Immigrant and minority parents' experiences in a neonatal intensive care unit: A meta-ethnography review.

AIMS: To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families. DESIGN: A meta-ethnographic review informed by eMERGe guidelines. METHODS: We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines. DATA SOURCES: Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies. RESULTS: Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level-Spirituality; External Level-Connecting with Family; Structured Peer-to-Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme. CONCLUSIONS: There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists were used to report the screening process.

Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery.

AIM(S): To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery. DESIGN: This scoping review was conducted according to the JBI scoping review framework. METHODS: Review included systematic reviews that evaluated any nurse-initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria. DATA SOURCES: Systematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023. RESULTS: A total of 428 articles were identified; following screening, 81 reviews underwent full-text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%). CONCLUSIONS: This review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Implementing up-to-date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes. PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement in this scoping review.

Interpreter use in sustained nurse home visiting: interpreter experience and support.

BACKGROUND: The aim of this study was to explore the experiences of healthcare interpreters working with child and family health nurses (CFHNs) in providing child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs to culturally and linguistically diverse (CALD) families with limited English proficiency. METHODS: A mixed methods longitudinal research design was conducted to develop, implement and evaluate a training and practice support model for healthcare interpreters working with nurses and CALD families in providing CFHN services and SNHV programs in three major local health services in Sydney, Australia. One pre-training survey with 24 healthcare interpreters was conducted; field notes were recorded during training and implementation; and a post-implementation focus group with six healthcare interpreters was conducted. Quantitative survey data were analysed descriptively using Alchemer. The focus group was audio-recorded for transcription purposes, and this and the field notes were thematically analysed applying a socioecological framework. RESULTS: Three themes were identified from the initial, pre-training survey: facilitate communication and delivery accurately; a bridge linking the clients and the healthcare practitioners; and make everybody feel comfortable. Practice support implementation was negatively impact by system and COVID-19 related barriers. Four themes were developed from evaluative phase of the study including: system-related issues; interpreters' challenges; working with nurses; and client session related issues. CONCLUSION: Quality interpreting was favourably influenced by adequate time for interpreting the session including a pre- and post-briefing session with CFHNs, an appropriate mode of interpretation, allocation of female interpreters and the same interpreters with CALD mothers and clarity about interpreter role and cultural comfort. These strategies support the quality of communication and relationships in delivery of CFHN services and SNHV programs to CALD mothers with limited English proficiency.

Having to manage: culturally and linguistically diverse mothers' lived experiences with sustained nurse home visiting programs.

BACKGROUND: Culturally and linguistically diverse (CALD) mothers with young children with limited English proficiency (LEP) encounter multiple barriers in accessing and engaging with primary healthcare services. The aim of this study was to explore the lived experiences and perceptions of CALD mothers with LEP in receiving child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs. METHODS: Fourteen mothers were interviewed from two large Local Health Districts in Sydney. All interviews were audio-recorded for transcription purposes. Interpretative Phenomenology Analysis (IPA) was used for analysis and the socioecological approach was applied to interpret the data. RESULTS: CALD mothers with LEP experienced both challenges and facilitators in their access and engagement with CFHN services and SNHV programs that were identified in four themes: managing culture; managing the service system; managing the relationship; and strengths and weaknesses of CFHN services. CONCLUSION: The integration of strategies such as building trusting relationships, using female professional interpreters and better understanding of CALD mothers' cultural practices may address CALD mothers' needs and facilitate communication. Design and development of model of support involving CALD mothers with LEP in ways that voice their ideas could meet their needs and contribute to better engagement of this vulnerable population with CFHN services and SNHV programs.

The needs of older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care: An integrative review.

AIMS AND OBJECTIVES: To synthesise information about the needs of older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care from the perspectives of the residents, families and care staff. BACKGROUND: Older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care have care needs that are complex. Identifying these needs is critical to ensure quality care is delivered. DESIGN: An integrative review of literature. METHODS: Five databases were searched for relevant articles: APA PsychINFO, CINAHL, MEDLINE, Scopus and Google Scholar. The search and screening were guided by PRISMA guidelines and Whittemore and Knafl's five-step framework. RESULTS: Fifteen papers were included in this review consisting of 4 quantitative, 9 qualitative and 2 mixed method studies. Two themes described the needs of older people with dementia from culturally and linguistically diverse backgrounds living in residential aged care. The first was related to culture-specific needs, and the second was related to dementia-specific care needs. Culture-specific needs comprised of three subthemes: (a) common language, (b) traditional food, and (c) social and spiritual requirements. Dementia-specific needs comprised of (a) focusing on comfort in addition to clinical requirements and (b) individualised care that addresses behavioural symptoms of dementia. CONCLUSIONS: Identifying and meeting the needs of older people with dementia from culturally and linguistically diverse backgrounds will improve quality care delivery in addition to increased caregiving satisfaction among residents, families and care staff, and the management of behaviours that characterise dementia. RELEVANCE TO CLINICAL PRACTICE: Care needs of older people with dementia from culturally and linguistically diverse backgrounds living in the residential setting can be complex. Education and training of care staff including nurses must be considered so that provision of care is inclusive of the cultural and dementia needs for older people in residential aged care.

Music Therapy with Preterm Infants and Their Families after Hospital Discharge: An Integrative Review.

After discharge from a neonatal unit, families of preterm infants may require therapeutic support to address challenges related to their infant/s' development, changed family circumstances, and/or parent wellbeing. This integrative review (IR) sought to examine the impact of music therapy on preterm infants and their families post-hospital discharge. A systematic search encompassing seven databases resulted in 83 citations, with six studies initially meeting the inclusion criteria. A further six studies were evaluated and selected upon their publication during the review process. Each study was assessed using the Mixed Methods Appraisal Tool (MMAT), followed by the identification of major themes and sub-themes. Our results suggest that music therapy contributed to creating supportive physical and metaphorical environments for preterm infants and their families, in which they could acquire essential skills, tools, and resources for fostering communication and connection with one another. Preterm infants and toddlers may have also enhanced their developmental skills through music therapy sessions post-discharge. Further investigation into the impact of music therapy on preterm infants and their caregivers at different timepoints after hospital discharge is recommended, as well as a comparison of individual and group music therapy outcomes on infant development and parent health. Future research should include a broader spectrum of family members, along with caregivers from diverse family structures and gender identities, reflecting practices already established in some clinical settings.

Implementing the 4D cycle of appreciative inquiry in health care: a methodological review.

AIM: To examine and critique how the phases of the 4D cycle (Discovery, Dream, Design, and Destiny) of appreciative inquiry are implemented in a healthcare context. BACKGROUND: Appreciative inquiry is a theoretical research perspective, an emerging research methodology and a world view that builds on action research, organizational learning, and organizational change. Increasing numbers of articles published provide insights and learning into its theoretical and philosophical underpinnings. Many articles describe appreciative inquiry and the outcomes of their studies; however, there is a gap in the literature examining the approaches commonly used to implement the 4D cycle in a healthcare context. DESIGN: A methodological review following systematic principles. DATA SOURCES: A methodological review was conducted including articles from the inception of appreciative inquiry in 1986 to the time of writing this review in November, 2011. Key database searches included CINAHL, Emerald, MEDLINE, PubMed, PsycINFO, and Scopus. REVIEW METHODS: A methodological review following systematic principles was undertaken. Studies were included if they described in detail the methods used to implement the 4D cycle of appreciative inquiry in a healthcare context. RESULTS: Nine qualitative studies met the inclusion criteria. Results highlighted that appreciative inquiry application is unique and varied between studies. The 4D phases were not rigid steps and were adapted to the setting and participants. CONCLUSION: Overall, participant enthusiasm and commitment were highlighted suggesting appreciative inquiry was mostly positively perceived by participants. Appreciative inquiry provides a positive way forward shifting from problems to solutions offering a new way of practicing in health care and health research.

Using appreciative inquiry to transform health care.

Amid tremendous changes in contemporary health care stimulated by shifts in social, economic and political environments, health care managers are challenged to provide new structures and processes to continually improve health service delivery. The general public and the media are becoming less tolerant of poor levels of health care, and health care professionals need to be involved and supported to bring about positive change in health care. Appreciative inquiry (AI) is a philosophy and method for promoting transformational change, shifting from a traditional problem-based orientation to a more strength-based approach to change, that focuses on affirmation, appreciation and positive dialog. This paper discusses how an innovative participatory approach such as AI may be used to promote workforce engagement and organizational learning, and facilitate positive organizational change in a health care context.

Neonatal nurses' perspectives of family-centred care: a qualitative study.

AIMS AND OBJECTIVES: The aim of this study is to explore neonatal nurses' perspectives of their role in facilitating family centred care in the neonatal intensive care unit. BACKGROUND: The philosophy of family centred care focuses on the health and wellbeing of the newborn and their family, through the development of a respectful partnership between the health care professional and the infant's parents. Many studies report family centred care in the context of paediatric care; however, few studies explore neonatal nurses' perspective of family centred care in the context of neonatal care. DESIGN: Qualitative interpretative approach. METHODS: Four focus groups and five individual face-to-face interviews were conducted with neonatal intensive care nurses (total n=33) currently practicing in a tertiary Neonatal Intensive Care Unit in Australia. Each focus group and face to face interview was audio-taped and transcribed. Data was analysed using thematic analysis. RESULTS: Four dominant themes emerged from the data: (1) Getting to know parents and their wishes (2) Involving family in the day to day care (3) Finding a 'happy' medium (4) Transitioning support across the continuum. CONCLUSION: These findings revealed a general understanding of family centred care principles. Nurses reported the potential benefits and challenges of adopting a family centred care approach to deliver optimal care for neonates and their families. The study highlighted that nurses need ongoing organisation support, guidance and further education to assist them in delivering family centred care effectively. RELEVANCE TO CLINICAL PRACTICE: Family centred care is a central tenet underpinning neonatal care. Understanding neonatal nurses' perspectives will be useful when developing strategies to strengthen family centred care in the neonatal intensive care unit, and potentially improve neonatal care and family outcomes.

Students' experiences of embedded academic literacy support in a graduate entry nursing program: A qualitative study.

Graduate entry nursing (GEN) programs were designed to address the predicted nursing shortfall. In Australia, although these programs attract students from culturally and linguistically diverse (CALD) backgrounds, the workload is compounded by cultural differences and a new academic learning environment which presents additional challenges. This qualitative descriptive study explored the experiences of GEN students enrolled in the introductory unit of their nursing program with embedded academic literacy support in Sydney, Australia. Twenty-four commencing GEN students were interviewed in January 2016. Interviews were transcribed verbatim and thematically analysed. Three main themes emerged which illustrated that GEN students were 'diamonds in the rough'. They possessed a raw natural beauty that required some shaping and polishing to ensure academic needs were met. To ensure retention is high, institutions need to evaluate how best to support and harness the potential of these unique students.

Using appreciative inquiry to bring neonatal nurses and parents together to enhance family-centred care: A collaborative workshop.

Family-centred care (FCC) has been well recognised, accepted and reported in the literature as an optimised way of caring for hospitalised children. While neonatal units strive to adopt this philosophy, published research suggests there are difficulties implementing FCC principles in daily practice. Appreciative inquiry (AI) is a philosophy and methodology that offers a unique, strength-based approach to promoting organisational learning and positive organisational change. As a participatory approach, AI facilitates change from the ground up and lends itself to building effective partnerships or collaborations. This article reports the findings of a one-day workshop using an AI methodology to bring neonatal nurses and parents together to enhance the FCC within a neonatal intensive care unit in Sydney, Australia. Participants (n = 15) developed collaborative insights of optimal FCC that can be built upon to support neonates and their families in the future. Shared visions were formed, strategies identified and a development plan made for ongoing collaborations and partnerships. AI provides a flexible framework that enables the mandatory collaboration needed to develop action plans that can form the catalyst for organizational change in health-care research and practice.

Demographic and academic-related differences between standard-entry and graduate-entry nursing students: a prospective correlational survey.

BACKGROUND: Students who enroll in graduate-entry nursing programs are described as more highly motivated, scoring higher in most learning strategies, and achieving greater academic success than standard-entry nursing students. DESIGN: A prospective correlational design was used to compare the demographic and academic-related characteristics of standard-entry and graduate-entry nursing students in their first year of study. METHODS: Between 2007 and 2011, students enrolled in the Bachelor of Nursing, Standard Entry and the Bachelor Nursing, Graduate Entry at a large Australian university were surveyed in the first year of their program. Data included English-language usage and time spent in paid work, as well as four dimensions of Pintrich's Motivated Strategies for Learning Questionnaire. Survey data was linked to students' academic grades at the end of the semester. RESULTS: A total of 730 students completed the survey and consented to collection of their academic grades. Graduate-entry students were more likely to be older (28.6 vs. 24.3 years, P < 0.001), and there was a higher percentage of males (25.2% vs. 15.9%, P = 0.003). Although no difference was identified between groups for use of Extrinsic Goal Orientation as a learning strategy, the graduate-entry students were more likely to identify Peer Learning, Help Seeking and Critical Thinking as strategies for learning than the standard-entry students (P < 0.001). Further, while this group of students achieved a higher mean GPA (4.8 vs. 4.0, P < 0.001) compared to the standard-entry students, regression analyses revealed that in both groups, lower levels of English-language proficiency and increased time spent in paid work were predictors of poorer academic performance. CONCLUSIONS: Similar to US-based studies, demographic and academic-related differences were identified between standard-entry and graduate-entry nursing students. However, the study also highlights lower levels of English-language proficiency and increased time spent in paid work negatively impacted academic performance in both groups of nursing students.