An Integrative Review of Fathers' Needs in the Neonatal Intensive Care Unit.

Having a child admitted to the neonatal intensive care unit (NICU) is traumatic for both parents, but mothers and fathers may have different experiences, and thus, different needs. The purpose of this integrative review was to identify the needs of fathers of premature infants. A systematic review of 7 databases was conducted, and studies were evaluated by the Critical Appraisal Programme checklist. To provide structure for searching and reporting findings, the Whittemore and Knafle interpretive methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were used. A total of 19 articles were identified. The resulting themes included: need to be close to infant and involved in infant's care; need for information; need for a better NICU environment; need for emotional support; and need for a relationship with the NICU staff.

Reducing parental trauma and stress in neonatal intensive care: systematic review and meta-analysis of hospital interventions.

OBJECTIVE: To classify NICU interventions for parental distress and quantify their effectiveness. STUDY DESIGN: We systematically reviewed controlled studies published before 2017 measuring NICU parental distress, defined broad intervention categories, and used random-effects meta-analysis to quantify treatment effectiveness. RESULTS: Among 1643 unique records, 58 eligible trials predominantly studied mothers of preterm infants. Interventions tested in 22 randomized trials decreased parental distress (p < 0.001) and demonstrated improvement beyond 6 months (p < 0.005). In subgroup analyses, complementary/alternative medicine and family-centered instruction interventions each decreased distress symptoms (p < 0.01), with fathers and mothers improving to similar extents. Most psychotherapy studies decreased distress individually but did not qualify for meta-analysis as a group. CONCLUSION: NICU interventions modestly reduced parental distress. We identified family-centered instruction as a target for implementation and complementary/alternative medicine as a target for further study. Investigators must develop psychosocial interventions that serve NICU parents at large, including fathers and parents of full-term infants.

Intervenção musicoterápica para mãe-bebê pré-termo: uma proposta de intervenção na UTI neonatal / Intervención musicoterapéutica para Madre-Bebé Prematuro: una propuesta de intervención en la Unidad de Cuidados Intensivos Neonatales / Music therapy intervention for the mother-preterm infant dyad: a proposal of intervention in the neonatal intensive care unit

RESUMO O presente relato de experiência descreve a Intervenção musicoterápica para mãe-bebê pré-termo - IMUSP, que visa sensibilizar a mãe a cantar para seu bebê pré-termo, durante a internação na Unidade de Terapia Intensiva Neonatal. A IMUSP está prevista para oito sessões, alternadas entre sessões individuais com a mãe e sessões com mãe-bebê. Na implementação da IMUSP, a musicoterapeuta realizou a intervenção na UTINeo de um hospital público com nove mães e bebês prematuros. Foram encontrados vários desafios relativos à disponibilidade das famílias atendidas e às exigências do hospital. Em função disso, foi necessário adaptar a IMUSP, flexibilizando o número de sessões, o tipo de atividades propostas, bem como a alternância entre sessões com a mãe e com mãe-bebê. Evidências sugerem que a IMUSP contribuiu para o 'empoderamento' da mãe e do bebê, e para a 'musicalidade comunicativa' da díade, fortalecendo a interação mãe-bebê pré-termo. A IMUSP é uma intervenção de baixo custo com grande potencial de impacto a longo prazo, uma vez que, além de oferecer apoio à díade na UTINeo, orienta a mãe para que possa cantar autonomamente para seu bebê durante a internação e após a alta hospitalar. Futuros estudos são necessários para ampliar a aplicação da IMUSP e verificar os seus benefícios a curto e longo prazo para a mãe, o bebê pré-termo e a interação mãe-bebê.

RESUMEN En este reporte de experiencia se describe la Intervención musicoterapéutica para madre-bebé prematuro - IMUSP, que tiene como objetivo sensibilizar a la madre a cantar a su bebé prematuro durante la hospitalización en la Unidad de Cuidados Intensivos Neonatales. La IMUSP está organizada en 8 sesiones, alternando entre sesiones individuales con la mamá, y sesiones con mamá-bebé. En la implementación de la IMUSP, la músico-terapeuta realizó la intervención en un hospital público con nueve mamás y sus bebés prematuros. Se encontraron varios retos relacionados a la disponibilidad de las familias atendidas y las exigencias del hospital. Por este motivo, fue necesario adaptar la IMUSP, flexibilizando el número de sesiones, el tipo de actividades propuestas, y la secuencia de las sesiones con mamá y mamá-bebé. Las evidencias sugirieron que la IMUSP contribuyó al 'empoderamiento' de la mamá y el bebé, y a la 'musicalidad comunicativa' de la diada, mejorando así la interacción mamá-bebé prematuro. La IMUSP es una intervención de bajo costo con un gran potencial de impacto a largo plazo, ya que, además de ofrecer apoyo a la diada en la UTINeo, orienta la mamá para que pueda cantar autónomamente a su bebé, durante la hospitalización y después de recibir el alta del hospital. Son necesarios estudios adicionales para ampliar la aplicación de la IMUSP y verificar sus beneficios a corto y largo plazo para la mamá, el bebé prematuro y la interacción mamá-bebé.

ABSTRACT This report of experience describes the Music therapy intervention for the mother-preterm infant dyad - MUSIP, that aims at sensitizing the mother to sing to her preterm infant, during the hospitalization in the Neonatal Intensive Unit Care. The MUSIP is organized in eight sessions, alternating individual sessions with the mother and sessions with the mother-infant dyad. During the implementation of the MUSIP, the music therapist carried out the intervention in a NICU of a public hospital with nine mothers and their preterm infants. Several challenges were found regarding the availability of the families and the demands of the hospital. Therefore, it was necessary to adapt the MUSIP, by making the number of sessions more flexible, the kind of activities that were proposed, as well as the alternation between the sessions with the mother and with mother-infant dyad. Evidences suggest that MUSIP contributed to the mother's and the infant's 'empowerment' and to their 'communicative musicality', enhancing the mother-preterm infant interaction. The MUSIP is a low-cost intervention with a big potential of long-term effects, since, besides supporting the dyad in the NICU, it guides the mother to sing autonomously for her infant during the hospitalization and after discharge. Future studies are needed to expand the MUSIP and to investigate its short and long-term effects for the mother, the preterm infant and mother-infant interaction.

Quality of life of parents of very preterm infants 4 months after birth: a mixed methods study.

BACKGROUND: Knowledge about parental quality of life (QoL) is paramount to family-centred and integrated healthcare on prematurity, but evidence is limited. We aimed to explore mothers' and fathers' perspectives about their QoL 4 months after a very preterm childbirth. METHODS: This is a cross-sectional mixed methods study using a convergent design. Parents of very preterm infants were systematically recruited at all level III neonatal intensive care units in the Northern health region of Portugal for one year. Four months after childbirth, 61 mothers and 56 fathers filled-in the World Health Organization Quality of Life - BREF Inventory, and 26 couples were interviewed. Linear regression models were computed to assess the association between participants' characteristics and the QoL. Qualitative data were thematically analysed. RESULTS: A quantitative analysis revealed that the perception of QoL was not significantly different by gender. QoL scores increased slightly from the environment (Mean (SD): 72.1 (14.2)) to the psychological domains (Mean (SD): 78.7 (14.4)). All scores were influenced by psychological characteristics. Socioeconomic position influenced both parents' perceptions concerning the environment domain, and maternal physical and psychological QoL. Infant-related factors were associated with overall QoL among women and with the physical, psychological, social and environment domains among men. Qualitative findings indicated accommodation mechanisms that intertwine the focus on constraining factors (surveillance, sleep disturbances, non-supportive healthcare policies, hygienization) with facilitating factors (social support, accessibility/quality of healthcare, opportunities for developing parental skills). These processes were anchored in child-centredness and a framework that construct hierarchies of hope and expectations about infant's health and development. CONCLUSIONS: To capture parental QoL using mixed methods raises awareness for developing intersectoral family-centred policies, integrated health services and focused-interventions to decrease the disempowering effects of surveillance and hygienization.

A mindfulness intervention to reduce maternal distress in neonatal intensive care: a mixed methods pilot study.

Mothers with an infant in the neonatal intensive care unit (NICU) are at risk for depression, anxiety, and trauma symptoms, with negative implications for maternal-infant bonding, maternal well-being, and infant development. Few interventions to promote NICU mothers' mental health, however, have been developed or tested. This pre-post pilot study assessed feasibility, acceptability, and preliminary outcomes of a mindfulness intervention for NICU mothers. Twenty-seven mothers were recruited from a university NICU and offered a mindfulness intervention via introductory video and audio-recorded practices. Participants completed a baseline self-report survey. After 2 weeks of engaging with intervention materials, participants completed a second survey and in-depth interview. Quantitative data were analyzed using paired t tests; qualitative data were analyzed using thematic coding. Twenty-four women (89%) completed the study. Quantitative data indicated significant improvements in depressive, anxiety, and trauma symptoms, negative coping, NICU-related stress, and sleep (p < 0.05). Qualitative data identified themes of perceived improvements in psychological distress and stress symptoms, self-care, and relationships. Findings support the mindfulness intervention's feasibility, acceptability, and potential promise for reducing maternal distress and promoting well-being. Use of video and audio modalities may facilitate program sustainability and scale up. Further research on the program is merited.

[Palliative care in delivery room for preterm infants less than 24 weeks of gestation. Analysis of two different behaviors]. / Place des soins palliatifs en salle de naissance dans la prise en charge des prématurés de moins de 24 semaines d'aménorrhée. Expérience de 2 maternités.

AIMS OF THE STUDY: To describe the management of extremely preterm newborns at the threshold of viability before 24 weeks of gestation in the delivery room when the decision has been made not to provide intensive care; to assess the role of palliative care (PC); to report the problems encountered. METHOD: A prospective qualitative study was conducted using semi-structured interviews from November 2009 to June 2010 in two level III French maternity hospitals (A and B). In each center, four midwives, two obstetricians, two pediatricians, two anesthetists, and one chief midwife were interviewed. RESULTS: In maternity hospital A, a protocol was in place that proposed PC derived from developmental care (noise limitation, drying, warming) provided by parents or staff. The problems reported were related to former euthanasia practices rather than new procedures. In maternity hospital B, no palliative care protocol had been set up. Euthanasia was practiced and accepted fatalistically because the only currently existing alternative (letting the infant die) was considered inhumane. Few problems were reported. The reluctance to carry out PC is conceptual and organizational (the ratio of births per midwife in maternity hospital B was twice that of maternity hospital A). Lexical analysis showed preferential use of the words "fetus" and "expulsion" versus "child" and "delivery" in maternity hospital B (p<0.05) when speaking of the delivery of the extremely preterm infant. Our explanatory hypothesis is that the concept of "fetus ex utero" legitimates euthanasia by assimilating it to feticide. CONCLUSION: At the time of this study, two very different approaches to the death of extremely preterm, non-resuscitated newborns in the delivery room coexisted in France. Palliative care is obviously possible, after group reflection, if a true motivation to change, a better understanding of the law, and a clear identification of the respective status of the fetus and the newborn exist in the maternity hospital.

Mothering an extremely low birth-weight infant: a phenomenological study.

Mothers of preterm infants are reported to experience heightened levels of psychological stress, greater than mothers of full-term infants during the neonatal period. The purpose of this study is to describe the lived experience of what it is like to be a mother of an extremely low birth-weight infant during their stay with their infants in the NICU. Interpretive phenomenology articulated by Benner and Diekelmann is the method of qualitative research employed. Thematic analysis is the method of narrative analysis that is used to capture and describe the lived experience with emerging themes, patterns, and meanings. Participants were chosen by purposive sampling. Sample size was 9 participants. Repeated interviews of the participants were done to obtain "redundancy, clarity, and confidence" in the interpreted text. Understanding the themes offers guidance for future research and future programs to aid in the development of meaningful healthy mother-infant relationships and helpful relationships of and with NICU structure and staff.

Patient safety: effective interdisciplinary teamwork through simulation and debriefing in the neonatal ICU.

According to the Institute of Medicine, team training is necessary to promote a safe and high-quality patient care environment. The complexity of the neonatal ICU requires that interdisciplinary teams collaborate, coordinate, and communicate to achieve common goals and support families. The use of strategies from the aerospace, nuclear power, and national defense industries-simulation, and debriefing-equips health care providers with the knowledge, skills, and behaviors necessary to perform effectively and safely. Families are encouraged to participate in simulation and debriefing so interdisciplinary teams can learn how to approach and support families when disclosing errors and to communicate sensitive information in a safe and nonthreatening environment.

Living with grief following removal of infant life support: parents' perspectives.

Research findings reported in the literature about making life and death decisions for critically ill infants in the neonatal ICU focus primarily on the experiences of health care providers and the ethical dilemmas surrounding these decisions. Fewer studies focus on parents' experiences in making decisions about discontinuing life support for their infant, and even fewer address what life is like for parents following the deaths of their infants. This article expands on the concepts identified by parents as factors in their decision making and on the facilitators and barriers parents faced, and continue to face, in their grieving process.

Analysis of enacted difficult conversations in neonatal intensive care.

OBJECTIVE: To analyze the communicative contributions of interdisciplinary professionals and family members in enacted difficult conversations in neonatal intensive care. STUDY DESIGN: Physicians, nurses, social workers, and chaplains (n=50) who attended the Program to Enhance Relational and Communication Skills, participated in a scenario of a preterm infant with severe complications enacted by actors portraying family members. Twenty-four family meetings were videotaped and analyzed with the Roter Interaction Analysis System (RIAS). RESULT: Practitioners talked more than actor-family members (70 vs 30%). Physicians provided more biomedical information than psychosocial professionals (P<0.001), and less psychosocial information than nurses, and social workers and chaplains (P<0.05; P<0.001). Social workers and chaplains asked more psychosocial questions than physicians and nurses (MD=P<0.005; RN=P<0.05), focused more on family's opinion and understanding (MD=P<0.01; RN=P<0.001), and more frequently expressed agreement and approval than physicians (P<0.05). No differences were found across disciplines in providing emotional support. CONCLUSION: Findings suggest the importance of an interdisciplinary approach and highlight areas for improvement such as using silence, asking psychosocial questions and eliciting family perspectives that are associated with family satisfaction.

Caring for a critically ill Amish newborn.

This article describes a neonatal nurse's personal experience in working with a critically ill newborn and his Amish family in a newborn intensive care unit in Montana. The description includes a cultural experience with an Amish family with application to Madeleine Leininger's theory of culture care diversity and universality.

Comparisons of needs, need responses, and need response satisfaction of mothers of infants in neonatal intensive care units.

Providing nursing care to meet the needs of mothers may be unsuccessful because most nurses perceive and prioritize maternal needs differently from how mothers do. In this study, 140 mothers of infants in each neonatal intensive care unit of three hospitals in southern Thailand were interviewed using questionnaires on maternal needs, need responses, and need response satisfaction. Significant differences in mean total scores and mean subscale scores of needs, need responses, and need response satisfaction were found among the three groups of mothers. Significant differences in mean differences of total needs, need responses, and need response satisfaction were found when comparing mothers in each group. The mean rankings of maternal needs, need responses, and need response satisfaction were identified. This study supported the idea of individualized maternal needs and priorities. In providing effective nursing care to meet the needs and satisfaction of mothers, nurses should be concerned with the needs of individuals, their responses to those needs, and need response satisfaction because the satisfaction of these needs is essential for infant well-being.

[Integrated psychological parental assistance in the neonatal intensive care unit: concepts and first experiences]. / Integrative psychologische Elternbetreuung auf der neonatologischen Intensivstation: Konzept und erste Erfahrungen.

BACKGROUND AND HYPOTHESIS: Psychosocial support programs have been established in view of the burden caused to parents having their newborn admitted to the neonatal intensive care unit (NICU). Due to limited resources, preventive programs can only be offered to parents who are identified by the staff to be at risk. Based on the results of a parent questionnaire, the University Children's Hospital Vienna has developed a standardized concept of integrated psychological support. The program and first results are presented. PATIENTS AND METHODS: The psychological support is offered to parents of newborns admitted to the neonatal intensive care unit. The aim of the support is to avoid later psychosocial problems for child and parents. In an interdisciplinary collaboration, the psychologist facilitates parent-child bonding, family development and coping with the baby's illness. The standardized psychological support consists of a consultation at the beginning and end of the hospital stay. Parents are offered optional psychological support or intensive assistance. RESULTS: Parents from 152 patients received the standardized basic psychological support. The majority of the parents took advantage of the additional optional assistance. Because of external transfers (42.1 %) or infant death (18.4 %), only 39.5 % of the parents could be accompanied until discharge. CONCLUSIONS: A standardized psychological model provides parents with the psychological support as one important part of the overall concept of neonatal treatment. Additionally, the medical and nursing staff were sensitized to psychological factors. An effective psychosocial prevention requires psychological support as an essential part of intensive neonatal care.

Nurses' beliefs and values about doing cue-based care in an NICU in Taiwan.

Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU) . This study uses qualitative research methods to grasp the richness and diversity of nurses' beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses' perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.

[Music therapy for prematures]. / Musiktherapie bei Frühgeborenen. Praktische Durchführung und mögliche Auswirkungen anhand eines Fallbeispiels.

BACKGROUND: More than ever before the neonatal care besides the medical and nursing work has to been balanced between protecting the child against over extension due to the concept of "minimal handling" and on the other hand the necessary fostering of the young patients psychic and sensomotor development during the long stationary treatment. In addition to known approaches of auditive stimulation as receptive music therapy a concept of active music therapy methods based on the Nordoff/Robbins creative music-therapy (University Witten/Herdecke) is presented in a case-report. PATIENT AND METHODS: The report describes in a single case-report the music-therapeutic work with a premature of the 23 + 3 (th) week of pregnancy at the neonatological unit of the Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke. The main focus was the observation of the prematures reactions on specific synchronisation of motoric, sensor and acoustical stimulation. RESULTS: Positive reactions allow to presume the effectiveness of music therapy with early born children as they are already shown in clinical studies about receptive music therapy. On the level of involuntary motional actions in the area of head-, face- and hand movements increased directly reactions of awareness on the coordination of sensomotor and acoustical stimulation have been observed. Temporary increase of oxygen partial pressure and reduction of heart/pulse rate seem to cause positive physiological effects. CONCLUSIONS: Active music therapeutic treatment does not seem to be an other risk of over-tension for prematures, but offers through the coordination of different levels of perception an adequate development fostering stimulation.

Care of children and families in the CICU: A focus on their developmental, psychosocial, and spiritual needs.

The staff of Patient and Family Support Services oversees the developmental, psychosocial, and spiritual care of the child in the cardiac intensive care unit. Staff collaborate with medical team members, as well as the patient's family, to promote holistic care. This article describes the roles and responsibilities of the child life specialist, the social worker, and the chaplain and identifies discipline-specific assessment techniques and interventions. The article highlights identified needs of children and their families, offering tools and interventions health care clinicians can use in the cardiac intensive care unit.

Spiritual and religious components of patient care in the neonatal intensive care unit: sacred themes in a secular setting.

OBJECTIVE: We hypothesized that spiritual distress was a common, unrecognized theme for neonatal intensive care unit (NICU) care providers. STUDY DESIGN: An anonymous questionnaire form assigned to a data table in a relational database was designed. RESULTS: Surveys were completed by 66% of NICU staff. All respondents viewed a family's spiritual and religious concerns as having a place in patient care. Eighty-three percent reported praying for babies privately. Asked what theological sense they made of suffering of NICU babies, 2% replied that children do not suffer in the NICU. Regarding psychological suffering of families, the majority felt God could prevent this, with parents differing (p = 0.039) from nonparents. CONCLUSION: There exists a strong undercurrent of spirituality and religiosity in the study NICU. These data document actual religious and spiritual attitudes and practices and support a need for pastoral resources for both families and care providers. NICU care providers approach difficulties of their work potentially within a religious and spiritual rather than a uniquely secular framework.