Parents’ perspectives on safety in neonatal intensive care: a mixed-methods study

Abstract

Background & Objectives Little is known about how parents think about neonatal intensive care unit (NICU) safety. Due to their physiologic immaturity and small size, infants in NICUs are especially vulnerable to injury from their medical care. Campaigns are underway to integrate patients and family members into patient safety. This study aimed to describe how parents of infants in the NICU conceptualize patient safety and what kinds of concerns they have about safety. Methods This mixed-methods study employed questionnaires, interviews, and observation with parents of infant patients in an academic medical centre NICU. Measures included parent stress, family-centredness, and types of safety concerns. Results 46 parents completed questionnaires and 14 of these parents also participated in 10 interviews (including 4 couple interviews). Infants had a range of medical and surgical problems, including prematurity, congenital diaphragmatic hernia, and congenital cardiac disease. Parents were positive about their infants’ care and had low levels of concern about the safety of procedures. Parents reporting more stress had more concerns. We identified three overlapping domains in parent’s conceptualizations of safety in the NICU, including physical, developmental, and emotional safety. Parents demonstrated sophisticated understanding of how environmental, treatment, and personnel factors could potentially influence their infants’ developmental and emotional health. Conclusions Parents have safety concerns that cannot be addressed solely by reducing errors in the NICU. Parent engagement strategies that respect parents as partners in safety and address how clinical treatment articulates with physical, developmental, and emotional safety domains may result in safety improvements.

Parents' Perspectives on “Keeping Their Children Safe” in the Hospital

“…This supports further efforts to promote "safety culture" and an environment that is consistently emotionally and physically comfortable for parent participation. 25,26 These parent perspectives on safety suggest that current models on patient engagement and participation 19,20 have not adequately addressed the complicated interpersonal issues that characterize the social role of a parent of hospitalized children. A "social role" consists of a set of connected behaviors, rights, obligations, beliefs, and norms as conceptualized by people in a social situation.…”

The case for quality improvement in the Neonatal Intensive Care Unit

“…Parents are often as vulnerable as their babies. Lyndon et al [19] demonstrate that parents have safety concerns, expect reliability, consistency and technical skill, but also want pain management, gentle handling, and attention to the developmental needs of their infants. They conclude that parents need to be included in decision-making as well as in the development of situational awareness around safety.…”

Segurança Do Paciente Em Unidade Neonatal: Preocupações E Estratégias Vivenciadas Por Pais

“…Nesse contexto, o enfermeiro apresenta fundamental importância, pois ao não se utilizar de uma comunicação eficiente, passa a ser compreendido como um profissional meramente técnico, deixando uma lacuna no cuidado (12) . Ressalta-se que a comunicação deficiente contribui para a angústia dos pais, especialmente, quando não são consultados ou informados sobre procedimentos ou intercorrências (15) . Diante da subcategoria "A gente encontra um pouquinho de dificuldade",observou-se que, assim como em outra pesquisa, os participantes consideram olocal pouco acolhedor, apresentam preocupação com o rodízio entre as equipes, necessitando adaptar-se ao ambiente rico em tecnologia, com diversos ruídos, o que pode desencadear medo (12) .…”

“…De forma semelhante, outro estudo evidenciou que os pais observaram que visitantes e funcionários nem sempre seguiam boas práticas para a prevenção (15) . A infecção é um processo multifatorial e tem como possíveis causas:estrutura física, dimensionamento insuficiente dos profissionais, superlotação e descumprimento das normas dehigienização (26) .…”