Parents' Satisfaction With Care in the Neonatal Intensive Care Unit: The Role of Sociocultural Factors

This study explores factors related to parents' expectations and assessments of care in a newborn intensive care unit (NICU) in Israel. Sixty-three couples, including Moslems, ultraorthodox Jews, and secular or traditional Jews, were interviewed shortly following admission regarding their expectations of the NICU staff and again 2 to 3 weeks following discharge regarding their assessments of the actual care, using both closed and open-ended questions. Mothers' expectations were higher than their assessments of actual care. They were also higher than fathers' expectations in both Jewish groups, but not for Moslem parents. Differences among groups were observed for expectations regarding communication and emotional support from the staff. Differences were also observed regarding parents' assessments of physician, nurse, and social worker behaviors. Implications of the findings for child health care in multicultural environments are discussed.     

Understanding Utilization of Outpatient Clinics for Children with Special Health Care Needs in Southern Israel

To understand the pattern of utilization of ambulatory care by parents of children with special health care needs (CSHCN) and to explore parental challenges in coping with health maintenance of their infants after discharge from a neonatal intensive care unit (NICU). CSHCN require frequent utilization of outpatient ambulatory clinics especially in their first years of life. Multiple barriers are faced by families in disadvantaged populations which might affect adherence to medical referrals. Our study attempts to go beyond quantitative assessment of adherence rates, and capture the influence of parental agency as a critical factor ensuring optimal utilization of healthcare for CSHCN. A prospective, mixed-methods, cohort study followed 158 Jewish and Bedouin-Arab infants in the first year post discharge from NICU in southern Israel. Rates of utilization of ambulatory clinics were obtained from medical records, and quantitative assessment of factors affecting it was based on structured interviews with parents at baseline. Qualitative analysis was based on home visits or telephone in-depth interviews conducted about 1 year post-discharge, to obtain a rich, multilayered, experiential perspectives and explained perceptions by parents. Adherence to post-discharge referrals was generally good, but environmental, cultural, and financial obstacles to healthcare, magnified by communication barriers, forced parents with limited resources to make difficult choices affecting utilization of healthcare services. Improving concordance between primary caregivers and health care providers is crucial, and further development of supportive healthcare for CSHCN in concordance with parental limitations and preferences is needed.     

Partners in Growth: Implementing Family-Centered Changes in the Neonatal Intensive Care Unit

Although there are several forces driving changes with regard to parents within neonatal intensive care units (NICUs), they all culminate in the ideals represented in family-centered care. This article examined the variables that are perceived by parents to be barriers to their assumption of parental roles while their infants were hospitalized in the NICU. Data were used to support and implement pragmatic changes in program development and service delivery within the NICU.     

Partners in Growth: Implementing Family-Centered Changes in the Neonatal Intensive Care Unit

Although there are several forces driving changes with regard to parents within neonatal intensive care units (NICUs), they all culminate in the ideals represented in family-centered care. This article examined the variables that are perceived by parents to be barriers to their assumption of parental roles while their infants were hospitalized in the NICU. Data were used to support and implement pragmatic changes in program development and service delivery within the NICU.     

超早期干预对早产儿智能和体格发育的影响

目的 探讨超早期干预对早产儿智能和体格发育的临床效果.方法 选择2005年8月至2008年7月在本院新生儿重症监护病房(NICU)住院的出生时胎龄为30～36孕周的早产儿120例(除外先天畸形和遗传代谢性疾病)为研究对象.按照家长是否自愿让新生儿参加超早期干预模式指导的原则,将其分别纳入干预组(n=60)和对照组(n=60)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书).对两组早产儿于NICU住院期间在进行常规治疗的同时,当干预组早产儿生命体征稳定后,即给予超早期干预模式治疗,该模式为多感官刺激为主的康复训练,包括强化体操、动作和运动训练干预,而对照组早产儿不接受相应干预.白早产儿出院后,两组均在家中由家长按照本研究制定的早期教育计划对早产儿进行早期教育,均定期接受<盖塞尔量表>智能及体格发育指标评价.干预组则在早期教育基础上,继续按照超早期干预模式对早产儿重点进行强化体操、动作和运动训练干预.结果 干预组早产儿于NICU的平均住院时间(8 d)显著短于对照组(15 d).两组比较,差异有统计学意义(P<0.05).干预组早产儿6个月龄及12个月龄时,平均发育商(DQ)(粗大动作能力、精细动作能力、应物能力、语占能力、应人能力5个能区)均高于对照组,且差异有统计学意义(P<0.05).结论 对早产儿采取超早期干预模式进行干预,可促进早产儿的消化、呼吸等器官功能成熟,缩短住院时间,明显促进早产儿的智能和体格发育.     

‘Opportunity to bond and a sense of normality’: Parent and staff views of cuddling babies undergoing therapeutic hypothermia in neonatal intensive care: ‘CoolCuddle’

BackgroundCurrently, parents whose sick babies are undergoing three days of cooling therapy for hypoxic–ischaemic encephalopathy in neonatal intensive care units (NICUs) are not permitted to cuddle their cooled babies, due to concerns of warming the baby or dislodging breathing tubes or vascular catheters. Parents want to stay and care for their cooled babies and have reported that bonding is adversely affected when they are not permitted to hold them.Design and ParticipantsQualitative interviews with 21 parents of cooled babies in NICU (11 mothers and 10 fathers) and 10 neonatal staff (4 consultants and 6 nurses) explored their views and experiences of an intervention to enable parents to cuddle their cooled babies (CoolCuddle). Thematic analysis methods were used to develop the themes and compare them between parents and staff.ResultsFive themes were produced. Three themes were comparable between parents and staff: Closeness, a sense of normality and reassurance and support. An additional parent theme reflected their mixed feelings about initial participation as they were apprehensive, but felt that it was an amazing opportunity. Parents and staff described the closeness between parents and babies as important for bonding and breastfeeding. Fathers particularly appreciated the opportunity to hold and bond with their infants. Parents valued the reassurance and support received from staff, and the cuddles helped them feel more normal and more like a family at a very stressful time. In a final staff theme, they discussed the skills, number of staff and training needed to undertake CoolCuddle in NICU.ConclusionsParents cuddling their babies during cooling therapy enhanced parent–infant bonding and family‐centred care in NICU and was positively received. Adverse perinatal mental health, impaired mother–infant bonding and their effects on the establishment of breastfeeding may be ameliorated by introducing CoolCuddle.Patient ContributionOur parent advisors contributed to the interview topic guides and endorsed the themes from the analysis.     

Adolescent girls' and boys' preferences for provider gender and confidentiality in their health care.

PURPOSE: To assess the influence of demographic variables and health risk status on adolescents' preferences and actual receipt of services regarding provider gender, sharing a physician with parents, and private examinations. METHODS: Data from students participating in the Commonwealth Fund 1997 Survey of the Health of Adolescent Girls were analyzed. The weighted sample included 6748 students from grades 5-12. The influence of demographic variables and health risk status on preferences regarding physician gender, sharing a physician with parents, and parental presence during examinations and on actual physician gender, sharing a physician with parents, and receipt of confidential care was assessed for the 5067 students who indicated that they had a health check-up or physical examination within the past 2 years. Associations were examined using SAS to determine preliminary estimates of significance and correlation coefficients, and SUDAAN to generate proportions and Cochran Mantel-Haenszel Chi-squared values. A multiple logistic regression procedure in SUDAAN was used to assess interaction among demographic variables. RESULTS: Gender, race/ethnicity, grade level, and risk status were associated with preferences regarding provider gender and sharing a physician with parents. 50% of girls preferred a female provider; 48% had no preference. 23% of boys preferred a male provider; 65% had no preference. Most adolescents had no preference regarding whether they shared a physician with parents. Gender, race/ethnicity, grade level, and risk status were associated with preference regarding parental presence during examinations. Most younger girls preferred to have a parent present; most younger boys had no preference. Most older girls and boys preferred private examinations. For actual care situation, most adolescents were cared for by male health providers and did not share a physician with parents. 57% of girls and 66% of boys spoke privately with their health provider. Girls who had a female physician were more likely to have private time than were girls receiving care from a male physician. Gender, grade level, and risk status were associated with having private time with a physician. CONCLUSIONS: Gender was a significant variable in adolescents' preferences regarding health care. Preferences were also influenced by race/ethnicity, grade level, and risk status. A substantial proportion of adolescents, including those involved in health risk activities, report not having private time with their health provider.     

Parent Preparation for the NICU-to-Home Transition: Staff and Parent Perceptions

Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided.     

Parent Preparation for the NICU-to-Home Transition: Staff and Parent Perceptions

Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided.     

Prevalence and Predictors of Back-Transport Closer to Maternal Residence After Acute Neonatal Care in a Regional NICU

Objectives To describe the demographics, clinical characteristics and referral patterns of premature infants to a regional level IV neonatal intensive care unit (NICU); to determine the prevalence and predictors of back-transport of infants?≤?32 weeks gestational age in a level IV NICU; for infants not back-transported closer to maternal residence, determine the length of stay beyond attainment of clinical stability. Methods Data (2010–2014) from the Children’s Hospital Neonatal Database and individual chart review for infants?≤?32 weeks admitted to a level IV NICU whose maternal residence was outside the metro area were included. Bivariate associations of maternal and infant characteristics with back-transport were estimated using two-sample t tests and Fisher’s exact test. Multivariable logistic regression was used to measure independent predictors of back-transport. Clinical stability was defined as the attainment of full volume enteral feedings and low flow nasal cannula. Results A total of 223 infants were eligible for analysis; of whom 26% were back-transported after acute care. In the adjusted analysis, insurance status, distance from maternal residence and gestational age were significantly associated with back-transport. For infants not back-transported closer to maternal residence, median length of stay in the level IV NICU beyond attainment of clinical stability was 28.5 days. Conclusion for Practice Predictors of back-transport include private insurance, greater distance of maternal residence from NICU and younger gestational age. Many preterm infants admitted to a regional NICU for acute care remained hospitalized in a level IV NICU after achieving clinical stability, for which care in a NICU closer to maternal residence may be appropriate.

     

Prolonged travel time to neonatal intensive care unit does not affect content of parental visiting: a controlled prospective study.

Decreased local obstetric care appears to be increasing the rate of premature births to rural populations. With increased numbers of premature and complicated births in rural populations, understanding the impact of the Neonatal Intensive Care Unit (NICU) environment on the development of parent-child relationships becomes critical. NICU infants appear to be at increased risk for failure to thrive, child abuse, and neglect. Some reports suggest that the frequency of parental visits to the NICU can predict infants likely to be at risk. Because rural parents visiting infants hospitalized in urban centers are likely to visit less often, understanding this possible relationship is critical. In this controlled prospective study, three groups of parents were observed visiting their hospitalized infants: (1) those visiting "in house" while the mother was still hospitalized; (2) those whose visits required one hour or less in travel time; and (3) those whose visits required more than one hour in travel time. Results showed that travel time influenced the frequency of visits, with fewer visits from those living furthest from the NICU. However, those visiting from greater distances stayed with their infants longer so that there was no difference in the total visiting time over a two-week period. Direct observations of the visits by both mothers and fathers showed no differences in the content of parent-child interactions among groups. Thus, visit frequency alone must be viewed cautiously as a potential indicator of failure to bond with a hospitalized infant, especially in settings serving rural populations.     

A Qualitative Examination of Physician Gender and Parental Status in Pediatric End-of-Life Communication

In this study we utilized the framework of patient-centered communication to explore the influence of physician gender and physician parental status on (1) physician-parent communication and (2) care of pediatric patients at the end of life (EOL). The findings presented here emerged from a larger qualitative study that explored physician narratives surrounding pediatric EOL communication. The current study includes 17 pediatric critical care and pediatric emergency medicine physician participants who completed narrative interviews between March and October 2012 to discuss how their backgrounds influenced their approaches to pediatric EOL communication. Between April and June of 2013, participants completed a second round of narrative interviews to discuss topics generated out of the first round of interviews. We used grounded theory to inform the design and analysis of the study. Findings indicated that physician gender is related to pediatric EOL communication and care in two primary ways: (1) the level of physician emotional distress and (2) the way physicians perceive the influence of gender on communication. Additionally, parental status emerged as an important theme as it related to EOL decision-making and communication, emotional distress, and empathy. Although physicians reported experiencing more emotional distress related to interacting with patients at the EOL after they became parents, they also felt that they were better able to show empathy to parents of their patients.     

Support for siblings of NICU patients: an interdisciplinary approach

Siblings of hospitalized newborns in neonatal intensive care units (NICU) experience unique thoughts and feelings in response to this situational crisis. Providing an opportunity for siblings and their parents to address both of their concerns can improve sibling adjustment to the NICU, and is also consistent with a family-centered care philosophy. This article traces the development and evolution of sibling policy and program changes at Helen DeVos Children's Hospital (HDVCH) NICU, and describes the current comprehensive model for inclusion of siblings. Particular emphasis will be given to the cornerstone program "Celebrating Siblings Pizza Party." Infection control considerations and the importance of an interdisciplinary team approach to enhance an array of sibling services are also highlighted.     

Support for Siblings of NICU Patients: An Interdisciplinary Approach

Siblings of hospitalized newborns in neonatal intensive care units (NICU) experience unique thoughts and feelings in response to this situational crisis. Providing an opportunity for siblings and their parents to address both of their concerns can improve sibling adjustment to the NICU, and is also consistent with a family-centered care philosophy. This article traces the development and evolution of sibling policy and program changes at Helen DeVos Children's Hospital (HDVCH) NICU, and describes the current comprehensive model for inclusion of siblings. Particular emphasis will be given to the cornerstone program “Celebrating Siblings Pizza Party.” Infection control considerations and the importance of an interdisciplinary team approach to enhance an array of sibling services are also highlighted.     

以家庭为中心的出院计划在NICU早产儿中的应用效果

目的观察以家庭为中心的出院计划在新生儿童重症监护(NICU)早产儿中的应用效果。方法 120例早产儿按时间先后分为对照组和观察组。比较两组早产儿出院时家长的家庭照护能力、出院后1周的护理工作满意度和出院后1个月内的再住院率。结果观察组早产儿出院时家长的家庭照护能力明显高于对照组。观察组早产儿出院后1周的护理工作满意度明显高于对照组。观察组早产儿出院后1个月内的再住院率明显低于对照组(P0.05)。结论以家庭为中心的出院计划在早产儿中的应用,能提高早产儿家长的家庭照护能力,降低早产儿出院后1个月内的再住院率,提高家属对护理工作的满意度。     

Use of an east end children''s accident and emergency department for infants: a failure of primary health care?

OBJECTIVE--To ascertain why parents use an accident and emergency department for health care for their infants. DESIGN--Prospective one month study. SETTING--One accident and emergency department of a children's hospital in the east end of London. SUBJECTS--Parents of 159 infants aged < 9 months attending as self referrals (excluding infants attending previously or inpatients within one month, parents advised by the hospital to attend if concerned about their child's health, infants born abroad and arrived in Britain within the previous month). MAIN MEASURES--Details of birth, postnatal hospital stay, contact with health professionals, perceptions of roles of community midwife and health visitor, and current attendance obtained from a semistructured questionnaire administered in the department by a research health visitor; diagnosis, discharge, and follow up. RESULTS--152(96%) parents were interviewed, 43(28%) of whom were single parent and 68(45%) first time mothers. Presenting symptoms included diarrhoea or vomiting, or both (34, 22%), crying (21, 14%), and feeding difficulties (10, 7%). Respiratory or gastrointestinal infection was diagnosed in 70(46%) infants. Only 17(11%) infants were admitted; hospital follow up was arranged for 27(20%) infants not admitted. Most (141, 94%) parents were registered with a general practitioner; 146(27%) had contact with the community midwife and 135(89%) the health visitor. CONCLUSION--Most attendances were for problems more appropriately dealt with by primary care professionals owing to patients' perceptions of hospital and primary health care services. IMPLICATIONS--Closer cooperation within the health service is needed to provide a service responsive to the real needs of patients.     

Rural parents' communication with their teen-agers about sexual issues

This survey assessed rural parents' (n = 374) perceptions of the characteristics, content, and comfort level of discussions about sexual issues with their teens. Almost all parents (94%) reported they had talked with their teens about sex. Two-thirds (65%) reported being comfortable talking with their teens about sexual issues. From a list of 17 potential topical areas in sexual communication, parents were most likely to discuss with their teens the responsibilities of being a parent (46%), sexually transmitted diseases (40%), dating behavior (37%), and not having sex until marriage (36%). Most parents (80%) believed that the majority of sexuality education should be provided by the family and supplemented by outside organizations, preferably schools. Almost all parents (92%) believed sexuality education should include information on birth control methods including condoms. Almost two of three parents (64%) believed schools should begin teaching sexuality education before students reach seventh grade. Parents (52%) claimed they could best be helped in communicating with their teens by receiving a regular newsletter regarding teen sexual issues.     

Adolescents' health beliefs are critical in their intentions to seek physician care

BACKGROUND: The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems. METHODS: Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care. RESULTS: Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001). CONCLUSIONS: Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.     

Likelihood of nursing home referral for fecally incontinent elderly patients is influenced by physician views on nursing home care and outpatient management of fecal incontinence

Objectives(1) Characterize physicians’ management practices for fecal incontinence (FI) among elderly patients, (2) describe physician perceptions of the quality of care for FI provided in nursing homes (NH), and (3) identify physician views and attributes associated with referral of elderly patients with FI to an NH.DesignCross-sectional.SettingUnited States.ParticipantsPhysician members of the American Geriatrics Society.MeasurementsQuestionnaire pertaining to physician views on (1) their own FI management practices, (2) management of FI in NHs, and (3) referral of an elderly patient with FI to an NH.ResultsOf the respondents (n = 606), 54.1% reported screening for FI and 59.3% thought FI could be managed conservatively on an outpatient basis. Only 32.9% believed NHs provide good care for FI, and 27.1% believed NH care conditions exacerbate FI. Responding to a hypothetical vignette, 10.6% would probably or definitely refer an older adult patient with only FI to an NH, and 17.2% were uncertain about whether or not to refer. Logistic regression analysis identified physician characteristics associated with decreased likelihood of NH referral as the belief that FI can be managed conservatively, the belief that NHs provide poor care for FI, longer practice experience, and practicing in an academic medical center.ConclusionMost geriatricians believe FI can be managed conservatively and that NHs provide poor care for FI. These beliefs plus longer years of practice and practice in an academic setting decrease the likelihood of referral to NH for patients with FI.     

Neonatal intensive-care unit admission of infants with very low birth weight --- 19 States, 2006

Neonatal mortality is disproportionately common among infants with very low birth weight (VLBW) (<1,500 g [3.3 lbs]). In 2006, the mortality rate among infants with VLBW was 240.4 per 1,000 live births. Because neonatal intensive care has been shown to reduce mortality among infants with VLBW, current standards call for neonatal intensive-care for all infants with VLBW; however, the proportion of infants with VLBW who are admitted to a neonatal intensive care unit (NICU) is not known, nor are the predictors for NICU admission. To estimate the prevalence of admission to NICUs among infants with VLBW and assess factors predicting admission, CDC analyzed birth data from 2006 for 19 states. This report summarizes the results of that analysis, which found that overall, 77.3% of infants with VLBW were admitted to NICUs (range: 63.7% in California to 93.4% in North Dakota). Among infants with VLBW born to Hispanic mothers, 71.8% were admitted to NICUs, compared with 79.5% of those with non-Hispanic black mothers and 80.5% of those with non-Hispanic white mothers. Multivariate analysis of the data indicated that preterm delivery, multiple births, and cesarean delivery all were independently associated with greater prevalence of NICU admission among infants with VLBW. Wide variation was observed among states in the prevalence of NICU admission of infants with VLBW; these state data should be assessed further, and barriers to NICU admission should be identified and addressed.