Caring for at-risk infants : the experiences of parents with infants on home apnoea monitors : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University

Home apnoea monitoring for infants considered to be at risk for sudden infant death syndrome (SIDS) has been available in New Zealand since 1978. In light of the fact that the efficacy of home monitoring is unproven (Krongrad and O'Neill. 1986; Phipps and Drotar, 1990) an understanding of the impact of monitoring on families is essential. In the present study, descriptive case studies (as described by Yin, 1984) are presented of six New Zealand families undertaking the home apnoea monitoring of their infants. Indepth interviews, conducted over a three month period, prospectively explored the experiences of one or more caregivers. Analysis of the data confirmed many of the reported findings from previous (mainly American) studies. In particular, parents perceived their infants to be "at risk" whilst monitored, and tended to become socially isolated because of their reluctance to leave their infants with other caregivers. The false alarms were a serious problem, causing negative arousal in the parents. When the alarms sounded parents found it very difficult to determine whether or not the infant was, or had been apnoeic. The monitor itself became the best indicator of the child's risk status and parents sometimes relied on the monitor to the detriment of other treatment regimes and of surveillance of the infant's condition for problems other than the risk of apnoea. The present study used a systemic family nursing perspective to frame the participants' experiences. It was thus considered essential to take into account the family context in which monitoring was undertaken. Parents in the present study who, for example, had previously lost infants to SIDS, spoke of the ongoing grieving processes underpinning their monitoring experiences of subsequent infants. When the youngest child was no longer monitored, the focus of attention shifted from the risk status of the infant to the prospect of a normal childhood. Parents increasingly made their own decisions about how and when to use the monitor, based on their perceptions of their own ability to cope without it, rather than on the medical indications for its use or discontinuance. Mothers, especially, expressed strong needs for support from knowledgeable health professionals who could provide an integrated, holistic approach to the care of their infants, for monitoring supervision and for general parenting advice and support. The concept of a community-based nurse case manager is suggested as an appropriate means to meet their needs for a co-ordinated professional support service

A Comparison of Sound Levels in Open Plan Versus Pods in a Neonatal Intensive Care Unit

Author version made available in accordance with publisher copyright policy.OBJECTIVE: The objective of this study was to compare the noise levels recorded in two different neonatal intensive care unit (NICU) settings: a pod and an open plan NICU located in the same hospital. BACKGROUND: The NICU is a busy environment with ambient noise levels that often exceed established recommendations. This noise deleteriously affects the physiological stability and developmental outcomes of sick and preterm infants. Pods have reduced numbers of cots (in this case, 6) compared to open plan NICUs (in this case, 11), yet the noise levels in pods have not been reported. METHOD: This study compared real-time decibel (dB) levels in an A-weighted scale, captured continuously by sound dosimeters mounted in both NICU settings for a period of 4 weeks: a pod setting and an open plan NICU. Researchers also collected observational data. RESULTS: The average noise level recorded in the pod was 3 dBs less than in the open plan NICU. This result was statistically significant. However, dB recordings in both areas were over the recommended limits by 4-6 dBs, with isolated peaks between 74.5 dBs (NICU) and 75.9 dBs (pod). Observational data confirmed this correlation. CONCLUSIONS: Further research to evaluate interventions to decrease the noise levels in both settings are needed, especially during times of peak activity. Staff working in these settings need to be more aware that control of acoustic levels is important in the neuroprotection of neonates. Coupling this with careful consideration to structural components and evidence-based design planning may contribute to lowering dB levels in the NICU environment

Therapeutic Environment and Premature newborns Development

Introduction: Prematurity is the leading cause of neonatal mortality, however, the survival of preterm infants is guaranteed. Prolonged exposure to numerous sensory stimuli during early neonatal intensive care units contributes to the increased likelihood of organic and/or psychological sequelae. Objectives: Identify the best measures to minimize the impact that the sensorial environment of neonatal intensive care units has on the development of premature newborns. Methods: An integrative literature review was carried out in CINAHL, PubMed and MEDLINE databases, according to the PICOD methodology (participants, intervention, context, results and design). Results: The analysis of the 6 articles included in the study showed a set of environmental measures to be included in the care of premature newborns. The main recommendations mentioned were organized into categories, namely, physical environment, sensory environment, technology and parental training. Conclusion: From this review emerges the need to define consistent and consensual strategies for the optimization of the therapeutic environment in neonatal intensive care units

Accurate Automated Apnea Analysis in Preterm Infants

Objective In 2006 the apnea of prematurity (AOP) consensus group identified inaccurate counting of apnea episodes as a major barrier to progress in AOP research. We compare nursing records of AOP to events detected by a clinically validated computer algorithm that detects apnea from standard bedside monitors. Study Design Waveform, vital sign, and alarm data were collected continuously from all very low-birth-weight infants admitted over a 25-month period, analyzed for central apnea, bradycardia, and desaturation (ABD) events, and compared with nursing documentation collected from charts. Our algorithm defined apnea as\u3e10seconds if accompanied by bradycardia and desaturation. Results Of the 3,019 nurse-recorded events, only 68% had any algorithm-detected ABD event. Of the 5,275 algorithm-detected prolonged apnea events\u3e30seconds, only 26% had nurse-recorded documentation within 1 hour. Monitor alarms sounded in only 74% of events of algorithm-detected prolonged apnea events\u3e10 seconds. There were 8,190,418 monitor alarms of any description throughout the neonatal intensive care unit during the 747 days analyzed, or one alarm every 2 to 3 minutes per nurse. Conclusion An automated computer algorithm for continuous ABD quantitation is a far more reliable tool than the medical record to address the important research questions identified by the 2006 AOP consensus group

An analytical study investigating noise levels in neonatal intensive care units within the public sector in the eThekwini district.

Masters Degree. University of KwaZulu-Natal, Durban.Noise is a well-documented environmental stressor in the NICU and has emerged as a public health problem. The aim of this study was to investigate noise levels and identify contributing factors to the high noise levels, in NICUs within the public sector in the eThekwini District. The study used an analytical observational research design and a purposive sampling method. Noise measurements were conducted in four hospitals with the sound level meter (CEL 450 C) placed in the centre of each NICU for 48 hours on two consecutive days of the week (Sunday and Monday). A sample of sources of noise and their frequency of occurrence were identified through direct observation in the morning, as well as a frequency analysis using one-third octave bands were conducted. Mean LAeqs were above 45dBA in all hospitals and a marginal difference between LAeqs during the morning, afternoon and night was seen in hospital D (p=0,046). A significant difference between LAeqs on Sunday and Monday was found in hospital C (p=0,028). The majority of the sources of noise were from alarms of devices and human-related noise, with the most frequently occurring sources of noise being staff conversations (30.9%), alarms (21,0%) and closing of metal pedal bins (20,0%). Multiple high frequency alarms increased the LAeq to 74,6dBA and dropping a metal object increased the LZpeak to 116,0dBA. LAeqs higher than 45dBA were seen in the mid and high frequencies (250Hz-6300Hz) specifically during the afternoon in all hospitals. The findings have implications for education and training, as well as for the development of practice and policy guidelines in NICUs

The soundscape of neonatal intensive care: a mixed-methods study of the parents’ experience

Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a com-prehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underly-ing dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analy-sis was carried out to further elucidate relationships between variables. Finally, thematic analy-sis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising inter-ventions to best support parents’ mental health, which could in turn support infants’ develop-mental outcomes

Reducing Parental Stress in Neonatal and Pediatric Intensive Care Units

Abstract The neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) are highly operational and highly active environments. Health care workers must react quickly to care for patients and provide life-saving measures fundamental to favorable patient outcomes. Caregivers of this critical patient population are often overlooked as the healthcare team prioritizes patient’s needs. In addition, medical equipment, machines, and monitors have multiple safety alarms sounding frequently and contributing to high levels of parental stress upon their child’s admission to the NICU and PICU. Lack of giving adequate prominence to the value of caregiver support services in the hospital milieu has been identified as a professional concern in many healthcare settings. Furthermore, many of these programs were suspended in the wake of the COVID-19 pandemic and in some settings continue to be interrupted. This study aims to evaluate the insights of caregivers who received and did not receive caregiver wellness services and the impact of these services on their stress levels during their child’s NICU or PICU stay. These stress levels were evaluated using a parent survey tool. These survey results did reveal that parents experienced a decrease in their stress level after receiving stress-reducing techniques provided by caregiver wellness programs in the hospital setting. These findings provide nurse leaders with implications for nursing regarding the importance of communicating the merits of structured caregiver support programs to policymakers and championing caregiver well-being

Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios:A Case-Control Study

Background: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. Objective: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR). Study design: This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software. Results: Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT. Conclusion: Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants

Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios: A Case-Control Study

Background: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. Objective: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR). Study design: This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software. Results: Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT. Conclusion: Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants.publishedVersio

Noise in an intensive care unit

Patients and staff in hospitals are exposed to a complex sound environment with rather high noise levels. In intensive care units, the main noise sources are hospital staff on duty and medical equipment, which generates both operating noise and acoustic alarms. Although noise in most cases is produced during activities for the purpose of saving life, noise can induce significant changes in the depth and quality of sleep and negatively affect health in general. Results of a survey of hospital staff are presented as well as measurements in two German hospital wards: a standard two-bed room and a special Intermediate Care Unit (IMC-Unit), each in a different Intensive Care Unit (ICU). Sound pressure data were collected over a 48 hour period and converted into different levels (LAFeq, LAFmax, LAFmin, LAF 5%), as well as a rating level LAr, which is used to take tonality and impulsiveness into account. An analysis of the survey and the measured data, together with a comparison of thresholds of national and international regulations and standards describe the acoustic situation and its likely noise effects on staff and patients