Katie Gallagher

The use of interviews in Q methodology: card content analysis.

Background: Although much has been published in the literature on how to perform a Q methodological study, the use of interviews within this process has received little attention. Approach: The purpose of this review is to explore the use of interviews in a Q methodological study. Results: An introduction to Q methodology is provided. The aims of an interview within a Q methodological study are described, and how these aims lend themselves to a particular method of analysis is explored. How to perform this analysis is outlined. Discussion: The use of interviews can increase the validity of a Q methodological study by providing the participants rationale for analysis of the factor arrays. When to perform the interviews is still under debate, and further study is required to determine whether the timing affects the results.

The attitudes of neonatologists towards extremely preterm infants: a Q methodological study

Objectives The attitudes and biases of doctors may affect decision making within Neonatal Intensive Care. We studied the attitudes of neonatologists in order to understand how they prioritise different factors contributing to decision making for extremely preterm babies. Design Twenty-five neonatologists (11 consultants and 14 senior trainees) participated in a Q methodological study about decision making that involved the ranking of 53 statements from agree to disagree in a unimodal shaped grid. Results were explored by person factor analysis using principle component analysis. Results The model of best fit comprised 23 participants contributing a three-factor model, which represented three different attitudes towards decision making and accounted for 59% of the variance. Fourteen statements were ranked in statistically significant similar positions by 23 participants; consensus statements included placing the baby and family at the centre of care, limitation of intervention based upon perceived risk and non-mandatory intervention at birth. Factor 1 participants (n=12) believed that treatment should not be limited based on gestational age and technology should be used to improve treatment. Five factor 2 participants identified strongly with a limit of 24 weeks for treatment, one of whom being polar opposite, believing in treatment at all costs at all gestations. The remaining six factor 3 participants identified strongly with statements that treatment should be withheld on quality of life grounds. Conclusions This study has identified differences in attitudes towards decision making between individual neonatologists and trainees that may impact how decisions are communicated to families.

The attitudes of neonatal nurses towards extremely preterm infants.

AIM The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. BACKGROUND Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant. METHODS A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis. RESULTS Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions. CONCLUSION Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of individual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations.

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Objective To determine the short-term outcomes of babies for whom clinicians or parents discussed the limitation of life-sustaining treatment (LST). Design Prospective multicentre observational study. Setting Two level 3, six level 2 and one level 1 neonatal units in the North-East London Neonatal Network. Participants A total of 87 babies including 68 for whom limiting LST was discussed with parents and 19 babies died without discussion of limiting LST in the labour ward or neonatal unit. Outcome measures Final decision reached after discussions about limiting LST and neonatal unit outcomes (death or survived to discharge) for babies. Results Withdrawing LST, withholding LST and do not resuscitate (DNR) order was discussed with 48, 16 and 4 parents, respectively. In 49/68 (72%) cases decisions occurred in level 3 and 19 cases in level 2 units. Following the initial discussions, 34/68 parents made the decision to continue LST. In 33/68 cases, a second opinion was obtained. The parents of 14/48 and 2/16 babies did not agree to withdraw and withhold LST, respectively. Forty-seven out of 87 babies (54%) died following limitation of LST, 28/87 (32%) died receiving full intensive care support, 5/87 (6%) survived following a decision to limit LST and 7/87 (8%) babies survived following decision to continue LST. Conclusions A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated.

Experience of training in communication skills among trainee neonatologists

Communication between medical teams and parents is a critical aspect of day-to-day neonatal care and helps to include parents in decisions made for their child. Nonetheless, parents report that current involvement is less than optimal.1 Communication skills are part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum,2 assessed briefly during professional examinations, and signed off at the end of training. However, most training is delivered locally without formal evaluation. This study aimed to explore the experience of and need for communication training among trainee neonatologists. Using a short open-ended questionnaire, we explored the involvement of trainee neonatologists (ST3-8) in communications skills training. Data were collected during a British Association of Perinatal Medicine national training day during September 2014. Forty nine of 58 trainees attending completed the questionnaire. Of the 49, 51% (n=25) had …

Parental experience of interaction with healthcare professionals during their infant’s stay in the neonatal intensive care unit

Objective To explore the experiences of parents of infants admitted to the neonatal intensive care unit towards interaction with healthcare professionals during their infants critical care. Design Semi-structured interviews were conducted with parents of critically ill infants admitted to neonatal intensive care and prospectively enrolled in a study of communication in critical care decision making. Interviews were transcribed verbatim and uploaded into NVivo V.10 to manage and facilitate data analysis. Thematic analysis identified themes representing the data. Results Nineteen interviews conducted with 14 families identified 4 themes: (1) initial impact of admission affecting transition into the neonatal unit; (2) impact of consistency of care, care givers and information giving; (3) impact of communication in facilitating or hindering parental autonomy, trust, parental expectations and interactions; (4) parental perception of respect and humane touches on the neonatal unit. Conclusion Factors including the context of infant admission, interprofessional consistency, humane touches of staff and the transition into the culture of the neonatal unit are important issues for parents. These issues warrant further investigation to facilitate individualised family needs, attachment between parents and their baby and the professional team.

PO-0282 Power Of Empowerment: Parent Controlled Visitors’ Badges To Monitor Bedspace Visitor Numbers In A Picu

Background and aims Recent audit found common practice in the UK is to restrict visitors on PICU to 2 adults, including parents, to ensure staff’s safe patient access. This requires nurses to take responsibility for bed space visitors, however, this proves difficult in clinical practice for all concerned. This research explored whether empowering parents to take visitor responsibility impacted visitor numbers and therefore patient safety on PICU. Methods The research took place on a 19 bedded tertiary PICU in the UK. Each day parents were issued two visitors badges, allocated at their discretion. Badges display day, bed number and badge number, and must be visible at all times. Twelve months post-implementation, a 3 month audit was undertaken to assess bed space adherence. Questionnaires were conducted to assess staff and parent knowledge and opinion towards the system. Results 178 bed space observations were undertaken and 95 questionnaires completed (visitors=53; staff=42). In 26 observations visitors were without visible badges (15%) and in 2 instances over two visitors were at the bed space (1%). In one exceptional instance, end-of-life care was occurring. Questionnaire results showed 98% of staff and visitors were aware of the system, with 81% reporting it beneficial to the child and family, and 92% beneficial to the unit. Conclusions Both staff and parents report the new system is empowering to parents, granting responsibility for their child’s welfare whilst still allowing staff to monitor effectually. This research has shown that through effective interaction with parents, systems can be implemented and successfully utilised, benefitting patient safety.