Healthcare processes for parent participation in neonatal intensive care units: A self-determination theory perspective.

This research explores parents' experiences in the NICU to inform design and implementation of processes that motivate and direct parent participation in healthcare processes for their children. Qualitative methods were employed combining elements of grounded theory and phenomenology. Findings reveal that despite known benefits, parent participation does not always occur in NICUs due to difficulties NICUs face while balancing technologically complex care that increases survival rates with parent-participation models that provides holistic wellbeing. Self-determination theory provides a work design perspective that can guide design and implementation of parent participation, as partial employees, as a key component of NICU healthcare processes.

Application of a Risk Management Framework to Parent Sleep During Skin-to-Skin Care in the NICU.

As NICU staff work to increase the frequency, duration, and comfort of skin-to-skin care (SSC) sessions, barriers to implementation are frequently encountered. Safety concerns are often raised when parents fall asleep during SSC intentionally or unintentionally. We present a risk management framework that we use in clinical practice to address risk related to parent sleep during SSC. Our approach is based on the steps of the Risk Management Life Cycle, which include the following: establish context, identify risk, analyze risk, respond to risk, and monitor and adapt response to risk. Clinicians may use this framework in clinical practice to manage risks related to prolonged SSC, specifically when parents relax and fall asleep during SSC.

Clinician Opinions and Approaches to Manage Risk Related to Safe Sleep During Skin-to-Skin Care.

OBJECTIVE: To understand the opinions of clinicians about the risks, benefits, barriers, and facilitators to the practice of parent sleep during skin-to-skin care in hospital settings. DESIGN: Cross-sectional survey. SETTING: Online survey. PARTICIPANTS: Clinicians who self-identified as infant care providers, that is, neonatal clinicians (N = 158). METHODS: We sent an online survey invitation to neonatal clinicians through neonatal websites, conferences, and social media sites in the United States and used snowball recruitment. We used a risk management framework to analyze qualitative data. We used descriptive statistics and the chi-square and Fisher's exact tests to determine if opinions differed based on clinician and organizational characteristics. RESULTS: Respondents' support of parent sleep during skin-to-skin care (yes/no) did not differ on the basis of whether the clinician had taken a formal course on skin-to-skin care, facilitated skin-to-skin care more than 100 times, or frequently promoted skin-to-skin care in current practice. Respondents who supported parent sleep (n = 93, 59% of respondents) reported greater implementation of risk control strategies than nonsupporters (n = 53 [57%] vs. n = 3 [5%]; p < .001), such as frequent monitoring of vital signs (n = 33 [35%] vs. n = 2 [3%]; p < .001), use of devices to support skin-to-skin care (n = 49 [53%] vs. n = 19 [29%]; p = .003), and proper positioning (n = 20 [22%] vs. n = 0 [0%]; p < .001). Nonsupporters more frequently reported that parent sleep during skin-to-skin care violates safe sleep recommendations, is habit forming for home, poses a fall risk, and jeopardizes the infant's airway. CONCLUSION: Most respondents supported parent sleep during skin-to-skin care, but concerns regarding safety for the infant remained a barrier. The use of a risk management framework may help facilitate a systematic approach to improve the implementation of safe skin-to-skin practices.