Neonatal Intensive Care Unit Staff Research Articles

Implementation of an Extubation Readiness Guideline for Preterm Infants.

Intubated preterm infants 326/7 weeks or less of gestation in a mid-Atlantic level IV neonatal intensive care unit (NICU) faced a high number of ventilator days. Based on 6 weeks of electronic health record (EHR) chart audits of extubations in this NICU in 2021, 44% of preterm infants 326/7 weeks or less of gestation were intubated for more than 28 days, with an average of 23 days on a ventilator. This NICU lacked a standardized extubation guideline providing criteria to drive extubation eligibility. The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an extubation readiness guideline in preterm infants 326/7 weeks or less of gestation in a mid-Atlantic level IV NICU. This project occurred over a 17-week period in 2021. Implementation included a multidisciplinary committee formation, identification of champions, NICU staff education, completion of a guideline checklist by bedside nursing (for eligible patients), clinician reminders, and chart audits for collection of pre-/postimplementation data. Staff education completion, guideline use and compliance, demographic patient data, ventilator days, time to first extubation, and need for reintubation were tracked. Postimplementation data indicated decreased need for intubation for more than 28 days, ventilator days, and days to first extubation attempt. Results suggested that implementation of the evidence-based guideline was effective in decreasing average total ventilator days for preterm infants 326/7 weeks or less of gestation.

The Neonatal Intensive Care Unit (NICU) Context and the Perceived Soundscape: A Grounded Theory Approach.

Studies address excessive sound levels and their adverse effects on infants in neonatal intensive care units (NICUs). However, objective measurements represent merely one aspect of the acoustic environment, and investigations into staff's perceptions of the acoustic environment remain scarce in the NICU context. A holistic approach, soundscape, is needed to explore the acoustic environment in-depth. This study aims to (1) contribute to indoor soundscape literature and inform decision-makers of future NICU design and research by focusing on staff members' perceptions of the soundscape and (2) explore whether there is a relationship between staff members' perceptions of soundscapes and the built and acoustic environments of one NICU. Following the ISO/TS 12913-2/3 protocols, semi-structured interviews were conducted with 10 NICU staff members and analyzed using the grounded theory to generate a conceptual framework for NICU soundscapes. The results indicated that the task-related sounds, including false alarms, were neutrally responded to as they evoked acceptance and adaptation behaviors. The sound sources perceived as irrelevant were responded to negatively. NICU staff indicated that although they expect to hear alarms clearly, specific features of alarms caused several physiological and psychological problems. The findings of the study revealed the importance of conducting a soundscape approach to investigate NICU acoustic environment in detail. The study showed that staff members' perceptions and responses primarily depend on the context rather than on sound levels.

MHealth Gratitude Exercise Mindfulness App for Resiliency Among Neonatal Intensive Care Unit Staff: Three-Arm Pretest-Posttest Interventional Study.

Health care is highly complex and can be both emotionally and physically challenging. This can lead health care workers to develop compassion fatigue and burnout (BO), which can negatively affect their well-being and patient care. Higher levels of resilience can potentially prevent compassion fatigue and BO. Strategies that enhance resilience include gratitude, exercise, and mindfulness. The purpose of this study was to determine if a 3-week daily resiliency practice, prompted via a gratitude, exercise, and mindfulness smartphone app, impacted the professional quality of life, physical activity, and happiness level of health care workers in a newborn intensive care unit setting. In total, 65 participants from a level III newborn intensive care unit at a regional hospital in the western United States completed this study. The Professional Quality of Life Scale, Physical Activity Vital Sign, and Subjective Happiness Score instruments were used to evaluate the effects of the mobile health (mHealth) intervention. Further, 2-tailed dependent paired t tests were used to evaluate participant pre- and postintervention instrument scores. Multiple imputation was used to predict scores of participants who practiced an intervention but did not complete the 3 instruments post intervention. Dependent t tests using the original data showed that participants, as a whole, significantly improved in BO (t35=2.30, P=.03), secondary trauma stress (STS; t35=2.11, P=.04), and happiness (t35=-3.72, P<.001) scores. Compassion satisfaction (CS; t35=-1.94, P=.06) and exercise (t35=-1.71, P=.10) were trending toward, but did not reach, significance. Using the original data, only the gratitude intervention group experienced significant improvements (CS, BO, and happiness), likely due to the higher number of participants in this group. Analysis using imputed data showed that participants, as a whole, had significant improvements in all areas: CS (t64=-4.08, P<.001), BO (t64=3.39, P=.001), STS (t64=4.08, P<.001), exercise (t64=-3.19, P=.002), and happiness (t64=-3.99, P<.001). Looking at the intervention groups separately using imputed data, the gratitude group had significant improvements in CS, BO, STS, and happiness; the exercise group had significant improvements in STS and exercise; and the mindfulness group had significant improvements in CS and happiness. Phone app delivery of resilience-enhancing interventions is a potentially effective intervention model for health care workers. Potential barriers to mHealth strategies are the technical issues that can occur with this type of intervention. Additional longitudinal and experimental studies with larger sample sizes need to be completed to better evaluate this modality.

Using the providers’ perspective on video review of neonatal procedures to create a roadmap: a qualitative study

ObjectiveTo examine the providers’ perceptions and experiences on implementation of video review (VR) of procedures in the neonatal intensive care unit (NICU).DesignQualitative study using semi-structured interviews with neonatal care providers...

Working dilemmas in care for breastfed newborns: An exploratory study in a single center in Taiwan.

Clinical medical staff should be aware of and examine the correlation between breastfeeding and neonatal hospitalization. Additional attention should be paid to work dilemmas experienced by the nursing staff caring for newborns to avoid exposing newborns to hospitalization risk. The present study investigated the working dilemmas by neonatal nurses caring for breastfed newborns and risk of newborn hospitalization. This hospital-based study in Taiwan surveyed 84 neonatal nurses using a structured questionnaire entitled "Working Dilemmas in Clinical Care for Breastfed Newborns." Collected data were analyzed statistically (descriptive analysis, chi-square test, and t test) using Statistical Package for the Social Sciences (SPSS) software. Neonatal intensive care unit (NICU) staff noted that breastfed newborns showed a high risk of hospitalization and nursery staff highlighted a lack of manpower and time. NICU staff experienced more working dilemmas (117.460±12.260) than nursery staff (87.410±15.820) when caring for breastfed newborns (t = 1.080, P < 0.001). NICU staff reported a higher risk of hospitalization in breastfed newborns and experienced more working dilemmas caring for these patients compared with nursery staff, who reported a lack of manpower and time. Our findings highlight the working dilemmas by neonatal nurses and can serve as a foundation for further critical studies.

Considering the Influence of Social Determinants of Health on Parent Feeding Practices: A Case Example.

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. 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. 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. 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.

Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study.

Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.

Making respiratory care safe for neonatal and paediatric intensive care unit staff: mitigation strategies and use of filters.

Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment. We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment. The approach combined a high level of personal protective equipment (PPE), strict hand hygiene, air filtration and air conditioning and other relevant viral risk mitigation guidelines. This report describes the experiences from the SARS-CoV-2 pandemic to provide a reference framework that can be applied generally. The steps we took consisted of auditing our equipment and processes to identify risk through sources of potentially contaminated gas that may contain aerosolized virus, seeking advice and liaising with suppliers/manufacturers, devising mitigation strategies using indirect and direct approaches (largely filtering), performing tests on equipment to verify proper function and the absence of negative impacts and the development and implementation of relevant procedures and practices. We had a multidisciplinary team to guide the process. We monitored daily for hospital-acquired infections among staff caring for SARS-CoV-2 patients. Our approach was successful as we have continued to offer optimal intensive care to our patients, and we did not find any healthcare worker who was infected through the course of caring for patients at the bedside. The lessons learnt will be of benefit to future local outbreaks or pandemics.

1703. Pseudo-Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit: Implications for Surveillance

Abstract Background We conduct weekly surveillance screening for methicillin-resistant Staphylococcus aureus (MRSA) in our neonatal intensive care unit (NICU). In September 2021, we noted an increase in positive MRSA screening results and identified 2 patients with MRSA wound infection. We conducted an investigation to explore the possibility of in-unit transmission. Methods We launched a multi-pronged investigation that included additional patient screening. Surveillance isolates were assessed for the presence of MRSA using chromogenic agar. Additional antimicrobial sensitivity testing was performed on an automated bacterial identification system if chromogenic agar results were inconclusive, fig 1 &amp; 2. We also conducted audits of staff hand hygiene, enhanced cleaning and disinfection of shared patient-care equipment, implemented standardized chlorhexidine gluconate (CHG) scrub use for NICU staff upon unit entry, and added new CHG bathing for certain patients. Positive control chromogenic agar plate Ambiguous chromogenic agar results Results Over the course of a 6-week long investigation, 18 neonates were found to be MRSA-positive on surveillance swabs using chromogenic agar. In the first 2 weeks of the investigation, PFGE showed that 9 MRSA isolates were genetically distinct. Over the next weeks, additional MRSA-positive surveillance swabs were collected and ultimately 15 isolates underwent whole genome sequencing at the Mass. State Public Health Laboratory. Only 2 pairs of isolates appeared related. Antimicrobial resistance genes were identified and revealed only 6 of the 15 isolates contained the mecA gene consistent with MRSA. As a result, all 18 positive surveillance swabs obtained during the investigation underwent full identification and sensitivity testing confirming only 6 samples contained MRSA and 12 contained methicillin-sensitive Staphylococcus aureus (MSSA). Testing discordance with breakthrough MSSA growth was reported to the chromogenic agar manufacturer. Conclusion Our investigation identified that an increase in MRSA-positive surveillance swabs was a pseudo-outbreak due to false-positive MSSA growth on MRSA selective media. At the conclusion of this investigation, the need for ongoing surveillance swabs was re-evaluated and ultimately discontinued. Clinical NICU specimens are now monitored in real-time by Infection Control. Disclosures James Kirby, MD, D(ABMM), Abbott Molecular: Educational Grant

Motheŕs own milk (MOM) feeding in preterm infants in Germany – A status quo of personal attitudes

Abstract Background The best nutrition for all new-borns and especially vulnerable groups like preterm infants is motheŕs own milk (MOM). Nevertheless, recent research showed that many preterm infants receive formula in neonatal intensive care units (NICU) in Germany. In order to achieve MOM feeding in preterm infants, a MOM-friendly clinical environment is crucial. In Germany, no data is yet available on the attitudes towards MOM of physicians and nurses in NICUs and mothers. Methods Written surveys were conducted to assess attitudes and the current status of MOM-feeding from different perspectives (medical and nursing staff and mothers of preterm infants). Questions included personal attitudes towards MOM and perceived lactation support in NICUs. Descriptive statistics and bivariate tests (Spearman's rho, Pearson chi2) were examined. Results Data of 158 leading physicians (response rate: 76%), 143 nurses (response rate: 68%) and 533 mothers (response rate: 32%) was included. The personal importance of MOM feeding is slightly higher in both physicians and nurses than their attitude towards the effects of feeding with MOM on the medical outcome of preterm infants (M: 9.5/9.5 vs. 8.3/8.9; [1-10]). Mothers predominantly perceived the NICU staff as MOM promotive (M:4.7,4.9; [1-6]) and reported an overall positive attitude towards feeding preterm infants with MOM (M:5.6; [1-6]). Their attitude showed no significant differences between educational levels (p = 0.635), age (p = 0.079) or ethnicity (p = 0.184), whereas the MOM promotive NICU staff was significantly correlated to the motherś attitude (p = 0.001, p = 0.001). Conclusions The status quo of attitudes towards MOM in Germany is rather positive in both health care professionals and mothers, independently of sociodemographic characteristics. Presumably, the challenge in achieving MOM feeding seems to occur in transferring positive attitudes to actual interventions. Key messages • To enhance MOM feeding in preterm infants, future interventions should focus on the transmission of positive attitudes to actual strategies. • NICU staff that is MOM promotive is eminent for the maternal attitudes towards MOM.

Integrating Neonatal Intensive Care Into a Family Birth Center: Describing the Integrated NICU (I-NIC).

Parent-infant separation resulting from admission to a neonatal intensive care unit (NICU) is often reported as the most challenging and distressing experience for parents. Aiming to mitigate the stress of parent-infant separation, a new neonatal care model was designed to integrate NIC with delivery and postpartum care. Yet, little is known about the model and its implementation. Using a qualitative descriptive design with field observations, we describe the characteristics of an integrated-neonatal intensive care (I-NIC) model and examined perceptions of clinical staff (n = 8) and parents (n = 3). The physical layout of the I-NIC rooms required additional oxygen and suction columns and new signage to specify them as NICU-equipped. Other NICU-related equipment was mobile, thus moved into rooms when necessary. Nurses were cross-trained in labor/delivery, postpartum, neonatal care; however, nurses primarily worked within their specific area of expertise. Clinician and parent perceptions of the model were notably positive, reporting decreased anxiety related to separation, increased ability for chest feeding and skin-to-skin care, and improved interdisciplinary care. Future work is needed to understand implementation of the model in other settings, with specific attention to unit architecture, level of NICU care services, patient census, and staff and patient outcomes.

Recurrent Harlequin Ichthyosis in a Family: A Case Report

Introduction: Harlequin ichthyosis is a severe form of erythrodermic ichthyosis that manifests in a distinctive and distressing appearance at birth. The newborn baby is covered in thick, plate-like scales with distorted surface features, resulting in limited mobility. Fortunately, this condition is rare, with an estimated incidence of approximately 1 in 300,000 births. It is inherited in an autosomal recessive manner and is caused by a mutation in the adenosine triphosphate binding cassette subfamily A member 12 (ABCA12) gene. This mutation affects lipid transport, and the activity of ABCA12 is crucial to produce long-chain ceramides, which are essential for the development of a normal skin barrier. Methods: We present a case report of a newborn who presented with thick, firmly adherent dense plaques covering the entire body, accompanied by deep fissures that extended into the dermis. The facial features included severe ectropion, conjunctival chemosis, eclabium, tethered ears, and a rudimentary nose. In addition, there was flexion contracture of the arms, legs, and digits, along with hypoplastic nails. Results: The baby experienced respiratory difficulty, poor sucking, and a severe cutaneous infection. Unfortunately, the baby’s condition deteriorated and passed away on the 20th day after delivery. Conclusion: Previously considered universally fatal, harlequin ichthyosis now has reported cases of survivors, although it remains a challenging condition. It is crucial to provide parents and family with comprehensive information about the implications of the condition. They should be encouraged to explore all available options and receive psychological support throughout the process. It is essential for the neonatal intensive care unit staff to be trained in providing specialized care for these babies. In addition, parents should be offered the option of antenatal counseling, particularly in cases where there is a previously affected sibling or a history of consanguinity.

Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units.

Learning to navigate difficult clinical conversations is an essential feature of residency training, yet much of this learning occurs "on the job," often without the formative, multisource feedback trainees need. To generate insight into how on-the-job training influences trainee performance, the perspectives of parents and health care providers (HCPs) who engaged in or observed difficult conversations with Neonatal Intensive Care Unit (NICU) trainees were explored. The iterative data generation and analysis process was informed by constructivist grounded theory. Parents (n = 14) and HCPs (n = 10) from 2 Canadian NICUs were invited to participate in semistructured interviews informed by rich pictures-a visual elicitation technique useful for exploring complex phenomena like difficult conversations. Themes were identified using the constant comparative approach. The study was conducted between 2018 and 2021. According to participants, misalignment between parents' and trainees' communication styles, HCPs intervening to protect parents when trainee-led communication went awry, the absence of feedback, and a culture of sole physician responsibility for communication all conspired against trainees trying to develop communication competence in the NICU. Given beliefs that trainees' experiential learning should not trump parents' well-being, some physicians perceived the art of communication was best learned by observing experts. Sometimes, already limited opportunities for trainees to lead conversations were further constricted by perceptions that trainees lacked the interest and motivation to focus on so-called "soft" skills like communication during their training. Parents and NICU staff described that trainees face multiple barriers against learning to navigate difficult conversations that may set them up to fail. A deeper understanding of the layered challenges trainees face, and the hierarchies and sociocultural norms that interfere with teaching, may be the start of breaking down multiple barriers trainees and their clinician supervisors need to overcome to succeed.

Clotted blood samples in the neonatal intensive care unit: A retrospective, observational study to evaluate interventions to reduce blood sample clotting.

Blood draws for laboratory investigations are essential for patient management in neonatal intensive care units (NICU). When blood samples clot before analysis, they are rejected, which delays treatment decisions and necessitates repeated sampling. To decrease the incidence of rejected blood samples taken for laboratory investigation as a result of clotted sample. This retrospective observational study used routine data on blood draws from preterm infants collected between January 2017 and June 2019 in a 112-cot NICU in Qatar. Quality improvement interventions to reduce the rate of clotted blood samples included: awareness raising and safe sampling workshops with NICU staff, involvement of the neonatal vascular access team, development of a complete blood count (CBC) sample collection pathway, review of sample collection equipment, introducing the Tenderfoot® heel lance, establishment of benchmarks and provision of dedicated blood extraction equipment. First attempt blood draw occurred in 10 706 cases, representing a 96.2% success rate. In 427 (3.8%) cases, the samples were clotted requiring repeat collection. The overall rate of clotted specimens decreased from 4.8% in 2017 and 2018 to 2.4% in 2019, with odds ratios of 1.42 (95% confidence interval [CI] 1.13-1.78, p = .002), 1.46 (95% CI 1.17-1.81, p < .001) and 0.49 (95% CI 0.39-0.63, p < .001), respectively. The majority (87%-95%) of blood samples were by venepuncture using an intravenous (IV) catheter or the NeoSafe™ blood sampling device. Heel prick sampling was the second (2%-9%) most common method. Clotted samples were most frequently associated with needle use, 228 of 427 (53%), and IV cannula, 162 of 427 (38%), with odds ratios of 4.14 (95% CI 3.34-5.13, p < .001) and 3.11 (95% CI 2.51-3.86, p < .001), respectively. Our interventions over 3 years were associated with reduced rates of sample rejection due to clotting, and this led to improved patient experience through fewer repeated samplings. The insights gained from this project can help to improve patient care. Interventions that reduce the rate of blood sample rejection by clinical laboratories can lead to economic savings, timelier diagnostic and treatment decisions, and contribute to an improved quality care experience for all critical care patients, irrespective of age, by reducing the need for repeated phlebotomy and the risk of related complications.

Effect of family integrated care on breastfeeding of preterm infants: A scoping review.

The aims are to describe the key components of family integrated care intervention for preterm infants in the neonatal intensive care unit (NICU) and assess the impact on breastfeeding outcomes for those infants. A scoping review. We conducted a systematic study search based on the databases, including PubMed, Scopus, Cochrane, Web of Science, MEDLINE, CINAHL, CNKI and Wanfang Database in December 2022. The search time ranged from database establishment to 31 December 2022. Papers by manual searching were also listed on the references. We adopted Joanna Briggs Institute Reviewer's Manual methodology and followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to conduct the review. Two independent reviewers filtered the papers, extracted data and synthesized the findings. A table was used to extract data and synthesize results. After systematic searching, 11 articles that implemented family integrated care (FIcare) were finally included in this scoping review. By analysing the implementation of this nursing model, we identified seven main components: NICU staff training, parent education, parent participation in infants' care, parent involvement in medical plans, peer support, NICU environmental support and mobile app for parents. Based on the extracted breastfeeding data, this scoping review concludes that family integrated care shows a positive effect on increasing breastfeeding rates at discharge. Through this scoping review, we find that family integrated care is feasible and it can support breastfeeding of preterm infants. Further studies will be needed to provide more evidence that family integrated care could facilitate breastfeeding of preterm infants. This scoping review provides evidence for the positive role of family integrated care on breastfeeding outcomes. The analysis may contribute to the implementation of family integrated care. No further public or patient contribution was made in view of the review-based nature of the research.

Effects of implementation of healthcare associated infection surveillance and interventional measures in the neonatal intensive care unit: Small steps matter

PurposeNeonatal sepsis has been a global concern considering the mortality and morbidity. This study was undertaken to determine the effects of implementation of interventions namely healthcare associated infection (HAI) surveillance and hand hygiene (HH) monitoring in the neonatal intensive care unit (NICU). Materials and methodsThe cohort study was conducted in the NICU of a tertiary care hospital over a period of June–September 2021 (pre-intervention) to October–March 2022 (post-intervention). HAI surveillance of primary bloodstream infections (BSI) and HH monitoring was initiated as interventions post outbreak due to non-albicans Candida (NAC). The primary outcome of the interventions was to record any improvement in HH rates or any change in HAI rates in the 6 months intervention period. Characteristics of the pre- and post-intervention period were compared by Fisher exact test. ResultsThere was significant reduction in BSI cases in the post-intervention period (p ​< ​0.05). Mortality and BSI due to NAC were significantly more in the pre-intervention period even though low birth weight neonates (<2500 ​g) were significantly more in the post-intervention period (p ​< ​0.05). The HAI rate for primary BSI in the NICU was 10.82 per 1000 patient days. The overall adherence rate to HH was 10.68% (complete) and 73.35% (partial). HAI rates were seen to change reciprocally with changes in HH rates. ConclusionsHAI rates of primary BSI in the NICU could be regulated by the effective implementation of HAI surveillance, HH monitoring, feedback meetings with the NICU staff and other simple interventional measures even in resource-limited setups.

Parental Narratives of Bonding and Relational Experiences with Preterm Infants Born at 23 to 24 Weeks-A Qualitative Descriptive Study.

(1) Background. The birth of an infant at 23 to 24 weeks poses a significant challenge to healthy parent-infant bonding because of the high risk of infant loss and the prolonged separation. The aim of this study was to retrospectively explore the narratives of parents with children born at 23-24 weeks about their bonding formation and relational experiences. (2) Methods. This was a qualitative descriptive study conducted with Finnish parents of children born at 23 or 24 weeks of gestation. Twenty-nine mothers and eight fathers were retrospectively interviewed using a semi-structured interview about the bonding process with their infant during the period in the neonatal intensive care unit (NICU) and their later parent-child relationship. Parents' narratives were deductively analysed according to a framework previously developed for studying parental bonding. (3) Results. Our results showed that several parents described the bonding process as natural or even easy despite the traumatic start to parenthood. Support from NICU staff and providing opportunities for participation in infant care and parent-infant physical closeness were reported to enhance the bonding process. Our study identified earlier parenting experience as a new element supporting bonding. (4) Conclusions. According to our results, essential elements enhancing parent-infant bonding in NICU settings seem to be supporting parents psychologically, promoting parent-infant closeness, and encouraging parental participation in the infants' care, even with the most immature infants.

Parental Perceptions of the Impact of NICU Visitation Policies and Restrictions Due to the COVID-19 Pandemic: A Qualitative Study.

The COVID-19 pandemic has impacted parents' ability to participate in their infants' care during the neonatal intensive care unit (NICU) stay in unprecedented ways. The purpose of this study was to explore the lived experience of parents whose infants was in the NICU during the COVID-19 pandemic. A qualitative telephone interview survey was conducted. Participants included parents of preterm infants who were born less than 34 weeks' gestation during the first wave of the COVID-19 pandemic (March 2020-August 2020). Telephone surveys were conducted through open-ended questions. A thematic content analysis identifying themes was performed after interviews were completed and transcribed. A total of 8 mothers completed the telephone survey. Key themes from this study include parents experiencing increased stress due to the restricted visitation policies, limited opportunities to care for their infant, lack of support, and inconsistent communication regarding their infant status and COVID-19 protocols. Suggestions provided to enhance NICU services during the pandemic include increasing parental engagement opportunities to care for their infant in the NICU, enhanced empathy and compassion from the neonatal team, and open and transparent communication. Further research investigating cultural impact on parents' perspectives, perspectives of fathers, long-term impact of how parents coped after discharge from the NICU, and emotional impact on NICU staff members may be beneficial to aid improvements in NICU service delivery during the ongoing and future pandemic.

Rudeness and civility in health care

Rudeness and civility in health care

Promoting sleep and rest of infants using nonpharmacological interventions within the neonatal intensive care unit at Children's of Mississippi.

This project aimed to promote evidence-based practices regarding the promotion of sleep and rest using nonpharmacological interventions for infants in the neonatal intensive care unit (NICU) at Children's of Mississippi. Sleep is a basic physiological need that plays a fundamental role in the growth and development of infants. Unfortunately, infants admitted to the NICU after birth may not receive adequate sleep and rest, especially when compared to infants discharged home after delivery. The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research in Practice audit tool for promoting change in healthcare practice. A baseline audit of NICU staff and patient caregivers was conducted and measured against five best practice recommendations, followed by implementation of targeted strategies and a follow-up audit. The project team discovered two barriers to sleep promotion and rest in the NICU at Children's of Mississippi: lack of nurse knowledge of evidence-based practices for promotion of sleep and rest for infants in the NICU and a lack of location in the electronic health record to document sleep quality of infants. Strategies were implemented to address these barriers and compliance improved in four of the five audit criteria. Implementation of an educational PowerPoint that focused on sleep promotion of infants in the NICU was developed and distributed to all of the nurses and resulted in average increased compliance from 43% to 53% for all audit criteria.