Neonatal Intensive Care Unit Staff Research Articles

Support needs of parents in neonatal intensive care unit: An integrative review.

Having an infant in the neonatal intensive care unit (NICU) is associated with intense emotional stress for both mothers and fathers. However, with the right support from staff, this stress can be reduced significantly. Although evidence on needs of parents in the neonatal unit exists, there is lack of a systematic integrative review on the support needs of parents in the neonatal unit. Current review evidence is needed to support busy neonatal unit clinicians in their practice. The purpose of this integrative review is to explore the current available evidence to describe and understand the support needs of parents of infants in the NICU. The integrative review process of Whittemore and Knafl (2005) was used to guide this study. Six databases-MEDLINE, CINHAL, PubMed, Scopus, Google Scholar and PsycINFO-were searched for eligible studies using relevant keywords. Primary studies published in English language from 2010 to 2021 were reviewed following a pre-determined inclusion criteria. Studies that met the inclusion criteria were critically appraised using the Mixed Methods Appraisal Tool (MMAT). The review report is guided by the PRISMA 2020 checklist for systematic reviews. Overall, 24 primary qualitative, quantitative and mixed methods studies were included in the review. Analysis of included studies resulted in six themes that demonstrate the support needs of parents in the NICU; 1. Information needs; 2. Emotionally intelligent staff; 3. Hands-on support; 4. Targeted support; 5. Emotional needs; and 6. Practical needs. This review has presented the current evidence on the needs of parents from their own perspective. Healthcare workers' understanding and supporting these needs in the NICU is likely to increase parental satisfaction and improve health outcomes for parents, infants and their family. Parents of infants in the NICU require staff support to enhance their experiences, well-being, caring and parenting confidence during admission and post-discharge. As parents are in constant need for informational, emotional and practical support, continuing professional development for NICU staff should place emphasis on effective communication strategies, enhancing emotional intelligence and empathy among staff. NICU staff should build positive ongoing relationships with parents and provide targetted support for mothers and fathers.

Reducing neonatal phlebotomy blood losses through the accurate calculation of minimum test volume requirements

Repeated phlebotomy for laboratory diagnostic testing is a known cause of iatrogenic anaemia and in critically ill neonates often leads to blood transfusion being required. This study has developed a spreadsheet clinical decision support tool to allow neonatal staff to determine the true minimum blood volume required to analyse groups of blood tests and modelled its potential benefit compared with the existing system in use. The tool calculates the minimum blood volume accounting for novel factors including the current patient haematocrit for plasma/serum samples, instrument minimum test and dead volumes (including those where shared) and sharing of samples within/between laboratory departments. A year of neonatal unit laboratory requests were examined comparing the volumes and containers of blood recommended by the hospital information system with both the amount actually collected by staff and that recommended by the tool. A total of 463 patients had 8481 blood draws for 23,899 tests or test profiles over the year. The hospital information system recommended collecting 11,222 mL of blood into 18,509 containers, while 17,734 containers were actually received (10,717 mL if fully filled). The tool recommended collecting 4915 mL of blood into 15,549 containers. This tool allows neonatal intensive care unit staff to objectively determine the minimum blood volume required for a combination of tests and is generalizable between laboratory instruments. Compared with the hospital information system, use of the minimum blood volume clinical decision support tool could maximally reduce the volume of blood collected from this neonatal unit by more than a half. Neonatal intensive care unit staff had apparently already gone some way to determining their own minimum volumes required.

A clinical-academic partnership to develop a family management intervention for parents of preterm infants.

To examine the critical role that an academic clinical partnership played in the development and refinement of a family management intervention in the Neonatal Intensive Care Unit (NICU). Clinical-academic partnerships enable earlier infusion of implementation science principles into development of evidence-based interventions, yet partners often report difficulty leveraging resources, personnel and expertise to create beneficial outcomes for all. Longitudinal qualitative descriptive design. To develop and refine the intervention, designated time was taken during meetings of the NICU's Parent Partnership Council (PPC), a committee comprised of nursing, physician and allied health leadership and former NICU parents. Partnership was also achieved by having bedside clinical nurses, in addition to medical and nursing students, participate as research team members. Qualitative data were collected via email, research team and Council meetings, and informal individual chats with key stakeholders (N=25) and NICU mothers (N=22). Qualitative data were analysed deductively using thematic analysis based on MacPhee's partnership logic model and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model. The consolidated criteria for reporting qualitative research checklist guided our work. During Council meetings, the clinical-academic nurse, Director of Family-Integrated Care and Council members identified the need for a family management intervention, and worked together to develop and refine PREEMIE PROGRESS. Mothers found the intervention had numerous strengths and perceived a benefit knowing they helped future parents. This work was only possible by leveraging both the university's technology/research resources and the clinical expertise of the NICU staff and PPC. Co-authored presentations, publications and grant funding continued this NICU's legacy in family-centred care and helped shape the clinical-academic nurse's career. Clinical-academic partnerships can promote excellence in nursing practice, research and education through swifter knowledge translation and earlier infusion of implementation science principles into the development of evidence-based nursing interventions.

Investigating the Strategic Elements of Family-Centered Care in the Neonatal Intensive Care Unit: A Qualitative Study

Introduction: The family is an integral part of the health care team. Focusing on family-centered care in neonatal intensive care units (NICUs) involves using strategies to support families by supporting parental involvement in NICUs. Accordingly, the present study aimed to examine the strategic elements of family-centered care in NICUs. Methods: The present study was conducted using conventional qualitative content analysis based on Graneheim and Lundman’s approach and purposive sampling. This study was conducted in NICUs of Isfahan hospitals in 2018. The data were collected through unstructured face-to-face interviews with 15 participants including parents and NICU staff. The collected data were encoded and analyzed through Microsoft Word Office and OneNote 2010. Results: The analysis of the data revealed 3 main themes and 7 subthemes related to the strategic elements of family-centered care. The extracted themes (and subthemes) were: (1) Family and care (family involvement in the care process, the interaction between the medical staff and the family), (2) Parental characteristics in care (the mother as the core element of care, the father’s role in care), (3) Family needs (the need of the family for information, the importance of family preparation, the family’s need for spiritual support). Conclusion: The present study revealed the key elements of the structure of family-centered care from the perspective of families and medical staff. The findings of this study also highlighted the role of the family in caring for patients and meeting their needs. Accordingly, measures should be taken to improve the quality of family-centered care by taking into account the strengths of this strategy.

Associations between safety perceptions and medical error reporting among neonatal intensive care unit staff.

Critically ill neonates are particularly susceptible to medical errors; however, few studies have evaluated NICU safety climate in the context of medical error reporting. This study aims to identify the association between perceptions of safety and culture among NICU staff with medical error reporting behaviours. This study used a convenience sample of 79 NICU staff members (38 Nurses and 41 Respiratory Therapists). Questionnaires consisted of demographic factors (years of experience, sex and education), the Safety Attitudes Questionnaire (SAQ) and hypothetical medical error reporting scenarios (categorized into minor harm or major harm). The SAQ consists of six domains: job satisfaction, teamwork climate, safety climate, perceptions of management, working conditions and stress recognition. Scores ranged from 0-5, with a 5 indicating a more positive perception. Logistic regression was used to determine statistically significant predictors for each individual harm scenario (odds of being very likely/likely to report vs. all other responses). Among those who completed the study, approximately 84.8% were female. Safety attitude domain scores were similar for both NICU respiratory therapists and nurses across all domains except for job satisfaction and stress. Respiratory therapists reported higher levels of job satisfaction compared to nurses (24 vs. 23, respectively, p=0.01). However, nurses reported higher levels of stress management compared to respiratory therapists (12 vs. 9, respectively, p<0.01). While we did not find a significant association between safety attitudes and hypothetical medical error reporting, NICU staff overall were more likely to report major medical errors compared to minor medical errors. This study suggests that safety climate may not play a significant role in promoting medical error reporting in the NICU setting. Interventions aimed at increasing medical error reporting should also incorporate established employees rather than targeting new employees only.

An exploration of Neonatal Intensive Care Unit (NICU) staff experiences of attending pre-brief and debrief groups surrounding a patient's death or redirection of care

This paper presents the findings of a service evaluation project exploring staff experiences of Neonatal Intensive Care Unit staff support groups. The Neonatal Intensive Care Unit at a local regional hospital, developed and provided staff support groups before (pre-brief) and after (debrief) a death of an infant on the ward. These groups were run between December 2018 and July 2019. Content analysis was used to understand and summarise patterns and themes within the data. Frequency data was used to identify how these themes linked with staff ratings of the groups. The majority of staff had a positive experience of the group and recommended expanding the support groups to wider intensive care units. A subgroup of staff felt vulnerable in the groups and recommendations were put forward to promote the group's psychological safety. Directions for future service evaluations are discussed.

The Next Generation of NICU Staff

The article offers information on Southern California, there were programs available that provided in-depth Neonatal Intensive Care Unit (NICU) classes and clinical training in both programs have subsequently closed, and leaving nowhere for therapists to get basic NICU training Topics include the goal is to reach out to NICU babies' parents and family to support them while their baby is in our care

The Collateral Impact of COVID-19 Emergency on Neonatal Intensive Care Units and Family-Centered Care: Challenges and Opportunities.

The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staff facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices.

Increasing Parent Satisfaction With Discharge Planning: An Improvement Project Using Technology in a Level 3 NICU.

Background:Neonatal intensive care unit (NICU) families are often overwhelmed by the discharge process. Their anxiety can inhibit learning and contribute to poor infant outcomes and increased healthcare utilization after discharge. Quality of the discharge teaching is the strongest predictor of discharge readiness, so NICUs must develop excellent discharge preparation programs.Purpose:This improvement project enhances NICU discharge preparedness by providing consistent, early discharge teaching using technology as a supplemental resource and raises parental satisfaction with the process.Methods:Neonatal intensive care unit staff and former NICU parents developed a task force to create technology-based discharge education content. The content was originally uploaded to an e-book and later transferred to the electronic health record inpatient portal. Families were able to view discharge teaching content at their own convenience and pace and review topics as needed with the NICU staff. Postdischarge follow-up phone calls provided insight into parental reaction to the new education format.Results:Parent satisfaction top-box scores, reflecting the highest rating in the “Prepared for Discharge” category of the patient satisfaction survey, improved from a baseline of 47% in 2017 to 70% in 2019. Overwhelmingly, 92% of families highly rated the tablet-based discharge teaching during postdischarge phone calls.Implications for Practice:A comprehensive, consistent, and early discharge program using technology can lead to more effective and efficient NICU discharge education and improved parent satisfaction.Implications for Research:Further studies are needed to generalize hospital-based inpatient portal teaching as an additional resource for parental education in the NICU.

Goals of Care Discussions and Moral Distress Among Neonatal Intensive Care Unit Staff

ContextThe relationship between quality of Goals of Care (GOC) conversations and moral distress among neonatal intensive care unit (NICU) providers is not known. ObjectivesWe sought 1) to explore levels of moral distress in providers, 2) to evaluate how staff moral distress changes in relation to GOC discussions, and 3) to identify elements of GOC discussions associated with change in moral distress. We hypothesized that staff moral distress would change after GOC discussions and that change would vary with presence of key discussion elements. MethodsProspective cohort study in a level IV NICU in an urban teaching hospital. We administered validated instruments at baseline and following GOC discussions including the Moral Distress Thermometer (MDT) and Williams Instrument (a measure of end-of-life care) to physicians, nurses, and social workers. ResultsWe collected data on 79 GOC conversations over a 1-year period from 2018 to 2019. Most providers experienced an increase in moral distress following a GOC discussion. Providers experienced an average increase in moral distress, as measured by the MDT, of 0.84 (+/-3.15; P = 0.002). Physicians experienced an average change in moral distress of 1.1 (+/-3.52; P = 0.01) while nurses experienced an average change of 0.55 (+/-2.66; P = 0.07). Several elements of discussions were associated with the degree of increase in moral distress after the conversation. ConclusionChange in moral distress among providers may be a useful metric of quality of GOC discussions. There are identifiable elements of GOC conversations that are associated with high-quality discussions. These elements warrant further study.

Factors associated with secondary traumatic stress and burnout in neonatal care staff: A cross-sectional survey study.

High rates of secondary traumatic stress and burnout have been found across nursing populations. However, few studies have focused on neonatal staff. The objectives of this article are to explore the prevalence and severity of secondary traumatic stress (STS) and burnout in neonatal staff, and identify risk factors and protective factors for STS and burnout within this population with the aim of informing future staff support. A quantitative, cross-sectional study using a survey design was conducted; 246 neonatal staff reported measures of STS, burnout, self-compassion and satisfaction with ward climate. Neonatal staff reported high rates of moderate-severe STS and burnout. STS and burnout were negatively associated with self-compassion and satisfaction with ward climate, suggesting them to be protective factors against STS and burnout. STS was found to be a risk factor for burnout and vice versa. Interventions that increase understanding of STS and burnout, nurture self-compassion, provide support and enhance stress management could help mitigate the impact of STS and burnout amongst neonatal staff.

An Integrative Review of Fathers' Needs in the Neonatal Intensive Care Unit.

Having a child admitted to the neonatal intensive care unit (NICU) is traumatic for both parents, but mothers and fathers may have different experiences, and thus, different needs. The purpose of this integrative review was to identify the needs of fathers of premature infants. A systematic review of 7 databases was conducted, and studies were evaluated by the Critical Appraisal Programme checklist. To provide structure for searching and reporting findings, the Whittemore and Knafle interpretive methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were used. A total of 19 articles were identified. The resulting themes included: need to be close to infant and involved in infant's care; need for information; need for a better NICU environment; need for emotional support; and need for a relationship with the NICU staff.

NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress.

This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.

Discipline-Specific Perspectives on Caring for Babies with Trisomy 13 or 18 in the Neonatal Intensive Care Unit

Care offerings vary across medical settings and between families for babies with trisomy 13 or 18. The purpose of this qualitative descriptive study was to explore nurse, advanced practice practitioner, and neonatologist perspectives on care for babies with trisomy 13 or 18 in the intensive care unit. Voice-recorded qualitative interviews occurred with 64 participants (41 bedside nurses, 14 advance practice practitioners, and 9 neonatologists) from two neonatal intensive care units (NICU) in the midwestern United States. Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Content analyses occurred utilizing MAXQDA (VERBI Software, 2020). Over half of NICU staff perceived care for babies with trisomy 13 or 18 as different from care for other babies with critical chronic illness. Qualitative themes included internal conflict, variable presentation and prognosis, grappling with uncertainty, family experiences, and provision of meaningful care. Neonatologists emphasized the variability of presentation and prognosis, while nurses emphasized provision of meaningful care. Phrases "hard/difficult" were spoken 31 times; primarily describing the comorbidities, complexities, and prognostic uncertainty. Care for babies with these genetic diagnoses reveals need for a shared dialogue not only with families but also across staff disciplines. While perspectives differ, participants depicted striving to offer compassionate, family-centered care while also balancing biomedical uncertainty about interventions for children with trisomy 13 and 18. · Care for babies with trisomy 13 or 18 has been recognized as shifting.. · Controversy exists across the diverse and changing range of care models.. · This study describes perspectives of bedside neonatal nurses, advanced practitioners, and neonatologists.. · Differences in perspectives warrant attentiveness to insights and dialogue across disciplines..

Optimal Crash Cart Configuration for a Surgical NICU: Utilizing Human Factors Principles.

Neonates admitted to cardiac and surgical neonatal intensive care units (NICUs) are at an increased risk of requiring emergency lifesaving interventions that require the use of both Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) algorithms. Clinicians working within the surgical NICU must be able to access emergency equipment and medications quickly in order to respond to critical situations. A crash cart that integrates human factors principles and supports both the NRP and PALS algorithms is necessary to promote patient safety for this high-risk population. A multidisciplinary quality improvement project constructed an optimal crash cart configuration that embedded human factors principles and supported clinical workflow by reflecting both the NRP and the PALS algorithms in an NICU that cares for cardiac and surgical patients. A crash cart working group including frontline NICU staff, simulation experts, and a human factors specialist was formed within a surgical NICU. Human factors principles were utilized to align the organization of the cart with the NRP and PALS algorithms to increase the efficiency and intuitiveness of the cart. The new crash cart configuration was usability tested through simulation, revised on the basis of clinical feedback, and then implemented in a clinical setting. Data were collected following implementation of the new crash cart to validate that the new configuration was viewed as a significant improvement. The Plan-Do-Study-Act cycle was used to make improvements and capture outcome indicators. Evaluation data collected both during usability simulation testing and in situ within the NICU clinical environment indicated that the revised crash cart scored higher on Likert scale response questions than the previous crash cart. Human factors science, in combination with frontline user engagement, should be utilized to create intuitive crash cart configurations, which are then tested in a simulation environment and evaluated in situ in the NICU. Further research around crash cart design within NICUs that use multiple lifesaving algorithms would add to the paucity of research around the impact of human factors theory in the utilization of lifesaving equipment and medications within this specific population.

Correspondence: the donation of human milk during the COVID-19 pandemic

Dear Editor, In previous epidemics, it has been shown that the use of breast milk represents one of the first crucial measures to be taken in emergencies. On the occasion of the World Day for the Donation of Human Milk, which was celebrated on May 22, the Italian Society of Neonatology (SIN) reaffirmed the importance of Human Milk Banks (HMBs), reassuring mothers about the safety of donation at HMBs, also in this pandemic period. In the Neonatal Intensive Care Unit (NICU) of San Giovanni Rotondo, Italy, we found that the restrictive measures did not represent a reason to limit breastfeeding nor donation. We have been close to nursing and donating mothers, providing constant support from the HMB and NICU staff, with practical advice and psychological closeness. In particular, in the February-May period, the crucial one of the pandemic, 15 donors donated 91.25 liters. In comparison with the average of previous years of donation data to the HMB, the balance is even in favor of the current year. In fact, in 2019, in the same period, 12 mothers were recruited and 58.7 liters were collected and, in 2018, the donor women were 10 but they donated 119.5 liters. As manager of the HMB, I found it useful to report the experience of our HMB and our NICU on this specific aspect, and I hope that other HMBs can do the same. I believe that these testimonies can represent an element of hope, encouragement and reflection. Solidarity did not end with the lockdown.

A Neonatal Intensive Care Unit's Experience with Implementing an In-Situ Simulation and Debriefing Patient Safety Program in the Setting of a Quality Improvement Collaborative.

Extensive neonatal resuscitation is a high acuity, low-frequency event accounting for approximately 1% of births. Neonatal resuscitation requires an interprofessional healthcare team to communicate and carry out tasks efficiently and effectively in a high adrenaline state. Implementing a neonatal patient safety simulation and debriefing program can help teams improve the behavioral, cognitive, and technical skills necessary to reduce morbidity and mortality. In Simulating Success, a 15-month quality improvement (QI) project, the Center for Advanced Pediatric and Perinatal Education (CAPE) and California Perinatal Quality Care Collaborative (CPQCC) provided outreach and training on neonatal simulation and debriefing fundamentals to individual teams, including community hospital settings, and assisted in implementing a sustainable program at each site. The primary Aim was to conduct two simulations a month, with a goal of 80% neonatal intensive care unit (NICU) staff participation in two simulations during the implementation phase. While the primary Aim was not achieved, in-situ simulations led to the identification of latent safety threats and improvement in system processes. This paper describes one unit’s QI collaborative experience implementing an in-situ neonatal simulation and debriefing program.

Nurse Perceptions of Babywearing for Neonates With Neonatal Abstinence Syndrome in the Neonatal Intensive Care Unit.

Infants diagnosed with neonatal abstinence syndrome (NAS) often spend several weeks in a neonatal intensive care unit (NICU) and have difficulty being consoled. Infant carriers may be used to help with irritability, while allowing the adult user to be more mobile, through the practice of babywearing (the facilitated holding of an infant using a soft cloth infant carrier worn on the body). To examine the experience of babywearing infants diagnosed with NAS while admitted in the NICU from the perspective of the nurses who care for them. Nurses (N = 18; mean age = 35.44 years, SD = 9.45) were recruited and interviewed using a semistructured interview method from a 38-bed NICU in the Southwestern United States. A thematic content analyses using an open coding scheme yielded 6 themes that fell into 2 categories: (1) benefits of babywearing infants with NAS in the NICU (Infant Consoling, Adult Multitasking, Caregiver-Infant Trust); and (2) suggestions to maximize babywearing in the NICU (Infection Control, Reoccurring Infant Carrier Education, and Reduced Patient Load). Many NICUs incorporate kangaroo care (or skin-to-skin contact) as a treatment option; however, NICU staff cannot participate in kangaroo care. Babywearing is a practical alternative for nurses and support staff. Nurses supported the practice of babywearing as a means to improve the well-being of infants with NAS while also allowing for increased efficiency in nursing tasks. More prospective studies are needed that evaluate the carryover effects and long-term impact of babywearing for infants diagnosed with NAS.

Changing safety culture.

Safety culture, an aspect of organizational culture, that reflects work place norms toward safety, is foundational to high-quality care. Improvements in safety culture are associated with improved operational and clinical outcomes. In the neonatal intensive care unit (NICU), where fragile infants receive complex, coordinated care over prolonged time periods, it is critically important that unit norms reflect the high priority placed on safety. Changing the safety culture of the NICU involves a systematic process of measurement, identifying strengths and weaknesses, deploying targeted interventions, and learning from the results, to set the stage for an iterative process of improvement. Successful change efforts require: effective partnerships with key stakeholders including management, clinicians, staff, and families; using data to make the case for improvement; and leadership actions that motivate change, channel resources, and support active problem- solving. Sustainable change requires buy-in from NICU staff and management, resources, and long-term institutional commitment.

Earlier Intervention for Medically Fragile Pediatric Inpatient Population

Earlier Intervention for Medically Fragile Pediatric Inpatient Population