The Experiences of Parent Dyads in the Neonatal Intensive Care Unit: A Qualitative Description.

Background The hospitalization of an infant in the neonatal intensive care unit (NICU) is a distressing and often unexpected event for parents. Parents have risk for depression, anxiety, and posttraumatic stress, which can adversely impact them and their relationship. The hospitalization and subsequent stress may affect parents' capability to connect with and parent their child. Purpose Describe parents' experiences and ability to cope with the NICU; identify experiential and coping differences between mothers and fathers; examine the effect of the NICU hospitalization on the parent dyad relationship. Methods A qualitative descriptive design with dyadic interviews examined parents' experiences and coping skills, and subsequent effects on the parental relationship. Data collection continued until saturation was achieved and no new themes emerged. Through content analysis, an accurate description of parents' experiences in the NICU was rendered. Findings Nine themes from eight dyad interviews emerged and were categorized within the six domains of the transactional theory of stress and coping. The major themes were: Deeply Distressing, Unexpected and Unprepared, Expecting to Hear and Be Heard, Becoming Parents, Stronger Together, Support is Key, Parents Want Better Communication, and Adjusting to the NICU. Implications for practice Support from professionals and family, and clear and consistent communication from the treatment team helped alleviate parents' anxiety about their infant. Implications for research Research regarding the impact of a NICU hospitalization on the relationship between parent dyad members, specifically longitudinal studies, may lead to a better understanding of the long-term effects of this specific stressor on parents.

Lessons Learned From a Mental Health Hospital: Managing COVID-19.

Congregate settings such as psychiatric units have an increased risk of disease transmission because of the milieu setting and the inability to isolate patients. Interventions to prevent infection and cross-contamination are discussed including monitoring of patient temperatures, personal protective equipment, remote care, monitoring of human resources, and reinforcement of infection prevention strategies. We discuss the effectiveness of those interventions and the lessons learned, including implications for psychiatric clinical care, during future pandemics or a next wave of COVID-19.

The Experiences of Parents in the Neonatal Intensive Care Unit: An Integrative Review of Qualitative Studies Within the Transactional Model of Stress and Coping.

Having a child hospitalized in the neonatal intensive care unit (NICU) is a deviation from the norms expected for pregnancy and childbirth. A NICU admission may be traumatic for some parents, causing psychological distress and altered parenting roles. The aim of this integrative review is to examine the experiences and perceptions of a NICU hospitalization from the perspective of both parents to inform clinical practice and future research. A systematic search of 3 databases was conducted and included studies were evaluated by the Critical Skills Appraisal Programme checklist for qualitative studies. The Whittemore and Knafl integrative review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were followed to provide a structure for searching and reporting findings. There were 248 participants (153 mothers and 95 fathers) from 9 countries and of varying socioeconomic backgrounds in the 16 primary qualitative studies included in this review. The resulting major themes included panic sequence, emotional upheaval, social support, faith, and adjusting. Interventions directed at managing parents' emotions, supporting their spiritual needs, facilitating parenting skills and infant attachment, and adapting the environment to parents' needs can help improve the NICU experience.

Parent Psychological Distress in the Neonatal Intensive Care Unit Within the Context of the Social Ecological Model: A Scoping Review.

BACKGROUND: Neonatal intensive care unit (NICU) parents are at risk for psychological distress and impaired mental health, and statistics related to parent psychological distress vary. OBJECTIVE: To determine the scope of literature regarding the mental health and psychosocial well-being of parents in the NICU. DESIGN: A scoping review within the Arksey and O'Malley framework and the SEM was undertaken to answer, "What factors contribute to parent's mental health in the NICU?" A systematic review of the literature was performed using the PRISMA methodology. RESULTS: Common socioeconomic factors and infant and parent characteristics may place parents at a greater risk for developing distress. History of mental illness, family cohesion, birth trauma, altered parenting role, gestational age, birth weight, and severity of prematurity/illness emerged as themes. CONCLUSION: Further research is required to provide a standard for the screening and assessment of parents' mental health and psychosocial well-being during a NICU hospitalization. The experiences of nonbirth parents in the NICU should be explored to examine the effects of the hospitalization on all types of parents.

Medical Rapid Response in Psychiatry: Reasons for Activation and Immediate Outcome.

Rapid response teams are used to improve the recognition of acute deteriorations in medical and surgical settings. They are activated by abnormal physiological parameters, symptoms or clinical concern, and are believed to decrease hospital mortality rates. We evaluated the reasons for activation and the outcome of rapid response interventions in a 222-bed psychiatric hospital in New York City using data obtained at the time of all activations from January through November, 2012. The primary outcome was the admission rate to a medical or surgical unit for each of the main reasons for activation. The 169 activations were initiated by nursing staff (78.7 %) and psychiatrists (13 %) for acute changes in condition (64.5 %), abnormal physiological parameters (27.2 %) and non-specified concern (8.3 %). The most common reasons for activation were chest pain (14.2 %), fluctuating level of consciousness (9.5 %), hypertension (9.5 %), syncope or fall (8.9 %), hypotension (8.3 %), dyspnea (7.7 %) and seizures (5.9 %). The rapid response team transferred 127 (75.2 %) patients to the Emergency Department and 46 (27.2 %) were admitted to a medical or surgical unit. The admission rates were statistically similar for acute changes in condition, abnormal physiological parameters, and clinicians' concern. In conclusion, a majority of rapid response activations in a self-standing psychiatric hospital were initiated by nursing staff for changes in condition, rather than for policy-specified abnormal physiological parameters. The findings suggest that a rapid response system may empower psychiatric nurses to use their clinical skills to identify patients requiring urgent transfer to a general hospital.

Going beyond traditional educational models: the evolution of the nursing clinical case conference in behavioral health settings.

This column discusses using nursing clinical case conferences to assist with the ongoing development of staff nurses.