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Vol. 94. Issue 2.
Pages 112-113 (01 February 2021)
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Vol. 94. Issue 2.
Pages 112-113 (01 February 2021)
Scientific Letter
DOI: 10.1016/j.anpede.2020.02.013
Open Access
Presence of parents during invasive techniques in neonatology: A perspective of Spanish professionals
Presencia de padres en técnicas invasivas en neonatología: perspectiva de los profesionales en España
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Álvaro Solaz-Garcíaa,
Corresponding author
alvarosogar@gmail.com

Corresponding author.
, María Dolores Lorena Mocholí-Tomásb, Lola Pérez Vidalb, Cristina Durá Tarvéb, Rosario Ros Navarretc
a Grupo Investigación en Perinatología, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
c Área del Ni˜no, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Tables (2)
Table 1. Responses to questionnaire items in the nationwide survey on the presence of family members during invasive procedures in the neonatal care units.
Table 2. Results of the nationwide survey on the presence of family members during invasive procedures in the neonatal care units.
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To the editor:

Based on quality standards and recommendations for neonatal units and European standards of care for newborn health, institutions should promote and facilitate access of parents to their babies 24 h a day and support their participation in newborn care, with parents becoming one of the pillars of the family-centred developmental care model.1,2 In 2013, the Interterritorial Council of the National Health System of Spain, with the aim of promoting and standardising the humanization of care in neonatal intensive care units, stated that institutions should “ensure that any parent that so wishes is allowed to stay with the child 24 h a day and to accompany the child during performance of painful and stressful medical procedures with the aim of reducing their anxiety, as long as it does not interfere with professional care delivery”.2 However, while advances have been made so that parents will no longer be mere spectators, the medical literature shows that there are barriers involving the providers when it comes to the parental presence during invasive procedures, despite evidence that it may be beneficial for parents.3–6

The aim of our study was to explore the opinions of health care professionals involved in neonatal care on the presence of parents during invasive procedures, which we defined as those requiring incision of the skin of the neonate (vascular access), introduction of an object in the airway (aspiration, intubation), cardiopulmonary resuscitation and surgery.

To this end, we conducted a prospective cross-sectional and observational study, conducting a survey between April and September 2019 based on online questionnaires submitted to the health care staff (physicians, nurses and nurse technicians) of neonatal units in Spain. The questionnaire asked about the participation of family members in newborn care and the opinions of health professionals on this subject. We distributed the questionnaire through the social networks of the blog Cuidando neonatos and the Sociedad Española de Neonatología (Spanish Society of Neonatology, SENeo), and therefore we calculated the sample size without knowing the actual size of the population, estimating that the study would need a minimum of 239 responses to the questionnaire (anticipating losses of 15%). We exceeded this estimate, as we received 650 responses, on which we based the study and its conclusions. We performed the statistical analysis with the software SPSS 20.0.

Of the total of 650 responses, 66% had been submitted by nurses, 23% by paediatricians and 11% by nurse technicians. When it came to their experience in neonatal care, 66.8% of respondents reported having worked in this setting for more than 5 years. Table 1 presents the results of the study comparing the different professional categories, suggesting that the highest proportion of providers that felt concern about the presence of parents during invasive techniques corresponded to the nurses, independently of the years of experience, and decreasing only in those with more than 5 years’ experience. Although 93% of respondents worked in neonatal units open to the family around the clock, only 45% reported the presence of parents during invasive procedures. In addition, 86.3% of respondents considered that parental presence during these procedures could affect the parents, 68.4% that it could affect the neonates, and 64.8% that it could affect health care professionals. When it came to participation of parents, 98.2% reported parental involvement in caregiving (Table 2).

Table 1.

Responses to questionnaire items in the nationwide survey on the presence of family members during invasive procedures in the neonatal care units.

Results    During invasive procedures:Do you feel that parents may question your clinical practices and care delivery?
    YesNoP 
    n  n   
Years of experience in the Department of Neonatology< 3 years  98  72.6  36  26.7  < .001
3−5 years  56  72.7  21  27.3 
> 5 years  267  62.5  160  37.5 
Professional categoryPaediatrician  62  41.9  86  58.1  < .001
Nurse/nurse technician  301  71.8  118  28.2 
  58  80.6  13  18.1 
Source: in house.
Table 2.

Results of the nationwide survey on the presence of family members during invasive procedures in the neonatal care units.

Results of the survey   
Participation of family in care delivery  650 (100%) 
Kangaroo care  81 (12.50%) 
Holding during invasive procedures  2 (0.30%) 
Newborn cleaning and feeding  34 (5.20%) 
All of the above  533 (82%) 
Perceptions of health care providers of how parental presence may impact their performance in care delivery  441 (100%) 
Aseptic technique  19 (4.31%) 
Increases stress, makes procedure more difficult  160 (36.28%) 
Affects concentration, increases the risk of errors  101 (22.90%) 
All of the above  161 (36.51%) 
Perceptions of health care providers of how parental presence during invasive techniques may affect the parents  558 (100%) 
Increases anxiety  39 (6.99%) 
Causes stress  30 (5.38%) 
Engenders mistrust  54 (9.68%) 
All of the above  435 (77.96%) 
Source: in house.

In response to the open-ended question about the improvement that could be made to facilitate active involvement of parents in caregiving and during invasive procedures, the respondents agreed on aspects such as the training and motivation of professionals, the empowerment of the caregiver and the development of guidelines for parents. They stressed the importance of raising awareness among hospital administrators and society to ensure adequate patient-staff ratios, making spaces suitable for family-centred care and having individual rooms available for infants and their families. Among the limitations of the study, we ought to highlight that some participants did not fill out every item of the questionnaire, and therefore some of the responses were incomplete.

In conclusion, our findings show that while most neonatal units in Spain have an open-door policy and actively involve parents in the care of the patients, health care staff still consider that the presence of parents during invasive procedures may affect care delivery with a potentially negative impact. This “presence” is a key element in the pursuit of family-centred care, so we think it is important for institutions to promote the development of protocols and training programmes to support, facilitate and ensure the integration of family members in care delivery and guide the clinical practice of their health care staff.

Acknowledgments

We want to particularly thank the nurses and nurse technicians working shift 5 in the NICU of the Hospital Universitario y Politécnico La Fe (Valencia), who suggested the performance of this survey. We also want to acknowledge all the professionals that take care of newborn infants in neonatal units across Spain on a daily basis and that have contributed to this survey by completing the questionnaire.

References
[1]
Unidades de Neonatología.
Estándares y Recomendaciones de Calidad. Ministerio de Sanidad Servicios Sociales e Igualdad.
(2014),
[2]
European Standards of Care for Newborn Health. https://newborn-health-standards.org/project/about-2/.
[3]
B. Benoit, S. Semenic.
Implementing the Baby-Friendly Hospital Initiative in Neonatal Intensive Care Units.
JOGNN., 43 (2014), pp. 614-624
[4]
K. O’Brien, M. Bracht, K. Macdonell, et al.
A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit.
BMC Pregnancy Childbirth, 13 (2013), pp. S12
[5]
S.K. Lee, K. O’Brien.
Parents as primary caregivers in the neonatal intensive care unit.
CMAJ Can Med Assoc J J Assoc Medicale Can., 186 (2014), pp. 845-847
[6]
N. Power, L. Franck.
Parent participation in the care of hospitalized children: a systematic review.
Journal of Advanced Nursing., 62 (2008), pp. 622-641

Please cite this article as: Solaz-García A, Mocholí-Tomás MDL, Vidal LP, Tarvé CD, Navarret RR. Presencia de padres en técnicas invasivas en neonatología: perspectiva de los profesionales en España. An Pediatr (Barc). 2021;94:113–115.

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