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- Ahlqvist-Bjorkroth, Sari, et al.
(author)
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Improving NICU staff decision-making with parents in medical rounds : a pilot study of reflective group dialogue intervention
- 2023
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In: Frontiers in Pediatrics. - : Frontiers Media S.A.. - 2296-2360. ; 11
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Journal article (peer-reviewed)abstract
- Introduction: The communication skills of healthcare professionals play a crucial role in successful shared decision-making with parents in neonatal intensive care. Improving communication skills can be achieved through practice and reflection on personal experiences after authentic interaction events with parents. The process of reflection typically involves three phases: description, reflection, and critical reflection. In this study, our aim was to explore the acceptability of the Reflective Group Dialogue intervention and its effectiveness in supporting the reflective process.Methods: This qualitative pilot study was conducted in the neonatal intensive care unit at Uppsala University Children's Hospital, Sweden. The sample consisted of nine medical rounds with seven families, five neonatologists, seven registered nurses, and five assistant nurses. Purposive sampling was used to collect the data. The intervention comprised four elements: (1) before the intervention, a recorded presentation on shared decision-making was given to the entire unit staff, (2) an observation of a normal medical round discussion with parents, (3) an interview with parents about their experience after the same round, and (4) a reflective discussion with the participating health care professionals after the round. The parent interviews and reflective discussions were audio-recorded and transcribed verbatim. They were analyzed using thematic analysis as a theoretical strategy.Results: Both parents and staff widely accepted the intervention and found it beneficial. We identified four discussions that remained in the descriptive phase of the reflection process, four that reached the reflective phase, and one that reached the critical reflection phase. The descriptive discussions were characterized by using a single perspective to reflect, often based on personal opinions. The reflective discussions included analyzing interaction sequences from both staff and parent perspectives and were primarily based on actual observations of communication during medical rounds. The critical discussion led to a new awareness of current practices concerning parental involvement in decision-making. These discussions also utilized "what-if" thinking to evaluate potential new practices and their pros and cons.Conclusions: The intervention seems promising as it was perceived as beneficial by the recipients and facilitated reflection in most cases. However, to enhance the feasibility of the intervention, some improvements are discussed.
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| 2. |
- Akerman, Sara, et al.
(author)
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Adapting the Cornell assessment of pediatric delirium for Swedish context : translation, cultural validation and inter-rater reliability
- 2024
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In: BMC Pediatrics. - : BioMed Central (BMC). - 1471-2431. ; 24:1
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Journal article (peer-reviewed)abstract
- Background: Pediatric delirium causes prolonged hospital stays, increased costs, and distress for children and caregivers. Currently, there is no delirium screening tool available in Sweden that has been translated, culturally validated, and tested for reliability. This study aimed to translate, culturally adapt, and assess the suitability of the Cornell Assessment of Pediatric Delirium (CAPD) for implementation in Swedish healthcare settings.Methods: The CAPD was translated and culturally adapted to Swedish context following the ten-step process recommended by the International Society for Pharmacoeconomics and Outcomes Task Force for Translation and Cultural Adaptation. The Swedish CAPD was tested in the pediatric intensive care unit of Uppsala University Hospital, a tertiary hospital in Sweden. Inter-rater reliability was tested using intraclass correlation coefficient (ICC), with both Registered Nurses (RNs) and Assistant Nurses (ANs) conducting parallel measurements using the Swedish CAPD. A reliability score of ICC > 0.75 was considered indicative of good reliability.Results: After translation of the CAPD into Swedish, 10 RNs participated in the cultural adaptation process. Issues related to word choice, education, and instructions were addressed. Wording improvements were made to ensure accurate interpretation. Supplementary training sessions were organized to strengthen users' proficiency with the Swedish CAPD. Additional instructions were provided to enhance clarity and usability. Inter-rater reliability testing resulted in an ICC of 0.857 (95% CI: 0.708-0.930), indicating good reliability.Conclusion: This study successfully translated and culturally adapted the CAPD to align with Swedish contextual parameters. The resulting Swedish CAPD demonstrated good inter-rater reliability, establishing its viability as a tool for measuring delirium among pediatric patients in Swedish pediatric intensive care units. Trail registration Not applicable.
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| 3. |
- Andersen Dovland, Randi, et al.
(author)
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PEARL : Pain in early life. A new network for research and education
- 2016
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In: Scandinavian Journal of Pain. - : Elsevier. - 1877-8879.
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Conference paper (peer-reviewed)abstract
- Aims: To establish a network for research and education and to provide expert knowledge to parents and health care professionals about pain in early life.Methods: In November 2014 a group of Nordic researchers and research students, committed to the field of pain in early life, gathered for an open lecture day and workshop in Örebro, Sweden. Inspired by the work of the Canadian initiative PICH – Pain In Child Health, the network formulated it’s vision: To be a stabile and competent research and training network within the area of pain in early life. A first collaborate project was designed: “Translation, cultural adaptation and validation of the revised version of the Premature Infant Pain Profile (PIPP-R): An effort to improve pain assessment in infants in the Nordic countries”.Results: Fourteen months later, in January 2016, the second PEARL-meeting was held, in Oslo, Norway. The lecture day provided clinically active nurses and physicians from several countries with the latest findings on how to best manage pain in neonatal settings. The network which now consist of 18 researchers from different professions and academic levels presents itself on a five-language website: www.pearl.direct. The PIPP-R project has progressed according to the plan. The PIPP-R is translated into Finnish, Icelandic, Norwegian and Swedish. The cultural adaptation and validation should be finished in fall 2016. The members work on and plan for further collaborate projects. The next two steps are to translate and distribute educational material for parents via Internet and social media, and to establish a research and masters course about pain in early life. The work has been secured by funding from Örebro University and and Örebro University Hospital Research Foundation.Conclusions: PEARL fulfils the need for a collaborative network for pain in early life researchers in the Nordic countries.
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| 6. |
- Arwehed, Sofia, et al.
(author)
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Nordic survey showed wide variation in discharge practices for very preterm infants
- 2023
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227.
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Journal article (peer-reviewed)abstract
- AimWe aimed to describe clinical practices and criteria for discharge of very preterm infants in Nordic neonatal units.MethodsMedical directors of all 89 level-2 and level-3 units in Denmark, Finland, Iceland, Norway and Sweden were invited by e-mail to complete a web-based multiple-choice survey with the option to make additional free-text comments.ResultsWe received responses from 83/89 units (93%). In all responding units, discharge readiness was based mainly on clinical assessment with varying criteria. In addition, 36% used formal tests of cardiorespiratory stability and 59% used criteria related to infant weight or growth. For discharge with feeding tube, parental ability to speak the national language or English was mandatory in 45% of units, with large variation among countries. Post-discharge home visits and video-consultations were provided by 59% and 51%, respectively. In 54% of units, parental preparation for discharge were not initiated until the last two weeks of hospital stay.ConclusionDischarge readiness was based mainly on clinical assessment, with criteria varying among units despite similar population characteristics and care structures. This variation indicates a lack of evidence base and may unnecessarily delay discharge; further studies of this matter are needed. Earlier parental preparation and use of interpreters might facilitate earlier discharge.
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| 7. |
- Ashish, K.C. 1982-, et al.
(author)
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Coverage, associated factors, and impact of companionship during labor : A large-scale observational study in six hospitals in Nepal
- 2019
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In: Birth. - : John Wiley & Sons. - 0730-7659 .- 1523-536X. ; 47:1, s. 80-88
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Journal article (peer-reviewed)abstract
- BACKGROUND: Companionship at the time of birth is a nonclinical intervention that has been proven to improve the quality of intrapartum care. This study aims to evaluate the coverage, associated factors, and impact of companionship during labor at public hospitals in Nepal.METHODS: We conducted a cross-sectional observational study in six public hospitals in Nepal. The study was conducted from July 2018 to August 2018. Data were collected on sociodemographic, maternal, obstetric, and neonatal characteristics from patient case notes and through predischarge interviews. Coverage of companionship during labor and its association with intrapartum care was analyzed. Bivariate and multivariate analyses were done to assess the association between companionship during labor and demographic, obstetric, and neonatal characteristics.RESULTS: A total of 63 077 women participated in the study with 19% of them having a companion during labor. Women aged 19-24 years had 65% higher odds of having a companion during labor compared with women aged 35 years and older (aOR 1.65 [95% CI, 1.40-1.94]). Women who were from an advantaged ethnic group (Chhetri/Brahmin) had fourfold higher odds of having a companion than women from a disadvantaged group (aOR 3.84; [95% CI, 3.24-4.52]). Women who had companions during labor had fewer unnecessary cesarean births than those who had no companions (5.2% vs 6.8%, P < .001).CONCLUSIONS: In Nepal, sociodemographic factors affect women's likelihood of having a companion during labor. As companionship during labor is associated with improved quality of care, health facilities should encourage women's access to birth companions.
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| 8. |
- Axelin, Anna, et al.
(author)
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Neonatal intensive care nurses' perceptions of parental participation in infant pain management : a comparative focus group study
- 2015
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In: Journal of Perinatal & Neonatal Nursing. - Philadelphia, USA : Lippincott Williams & Wilkins. - 0893-2190 .- 1550-5073. ; 29:4, s. 363-374
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Journal article (peer-reviewed)abstract
- 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. When nurses collaborated with parents, they negotiated the optimal pain management approach for an individual infant. The collaborative approach was most evident for the nurses in the Swedish NICUs and somewhat evident in the NICUs in Finland and the United States. Further research is needed to address some nurses' perceptions and concerns and to facilitate greater consistency in the application of evidence-based best practices.
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| 10. |
- Axelin, Anna, et al.
(author)
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NICU Nurses’perceptions regarding parental involvement in infant pain management
- 2013
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Conference paper (peer-reviewed)abstract
- Nurses play a key but varied role in enabling (or impeding) parents’ access to information and support needed for parental participation, influenced by individual, institutional and regional factors. We know very little about parental involvement from the perspective of nurses. The aim of this study was to explore views of nurses in 3 countries regarding the role of parents in infant pain management.Methods: A qualitative semi-structured interview study involving NICU nurses was conducted in Finland (n=47), Sweden (n=14), and the US (n=26). The interviews were analyzed with a deductive framework of a range of potential parent roles in infant pain management: none, being informed, being present, providing comfort, an informant for NICU staff, an active decision maker, or advocate for infant (Franck et al. 2012).Results: In all three countries, the nurses described two common parental roles: being informed and providing comfort. Parents were rarely described as informants, active decision makers, or advocates in relation to infant pain management. A new role of ‘parent as assistant’ emerged as some nurses described how parents provided infant comfort while the nurses concentrated on the technical performance of the painful procedure. Interviews also revealed that parents were sometimes actively excluded from infant pain management because their presence made nurses anxious when performing painful procedures. In the Finnish and Swedish samples, collaborative relations with parents were emphasized. The Swedish nurses highlighted the mutual dialogue between nurses and parents. In the US sample, some nurses reported that an active parent role in pain management was not necessary or desirable, since they considered good pain management to be the responsibility of nurses.Discussion and Conclusion: Nurses’ support for parental involvement in infant pain management varies considerably. In some cases, they actively oppose or prevent parental involvement. In other instances, they facilitate parental involvement and encourage partnerships in all aspects of pain management. The transition to a more family-centered approach to infant pain management requires further examination of areas of alignment and dissonance between nurses and parents’ values, needs, perceptions and roles in caring for infants at high risk for pain.Franck LS, Oulton K, Bruce E. Parental involvement in neonatal pain management: an empirical and conceptual update. J Nurs Scholarsh, 2012;44(1):45-54.
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