Ghanaian parents’ experiences of caring for their preterm infants after discharge from the neonatal unit - a narrative inquiry study

The care of preterm infants is associated with stress. In the busy neonatal unit where highly skilled healthcare workers are always present, parents have reported being stressed when caring for their preterm infants in the neonatal unit. In Ghana, preterm birth is the highest cause of neonatal mortality with 70% of these morbidities and mortalities occurring in the community. Yet to date, no study in Ghana has explored how parents experience their care giving role after discharge from the neonatal unit into the community. This study explored the experiences of caring for preterm infants in the neonatal unit and after discharge from the perspective of parents. Narrative inquiry methodology was utilised as it explores lived experiences using stories as data. In all, 42 participant carers (mothers, fathers and significant others) of preterm infants discharged from one of four neonatal intensive care units in Ghana were interviewed at three different stages - one week, one month and four months after discharge. Data were collected from February to June, 2015 in the residences of parents. Interviews were conducted face-to-face and audio-recorded. As Ghanaians live communally, members of households were also engaged in informal conversation to explore their experiences of caring for preterm infants after discharge. In addition to this, participants were observed in their natural environment as they cared for the preterm infant in the community. Results of the study suggest that in the neonatal units and after discharge, parents have concerns caring for their preterm infants. The findings suggest that after discharge, grandmothers of preterm infants who were not involved in pre-discharge education in the neonatal unit take charge of the care of preterm infants in the community. Grandmothers diagnose preterm infants’ illnesses and decide whether to refer an infant to hospital or herbalist for treatment. Cultural practices mainly initiated by grandmothers resulted in adverse health problems for preterm infants and disruption in parents’ mental health. The current study also revealed that in the neonatal unit, fathers were excluded from caring for their preterm infants, making them less confident to assume the caring role after discharge. This study has deepened our understanding of some of the challenges parents of preterm infants face in the neonatal unit and after discharge as they assume full responsibility of caring for their preterm infants in the Ghanaian community without any formal support from healthcare workers. It is recommended that healthcare workers should identify the support persons of parents and involve them in the care of preterm infants while on admission in the neonatal unit and during pre-discharge education. In addition to this, the study recommends that healthcare workers place regular mobile phone calls to parents of discharged preterm infants to discuss areas of concerns about the care of the preterm infant in the community in order to provide evidence based support

Sociocultural practices affecting the care of preterm infants in the Ghanaian community

Introduction Although culture is an integral part of health, there is scarcity of evidence on the influence of culture on caregiving experiences of parents of preterm infants. The aim of this study was to explore the influence of sociocultural practices on caring for preterm infants in the Ghanaian community. Method Narrative inquiry was utilized to explore the influence of sociocultural practices on the care of preterm infants from 21 mothers, 9 fathers, and 12 household members. Data were collected through face-to-face semistructured interviews and observations at participants’ homes. Results Analysis of data resulted in three threads/themes—respect for the elderly, use of herbal medicines, and communal living. Discussion Community and extended family members have great influence on the care of preterm infants. Traditional herbal medicines are considered effective in treating traditional illnesses among preterm infants. Understanding the influence of culture on the care of vulnerable preterm infants in the community is essential in developing interventions for infant survival

COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU—An exploratory cross-sectional study

Aim To describe the impact of the COVID-19 restrictions on the caregiving activities and psychological well-being of fathers with infants admitted to neonatal units. Methods Cross-sectional study using adapted COPE-IS and COPE-IU tools. Participants\u27 recruitment occurred online via social media and parents\u27 associations. Online survey in English, French and Italian were distributed and promoted via websites and social media platforms of parent\u27s associations. The study was undertaken across 12 countries in Asia, Australia, Africa and Europe. Results A total of 108 fathers of NICU infants completed the survey. COVID-19 related restrictions were categorised into 3 types: no restrictions, partial and severe restrictions. Fathers who experienced partial restrictions reported more involvement in caregiving activities but high levels of emotional difficulties and sleeping problems compared to those who experienced full or no restrictions. Conclusion Given the impact on the psychological well-being of fathers, restrictions should be avoided as much as possible in the neonatal unit and fathers given free access to their infants if they follow appropriate infection control precautions

Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT)

Background Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants’ neural plasticity. Methods/design The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial. Discussion Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. Trial registration Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov)

Parents' experiences of caring for preterm infants after discharge from Neonatal Intensive Care Unit : A meta-synthesis of the literature

The difficulties of caring for preterm infants and associated psychological stress incurred by parents of preterm infants admitted to Neonatal Intensive Care Unit (NICU) have been well established. However, much less is known about parents' experiences of caring for preterm infant at home after NICU discharge. This study synthesized qualitative studies on this phenomenon. Nine categories were obtained from 12 qualitative studies and grouped into three syntheses – (1) support improves confidence in care; (2) dealing with challenges of caring for preterm infant; (3) overprotective parenting. Parents' experiences of caring for preterm infants post-NICU discharge is constructed as a process that requires support to improve caring confidence, a process that deals with the challenges of caring for preterm infants after discharge and complicated by overprotective parenting. Thus, NICU nurses must endeavour to provide appropriate support for parents in order to increase their caring confidence after discharge

Support needs of parents in neonatal intensive care unit : An integrative review

Background Having an infant in the neonatal intensive care unit (NICU) is associated with intense emotional stress for both mothers and fathers. However, with the right support from staff, this stress can be reduced significantly. Although evidence on needs of parents in the neonatal unit exists, there is lack of a systematic integrative review on the support needs of parents in the neonatal unit. Current review evidence is needed to support busy neonatal unit clinicians in their practice. Aim and objectives The purpose of this integrative review is to explore the current available evidence to describe and understand the support needs of parents of infants in the NICU. Methods The integrative review process of Whittemore and Knafl (2005) was used to guide this study. Six databases—MEDLINE, CINHAL, PubMed, Scopus, Google Scholar and PsycINFO—were searched for eligible studies using relevant keywords. Primary studies published in English language from 2010 to 2021 were reviewed following a pre-determined inclusion criteria. Studies that met the inclusion criteria were critically appraised using the Mixed Methods Appraisal Tool (MMAT). The review report is guided by the PRISMA 2020 checklist for systematic reviews. Results Overall, 24 primary qualitative, quantitative and mixed methods studies were included in the review. Analysis of included studies resulted in six themes that demonstrate the support needs of parents in the NICU; 1. Information needs; 2. Emotionally intelligent staff; 3. Hands-on support; 4. Targeted support; 5. Emotional needs; and 6. Practical needs. Conclusion This review has presented the current evidence on the needs of parents from their own perspective. Healthcare workers’ understanding and supporting these needs in the NICU is likely to increase parental satisfaction and improve health outcomes for parents, infants and their family. Relevance to clinical practice Parents of infants in the NICU require staff support to enhance their experiences, well-being, caring and parenting confidence during admission and post-discharge. As parents are in constant need for informational, emotional and practical support, continuing professional development for NICU staff should place emphasis on effective communication strategies, enhancing emotional intelligence and empathy among staff. NICU staff should build positive ongoing relationships with parents and provide targetted support for mothers and fathers

COVID-19 and alternative assessments in higher education: implications for academic integrity among nursing and social science students

Abstract Background COVID-19 and its associated restrictions called for innovations in higher education teaching and learning space with many universities resorting to online teaching and alternative assessments. However, little has been done to understand the academic integrity implications in alternative online and non-invigilated assessments. Aim This study explored the perceptions of higher education students regarding academic integrity in alternative assessments. Methods Cross-sectional mixed method design following the parallel convergent approach was utilised in this study. A convenience sample of 380 undergraduate and postgraduate nursing and social science students completed an online survey on academic integrity behaviours associated with alternative assessments. Results High risk (31.7%) of academic misconduct was perceived among young people (18-24 years old). Collusion was common among nursing students (24.5%) and cheating likely to occur in assessments with longer duration—between 2 and 4 hours (18.8%) and between 1 and 2 weeks (46%). Qualitative data resulted in 274 findings and three themes— (i) impossible to cheat; (ii) easy to cheat and (iii) understanding the consequence of cheating. Suggestions for preserving academic integrity in alternative assessments were also made from the qualitative data. Conclusion Like other forms of traditional assessments, alternative assessments have increased risk of breach of academic integrity; however, with the right strategies, they could serve as effective means of assessing learning outcomes