ABSTRACT
OBJECTIVE: To characterize (1) the prevalence of mental health discussion and (2) facilitators of and barriers to parent disclosure of mental health needs to clinicians. STUDY DESIGN: Parents of infants with neurologic conditions in neonatal and pediatric intensive care units participated in a longitudinal decision-making study from 2018 through 2020. Parents completed semi-structured interviews upon enrollment, within 1 week after a conference with providers, at discharge, and 6 months post-discharge. We used a conventional content analysis approach and NVIVO 12 to analyze data related to mental health. RESULTS: We enrolled 61 parents (n = 40 mothers, n = 21 fathers) of 40 infants with neurologic conditions in the intensive care unit. In total, 123 interviews were conducted with 52 of these parents (n = 37 mothers, n = 15 fathers). Over two-thirds of parents (n = 35/52, 67%) discussed their mental health in a total of 61 interviews. We identified two key domains when approaching the data through the lens of mental health: (1) self-reported barriers to communicating mental health needs: parents shared uncertainty about the presence or benefit of support, a perceived lack of mental health resources and emotional support, and concerns about trust; (2) self-reported facilitators and benefits of communicating mental health needs: parents described the value of supportive team members, connecting to peer support, and speaking to a mental health professional or neutral third party. CONCLUSIONS: Parents of critically ill infants are at high risk of unmet mental health needs. Our results highlight modifiable barriers and actionable facilitators to inform interventions to improve mental health support for parents of critically ill infants.
Subject(s)
Disclosure , Mental Health , Infant, Newborn , Child , Female , Humans , Infant , Critical Illness/therapy , Critical Illness/psychology , Aftercare , Patient Discharge , Parents/psychology , Intensive Care Units, NeonatalABSTRACT
OBJECTIVE: To characterize decisional satisfaction, regret, and conflict among parents of critically ill infants with neurologic conditions. STUDY DESIGN: In this prospective cohort study, we enrolled parents of infants with neurologic conditions in the intensive care unit (ICU). Hospital discharge surveys included the validated Family Satisfaction with the ICU (FS-ICU) decision making subscale, Decision Regret Scale (DRS), and Decisional Conflict Scale (DCS). We defined high satisfaction with decision making as an FS-ICU score ≥75, high decisional regret/conflict as DRS/DCS score >25, and within-couple disagreement as a difference of at least 25 points between scores. RESULTS: We enrolled 61 parents of 40 infants (n = 40 mothers, n = 21 fathers); 35 mothers and 15 fathers completed surveys. Most mothers reported high satisfaction with decision making (27 of 35; 77%) and low decision regret (28 of 35; 80%); 40% (14 of 35) reported high decisional conflict. Mothers and fathers reported higher decisional conflict in the domains of uncertainty and values clarity compared with the domain of effective decision making (Bonferroni-corrected P < .05). There were no differences in decision outcomes between paired mothers and fathers; however, within any given couple, there were numerous instances of disagreement (7 of 15 for decision regret and 5 of 15 for decisional conflict). CONCLUSIONS: Many parents experience decisional conflict even if they ultimately have high satisfaction and low regret, underscoring the need for decision aids targeting uncertainty and values clarity. Couples frequently experience different levels of decisional regret and conflict.
Subject(s)
Decision Making , Personal Satisfaction , Emotions , Humans , Infant , Parents , Prospective StudiesABSTRACT
BACKGROUND: Nonelective removal of peripherally inserted central catheters (PICCs) due to complications continues to be a major concern in neonatal intensive care units (NICUs) around the world. Nonelective removal results in interruption of intravenous therapy, added costs, stress, and negative impacts on infant's health. Identification of predictors of complications that lead to nonelective removal of PICCs would allow for the initiation of preventive strategies to improve the quality of care. AIM: To identify predictors of nonelective removal of PICCs in neonates. METHODS: A prospective cohort study with a sample of 524 PICC lines inserted in 436 neonates admitted to a tertiary-level NICU of a Brazilian hospital. Data were collected on all neonates between August 31, 2010, and August 30, 2012. Neonates were monitored daily from insertion of the catheter until its removal. Bivariate analysis and a logistic regression were conducted in order to identify predictors of nonelective removal. RESULTS: A diagnosis of a transitory metabolic disorder (hypoglycemia; disorders of calcium, magnesium, sodium, or potassium; or dehydration), previous PICC line insertion, insertion of dual-lumen polyurethane PICC, noncentral tip position, and multiple intravenous solutions in a single-lumen silicone PICC were predictors of nonelective removal of PICC lines. CONCLUSION: The avoidance of repeated PICC insertions, noncentral tip position, and placement of single-lumen silicone PICCs for administration of four or more intravenous solutions is suggested. Interventions should be explored that facilitate PICC insertion success and correct tip placement.
Subject(s)
Catheter-Related Infections/etiology , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/nursing , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/nursing , Device Removal/statistics & numerical data , Brazil , Catheterization, Central Venous/statistics & numerical data , Catheterization, Peripheral/statistics & numerical data , Cohort Studies , Female , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Male , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns. METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve. RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (≥ 9 points). Accuracy was 0.76. CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.
Subject(s)
Catheterization, Peripheral , Catheters, Indwelling , Device Removal , Female , Humans , Infant, Newborn , Male , Neonatal Nursing , Prospective Studies , Risk Assessment , Risk FactorsABSTRACT
to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns. prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve. the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (≥ 9 points). Accuracy was 0.76. the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.
elaborar um escore de risco para remoção não eletiva do cateter central de inserção periférica em neonatos. estudo de coorte prospectivo conduzido em unidade de terapia intensiva neonatal com recém-nascidos submetidos à instalação de 524 cateteres centrais de inserção periférica. As características clínicas do neonato, a técnica de inserção do cateter e a terapia intravenosa foram testadas como fatores de risco para remoção não eletiva do cateter na análise bivariada. O escore de risco foi elaborado a partir da regressão logística, validado internamente e sua acurácia avaliada por meio da área sob a curva receiver operating characteristic. o escore de risco foi composto pelos fatores de risco: diagnóstico de transtorno transitório do metabolismo, inserção prévia do cateter, uso de cateter duplo lúmen de poliuretano, infusão de múltiplas soluções endovenosas através de cateter mono lúmen e posição não central da ponta do cateter. Sua aplicação permitiu classificar os recém-nascidos em três categorias de risco: baixo (0 a 3 pontos), moderado (4 a 8 pontos) e alto (≥ 9 pontos) para remoção não eletiva, com acurácia de 0,76. recomenda-se adotar estratégias preventivas baseadas em evidências de acordo com a classificação e fatores de risco do recém-nascido, visando minimizar a ocorrência de remoção não eletiva do cateter.
elaborar un puntaje de riesgo para remoción no electiva del catéter central de inserción periférica en neonatos. estudio de cohorte prospectivo realizado en una unidad de terapia intensiva neonatal con recién nacidos sometidos a instalación de 524 catéteres centrales de inserción periférica. Las características clínicas del neonato, la técnica de inserción del catéter y la terapia intravenosa fueron verificadas como factores de riesgo para remoción no electiva del catéter en un análisis bivariado. El puntaje de riesgo fue elaborado a partir de regresión logística, fue validado internamente y su precisión evaluada por medio de la área bajo la curva receiver operating characteristic. el puntaje de riesgo fue compuesto por los factores de riesgo: diagnóstico de trastorno transitorio del metabolismo, inserción previa del catéter, uso de catéter doble lumen de poliuretano, infusión de múltiples soluciones intravenosas a través de catéter mono lumen, y posición no central de la punta del catéter. Su aplicación permitió clasificar a los recién nacidos en tres categorías de riesgo: bajo (0 a 3 puntos), moderado (4 a 8 puntos) y alto (≥ 9 puntos) para remoción no electiva, con precisión de 0,76. se recomienda adoptar estrategias preventivas basadas en evidencias de acuerdo con la clasificación y factores de riesgo del recién nacido, objetivando minimizar la ocurrencia de remoción no electiva del catéter.
Subject(s)
Humans , Male , Female , Infant, Newborn , Catheterization, Peripheral , Catheters, Indwelling , Device Removal , Prospective Studies , Risk Factors , Neonatal Nursing , Risk AssessmentABSTRACT
OBJECTIVES: Our purpose was to evaluate the benefits of cycled light (CL) versus near darkness (ND) on health in preterm infants born at <31 weeks' gestational age. STUDY DESIGN: Randomized, interventional study comparing infants receiving (1) CL from birth, (2) CL at 32 weeks' postconceptional age (PCA), and (3) CL at 36 weeks' PCA in transition for discharge home. Statistical significance was assessed with segmented mixed general linear models, analysis of covariance, general estimating equations, chi(2), and Fisher's exact procedure. RESULTS: Infants receiving CL at birth and 32 weeks' PCA gained weight faster than infants not receiving CL until 36 weeks' PCA. There were no differences among the groups in length of hospitalization stay or number of ventilator days, but the power was low for these variables. CONCLUSIONS: These findings suggest that CL has significant weight gain benefits over ND, and there are no short-term advantages of ND over cycled light for health in preterm infants.