Neonatal ICU Parent Support Groups Quality Improvement ProjectKate ThibaultUniversity of South Florida, College of Nursing

Objectives

Describe a Neonatal ICU Parent Support Group

Identify the benefits of implementing a parental support at Tampa General Hospital’s Neonatal ICU

Discuss a potential roll-out plan and how it may be implemented

BackgroundAfter discharge from Tampa General Hospital’s (TGH) Neonatal Intensive Care Unit (NICU), parents are sent a Press Ganey survey to evaluate their experience

Press GaneyBenchmarked data from 9/30/2013 reported that the NICU at TGH scored lowest in the following categories:

Staff met emotional needs

Staff sensitivity re: stress

Current Problem Emotional needs of parents are not being met

Parental stress involved with parenting a NICU infant:

Infant’s appearance and behavior may be confusing

Unfamiliar environment of the NICU

Isolated from usual systems of support

Coping with their feelings of:Anxiety

Fear

Guilt

Helplessness

Depression

Meet Mrs. H

Mrs. H delivered her 1200g son, Joshua, prematurely at 27 weeks. Joshua was transferred to the NICU immediately after delivery. Since recovering

from delivery, Mrs. H and her husband have been at Joshua’s bedside every day. As first time parents they have many questions, fears and anxieties

that have been compounded by Joshua’s current condition and NICU hospitalization. They are feeling overwhelmed and do not like to bother the

nursing staff with so many questions. Their friends who delivered at St. Joseph’s Hospital recommend that they get involved in a Parent Support group at TGH. Mrs. H and her husband think this is a great idea, and ask

Joshua’s nurse– “Does TGH have a NICU parent support group?”

Opportunity for Improvement

“Does TGH have a NICU parent support group?”

No – TGH does not presently offer a NICU parent support group

How would a support group help? Would provide a place of support for the parents of neonatal patients being cared for

Would improve the amount of emotional support & assistance provided

Would enhance family-centered care approach

What is a support group?

Ways to link current NICU parents with current and former NICU parents:

Scrapbooking nights/arts & crafts

Bedside/Telephone support to new NICU parents

Educational topic nights

Infant CPR certification classes

Transitioning home

Sibling support

Breastfeeding support

To ensure for a positive experience for all individuals former NICU parents must be screened, prepared, and trained

PurposeProvide NICU parents with contact with other NICU parents and families – both past and present

Valuable source of:Hope

Information

Advice

Support Share their feelings

ConnectionSimilar conditions

Experiences

Benefits

Place to share feelings

Educational

Receive advice

Help parents to cope with stress

More confident in their ability to provide care

Less depression & anxiety

Greater satisfaction with NICU stay

Increased self-esteem

Better maternal-infant relationships

More nurturing home environments

Improved communication with hospital staff

Parent-to-Parent SupportA study of 70 mothers of preterm infants in the NICU in a Midwestern regional perinatal center

Participants were divided into:Nurse managed parent-to-parent support group (treatment group)

Comparison group

Results:

Mothers who participated in the treatment group had:Less anxiety during first 4 months post discharge

Self-esteem increase during first 4 months post discharge

Better maternal-infant relationships

More nurturing home environments

Roman, L.A., Lindsay, J.K., Boger, R.P., DeWys, M., Beaumont, E.J., Jones, A.J., & Haas, B. (1995). Parent-to-parent support initiated in the neonatal intensive care unit. Research in Nursing & Health 18(5), 385-394.

Parent “Buddy” Program

This study evaluated the effectiveness of parent-to-parent peer support for mothers of very preterm infants in a NICU

32 mothers in the intervention group/28 mothers in control

Intervention Group:Paired with trained mothers who had previously had a very preterm infant in the NICU

Telephone support was provided

Results - Mothers in the intervention group reported:

Less stress

Less anxiety

Less depression

Greater perceived social support

Overall – support from trained peers was found to be effective in helping mothers deal with the stress of a very preterm birth

Preyde, M. & Ardal, F. (2003). Effectiveness of a parent “buddy” program for mothers of very preterm infants in a neonatal intensive care unit. Canadian Medical Association Journal 168(8), 969-973.

Potential Roll-Out Plan at TGH

Utilize an interdisciplinary approach – involving all members of healthcare team

Locate a meeting space for the parental support group

Identify and screen graduate NICU parent volunteers

Develop educational topics & ideas for meetings

Place informational posters about the group and meeting times around the unit

Educate the Staff about:Implementation of the group

Encourage them to share the information with parents & families

Upon NICU admission, parents will be provided with information about the NICU support group and how to be involved

Upon discharge, NICU parents will be encouraged to stay involved

Remember Mrs. H? After the implementation of TGH’s NICU Parent Support Group – Mrs. H became one of its first members!

Mrs. H utilized the group for:SupportAs a place to share her feelingsTo aid her in coping with stress & anxietyEducation

As a result – Mrs. H felt that the following improved:Communication with the staff

Satisfaction with NICU stay

Involvement in her son’s care

Relationship with her son

ConclusionImplementing a NICU support group at TGH would benefit the parents, the patients, and the unit

A support group would:Meet the emotional needs of the parents/families

Promote parental involvement

Enhance family-centered care approach

Improve communication between parents and staff

Provide a forum for parental education

Help me AND my Mom & Dad

References Browne, J.V. & Talmi, A. (2005). Family-based intervention to enhance infant-parent relationships in the neonatal intensive care unit. Journal of Pediatric Psychology, 30(8), 667-677. Doi:10.1093/jpepsy/jsi053

Coughlin, M., Gibbins, S., & Hoath, S. (2009). Core measures for developmentally supportive care in neonatal intensive care units: Theory, precedence and practice. Journal Of Advanced Nursing, 65 (10), 2239-2248. doi:10.1111/j.1365-2648.2009.05052.x

Gooding, J., Cooper, L., Blaine, A., Franck, L., Howse, J., & Berns, S. (2011). Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Seminars In Perinatology, 35(1), 20-28. doi:10.1053/j.semperi.2010.10.004

Preyde, M. & Ardal, F. (2003). Effectiveness of a parent “buddy” program for mothers of very preterm infants in a neonatal intensive care unit. Canadian Medical Association Journal 168(8), 969-973.

Roman, L.A., Lindsay, J.K., Boger, R.P., DeWys, M., Beaumont, E.J., Jones, A.J., & Haas, B. (1995). Parent-to-parent support initiated in the neonatal intensive care unit. Research in Nursing & Health 18(5), 385-394.