Please enable JavaScript.
Coggle requires JavaScript to display documents.
Communication Between Staff + Parents in Neonatal Units - Coggle Diagram
Communication Between Staff + Parents in Neonatal Units
Research Question
What are
parents
and
health professionals
experiences
and
perspectives
of current
communication
strategies, methods and approaches surrounding
discharge education
for parents of babies admitted to secondary neonatal units?
Purpose statement:
"The purpose of this
qualitative study
will be to discover the
perspectives of/understand the experiences of
parents and health professionals on
communication around discharge education and planning and
the influence
of this communication on preparedness for home, at a secondary neonatal unit"
Research Gap
?Secondary units vs tertiary
None using only secondary neonatal units
?staff and parent perspectives from different time periods (during and post admission - but not same sample, although could be)
Some research but not a lot focusing specifically on communication around discharge education
A few studies include nurse+parent or doctor+parent persepcectives. Less include all 3
?communication around discharge education/planning
More interventional + positivist/mixed methods - less qual. research around this
More research focused on readiness for discharge and less on communication and it's role in discharge planning/education
Method used - mixed/qual.
some research but methods vary for specific question being studied (mixed methods tends to be for review of intervention effectiveness rather than experience of communication)
NZ/Australasian context
Very little research currently - more family centred care or communication in NICU generally
Methodology
Outcomes
Strengths
Limitations
Ethical Considerations
?Grounded Theory - process overtime
Maximum variation sampling
Larger samples
semi-structured interviews
Survey w/open-ended Qs to include more variations of population
?Ethnography - values + beliefs
Observation
For validity - especially with staff
Do they practice how they say they do? how do parents react?
For initial reflection to establish/elicit/develop interview Qs + survey
For emergent design
Open Qs survey
Interviews
?Mixed Methods
Initial quant. survey
Determine
importance
of communication to discharge planning/expectations/management + prep/education of each group (staff/parents/ex-parents)
Determine level of health literacy prior to interview
Qual. semi-structured interviews developed using Quant. data
Testing
quality
of communication around discharge planning/prep/management/education/expectations
Want to know
efficacy
of communication around discharge education/planning in preparing parents for home
Methods
Sampling
Sample Population
Staff (nurses, doctors, allied health/MDT) - on a secondary neonatal unit
Parents with babies currently patients on secondary neonatal units
If possible, parents of babies discharged from a secondary neonatal unit (SCBU - special care baby unit) in the last 6 months
Secondary units chosen as more likely to be at or near discharge stage - also best access to these for researcher + parents potentially more receptive to reflection + discussion as less intense stage of baby's care
Single DHB chosen as can more directly inform policy + practice for this context
Sampling methods
?Theoretical sampling
Purposive sampling
?maximum variation sampling if possible
Range of Parents currently admitted
Age
Ethnicity
Level of education/employment
Mothers + Fathers
Number of other children
Gestation of baby- late preterm, very preterm, congenital conditions, discharge needs etc.
Length of admission
Limited by population range of that DHB and babies currently admitted
May need to collect over several months for better diversity of sampling
Potentially time-consuming + expensive
Range of HP's
Nurses
Doctors
VNT/SLT
Social Work
Dietician
LC
Range of parents post-NICU
Similar to other parent criteria
Potentially more difficult to achieve diversity in this group
?phone call from discharge info
Make contact with NICU support groups/FB groups of ex-NICU babies
snowball sampling may be easiest here - HPs or other mums refer people who may be willing to be part of a study
Parents often express desire to 'give-back' to those experiencing SCBU admission or premature birth so may be more willing to participate than other populations
Issues with memory - asking parents to think retrospectively
1 more item...
Important data as parents have had time to reflect on their experiences with hindsight + without stress of hospital environment - may have clearer insight
Parents can now see what was helpful + what wasn't in terms of actual usefulness of discharge education received while on SCBU
Snowball/opportunistic sampling (if above not possible)
Sample size
5-7 participants interviewed for each of the 3 groups collected from two secondary neonatal units (SCBUs) from same DHB
Survey/questionnaire for 8-12 participants of each of 3 groups (can be different participants)
Site selection + Recruitment
Inclusion criteria
Any parents other than those excluded (current admissions)
Medical staff currently working on neonatal unit + involved in d/c planning/education
Any parents of baby's discharged within last 6 months from neonatal unit who are the primary caregivers of the baby
Exclusion criteria
Parents who will not be going home with their baby (eg. OT cases or whāngai)
Primary caregivers who are not the biological parents of the baby (too difficult to sample in unit as not always there/will have had different and varying experiences to parents as not involved from delivery of child)
Data Collection
semi-structured interviews
May give parents outlet to process their experience + feelings around their own efficacy
Chance for participants to reflect on their journey + progress
Chance for staff to reflect on their professional practice + current unit structure + policy
Opportunity for all participants to inform change to improve experiences of future parents
In-depth data while slightly less time to reach saturation?? OR less time to analyse as more focused answers?
Survey/questionnaire - anonymous??
Initial demographic questions
Parents
Age, ethnicity, gestation of baby, no. child, length of admission/time since discharge
?level of education/employment - although may appear discriminatory
Not necessarily an indicator of health literacy
Potentially an objective survey on level of health literacy? Or too quant??
If did max variation sampling, may account for this variation??
Staff
Discipline/role
Length of time working in this field
Initial observation of communication + interactions on neonatal unit prior to interviews
To establish interview questions
Let data guide it's own format
Potential researcher bias
To observe current communication
Amount of time spent communicating
Information communicated
Manner/non-verbal aspects of communication
Parents reaction to communication
Data Analysis
?thematic analysis
?coding
Trustworthiness/Rigor
Data Validation
Data Interpretation
Data Representation
'Tradition' or Qualitative Method(s) chosen
Relevance
Better parental preparedness for discharge (mentally, skillset, engagement with baby, plan for home, supports in place - from staff and parents) leads to better longterm outcomes for baby
Improved child development
Better managed medical conditions
CPR + choking management skills developed
Safe meds admin
Feelings of efficacy from parents
Reduced parental stress + psychological impacts of NICU admission
Safer + healthier homes
Better understanding of, and adherence to safe sleep guidelines
Homes + lives better setup for discharge - eg. smoking cessation?
Awareness of coping strategies + organisations that help with these
Good nutrition + growth for baby
knowledge of breast feeding + expressing techniques + management with prems/vulnerable babies
knowledge of managing NG tubes + other alternative feeding with babies who need them
Managing reflux + colic in babies
Better buy-in + engagement from parents
Better relationships + rapport between staff and parents
Potential for more collaborative decision-making - medical, feeding plans, discharge planning etc.
Improved attachment + bonding with baby
Reduced stress on staff from parental distress or disengagement
Potentially better job satisfaction for staff?
Ultimately stronger policies around communication + more efficient and effective tools to improve this on neonatal units
Better outcomes + safer children
Highlights need for development of intervention (or implementation of previously developed intervention) for improving communication
Spotlight on importance of communication to staff, parents + babies
Communication between staff and parents shown to be an important mediator for parental stress [REFERENCES]
Parents rate communication as important for ....[REFERENCES]
Less parental stress leads to improved bonding + time spent on unit [REFERENCE}
So better knowledge of own child, cues, how to care for prems etc.
Better care at home + longterm child outcomes [REFERENCE]
Approach/Research Paradigm
Why this one + not another
Not Quant. as wanted to see perspectives of families to influence practice change, no point in conducting research and getting results that are not relevant or important to parents/staff - interventions derived from this will not be effective if it is from researcher or provider agenda. Poor uptake - won't actually improve anything
Too narrow and not responsive/receptive enough to needs and desires of population
Limited by researcher bias influencing study design (eg. survey/interview questions determined by researcher - so what they deem as important not participants)
Tools used may not take into account variation in population or other factors that influence a topic as complex as communication in a healthcare setting
More important for findings to be transferable than generalisable as informing practice change rather than applying results to widest possible population
Aims + Objectives
Aim: To determine the effectiveness (?importance) of communication around discharge education between healthcare professionals and parents of babies in the neonatal unit OR to explore communication between staff + parents around discharge education on neonatal units
Focus on communication methods + efficacy + acceptability in regard to parental discharge planning + preparedness for home (parent's + HP's feelings + Health professional assessment of this)
From both Health Professionals (HPs) + parents' persepctives
Objective: To gain insight into experience of both staff and parents with current communication strategies, methods + approaches toward discharge education + preparedness of parents with babies in neonatal units
To establish the need for development of an intervention, staff training, tool, policy or technology to improve communication in neonatal units
To initiate the development of a tool/technology/intervention to improve communication around discharge education in neonatal units
To explore staff + parents perspectives on efficacy + efficiency of current communication between staff + parents on neonatal units
Highlight the importance of communication around discharge education in secondary neonatal units
To determine the perceived importance of staff-parent communication on neonatal units to both staff + parents
To open the way for future research??
Future research could include focus group discussion from staff + parents (separately + maybe together?) around possible interventions, attitudes, skills, tools or technology that may improve discharge education in secondary neonatal units
To inform practice/clinical/unit change for improved outcomes for vulnerable children (by empowering caregivers)