Neonatal medical trainee doctors' perceptions and parents' self-reported needs and stressors in a surgical neonatal intensive care unit: An individualised approach.

AIM: As more infants survive surgery in the newborn period for major congenital anomalies, the focus has shifted to the quality of care for parents as well as infants. In contemporary neonatal intensive care units (NICUs), doctors are encouraged to practice family-centred care and partner with parents in their infant's care. This study explored doctors' perceptions and parents' self-reported needs and stressors in a surgical NICU. METHODS: From January 2014 to September 2015, parents of infants admitted for general surgery for a major congenital anomaly who were present in the NICU between 48 and 72 h of admission and doctors caring for their infant at the time of data collection were invited to participate. Matched data were provided using the Neonatal Family Needs Inventory and the Parental Stressor Scale:NICU. RESULTS: Matched data for 12 doctor-parent dyads showed that doctors (neonatal medical trainees) consistently under-rated the importance of parents' needs and identified fewer of mothers' than fathers' most important needs. Doctors also consistently under-rated parents' stressors. They perceived few of fathers', but all of mothers', greatest stressors. Thematic analysis revealed four themes: infant pain management; parental autonomy; empathy; and communicating reassurance and education to parents. CONCLUSION: The findings suggest incongruences between doctors' perceptions and parents' self-reported needs and stressors. While there is hesitation in making recommendations with this sample size, the findings highlight issues that may inform further research and contribute to a dialogue regarding the role of doctors in family-centred relationship-based models of care in the NICU.

Fathers' needs in a surgical neonatal intensive care unit: Assuring the other parent.

OBJECTIVES: Fathers of infants admitted to Neonatal Intensive Care Unit (NICU) play an important role and have individual needs that are often not recognised. While there is considerable evidence regarding mothers' needs in the NICU, information about fathers' is particularly limited. This study identifies the needs of fathers of newborns admitted to NICU for general surgery of major congenital anomalies, and whether health-care professionals meet these needs. METHODS: Forty-eight fathers of infants admitted for surgery between February 2014 and September 2015 were enrolled in a prospective cohort study. Fathers completed the Neonatal Family Needs Inventory comprising 56 items in 5 subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge and whether these needs were met; as well as the Social Desirability Scale. RESULTS: Responses showed Assurance was the most important subscale (M 3.8, SD .26). Having questions answered honestly (M 3.9, SD .20) and knowing staff provide comfort to their infant (M 3.94, SD .24) were fathers' most important needs. By discharge, fathers expressed a greater importance on being recognised and more involved in their infant's care. More than 91% indicated their ten most important needs were met by the NICU health-care professionals, with no significant changes at discharge. Clergical visits (M 2.08, SD 1.21) were least important. CONCLUSIONS: Reassurance is a priority for fathers of neonates in a surgical NICU, particularly regarding infant pain management and comfort. It is important that health-care professionals provide reliable, honest information and open-access visiting. Notably, fathers seek greater recognition of their role in the NICU-beyond being the 'other' parent.

Stressors of parents of infants undergoing neonatal surgery for major non-cardiac congenital anomalies in a surgical neonatal intensive care unit.

AIM: As more babies survive major neonatal surgery, the quality of life of the whole family is a major focus of health care. While there is evidence suggesting that parents of babies admitted to neonatal intensive care units (NICUs) experience high levels of stress, little is known about stressors in parents whose infants also require neonatal surgery. This study identified fathers' and mothers' stressors in a surgical NICU. METHODS: Parents of infants admitted for general surgery to the NICU at a tertiary children's hospital from February 2014 to September 2015 were eligible for enrolment. Parents completed the Parental Stressor Scale: NICU to measure levels of stress related to three subscales: sights and sounds, infant appearance and parental role alteration, using a 5-point Likert scale. RESULTS: Data for 111 parents (57% mothers) showed parental role alteration as the greatest stressor for parents (M = 2.98, standard deviation (SD) = 0.89), particularly for mothers, followed by infant appearance (M = 2.84, SD = 0.95). Both fathers and mothers rated feeling helpless (M = 4.1, SD = 1.0), unable to protect their baby (M = 4.1, SD = 0.9) and seeing their baby in pain (M = 3.9, SD = 1.2) the most common, most stressful experiences and highest contributors to overall stress in the surgical NICU environment. CONCLUSION: Parental role alteration is the greatest stressor for parents in the surgical NICU. Reducing stress for parents of infants undergoing neonatal surgery requires management of the infant's pain and strategies to support parents in their role in the NICU.

Needs of parents in a surgical neonatal intensive care unit.

AIM: While there is evidence of parental needs in the neonatal intensive care unit (NICU), parents of newborns admitted for general surgery are an under-researched population. This study aimed to identify needs in parents of newborns admitted to the NICU for general surgery and whether health-care professionals meet these needs. METHODS: This was a prospective cohort study of 111 parents (57% mothers) of newborns admitted to a surgical NICU for general surgery in Australia from January 2014 to September 2015. Parents completed the Neonatal Family Needs Inventory (NFNI), comprising 56 items in five subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge, as well as the Social Desirability Scale (SDS). Data were analysed using parametric and non-parametric techniques. RESULTS: At both admission and discharge, parents rated Assurance (M = 3.8, standard deviation (SD) = 0.24) needs as the most important, followed by Proximity (M = 3.6, SD = 0.32) and Information (M = 3.5, SD = 0.38). Mothers rated Assurance significantly more important than fathers (P < 0.02). Overall, parents' most important needs were having questions answered honestly (M = 3.96, SD = 0.19), seeing their infant frequently and knowing about the medical treatment (both M = 3.95, SD = 0.23). The 10 most important needs were met for more than 96% of parents, with no evidence of response bias. CONCLUSIONS: Reassurance is a priority need for parents in the surgical NICU. Mothers' and fathers' needs may be best met by practices based on family-centred, individualised care principles.