HEALTH STATUS AND HEALTH SERVICE UTILIZATION OF INFANTS AND MOTHERS DURING THE FIRST YEAR AFTER NEONATAL INTENSIVE CARE
Spicer A, Pinelli J, Saigal S, Wu Y, Cunningham C, DiCenso A. Adv Neonatal Care. 2008;8(1):33-41.
Self-reported health status of mothers and their infants, as well as health service utilization of both after discharge from the neonatal intensive care unit, were examined in this descriptive, longitudinal study that was part of a larger project regarding changes in family function.
Data were collected at a 33-bed, tertiary-level neonatal intensive care unit at a teaching hospital in Ontario, Canada, from admissions between July 2000 and July 2001. The final sample consisted of 152 mothers and 165 infants. Infants included 12 sets of twins and 1 set of triplets. Mothers completed questionnaires that were mailed to them at 3, 6, and 12 months. Items in the questionnaires inquired about maternal health status, maternal report of infants' health problems, health service utilization by mothers and infants, and infants' rehospitalization patterns.
Most mothers (73%, 64%, and 73% at 3, 6, and 12 months, respectively) described their health to be excellent or very good. Health status utilization by the mothers for themselves was mainly done in the first 3 months after discharge and consisted largely of visits or calls to physicians, midwives, nurses, emergencies, or walk-in clinics. The group of providers most often utilized was physicians.
A similar pattern was noted for use of health care by infants, except for visits to emergency departments and walk-in clinics, which the mothers reported visiting most at 12 months (25% and 16%, respectively). Physicians were used most often. During the first 3 months after discharge, 14% of infants were rehospitalized, 6% at 6 months, and 10% at 12 months. At 12 months after discharge, mothers rated their infants' health as excellent (45.8%) or very good (29.9%).
Limitations to the study findings noted by the researchers include the women in the study being well educated, had high income levels, and were from a geographically defined region. They recommend that future studies include women from diverse regions with more variance in socioeconomic status to determine if such factors affect health status and health service utilization.
EDUCATIONAL INTERVENTIONS IN END-OF-LIFE CARE: PART I
Rogers S, Babgi A, Gomez C. Adv Neonatal Care. 2008;8(1):56-65.
This study used a quantitative pretest, intervention, posttest design to determine whether nurses working in a neonatal intensive care unit caring for dying infants could be assisted in their knowledge and comfort.
A final sample of 82 registered nurses who specialized in neonatal and pediatric nursing was provided a pretest, an intervention of a monthly 1-hour neonatal end-of-life program over 6 months, followed by a posttest. A pretest and posttest were provided at each educational session. Educational programs were based on the ELNEC (End-of-Life Nursing Education Consortium) and IPPC (Initiative for Pediatric Palliative Care) curricula. Data were collected using the Comfort in Caring for Dying Infants tool. Demographic information was also collected.
Findings showed that overall, educational sessions improved the comfort level of neonatal intensive care unit nurses caring for dying infants (t = 4.2, P < .001). The nurses did not differ significantly in their comfort level scores based on the type of module session.
There was a statistically significant change comfort level from pretest to posttest for the ethical/legal issues module (P < .05) and symptom management modules (P < .001). However, although posttest scores for 3 remaining modules (pain management, prevention of compassion fatigue, and spirituality/anxiety) were higher than pretest scores, they were not statistically significant. For the module of communication/culture, a negative impact was found for nurses' comfort level, although not statistically significant. This may be due to nurses discovering from the module that their communication skills were lacking, and thus their comfort level decreased.
Researchers recommend that a follow-up questionnaire be sent to participants to determine whether a change in practice was retained. They note that content of the modules that did not result in changes in nurses' comfort level needs to be examined to identify which information should be added or deleted.