The Wee Care Neuroprotective NICU Program (Wee Care): The Effect of a Comprehensive Developmental Care Training Program on Seven Neuroprotective Core Measures for Family-Centered Developmental Care of Premature Neonates

AbstractThe impact of neuroprotective care on preterm infants has been investigated at length, yet professional development and training related to this type of care has not been extensively examined. The Wee Care Neuroprotective NICU program (Wee Care; Philips Healthcare, Andover, MA), a comprehensive developmental care training program (Philips Healthcare) is an evidence-based total change management program designed to optimize the neonatal intensive care unit (NICU) environment and caregiving practices. The Wee Care Neuroprotective NICU program is based on a recently developed Neonatal Integrative Developmental Care Model (© Koninklijke Philips N.V., 2014. All rights reserved).), which utilizes a holistic approach in describing seven core measures for neuroprotective family-centered developmental care of premature neonates of the lotus flower. The seven core measures are depicted on petals of a lotus as the Healing Environment, Partnering with Families, Positioning and Handling, Safeguarding Sleep, Minimizing Stress and Pain, Protecting Skin, and Optimizing Nutrition. The overlapping petals of the Neonatal Integrative Developmental Care (IDC) model IDC model demonstrate the integrative nature of neuroprotective care (Fig. 1). Items on the inside of the lotus flower represent core measure 1, the Healing Environment; which highlight the significance of the developing sensory system, as well as the physical environment in which the neonate now lives. The aim of this quality improvement project was to determine the effect of the comprehensive Wee Care Neuroprotective NICU program (Wee Care) on seven neuroprotective core measures for neuroprotective family-centered neuroprotective developmental care of premature neonates. The sample consisted of 81 hospital NICU sites from 27 US states as well as Belgium and the Netherlands which had implemented the Wee Care comprehensive neuroprotective care training program and had completed pre- and post-site surveys. A secondary data analysis of the extant Wee Care database of pre and post-testing surveys was done to evaluate the training program. The results demonstrated that the Wee Care Neuroprotective NICU training program was effective in improving seven neuroprotective core measures for family-centered developmental care of premature neonates. Each core measure as well as the overall composite core measures score (core measures 1–7) showed statistically significant improvement post training (p < .001). The positive impact of the Wee Care program was independent of the level of NICU, the type of hospital, the presence of a labor and delivery service, or the program year of implementation. The Wee Care Program has been shown to be beneficial based on seven neuroprotective core measures for neuroprotective family-centered developmental care of premature and sick neonates. The transformational training program incorporates evidence-based literature, and standardizes clinical practices for all staff, therefore enhancing consistency in quality. The program improves overall neonatal care and practices and should be widely implemented in NICU's wanting to enhance neuroprotective care of premature and/or sick infants

Health Care Provider Knowledge and Practices Regarding Folic Acid, United States, 2002–2003

Objective: To assess health care providers (HCP) knowledge and practices regarding folic acid (FA) use for neural tube defect (NTD) prevention. Methods: Two identical surveys were conducted among 611 obstetricians/gynecologists (OB/GYNs) and family/general physicians (FAM/GENs) (2002), and 500 physician assistants (PAs), nurse practitioners (NPs), certified nurse midwives (CNMs), and registered nurses (2003) to ascertain knowledge and practices regarding FA. For analysis, T-tests, univariate and multivariate logistic regression modeling were used. Results: Universally, providers knew that FA prevents birth defects. Over 88% knew when a woman should start taking folic acid for the prevention of NTDs; and over 85% knew FA supplementation beyond what is available in the diet is necessary. However, only half knew that 50% of all pregnancies in the United States are unplanned. Women heard information about multivitamins or FA most often during well woman visits in obstetrical/gynecology (ob/gyn) practice settings (65%), and about 50% of the time during well woman visits in family/general (fam/gen) practice settings and 50% of the time at gynecology visits (both settings). Among all providers, 42% did not know the correct FA dosage (400 μg daily). HCPs taking multivitamins were more than twice as likely to recommend multivitamins to their patients (Odds Ratio [OR] 2.27 95%, Confidence Interval [CI] 1.75–2.94). HCPs with lower income clients (OR 1.49, CI 1.22–1.81) and HCPs with practices having more than 10% minorities (OR 1.46, CI 1.11–1.92) were more likely to recommend supplements. NPs in ob/gyn settings were most likely and FAM/GENs were least likely to recommend supplements (OR 3.06, CL 1.36–6.90 and OR 0.64, CL 0.45–0.90 respectively). Conclusions: Knowledge about birth defects and the necessity of supplemental FA was high. Increasing knowledge about unintended pregnancy rates and correct dosages of FA is needed. The strongest predictor for recommending the use of FA supplements was whether the provider took a multivitamin

The urban community as the client in preterm birth prevention: Evaluation of a program component

Education of communities about preterm birth is essential because preterm birth is a major perinatal health problem, contributing 60-80% of the perinatal mortality in the United States. Preterm birth impacts on the health of the community through the increased morbidity and mortality of the affected children, which leads to higher health care costs and compromised future productivity. The role of early enrollment into prenatal care in the improvement of perinatal outcomes has been established by many investigators. A health education strategy using a communication in the form of a videotaped program was designed in order to increase community awareness about this serious health problem and about the importance of early prenatal care. The purpose of this investigation was to evaluate that strategy by: determining the validity of the communication; analyzing its impact on related behavioral intentions of Community Board members; and assessing the association between behavioral intentions and reported behaviors in those Community Board members. A panel of experts in the fields of prenatal care/preterm birth or health education/communication was used to evaluate the face validity of the communication, using the Communication Rating Scale, an instrument developed by James Malfetti, Ed.D. The Fishbein Linear Regression Model was utilized in ascertaining attitudes and social normative factors predictive of behavioral intentions. A nonequivalent control group design was used to measure the impact of the communication on the behavioral intentions of 10 Community Boards in the Bronx, New York. The findings included high ratings by the expert panel; a positive significant difference behavioral intentions of Community Board members before and after viewing the communication; and significant correlation between behavioral intentions and reported behaviors. Since attitudes were found to be the best predictor of behavioral intention, this investigation concluded that a short potent communication can have a significant impact on attitudes of Community Board members. This evaluation of a community education program suggests that health educators can utilize this strategy in urban areas with poor health outcomes in order to impact on behavioral intentions of community leaders.preterm birth program evaluation health education urban community

Communicating Risks and Benefits in Informed Consent for Research: A Qualitative Study

Multiple studies have documented major limitations in the informed consent process for the recruitment of clinical research participants. One challenging aspect of this process is successful communication of risks and benefits to potential research participants. This study explored the opinions and attitudes of informed consent experts about conveying risks and benefits to inform the development of a survey about the perspectives of research nurses who are responsible for obtaining informed consent for clinical trials. The major themes identified were strategies for risks and benefits communication, ensuring comprehension, and preparation for the role of the consent administrator. From the experts’ perspective, inadequate education and training of the research staff responsible for informed consent process contribute to deficiencies in the informed consent process and risks and benefits communication. Inconsistencies in experts’ opinions and critique of certain widely used communication practices require further consideration and additional research

Reaching women through health information technology: the Gabby preconception care system

PURPOSE: The Centers for Disease Control and Prevention have endorsed the concept of preconception care (PCC). New tools must be developed to promote PCC. DESIGN: Development and testing of a health information technology system to provide PCC. SETTING: An urban safety net hospital and an urban university. SUBJECTS: Community recruitment of 31 women in focus groups and 15 women participating in observed usability testing; 9 students recruited from the Office of Minority Health Preconception Peer Educators program participated in pilot testing for 2 months. INTERVENTION: Online interactive animated character ( Gabby ) designed to identify and modify preconception risks. MEASURES: Qualitative transcripts, preconception risk assessment, server data for system usage, self-administered satisfaction surveys, and follow-up phone calls. ANALYSIS: Descriptive statistics of subjects\u27 demographics, satisfaction, PCC risks, and system usage. Transcripts coded using NVIVO. RESULTS: Subjects (n = 24) reported an average of 23 preconception risks; in the pilot, 83% of risks added to the My Health To-Do List were addressed by the subject. Seventy-three percent of risks identified as contemplative progressed to action or maintenance. Differences were noted in effectiveness of the system based on initial stage of change for each risk. CONCLUSION: Results suggest that the PCC system could be effective in influencing positive behavior change. Adding stage of change-focused functionality might have added benefits. This system has great potential to assist in the delivery of PCC

Reducing Preconception Risks Among African American Women with Conversational Agent Technology

BACKGROUND: Systems and tools are needed to identify and mitigate preconception health (PCH) risks, particularly for African American (AA) women, given persistent health disparities. We developed and tested Gabby, an online preconception conversational agent system. METHODS: One hundred nongravid AA women 18-34 years of age were screened for over 100 PCH risks and randomized to the Gabby or control group. The Gabby group interacted with the system for up to six months; the control group received a letter indicating their health risks with a recommendation to talk with their clinician. The numbers, proportions, and types of risks were compared between groups. RESULTS: There were 23.7 (SD 5.9) risks identified per participant. Eighty-five percent (77 of 91) provided 6 month follow up data. The Gabby group had greater reductions in the number (8.3 vs. 5.5 risks, P \u3c .05) and the proportion (27.8% vs 20.5%, P \u3c 0.01) of risks compared to controls. The Gabby group averaged 63.7 minutes of interaction time. Seventy-eight percent reported that it was easy to talk to Gabby and 64% used information from Gabby to improve their health. CONCLUSION: Gabby was significantly associated with preconception risk reduction. More research is needed to determine if Gabby can benefit higher risk populations and if risk reduction is clinically significant