Parents’ Experiences of the First Year at Home with an Infant Born Extremely Preterm with and without Post-Discharge Intervention: Ambivalence, Loneliness, and Relationship Impact

With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.

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Longitudinal Study of Music Therapy’s Effectiveness for Premature Infants and Their Caregivers (LongSTEP): Feasibility Study With a Norwegian Cohort

Journal of Music Therapy ◽

10.1093/jmt/thaa023 ◽

2021 ◽

Author(s):

Claire M Ghetti ◽

Bente Johanne Vederhus ◽

Tora Söderström Gaden ◽

Annette K Brenner ◽

Łucja Bieleninik ◽

...

Keyword(s):

Longitudinal Study ◽

Feasibility Study ◽

Premature Infants ◽

Neonatal Intensive Care ◽

Perinatal Period ◽

First Year ◽

Structured Interviews ◽

Post Discharge ◽

Critical Realist ◽

Musical Interaction

Abstract Premature infants and their parents experience significant stress during the perinatal period. Music therapy (MT) may support maternal–infant bonding during this critical period, but studies measuring impact across the infant’s first year are lacking. This nonrandomized feasibility study used quantitative and qualitative methods within a critical realist perspective to evaluate the feasibility, acceptability, and suitability of the treatment arm of the Longitudinal Study of music Therapy’s Effectiveness for Premature infants and their caregivers (LongSTEP) (NCT03564184) trial with a Norwegian cohort (N = 3). Families were offered MT emphasizing parent-led infant-directed singing during neonatal intensive care unit (NICU) hospitalization and across 3 months post-discharge. We used inductive thematic analysis of semi-structured interviews with parents at discharge from NICU and at 3 months and analyzed quantitative variables descriptively. Findings indicate that: (1) parents of premature infants are willing to participate in MT research where parental voice is a main means of musical interaction; (2) parents are generally willing to engage in MT in NICU and post-discharge phases, finding it particularly interesting to note infant responsiveness and interaction over time; (3) parents seek information about the aims and specific processes involved in MT; (4) the selected self-reports are reasonable to complete; and (5) the Postpartum Bonding Questionnaire appears to be a suitable measure of impaired maternal–infant bonding. Parents reported that they were able to transfer resources honed during MT to parent–infant interactions outside MT and recognized parental voice as a central means of building relation with their infants. Results inform the implementation of a subsequent multinational trial that will address an important gap in knowledge.

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Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-06719-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Patricia Jepma ◽

Corine H. M. Latour ◽

Iris H. J. ten Barge ◽

Lotte Verweij ◽

Ron J. G. Peters ◽

...

Keyword(s):

Qualitative Study ◽

Transitional Care ◽

Living Arrangement ◽

Intervention Group ◽

Adverse Outcomes ◽

Cardiac Patients ◽

Added Value ◽

Structured Interviews ◽

Post Discharge ◽

Care Intervention

Abstract Background Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients’ participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. Methods A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. Results Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants’ recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. Conclusion Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients’ needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.

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Socio-family support for parents of technology-dependent extremely preterm infants after hospital discharge

Journal of Child Health Care ◽

10.1177/1367493521996490 ◽

2021 ◽

pp. 136749352199649

Author(s):

Isabel María Fernández-Medina ◽

José Granero-Molina ◽

José Manuel Hernández-Padilla ◽

María del Mar Jiménez-Lasserrotte ◽

María Dolores Ruiz-Fernández ◽

...

Keyword(s):

Family Support ◽

Hospital Discharge ◽

Preterm Infants ◽

Healthcare Professionals ◽

Phenomenological Study ◽

Psychological Impact ◽

Structured Interviews ◽

Post Discharge ◽

Extremely Preterm ◽

Extremely Preterm Infants

Parents of extremely preterm infants (<28 weeks of gestation) report high levels of stress and anxiety related to daily needs after hospital discharge. Social support has a significant role in reducing the negative psychological impact of preterm birth and parents’ adaptation to caregiving. We conducted a hermeneutic phenomenological study using Gadamer’s approach to explore and describe the experiences of parents of technology-dependent extremely preterm infants of socio-family support after hospital discharge. The study was conducted in four several Spanish organizations for families with preterm infants. It includes 17 semi-structured interviews (12 mothers and 5 fathers). Three main themes emerged from the analysis: post-discharge formal support for extremely preterm infants and families, home neonatal care: family support, and a thread of hope: parent-to-parent support. The parents’ main support resources to deal with everyday difficulties are healthcare professionals, their partners, grandmothers, and peer parents of extremely preterm infants. The findings may be used to guide healthcare professionals in the creation of a support program according to preferences and needs of parents.

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A Pilot Study on the Efficacy of Volunteer Mentorship for Young Adults With Self-Harm Behaviors Using a Quasi-Experimental Design

Crisis ◽

10.1027/0227-5910/a000393 ◽

2016 ◽

Vol 37 (6) ◽

pp. 415-426 ◽

Cited By ~ 4

Author(s):

Yik-Wa Law ◽

Paul S. F. Yip ◽

Carmen C. S. Lai ◽

Chi Leung Kwok ◽

Paul W. C. Wong ◽

...

Keyword(s):

Experimental Design ◽

Suicide Ideation ◽

Intervention Group ◽

Well Being ◽

Control Group ◽

Treatment As Usual ◽

Prevention Services ◽

Quasi Experimental ◽

Self Harm ◽

Volunteer Support

Abstract. Background: Studies have shown that postdischarge care for self-harm patients is effective in reducing repeated suicidal behaviors. Little is known about whether volunteer support can help reduce self-harm repetition and improve psychosocial well-being. Aim: This study investigated the efficacy of volunteer support in preventing repetition of self-harm. Method: This study used a quasi-experimental design by assigning self-harm patients admitted to the emergency departments to an intervention group with volunteer support and treatment as usual (TAU) for 9 months and to a control group of TAU. Outcome measures include repetition of self-harm, suicidal ideation, hopelessness, and level of depressive and anxiety symptoms. Results: A total of 74 cases were recruited (38 participants; 36 controls). There were no significant differences in age, gender, and clinical condition between the two groups at the baseline. The intervention group showed significant improvements in hopelessness and depressive symptoms. However, the number of cases of suicide ideation and of repetition of self-harm episodes was similar for both groups at the postintervention period. Conclusion: Postdischarge care provided by volunteers showed significant improvement in hopelessness and depression. Volunteers have been commonly involved in suicide prevention services. Further research using rigorous methods is recommended for improving service quality in the long term.

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Educational Intervention to Improve Citizen’s Healthcare Participation Perception in Rural Japanese Communities: A Pilot Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041782 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1782

Author(s):

Ryuichi Ohta ◽

Yoshinori Ryu ◽

Jun Kitayuguchi ◽

Chiaki Sano ◽

Karen D. Könings

Keyword(s):

Rural Communities ◽

Self Efficacy ◽

Cognitive Theory ◽

Health Management ◽

Intervention Group ◽

Educational Interventions ◽

Medical Professionals ◽

Control Group ◽

Structured Interviews ◽

Japanese Elderly

In this mixed-methods study, we hypothesized that social cognitive theory (SCT)-based educational interventions for healthcare participation can improve the self-efficacy of older rural citizens in participating in their health management without any difficulties. Quasi-experimental study before and after SCT-based educational interventions and semi-structured interviews were conducted. Participants were Japanese elderly (>65 years) from rural communities. Propensity score matching was performed to estimate the effectiveness of educational interventions on participants’ perception (intervention: n = 156; control: n = 121). Interview contents were transcribed verbatim and analyzed based on thematic analysis. The intervention group scored significantly higher than the control group for participation in planning and managing self-care. Interviews revealed three themes: ability to manage health conditions, relationship with medical professionals, and relationship among citizens. Participants reported difficulties in judging symptoms and communicating with medical professionals. Hierarchy and low motivation to participate in healthcare hindered collaboration. The findings suggest that SCT-based educational interventions can positively impact rural citizens’ self-efficacy in healthcare participation.

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Methodology for Development of a Community Level Intervention Module for Physical Illness in Persons with Mental Illness (CLIPMI)

Indian Journal of Psychological Medicine ◽

10.1177/0253717620973381 ◽

2020 ◽

Vol 42 (6_suppl) ◽

pp. S94-S98

Author(s):

Ramanujam Govindan ◽

Thara Rangaswamy ◽

Sujit John ◽

Sunitha Kandasamy

Keyword(s):

Mental Health ◽

Intervention Program ◽

Intervention Group ◽

Mental Health Program ◽

Mental Illnesses ◽

Community Level ◽

Treatment As Usual ◽

Health Delivery ◽

Expected Outcome ◽

Health Delivery System

Background and Objectives: Medical illnesses seen in persons with psychiatric disorders are important but often ignored causes of increased morbidity and mortality. Hence, a community level intervention program addressing the issue is proposed. Materials and Methods: Patients with severe mental illnesses will be identified by a door-to-door survey and assessed for comorbid physical illnesses like anemia, hypertension, diabetes, and so on. They will then be randomized into two groups. The treatment as usual (TAU) group will not receive intervention from the trained community level workers, while the Intervention group will receive it. Results: The two groups will be compared for the prevalence and severity of comorbid physical illnesses. The expected outcome is compared to the TAU group, the intervention group will have a greater reduction in the morbidity due to physical illnesses and improved mental health. Conclusion: If successful, the module can be incorporated into the community level mental health delivery system of the District Mental Health Program (DMHP).

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Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial

BMC Health Services Research ◽

10.1186/s12913-021-06156-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lamis R. Karaoui ◽

Elsy Ramia ◽

Hanine Mansour ◽

Nisrine Haddad ◽

Nibal Chamoun

Keyword(s):

Tertiary Care ◽

Intervention Group ◽

Bleeding Event ◽

Transitions Of Care ◽

Control Group ◽

Published Data ◽

Post Discharge ◽

Readmission Rates ◽

The Impact

Abstract Background There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. Methods This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. Results Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. Conclusions Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. Trial registration Lebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

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Efficacy of implementing intermittent STOP THE BLEED® reviews on long term retention of hemorrhage control skills of first year medical students

Journal of Osteopathic Medicine ◽

10.1515/jom-2020-0231 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Enkhtsogt Sainbayar ◽

Nathan Holt ◽

Amber Jacobson ◽

Shalini Bhatia ◽

Christina Weaver

Keyword(s):

Medical Students ◽

Intervention Group ◽

Training Session ◽

Likert Scale ◽

Control Group ◽

First Year ◽

Hemorrhage Control ◽

Term Retention ◽

Long Term Retention

Abstract Context Some medical schools integrate STOP THE BLEED® training into their curricula to teach students how to identify and stop life threatening bleeds; these classes that are taught as single day didactic and hands-on training sessions without posttraining reviews. To improve retention and confidence in hemorrhage control, additional review opportunities are necessary. Objectives To investigate whether intermittent STOP THE BLEED® reviews were effective for long term retention of hemorrhage control skills and improving perceived confidence. Methods First year osteopathic medical students were asked to complete an eight item survey (five Likert scale and three quiz format questions) before (pretraining) and after (posttraining) completing a STOP THE BLEED® training session. After the surveys were collected, students were randomly assigned to one of two study groups. Over a 12 week intervention period, each group watched a 4 min STOP THE BLEED® review video (intervention group) or a “distractor” video (control group) at 4 week intervals. After the 12 weeks, the students were asked to complete an 11 item survey. Results Scores on the posttraining survey were higher than the pretraining survey. The median score on the five Likert scale items was 23 points for the posttraining survey and 14 points for the pretraining survey. Two of the three knowledge based quiz format questions significantly improved from pretraining to posttraining (both p<0.001). On the 11 item postintervention survey, both groups performed similarly on the three quiz questions (all p>0.18), but the intervention group had much higher scores on the Likert scale items than the control group regarding their confidence in their ability to identify and control bleeding (intervention group median = 21.4 points vs. control group median = 16.8 points). Conclusions Intermittent review videos for STOP THE BLEED® training improved medical students’ confidence in their hemorrhage control skills, but the videos did not improve their ability to correctly answer quiz-format questions compared with the control group.

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Metaphors and cultural narratives on adaptive responses to severe adversity: A field study among the Indigenous Pitaguary community in Brazil

Transcultural Psychiatry ◽

10.1177/1363461519890435 ◽

2019 ◽

Vol 57 (2) ◽

pp. 332-345 ◽

Cited By ~ 1

Author(s):

Iara Meili ◽

Eva Heim ◽

Ana C Pelosi ◽

Andreas Maercker

Keyword(s):

Posttraumatic Growth ◽

Field Study ◽

Cultural Context ◽

Field Research ◽

Adaptive Responses ◽

Cultural Narratives ◽

Structured Interviews ◽

The Core ◽

Recovery Processes ◽

Context Specific

The expressions resilience and posttraumatic growth represent metaphorical concepts that are typically found in Euro-American contexts. Metaphors of severe adversity or trauma and the expressions of overcoming it vary across cultures—a lacuna, which has not been given much attention in the literature so far. This study aimed to explore the metaphorical concepts that the Indigenous Pitaguary community in Brazil uses to talk about adaptive and positive responses to severe adversity and to relate them to their socio-cultural context. We carried out 14 semi-structured interviews during field research over a one-month period of fieldwork. The data were explored with systematic metaphor analysis. The core metaphors included images of battle, unity, spirituality, journeys, balance, time, sight, transformation, and development. These metaphors were related to context-specific cultural narratives that underlie the Pitaguary ontological perspective on collectivity, nature, and cosmology. The results suggest that metaphors and cultural narratives can reveal important aspects of a culture’s collective mindset. To have a contextualized understanding of expressive nuances is an essential asset to adapt interventions to specific cultures and promote culture-specific healing and recovery processes.

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Music Is Life—Follow-Up Qualitative Study on Parental Experiences of Creative Music Therapy in the Neonatal Period

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126678 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6678

Author(s):

Friederike Barbara Haslbeck ◽

Lars Schmidli ◽

Hans Ulrich Bucher ◽

Dirk Bassler

Keyword(s):

Music Therapy ◽

Positive Reinforcement ◽

Positive Impact ◽

Complementary Therapy ◽

Structured Interviews ◽

Developmental Problems ◽

Creative Music ◽

Modifiable Factors ◽

Hospitalization Period ◽

Extremely Preterm

Developmental problems in extremely preterm (EP) infants and the associated longitudinal burden for their families are major health issues worldwide. Approaches to social-emotional support such as family-integrating Creative Music Therapy (CMT) are warranted. We aimed: (1) to explore parental perspectives on the use of CMT with EP infants in the neonatal hospitalization period and (2) to examine the possible longitudinal influence of CMT. A qualitative design was used to examine the perspective of six families from various backgrounds. Semi-structured interviews were carried out when the infants reached school age. We used an inductive–deductive thematic analysis to identify three main themes, each with three sub-themes: (1) the positive impact of CMT on the infants, the parents, and bonding; (2) the attitude toward CMT, from being open-minded to recommending it as complementary therapy; and (3) the experience of overall healthy infant development despite unique developmental delay issues. The findings elucidate the positive and formative impact of CMT on both infants and parents in the stressful NICU setting and beyond. CMT may empower positive transformation in the parents through individualized early nurturing musical interactions, capacity building, and positive reinforcement. Further research may help to identify and implement potentially modifiable factors for improving health care in this vulnerable group through early family-integrating, resource-based approaches such as CMT.

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