The health care system is making ‘too much noise’ to provide family-centred care in neonatal intensive care units: Perspectives of health care providers and hospital administrators

Objective This article assesses the degree of variability in the current practice of skin antiseptics used in Canadian neonatal intensive care units (NICUs) and different experiences related to each antiseptic used. Methods An anonymous survey was distributed to a clinical representative of each of the 124 Canadian level II and level III NICUs. Results One hundred and two respondents (82.2%), representing all Canadian provinces, completed the survey. Chlorhexidine gluconate with/without alcohol was the antiseptic most used (96%) and the antiseptic with the highest reported adverse effects (68% reported skin burns/breakdown). Other antiseptics used include povidone-iodine (35%) and isopropyl alcohol (22%). Specific guidelines for antiseptic use were available in only 50% of the units with many NICUs lacking gestational and/or chronological age restrictions. Only 23% of responders believed that there was awareness among health care providers of the adverse effects of antiseptics used. Less than half (43%) were completely satisfied with the antiseptics used in their units. Conclusion Chlorhexidine gluconate is the most commonly used antiseptic in Canadian NICUs. The high number of associated adverse effects and the lack of guidelines regulating antiseptic use are of concern. Large clinical trials are urgently needed to guide practice and improve the safety of antiseptics.

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Neonatal skin care in tertiary Neonatal Intensive Care Units in Hungary

Orvosi Hetilap ◽

10.1556/oh.2014.29910 ◽

2014 ◽

Vol 155 (28) ◽

pp. 1102-1107

Author(s):

Zsanett Renáta Csoma ◽

Péter Doró ◽

Gyula Tálosi ◽

Tamás Machay ◽

Miklós Szabó

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Health Care Providers ◽

Neonatal Intensive Care ◽

Skin Care ◽

Neonatal Intensive Care Units ◽

Care Providers ◽

Care Protocol ◽

Skin Disinfection ◽

Skin Physiology

Introduction: Skin physiology of neonates and preterm infants and evidence-based skin care are not well explored for health care providers. Aim: The aim of our present study was to investigate the skin care methods of the tertiary Neonatal Intensive Care Units in Hungary. Method: A standardized questionnaire was distributed among the 22 tertiary Neonatal Intensive Care Units with questions regarding skin care methods, bathing, emollition, skin disinfection, umbilical cord care, treatment of diaper dermatitis, and use of adhesive tapes. Results: The skin care methods of the centres were similar in several aspects, but there were significant differences between the applied skin care and disinfectant products. Conclusions: The results of this survey facilitate the establishment of a standardized skin care protocol for tertiary Neonatal Intensive Care Units with the cooperation of dermatologists, neonatologists and pharmacists. Orv. Hetil., 2014, 155(28), 1102–1107.

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Implementation of amplitude-integrated electroencephalography in tertiary Canadian Neonatal Intensive Care Units—a longitudinal study

Paediatrics & Child Health ◽

10.1093/pch/pxz091 ◽

2019 ◽

Vol 25 (8) ◽

pp. 511-517

Author(s):

Beate Grass ◽

Blondel Crosdale ◽

Matthew Keyzers ◽

Poorva Deshpande ◽

Cecil Hahn ◽

...

Keyword(s):

Intensive Care ◽

Longitudinal Study ◽

Intensive Care Units ◽

Health Care Providers ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Preterm Neonates ◽

Care Providers ◽

Cerebral Function ◽

Almost All

Abstract Aim To investigate the implementation of amplitude-integrated electroencephalography (aEEG) as bedside monitoring tool of cerebral function in tertiary Canadian Neonatal Intensive Care Units (NICU) over the past decade. Methods Longitudinal study consisting of online surveys of neonatologists on the use of aEEG in 2009 and 2018. Results The response rate to the survey was 72 of 149 (49%) in 2009 and 18 of 30 (60%) in 2018, respectively. aEEG has been implemented in almost all (2009: 62.5%; 2018: 94%) tertiary Canadian NICUs. Two-thirds (2009: 67%; 2018: 71%) of the respondents considered information from aEEG tracing helpful in clinical practice. The main indications for aEEG were term neonates with hypoxic ischemic encephalopathy (2009 and 2018: 76%) and seizure detection/surveillance (2009: 88%; 2018: 94%). Teaching on aEEG has been implemented for neonatologists (2018: 100%) and health care providers (2018: 50%) in tertiary Canadian NICUs but there is a lack of standardization of training. Use of aEEG in preterm neonates (2009: 37%, 2018: 33%) and application of aEEG in research (18% reported occasional use) is less common. Conclusion aEEG is well established in tertiary Canadian NICUs to monitor cerebral function and detect seizure activity. There is a need to develop formalized aEEG training programs and methods to assess competence. Further implementation of aEEG in preterm neonates and research is desirable.

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Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States

PEDIATRICS ◽

10.1542/peds.94.2.190 ◽

1994 ◽

Vol 94 (2) ◽

pp. 190-193

Author(s):

Rita G. Harper ◽

Concepcion G. Sia ◽

Regina Spinazzola ◽

Raul A. Wapnir ◽

Shahnaz Orner ◽

...

Keyword(s):

United States ◽

Intensive Care ◽

Health Care Providers ◽

Curriculum Design ◽

Neonatal Intensive Care ◽

District Of Columbia ◽

The United States ◽

Geographic Region ◽

Neonatal Intensive Care Units ◽

Care Providers

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.

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“Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

PLoS ONE ◽

10.1371/journal.pone.0242604 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242604

Author(s):

Marian Loveday ◽

Sindisiwe Hlangu ◽

Jennifer Furin

Keyword(s):

Health Care ◽

Pregnant Women ◽

Health Care System ◽

Health Care Providers ◽

Physical Symptoms ◽

Coding System ◽

Care Providers ◽

Convenience Sample ◽

Care System

Background There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. Objective To describe the treatment journeys of pregnant women with RR-TB—including how their care experiences shape their identities—and identify areas in which tailored interventions are needed. Methods In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Results Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to “be brave”). Care experiences required them to negotiate seemingly contradictory identities as both new mothers—“givers of life”—and RR-TB patients facing a complicated and potentially deadly disease. In terms of their “pregnancy identity” and “RR-TB patient identity” that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the “mothering” and “patient” roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child’s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. Conclusion The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

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The Effect of Facilitated Peer Support Sessions on Burnout and Grief Management among Health Care Providers in Pediatric Intensive Care Units: A Pilot Study

Journal of Palliative Medicine ◽

10.1089/jpm.2012.0231 ◽

2012 ◽

Vol 15 (11) ◽

pp. 1178-1180 ◽

Cited By ~ 14

Author(s):

Samantha Eagle ◽

Amy Creel ◽

Anne Alexandrov

Keyword(s):

Health Care ◽

Intensive Care ◽

Pilot Study ◽

Intensive Care Units ◽

Peer Support ◽

Health Care Providers ◽

Pediatric Intensive Care ◽

Care Providers ◽

Pediatric Intensive Care Units

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Outside Looking In: A Pharmacist's Personal Journey With Family Elders

The Senior Care Pharmacist ◽

10.4140/tcp.n.2019.156 ◽

2019 ◽

Vol 34 (3) ◽

pp. 156-167

Author(s):

Jeannette Y. Wick

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Providers ◽

Transitions Of Care ◽

Clinical Inertia ◽

Older Individuals ◽

Care Providers ◽

Term Care ◽

Personal Journey ◽

Care System

Pharmacists who work in long-term care—or in any area of health care—are exposed to the health care system on a daily basis. While most of us recognize that the health care system has problems, especially at transitions of care, few of us appreciate fully how serious these problems can be. Certifying and accrediting agencies have encouraged health care providers to step out of their silos and work more collaboratively, and educators have emphasized understanding geriatric syndromes. A description of a personal journey through the health system—for both the patient and the caregiver—with two older individuals, this narrative discusses how difficult it is for patients to understand what's happening around them. It also discusses the clinical inertia in addressing geriatric issues and offers suggestions to health care providers facing similar situations.

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HIV status, trust in health care providers, and distrust in the health care system among Bronx women

AIDS Care ◽

10.1080/09540120600774263 ◽

2007 ◽

Vol 19 (2) ◽

pp. 226-234 ◽

Cited By ~ 36

Author(s):

C. O. Cunningham ◽

N. L. Sohler ◽

L. Korin ◽

W. Gao ◽

K. Anastos

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Providers ◽

Care Providers ◽

Hiv Status ◽

Care System

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Emerging Chryseobacterium indologenes Infection in Indian Neonatal Intensive Care Units: A Case Report

Antibiotics ◽

10.3390/antibiotics7040109 ◽

2018 ◽

Vol 7 (4) ◽

pp. 109 ◽

Cited By ~ 4

Author(s):

Rishika Mehta ◽

Ashish Pathak

Keyword(s):

Health Care ◽

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Multidrug Resistant ◽

Neonatal Intensive Care Units ◽

Indwelling Catheters ◽

Chryseobacterium Indologenes ◽

Life Threatening ◽

Health Care Associated Infections

Antibiotic-resistant pathogens and nosocomial infections constitute common and serious problems for neonates admitted to neonatal intensive care units worldwide. Chryseobacterium indologenes is a non-lactose-fermenting, gram-negative, health care-associated pathogen (HCAP). It is ubiquitous and intrinsically resistant to several antibiotics. Despite its low virulence, C. indologenes has been widely reported to cause life-threatening infections. Patients on chronic immunosuppressant drugs, harboring invasive devices and indwelling catheters become the nidus for C. indologenes. Typically, C. indologenes causes major health care-associated infections such as pneumonia, empyema, pyelonephritis, cystitis, peritonitis, meningitis, and bacteremia in patients harboring central venous catheters. Management of C. indologenes infection in neonates is not adequately documented owing to underreporting, particularly in India. Because of its multidrug resistance and the scant availability of data from the literature, the effective empirical treatment of C. indologenes is challenging. We present an uncommon case of bacteremia caused by C. indologenes in a preterm newborn baby with moderate respiratory distress syndrome who was successfully treated. We also provide a review of infections in the neonatal age group. Henceforth, in neonates receiving treatments involving invasive equipment use and long-term antibiotic therapy, multidrug resistant C. indologenes should be considered an HCAP.

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