Anna Axelin

Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices

Aim:  To investigate the application of skin‐to‐skin care (SSC) in the Nordic countries, the existence of guidelines for SSC and the attitudes of neonatal staff towards SSC.

Pathways to emotional closeness in neonatal units - a cross-national qualitative study.

BackgroundResearch shows evidence for the importance of physical and emotional closeness for the infant, the parent and the infant-parent dyad. Less is known about how, when and why parents experience emotional closeness to their infants in a neonatal unit (NU), which was the aim of this study.MethodsA qualitative study using a salutogenic approach to focus on positive health and wellbeing was undertaken in three NUs: one in Sweden, England and Finland. An ‘emotional closeness’ form was devised, which asked parents to describe moments/situations when, how and why they had felt emotionally close to their infant. Data for 23 parents of preterm infants were analyzed using thematic networks analysis.ResultsA global theme of ‘pathways for emotional closeness’ emerged from the data set. This concept related to how emotional, physical, cognitive and social influences led to feelings of emotional closeness between parents and their infants. The five underpinning organising themes relate to the: Embodied recognition through the power of physical closeness; Reassurance of, and contributing to, infant wellness; Understanding the present and the past; Feeling engaged in the day to day and Spending time and bonding as a family.ConclusionThese findings generate important insights into why, how and when parents feel emotionally close. This knowledge contributes to an increased awareness of how to support parents of premature infants to form positive and loving relationships with their infants. Health care staff should create a climate where parents’ emotions and their emotional journey are individually supported.

Integrating a sense of coherence into the neonatal environment

BackgroundFamily centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes.DiscussionIn this paper we present a new perspective to neonatal care based on Aaron Antonovksy’s Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed.SummaryConsideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned.

Early physical contact between a mother and her NICU-infant in two university hospitals in Finland

OBJECTIVE the first aim of this two-phase study was to describe and compare, between two university hospitals, the early physical contact of mothers and their preterm or sick newborn infants in the delivery room. Secondly, the staffs perceptions of factors facilitating and promoting or impeding this contact were evaluated. Thirdly, the association between early physical contact and the initiation of breast feeding was examined. DESIGN AND SETTING a structured survey was conducted between November 2008 and March 2009 in two university hospitals in Finland. PARTICIPANTS in phase I, the sample consisted of all preterm or sick infants who needed NICU care and whose questionnaires were completed by labour ward staff (hospital A, n=178/185, hospital B, n=203/235). In phase II, a subsample of these infants (A, n=76, B, n=94) and their mothers who completed their questionnaires participated in the study. MEASUREMENTS structured questionnaires developed for this study were used. FINDINGS the implementation of early physical contact differed between the study hospitals. The infants had physical contact with their mothers more often in hospital A than in hospital B whether they were sick full-term (83% versus 58%, p<0.001) or late preterm (49% versus 34%, p=0.051). None of the very preterm infants (<32 weeks) had early physical contact in the delivery room in either hospital. An infants unstable condition and delivery by caesarean section were the most common obstacles against early contact. There was a moderate association between early contact and the initiation of breast feeding. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE caring practices concerning early physical contact seemed to be different in the study hospitals. The obstacles impeding early contact should be re-evaluated. Guidelines might enhance early physical contact between preterm or sick infants and their mothers.

Close Collaboration with Parents™ intervention to improve parents’ psychological well-being and child development: Description of the intervention and study protocol

HighlightsSystematic interventions are needed to integrate parenting in neonatal hospital care.To change hospital care culture, the whole staff of a unit needs to be trained.The key skills are to learn to observe infant’s cues and to listen to the parents.Supporting intuitive parenting and bonding is a preventive and salutogenic strategy. Abstract Parents of preterm infants commonly experience separation from their infant or exclusion from their role as primary caregivers during the hospital care of their infant, which may impair parent‐infant bonding and parents’ psychological well‐being. Therefore, we developed the Close Collaboration with Parents™ intervention to improve staff skills in communicating and collaborating with parents in neonatal intensive care units (NICU), to increase parents’ presence and participation into infant care, and to improve parent‐infant bonding and, thereby, parents’ psychological well‐being and later child development. The Close Collaboration with Parents™ intervention was developed and carried out at Turku University Hospital. The intervention was based on developmental theories about early parenthood and parent‐infant attachment. The training was targeted at both doctors and nurses. The goals of the training included understanding individual behaviors and responses of infants and the uniqueness of families, using receptive listening skills in communication with parents and making decisions collaboratively with them. By increasing the sensitivity of the staff to the individual needs of infants and parents and by increasing staff‐parent collaboration in daily care, the intervention supported parents’ presence and parents’ participation in the care of their infant. The effectiveness of the intervention is being evaluated in a prospective study comparing the post‐intervention cohort (n = 113) to the baseline cohort (n = 232). The outcomes include bonding, long‐term psychological well‐being of both mothers and fathers and child development up to 5 years of age. The Close Collaboration with Parents™ intervention potentially offers a preventive and salutogenic model to integrate parents and parenting in neonatal hospital care.

Facilitated tucking as a non-pharmacological intervention for neonatal pain relief: is it clinically feasible?

There is an impressive body of knowledge on pain management in infants hospitalized in neonatal intensive care units. However, deficits in the clinical management of pain in these infants remain. One reason is the gap between research evidence and translation of this knowledge into the clinical setting. This is particularly true for non‐pharmacological pain‐relieving methods. Effective performance of some of these methods requires additional staffing and time. This viewpoint articles describes the clinical challenges associated with implementing ‘facilitated tucking’. Although ‘facilitated tucking’ is described as an efficient method for acute pain relief, the clinical facilitators required to successfully implement such a resource consuming‐intervention remain unclear.

Translation and cultural adaptation of an objective pain assessment tool for Finnish ICU patients

AIM The purpose of this study was to culturally validate three pain measurement instruments [Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT) and the Nonverbal Adult Pain Assessment Scale (NVPS)] for sedated intensive care patients and in doing so to prepare the tools for psychometric testing in the Finnish intensive care environment. BACKGROUND Most patients feel pain during their stay in an intensive care unit. Pain recognition and assessment is the first step towards effective pain management. The BPS, CPOT and NVPS are the most valid and reliable pain assessment instruments developed to objectively assess pain in sedated intensive care patients. METHOD The translation and cultural adaptation of the instruments were done according to the guidelines of the International Society for Pharmacoeconomics and Outcomes (ISPOR). The process included 10 phases aiming to produce semantically correct Finnish versions of the pain assessment instruments. This translation process was chosen due to its rigorousness and systematic approach. RESULTS The 10-step translation and cultural validation process were successfully conducted, although it was complex and time-consuming. The resulting Finnish versions of the three pain assessment instruments showed good evidence of content and conceptual equivalence. Although further work is needed to test these instruments in the Finnish intensive care context, the current Finnish versions are potential instruments for clinicians to use. CONCLUSION Deciding when this high-quality process is needed requires thorough consideration. However, it is worthwhile to use it when implementing new instruments at a national level. We need a valid, reliable and feasible instrument for pain assessment in sedated intensive care patients in Finland. The next step in our process is conducting psychometric testing of these three instruments to choose the tool with the best properties to be implemented in clinical practice.

Parents' presence and parent–infant closeness in 11 neonatal intensive care units in six European countries vary between and within the countries

Little is known about the amount of physical parent–infant closeness in neonatal intensive care units (NICUs), and this study explored that issue in six European countries.

Parents' Perspectives of Closeness and Separation With Their Preterm Infants in the NICU

Objective To discover parents’ perceptions of closeness to and separation from their preterm infants in the NICU. Design Qualitative descriptive. Setting Urban Level III NICU. Participants Twenty parents of preterm infants in the NICU. Methods After ethics approval, data were collected with a smartphone application created for this study. Parents recorded their descriptions of moments of closeness and separation over a 24‐hour period in the NICU. Data were transcribed verbatim and content was analyzed. Results Five themes related to parents’ perceptions of closeness and separation were identified: Having a role as a parent: Feeling autonomous and making decisions; Providing for and getting to know the infant: Feeding, holding, and interacting; Support from staff; Reluctantly leaving the infants bedside; and NICU environment. Conclusion Autonomy is a key element of a parents perception of closeness. Staff in the NICU can facilitate autonomy by involving parents in the care of their preterm infants as much as possible to reinforce the parental role. Parents described leaving their infants’ bedsides as very difficult.

Sleep-wake cycling in a neonate admitted to the NICU: a video-EEG case study during hypothermia treatment.

This retrospective case study describes the sleep-wake cycles of an infant in the neonatal intensive care unit. We analyzed video-electroencephalographic recording of the term infant monitored during treatment with therapeutic hypothermia for hypoxic-ischemic encephalopathy. The continuous video-electroencephalographic recording over a 4-day period also allowed us to describe the following dimensions of daily care in relation to the infants sleep-wake states: (1) handling by professional and parent caregivers and (2) stress, pain, and analgesia. Physical contact constituted 17% to 36% of each 24-hour period. The infants care was fragmented, with a mean of 3 to 4 physical contacts per hour. As a result, the structure of infant sleep was altered by the increased amount of awake and quiet sleep. The number of painful procedures ranged from 5 to 24 per day. Nurses were the main care providers. Parents had more contact after the infant was rewarmed. This case study suggests that neonatal intensive care unit infants are exposed to frequent handling and stress as well as altered sleep. The cumulative negative impact of frequent handling and sleep fragmentation may go unnoticed by caregivers focused on episodes of care. Continuous video-electroencephalographic monitoring is a useful tool for longitudinal evaluation of infant sleep and responses to caregiving in the neonatal intensive care unit.