Neonatal Unit Staff Research Articles

An exploration of neonatal staff knowledge and attitudes towards neonatal organ donation

An exploration of neonatal staff knowledge and attitudes towards neonatal organ donation

Development and testing of a survey measure of organizational perinatal patient-centered care culture.

To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care. Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing. We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity. Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N=316). Using responses from 10 hospitals with ≥4 responses from both units (n=240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α=0.95) while capturing all PCC dimensions (subscale Cronbach's α=0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square=214 [p-value=0.012], SRMR=0.056, RMSEA=0.041, CFI=0.97, and TLI=0.96). Aggregation statistics (ICCs < 0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values < 0.05), except for neonatal unit scores and RC (p-value=0.11). The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.

Mixed-method study to assess the feasibility, acceptability and early effectiveness of the Hospital to Home programme for follow-up of high-risk newborns in a rural district of Central Uganda: a study protocol

IntroductionA follow-up programme designed for high-risk newborns discharged from inpatient newborn units in low-resource settings is imperative to ensure these newborns receive the healthiest possible start to life. We aim...

Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre\u2013post study

BackgroundThe quality of family-centered care and parental participation in care in neonatal units differ widely across the world. Appropriate education might be an effective way to support medical staff in neonatal units to collaborate with parents and implement family-centered care. The aim of this study was to evaluate the effects of the educational intervention on the quality of family-centered care in eight Finnish neonatal intensive care units from both the staff and parent perspectives.MethodsA mixed-method pre–post intervention study was conducted in eight neonatal intensive care units in Finland. Data were collected from staff and parents using the Bliss Baby Charter audit tool and semi-structured interviews.ResultsThe quality of family-centered care, as assessed by staff and parents, increased significantly after the intervention in all eight units. The intervention was able to help staff define and apply elements of family-centered care, such as shared decision making and collaboration between parents and staff. In interviews, staff described that they learned to support and trust the parents’ ability to take care of their infant.ConclusionsThe educational intervention increased the quality of family-centered care and enabled mutual partnership between parents and staff.ImpactThis study shows that the educational intervention for the whole multi-professional staff of the neonatal unit improved the quality of family-centered care.The Close Collaboration with Parents intervention enabled mutual partnership between parents and staff.It also provides evidence that during The Close Collaboration with Parents intervention staff learned to trust the parents’ ability to take care of their infant.

A health systems strengthening intervention to improve quality of care for sick and small newborn infants: results from an evaluation in district hospitals in KwaZulu-Natal, South Africa

BackgroundMany newborn infants die from preventable causes in South Africa, often these deaths occur in district hospitals. A multipronged intervention aiming to improve quality of newborn care in district hospitals was implemented comprising training in clinical care for sick and small newborns, skills development for health managers, on-site mentoring, and hospital accreditation. We present the results of the project evaluation.MethodsWe conducted three sequential cross-sectional surveys in 39 participating district hospitals at baseline, midpoint and endpoint of the three-year intervention period. Data were collected by a trained midwife using a series of checklists including: availability of trained staff, drugs and equipment; newborn care practices; perinatal mortality audits; neonatal unit staff skills; quality of record keeping. A scoring system was developed for three domains: resources; care practices; resuscitation equipment, and a composite score that included all variables measured. Health worker (HW) knowledge was assessed at midpoint and endpoint.ResultsThe average score for resources increased from 13.5 at baseline to 22.6 at endpoint (maximum score 34), for care practices from 17.7 to 22.6 (maximum score 29), and for resuscitation equipment from 10.8 to 16.1 (maximum 25). Average composite score improved significantly from 42.0 at baseline to 55.7 at midpoint to 60.7 at endpoint (maximum score 88) (p = 0.0012). Among 39 participating hospitals, 38 achieved higher scores at endpoint compared to baseline. Knowledge was higher among HWs trained during the project at midpoint and endpoint. Gaps that remained included poor infrastructure, lack of resuscitation equipment in some areas, poor postnatal care and lack of a dedicated doctor.ConclusionsThis intervention achieved measurable improvements in many important elements contributing to newborn care. A scoring system was used to track progress, compare facilities’ performance, and identify areas for improvement. Various methods were used to generate the quality of care score, including skills assessment and record reviews. However, measuring quality of clinical care and outcomes was challenging, and we were unable to determine whether the intervention improved clinical care and lead directly to improved outcomes for babies. In developing a future score for quality of care, a stronger focus should be placed on assessing clinical care and outcomes.

Neopuff T-piece resuscitator mask ventilation: Does mask leak vary with different peak inspiratory pressures in a manikin model?

The aim of this study was to compare mask leak with three different peak inspiratory pressure (PIP) settings during T-piece resuscitator (TPR; Neopuff) mask ventilation on a neonatal manikin model. Participants were neonatal unit staff members. They were instructed to provide mask ventilation with a TPR with three PIP settings (20, 30, 40 cm H2 O) chosen in a random order. Each episode was for 2 min with 2-min rest period. Flow rate and positive end-expiratory pressure (PEEP) were kept constant. Airway pressure, inspiratory and expiratory tidal volumes, mask leak, respiratory rate and inspiratory time were recorded. Repeated measures analysis of variance was used for statistical analysis. A total of 12 749 inflations delivered by 40 participants were analysed. There were no statistically significant differences (P > 0.05) in the mask leak with the three PIP settings. No statistically significant differences were seen in respiratory rate and inspiratory time with the three PIP settings. There was a significant rise in PEEP as the PIP increased. Failure to achieve the desired PIP was observed especially at the higher settings. In a neonatal manikin model, the mask leak does not vary as a function of the PIP when the flow rate is constant. With a fixed rate and inspiratory time, there seems to be a rise in PEEP with increasing PIP.

Perceptions and experiences of using a nipple shield among parents and staff \u2013 an ethnographic study in neonatal units

BackgroundPreterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England.MethodsAn ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis.ResultThe global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes, ‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized.ConclusionThis study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these in balance may be the key to appropriate use of the nipple shield.

Providing the best medicine: adopting a systematic approach to identifying and using evidence to support breastfeeding and breastmilk feeding in neonatal units in Scotland

Abstract Background The breastmilk feeding of premature babies is of great importance to public health, and it provides the optimum nutrition. Yet the difficulties experienced by mothers who have preterm babies are compounded by anxiety and loss because staff may be unable to fully support parents owing to time pressures, established models of care, and limited training opportunities. To inform the 2016 Scottish Government-led review of maternity and neonatal services, we aimed to summarise evidence about effective interventions to support breastmilk feeding in neonatal units and, drawing on findings from qualitative papers, to describe the infant feeding experiences of parents of babies in neonatal units and the views of staff. Methods We searched Medline, Embase, Web of Science, and Cochrane databases to identify systematic reviews published in English between Nov 1, 2010, and April 1, 2014, using the keywords neonatal/intensive care, KMC, kangaroo mother care, low birth weight, premature, breastfeeding, and breast milk. We searched CINAHL and MIDIRS using the same criteria to identify qualitative papers that explored the infant feeding experiences of both parents and neonatal staff. Findings Eight systematic reviews and 17 qualitative publications were identified. Synthesis of systematic review level evidence indicated the effectiveness of interventions including kangaroo mother care, mother's breastmilk, and donor human milk for protecting the infant against necrotising enterocolitis and promoting neurodevelopment and growth. Thematic analysis of the qualitative studies emphasised the importance of attending to the experiences of parents, who had to deal with the impact of premature delivery and the neonatal unit environment, and of developing coping strategies to help them respond to the unpredictability of their baby's health-related feeding issues. Findings from staff indicated that they needed to feel in control, relying on technology and efficiently using time to maximise the health of babies in the neonatal unit in the midst of uncertainty. Interpretation Evidence about the infant feeding experiences of parents and staff in neonatal units (with evidence related to effective interventions for promoting breastmilk feeding) has enhanced the timely partnership between colleagues from NHS Health Scotland and the Scottish Government to influence policy and practice. This evidence has informed the national review of maternity and neonatal provision in Scotland and will be jointly disseminated throughout Scotland. Funding None.

Understanding and knowledge of sustainable waste management within the neonatal unit: A qualitative investigation

Abstract The literature identifies a need for healthcare organisations to reduce the quantities of waste they generate, their carbon footprints, financial costs and adverse environmental impacts. This paper discusses a qualitative investigation carried out a within a neonatal unit (NNU) using semi-structured interviews with staff with the intent of gaining a greater understanding of their knowledge around sustainability, their waste management practice and to identify opportunities in relation to potential sustainable waste management interventions within the NNU. The research was sited in a NNU within a United Kingdom (UK) district general hospital. Five semi structured interviews were carried out with key informants recruited from the nursing staff based within the NNU. Results indicate that NNU staff are aware of cost and environmental issues surrounding healthcare waste management and are willing to consider and adopt changes in practice intended to make financial savings and manage waste sustainably. This may be facilitated by the use of some form of continuing information feedback system and use of sustainable waste management interventions that change the management of waste within the neonatal unit.

THE FEASIBILITY OF USING "PREMIESTART," A MOTHER-PREMATURE INFANT INTERACTION PROGRAM, ON A NEONATAL UNIT IN ENGLAND.

This article explores the feasibility of running "PremieStart," a nine-individual-session maternal-premature infant interaction program, within a neonatal unit (NNU) in England. Four mothers of premature infants completed seven sessions on the NNU and two at home. Mothers and NNU staff provided feedback on PremieStart. Measures of maternal-infant relationship, maternal well-being, and maternal reflective functioning were completed before and after intervention. Thematic analysis of mothers' feedback highlighted the emotional, but cathartic, experience of engaging with PremieStart. NNU staff feedback indicated the need to include them more in PremieStart. Both mothers and staff were supportive of future implementation of PremieStart and highlighted the ongoing need for psychological support on the NNU. PremieStart was implemented with positive feedback from mothers and staff, with support shown for the continued use of PremieStart in the NNU. However, for future implementation, the self-report outcome measures need reviewing, and more involvement of fathers and NNU staff is needed. In addition, a larger sample with a control group should be utilized.

Caring for a premature child at home: from fear and doubt to trust

Being a mother is the result of a process that involves the development of a strong maternal identity, begins during pregnancy, and includes the child's first months of life. This process thrives on the constant mother-child interaction. In order to know the lived experiences of mothers of previously hospitalized premature infants while assuming the child's care at home, a phenomenological study involving ten mothers was conducted. Findings indicate that the separation of the dyad during hospitalization imposes limitations, which prevent women from taking on the new role with confidence and joy. It is important to empower the nursing staff in neonatal units toward implementing strategies for early and continuous mother-child contact that will support women in the process of becoming mothers.

Meanings, beliefs and attitudes of the neonatal unit staff in México about the parents' participation in a neonatal unit: A qualitative approach

Background and context: The two most important factors and determinants of morbidity and mortality of the newborn are prematurity and low birth weight, c hildren are admitted in neonatal unit and require many specialized therapeutic interventions, thus, a medical and technical focus is predominating. T he staff of neonatal unit ha s a challenge in provide support to parents´ participation i n the care of their child. The study was performed in a public hospital offering second-level care in San Luis Potosi, Mexico. Purpose : To identify and analyze the meanings, beliefs and attitudes of the neonatal unit staff about the Mexican parents' participation in the care of hospitalized preterm neonates. Design and Methods : A qualitative research study was conducted at a neonatal unit in Mexico. Data collection consisted of semi-structured and recorded in-person interviews with staff who signed an informed consent. The analysis method used was content analysis in its thematic mode. Results: The results summarize the most relevant information of the meanings, beliefs and attitudes of the health professionals- benefits, barriers, encouragement-, about the parents’ participation in a Mexican neonatal unit. Three themes emerged: The parental participation benefits the hospitalized premature infants; restriction and barriers for parents’ participation; encouragement of parents’ participation. Conclusions: The staff considered parental participation to be important, and they therefore proposed certain changes to promote participation based on a system of teamwork and a transformation of the hospital rules, emphasizing the experiences of parents in the NU and supporting their emotional responses and feelings. The participants thought that they should be teaching about childcare. However, controversy was revealed among the practitioners regarding parental involvement with respect to gender, particularly the idea that the mother should be the main presence whereas the father should be a recipient of information, despite expressing a positive view of the father’s inclusion and his right to take care of his child. Summary: T he hospitalization of premature neonates produces separation from their families. Parental visit to NUs in Mexico depends on factors such as human milk production, neonate clinical conditions and medical treatment. It also depends on the meanings, beliefs, attitudes of the health team concerning the parents´ participation. This study provides information on parental participation to promote unrestricted access to the neonatal unit. Potential implications: The construction of a model of family participation based on a framework of parental participation in the NICU .

The impact of the clinical environment on family centred care in the neonatal unit: A qualitative investigation

Abstract It has been suggested that the clinical environment has a significant impact on the wellbeing and recovery of patients. Furthermore, the design, physical environment and use of resources within the neonatal unit (NNU) is crucial to family centred care (FCC) and the provision of a supportive infrastructure for patients, families, staff and carers. It has also been claimed that poorly designed NNU can hinder the best intentioned efforts of NNU staff. This paper reports the findings of a qualitative investigation using non-participant observation and follow up interviews with key informants aimed at understanding ways in which the clinical environment might influence and impact upon the behaviour and practice of those employed within the NNU. Results indicate that topics such as noise, lighting, heating, ventilation and particularly space in which to care for patients and families are significant issues. It is concluded that poor clinical environments may impede staff in achieving improvements in care quality, and that an ergonomic, supportive environment is required within the NNU in order to enable quality care and increase efficiency. Further investigation into resource managed NNU, guided by lean thinking and the productive ward literature may provide a means of enabling improved FCC.

Inaccuracy of ROP screening data in National Neonatal Audit Programme report

Sir, National audit programmes inform the commissioning of services and the development of guidelines by the National Institute of Clinical Excellence. Accurate data and reports are important to set local targets and evaluate service quality. The National Neonatal Audit Programme (NNAP), established in January 2006 and funded by the Healthcare Quality Improvement Partnership (HQIP), contains a data set evaluating the occurrence and timeliness of screening for retinopathy of prematurity (ROP). Paediatric ophthalmologists have expressed concern about inaccurate NNAP reports, but to our knowledge these concerns have not been published. The NNAP 5-year trends of the proportion of eligible babies receiving ROP screening (2007: 38%, 2011: 82%) and first screening occurring on time (2009: 27%, 2011: 87%)1 indicate that NNAP reports are likely to be inaccurate and may have a high proportion of missing data, although trends may be improving. There has been frustration about eye teams not being allowed to contribute to data upload, and about the impossibility of correcting uploaded data before the publication of the annual report. Neonatal unit (NNU) staff upload data via the UK National Neonatal System (UKNNS, previously Standardised Electronic Neonatal Data System, SEND). A ‘dashboard' summarises data for each month of the calendar year (Figure 1). The Neonatal Data Analysis Unit (NDAU) at Imperial College London analyses the data and collates the NNAP report. Figure 1 ‘Dashboard' summarising ROP screening data on a monthly basis. We recently carried out our annual ROP screening audit.2 All babies whose first screening was due in our unit were assessed within the NNAP time window. However, the ‘dashboard' showed one baby as not having been screened. We verified the screening status and updated the data on UKSNN, resulting in 100% compliance (Figure 1). However, the 2013 NNAP report shows two discrepancies with the dashboard: a greater number of babies eligible for ROP screening, and missing data for four infants. Our data update in August 2013 had occurred after NDAU had analysed the data for the annual report in February 2013. In 2014, NDAU will feed data back to NNUs before analysis to allow an update before publication. Ophthalmologists involved in ROP screening may wish to carry out their local audit in January of each calendar year, so that NNU staff can upload correct data before the NDAU analysis in February.

1875 Kangaroo Mother Care in a Neonatal Context: Parents’ Experiences of Information and Communication

Kangaroo Mother Care (KMC) is an evidence-based nursing practice with many benefits for children and parents. The purpose of this study was to describe mothers’ and fathers’ experiences of information...

Does facility-based newborn care improve neonatal outcomes? A review of evidence

Facility based newborn care is gaining importance as an intervention aiming at reduction of neonatal mortality. To assess different factors that affect effectiveness of facility based newborn care on neonatal outcomes. Electronic search using key search engines along with search of grey literature manually. Observational and interventional studies published between 1966-Aug 2010 in English having a change in neonatal mortality as an outcome measure were considered. A total of 40 articles were fully reviewed for generating synthesized evidence. All were observational studies. The exposure variables that affected neonatal outcomes were grouped into three categories- regionalization of perinatal care (17 articles), strengthening of lower level neonatal facilities (12), and other miscellaneous factors (11). Regionalization played a key role in advancing newborn care practices. It increased in-utero transfer of high risk newborns and improved survival outcomes especially for very low birth weight neonates at level III facilities. It led to reduction in neonatal mortality owing primarily to enhanced survival of low birth weight infants. Strengthening of lower level units contributed significantly in reducing neonatal mortality. High patient volume (>2,000 deliveries/year), inborn status, availability of referral system and inter-facility transfers, and adequate nursing care staff in neonatal units also demonstrated protective effect in averting neonatal deaths. Countries investing in facility based newborn care should give impetus to establishing regionalized systems of perinatal care. Strengthening of lower level units with high case loads, can yield optimal reduction in NMR.

Staff perceptions on Newborn Individualized Developmental Care and Assessment Program (NIDCAP) during its implementation in two Spanish neonatal units

The implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) requires great effort. Few studies evaluating staff perception of NIDCAP exist, especially in Southern Europe, and these few studies usually have a low representation of the medical staff. Exploration of staff perception (neonatologists, nurses and nursing assistants) of NIDCAP during its implementation and their attitude towards it and intention to put it into practice. This study is a descriptive survey measuring staff perceptions of NIDCAP and its effects on their work in two Spanish neonatal level III intensive care units (NICUs). Validated questionnaires were distributed to neonatologists, nurses and nursing assistants of which 305 were completed (response rate: 85%). Virtually all the items which assess the infant's well being and the parents' role received a positive evaluation. However, three items got slightly negative evaluations: NIDCAP was more time consuming and nurses' working conditions and lighting in the unit were less optimal than in earlier practices. The professionals also had a positive attitude and a willingness to use the NIDCAP. Neonatologists perceived NIDCAP more positively than the nursing staff with statistically significant differences. The neonatal unit staff in two Spanish NICUs perceived NIDCAP positively. This assessment is more positive for neonatologists than for nurses.

Education Increases the Proportion of Infants Achieving Target Temperature during Transport for Therapeutic Hypothermia, without the Need for In-Transit Active Cooling

Background and aims: Therapeutic hypothermia for moderate or severe hypoxic ischaemic encephalopathy is a treatment for which infants born in Level 1 and 2 units will need transfer to a Level 3 centre. The target temperature should be achieved within six hours. Our aim was to improve the time it took to transfer these infants, and their temperature management, without using active cooling equipment in transit. Methods: We prospectively collected data over two periods. The first from 19/4/10 to 19/9/10, and the second from 1/11/10 to 31/1/11. After the first period education was delivered to improve team understanding of transporting infants for cooling. This was given to transport nurses, neonatal unit's staff and lead clinicians for Trent Perinatal and Central Newborn Networks. We compared data on timing and temperature between the two periods. Results: Thirteen babies were referred and moved for cooling in the first period. Two were excluded, one due to active cooling at the referring unit, and one for lack of data. Ten babies were referred in the second period. One was excluded as he did not fulfil cooling criteria. The number of babies reaching cooling temperatures (33.0-34.0) during transfer significantly improved between the two time periods (p=0.04). The change in temperature from referral to arrival at a cooling centre, and the age of the infant on arrival at a cooling centre show an improving trend. Conclusions: Passive cooling alone when used with educated NICU and transport teams may be sufficient to achieve target temperature and time goals.

Random safety audits for improving standards in the neonatal unit

BackgroundRandom safety auditing is a simple method that can be applied by frontline clinical staff on the neonatal unit to enhance quality and safety in the routine care of babies.AimFollowing...

Infants admitted to neonatal units – interventions to improve breastfeeding outcomes: a systematic review 1990–2007

This review aimed to identify interventions to promote breastfeeding or breast milk feeding for infants admitted to the neonatal unit. The medical electronic databases were searched for papers listed between 1990 and June 2005 which had breastfeeding or breast milk as an outcome and which targeted infants who had been admitted to a neonatal unit, thus including the infant and/or their parents and/or neonatal unit staff. Only papers culturally relevant to the UK were included resulting in studies from the USA, Canada, Europe, Australia and New Zealand. This search was updated in December 2007 to include publications up to this date. We assessed 86 papers in full, of which 27 ultimately fulfilled the inclusion criteria. The studies employed a range of methods and targeted different aspects of breastfeeding in the neonatal unit. Variations in study type and outcomes meant that there was no clear message of what works best but skin-to-skin contact and additional postnatal support seemed to offer greater advantage for the infant in terms of breastfeeding outcome. Galactogogues for mothers who are unable to meet their infants' needs may also help to increase milk supply. Evidence of an effect from other practices, such as cup-feeding on breastfeeding was limited; mainly because of a lack of research but also because few studies followed up the population beyond discharge from the unit. Further research is required to explore the barriers to breastfeeding in this vulnerable population and to identify appropriate interventions to improve breastfeeding outcomes.