Mother-clinician discussions in the neonatal intensive care unit: agree to disagree?
ABSTRACT Objective:To compare mothers' and clinicians' understanding of an infant's illness and perceptions of discussion quality in the neonatal intensive care unit.Study Design:English-speaking mothers with an infant admitted to the intensive care unit for at least 48 h were interviewed using a semi-structured survey. The clinician whom the mother had spoken to and identified was also surveyed. Interviews were audiotaped and transcribed.Result:A total of 101 mother-clinician pairs were interviewed. Most mothers (89%) and clinicians (92%) felt that their discussions had gone well. Almost all mothers could identify one of their infant's diagnoses (100%) and treatments (93.4%). Mothers and clinicians disagreed on infant illness severity 45% of the time. The majority of mothers (62.5%) who disagreed with clinician estimate of infant illness severity believed their infant to be less sick than indicated by the clinician.Conclusion:Mother-clinician satisfaction with communication does not ensure mother-clinician agreement about an infant's medical status.Journal of Perinatology advance online publication, 16 August 2012; doi:10.1038/jp.2012.103.
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ABSTRACT: AIM: To explore parental information and communication needs during their baby's care in the neonatal unit with a focus on brain imaging and neurological prognosis. METHODS: Eighteen parents recruited from one neonatal unit in the United Kingdom participated in semi-structured qualitative interviews using a grounded theory approach. The topic guide focused on information received about neonatal brain imaging, diagnosis and prognosis, emotional impact and support. RESULTS: Parents expressed different information needs influenced by their history, expectations, coping strategies and experiences. Most felt they initially were passive recipients of information and attempted to gain control of the information flow. Nurses were the main providers of information; doctors and other parents were also valuable. Attending ward rounds was important. Some parents felt accessing specific information such as the results of brain imaging could be difficult. Concerns about long-term developmental outcomes and the need for information did not diminish over time. The emotional impact of having a preterm baby had a negative effect on parents' ability to retain information and all had an on-going need for reassurance. CONCLUSION: The findings provide insights about the needs and experiences of parents who have a continuing requirement for information about their infant's care, development and prognosis. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.Acta Paediatrica 01/2013; · 1.97 Impact Factor
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ABSTRACT: Under increasing pressure to contain costs, hospitals are challenged to provide high-quality care to an increasingly complex group of children with life-threatening illness (LTI) that often worsen over time. Pediatric palliative care is an essential component of optimal hospital care delivery for these children and their families. This article describes (1) the current landscape of pediatric hospital care for children with LTI, (2) the connection between palliative care and hospital care for such children, and (3) the relationship between health care reform and palliative care for children with LTI.Pediatric Clinics of North America 08/2014; 61(4):719–733. · 2.20 Impact Factor