Integrating a sense of coherence into the neonatal environment

Background: Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes. Discussion: In this paper we present a new perspective to neonatal care based on Aaron Antonovksy’s Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed. Summary: Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned

Informational Privacy in the Recovery Room-Patients' Perspective

Purpose: To describe patients' perceptions of informational privacy and factors promoting it in the recovery room. Design: A descriptive semistructured qualitative interview study. Methods: The study was conducted in 2013, and the data were analyzed with inductive content analysis. Adult surgical recovery room patients (n = 17) were recruited with purposive sampling at the Department of Ear, Nose and Throat diseases in a university hospital in Finland. Findings: Informational privacy was described as control of patients' health information maintained by the health care professionals and the patients. Informational privacy was especially important in relation to other patients. Health care professionals and patients' attitude, behavior, and knowledge of informational privacy, barriers of hearing and seeing, societal rules, and the electronic patient data system promoted informational privacy. Conclusions: Informational privacy in relation to other patients could be improved in the recovery room, for example, by developing patient health information transmission and architectural solutions.Peer reviewe

OPIOID-DEPENDENT MOTHERS IN MEDICAL DECISION MAKING ABOUT THEIR INFANTS’ TREATMENT: WHO IS VULNERABLE AND WHY?

Infants born to opioid-dependent women are typically admitted to neonatal intensivecare units for management of neonatal abstinence syndrome (NAS), and their treatment requires medical decisionmaking. It is not only the infants’vulnerability, in terms of theirincompetence and medical condition, that is present in those circumstances,but also the mothers’ situational vulnerability,which arises with the possibility of their engagement in medical decision making regarding their infants. Vulnerability is a concept that has often, if not always, been traced back to individuals. In this paper, we suggest that in some cases evaluations and attributions of vulnerability to either individuals or populations fall short of capturing all aspects of vulnerability.We ask whether this individual-basedevaluation is sufficient for identifying all the vulnerabilities arising in the situation. Moreover,we suggest that the “unit” of vulnerability attribution, typically a person who is a likely target of harm and/or moral violations, should not simply be reduced to the individual. Rather, the unit should in some cases be seen as constituted by an entity that is interpersonal in nature. The kind of real vulnerability that we identify in this paper is inherently embedded in a dyadic relationship, and notions of vulnerability that decomposesocial relations into individuals run the risk ofmissing the vulnerability in question.We elaborate this kind vulnerability by discussing of role of opioid-dependent mothers in decisionmaking about their infants’ treatment</p

Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby-Friendly Hospital Initiative : A quasi-experimental study

Objective: The purpose of this study was to examine maternal perceptions of postnatal breastfeeding support in the hospital before and after designation to the Baby-Friendly Hospital Initiative (BFHI). Further maternal and infant characteristics associated with the maternal perception of breastfeeding support were investigated. Our hypothesis was that mothers would perceive breastfeeding support more adherent to the standards of the BFHI after the hospital was designated to the BFHI compared with before.Design: The study had a quasi-experimental non-equivalent two-group design.Setting: The study was conducted in one postnatal ward and one neonatal intensive care unit in a public birth hospital in Finland. Participants: Postpartum mothers giving birth in the hospital before (pre-test group, n = 162) and after (post-test group, n = 163) designation to the BFHI participated. Intervention: The aim of the BFHI is to support and promote breastfeeding by implementing the Ten Steps to Successful Breastfeeding into routine care. Implementation in the study hospital required staff training and revision of current hospital practices, which took place during 2017-2018. The postnatal ward and neonatal intensive care unit were designated to the Baby-Friendly Hospital in February 2019. Measurements: Maternal perceptions of postnatal breastfeeding support were measured with a 20-item questionnaire developed for this study. Items were based on maternal self-report of the breastfeeding support in the hospital. A sum variable was created to measure the maternal perception of the support (scale 1-7), and higher scores indicated perception of breastfeeding support that is more adherent to the standards of the BFHI. Descriptive statics, nonparametric statistical tests, and multiple linear regression analysis were used to analyse data.Findings: Mothers in the post-test group (median 6.1, IQR 5.4-6.4) perceived breastfeeding support more adherent to the standards the BFHI compared with mothers in the pre-test group (median 5.0, IQR 4.25.8) (p 35 years) (median 4.4 vs 5.8, p = 7). After the BFHI designation, mothers who experienced preterm birth (GA < 37 weeks) perceived breastfeeding support less adherent to the BFHI standards compared with mothers who experienced a full-term birth. Key conclusions: Designation to the BFHI had a positive impact on breastfeeding support from the maternal perspective. Designation improved particularly multiparas' perceptions of receiving breastfeeding support that is in adherence with the standards of the BFHI. However, more emphasis should be placed, and further research should be conducted to ensure that mothers giving birth to a preterm infant receive breastfeeding support that is adherent to the BFHI standards. Implications for practice: Birth hospitals are recommended to implement the BFHI as it improves breastfeeding support in the hospital and provides mothers with a good basis and continuation for breastfeeding, even after hospital discharge. Maternal perceptions about the impact of BFHI designation are important to consider because mother - infant dyads are at the centre of that support, and their viewpoint may help to assess whether the designation to the BFHI in the unit is successful. Results of this study indicate that designation to BFHI improves breastfeeding support from the maternal perspective.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )Peer reviewe

The Effect of Educational Strategies Targeted for Nurses on Pain Assessment and Management in Children : An Integrative Review

Background: Nurses play an important role in children's pain assessment and management because they spend the majority of the time with them and provide care on a 24-hour basis. However, research studies continue to report on nurses' inadequate assessment and management of children's pain, which may be partly attributed to their insufficient education in this area. Objectives: This integrative review sought to examine the effect of strategies used in educating nurses on pediatric pain assessment and management. Design: An integrative review. Data Sources: Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed/Medline and Scopus. Review/Analysis Methods: Four databases were searched up to February 2018 based on a prescribed eligibility criteria. The review included 37 studies with varied methodologic quality. Results: Our findings revealed that various types of educational strategies improve nurses' knowledge, attitudes, and practice of pain assessment, management, and/or documentation. Conclusions: Developing a responsive program that includes expectations of beneficiaries, integrating it into existing facility training systems and delivering it through multidisciplinary collaboration, offers the benefit of securing sustainability of the educational gains. (C) 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.Peer reviewe

Video education for critical care nurses to assess pain with a behavioural pain assessment tool : A descriptive comparative study

Aim: To evaluate the impact of video education on critical care nurses' knowledge and skills in using a behavioural pain assessment tool for intensive care patients and to explore the nurses' experiences with video education. Methods: Forty-eight nurses in one intensive care unit watched an educational video on the use of the Critical-Care Pain Observation Tool, then assessed pain in two patients with the tool and took a knowledge test. The researcher made parallel pain assessments. Interrater reliability of patients' pain assessment between nurses and the researcher was determined to examine nurses' skills in using the tool after education. Twenty nurses were interviewed about their experiences with the video education. Interviews were analysed with deductive thematic analysis. Results: The knowledge test scores indicated that the nurses learned the principles of how to use the tool. The interrater reliability of pain assessments reached a moderate level of agreement during the painful procedure, with a weighted kappa coefficient value of 0.48, CL [0.37, 0.58]. The nurses perceived video education positively, but requested additional interaction. Conclusions: Video education is useful in teaching the principles of using a pain assessment tool. Additional clinical training is required for nurses to reach adequate skills in using the tool. (C) 2017 Elsevier Ltd. All rights reserved.Peer reviewe

The Development of Data Collection Tools to Measure Parent-Infant Closeness and Family-Centered Care in NICUs

Background Preterm and sick infants benefit from parent-infant closeness and family-centered care (FCC) in neonatal intensive care units (NICUs). Prospective and feasible tools are needed to measure these care practices to facilitate their implementation.Aims To describe the development process of three prospective data collection tools that measure parent-infant closeness and the quality of FCC.Methods Data collection tools were developed in an iterative process consisting of three development cycles. Feedback was gathered from parents, staff, and researchers. The first stages of development focused on the content validity, appropriate scaling, and optimization of the response rate of these tools.Results The study included parents of 490 infants and the nurses working at bedside in 15 NICUs in six countries. The Parent-Infant Closeness Diary was developed to measure the daily duration of parental presence, holding, and skin-to-skin contact. The optimal duration for daily diaries was 14 consecutive days to maintain a good response rate. Parents provided reliable documentation of parent-infant closeness. Digital FCC tools covering the nine aspects of FCC for parents and nurses were developed to measure the quality of FCC. Participants provided answers on a 7-point Likert scale. Parents' response rates remained >50% for approximately 1 month, and the nurses' mean response rate was 55% (39%-87%) for the 3-month study period.Linking Evidence to Action These new tools provide prospective daily information to aid the implementation of parent-infant closeness and the quality of FCC in NICU in different countries. They can be used to study and evaluate the implementation of these clinical practices NICUs in an international context

The golden hour in Finnish birthing units - An ethnographic study

Objective: To explore midwives’ and parents’ perceptions and actions as well as the culture surrounding the first hour after the birth of a baby –the golden hour. Design: Short-term ethnographic study, which included observations, informal interviews and focus group interviews. Thematic network analysis was used to analyse the data. Setting: Two birthing hospitals in Finland. Participants: The first hour following 16 births was observed and informal interviews of attending mid- wives ( n = 10) and parents ( n = 3 couples and n = 6 mothers) were conducted to supplement the observations. The 16 cases included both primiparous ( n = 8) and multiparous ( n = 8) women, as well as vaginal ( n = 12) and elective caesarean births ( n = 4). Furthermore, two focus group interviews with midwives ( n = 9) were conducted to deepen the understanding. Findings: The over-arching theme Unchallenged hospital ‘rules’ comprised the two main themes of Safety-driven support by midwives and Silent voices of the parents. The hospital guidelines and practices guided the first hour, unchallenged by parents and midwives. Based on the guidelines, all the babies were given skin-to-skin contact early but not immediately. Midwives strictly followed the guidelines and performed many activities with the mothers during the first hour. Embedded power was present: midwives were in control but tended to listen to the parents. Although the mothers displayed a strong need to be close to their babies, their voices were silent in the units. The parents’ compliance with midwives and parents’ intense focus on the baby strengthened the midwives’ embedded power. Key conclusion: Care culture in birthing units was ‘rule-based’ and the guidelines and practices sometimes inhibited uninterrupted skin-to-skin contact without questioning. The golden hour was mainly controlled by the maternity care staff. Implications for practice: Re-evaluation of hospital guidelines should enable more woman- and family- centred care. The golden hour is unique to families, and unnecessary separation and interventions should be avoided.</div