Nurses' perception of preterm infants' pain and the factors of their pain assessment and management

In the neonatal intensive care unit, preterm infants undergo many painful procedures. Although these can impair their neurodevelopment if not properly managed, only half of the painful procedures are optimally handled. This cross-sectional study aimed to evaluate nurses' perceptions of preterm infants' pain, to evaluate nurses' pain assessment and management practices, as well as to identify the individual and contextual factors that influence nurses' assessments and interventions for pain management. Secondary analyses, including a mixed-model analysis, were performed with data from a larger study (n = 202 nurses). Nurses were found to have attitudes and perceptions in favor of preterm infants' pain management, although they reported using few standardized instruments to assess pain. Nurses stated that they widely used sucrose, non-nutritive sucking, and positioning as pain management interventions, while skin-to-skin contact was rarely practiced. Nurses' attitudes and perceptions influenced their pain assessment practices, which predicted their implementation of interventions. Several contextual (country, level of care, and work shift) and individual factors (age, level of education, had a preterm infant, perceptions of family-centered care, and skin-to-skin contact) also predicted nurses' pain assessment and management practices

Maternal Attachment Style, Interpersonal Trauma History, and Childbirth-Related Post-traumatic Stress

Childbirth-related post-traumatic stress has potentially negative and enduring consequences for the well-being of women and their families. Although research to date has identified attachment style and trauma history as individual risk factors, they have yet to be examined as integrative processes in the development and maintenance of childbirth-related post-traumatic stress. The current investigation aimed to examine whether attachment style may moderate the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology across the first 6 months of the postpartum period. A large community sample of women were recruited from two Canadian urban hospitals. Childbirth-related post-traumatic stress symptoms were assessed longitudinally at 5 weeks, 2 months, and 6 months postpartum. Latent growth curve modeling (n = 251) revealed that attachment style moderated the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology, while controlling for other well-established psychosocial (e.g., trait anxiety, previous psychopathology, lack of perceived support) and childbirth-related (e.g., mode of birth, labor pain, subjective experience) risk factors. More secure attachment conferred resiliency and more fearful attachment conferred vulnerability among women without a history of interpersonal trauma, while more preoccupied and more dismissing attachment conferred resiliency among women with a history of interpersonal trauma. These findings highlight the importance of understanding the integrative processes among risk and protective factors underlying the development of and ability to cope with childbirth-related post-traumatic stress. Attachment style and trauma history, which can be quickly measured, should be considered as targets in antenatal screening

Oxytocin in pregnancy and the postpartum: relations to labor and its management.

The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown

Clinging to closeness: The parental view on developing a close bond with their infants in a NICU

Objective: To identify and understand how parents develop a close bond to their infants in the neonatal intensive care unit (NICU).Design: A qualitative descriptive study; closeness and separation stories recorded in a smartphone application by the parents were analyzed using thematic analysis.Setting and participants: Twenty-three parents of nineteen infants who were taken care of in a level III NICU in Finland.Findings: Bonding moments and a disrupted dyadic parent-infant relationship continuously alternated as in a rollercoaster ride during the hospital stay. Transitions from closeness to separation and vice versa were the most emotional stages on the journey. Parents had a natural desire to be close and create a bond with their infants; however, they accepted the separation as part of NICU care.Key conclusions: The findings indicate that closeness with their infant was the power that parents stored and that led them through unavoidable separation to normal parenthood.Implications for practice: Bonding and attachment will occur naturally if parents are close to their infants and permitted privacy and time with their infants. NICU staff should create a peaceful and calming environment that enables and supports this bonding process.</p

Facteurs influençant l’évaluation et la gestion de la douleur des prématurés par les infirmières

Introduction&nbsp;: Les prématurés subissent de nombreuses procédures douloureuses essentielles à leur survie, mais pouvant nuire à leur développement si elles ne sont pas soulagées adéquatement. Cette étude visait à évaluer les perceptions des infirmières quant à la douleur des prématurés, leurs pratiques d’évaluation et de gestion de la douleur, ainsi qu’à identifier les facteurs individuels et contextuels influençant leurs pratiques. Méthode&nbsp;: Des analyses secondaires ont été effectuées à partir des données recueillies dans le cadre d’une étude transversale comparative entre le Canada et la France. Un total de 202 infirmières a été recruté dans 4 unités néonatales. Le questionnaire Nurses' Attitudes and Perceptions of Pain Assessment (NAPPAQ-FIPM) a été utilisé pour collecter les données. Un modèle mixte a été réalisé pour les analyses. Résultats&nbsp;: Les infirmières ont des attitudes et des perceptions en faveur du soulagement de la douleur des prématurés. Elles ont précisé utiliser principalement des indices comportementaux pour l’évaluation de la douleur des prématurés et peu d’instruments normalisés. Les infirmières ont énoncé utiliser fréquemment le sucrose, la succion non nutritive et le positionnement comme interventions de soulagement de la douleur, tandis que le contact peau à peau, une intervention efficace, était rarement pratiquée. Les pratiques d’évaluation et de soulagement de la douleur des infirmières sont significativement influencées par plusieurs facteurs contextuels (pays, niveau de soins, quart de travail) et individuels (âge, niveau d’éducation, présence d’un enfant prématuré, perception des soins centrés sur la famille et du contact peau à peau). Discussion et conclusion&nbsp;: Des guides pratiques intégrant l’évaluation de la douleur seraient souhaitables ainsi que le développement d’interventions favorisant l’implantation de méthodes de soulagement de la douleur moins pratiquées tel le contact peau à peau.Introduction&nbsp;: Les prématurés subissent de nombreuses procédures douloureuses essentielles à leur survie, mais pouvant nuire à leur développement si elles ne sont pas soulagées adéquatement. Cette étude visait à évaluer les perceptions des infirmières quant à la douleur des prématurés, leurs pratiques d’évaluation et de gestion de la douleur, ainsi qu’à identifier les facteurs individuels et contextuels influençant leurs pratiques. Méthode&nbsp;: Des analyses secondaires ont été effectuées à partir des données recueillies dans le cadre d’une étude transversale comparative entre le Canada et la France. Un total de 202 infirmières a été recruté dans 4 unités néonatales. Le questionnaire Nurses' Attitudes and Perceptions of Pain Assessment (NAPPAQ-FIPM) a été utilisé pour collecter les données. Un modèle mixte a été réalisé pour les analyses. Résultats&nbsp;: Les infirmières ont des attitudes et des perceptions en faveur du soulagement de la douleur des prématurés. Elles ont précisé utiliser principalement des indices comportementaux pour l’évaluation de la douleur des prématurés et peu d’instruments normalisés. Les infirmières ont énoncé utiliser fréquemment le sucrose, la succion non nutritive et le positionnement comme interventions de soulagement de la douleur, tandis que le contact peau à peau, une intervention efficace, était rarement pratiquée. Les pratiques d’évaluation et de soulagement de la douleur des infirmières sont significativement influencées par plusieurs facteurs contextuels (pays, niveau de soins, quart de travail) et individuels (âge, niveau d’éducation, présence d’un enfant prématuré, perception des soins centrés sur la famille et du contact peau à peau). Discussion et conclusion&nbsp;: Des guides pratiques intégrant l’évaluation de la douleur seraient souhaitables ainsi que le développement d’interventions favorisant l’implantation de méthodes de soulagement de la douleur moins pratiquées tel le contact peau à peau

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

Parents' experiences of emotional closeness to their infants in the neonatal unit: A meta-ethnography

Physical and emotional parent-infant closeness activate important neurobiological mechanisms involved in parenting. In a neonatal care context, most research focuses on physical (parental presence, skin-to-skin contact) aspects; insights into emotional closeness can be masked by findings that overemphasise the barriers or challenges to parenting an infant during neonatal care. To explore existing qualitative research to identify what facilitates and enables parents' experiences of emotional closeness to their infants while cared for in a neonatal unit. A systematic review using meta-ethnographic methods. Search strategy involved searches on six databases, author runs, and backward and forward chaining. Reciprocal translation was used to identify and compare key concepts of parent-infant emotional closeness. Searches identified 6992 hits, and 34 studies from 17 countries that involved 670 parents were included. Three overarching themes and associated sub-themes were developed. 'Embodied connections' describes how emotional closeness was facilitated by reciprocal parent-infant interactions, spending time as a family, and methods for parents to feel connected while physically separated. 'Inner knowing' concerns how knowledge about infant and maternal health and understanding the norms of neonatal care facilitated emotional closeness. 'Evolving parental role' relates to how emotional closeness was intertwined with parental identities of contributing to infant health, providing direct care, and being acknowledged as a parent. Parent-infant closeness evolves and is facilitated by multifaceted biopsychosocial factors. Practice implications include creating private and uninterrupted family time, strategies for parents to maintain an emotional connection to their infant when separated, and neurobiology education for staff. [Abstract copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Symptoms of depression in parents after discharge from NICU associated with family-centred care

AimsThe aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents’ depressive symptoms at discharge and at 4 months corrected for infant age.DesignA longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries.MethodsParents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants’ hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents’ depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age.ResultsThe mothers’ and the fathers’ perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents’ participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents’ perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents.ConclusionsOur study shows that family-centred NICU care associates with parents’ depressive symptoms after a NICU stay.ImpactDepression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.</p

The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants

Abstract Background Very low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues) in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mother's ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants. Methods and design Mothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals, and are randomly assigned to the experimental (Cues) intervention or to an attention control (Care) condition. The Cues intervention teaches mothers to attend to their own physiological, cognitive, and emotional cues that signal anxiety and worry, and to use cognitive-behavioural strategies to reduce distress. Mothers are also taught to understand infant cues and to respond sensitively to those cues. Mothers in the Care group receive general information about infant care. Both groups have 6 contacts with a trained intervener; 5 of the 6 sessions take place during the infant's hospitalization, and the sixth contact occurs after discharge, in the participant mother's home. The primary outcome is maternal symptoms of anxiety, assessed via self-report questionnaire immediately post-intervention. Secondary outcomes include maternal sensitive behaviour, maternal symptoms of posttraumatic stress, and infant development at 6 months corrected age. Discussion The Cues and Care trial will provide important information on the efficacy of a brief, skills-based intervention to reduce anxiety and increase sensitivity in mothers of very low birthweight infants. A brief intervention of this nature may be more readily implemented as part of standard neonatal intensive care than broad-based, multi-component interventions. By intervening early, we aim to optimize developmental outcomes in these high risk infants. Trial Registration Current Controlled Trials ISRCTN00918472 The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infant

Researching complex interventions in health: the state of the art

CITATION: Craig, P., et al. 2016. Researching complex interventions in health : the state of the art. BMC Health Services Research, 16:101, doi:10.1186/s12913-016-1274-0.The original publication is available at https://bmchealthservres.biomedcentral.comENGLISH SUMMARY : Keynote presentationsPublishers' Versio