Trauma Informed Care in the Neonatal Intensive Care Unit.

Parents who have a baby receiving care in the Neonatal Intensive Care Unit (NICU) likely all experience emotional distress and are at elevated risk of experiencing trauma. The NICU environment is a potential source of traumatic stress for parents and often the risk for neonatal death is substantial. While the stressors facing parents are considerable, the effects can be minimized through implementation of trauma-informed care. The Family Guidance Tool was developed to help parents and healthcare professionals in a NICU setting utilize a strengths-based approach to create an atmosphere of mutual trust and understanding while encouraging the family to be the guide. This practical tool shows promise to mitigate stress often experienced by parents in a NICU setting.

Improving attitudes toward trauma-informed care in the neonatal intensive care unit through comprehensive multi-disciplinary education.

OBJECTIVE: This study measured staff understanding and integration of trauma-informed care following comprehensive education. STUDY DESIGN: This mixed method design used the validated Attitudes Related to Trauma-Informed Care (ARTIC) scale and open-ended survey questions via REDCap optional surveys. Trauma-informed care education was made available to staff members in a level IV NICU. Pre- and post-intervention ARTIC scores were compared and post-intervention REDCap surveys were analyzed. RESULT: There were 245 multi-disciplinary NICU team members who completed the ARTIC survey before and/or after the educational intervention; and 764 REDCap surveys were completed throughout the study time. ARTIC scores increased from pre- to post-training both for participants with data at both time points (0.5 SD mean increase) and among those with data at only one time point (0.4 SD mean increase). Content analysis of the REDCap survey corroborated the ARTIC results. CONCLUSION: System-wide trauma-informed education can achieve measurable effect in a NICU setting.

Improving well-being among women in neonatology.

OBJECTIVE: To evaluate the factors that improve professional and personal well-being amongst women in neonatology (WiN). STUDY DESIGN: A 30-question survey of multiple choice, rank order, and open-ended questions focused on professional and personal factors that affect the well-being of WiN members. Quantitative and qualitative methods were used to determine leading factors and themes. RESULTS: Of 326 respondents, 64% felt "well" professionally over half of the time. Professional well-being was most affected by scheduling flexibility, helping patients, administrative and staffing support, feelings of being valued, and clinical workload/acuity. Time for family and self-care, having domestic help, and scheduling flexibility were factors that most positively impacted personal well-being. CONCLUSION: In this national survey, WiN members identified the factors that can improve their well-being. Strategic planning and targeted interventions are urgently needed to enhance work-life integration and job satisfaction, leading to improved neonatal workforce retention and improved quality of patient care.

Physician Health and Wellness.

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.

A Blueprint for Advocacy in Neonatology.

Advocacy is at the heart of pediatrics and neonatal care. Historically and currently, numerous pediatricians have used their expertise to raise the voices of children and families to promote child health and welfare. Despite a lack of formal training in advocacy and health policy, many of the skills required for daily clinical care can, and ought to, be applied to affect systemic change within neonatology. Advocacy can no longer be considered an optional activity, but rather a core competency and professional responsibility. In this review, the authors describe the necessity and foundational principles for advocacy success as well as provide guidance, resources, and opportunities for neonatologists and clinicians providing newborn care.

Trauma-informed care and ethics consultation in the NICU.

Trauma-informed care responds to our current understanding of the ways in which people's traumatic life experiences influence both their health and their interactions with the health care system. Many ethics consults arise because those past traumatic life experiences are not recognized and addressed. In this paper, we present a NICU case that led to an ethics consultation about end-of-life decisions for a dying baby. We illustrate the ways in which a trauma-informed approach helped doctors, nurses and ethics consultants to better understand and care for the mother and baby.

What do family physicians think about spirituality in clinical practice?

OBJECTIVES: To describe the context in which physicians address patients' spiritual concerns, including their attitudes toward this task, cues to discussion, practice patterns, and barriers and facilitators. STUDY DESIGN: This was a qualitative study using semistructured interviews of 13 family physicians. POPULATION: We selected board-certified Missouri family physicians in a nonrandom fashion to represent a range of demographic factors (age, sex, religious background), practice types (academic/community practice; urban/rural), and opinions and practice regarding physicians' roles in addressing patients' spiritual issues. OUTCOMES MEASURED: We coded and evaluated transcribed interviews for themes. RESULTS: Physicians who reported regularly addressing spiritual issues do so because of the primacy of spirituality in their lives and because of the scientific evidence associating spirituality with health. Respondents noted that patients' spiritual questions arise from their unique responses to chronic illness, terminal illness, and life stressors. Physicians reported varying approaches to spiritual assessment; affirmed that spiritual discussions should be approached with sensitivity and integrity; and reported physician, patient, mutual physician-patient, and situational barriers. Facilitators of spiritual discussions included physicians' modeling a life that includes a spiritual focus. CONCLUSIONS: These physicians differ in their comfort and practice of addressing spiritual issues with patients but affirm a role for family physicians in responding to patients' spiritual concerns. Factors that form a context for discussions of spiritual issues with patients include perceived barriers, physicians' role definition, familiarity with factors likely to prompt spiritual questions, and recognition of principles guiding spiritual discussions.

Intracerebral hemorrhage due to hemorrhagic disease of the newborn and failure to administer vitamin K at birth.

In infants, intracerebral hemorrhage (ICH) is most likely the result of trauma or disturbances of coagulation function. Routine and standard care of the newborn includes the administration of vitamin K to prevent hemorrhagic disease of the newborn. We present two infants, the products of home deliveries, who did not receive vitamin K at birth. Both infants developed ICH at 5 weeks of age and presented with signs and symptoms of increased IC pressure. In both cases, recombinant factor VIIa was administered to correct coagulation function and allow immediate surgical intervention which included craniotomy and hematoma evacuation in one patient and placement of a ventriculostomy in the other to treat increased IC pressure. Despite this therapy, both infants were left with severe neurologic sequelae. These two cases illustrate that hemorrhagic disease of the newborn can occur when prophylactic vitamin K is not administered and that it can have devastating consequences. Given these issues, the routine administration of vitamin K to all infants is mandatory and should not be considered optional.