Swedish Neonatal Care Research Articles

Music therapy and neonatal pain management: An interview with Dr Alexandra Ullsten.

Alexandra Ullsten, PhD, works as a music and art therapist, and postdoctoral researcher at the Central Hospital in Karlstad, Region Värmland, Sweden. She is affiliated researcher to the School of Health Sciences, Örebro University, Sweden. In 2010, Dr Ullsten pioneered the implementation of neonatal music therapy in Swedish healthcare. The Central Hospital Karlstad neonatal intensive care unit (NICU) became the first hospital and NICU in the Nordic countries to offer a family-centred music therapy programme for hospitalised infants and their parents. Alexandra’s research area concerns family-centred music therapy during painful procedures in neonatal care focusing on parent-delivered pain management such as parental infant-directed singing. She is one of the “grandparents” of Rhythm, Breath, Lullaby NICU Music Therapy (RBL) and a member of the international research network, Pain in Early Life (PEARL). She is the principal investigator of the interdisciplinary multi-centre research project, “Parents as pain management in Swedish neonatal care – SWEpap”. Dr Ullsten graciously agreed to partake in an interview and provide an insight into her research and the role music can play as affective support for infants and their parents during painful procedures in the NICU.

The Swedish Neonatal Network for outcomes improvement

: A vision for Swedish neonatal care is that all newborn infants receive the care they need, when they need it, that the experience is excellent for all families, and that neonatal care is executed by the highest quality and safety standards. To support this vision, the Swedish Neonatal Quality Register (SNQ) was founded with a mission to provide stake holders, professionals and the public with data and knowledge that would stimulate quality improvement (QI), research and development in neonatal care. SNQ covers all infants admitted to all 37 neonatal units (level I–III) serving the approximately 115,000 annual births in Sweden. Quality indicators include capacity and availability (number of beds, staffing, equipment), process (interventions) and outcome (survival and morbidity) measures for medical as well as nursing care. To better understand how neonatal care is associated with long-term outcome, the results of a national follow-up program at 2- and 5½-year-of-age are also reported to SNQ. In addition, parental experiences of neonatal care have recently become an integrated part of the database. SNQ’s completeness and validity, especially for preterm infants, has been found to be excellent. SNQ is therefore used as a tool for benchmarking over time and between unit and regions. Robust data from more than 230,000 neonatal admissions are available. Besides stimulating a continuously increasing number of clinical research projects, the data from SNQ has been found useful by Swedish authorities, professional and stakeholder organizations, local hospital administrations, teachers, as well as by the attending team in the neonatal unit. The most recent development with daily data collection in >95% of all admissions opens for new and more dynamic insights into the course of several neonatal conditions, as well as for timely outreach of results.

Study protocol: parents as pain management in Swedish neonatal care \u2013 SWEpap, a multi-center randomized controlled trial

BackgroundDuring the first period of life, critically ill as well as healthy newborn infants experience recurrent painful procedures. Parents are a valuable but often overlooked resource in procedural pain management in newborns. Interventions to improve parents’ knowledge and involvement in infants’ pain management are essential to implement in the care of the newborn infant. Neonatal pain research has studied a range of non-pharmacological pain alleviating strategies during painful procedures, yet, regarding combined multisensorial parent-driven non-pharmacological pain management, research is still lacking.Methods/designA multi-center randomized controlled trial (RCT) with three parallel groups with the allocation ratio 1:1:1 is planned. The RCT “Parents as pain management in Swedish neonatal care – SWEpap”, will investigate the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, during routine metabolic screening of newborn infants (PKU-test).DiscussionParental involvement in neonatal pain management enables a range of comforting parental interventions such as skin-to-skin contact, breastfeeding, rocking and soothing vocalizations. To date, few studies have been published examining the efficacy of combined multisensorial parent-driven interventions. So far, research shows that the use of combined parent-driven pain management such as skin-to-skin contact and breastfeeding, is more effective in reducing behavioral responses to pain in infants, than using the pain-relieving interventions alone. Combined parental soothing behaviors that provide rhythmic (holding/rocking/vocalizing) or orogustatory/orotactile (feeding/pacifying) stimulation that keep the parent close to the infant, are more effective in a painful context. In the SWEpap study we also include parental live lullaby singing, which is an unexplored but promising biopsychosocial, multimodal and multisensory pain alleviating adjuvant, especially in combination with skin-to-skin contact and breastfeeding.Trial registrationClinicalTrials.gov (NCT04341194) 10 April 2020.

Pain assessment practices in Swedish and Norwegian neonatal care units.

The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice. The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units. A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded. A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues. The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.

Communicating with parents who have difficulty understanding and speaking Swedish: An interview study with health care professionals

BackgroundNeonatal units care for sick and premature newborns, and staff meet the children's parents on a daily basis. Some parents are immigrants and do not speak or understand the local language, hampering both verbal communication and the parents' opportunity to be involved in their child's care and treatment. AimTo explore the experiences of health care professionals in Swedish neonatal care units regarding communication with parents of foreign origin who have difficulty understanding and speaking Swedish. MethodsIndividual open-ended interviews were conducted with 60 health care professionals at five neonatal care units in western Sweden: 10 physicians, 25 nurses, and 25 nursing assistants. The interviews were analysed using qualitative content analysis. ResultsThe health care professionals’ experiences were summarised in one main category: “Powerlessness in the face of inadequate care routines leading to failure to communicate.” The main category was constructed through three categories. “Inability to perform their work properly” meant that staff experienced frustration when they could not convey important information to parents. “Finding their own strategies” meant that staff found their own ways to communicate using body language and assistive technology. “Dependence on others” meant that staff were dependent on others, primarily talking through an interpreter. ConclusionThere is a need for organizational changes to increase parents' participation in their child's care in daily practice at neonatal care units. To ensure that parents who do not speak or understand the Swedish language are given sufficient time and possibilities, routines must be established in which interpreters are used more frequently.

National guidelines for Swedish neonatal nursing care: evaluation of clinical application.

To evaluate the clinical application of national guidelines for neonatal nursing. Questionnaire survey. Thirty-nine neonatal care units in Sweden. Thirty-five of 39 nurse managers at all Swedish neonatal care units. Thirteen clinical guidelines for neonatal nursing care were presented in 1997. Recommendations on evidence-based nursing care and auditing measures were given. Most neonatal units in Sweden participated in the guideline development. Extent of guideline application, ways in which the guidelines were used and perceived usefulness. The guidelines were applied to different extents in 30 of the 35 units. Almost all the guidelines were applied, especially those covering general nursing care. In total, 72 Quality Improvement (QI) projects were reported, of which 51 concerned specific topics covered in the guidelines. Twenty units applied the guidelines as a starting point for QI. Four units evaluated nursing practice against the guidelines. Four factors [Dynamic Standard Setting System (DySSSy) as the QI method, > or = 4 years of practice as nurse manager, experience of nursing research, and good staff resources] were closely related to a more extensive application of the guidelines. Units with both a nurse manager and an assistant nurse manager were more likely to have used the guidelines as the basis for changing clinical practice. The guidelines were successfully disseminated and diffused, but practitioner involvement in guideline development did not guarantee implementation. Downsizing, leadership and facilitation seemed to be crucial factors when getting evidence into practice. Limited occurrence of evaluations of clinical practice against guideline recommendations suggests a need for valid and user-friendly measures.

The Use of and Need for Patient Classification Systems in Swedish Neonatal Care

The Use of and Need for Patient Classification Systems in Swedish Neonatal Care

The Use of and Need for Patient Classification Systems in Swedish Neonatal Care

Patient Classification Systems (PCSs) comprise a large group of instruments which describe the condition of a patient regarding severity of disease, severity of illness, risk factors, intensity of nursing care, costs, and so on. They are advocated as an essential ingredient in outcome assessment, but the application of PCSs extends beyond research activities. The aim of this study was to investigate the use of and need for PCSs in Swedish neonatal care units as well as the need for evaluation and improvement of the systems already in use. A survey of 44 units revealed a low level of experience in the use of these systems. Among the 20 units using PCSs, only a few applied standard systems and 11 units pointed out the need for improving these systems. In addition, a second study, based on participant observation and interviews, indicated some potential applications of PCS in a specific unit, such as standard criteria for referring mothers and newborns, staff allocation, staff education and training, standard criteria for parent information, and prognostic systems for medical decision support. Evaluation and adaptation of the existing systems, which are generally developed outside the country, are necessary before they can become a tool for quality assurance, if a national programme for quality of neonatal care is to be established in Sweden.

Evaluation of a one-year Swedish neonatal care population.

A one-year population of 527 newborn infants treated in a Swedish neonatal unit was studied with regard to the effectiveness of the neonatal care in rate of normal survival and rate of handicaps at 3 years of age. The effectiveness could be accurately calculated in terms of survival rate being 84% and 98% of outborns and inborns respectively, and in terms of survivors without neurodevelopmental handicaps at 3 years of age being 90% and 97%, respectively. From available data on the cost of the neonatal care it could be estimated that the average annual costs for rehabilitation care for a light or moderately to a severely handicapped child were 5.8 to 11.2 times higher than in average per patient in-hospital costs during neonatal treatment. It is evident that skills in specialized neonatal care are indispensable for optimal outcome for very small low birthweight infants below 1500 g or born before 30(-32) weeks of gestation. However, in order to evaluate the return on expenditure for prevention of handicaps from the viewpoint of society adequate data on effectiveness of treatment as well as economic cost-efficiency are necessary for local and regional organization of neonatal care units.