"It Takes a Village" to Implement Family-Centered Care in the Neonatal Intensive Care Unit.

BACKGROUND: Although research has demonstrated positive impacts of family-centered care (FCC), many neonatal intensive care unit (NICU) nurses hesitate to fully engage in its practice. There has been little scientific focus on investigating the challenges of FCC implementation in the NICU setting. PURPOSE: The purpose of this study was to generate a grounded theory explaining the process by which neonatal nurses experience facilitators and challenges through engaging in FCC practices in the context of the NICU setting. METHODS: This qualitative, grounded theory portion of a mixed-methods study employed individual, semistructured, video-based dyadic interviews with 20 neonatal nurses. RESULTS: Successful implementation of FCC by neonatal nurses is affected by various factors. The adage that "it takes a village to raise a child" described this process for the nurse participants. The delivery of FCC involves respectful engagement and participation by multiple internal and external stakeholders. The process of delivering FCC was influenced by factors across 6 categories: equitable relationships, bond of trust, knowledge sharing, empowerment in workplace, environment and culture, and regulations. The findings suggest that FCC implementation is not an individual initiative; rather, it involves a complex set of interrelationships between care team members. NICU nurses may consider these findings when they are proposing a change to a FCC model. IMPLICATIONS FOR PRACTICE AND RESEARCH: Flexibility is necessary by multidisciplinary teams to achieve maximum benefits of FCC and minimize potential harm, despite the unit design. Facilities may support nurses with continuing education programs to expand their FCC knowledge and skills.

Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses.

BACKGROUND: Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent-infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice. PURPOSE: The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses. METHODS: This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments. RESULTS: Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (ß= 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices ( r =-0.199, P < .001). IMPLICATION FOR RESEARCH AND PRACTICE: Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.

Lived Experiences of Parents of Children with Celiac Disease: A Descriptive Qualitative Study.

Purpose: Celiac disease (CD) is one of the most prevalent food-related illnesses in children, with a global prevalence of approximately 1.4%. CD can create an emotional burden, particularly on mothers, who are mainly responsible for managing challenges related to adherence to a gluten-free diet, high food costs, and food problems in schools and social areas. There is a gap in the literature, and parental experiences of raising children with CD should be explicitly examined. This qualitative study sought to provide insights into the experiences of parents raising a child with CD in the Turkish context. Methods: This study used a descriptive qualitative research methodology and conducted individual semi-structured video-based dyadic interviews with 19 parents. Results: Participants experienced both challenges and motivators through management of their children's CD. Analyses of the interview transcripts through the data uncovered three main themes focusing primarily on parental concerns: (1) parental challenges in child's disease management, (2) supportive care needs, and (3) parental expectations. Conclusion: A multidisciplinary team should approach the child and family immediately after diagnosis, and facilities should support parents with continuing education and psychological, financial, and social assistance.

Effects of family-centered care on bonding: A systematic review.

Most critically ill neonates require constant monitoring, continuous care, and supervision. However, distance created by admission and prolonged stay in a neonatal intensive care unit (NICU) may contribute to a delay in parent-infant bonding. This review aimed to determine how family-centered care (FCC) in the NICU affects parental bonding with critically ill infants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to perform a systematic search of the literature within the following four electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, and Web of Science. The search was conducted through July/August 2020. Research quality was evaluated using the Johns Hopkins Nursing Evidence-Based Practice Grading Scale. Out of 816 articles identified through literature search, 16 of the studies met our inclusion criteria. The majority of the studies (n = 14) found FCC interventions resulted in a significant increase in parental bonding. Results showed evidence practicing FCC in the NICU setting supports early parent-infant bonding. Nurses should consider implementing evidence-based FCC strategies into practice, such as allowing parents unrestricted access to their infants. More rigorous research with larger samples is recommended. More studies are also needed focusing on father-infant dyads and mother-father-infant triads.

Predicting alternate light absorption in areas of trauma based on degree of skin pigmentation: Not all wavelengths are equal.

Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415 nm and 450 nm viewed through a yellow filter had the most frequent detections of bruises (415 nm: n = 2777, 11.2%; 450 nm: n = 2747, 11.1%) and greater predictive probability of a positive finding (415 nm: 0.90-0.99; 450 nm: 0.85-0.99) than white light (n = 2487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.

Development and Pilot Analysis of the Bruise Visibility Scale.

The accuracy of assessing and documenting injuries is crucial to facilitate ongoing clinical care and forensic referrals for victims of violence. The purpose of this cross-sectional, pilot study was to evaluate the inter-rater reliability and criterion validity of a newly developed Bruise Visibility Scale (BVS). Methods: The instrument was administered to a diverse sample (n = 30) with existing bruises. Bruises were assessed under fluorescent lighting typical of an examination room by three raters who were randomly selected from a pool of eight experienced clinical nurses. Colorimetry values of the bruise and surrounding tissue were obtained using a spectrophotometer. Results: The BVS demonstrated good single (ICC = 0.71, 95% CI = 0.54 - 0.84) and average agreement (ICC = 0.88, 95% CI = 0.78 - 0.94) between raters. A significant, positive moderate correlation was found between mean BVS scores and overall color difference between the bruise and surrounding skin (Pearson's r = 0.614, p < 0.001). Conclusion: With further research, the BVS has the potential to be a reliable and valid tool for documenting the degree of clarity in bruise appearance.

Quantifying the Degree of Bruise Visibility Observed Under White Light and an Alternate Light Source.

BACKGROUND: Documentation of injuries associated with abuse and assault has pivotal impacts on clinical and legal outcomes. Before this study, no reliable and valid tools to consistently document the clinical visibility of bruises existed. The purpose of this study was to systematically evaluate reliability and validity of the Bruise Visibility Scale for documenting bruises visualized in normal (white) light and the Absorption Visibility Scale for documenting bruises visualized using an alternate light source (ALS). METHODS: Bruises were induced using a paintball on the upper arms of 157 participants stratified into six skin color categories. Bruises were visualized 21 times over 4 weeks under white light and 10 ALS wavelength/goggle color combinations. Bruise size was measured using a metric ruler; bruise color was measured using a spectrophotometer. Interrater reliability was calculated using kappa and intraclass correlations coefficients. Construct validity was evaluated using generalized linear mixed modeling of associations between bruise size and color with both visibility scales. RESULTS: Interrater agreement for bruise detection was over 90% for all but two ALS wavelength/goggle combinations. Kappa values indicated adequate interrater agreement under white light (κ = 0.76) and ALS (κ = 0.78). The visibility scale intraclass correlation coefficients were .91 for normal light and .93 for ALS. Statistical modeling showed greater bruise size was associated with higher visibility using either scale, and greater contrast in color or lightness was associated with higher Bruise Visibility Scale values. IMPLICATIONS FOR PRACTICE: Both visibility scales showed satisfactory reliability and validity. Forensic nurses can use the scales to consistently document bruises.