Ethical Consequences of Technological Mediation on Parental Decision-Making Experiences in the Neonatal Intensive Care Unit.

The neonatal intensive care unit (NICU) is a morally charged space in which parents may be confronted with difficult decisions about the treatment of their newborns, decisions often complicated and created by the increasing use of technologies. This paper adopts a postphenomenological approach to explore the ethical consequences of technological mediation on parental treatment decision-making in the NICU. Semi-structured interviews were conducted with parents of children who received invasive technological support in the NICU to better understand how they made treatment decisions or decisions about specific interventions during their child's hospitalization. The findings suggest that technological mediation-or the various ways in which humans can interact with their world via technologies-contributes to experiences of ambiguity, ambivalence, and alienation in parental decision-making. The ambiguity of invasive NICU technologies can create uncertainty in a decision, which can then lead to internal ambivalence about which decision to make. Ultimately, this ambiguity and ambivalence may lead to alienation from one's child, as parents are disconnected physically and emotionally from the decision and thus their child. Articulating the effects of technological mediation on parental decision-making is a key step in addressing decisional conflict in neonatal intensive care settings and better supporting parents in their decision-making roles.

'Opportunity to bond and a sense of normality': Parent and staff views of cuddling babies undergoing therapeutic hypothermia in neonatal intensive care: 'CoolCuddle'.

BACKGROUND: Currently, parents whose sick babies are undergoing three days of cooling therapy for hypoxic-ischaemic encephalopathy in neonatal intensive care units (NICUs) are not permitted to cuddle their cooled babies, due to concerns of warming the baby or dislodging breathing tubes or vascular catheters. Parents want to stay and care for their cooled babies and have reported that bonding is adversely affected when they are not permitted to hold them. DESIGN AND PARTICIPANTS: Qualitative interviews with 21 parents of cooled babies in NICU (11 mothers and 10 fathers) and 10 neonatal staff (4 consultants and 6 nurses) explored their views and experiences of an intervention to enable parents to cuddle their cooled babies (CoolCuddle). Thematic analysis methods were used to develop the themes and compare them between parents and staff. RESULTS: Five themes were produced. Three themes were comparable between parents and staff: Closeness, a sense of normality and reassurance and support. An additional parent theme reflected their mixed feelings about initial participation as they were apprehensive, but felt that it was an amazing opportunity. Parents and staff described the closeness between parents and babies as important for bonding and breastfeeding. Fathers particularly appreciated the opportunity to hold and bond with their infants. Parents valued the reassurance and support received from staff, and the cuddles helped them feel more normal and more like a family at a very stressful time. In a final staff theme, they discussed the skills, number of staff and training needed to undertake CoolCuddle in NICU. CONCLUSIONS: Parents cuddling their babies during cooling therapy enhanced parent-infant bonding and family-centred care in NICU and was positively received. Adverse perinatal mental health, impaired mother-infant bonding and their effects on the establishment of breastfeeding may be ameliorated by introducing CoolCuddle. PATIENT CONTRIBUTION: Our parent advisors contributed to the interview topic guides and endorsed the themes from the analysis.

Analysis of communication and logistic processes in neonatal intensive care unit.

BACKGROUND: In neonatology, parents play a central role as guarantors of the new-born's autonomy. Notifying parents about their infant's status in neonatal critical care is an integral part of the care. However, conveying this information can be very difficult for physicians and the neonatal medical team. The objective of this work is to assess the dimensions and dynamic processes of critical care communications in neonatal intensive care in order to enhance the development of theoretical and applied knowledge of these discussions. METHODS: This qualitative, descriptive study was conducted on critical care new-borns less than 28 days-old who were hospitalized in a neonatal intensive care unit. Verbatim communications with the parents were recorded using a dictaphone. RESULTS: The verbatim information had five themes: (a) critical care, (b) establishing the doctor-patient relationship, (c) assistance in decision making, (d) Socio-affective and (e) socio-symbolic dimensions. Our recordings underscored both the necessity of communication skills and the obligation to communicate effectively. Analysis of the dynamics of the communication process, according to the categories of delivering difficult information, showed few significant differences. CONCLUSION: Physician training needs to include how to effectively communicate to parents to optimize their participation and cooperation in managing their care.

Impacts of Neonatal Hospitalization on Families during the 2019 Coronavirus Pandemic.

OBJECTIVE: Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19. STUDY DESIGN: Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The primary outcomes were impact on family life and financial stability, as measured by the Impact on Family scale, an instrument that evaluates changes to family life as a result of infant or childhood illness. RESULTS: Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. Parents reported significant family impact and greater financial difficulty. Extremely premature infants, lower household income, parent mental health, and lower parental confidence were predictive of greater impacts on family life. CONCLUSION: Parents reported significant family and financial impacts during their infant's hospitalization amid COVID-19. Further studies are needed to guide clinical practice and inform family-supportive resources that can mitigate consequences to family well-being. KEY POINTS: · Impact of infant hospitalization in the context of COVID-19 is largely unknown.. · In a cohort of NICU parents during COVID-19, they reported changes to family life and finances.. · Greater impacts were reported by parents with lower income, confidence, and very premature infants..

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.

Infant-Family Mental Health in the NICU: A Mixed-Methods Study Exploring Referral Pathways and Family Engagement.

Parents and infants in the neonatal intensive care unit (NICU) are exposed to considerable stress, and infant-family mental health (IFMH) services foster emotional well-being in the context of the parent-infant relationship. This mixed-methods study examined the role of an IFMH program introduced in a level 4 NICU. The study included (1) retrospective medical record review of NICU patients who were referred to the IFMH program and (2) qualitative interviews with NICU nurse managers, neonatologists, and medical social workers to explore their understanding of the IFMH program, explore the referral pathways and factors that supported family engagement, and identify specific recommendations for program improvement. Of the 311 infant-parent dyads referred to the IFMH program, 62% had at least one session and Spanish-speaking families were more likely to engage. Of those families receiving services, about one-third had brief intervention, one-third had 4 to 10 sessions, and one-third had long-term services, including in-home after-discharge services. Qualitative interviews with health providers identified unique qualities of the IFMH program and why families were and were not referred to the program. Recommendations centered on adding a full-time IFMH mental health provider to the NICU and increasing communication and integration between the IFMH program and the medical team.

Effect of a Parent Empowerment Program on Parental Stress, Satisfaction, and Length of Stay in the Neonatal Intensive Care Unit.

Parental stress is high when infants are admitted to a neonatal intensive care unit in community-based hospital. This quasi-experimental study explored the effect of implementing the "Creating Opportunities for Parent Empowerment" (COPE) program on parental stress, postpartum depression, parental satisfaction with care, and length of stay in a community-based hospital. A cohort of nurses completed a 1-day "COPE for HOPE" parent empowerment training session. A nurse implemented the COPE parent training at the bedside soon after birth and extended throughout hospitalization. The following instruments were used to collect data: a demographic data sheet, Parental Stress Scale: Neonatal Intensive Care Unit, Edinburgh Postnatal Depression Scale, and an investigator-designed parent satisfaction survey. Forty-nine parent sets participated in the study (29 in the intervention group, 20 in the comparison group). A significant difference was found between the groups related to lower parental stress. There was no difference in terms of parental depression scores or length of hospital stay. However, clear trends revealed that parents in the COPE group exhibited lower depression scores. Parents in both groups reported being greater than 95% satisfied with care across all items. These findings may motivate administrators in other community-based hospitals to implement this intervention.

COVID-19 and the NICU: #Zeroseparation.

COVID-19's first wave created chaos for new NICU families as they struggled to cope with the challenge of a fragile infant along with a pandemic. Safety was paramount due to a lack of understanding around how the virus transmits, but much has been learned since then. The next wave of the virus needs to have a rethink around family separation. World leader organization European Foundation for the Care of Newborn Infants (EFCNI) provides insight into the challenges with the first wave and suggests ideas around rethinking how families interact with their baby in the subsequent waves.

Is This My Home? A Palliative Care Journey Through Life and Death in the NICU: A Case Report.

BACKGROUND: With advancements in neonatology, patients in the neonatal intensive care unit (NICU) are living in the hospital with complex life-limiting illnesses until their first birthday or beyond. As palliative care (PC) becomes a standard of care in neonatology, a level IV NICU developed an interdisciplinary PC team with the mission to ease the physical, mental, and moral distress of the patients, families, and staff. This case report highlights the teamwork and long-term palliative care and ultimately end-of-life care that an infant received by this dedicated NICU palliative care team. CLINICAL FINDINGS: This case discusses a premature ex-27-week gestation male infant who initially presented to the emergency department at 5 months of age with significant tachypnea, increased work of breathing, and poor appetite. PRIMARY DIAGNOSIS: The primary diagnosis was severe pulmonary vein stenosis resulting in severe pulmonary hypertension. INTERVENTIONS: The severity of the infant's pulmonary vein stenosis was incurable. He required substantial life-extending surgical procedures and daily intensive care interventions. In addition to his life-extending therapies, the infant and his family received palliative care support by the NICU PC team and the hospital-wide PC team (REACH team) throughout his admission. This was specialized care that focused on easing pain and suffering while also addressing any social/emotional needs in the infant, his family, and in the hospital staff. The PC teams also focused on protecting the families' goals of care, memory making, and providing a positive end-of-life experience for the infant and his family. The infant's end-of-life care involved providing adequate pain and symptom management, education, and communication to his family about the dying process and allowing unlimited family time before and after his death. OUTCOMES: After 11 months in the NICU and despite aggressive therapies, he required more frequent trips to the cardiac catheterization laboratory for restenosis of his pulmonary veins. He was dependent on iNO to treat his pulmonary hypertension and he continued to require an ICU ventilator. His parents ultimately decided to pursue comfort care. He died peacefully in his mother's arms. PRACTICE RECOMMENDATIONS: The American Academy of Pediatrics and the National Association of Neonatal Nurses both have statements recommending that palliative care be standard of care in NICUs. Establishing a NICU-dedicated interdisciplinary PC team can improve outcomes for infants and families living in the NICU with complex life-limiting illnesses.

Healthcare Satisfaction and Unmet Needs Among Bereaved Parents in the NICU.

BACKGROUND: Learning directly from bereaved parents about their experiences in the neonatal intensive care unit (NICU) can improve services at end-of-life (EOL) care. Parents who perceive that their infant suffered may report less satisfaction with care and may be at greater risk for distress after the death. Despite calls to improve EOL care for children, limited research has examined the EOL experiences of families in the NICU. PURPOSE: We examined parent perceptions of their infant's EOL experience (eg, symptom burden and suffering) and satisfaction with care in the NICU. METHODS/SEARCH STRATEGY: Forty-two mothers and 27 fathers (representing 42 infants) participated in a mixed-methods study between 3 months and 5 years after their infant's death (mean = 39.45 months, SD = 17.19). Parents reported on healthcare satisfaction, unmet needs, and infant symptoms and suffering in the final week of life. FINDINGS/RESULTS: Parents reported high levels of healthcare satisfaction, with relative strengths in providers' technical skills and inclusion of the family. Greater perceived infant suffering was associated with lower healthcare satisfaction and fewer well-met needs at EOL. Parents' understanding of their infant's condition, emotional support, communication, symptom management, and bereavement care were identified as areas for improvement. IMPLICATIONS FOR PRACTICE: Parents value comprehensive, family-centered care in the NICU. Additionally, monitoring and alleviating infant symptoms contribute to greater parental satisfaction with care. Improving staff knowledge about EOL care and developing structured bereavement follow-up programs may enhance healthcare satisfaction and family outcomes. IMPLICATIONS FOR RESEARCH: Prospective studies are needed to better understand parental perceptions of EOL care and the influence on later parental adjustment.

Mutual trust in infant care: the nurses and mothers experiences.

The relationship between healthcare providers and parents of infants in neonatal intensive care unit is based on trust and constitutes a core measure of family-centred care and health. The aim of the present qualitative study was to explore mothers and nurses experiences of trust in one another around the caregiving of the hospitalised infant in intensive neonatal care unit. Focused ethnographic research study conducted through observations and in-depth interviews with 20 mothers and 16 nurses in NICU of Tabriz (Iran) in 2017. Two main themes of 'gradual and fragile trust of mother-to-nurse' (subthemes: Primary trust-mistrust, mother's trust to responsible nurse, mother trust Increase with skilful nurse performance, and vulnerability to trust) and 'gradual and fragile trust of nurse-to-mother' (subthemes: Nurse's initial assessment of trust to mother's readiness to participate, Development of trust to mother, and vulnerability of nurse's trust to mother) were obtained. The present study revealed that mutual trust between the nurse and the mother in the care of the infant was a gradual and progressive process that was achieved over time. Complexities around the care of a hospitalised infant influenced how fragile or vulnerable the trust became between nurse and mother. Findings from this research can be used in supporting increased maternal participation in infant care and improvement of family-centred care in the neonatal intensive care unit.

NICU Maternal-Infant Bonding: Virtual Visitation as a Bonding Enhancement Tool.

The admission of an infant to the neonatal intensive care unit (NICU) presents specialized barriers to the maternal-infant bonding (MIB) process. Virtual visitation (VV) provides a mother with the opportunity to have continual access to her hospitalized infant via a one-way live Web camera. While increasingly used in the NICU, VV remains a novel concept. The objective of this study was to introduce a conceptual model that incorporates the use of VV into the NICU MIB process. Adapted from the Model of Mother-Infant Bonding After Antenatal HIV Diagnosis, a newly developed model of MIB using VV as a bonding enhancement tool is offered. A Model of NICU Maternal-Infant Bonding Incorporating Virtual Visitation presents the NICU bonding process in a chronological manner, with 5 primary propositions and an explanation of their related themes. Virtual visitation is introduced into the bonding process and is shown to act as a moderated variable. A Model of NICU Maternal-Infant Bonding Incorporating Virtual Visitation introduces VV as a tool to enhance the MIB process that occurs in the NICU. The model provides the basis for the development of a research program to examine the multiple potential effects of VV in the NICU.

Infant illness severity and family adjustment in the aftermath of NICU hospitalization.

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.

Hasta un 15% de progenitores tiene un infante que pasará un tiempo en una Unidad de Cuidado Intensivo Neonatal (NICU). Después de la salida, los progenitores deben cuidar de un infante médicamente débil y preocuparse por su desarrollo. El presente estudio examinó cómo la severidad de la enfermedad del infante se asocia con la adaptabilidad familiar. Los participantes eran progenitores con infantes que habían salido de la Unidad de Cuidado Intensivo Neonatal entre 6 meses y 3 años antes de participar en el estudio (N = 199). Por medio de una encuesta electrónica tipo Qualtrics, los progenitores reportaron el historial médico de su infante, el estrés de la crianza, la carga familiar, el funcionamiento como pareja y el acceso a recursos. Los análisis de regresión de variables múltiples revelaron que asuntos médicos más severos del infante durante la hospitalización (v.g. período más largo de hospitalización, más aparatos médicos) se asociaban con mayor carga familiar, aunque no así con estrés o el funcionamiento como pareja. Los asuntos de salud infantil posteriores a la hospitalización (v.g. diagnóstico médico, más médicos especialistas) se asociaron con mayor estrés, un más pobre funcionamiento como pareja y mayor carga familiar. Menos tiempo para los progenitores se asoció con un aumento en el estrés y un más pobre funcionamiento como pareja. De modo sorprendente, los progenitores de infantes que habían sido hospitalizados otra vez reportaron menos estrés y mejor funcionamiento como pareja, pero mayor carga familiar. Las intervenciones con enfoque familiar que incorporan educación sicológica acerca de la comunicación entre proveedor y paciente, apoyo a la propia pareja y el cuidado propio pudieran ser eficaces para prevenir la secuela sicosocial entre familias.

Jusqu'à 15% des parents ont un bébé qui passera du temps en Unité Néonatale de Soins Intensifs. A la sortie de l'hôpital les parents peuvent se retrouver à prendre soin d'un bébé fragile du point de vue médical et s'inquiéter de son développement. Cette étude a examiné comment la sévérité de la maladie du bébé est liée à l'ajustement de la famille. Les participants ont inclu des parents avec des bébés étant sortis de l'Unité Néonatale de Soins Intensifs 6 mois à trois ans avant la participation à l'étude (N = 199). Au travers d'un questionnaire Qualtrics en ligne, les parents ont fait état de l'histoire médicale des bébés, du stress de parentage, du poids sur la famille, du fonctionnement du couple et de l'accès aux ressources. Des analyses de régression multivariables ont révélé que les problèmes médicaux du bébé durant l'hospitalisation les plus graves (i.e. durée plus longue du séjour, plus de dispositifs médicaux) étaient liés à un poids sur la famille plus fort, mais pas au stress ni n'affectait le fonctionnement du couple. Les problèmes de santé du bébé après l'hospitalisation (soit un diagnostic médical, plus de spécialistes médicaux) étaient liés à un stress plus élevé, à un fonctionnement du couple moins bon, et à un poids sur la famille plus fort. Moins de temps pour les parents était lié à un stress supplémentaire et à un fonctionnement du couple moins bon. Avec surprise, les parents de bébés qui étaient réhospitalisés ont fait état de moins de stress et d'un meilleur fonctionnement de couple, mais d'un poids plus fort sur la famille. Les interventions centrées sur la famille qui incorporent une psychoéducation sur la communication médecin-parent, le soutien du partenaire et le soin de soi peut s'avérer efficace afin d'éviter des séquelles psychosociales négatives chez les familles.

Needs of parents in a surgical neonatal intensive care unit.

AIM: While there is evidence of parental needs in the neonatal intensive care unit (NICU), parents of newborns admitted for general surgery are an under-researched population. This study aimed to identify needs in parents of newborns admitted to the NICU for general surgery and whether health-care professionals meet these needs. METHODS: This was a prospective cohort study of 111 parents (57% mothers) of newborns admitted to a surgical NICU for general surgery in Australia from January 2014 to September 2015. Parents completed the Neonatal Family Needs Inventory (NFNI), comprising 56 items in five subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge, as well as the Social Desirability Scale (SDS). Data were analysed using parametric and non-parametric techniques. RESULTS: At both admission and discharge, parents rated Assurance (M = 3.8, standard deviation (SD) = 0.24) needs as the most important, followed by Proximity (M = 3.6, SD = 0.32) and Information (M = 3.5, SD = 0.38). Mothers rated Assurance significantly more important than fathers (P < 0.02). Overall, parents' most important needs were having questions answered honestly (M = 3.96, SD = 0.19), seeing their infant frequently and knowing about the medical treatment (both M = 3.95, SD = 0.23). The 10 most important needs were met for more than 96% of parents, with no evidence of response bias. CONCLUSIONS: Reassurance is a priority need for parents in the surgical NICU. Mothers' and fathers' needs may be best met by practices based on family-centred, individualised care principles.

How Nurse Work Environments Relate to the Presence of Parents in Neonatal Intensive Care.

BACKGROUND: Parental presence in the neonatal intensive care unit (NICU) is essential for families to participate in infant care and prepare them to transition from hospital to home. Nurses are the principal caregivers in the NICU. The nurse work environment may influence whether parents spend time with their hospitalized infants. PURPOSE: To examine the relationship between the NICU work environment and parental presence in the NICU using a national data set. METHODS: We conducted a cross-sectional, observational study of a national sample of 104 NICUs, where 6060 nurses reported on 15,233 infants cared for. Secondary analysis was used to examine associations between the Practice Environment Scale of the Nursing Work Index (PES-NWI) (subscale items and with a composite measure) and the proportion of parents who were present during the nurses' shift. RESULTS: Parents of 60% (SD = 9.7%) of infants were present during the nurses' shift. The PES-NWI composite score and 2 domains-Nurse Participation in Hospital Affairs and Manager Leadership and Support-were significant predictors of parental presence. A 1 SD higher score in the composite or either subscale was associated with 2.5% more parents being present. IMPLICATIONS FOR PRACTICE: Parental presence in the NICU is significantly associated with better nurse work environments. NICU practices may be enhanced through enhanced leadership and professional opportunities for nurse managers and staff. IMPLICATIONS FOR RESEARCH: Future work may benefit from qualitative work with parents to illuminate their experiences with nursing leaders and nurse-led interventions in the NICU and design and testing of interventions to improve the NICU work environment.

Improving Staff Knowledge and Attitudes Toward Providing Psychosocial Support to NICU Parents Through an Online Education Course.

BACKGROUND: Provider-parent communication is a critical determinant of how neonatal intensive care unit (NICU) parents cope, yet staff feel inadequately trained in communication techniques; many parents are not satisfied with the support they receive from hospital providers. PURPOSE: This study evaluated whether NICU staff would demonstrate improved knowledge and attitudes about providing psychosocial support to parents after taking an online course. METHODS: After providing demographic information, staff at 2 NICUs took a 33-item survey both before and after taking a 7-module online course "Caring for Babies and Their Families," and again at 6-month follow-up. Scores (means ± standard deviation) from all time periods were compared and effect sizes calculated for each of the course modules. RESULTS: NICU staff participants (n = 114) included nurses (88%), social workers (7%), physicians (4%), and occupational therapists (1%). NICU staff showed significant improvement in both knowledge and attitudes in all modules after taking the course, and improvements in all module subscores remained significant at the 6-month follow-up mark. Night staff and staff with less experience had lower pretest scores on several items, which improved on posttest. IMPLICATIONS FOR PRACTICE: This course, developed by an interprofessional group that included graduate NICU parents, was highly effective in improving staff knowledge and attitudes regarding the provision of psychosocial support to NICU parents, and in eliminating differences related to shift worked and duration of work experience in the NICU. IMPLICATIONS FOR RESEARCH: Future research should evaluate course efficacy across NICU disciplines beyond nursing, impact on staff performance, and whether parent satisfaction with care is improved.

An Ethnography of Parents' Perceptions of Patient Safety in the Neonatal Intensive Care Unit.

BACKGROUND: Parents of neonates are integral components of patient safety in the neonatal intensive care unit (NICU), yet their views are often not considered. By understanding how parents perceive patient safety in the NICU, clinicians can identify appropriate parent-centered strategies to involve them in promoting safe care for their infants. PURPOSE: To determine how parents of neonates conceptualize patient safety in the NICU. METHODS: We conducted qualitative interviews with 22 English-speaking parents of neonates from the NICU and observations of various parent interactions within the NICU over several months. Data were analyzed using thematic content analysis. Findings were critically reviewed through peer debriefing. FINDINGS: Parents perceived safe care through their observations of clinicians being present, intentional, and respectful when adhering to safety practices, interacting with their infant, and communicating with parents in the NICU. They described partnering with clinicians to promote safe care for their infants and factors impacting that partnership. We cultivated a conceptual model highlighting how parent-clinician partnerships can be a core element to promoting NICU patient safety. IMPLICATIONS FOR PRACTICE: Parents' observations of clinician behavior affect their perceptions of safe care for their infants. Assessing what parents observe can be essential to building a partnership of trust between clinicians and parents and promoting safer care in the NICU. IMPLICATIONS FOR RESEARCH: Uncertainty remains about how to measure parent perceptions of safe care, the level at which the clinician-parent partnership affects patient safety, and whether parents' presence and involvement with their infants in the NICU improve patient safety.

The effect of a care program and social support on anxiety level in mothers of late preterm infants in Sistan and Baluchestan, Iran.

Late and moderate preterm (LAMP) neonates are at risk of developing severe complications that can lead to anxiety in mothers. The aim of this study was to determine the effectiveness of a care program on the anxiety level of mothers with LAMP babies and to determine the effectiveness of the care program on the level of anxiety of new mothers in the presence of social support. This quasi-experimental study was conducted on 80 mothers whose late preterm infants were admitted to neonatal intensive care unit at Ali-ibn Abi Talib Hospital, Zahedan. Data were gathered between July 10 and October 13, 2016. The intervention group received the care program. Anxiety and social support were evaluated using the State-Trait Anxiety Inventory and Multidimensional Scale of Perceived Social Support (MSPSS), respectively. After receiving the intervention, the mean MSPSS was higher for the mothers in the intervention group (p = .0025). Additionally, they experienced less state anxiety 72 hours after discharge and 1 month after delivery (p < .0025). Regression analysis showed that mothers with higher social support were 39 percent more likely to be in the "no to moderate STAI" (<51) group. Perceived social support can mediate the effect of care programs on diminishing anxiety.

Prevalence and Associated Factors to Depression and Anxiety in Women with Premature Babies Hospitalized in a Neonatal Intensive-Care Unit in a Mexican Population.

PURPOSE: The aims of this study were to investigate the frequency of depression and anxiety in mothers of children hospitalized in a neonatal intensive care unit, and to determine the characteristics associated with depression and anxiety in a sample of Mexican mothers. METHOD: We studied 188 mothers who had premature babies in a neonatal intensive-care. Sociodemographic and clinical characteristics were collected through a face to face interview performed by professional staff. We assessed depression using the Beck Depression Inventory (BDI) and clinical anxiety using the Hamilton Anxiety Rating Scale (HAM-A). RESULTS: Clinical anxiety was reported in more than one-third of women (34.0%, n = 64) followed by depression (19.7%, n = 37), while twenty-six women reported both significant depression and anxiety (13.8%). Women with both clinical symptoms were younger, they were more frequently students and were living within extended families. Women who presented only symptoms of depression reported lower educational level (elementary school 29.7%, n = 11). CONCLUSION: Our results show a high incidence of anxiety, depression, and both emotional disorders in Mexican mothers of premature babies hospitalized in a neonatal intensive care unit. Demographic features such as occupation or age may impact the occurrence and severity of joint symptoms of depression and anxiety which should be monitored by the health team and referred to a mental health service.

Investigation of stress and nursing support in mothers of preterm infants in neonatal intensive care units.

BACKGROUND: The birth and hospitalisation of a premature infant in a neonatal intensive care unit (NICU) are stressful experiences for the mother and the family. The support of neonatal nurses is necessary to control and reduce the stress of mothers. And nurse-parent support may play a role in effective stress management and make a positive contribution to the health of mothers. AIM: To determine the correlation of stress and nurse-parent support levels with mothers' age and educational status, number of children, gestational week of the infant and the hospitalisation period of the infant among mothers of premature infants hospitalised in the NICU. METHODS: This descriptive and cross-sectional study was conducted in the NICUs of two medical faculties. The study was conducted between March and June 2017 with the participation of 106 mothers with hospitalised premature infants. The data of the study were collected using a 'mother information form', Parental Stressor Scale: Neonatal Intensive Care Unit and Nurse-Parent Support Tool. Number, percentage, mean, standard deviation, t-test, analysis of variance test, Pearson's correlation and multiple regression analysis were used to analyse the data. RESULTS: It was determined that the stress levels were high in mothers regarding their PSS: NICU parental role subscale. The stress levels of mothers with infants connected to mechanical ventilation and fed parenterally were high (p < 0.05). The nurse support levels of mothers with middle- and low-income status were high. Multiple regression analysis, mechanical ventilation was determined to be effective in the use of the PSS:NICU total score (p < 0.05). CONCLUSIONS: As a result, it was determined that mechanical ventilation and parenteral nutrition of the infant increased the stress level of mothers. Furthermore, in the study, the Nurse-Parent Support score of the mothers with middle- and low-income status was higher.