
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Affiliation(s)
- Samuel Kidane
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
| | - Semay Desta Shamebo
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
| | - Edmond Ntaganda
- Department of Surgery, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Robin T Petroze
- Division of Pediatric Surgery, Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Zahirah McNatt
- Department of Community Health and Social Medicine, University of Global Health Equity, Butaro, Rwanda
| | - Rex Wong
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Melany Rabideau
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
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Abstract
Critical appraisal of the evidence is the third step in the evidence-based practice process. This column, the first in a multipart series to describe the critical appraisal process, defines and provides examples of the levels of evidence and tools to begin the appraisal process using a rapid critical appraisal technique.
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Adcock A, Cram F, Edmonds L, Lawton B. He Tamariki Kokoti Tau: Families of Indigenous Infants Talk about Their Experiences of Preterm Birth and Neonatal Intensive Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9835. [PMID: 34574759 PMCID: PMC8472228 DOI: 10.3390/ijerph18189835] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Māori (Indigenous peoples of Aotearoa New Zealand) bear an unequal burden of poor perinatal health outcomes, including preterm birth. An infant arriving preterm disrupts the birth imaginary of whānau (family collectives) and situates them in a foreign health environment that may not be culturally safe and nurturing. A cross-sectional interpretative phenomenological analysis of first interviews with 19 whānau participating in a Kaupapa Māori (by, with, for Māori) qualitative longitudinal study of preterm birth identified themes from their experiences and the meanings they attributed to them. Preterm birth was an emotional roller coaster, with the birth imaginary and anticipated roles disrupted as health practitioners took over the care of their infants. Whānau expressed the desire to be close to their infants, holding them, loving them, nurturing them, and emplacing them within whakapapa (genealogy, continual layering of foundations) networks. When health practitioners or hospital policies inhibited this intimacy by isolating, excluding, or discriminating, whānau were frustrated. Being familiar with hospital routines, staff, peers, infant cares, and being wrapped in wider whānau support were key for whānau coping. Whakawhanaungatanga (processes of establishing relationships) create safe spaces for whānau to be themselves. This quietens the 'storm' and returns whānau to a sense of calm, through the reclamation of their environment.
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Affiliation(s)
- Anna Adcock
- (Ngāti Mutunga) Te Tātai Hauora o Hine Centre for Women’s Health Research, Te Herenga Waka Victoria University of Wellington, Wellington 6140, New Zealand
| | - Fiona Cram
- (Ngāti Pāhauwera) Katoa Ltd., Auckland 1143, New Zealand;
| | - Liza Edmonds
- (Ngāpuhi, Ngāti Whātua) Dunedin Hospital, Southern District Health Board, Dunedin 9016, New Zealand;
- Department of Women’s and Children’s Health, University of Otago, Dunedin 9016, New Zealand
| | - Beverley Lawton
- (Te Aitanga-a-Hauiti) Te Tātai Hauora o Hine Centre for Women’s Health Research, Te Herenga Waka Victoria University of Wellington, Wellington 6012, New Zealand;
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Exploring implicit bias in the perceived consequences of prematurity amongst health care providers in North Queensland - a constructivist grounded theory study. BMC Pregnancy Childbirth 2021; 21:55. [PMID: 33441110 PMCID: PMC7805144 DOI: 10.1186/s12884-021-03539-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background A study was done to explore the attitudes of relevant health care professionals (HCP) towards the provision of intensive care for periviable and extremely premature babies. Methods/design Applying a constructivist grounded theory methodology, HCP were interviewed about their attitudes towards the provision of resuscitation and intensive care for extremely premature babies. These babies are at increased risk of death and neurodisability when compared to babies of older gestations. Participants included HCP of varying disciplines at a large tertiary centre, a regional centre and a remote centre. Staff with a wide range of experience were interviewed. Results Six categories of i) who decides, ii) culture and context of families, iii) the life ahead, iv) to treat a bit or not at all, v) following guidelines and vi) information sharing, emerged. Role specific implicit bias was found as a theoretical construct, which depended on the period for which care was provided relative to the delivery of the baby. This implicit bias is an underlying cause for the negativity seen towards extreme prematurity and is presented in this paper. HCP caring for women prior to delivery have a bias towards healthy term babies that involves overestimation of the risks of extreme prematurity, while neonatal staff were biased towards suffering in the neonatal period and paediatricians recognise positivity of outcomes regardless of neurological status of the child. The implicit bias found may explain negativity towards intensive care of periviable neonates. Conclusion Understanding the presence and origins of role specific implicit bias may enable HCP to work together to improve care for parents preparing for the delivery of extremely premature babies. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03539-5.
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Azeez S, Obst KL, Oxlad M, Due C, Middleton P. Australian fathers' experiences of support following neonatal death: a need for better access to diverse support options. J Perinatol 2021; 41:2722-2729. [PMID: 34556801 PMCID: PMC8460396 DOI: 10.1038/s41372-021-01210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore fathers' experiences of support following neonatal death, including the availability and perceived adequacy of support, barriers and facilitators to support and desired support. STUDY DESIGN Semi-structured interviews were conducted with ten Australian fathers who had experienced the death of a baby in the neonatal period at least 6 months previously. Data were analysed using thematic analysis. RESULTS Two overarching themes were identified: From hospital to home: Continuity of care and Self and community barriers to support. Fathers who could access the support they required found this to be beneficial. Overall, however, supports were perceived as inadequate in variety and availability, with more follow-up support from the hospital desired. Fathers highlighted limited opportunities to form emotional connections with others and a strong desire to talk about their baby. CONCLUSION Healthcare professionals and support organisations can more effectively assist fathers by increasing the variety of supports available and facilitating follow-up or referrals after hospital discharge.
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Affiliation(s)
- Shazleen Azeez
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.
| | - Kate Louise Obst
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Melissa Oxlad
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Clemence Due
- grid.1010.00000 0004 1936 7304School of Psychology, University of Adelaide, Adelaide, SA Australia
| | - Philippa Middleton
- grid.430453.50000 0004 0565 2606South Australian Health and Medical Research Institute, Adelaide, SA Australia
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Murthy S, Guddattu V, Lewis L, Nair NS, Haisma H, Bailey A. Stressors and support system among parents of neonates hospitalised with systemic infections: qualitative study in South India. Arch Dis Child 2021; 106:20-29. [PMID: 33177055 PMCID: PMC7788219 DOI: 10.1136/archdischild-2020-319226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore stressors and support system for families with a neonate admitted with a systemic infection. DESIGN Qualitative study using in-depth interviews (IDIs), based on principles of grounded theory. SETTING A busy level III neonatal unit of a tertiary care teaching hospital in coastal Karnataka, India, between May 2018 and January 2019. PARTICIPANTS Parents and accompanying attendants of neonates admitted to the neonatal unit with one or more systemic infections. METHODS Using purposive sampling, semi-structured IDIs were audio recorded, transcribed verbatim and a thematic analysis was performed. RESULTS Thirty-eight participants were interviewed, lasting between 30 and 59 min. Babies' hospitalisation with sepsis was an unprecedented, sudden and overwhelming event. Stressors related to uncertainties due to the information gap inherent to the nature of illness, cultural rituals, financial constraints, barriers to bonding and others. Parents reported experiencing insomnia, gastric disturbances and fatigue. Support (emotional and/or financial) was sought from families and friends, peers, staff and religion. Availability and preference of emotional support system differed for mothers and fathers. In our context, families, peers and religion were of particular importance for reinforcing the available support system. Participant responses were shaped by clinical, cultural, financial, religious and health service contexts. CONCLUSION Designing a family-centred care in our context needs consideration of stressors that extend beyond the immediate neonatal intensive care unit environment and interactions. Understanding the influence of the nature of illness, financial, familial and cultural contexts helps identify the families who are particularly vulnerable to stress.
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Affiliation(s)
- Shruti Murthy
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Leslie Lewis
- Department of Paediatrics, Kasturba Medical College, Manipal, Karnataka, India
| | - Narayanapillai Sreekumaran Nair
- Department of Medical Biometrics and Informatics (Biostatistics), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Transdisciplinary Centre for Qualitative Methods, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Baraldi E, Allodi MW, Smedler AC, Westrup B, Löwing K, Ådén U. Parents' Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9326. [PMID: 33322234 PMCID: PMC7764273 DOI: 10.3390/ijerph17249326] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/29/2022]
Abstract
With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent-child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent's own emotional state.
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Affiliation(s)
- Erika Baraldi
- Department of Special Education, Stockholm University, 106 91 Stockholm, Sweden;
| | - Mara Westling Allodi
- Department of Special Education, Stockholm University, 106 91 Stockholm, Sweden;
| | | | - Björn Westrup
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.W.); (K.L.); (U.Å.)
| | - Kristina Löwing
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.W.); (K.L.); (U.Å.)
- Karolinska University Hospital Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, 171 76 Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (B.W.); (K.L.); (U.Å.)
- Karolinska University Hospital Neonatal Unit, 171 76 Stockholm, Sweden
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