Acta paediatrica (Oslo, Norway : 1992), Jan 3, 2018
We explored the dynamics of neonatologist-parent communication and decision-making during medical... more We explored the dynamics of neonatologist-parent communication and decision-making during medical rounds in a level three neonatal intensive care unit. This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013 to 2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23 + 5 to 40 + 1 weeks, and the parents were aged 24-47. The neonatologists and parents were interviewed separately after the rounds. Four patterns of interaction emerged. The collaborative pattern was most consistent, with the ideal of shared decision-making, as the parents' preferences were genuinely and visibly integrated into the treatment decisions. In the neonatologist-led interactional pattern, the decision-making process was only somewhat inclusive of the parents' observations and preferences. The ...
MCN, The American Journal of Maternal/Child Nursing, 2014
To describe nurses' exper... more To describe nurses' experiences of a training program promoting family-centered care and its influence on their care practices in the Neonatal Intensive Care Unit (NICU). Descriptive qualitative interview study. A training program was used to teach nurses and physicians to collaborate closely with parents in infant care. After the program, 22 nurses were interviewed. Participants were asked to describe their current care practices and reflect on training program-initiated changes. The interviews were analyzed using thematic analysis. The main finding was that nurses felt the program had promoted beneficial change regarding family-centered care. The resulting new atmosphere and care practices supported increased parental involvement in infant care. Due to the nurses' increased interaction with parents, they became more aware of the parents' psychosocial situation. The role of the nurse changed from an active caretaker to a facilitator who supported the parents in infant care. The transition from professionally centered NICU care to family-centered care is achievable using a well-designed structured program that involves all staff members. The program was able to change the nurses' attitudes and care practices, signifying a successful implementation of family-centered care.
This comparative focus group study explored nurses' experiences and perceptions regarding par... more This comparative focus group study explored nurses' experiences and perceptions regarding parental participation in infant pain management in the neonatal intensive care unit (NICU). A total of 87 nurses from 7 NICUs in Finland, Sweden, and the United States participated in focus-group interviews (n = 25). Data were analyzed using deductive and inductive thematic analysis. Nurses' experiences and perceptions varied considerably, from nurses being in control, to nurses sharing some control with parents, to nurse-parent collaboration in infant pain management. When nurses controlled pain management, parents were absent or passive. In these cases, the nurses believed this led to better pain control for infants and protected parents from emotional distress caused by infant pain. When nurses shared control with parents, they provided information and opportunities for participation. They believed parent participation was beneficial, even if it caused nurses or parents anxiety. Whe...
The aim of this study was to develop a new pain management method called facilitated tucking by p... more The aim of this study was to develop a new pain management method called facilitated tucking by parents (FTP) to alleviate procedural pain in preterm infants in the Neonatal Intensive Care Unit (NICU). In two randomized controlled crossover trials, the effectiveness of FTP was compared to a non-pharmacological evidence-based practice (oral glucose), a pharmacological method (intravenous oxycodone) and a placebo (oral water) or control care in the context of heel lance and endotracheal or pharyngeal suctioning. In addition, the short-term adverse effects (desaturation, bradycardia) and the prolonged effects of pain management on sleep were measured. The gestational age of the infants was a median of 28 weeks (n=20) in Study I and a mean of 28 1/7 (n=20) in Study II. The primary outcome measure for procedural pain was the Premature infant pain profile (PIPP). After interventions, sleep structure was analysed from 13-hour polysomnographic recordings. In the third study, the mothers (n = 23) who had used FTP from 2-4 weeks in the NICU were interviewed using the Clinical interview for parents of high-risk infants with additional questions related to the infants' pain care.
Inability to sleep is one of the most distressing factors for patients in the intensive care unit... more Inability to sleep is one of the most distressing factors for patients in the intensive care unit (ICU). Sleep is perceived as light and awakenings are numerous. Nurses' documentations of sleep are narrow, mainly concentrating on the quantity and general quality. Nurses should diversely evaluate, document and promote sleep to provide patient centered care. To investigate the content of nurses' documentation about the sleep of ICU patients, patients' own perceptions of sleep, and the correspondence of the two. Nurses' documentations (n = 90) were analysed retrospectively with quantitative content analysis. A cross-sectional survey of patients' (n = 114) perspectives was collected with the five-item Richards-Campbell Sleep Questionnaire (RCSQ), on a visual analogue scale from 0 (the poorest quality sleep) to 100 (optimum sleep). The data was analysed statistically. Correspondence was tested with cross-tabulation. Nurses documented sleep quantity for 71% and quality for 27% of patients, along with the needs assessment, used interventions and their effect on sleep. Patients' perspectives varied widely. Sleep depth was rated the lowest and falling asleep highest of the RCSQ sleep domains. Age of the patients correlated positively with general quality of sleep, sleep depth and falling asleep. Nurses' documentations and patients' perceptions correlated in over half of the cases. Nurses' documentation of ICU patients' sleep is not systematic or comprehensive and corresponds only partially with patients' own perception. The sleep of non-intubated patients is light and awakenings are frequent. Documentation of ICU patients' sleep should include the whole nursing process, i.e. needs assessment, interventions used, and evaluation of sleep and the effects of the interventions, along with patients' own perspective to promote patient-centered care. Evaluation and documentation of patients' sleep must include patients' own perception to be comprehensive. Nurses' documentation should include all elements of nursing process.
Background: Several pain scales are available for neonates, but, unfortunately they are only rare... more Background: Several pain scales are available for neonates, but, unfortunately they are only rarely used in clinical practice. To help with the current situation of unrecognized and under-treated pain in neonatal intensive care units (NICUs), we developed an assessment tool in close collaboration with clinical staff. Objectives: To develop a multidimensional scale, NIAPAS (the Neonatal Infant Acute Pain Assessment Scale), that is sensitive to the needs of infants in neonatal intensive care units, and to test the validity, reliability, feasibility and clinical utility of the scale for this population. Design: Instrument development and psychometric analysis. Methods: Pain assessments (n = 180) were made of 34 neonates born between 23 and 42 weeks gestational age who were undergoing 60 painful procedures (heel lance 77%, tracheal suctioning 23%) in the NICU. Using bedside video recordings, each neonate was observed through three phases of the procedure: 1 min before the procedure, during the procedure (lasting from 0.6 to 11.2 min, mean 2.6), and 1 min after the procedure. In addition, an expert panel (n = 5) and nurses (n = 26) participated in the validation of the scale. Results: A pool of 8 pain indicators (5 behavioral and 3 physiological indicators), including the gestational age of neonates as a contextual factor, was identified based on the nurses' expertise in neonatal intensive care. Scores on the NIAPAS changed significantly across the phases (p < 0.001), indicating a good construct validity of the scale. Correlations between the NIAPAS and NIPS (the Neonatal Infant Pain Score) were high (0.751-0.873). The study also demonstrated high coefficients for inter-rater (r = 0.991-0.997) and intra-rater reliability (r = 0.992-1.00), with an internal consistency of 0.723. The content validity was very good (Mean I-CVI 1.00), as evaluated by the expert group. The nurses agreed that the * Corresponding author at: Vainioniementie 41,
Everyday care practices can facilitate or hinder parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;... more Everyday care practices can facilitate or hinder parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; participation and involvement in neonatal care. To evaluate trends in family-centered care practices in the Neonatal Intensive Care unit in Turku University Hospital. In this retrospective study, the patient charts of very preterm infants were reviewed in 4 cohorts: 2001 to 2002 (n=72), 2006 to 2007 (n=69), 2009 to 2010 (n=76), and 2011 to 2012 (n=78). Care practices with parental involvement were evaluated: 1) thermoregulation; 2) nutrition and feeding; 3) the beginning and number of skin-to-skin care episodes. As safety measures, the length of stay and weight gain were recorded at discharge. The significant trends included: a decrease in gestational age at the end of incubator care (mean 33.4 [standard deviation (SD) 1.36] to 31.6 [SD 1.1], p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and at the beginning of breast-feeding (35.3 [SD 1.34] to 33.1 [SD 1.89], p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), bottle feeding (from 34.1 [SD 1.04] to 33.3 [SD 1.51], p=0.003) and skin-to-skin care (from 32.8 [SD 1.99] to 29.9 [SD 2.34], p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The changes were most remarkable in the infants below 28 weeks. In addition, weight gain increased from 110 g to 159 g per week (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The hospital care practices of very preterm infants developed during the study period support parental involvement. During the same time period, the weight gain of very preterm infants improved, significantly. These practices can serve as indicators of progressive trends in family centered care.
The Internet and social media provide various possibilities for online peer support. The aim of t... more The Internet and social media provide various possibilities for online peer support. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents. A systematic integrative review. The systematic search was carried out in March 2014 in PubMed, Cinahl, PsycINFO and Cochrane databases. Two reviewers independently screened the titles (n=1793), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) an Internet-based community as an intervention, or at least as a component of an intervention; (2) the participants in the Internet-based community had to be mothers and/or fathers or pregnant women; (3) the parents had to interact and communicate with each other through the Internet-based community. The data was analysed using content analysis. When analysing peer-support interventions only interventions developed by researchers were included and when analysing the outcomes for the parents, studies...
Background and aims: Skin-to-skin contact (SSC) has positive physiological and psychological effe... more Background and aims: Skin-to-skin contact (SSC) has positive physiological and psychological effects and is implemented in neonatal care to various degree all over the world. Little is known though, to what extent and for which populations. The primary aim or this study was to investigate the level of implementation of SSC in the Nordic countries, and secondary to explore some of the barriers against and facilitators of SSC.
A literature review of 98 articles concerning clinical pain research in newborn infants was condu... more A literature review of 98 articles concerning clinical pain research in newborn infants was conducted to evaluate how researchers report the ethical issues related to their studies and how journals guide this reporting. The articles were published in 49 different scientific journals. The ethical issues most often mentioned were parental informed consent (94%) and ethical review approval (87%). In 75% of the studies the infants suffered pain during the research when placebo, no treatment or otherwise inadequate pain management was applied. Discussion about benefits versus harm to research participants was lacking. A quarter of the journals did not have any ethical guidelines for submitted manuscripts. We conclude that ethical considerations did not play a significant role in the articles studied. Missing and superficial guidelines enable authors to offer studies with fragile research ethics.
Objective: the first aim of this two-phase study was to describe and compare, between two univers... more 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 staff's 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 ¼ 178/185, hospital B, n ¼ 203/235). In phase II, a subsample of these infants (A, n ¼76, B, n ¼ 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 o0.001) or late preterm (49% versus 34%, p¼ 0.051). None of the very preterm infants (o 32 weeks) had early physical contact in the delivery room in either hospital. An infant's 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.
Preterm infants are usually breastfed less than full-term infants, and successful breastfeeding r... more Preterm infants are usually breastfed less than full-term infants, and successful breastfeeding requires a supportive environment and special efforts from their mothers. A breastfeeding peer-support group, utilising social media, was developed for these mothers in order to support them in this challenge. Mothers were able to discuss breastfeeding and share experiences. The purpose of this study was to describe the perceptions of breastfeeding mothers of preterm infants based on the postings in peer-support group discussions in social media. The actively participating mothers (n = 22) had given birth &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35 gestational weeks. They were recruited from one university hospital in Finland. The social media postings (n = 305) were analysed using thematic analysis. A description of the process of breastfeeding a preterm infant from the point of view of a mother was created. The process consisted of three main themes: the breastfeeding paradox in hospital, the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;reality check&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; of breastfeeding at home and the breastfeeding experience as part of being a mother. The mothers encountered paradoxical elements in the support received in hospital; discharge was promoted at the expense of breastfeeding and pumping breast milk was emphasised over breastfeeding. After the infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s discharge, the over-optimistic expectations of mothers often met with reality - mothers did not have the knowledge or skills to manage breastfeeding at home. Successful breastfeeding was an empowering experience for the mothers, whereas unsuccessful breastfeeding induced feelings of disappointment. Therefore, the mothers of preterm infants need evidence-based breastfeeding counselling and systematic support in a neonatal intensive care unit (NICU) and at home.
Acta paediatrica (Oslo, Norway : 1992), Jan 3, 2018
We explored the dynamics of neonatologist-parent communication and decision-making during medical... more We explored the dynamics of neonatologist-parent communication and decision-making during medical rounds in a level three neonatal intensive care unit. This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013 to 2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23 + 5 to 40 + 1 weeks, and the parents were aged 24-47. The neonatologists and parents were interviewed separately after the rounds. Four patterns of interaction emerged. The collaborative pattern was most consistent, with the ideal of shared decision-making, as the parents' preferences were genuinely and visibly integrated into the treatment decisions. In the neonatologist-led interactional pattern, the decision-making process was only somewhat inclusive of the parents' observations and preferences. The ...
MCN, The American Journal of Maternal/Child Nursing, 2014
To describe nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; exper... more To describe nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experiences of a training program promoting family-centered care and its influence on their care practices in the Neonatal Intensive Care Unit (NICU). Descriptive qualitative interview study. A training program was used to teach nurses and physicians to collaborate closely with parents in infant care. After the program, 22 nurses were interviewed. Participants were asked to describe their current care practices and reflect on training program-initiated changes. The interviews were analyzed using thematic analysis. The main finding was that nurses felt the program had promoted beneficial change regarding family-centered care. The resulting new atmosphere and care practices supported increased parental involvement in infant care. Due to the nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; increased interaction with parents, they became more aware of the parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; psychosocial situation. The role of the nurse changed from an active caretaker to a facilitator who supported the parents in infant care. The transition from professionally centered NICU care to family-centered care is achievable using a well-designed structured program that involves all staff members. The program was able to change the nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attitudes and care practices, signifying a successful implementation of family-centered care.
This comparative focus group study explored nurses' experiences and perceptions regarding par... more This comparative focus group study explored nurses' experiences and perceptions regarding parental participation in infant pain management in the neonatal intensive care unit (NICU). A total of 87 nurses from 7 NICUs in Finland, Sweden, and the United States participated in focus-group interviews (n = 25). Data were analyzed using deductive and inductive thematic analysis. Nurses' experiences and perceptions varied considerably, from nurses being in control, to nurses sharing some control with parents, to nurse-parent collaboration in infant pain management. When nurses controlled pain management, parents were absent or passive. In these cases, the nurses believed this led to better pain control for infants and protected parents from emotional distress caused by infant pain. When nurses shared control with parents, they provided information and opportunities for participation. They believed parent participation was beneficial, even if it caused nurses or parents anxiety. Whe...
The aim of this study was to develop a new pain management method called facilitated tucking by p... more The aim of this study was to develop a new pain management method called facilitated tucking by parents (FTP) to alleviate procedural pain in preterm infants in the Neonatal Intensive Care Unit (NICU). In two randomized controlled crossover trials, the effectiveness of FTP was compared to a non-pharmacological evidence-based practice (oral glucose), a pharmacological method (intravenous oxycodone) and a placebo (oral water) or control care in the context of heel lance and endotracheal or pharyngeal suctioning. In addition, the short-term adverse effects (desaturation, bradycardia) and the prolonged effects of pain management on sleep were measured. The gestational age of the infants was a median of 28 weeks (n=20) in Study I and a mean of 28 1/7 (n=20) in Study II. The primary outcome measure for procedural pain was the Premature infant pain profile (PIPP). After interventions, sleep structure was analysed from 13-hour polysomnographic recordings. In the third study, the mothers (n = 23) who had used FTP from 2-4 weeks in the NICU were interviewed using the Clinical interview for parents of high-risk infants with additional questions related to the infants' pain care.
Inability to sleep is one of the most distressing factors for patients in the intensive care unit... more Inability to sleep is one of the most distressing factors for patients in the intensive care unit (ICU). Sleep is perceived as light and awakenings are numerous. Nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; documentations of sleep are narrow, mainly concentrating on the quantity and general quality. Nurses should diversely evaluate, document and promote sleep to provide patient centered care. To investigate the content of nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; documentation about the sleep of ICU patients, patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; own perceptions of sleep, and the correspondence of the two. Nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; documentations (n = 90) were analysed retrospectively with quantitative content analysis. A cross-sectional survey of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (n = 114) perspectives was collected with the five-item Richards-Campbell Sleep Questionnaire (RCSQ), on a visual analogue scale from 0 (the poorest quality sleep) to 100 (optimum sleep). The data was analysed statistically. Correspondence was tested with cross-tabulation. Nurses documented sleep quantity for 71% and quality for 27% of patients, along with the needs assessment, used interventions and their effect on sleep. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspectives varied widely. Sleep depth was rated the lowest and falling asleep highest of the RCSQ sleep domains. Age of the patients correlated positively with general quality of sleep, sleep depth and falling asleep. Nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; documentations and patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions correlated in over half of the cases. Nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; documentation of ICU patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; sleep is not systematic or comprehensive and corresponds only partially with patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; own perception. The sleep of non-intubated patients is light and awakenings are frequent. Documentation of ICU patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; sleep should include the whole nursing process, i.e. needs assessment, interventions used, and evaluation of sleep and the effects of the interventions, along with patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; own perspective to promote patient-centered care. Evaluation and documentation of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; sleep must include patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; own perception to be comprehensive. Nurses&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; documentation should include all elements of nursing process.
Background: Several pain scales are available for neonates, but, unfortunately they are only rare... more Background: Several pain scales are available for neonates, but, unfortunately they are only rarely used in clinical practice. To help with the current situation of unrecognized and under-treated pain in neonatal intensive care units (NICUs), we developed an assessment tool in close collaboration with clinical staff. Objectives: To develop a multidimensional scale, NIAPAS (the Neonatal Infant Acute Pain Assessment Scale), that is sensitive to the needs of infants in neonatal intensive care units, and to test the validity, reliability, feasibility and clinical utility of the scale for this population. Design: Instrument development and psychometric analysis. Methods: Pain assessments (n = 180) were made of 34 neonates born between 23 and 42 weeks gestational age who were undergoing 60 painful procedures (heel lance 77%, tracheal suctioning 23%) in the NICU. Using bedside video recordings, each neonate was observed through three phases of the procedure: 1 min before the procedure, during the procedure (lasting from 0.6 to 11.2 min, mean 2.6), and 1 min after the procedure. In addition, an expert panel (n = 5) and nurses (n = 26) participated in the validation of the scale. Results: A pool of 8 pain indicators (5 behavioral and 3 physiological indicators), including the gestational age of neonates as a contextual factor, was identified based on the nurses' expertise in neonatal intensive care. Scores on the NIAPAS changed significantly across the phases (p < 0.001), indicating a good construct validity of the scale. Correlations between the NIAPAS and NIPS (the Neonatal Infant Pain Score) were high (0.751-0.873). The study also demonstrated high coefficients for inter-rater (r = 0.991-0.997) and intra-rater reliability (r = 0.992-1.00), with an internal consistency of 0.723. The content validity was very good (Mean I-CVI 1.00), as evaluated by the expert group. The nurses agreed that the * Corresponding author at: Vainioniementie 41,
Everyday care practices can facilitate or hinder parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;... more Everyday care practices can facilitate or hinder parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; participation and involvement in neonatal care. To evaluate trends in family-centered care practices in the Neonatal Intensive Care unit in Turku University Hospital. In this retrospective study, the patient charts of very preterm infants were reviewed in 4 cohorts: 2001 to 2002 (n=72), 2006 to 2007 (n=69), 2009 to 2010 (n=76), and 2011 to 2012 (n=78). Care practices with parental involvement were evaluated: 1) thermoregulation; 2) nutrition and feeding; 3) the beginning and number of skin-to-skin care episodes. As safety measures, the length of stay and weight gain were recorded at discharge. The significant trends included: a decrease in gestational age at the end of incubator care (mean 33.4 [standard deviation (SD) 1.36] to 31.6 [SD 1.1], p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and at the beginning of breast-feeding (35.3 [SD 1.34] to 33.1 [SD 1.89], p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), bottle feeding (from 34.1 [SD 1.04] to 33.3 [SD 1.51], p=0.003) and skin-to-skin care (from 32.8 [SD 1.99] to 29.9 [SD 2.34], p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The changes were most remarkable in the infants below 28 weeks. In addition, weight gain increased from 110 g to 159 g per week (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The hospital care practices of very preterm infants developed during the study period support parental involvement. During the same time period, the weight gain of very preterm infants improved, significantly. These practices can serve as indicators of progressive trends in family centered care.
The Internet and social media provide various possibilities for online peer support. The aim of t... more The Internet and social media provide various possibilities for online peer support. The aim of this review was to explore Internet-based peer-support interventions and their outcomes for parents. A systematic integrative review. The systematic search was carried out in March 2014 in PubMed, Cinahl, PsycINFO and Cochrane databases. Two reviewers independently screened the titles (n=1793), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) an Internet-based community as an intervention, or at least as a component of an intervention; (2) the participants in the Internet-based community had to be mothers and/or fathers or pregnant women; (3) the parents had to interact and communicate with each other through the Internet-based community. The data was analysed using content analysis. When analysing peer-support interventions only interventions developed by researchers were included and when analysing the outcomes for the parents, studies...
Background and aims: Skin-to-skin contact (SSC) has positive physiological and psychological effe... more Background and aims: Skin-to-skin contact (SSC) has positive physiological and psychological effects and is implemented in neonatal care to various degree all over the world. Little is known though, to what extent and for which populations. The primary aim or this study was to investigate the level of implementation of SSC in the Nordic countries, and secondary to explore some of the barriers against and facilitators of SSC.
A literature review of 98 articles concerning clinical pain research in newborn infants was condu... more A literature review of 98 articles concerning clinical pain research in newborn infants was conducted to evaluate how researchers report the ethical issues related to their studies and how journals guide this reporting. The articles were published in 49 different scientific journals. The ethical issues most often mentioned were parental informed consent (94%) and ethical review approval (87%). In 75% of the studies the infants suffered pain during the research when placebo, no treatment or otherwise inadequate pain management was applied. Discussion about benefits versus harm to research participants was lacking. A quarter of the journals did not have any ethical guidelines for submitted manuscripts. We conclude that ethical considerations did not play a significant role in the articles studied. Missing and superficial guidelines enable authors to offer studies with fragile research ethics.
Objective: the first aim of this two-phase study was to describe and compare, between two univers... more 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 staff's 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 ¼ 178/185, hospital B, n ¼ 203/235). In phase II, a subsample of these infants (A, n ¼76, B, n ¼ 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 o0.001) or late preterm (49% versus 34%, p¼ 0.051). None of the very preterm infants (o 32 weeks) had early physical contact in the delivery room in either hospital. An infant's 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.
Preterm infants are usually breastfed less than full-term infants, and successful breastfeeding r... more Preterm infants are usually breastfed less than full-term infants, and successful breastfeeding requires a supportive environment and special efforts from their mothers. A breastfeeding peer-support group, utilising social media, was developed for these mothers in order to support them in this challenge. Mothers were able to discuss breastfeeding and share experiences. The purpose of this study was to describe the perceptions of breastfeeding mothers of preterm infants based on the postings in peer-support group discussions in social media. The actively participating mothers (n = 22) had given birth &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35 gestational weeks. They were recruited from one university hospital in Finland. The social media postings (n = 305) were analysed using thematic analysis. A description of the process of breastfeeding a preterm infant from the point of view of a mother was created. The process consisted of three main themes: the breastfeeding paradox in hospital, the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;reality check&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; of breastfeeding at home and the breastfeeding experience as part of being a mother. The mothers encountered paradoxical elements in the support received in hospital; discharge was promoted at the expense of breastfeeding and pumping breast milk was emphasised over breastfeeding. After the infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s discharge, the over-optimistic expectations of mothers often met with reality - mothers did not have the knowledge or skills to manage breastfeeding at home. Successful breastfeeding was an empowering experience for the mothers, whereas unsuccessful breastfeeding induced feelings of disappointment. Therefore, the mothers of preterm infants need evidence-based breastfeeding counselling and systematic support in a neonatal intensive care unit (NICU) and at home.
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