Gaining an Empathetic Insight into Parenting: Evaluating Infant Simulator Dolls for Professional Learning.

The development of an empathetic approach when working with parents and families is fundamental to both social work and children's nursing; however, opportunities to develop this are limited. RealCare Baby infant simulator dolls were used with the aim of enabling students to gain an empathetic insight into parenting. A qualitative, evaluation study involving semistructured interviews with 10 social work and 11 children's nursing students was undertaken to evaluate experiences and views of infant simulator dolls, in relation to professional learning. Using reflexive thematic analysis of interview data, six key themes were identified: (1) positive experiences, (2) challenges, (3) impact on self, (4) empathy toward parents, (5) realism and (6) learning by reflection. All themes were evident from the participants' accounts in the context of the parenting experience. In addition to the overall positive impact on students, practical and technical challenges were also identified. However, despite these difficulties, participants valued the learning experience gained from caring for a doll and many articulated how an empathetic understanding of the parenting role was enhanced. This will potentially enable social work and children's nursing students to support parents more sensitively and empathetically.

'Blurred boundaries': When nurses and midwives give anti-vaccination advice on Facebook.

BACKGROUND: Nurses and midwives have a professional obligation to promote health and prevent disease, and therefore they have an essential role to play in vaccination. Despite this, some nurses and midwives have been found to take an anti-vaccination stance and promulgate misinformation about vaccines, often using Facebook as a platform to do so. RESEARCH QUESTION: This article reports on one component and dataset from a larger study - 'the positives, perils and pitfalls of Facebook for nurses'. It explores the specific issue of nurses and midwives who take an anti-vaccination stance, deemed to be unprofessional by crossing professional boundaries and by providing medical information on Facebook that is not within their scope of practice. PARTICIPANTS: Data were collected via an online worldwide survey from nurse and midwife participants, distributed and 'snowballed' through relevant nursing and midwifery groups on Facebook. In total, 1644 Registered Nurses and Midwives, and Enrolled Nurses worldwide attempted the online survey. There were 1100 (66.9%) completed surveys and 54 partially (33.1%) completed surveys. Semi-structured interviews were also conducted online using Skype® with 17 participants in Australia. ETHICAL CONSIDERATIONS: Ethical processes and procedures have been adhered to relating to privacy, confidentiality and anonymity of the participants. FINDINGS/RESULTS: A mixed-methods approach was used, including descriptive and content analysis of the quantitative survey data and thematic analysis of the qualitative interview data. The main theme 'blurred boundaries' was generated, which comprised three sub-themes: 'follow the science, 'abuse of power and erosion of trust' and 'the moral and ethical responsibility to safeguard public health'. The results offer an important and unique understanding of how nurses and midwives interpret the conduct of fellow health professionals as unprofessional and crossing the professional boundary if they used Facebook to promulgate anti-vaccination messages and/or give medical advice online. CONCLUSION: There are many positives and negatives for nurses and midwives associated with using Facebook for personal and professional communication, which is in keeping with the results of the larger study from which this article is taken. Professional behaviour is a key theme in the larger research as is the ethical construct of 'every act has a consequence'; however, in this article, the theme 'blurred boundaries' offers an overall understanding of how nurses and midwives interpret the behaviour of their colleagues who espouse anti-vaccination sentiment and/or give medical advice online that is outside their scope of practice and education.

Breastfeeding in the context of the COVID-19 pandemic: A discussion paper.

Breastfeeding offers one of the most fundamental global health benefits for babies. Breastmilk is lifesaving, providing not only nutrition but immunologic benefits and as such is strongly supported by the World Health Organization and leading healthcare associations worldwide. When the COVID-19 pandemic started in 2020, the impact of the restrictions to prevent the spread of the disease created challenges and questions about provision of safe, quality care, including breastfeeding practices, in a new 'normal' environment. Mothers were temporarily separated from their babies where infection was present or suspected, parents were prevented from being present on neonatal units and vital breastfeeding support was prevented. This discussion paper provides an overview of essential areas of knowledge related to practice for neonatal nurses and midwives who care for breastfeeding mothers and babies, in the context of the COVID-19 pandemic and the latest global guidance. Three areas will be discussed; the protective benefits of breastfeeding, keeping breastfeeding mothers and babies together and supporting mothers to breastfeed their babies. Finally, care recommendations are presented to serve as a summary of key points for application to practice for neonatal nurses and midwives.

Neonatal nursing led research activity in the UK: a survey of current practice.

BACKGROUND: Neonatal nurses are ideally placed in practice to undertake research enhancing the care of families. More information is required, however, around neonatal nursing led research to advance leadership in this area. The aim of this study was to determine neonatal nursing led research activity within the UK. METHODS: The study used a web-based survey design and neonatal nurses were eligible if they were working at or towards Masters or Doctoral level qualification in the UK. The survey was distributed to members of the Neonatal Nurses Association, UK Schools of Nursing and shared on social media pages of authors and professional organisations. Results were analysed using descriptive and frequency statistics and content analysis. RESULTS: Of the 56 respondents, 14% (n = 8) had a Doctoral level qualification and 43% (n = 24) of participants held a Masters qualification. Lack of time and funding knowledge was the largest barrier to research. Only 30% (n = 3) of participants had a research mentor and only 18% (n = 3) were from a neonatal nursing background. CONCLUSIONS: There are limited numbers of neonatal nurses undertaking or leading nursing research in the UK. Further support is required to enhance clinical academic career trajectories to ensure research is a viable pathway for future generations of neonatal nurses.

Exploring modifiable risk-factors for premature birth in the context of COVID-19 mitigation measures: A discussion paper.

During the COVID-19 pandemic, parents with sick or premature babies have faced challenges following admission to a neonatal unit due to the imposed lock-down restrictions on social contact, hospital visitation and the wearing of personal protective equipment. The negative short-term impact on neonatal care in relation to the prevention of close proximity, contact and bonding between parents and babies is potentially significant. However, an interesting finding has been reported of a reduction in premature birth admissions to the neonatal intensive care unit during the pandemic, raising important questions. Why was this? Was it related to the effect of the modifiable risk-factors for premature birth? This discussion paper focuses on an exploration of these factors in the light of the potential impact of COVID-19 restrictions on neonatal care. After contextualising both the effect of premature birth and the pandemic on neonatal and parental short-term outcomes, the discussion turns to the modifiable risk-factors for premature birth and makes recommendations relevant to the education, advice and care given to expectant mothers.

Neonatal nursing during the COVID-19 global pandemic: A thematic analysis of personal reflections.

BACKGROUND: The COVID-19 pandemic has resulted in significant changes and restrictions to neonatal care. The aim of this study was to explore the impact of these changes on neonatal nurses globally. METHODS: We conducted a thematic analysis on written reflections by neonatal nurses worldwide, exploring their experiences of COVID-19. Twenty-two reflections were analysed from eleven countries. RESULTS: Thematic analysis revealed 4 main themes relating to the nurses' role: 1) protector 2) challenges to human quality of care 3) vulnerability and 4) resilience. The measures taken as protector were described as compromising the human qualities of care fundamental to their role. This tension, together with other new challenges, heightened feelings of vulnerability. Concurrently, nurses identified role resilience, including resourcefulness and peer support, which allowed them to navigate the global pandemic. CONCLUSION: By identifying global challenges and strategies to overcome these, neonatal nurses may be better equipped as the pandemic continues. The reflections underscore the importance of family integrated care and the tension created when it is compromised.

The implications of face masks for babies and families during the COVID-19 pandemic: A discussion paper.

COVID-19 has changed the way that newborn babies are cared for within the neonatal setting due to the introduction of social distancing and wearing of face masks to limit the spread of the infection. Potential implications exist related to the normal development of bonding and connections with others. This paper discusses the importance of face to face interactions for early attachment between babies and parents within the context of relevant underpinning developmental theory. Mask wearing can also potentially impact relational communication, requiring us to change our current ways of working. Decreasing face to face interactions and relational communication, along with key recommendations for both parents and health professionals are further highlighted to mitigate the potential negative effects of masks on long-term development related to human connection and attachment.

COVID-19 in babies: Knowledge for neonatal care.

Infection is a leading cause of death worldwide in babies under one month of age who are more susceptible to sepsis due to immature host defence mechanisms. Usually, babies may become acutely unwell from infective pathogens due to specific differences in their respiratory and immune systems. However, with the COVID-19 virus, the focus of this paper, it appears that the neonatal population is not significantly affected in the same way as adults. That said, knowledge about this novel virus is rapidly emerging. Therefore, it is vital that neonatal nurses, midwives and other healthcare professionals are adequately informed and educated about the potential impact on neonatal practice. This review paper draws upon key findings and themes from a selection of recent literature to provide an overview of current knowledge on COVID-19 and the implications for care within the neonatal field. The discussion focuses on the nature of COVID-19, its pathophysiology and transmission relevant to maternal and neonatal care. This is followed by implications for practice; namely, maternal issues, the importance of human breast milk, neonatal care relating to parenting and specific management before a final review of the current World Health Organization guidance.

Understanding parents' emotional experiences for neonatal education: A narrative, interpretive approach.

AIMS AND OBJECTIVES: To explore the emotional experiences of parents who have had premature babies to inform and educate neonatal nurses and health professionals in this field. BACKGROUND: Parents find the neonatal unit a daunting and unfamiliar place leading to anxiety, uncertainty and fear about the future of their baby. Parents have significant emotional needs in relation to assisting them to cope with their neonatal experience. In line with a family-centred approach to neonatal education, it is essential to teach health professionals about the emotional impact of neonatal care based on an appreciation of the parent experience. DESIGN: A narrative-based, interpretive approach was undertaken in line with constructivist learning theory. METHODS: Twenty narrative interviews took place, with a total of 23 parents of premature babies. Following core story creation to create coherent stories from the raw transcripts, thematic analysis of the narrative constructs using the principles of Braun and Clarke's, International Journal of Qualitative Studies on Health and Well-Being, 2014, 9, 1, framework was undertaken. The study methods were compliant with the consolidated criteria for reporting qualitative research (COREQ). FINDINGS: Thematic analysis revealed key themes relating to the following: parents' emotions through the whole neonatal experience, feelings towards the baby, the environment, the staff and the transitions through the different phases of neonatal care. Both negative and positive experiences were reported. CONCLUSION: Understanding the emotional experience from the parent's perspective, following birth of their premature baby, informs empathic, family-centred teaching and learning within the neonatal education arena. RELEVANCE TO CLINICAL PRACTICE: Students and health professionals alike can learn what is important in the delivery of care that addresses the emotional needs of parents and families. Educators can use narratives and key messages from parents, both negative and positive, to teach family-centred principles to nurses and health professionals as a core component of a narrative curricula and potentially to enhance empathy.

The forgotten mothers of extremely preterm babies: A qualitative study.

AIMS AND OBJECTIVES: To explore the experiences of mothers of extremely premature babies during their Neonatal Intensive Care Unit stay and transition home. BACKGROUND: Mothers of extremely preterm infants (28 weeks' gestation or less) experience a continuum of regular and repeated stressful and traumatic events, during the perinatal period, during the Neonatal Intensive Care Unit stay, and during transition home. METHOD: An interpretive description method guided this study. Ten mothers of extremely premature infants who had been at home for less than six months were recruited via a Facebook invitation to participate in semi-structured telephone interviews exploring their experiences in the Neonatal Intensive Care Unit and the transition home. The data were examined using a six-phase thematic analysis approach. The COREQ checklist has been used. RESULTS: Two main themes emerged: (a) things got a bit dire; and (b) feeling a failure as a mother. Participants had a heightened risk of developing a mental disorder from exposure to multiple risk factors prior to and during birth, as well as during the postnatal period in the Neonatal Intensive Care Unit and their infant's transition to home. Mothers highlighted the minimal support for their mental health from healthcare professionals, despite their regular and repeated experience of traumatic events. CONCLUSION: The mothers were at high risk of developing post-traumatic stress symptoms and/or other mental health issues. Of note, study participants relived the trauma of witnessing their infant in the Neonatal Intensive Care Unit, demonstrated hypervigilance behaviour and identified lack of relevant support needed when their infant was at home. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need for nurses to include a focus on the mothers' psychosocial needs. Supporting maternal mental health both improves maternal well-being and enables mothers to be emotionally available and responsive to their extremely preterm infant.

Core story creation: analysing narratives to construct stories for learning.

BACKGROUND: Educational research uses narrative enquiry to gain and interpret people's experiences. Narrative analysis is used to organise and make sense of acquired narrative. 'Core story creation' is a way of managing raw data obtained from narrative interviews to construct stories for learning. AIM: To explain how core story creation can be used to construct stories from raw narratives obtained by interviewing parents about their neonatal experiences and then use these stories to educate learners. DISCUSSION: Core story creation involves reconfiguration of raw narratives. Reconfiguration includes listening to and rereading transcribed narratives, identifying elements of 'emplotment' and reordering these to form a constructed story. Thematic analysis is then performed on the story to draw out learning themes informed by the participants. CONCLUSION: Core story creation using emplotment is a strategy of narrative reconfiguration that produces stories which can be used to develop resources relating to person-centred education about the patient experience. IMPLICATIONS FOR PRACTICE: Stories constructed from raw narratives in the context of constructivism can provide a medium or an 'end product' for use in learning resource development. This can then contribute to educating students or health professionals about patients' experiences.

Emotion work in qualitative research: interviewing parents about neonatal care.

BACKGROUND: 'Emotion work' is a term used to describe the emotional responses that may arise in qualitative research exploring difficult experiences. Parents' experiences of neonatal care can raise sensitive issues during interviews, which may lead to emotional responses. AIM: To reflect on an interpretive study involving narrative interviews with parents of preterm neonates, to inform researchers about the potential emotive issues that may arise in such work. DISCUSSION: Reflection on interviews with parents of preterm neonates revealed areas for discussion relating to emotion work, the role of the researcher, emotional connections and empathic interviewing. Consideration of these areas highlights the importance of reflexivity for researchers. CONCLUSION: Qualitative researchers undertaking narrative interviews should be prepared for emotive issues that arise and recognise the need for emotional intelligence. Achieving a balance between being an empathic, emotionally aware interviewer and remaining objective can be challenging. IMPLICATIONS FOR PRACTICE: Strategies that researchers can use to address this balance and to manage the emotion work involved in research of this nature are provided.

Effects of climate change on the health of children and young people.

The effects of climate change, such as air pollution and extreme heat events, can adversely affect the physical and mental health of children and young people at all ages. This article explores the effects of climate change on children and young people's development and explains the effects of air pollution and heatwaves on their health. The article also discusses how children and young people are knowledgeable and concerned about the effects of climate change and can offer new perspectives on addressing these effects. Finally, the authors consider the role of nurses in raising awareness of the adverse effects of climate change on children's health, incorporating climate change in their practice and promoting opportunities for children's involvement in healthcare decision-making, strategies and policy development.

Understanding neonatal ventilation: strategies for decision making in the NICU.

Neonatal ventilation is an integral component of care delivered in the neonatal unit. The aim of any ventilation strategy is to support the neonate's respiratory system during compromise while limiting any long-term damage to the lungs. Understanding the principles behind neonatal ventilation is essential so that health professionals caring for sick neonates and families have the necessary knowledge to understand best practice. Given the range of existing ventilation modes and parameters available, these require explanation and clarification in the context of current evidence. Many factors can influence clinical decision making on both an individual level and within the wider perspective of neonatal care.

Why eating disorders in children and young people are increasing: implications for practice.

According to data collected by NHS England in 2022 1,721 children and young people were awaiting treatment for eating disorders compared with 603 patients in 2016. This reveals an increase of 185% in eating disorders among children and young people and suggests that this increase will continue to occur even with the government pledging £79 million ( GOV UK 2021 ) to expand children and adolescent mental health services (CAMHS) and early intervention services ( NHS England 2022a ). This is due to the already extensive CAMHS waiting list managing the sizeable accumulation of referrals combined with the consistent increase of new referrals. This article outlines the most common types of eating disorders, the importance of the school nurse and factors that have affected the prevalence of eating disorders in young people, highlighting that early intervention and prevention is vital. The authors argue that this can be achieved through increased funding for services such as CAMHS and the First Episode and Rapid Early Intervention for Eating Disorders service, stricter legislation surrounding social media and greater mental health education in schools for teachers, young people and their families.

Exploring the knowledge of community-based nurses in supporting parents of preterm babies at home: A survey-based study.

AIM: This study aimed to investigate the confidence levels, knowledge base and learning needs of community-based nurses relating to the care of preterm babies and parents, to explore what education is required and in what format. DESIGN: An online survey methodology was used. METHODS: A 32-item questionnaire was distributed via social media platforms to community-based nurses in Australia. RESULTS: Descriptive analysis was undertaken relating to knowledge base, confidence levels, previous training, learning and resource needs and barriers to education. It was deemed vital to expand confidence and knowledge in this area. Gaps in learning resources were identified and a need for more training in topics such as developmental outcomes, feeding, expected milestones, weight gain, growth trajectories and supporting parents. Online resources were the preferred format to teach key knowledge to community-based health professionals, tailored to the specific features of preterm babies and support needs of parents.

Using arts-based digital storytelling in neonatal care to enhance nursing students' empathy.

BACKGROUND: The emotional challenges experienced by parents of infants admitted to the neonatal unit are well documented. Stories based on parents' narratives can be an effective method for nursing students to learn about parents' experiences and develop empathy for them. AIM: To explore the contribution of arts-based digital storytelling based on parental experiences of neonatal care to enhancing empathy in children's nursing students. METHOD: A collection of digital stories based on parental narratives were developed using the ASPIRE (aim, storyboarding, population, implementation, release, evaluation) framework. A mixed-methods approach was used to evaluate the effects of three of those digital stories, whereby 67 children's nursing students completed questionnaires and seven of them were interviewed individually about the stories. FINDINGS: The mix of illustrations, animation, voice and text was well received by participants, not only aiding their learning, but also eliciting an emotional response from them. However, some aspects of the digital stories were found to hinder learning and some participants questioned the power of digital stories. Despite this, overall, the use of digital storytelling was found to be engaging, hold students' interest and enable learning via their senses. CONCLUSION: Arts-based digital storytelling can convey the complexities of parents' emotional experiences in the neonatal unit, so that nursing students are better equipped to understand and empathise with them.

Undertaking pre-pilot work to gain an empathetic insight into participants' perspectives.

BACKGROUND: Being an empathetic researcher can be crucial in understanding participants' perspectives. However, while the need for empathy is recognised in qualitative interview research, there is less acknowledgement of its value with other methods of collecting data. Researchers can face various challenges when the instruments and approaches used to collect data are new to them. The value of researchers acting as participants when undertaking pre-pilot work are not be underestimated. AIM: To provide a reflective account of the pre-pilot work undertaken by the authors before their main study. DISCUSSION: Pre-pilot work that involves the researchers as participants can develop cultural competence, as well as empathetic insight into participants' perspectives, thus enabling them to refine and strengthen their main study. CONCLUSION: It takes time when planning research to incorporate appropriate pre-pilot work that assists personal training and learning. However, this can pay dividends in terms of the empathetic insight gained for the refinement of the proposed study. Pre-pilot work and a reflective approach can strengthen rigour, as well as assist in planning research and collecting data. IMPLICATIONS FOR PRACTICE: Experienced researchers may be novices at using specific tools or methods of collecting data. Pre-pilot work enables a greater understanding and deeper appreciation of participants' perspectives.

Children's palliative care: examination of a nursing rotation programme.

BACKGROUND: An 8-month rotation programme was implemented for five nurses employed in two kinds of children's palliative care environments: hospital wards and hospices. This study reports the views of the nurses completing the rotation. The research drew on appreciative inquiry and involved a pre- and post-rotation interview and questionnaire. Thematic analysis of the interviews revealed seven themes: adjusting to the rotation programme; support mechanisms; being safe; new knowledge and skills; knowledge exchange; misconceptions; future plans. These were supported by the questionnaire findings. Although the nurses identified some frustration at having to undertake competency assessments relating to previously acquired skills, as well as being out of their 'comfort zone', all the participants highly recommended the programme. They commented very positively on the support they received and the overall learning experience as well as the new insight into different aspects of care. In addition, they were able to share their newfound knowledge and expertise with others.