Non-invasive ventilation in the care of patients with chronic obstructive pulmonary disease with palliative care needs: a scoping review.

BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) could have palliative care (PC) needs because of unmet needs such as dyspnoea. This may lead to anxiety and may have an impact on patients' ability to perform daily activities of living. PC can be started when patients with COPD have unmet needs and can be provided alongside disease-modifying therapies. Non-invasive ventilation (NIV) could be an important measure to manage dyspnoea in patients with COPD in need of PC. A scoping review was conducted to gain an overview of the existing research and to identify knowledge gaps. The aim of this scoping review was to systematically map published studies on the use of NIV in patients with COPD with PC needs, including the perspectives and experiences of patients, families, and healthcare professionals (HCPs). METHODS: This review was conducted following the framework of Arksey and O'Malley. The reporting of the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. The review protocol was published. AMED, CINAHL, Embase, MEDLINE, PEDro, and PsycInfo were searched from inception to November 14, 2022. The included studies had to report the perspectives and experiences of COPD patients, relatives, and HCPs regarding NIV in the care of patients with COPD with PC needs. In pairs, the authors independently assessed studies' eligibility and extracted data. The data were organised thematically. The results were discussed in a consultation exercise. RESULTS: This review included 33 papers from 32 studies. Four thematic groupings were identified: preferences and attitudes towards the use of NIV; patient participation in the decision-making process of NIV treatment; conflicting results on the perceived benefits and burdens of treatment; and heterogenous clinical outcomes in experimental studies. Patients perceived NIV as a 'life buoy' to keep them alive. Many patients wanted to take part in the decision-making process regarding NIV treatment but expressed varying degrees of inclusion by HCPs in such decision-making. Conflicting findings were identified regarding the perceived benefits and burdens of NIV treatment. Diversity in heterogeneous clinical outcomes were reported in experimental studies. CONCLUSIONS: There is a need for more studies designed to investigate the effectiveness of NIV as a palliative measure for patients with COPD with PC needs using comprehensive outcomes. It is especially important to gain more knowledge on the experiences of all stakeholders in the use of home-based NIV treatment to these patients.

"Hope at a crossroads" - Experiences of hope in intensive care patients: A qualitative study.

BACKGROUND: Hope is closely connected to experiences of health and illness. In critical illness, the future may be uncertain regarding survival, recovery, and daily functioning. More knowledge is needed on how to support hope in patients in intensive care units and during the following rehabilitation period. OBJECTIVES: The aim of this study was to explore hope and its impacting factors among critically ill patients in the intensive care unit. METHODS: This was an exploratory study using semistructured interviews for data collection. Thirteen patients discharged from intensive care were interviewed while still in hospital. Data were analysed using thematic analysis. The consolidated criteria for reporting qualitative research were used for reporting this study. FINDINGS: Three themes, consisting of 8 subthemes, were generated through the analysis. The first theme presented, 'Hope at the point of uncertainty', describes the perception of hope as a phenomenon in critical illness, while the last two, 'Nourishment for hope' and 'Barriers to hope', comprise possible promoting and constraining factors affecting hope during intensive care The overarching theme 'Hope at a crossroads' reflects the overall patient experience of hope in critical illness. CONCLUSION: To maintain or regain hope, healthcare personnel working with critically ill patients should be aware of the importance of encouraging and acknowledging physical progress even when small. Furthermore, they should attend to patients' relational needs and facilitate their ability to interact as the persons they are, not only as patients.

Starting parenting in isolation a qualitative user-initiated study of parents' experiences with hospitalization in Neonatal Intensive Care units during the COVID-19 pandemic.

BACKGROUND: Worldwide, strict infection control measures including visitation regulations were implemented due to the COVID-19 pandemic at Neonatal Intensive Care Units (NICUs). These regulations gave restricted access for parents to their hospitalized infants. The consequence was limited ability to involve in the care of their infants. At Oslo University Hospital entry to NICU was denied to all except healthy mothers in March 2020. The absolute access ban for fathers lasted for 10 weeks. The aim of this study was to explore parental experiences with an infant hospitalized in the NICU during this absolute visitation ban period. METHODS: We invited post discharge all parents of surviving infants that had been hospitalized for at least 14 days to participate. They were interviewed during autumn 2020 using an explorative semi-structured interview approach. Data were analyzed via inductive thematic analysis. RESULTS: Nine mothers and four fathers participated. The COVID-19 regulations strongly impacted the parent's experiences of their stay. The fathers' limited access felt life-impacting. Parents struggled to become a family and raised their voices to be heard. Not being able to experience parenthood together led to emotional loneliness. The fathers struggled to learn how to care for their infant. The regulations might lead to a postponed attachment. On the other hand, of positive aspect the parents got some quietness. Being hospitalized during this first wave was experienced as exceptional and made parents seeking alliances by other parents. Social media was used to keep in contact with the outside world. CONCLUSIONS: The regulations had strong negative impact on parental experiences during the NICU hospitalization. The restriction to fathers' access to the NICU acted as a significant obstacle to early infant-father bonding and led to loneliness and isolation by the mothers. Thus, these COVID-19 measures might have had adverse consequences for families.

From simulation room to clinical practice: Postgraduate neonatal nursing students' transfer of learning from in-situ resuscitation simulation with interprofessional team to clinical practice.

The purpose of this study was to investigate how postgraduate neonatal nursing students transfer learning from in-situ resuscitation simulation with interprofessional teams to clinical practice. It is essential that healthcare professionals involved in stabilization and resuscitation of newborns master technical (e.g.bag-mask ventilation) and non-technical skills (e.g. teamwork and communication). Simulation plays an important role in education as it allows healthcare professionals safe practicing of skills and teamwork under direct supervision. Debriefing is a central component. Eighteen postgraduate neonatal nursing students participated in in-situ simulation with interprofessional team. Subsequently, five students were interviewed individually. A qualitative content analysis was performed. Three descriptive categories were identified, representing the manifest content:'Non-technical skills','Task management in an acute situation', and 'Learning through reflection'. The interviewees highlighted a deeper understanding of the collaboration and mutual dependency in the team after in-situ simulation. One latent content was identified: "Trust and competence in a relational collaboration". It is challenging to choose the best suited learning activities for learning different subject matters, like skills and competencies needed in clinical neonatal resuscitation.Despite this being a small study, the findings can be transferred to similar educational contexts.

Parents of preterm-born children; sources of stress and worry and experiences with an early intervention programme - a qualitative study.

BACKGROUND: Preterm-born children are at increased risk of adverse developmental outcomes, and their parents may experience increased stress levels. The Mother-Infant Transaction Program (MITP) is an early intervention that aims to enhance the parent-infant relationship and child development. The present study investigated differences in parents' experience of stress and concerns about caring for their preterm-born child according to whether they participated in the programme. Parental satisfaction with the intervention was also explored. METHODS: As part of a follow-up study at 36 months, a randomized controlled trial of the MITP-14 parents of 11 children from the intervention group, and 17 parents of 14 children from the control group were interviewed by the use of semi-structured focus group interviews. The interviews were analysed thematically. RESULTS: The intervention parents reported that the knowledge, advice, guidance and emotional support given during the intervention made them feel less stressed and more confident, competent and secure caring for their preterm born child than they would otherwise have been. The control parents described feeling less involved and emotionally supported, and seemed more anxious about their child's development than the intervention parents. All parents were vigilant and alert to their child's needs and monitored developmental milestones carefully. CONCLUSION: This qualitative exploration of the influences of the MITP revealed a positive impact of the intervention and seems to be an important educational and supportive initiative. Thus, reducing parental stress and enhancing confidence in the parental role.

Effect of an early intervention programme on development of moderate and late preterm infants at 36 months: a randomized controlled study.

UNLABELLED: Aim of the present study was to examine the long-term effect of an early intervention for preterm infants on cognitive, gross motor and behavioural outcomes at 36 months corrected age. One hundred and eighteen preterm infants born 2005-2006 with gestational age ≥ 30.0 and <36.0 weeks were randomized to an early intervention involving the Mother-Infant Transaction Program (n = 61) or a control group (n = 57). At 36 months, 32 children in the intervention and 30 in the control group were assessed. OUTCOME MEASURES: Ages & Stages Questionnaire, Ages & Stages Questionnaire: Social-Emotional, Child Behaviour Checklist 1½-5 and Mullen Scale of Early Learning. The intervention programme had no effect on cognitive, motor or behavioural development in this group of mainly moderate and late preterm infants at 36 months corrected age. Four explanations may be proposed: the programme has a less effect on moderate and late preterm infants than in more preterm infants; modifications of the intervention might increase efficacy; a cumulative effect of the intervention leads to more obvious effects at later ages, and an improved standard care in the Neonatal Intensive Care Units may support infant development.