Interventions to improve quantitative measures of parent satisfaction in neonatal care: a systematic review

A greater nurse and midwife density protects against infant mortality globally

PURPOSE

As the largest profession within the health care workforce, nurses and midwives play a critical role in the health and wellness of families especially children and infants. This study suggests those countries with higher nurse and midwife densities (NMD) had lower infant mortality rates (IMR).

DESIGN AND METHODS

With affluence, low birthweight and urbanization incorporated as potential confounders, this ecological study analyzed the correlations between NMD and IMR with scatterplots, Pearson r correlation, partial correlation and multiple linear regression models. Countries were also grouped for analysing and comparing their Pearson's coefficients.

RESULTS

NMD inversely and significantly correlated to IMR worldwide. This relationship remained significant independent of the confounders, economic affluence, low birthweight and urbanization. Explaining 57.19% of IMR variance, high NMD was implicated in significantly reducing the IMR.

PRACTICE IMPLICATIONS

Countries with high NMD had lower IMRs both worldwide and with special regard to developing countries. This may interest healthcare policymakers, especially those from developing countries, to consider the impacts of global nursing and midwifery staffing shortages. Nurses and midwives are the group of healthcare professionals who spend most with infants and their carers. This may be another alert for the health authorities to extend nurses and midwives' practice scope for promoting infant health.

Turnover intention and its associated factors among nurses in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Nurses turnover intention, representing the extent to which nurses express a desire to leave their current positions, is a critical global public health challenge. This issue significantly affects the healthcare workforce, contributing to disruptions in healthcare delivery and organizational stability. In Ethiopia, a country facing its own unique set of healthcare challenges, understanding and mitigating nursing turnover are of paramount importance. Hence, the objectives of this systematic review and meta-analysis were to determine the pooled proportion ofturnover intention among nurses and to identify factors associated to it in Ethiopia.

METHODS

A comprehensive search carried out for studies with full document and written in English language through an electronic web-based search strategy from databases including PubMed, CINAHL, Cochrane Library, Embase, Google Scholar and Ethiopian University Repository online. Checklist from the Joanna Briggs Institute (JBI) was used to assess the studies' quality. STATA version 17 software was used for statistical analyses. Meta-analysis was done using a random-effects method. Heterogeneity between the primary studies was assessed by Cochran Q and I-square tests. Subgroup and sensitivity analyses were carried out to clarify the source of heterogeneity.

RESULT

This systematic review and meta-analysis incorporated 8 articles, involving 3033 nurses in the analysis. The pooled proportion of turnover intention among nurses in Ethiopia was 53.35% (95% CI (41.64, 65.05%)), with significant heterogeneity between studies (I2 = 97.9, P = 0.001). Significant association of turnover intention among nurses was found with autonomous decision-making (OR: 0.28, CI: 0.14, 0.70) and promotion/development (OR: 0.67, C.I: 0.46, 0.89).

CONCLUSION AND RECOMMENDATION

Our meta-analysis on turnover intention among Ethiopian nurses highlights a significant challenge, with a pooled proportion of 53.35%. Regional variations, such as the highest turnover in Addis Ababa and the lowest in Sidama, underscore the need for tailored interventions. The findings reveal a strong link between turnover intention and factors like autonomous decision-making and promotion/development. Recommendations for stakeholders and concerned bodies involve formulating targeted retention strategies, addressing regional variations, collaborating for nurse welfare advocacy, prioritizing career advancement, reviewing policies for nurse retention improvement.

Parental satisfaction with neonatal intensive care unit services and associated factors in Ethiopia: systematic review and meta-analysis

BACKGROUND

In the context of healthcare, satisfaction is the attainment of adequate or acceptable treatment and serves as both a benchmark for quality and the ultimate objective of providing care. In neonatal care facilities, parent satisfaction is a key measure of the quality of the services offered to the newborns and aids in improving healthcare delivery. This is the first systematic review aiming to address critical knowledge gaps regarding factors influencing parental satisfaction with neonatal intensive care unit services, and determine pooled prevalence in Ethiopia.

METHODS

After comprehensive systematic search for full texts in the English language through an electronic web-based search strategy from databases of PubMed, CINAHL, Embase, African Journals Online, PsycINFO, and Google Scholar, included a total of 8 articles. Checklists from the Joanna Briggs Institute were used to assess the studies' quality of methodology. STATA version 14 software for windows was used for all statistical analyses and meta-analysis was done using a random-effects method. Subgroup and sensitivity analyses were performed to clarify the source of heterogeneity.

RESULTS

Pooled national level of parents' satisfaction with neonatal intensive unit service was 57.87% (95% CI (49.99, 65.75%)). Age of respondents and availability of chair were significantly associated with parents' satisfaction with neonatal intensive unit service.

CONCLUSIONS AND RECOMMENDATION

In our review we found that nearly half of parents expressed dissatisfaction with neonatal intensive unit service, which is high. Age of respondents and availability of chair in neonatal intensive unit waiting area were significantly associated with neonatal intensive unit service. Efforts to enhance parental satisfaction with neonatal intensive unit services are crucial, given that nearly half of parents reported dissatisfaction. Necessary infrastructure should be fulfilled to increase parental satisfaction with neonatal intensive unit service. (PROSPERO) INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS: CRD42023483474.

Parental Satisfaction towards Care Given at Neonatal Intensive Care Unit and Associated Factors in Comprehensive and Referral Hospitals of Southern Ethiopia

Background

Patient satisfaction is an important aspect of the quality of care in the inpatient setting. In neonatal intensive care units, parents' satisfaction and their experiences are fundamental to assessing clinical practice and improving the quality of care delivered to infants. Hence then, it reduces infant mortality rates globally. In Ethiopia, few studies address the level of parental satisfaction towards care given at neonatal intensive care unit and no single study was done in the study area. Therefore, this study is aimed at assessing parental satisfaction towards care given at neonatal intensive care unit and associated factors in comprehensive and referral hospitals of southern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among 401 parents who visited neonatal intensive care from March 28 to April 28, 2022. The data were assorted via a structured interviewer-administered questionnaire using ODK collect version and exported to SPSS window version 25 for further cleaning and analysis. Bivariate and multivariate logistic regressions were used to identify factors associated with parental satisfaction with care given at the neonatal intensive care unit. The adjusted odds ratio with 95% CI was used to show the strength of the association, and a P value < 0.05 was used to declare the cutoff point to determine the level of significance.

Results

In this study, 63% (95% CI: 58%, 68%) of the parents were satisfied with the care given at the neonatal intensive care unit. Factors associated with parental satisfaction towards care given at neonatal intensive care unit were parents with no formal education (AOR: 0.15; 95% CI: 0.07-0.31), availability of necessary information using direction indicator (AOR: 3.14; 95% CI: 1.85-5.31), and availability of enough chairs in waiting area (AOR: 3.26; 95% CI: 1.81-5.87).

Conclusion

Nearly two-thirds of the parents were satisfied with the care given at the neonatal intensive care unit. The availability of enough chairs in the waiting area and the creation of direction indicators are key issues to improve parental satisfaction towards their neonatal care.

Parents' Experiences of Communication in Neonatal Care (PEC): a neonatal survey refined for real-time parent feedback

OBJECTIVE

Assessing parent experiences of neonatal services can help improve quality of care; however, there is no formally evaluated UK instrument available to assess this prospectively. Our objective was to refine an existing retrospective survey for 'real-time' feedback.

METHODS

Co-led by a parent representative, we recruited a convenience sample of parents of infants in a London tertiary neonatal unit. Our steering group selected questions from the existing retrospective 61-question Picker survey (2014), added and revised questions assessing communication and parent involvement. We established face validity, ensuring questions adequately captured the topic, conducted parent cognitive interviews to evaluate parental understanding of questions,and adapted the survey in three revision cycles. We evaluated survey performance.

RESULTS

The revised Parents' Experiences of Communication in Neonatal Care (PEC) survey contains 28 questions (10 new) focusing on communication and parent involvement. We cognitively interviewed six parents, and 67 parents completed 197 PEC surveys in the survey performance evaluation. Missing entries exceeded 5% for nine questions; we removed one and format-adjusted the rest as they had performed well during cognitive testing. There was strong inter-item correlation between two question pairs; however, all were retained as they individually assessed important concepts.

CONCLUSION

Revised from the original 61-question Picker survey, the 28-question PEC survey is the first UK instrument formally evaluated to assess parent experience while infants are still receiving neonatal care. Developed with parents, it focuses on communication and parent involvement, enabling continuous assessment and iterative improvement of family-centred interventions in neonatal care.