The nursing contribution to ethical decision making

Background: In the neonatal care units of the University Hospitals of Zurich and Bern, the nurse´s role in ethical decision-making is well established. However, nurses often reported uncertainty with regard to introducing the premature infant’s situation from the nursing perspective in ethics rounds. Aims: To empower neonatal nurses in fulfilling their role in the multiprofessional decision-making process, we performed a practice development project. On the basis of the Iowa model we developed a checklist for presenting the nursing history of premature infants in an ethically competent and responsible way. Conclusions: The ‘checklist for nursing assessment in the context of ethical decision-making’, equips nurses for their professional contribution to ethics rounds, making them better prepared to present the nursing perspective in a structured and thorough manner. Implications for practice: * The Iowa model supports practice development even with limited data availability * The instrument invigorates the neonatal nurse´s role in the multiprofessional ethical decision-making process * It is crucial to involve peers in practice developmen

Effect of the COPE Program on Self-Efficacy in Mothers of Preterm Infants

The birth of a premature infant and its subsequent hospitalization in the neonatal intensive care unit are stressful experiences for mothers. Because of uncertainty concerning interactions with a premature baby, mothers often feel helpless and only hesitantly assume their maternal role. This may have a negative impact on the mother-child interaction and prevents mothers from taking an active part in the care for their child. “Creating Opportunities for Parent Empowerment” (COPE) is a 4-phase educational intervention program aiming to systematically involve parents into caring for their premature infant. In this pretest-posttest quasi-experimental study in 2 Swiss university hospitals, we focused on maternal self-efficacy. We compared self-efficacy in mothers receiving the COPE program or standard care alone at baseline and 3 months after estimated delivery date. To measure maternal self-efficacy, we used the “Tool to measure Parenting Self-Efficacy” (TOPSE). While scores for “Emotion and Affection,” “Empathy and Understanding,” as well as “Learning and Knowledge” increased in both groups, only “Learning and Knowledge” scores were significantly higher in the intervention group. Given the intention of improving learning and knowledge, the COPE program might be a promising intervention contributing to enhanced maternal self-efficacy

Translating family systems care into neonatology practice: A mixed method study of practitioners’ attitudes, practice skills and implementation experience

Background Family-centered care interventions are a recommended part of high-quality neonatal intensive care. Evidence suggests that engaging and supporting families improves parental and infant health outcomes. Enabling practitioners to work with families in a relational, strength-oriented way is thus vital to ensure quality care. However, implementing family-centered care remains a challenge, and its uptake is often slow and inconsistent. Objectives To examine the impact of family systems care implementation activities on neonatal nurses’ and physicians’ attitudes and skills in working with families, and to explore their implementation experience. Design Mixed method design. Setting and participants Two neonatal intensive and one intermediate care unit in a Swiss, university-affiliated hospital. A total of 65 practitioners participated in the pre-post study, and 17 in focus group interviews. Methods Quantitative data was obtained before, mid-, and post-implementation through an online questionnaire. Attitudes were measured with the Families’ Importance in Nursing Care – Nurses’ Attitudes Scale. Skills and reciprocity in working with families was assessed with the Family Nursing Practice Scale. Four focus group interviews were conducted post-implementation. Data analysis included descriptive statistics, group comparison, and qualitative content analysis. Results A statistically significant increase in practice skills and reciprocity, but not in attitudes was found mid- and post-implementation. Practitioners reported new ways of working with families, which included enhanced awareness of the extended family, intentional relationship-building, augmented family involvement, and systemic interventions, such as therapeutic listening. They experienced implementation as a wheel that moved forward or stood still, depending on the challenges faced and the predominance of enabling versus limiting organizational factors. Practitioners felt not only challenged regarding the meaning of being-acting in family-centered ways, but also in delivering family systems care consistently and collaboratively. While practitioners experienced the educational workshop as helpful, they felt left alone during consolidation. Conclusions Findings demonstrate that the inter-professional implementation of family systems care is highly relevant for practitioners’ clinical practice. Implementation strategies yielded an increase in practice skills/reciprocity and new ways of working with families, but no quantifiable impact on attitudes. Adoption fluctuated and was ongoing, hindered by organizational constraints and lack of consolidation support. Nonetheless, practitioners gave numerous examples of family-centered practices. A combination of implementation strategies offered over time and supported by organizational structures are the most likely means to enable teams to work in partnership with families, and to promote infant and family well-being in neonatal care