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Fernandez CSP, Adatsi G, Hays CN, Noble CC, Abel-Shoup M, Connolly A. Immersive Leadership Training for Physicians: Comparing Retrospective Pre- and Post-Test Virtual vs in-Person 6-Month Follow-Up of Learning. J Healthc Leadersh 2024; 16:235-254. [PMID: 38946733 PMCID: PMC11213530 DOI: 10.2147/jhl.s455105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Little is known about the long-term efficacy of virtual leadership training for physicians. This study compares two highly similar groups of Obstetricians-Gynecologists' (OB-GYN) 6-month post-program changes in competency and skills after experiencing equity-centered leadership training in a virtual or in-person format. Participants and Methods Using a retrospective pre- and post-test method, we collected 6-month post-program data on 14 competencies for knowledge gains and skills use, comparing the virtual cohort (2021, n = 22) to the in-person cohort (2022, n = 33) in 55 total participants. Qualitative data from open-ended feedback questions informed on skills relevancy and professional impact since program participation. Results Data indicate strong, statistically significant knowledge and skills retention in both cohorts, with 63% of the virtual and 85% of the in-person participants responding. Data indicate participants report the course having a positive impact on their healthcare provision and nearly all report they made changes to their communication and leadership approaches in the 6-months after the program. 59% of the virtual and 55% of the in-person cohorts report new leadership opportunities since their participation and that the course helped prepare them for those roles. Qualitative data support the need for the training, specific elements of the training these physicians found particularly helpful, and that the learning was "sticky", in that it stayed with them in the months post-program. There was a clear stated preference for in-person experiences. Conclusion Either virtual or in-person leadership training can result in long-term (6-month) significant retention and application of knowledge and skills in physicians. While limited in size, this study suggests that in-person experiences seem to foster more effective bonds and also greater willingness to participate in post-program follow-up. Physicians find equity-centered leadership training to impact their subsequent communication and leadership practices and they report career benefits even in 6-month follow-up.
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Affiliation(s)
- Claudia S P Fernandez
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Georgina Adatsi
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline N Hays
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cheryl C Noble
- Evaluation Consultant, CNoble Consulting, Scotts Valley, CA, USA
| | - Michelle Abel-Shoup
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - AnnaMarie Connolly
- American College of Obstetricians and Gynecologists, Washington, DC, USA
- Department of Obstetrics and Gynecology (Emeritus), UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Stefanescu BM, Henderson-Sears SE, Stefanescu AR, Allen JD. Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e3074-e3084. [PMID: 37827504 DOI: 10.1055/a-2190-8288] [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: 10/14/2023]
Abstract
OBJECTIVE This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit. STUDY DESIGN Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and "in effect" unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively. RESULTS Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03). CONCLUSION Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further. KEY POINTS · Virtual visitation technology can bridge the distance gap for families of hospitalized infants.. · Utilization of virtual technology is affected by socioeconomic factors and seasonal unit visitation restrictions.. · Factors influencing disparities in access and utilization of virtual technology need to be investigated further..
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Affiliation(s)
- Beatrice M Stefanescu
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Andrei R Stefanescu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Jayme D Allen
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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LaManna S, Hatfield B, McCann E. Considering the Influence of Social Determinants of Health on Parent Feeding Practices: A Case Example. Adv Neonatal Care 2024; 24:110-118. [PMID: 38241685 DOI: 10.1097/anc.0000000000001138] [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: 01/21/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. SDOH can be grouped into 5 domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. SDOH impact people's health and quality of life but may also contribute to disparities in access to food, education, and healthcare. SDOH uniquely influence parent feeding practices in the neonatal intensive care unit (NICU) in a variety of ways, ranging from logistical considerations for parent visitation to cultural beliefs such as family perception of human milk feeding. EVIDENCE ACQUISITION A hypothetical case example of a preterm infant with a feeding disorder in the NICU is used to connect SDOH that influence prenatal health, parental lived experience, and postnatal medical care to maternal and infant outcomes with implications for feeding practices. Barriers and facilitators to successful feeding practices in the NICU and at discharge are considered for each SDOH domain. RESULTS This case example increases awareness of SDOH and how they influence parent feeding practices in the NICU, focusing on the intersection of SDOH, parent stress, and oral feeding outcomes. Examples were provided for how to support applying findings into practice. IMPLICATIONS FOR PRACTICE AND RESEARCH By being creating a culture of SDOH awareness, NICU staff can assist families in overcoming barriers by putting supports in place to increase equitable participation in developmentally supportive feeding practices during the NICU stay.
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Affiliation(s)
- Stefanie LaManna
- Author Affiliation: American Speech-Language-Hearing Association, Rockville, Maryland (Mss LaManna and Hatfield); and Independent Researcher, Voorhees, New Jersey (Ms McCann)
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Harris LM, Shabanova V, Martinez-Brockman JL, Leverette D, Dioneda B, Parker MG, Taylor SN. Parent and grandparent neonatal intensive care unit visitation for preterm infants. J Perinatol 2024; 44:419-427. [PMID: 37573462 DOI: 10.1038/s41372-023-01745-x] [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] [Received: 04/21/2023] [Revised: 07/11/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Characterize family NICU visitation and examine associations with maternal health and social factors and infant health outcomes. STUDY DESIGN Retrospective cohort study of 167 infants born ≤32 weeks at two urban NICUs 01/2019-03/2020. Average nurse-documented family member visitation and associations of visitation with maternal and infant factors and outcomes were compared. RESULTS Mothers visited 4.4 days/week, fathers 2.6 days/week, and grandparents 0.4 days/week. Older maternal age, nulliparity, and non-English primary language were associated with more frequent family visitation. Mothers with depression or anxiety history visited less. Maternal depression and public insurance were associated with fewer father visits. Low parental visitation was associated with lower odds of feeding any maternal milk at discharge and low maternal visitation with 11.5% fewer completed infant subspecialty appointments in the year following discharge (95% CI -20.0%, -3.0%). CONCLUSION Families with social disadvantage visited less often. Parental visitation was associated with infant feeding and follow-up.
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Affiliation(s)
- Leslie M Harris
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | | | | | - Desiree Leverette
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Brittney Dioneda
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Margaret G Parker
- University of Massachusetts Chan School of Medicine, Department of Pediatrics, Worcester, MA, USA
| | - Sarah N Taylor
- Yale School of Medicine, Department of Pediatrics, New Haven, CT, USA.
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DiBari JN, Rouse L. Parent Perspectives: Part 1-Considerations for Changing the NICU Culture. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1735. [PMID: 38002826 PMCID: PMC10670714 DOI: 10.3390/children10111735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023]
Abstract
While publications that aim to reflect the parent perspective are increasingly common in the medical literature, few are authored by parents in their own words. As mothers with lived and professional experience in the Neonatal Intensive Care Unit (NICU), we believe this perspective is vital to improving health outcomes. We are writing from a life course health development framework that regards health as an active process that develops over time with the integration of physical, social, emotional, and relational components. Health development trajectories are shaped by the family and community ecosystems that surround each child. This means that the child's ability to thrive is strongly linked to the family's health and well-being. These links are not being given sufficient attention in clinical practice. Psychological distress, trauma, and grief are common family experiences in the NICU. Left unaddressed, they can negatively impact parent-child bonding. Drawing on life course principles, we make a series of recommendations for changes to practice to enable NICUs to better serve children and families, and better prepare families for the post-NICU experience. These include setting a positive tone in the NICU, creating a nurturing, personalized environment; addressing the social determinants of health; supporting families to develop a 'growth' mindset; and communicating in an optimistic, positive manner. Building trust is key to ensuring families feel supported and can be promoted through establishing equitable collaborative models of care. Peer support, doulas, and community health worker engagement can facilitate early interactions crucial to the child's developmental progress and family healing.
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Affiliation(s)
- Jessica N. DiBari
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD 20857, USA
| | - LaToshia Rouse
- Certified Doula at Birth Sisters Doula Services and Patient Engagement Consultant, Knightdale, NC 27545, USA;
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Fernandez CSP, Hays CN, Adatsi G, Noble CC, Abel-Shoup M, Connolly A. Comparing Virtual vs In-Person Immersive Leadership Training for Physicians. J Healthc Leadersh 2023; 15:139-152. [PMID: 37588727 PMCID: PMC10426446 DOI: 10.2147/jhl.s411091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/08/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose The COVID-19 pandemic caused a disruption of in-person workforce development programs. Our immersive physician-oriented leadership institute suspended in 2020, resumed in 2021 with a virtual program, and in 2022 reconvened in-person training. We used this opportunity to compare the participant experience, including reported knowledge acquisition and ability gains, between these nearly identical curricula delivered in vastly different circumstances and formats. Participants and Methods We describe the differences in immersive leadership training implementation and adaptations made for virtual vs in-person engagement of two cohorts of OB-GYN physicians. Data were collected from virtual (n=32) and in-person (n=39) participants via post-session surveys. Quantitative data reported includes participant ratings for knowledge gain and ability gain. Qualitative data were obtained via open-ended feedback questions per session and the overall experience. Results Knowledge and ability scores indicated strong, statistically significant gains in both formats, with some reported learning gains higher in the virtual training. Qualitative data of participant feedback identified a number of positive themes similar across the in-person and virtual settings, with virtual participants noting how construction of the virtual program produced highly effective experiences and engagement. Constructive or negative feedback of the virtual setting included time constraint issues (eg, a desire for more sessions overall or more time per session) and technical difficulties. Positive comments focused on the effectiveness of the experience in both formats and the surprising ability to connect meaningfully with others, even in a virtual environment. However, there were also many comments clearly supporting the preference for in-person over virtual experiences. Conclusion Immersive physician leadership training can be effectively delivered via virtual or in-person methods, resulting in significant reported gains of knowledge and skills. These programs provide valuable interpersonal connections and skills to support physician leadership. While both formats are effective, participants clearly prefer in-person leadership development experiences and interpersonal learning.
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Affiliation(s)
- Claudia S P Fernandez
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline N Hays
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Georgina Adatsi
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Michelle Abel-Shoup
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - AnnaMarie Connolly
- American College of Obstetricians and Gynecologists, Washington, DC, USA
- Department of Obstetrics and Gynecology (Emeritus), UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Joseph RA. Understanding Facilitators and Barriers to Providing Equity-Oriented Care in the NICU. Neonatal Netw 2023; 42:202-209. [PMID: 37491038 DOI: 10.1891/nn-2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 07/27/2023]
Abstract
The current study examined the use of immersive technology as a way to improve access to high-quality interpersonal breastfeeding interactions in an undergraduate clinical lactation course. In particular, we investigated the impact of immersive consultation videos and related activities on student self-efficacy, motivational beliefs, and perceived skill level. Results indicate that usability was high, with participants rating videos, interactives, and activities positively. Although no significant improvements in their level of interest or perceived skill were found, students did report a significant increase in self-efficacy and their perceived ability to meet the course learning objectives. Our results demonstrate that high-quality immersive videos can be an important learning tool for teaching clinical skills when access to direct patient care is limited or absent.
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DeForge CE, George M, Baldwin MR, South K, Beauchemin M, McHugh ME, Smaldone A. Do Interventions Improve Symptoms Among ICU Surrogates Facing End-of-Life Decisions? A Prognostically-Enriched Systematic Review and Meta-Analysis. Crit Care Med 2022; 50:e779-e790. [PMID: 35997501 PMCID: PMC10193371 DOI: 10.1097/ccm.0000000000005642] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Evaluate the efficacy of interventions to improve symptoms for ICU surrogates at highest risk of developing psychologic distress: those facing end-of-life care decisions. DATA SOURCES MEDLINE, CINAHL, PsycInfo, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched through April 16, 2022. STUDY SELECTION Following an a priori protocol, randomized trials of interventions delivered to surrogates of adult ICU patients who died or had high likelihood of mortality evaluating surrogate symptoms were identified. DATA EXTRACTION Two reviewers performed screening and data extraction and assessed risk of bias (Cochrane Risk of Bias [RoB] 2 tool). Trials were eligible for meta-analysis if group mean symptom scores were provided at 3 or 6 months. Pooled effects were estimated using a random effects model. Heterogeneity was assessed (Cochrane Q, I2 ). Certainty of evidence was assessed (Grading of Recommendations Assessment, Development and Evaluation). DATA SYNTHESIS Of 1,660 records, 10 trials met inclusion criteria representing 3,824 surrogates; eight were included in the meta-analysis. Overall RoB was rated Some Concerns. Most ( n = 8) interventions focused on improving communication and enhancing psychologic support in the ICU. All trials measured anxiety, depression, and posttraumatic stress. Significant improvement was seen at 3 months (depression, mean difference [MD], -0.68; 95% CI, -1.14 to -0.22, moderate certainty; posttraumatic stress, standardized MD, -0.25; 95% CI, -0.49 to -0.01, very low certainty) and 6 months (anxiety, MD, -0.70; 95% CI, -1.18 to -0.22, moderate certainty). Sensitivity analyses suggest significant findings may be unstable. Subgroup analyses demonstrated differences in effect by trial location, interventionist, and intervention dose. CONCLUSIONS Communication and psychological support interventions in the ICU yielded small but significant improvement in psychological symptoms with moderate to very low certainty evidence in a prognostically-enriched sample of ICU surrogates facing end-of-life care decisions. A new approach to interventions that extend beyond the ICU may be needed.
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Affiliation(s)
| | | | - Matthew R Baldwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | | | | | - Marlene E McHugh
- Columbia University School of Nursing, New York, NY
- Palliative Care Service, Department of Family Medicine, Montefiore Medical Center, New York, NY
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, NY
- College of Dental Medicine, Columbia University Irving Medical Center, New York, NY
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De la Rosa-Zamboni D, Adame-Vivanco MJ, Luque-Coqui M, Jaramillo-Esparza CM, Ortega-Riosvelasco F, Reyna-Trinidad I, Guerrero-Díaz AC, Ortega-Ruiz SG, Saldívar-Salazar S, Villa-Guillen M, Nieto-Zermeño J, Bonilla-Pellegrini SR, Jamaica Balderas LMDC. Allowing access to parents/caregivers into COVID-19 hospitalization areas does not increase infections among health personnel in a pediatric hospital. Front Pediatr 2022; 10:896083. [PMID: 36186649 PMCID: PMC9515413 DOI: 10.3389/fped.2022.896083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background At the beginning of the current COVID-19 pandemic, it became critical to isolate all infected patients, regardless of their age. Isolating children has a negative effect on both, them and their parents/caregivers. Nevertheless isolation was mandatory because of the potential risk that visitation might have on COVID-19 dissemination mostly among health personnel. Methods From the starting of the COVID-19 pandemic in our pediatric hospital visits were forbidden. This 2 months period (April-May) was called P1. In June parents were allowed to visit (P2), under a visiting protocol previously published. Hospital workers were monitored for the presence of COVID-19 symptoms and tested for the infection when clinically justified. The positivity proportion and the relative risk (RR) of COVID-19 among the health personnel between periods were calculated. The caregivers were also followed up by phone calls. Results Since April 2020 to November 2020, 2,884 health personnel were studied for 234 days, (318,146 workers days). Although the COVID-19/1,000 health personnel days rate decreased from one period to another (1.43 vs 1.23), no statistically significant differences were found. During P1, 16 patients with COVID-19 were treated. During the follow up none of the family members were infected/symptomatic in P1, while in P2, 6/129 (4.65%) were symptomatic or had a positive test. All of them initiated between 2 and 4 days after the patient's admission. As they also had some other infected family members it was not possible to ensure the source of infection. There were no statistically significant differences in the RR of COVID-19 in health personnel, (RR 1, 95% CI 0.69-1.06, p = 0.162). Conclusions When safely implemented, allowing parents/caregivers to spend time with their hospitalized COVID-19 children does not increase the contagion risk for hospital workers or among themselves.
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Affiliation(s)
- Daniela De la Rosa-Zamboni
- Department of Comprehensive Patient Care, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - María José Adame-Vivanco
- Pediatric Psychology Coordination, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Mercedes Luque-Coqui
- Pediatric Psychology Coordination, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Irineo Reyna-Trinidad
- Department of Nursing, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Jang CJ, Lee HC. A Review of Racial Disparities in Infant Mortality in the US. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020257. [PMID: 35204976 PMCID: PMC8870826 DOI: 10.3390/children9020257] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022]
Abstract
Racial disparities in infant mortality have persisted, despite the overall decline in the United States’ overall infant mortality rate (IMR). The overall IMR of the entire United States (5.58 per 1000 live births) population masks significant disparities by race and ethnicity: the non-Hispanic Black population experienced an IMR of 10.8 followed by people from Native Hawaiian or Other Pacific Islander populations at 9.4 and American Indians at 8.2. The non-Hispanic White and Asian populations in the United States have the lowest IMR at 4.6 and 3.6, respectively, as of 2018. A variety of factors that characterize minority populations, including experiences of racial discrimination, low income and education levels, poor residential environments, lack of medical insurance, and treatment at low-quality hospitals, demonstrate strong correlations with high infant mortality rates. Identifying, acknowledging, and addressing these disparities must be performed before engaging in strategies to mitigate them. Social determinants of health play a major role in health disparities, including in infant mortality. The study and implementation of programs to address neighborhood factors, education, healthcare access and quality, economic stability, and other personal and societal contexts will help us work towards a common goal of achieving health equity, regardless of racial/ethnic background.
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Affiliation(s)
- Caleb J. Jang
- College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL 61801, USA
- Correspondence: (C.J.J.); (H.C.L.)
| | - Henry C. Lee
- Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
- Correspondence: (C.J.J.); (H.C.L.)
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Kelleher J, Dempsey J, Takamatsu S, Paul JJ, Kent E, Dempsey AG. Adaptation of infant mental health services to preterm infants and their families receiving neonatal intensive care unit services during the COVID-19 pandemic. Infant Ment Health J 2022; 43:100-110. [PMID: 34997613 PMCID: PMC9015475 DOI: 10.1002/imhj.21961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/20/2021] [Indexed: 11/11/2022]
Abstract
Multiple changes and stressors at the family, hospital, and societal levels have resulted from the COVID‐19 pandemic that impact the early social environment of infants in Neonatal Intensive Care Unit (NICU) settings. This manuscript reviews these pandemic‐related adversities, including hospital‐wide visitor restrictions, mask requirements that interfere with caregiver facial expressions, parental anxiety about virus transmission, and reduced support services. We will further describe adaptations to mental health service delivery and approaches to care in the NICU to mitigate increased risk associated with pandemic‐related adversities. Adaptations include integration of technology, staff education and support, and delivery of activity kits to encourage parent–infant bonding. Data was collected as part of routine program evaluation of infant mental health services from one 50‐bed NICU setting and describes family concerns, barriers to visitation, and utilization of mental health services during the pandemic. Concerns related to COVID‐19 rarely emerged as the primary presenting issue by the families referred for infant mental health services from April through December of 2020. However, a number of families indicated that infection concerns and visitation restrictions posed significant challenges to their parenting and/or coping. There were significant discrepancies noted between the visitation patterns of families with public and private insurance. Several adaptations were developed in response to the multiple challenges and threats to infant mental health present during the COVID‐19 pandemic.
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Affiliation(s)
- Jessalyn Kelleher
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jack Dempsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephanie Takamatsu
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer J Paul
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Evamaria Kent
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Allison G Dempsey
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
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Patrick-Esteve J, Mumphrey C, Yu D, Masoumy E, Lawson J, Hebert D, Barkemeyer B. Extracorporeal membrane oxygenation in the care of a preterm infant with COVID-19 infection: Case report. Front Pediatr 2022; 10:953122. [PMID: 36034575 PMCID: PMC9412163 DOI: 10.3389/fped.2022.953122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first reported to the World Health Organization (WHO) in December 2019 and has since unleashed a global pandemic, with over 518 million cases as of May 10, 2022. Neonates represent a very small proportion of those patients. Among reported cases of neonates with symptomatic COVID-19 infection, the rates of hospitalization remain low. Most reported cases in infants and neonates are community acquired with mild symptoms, most commonly fever, rhinorrhea and cough. Very few require intensive care or invasive support for acute infection. We present a case of a 2-month-old former 26-week gestation infant with a birthweight of 915 grams and diagnoses of mild bronchopulmonary dysplasia and a small ventricular septal defect who developed acute respiratory decompensation due to COVID-19 infection. He required veno-arterial extracorporeal membrane oxygenation support for 23 days. Complications included liver and renal dysfunction and a head ultrasound notable for lentriculostriate vasculopathy, extra-axial space enlargement and patchy periventricular echogenicity. The patient was successfully decannulated to conventional mechanical ventilation with subsequent extubation to non-invasive respiratory support. He was discharged home at 6 months of age with supplemental oxygen via nasal cannula and gastrostomy tube feedings. He continues to receive outpatient developmental follow-up. To our knowledge, this is the first case report of a preterm infant during their initial hospitalization to survive ECMO for COVID-19.
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Affiliation(s)
- Jessica Patrick-Esteve
- Department of Pediatrics-Division of Neonatology, Children's Hospital New Orleans, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - Christy Mumphrey
- Department of Pediatrics-Division of Neonatology, Children's Hospital New Orleans, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - David Yu
- Department of Surgery, Children's Hospital of New Orleans, Tulane University School of Medicine, New Orleans, LA, United States
| | - Emily Masoumy
- Department of Pediatrics-Division of Neonatology, Children's Hospital New Orleans, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - Jeremy Lawson
- Department of Pediatrics-Division of Neonatology, Children's Hospital New Orleans, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, United States
| | - David Hebert
- Department of Respiratory, Children's Hospital New Orleans, New Orleans, LA, United States
| | - Brian Barkemeyer
- Department of Pediatrics-Division of Neonatology, Children's Hospital New Orleans, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, United States
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The Implications of COVID-19 on Family-Centered Care in the NICU. Neonatal Netw 2022; 41:45-50. [PMID: 35105794 DOI: 10.1891/nn-2021-0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/25/2022]
Abstract
During the recent COVID-19 pandemic, neonatal intensive care units (NICUs) issued strict visiting policies that limited parent visitation and impacted how family-centered care was practiced. This article describes how these visiting policies impacted parents and neonates. Implications for clinical practice and future research will also be discussed.
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McCulloch H, Campbell-Yeo M, Richardson B, Dol J, Hundert A, Dorling J, Whitehead L, MacRae G, Bishop T, Afifi J, Earle R, Rose AE, Foye S, Inglis D, Kim T, Leighton C, Melanson A, Simpson DC, Smit M. The Impact of Restrictive Family Presence Policies in Response to COVID-19 on Family Integrated Care in the NICU: A Qualitative Study. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:49-62. [PMID: 34931565 PMCID: PMC9072949 DOI: 10.1177/19375867211065178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: To conduct a needs assessment with families and their healthcare team to understand the impact of restrictive family presence policies in the neonatal intensive care unit (NICU) in response to COVID-19. Background: In response to the COVID-19 pandemic, significant restrictive family presence policies were instituted in most NICUs globally intended to protect infants, families, and HCPs. However, knowledge on the impact of the stress of the pandemic and policies restricting family presence in the NICU on vulnerable neonates and their families remains limited. Methods: Individuals were eligible to participate if they were a caregiver of an infant requiring NICU care or a healthcare provider (HCP) in the NICU after March 1, 2020. Semi-structured interviews were conducted using a virtual communication platform, and transcripts were analyzed using inductive thematic qualitative content analysis. Results: Twenty-three participants were interviewed (12 families and 11 HCPs). Three themes emerged: (1) successes (family-integrated care, use of technology), (2) challenges (lack of standardized messaging and family engagement, impact on parental wellbeing, institutional barriers, and virtual care), and (3) moving forward (responsive and supportive leadership). Conclusions: Our findings highlight the significant impact of family restrictions on the mental well-being of families, physical closeness with parents, and empathetic stress to HCPs. Further study of potential long-term impact is warranted.
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Affiliation(s)
| | - Marsha Campbell-Yeo
- IWK Health, Halifax, Nova Scotia, Canada.,Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brianna Richardson
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Justine Dol
- IWK Health, Halifax, Nova Scotia, Canada.,Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | - Sarah Foye
- IWK Health, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Mike Smit
- School of Information Management, Dalhousie University, Halifax, Nova Scotia, Canada
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Doctor PN, Kamat D, Sood BG. Changes in Clinical Care of the Newborn During COVID-19 Pandemic: From the Womb to First Newborn Visit. Pediatr Clin North Am 2021; 68:1055-1070. [PMID: 34538298 PMCID: PMC8133491 DOI: 10.1016/j.pcl.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
COVID-19 has afflicted the health of children and women across all age groups. Since the outbreak of the pandemic in December 2019, various epidemiologic, immunologic, clinical, and pharmaceutical studies have been conducted to understand its infectious characteristics, pathogenesis, and clinical profile. COVID-19 affects pregnant women more seriously than nonpregnant women, endangering the health of the newborn. Changes have been implemented to guidelines for antenatal care of pregnant women, delivery, and newborn care. We highlight the current trends of clinical care in pregnant women and newborns during the COVID-19 pandemic.
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Affiliation(s)
- Pezad N. Doctor
- Department of Pediatrics, Children’s Hospital of Michigan, 3901, Beaubien Boulevard, Detroit, MI 48201, USA,Corresponding author. Office of Pediatric education, 3901 Beaubien, Detroit, MI 48201
| | - Deepak Kamat
- Department of Pediatrics, UT Health Science Center, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Beena G. Sood
- Department of Pediatrics, Wayne State University School of Medicine, 540E Canfield Street, Detroit, Michigan 48201, USA
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