Lyndon Audrey, Jacobson Carrie H, Fagan Kelly M, Wisner Kirsten, Franck Linda S
Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, California, USA.
UCSF Benioff Children's Hospital, San Francisco, California, USA.
BMJ Qual Saf. 2014 Nov;23(11):902-9. doi: 10.1136/bmjqs-2014-003009. Epub 2014 Jun 26.
BACKGROUND & OBJECTIVES: Little is known about how parents think about neonatal intensive care unit (NICU) safety. Due to their physiologic immaturity and small size, infants in NICUs are especially vulnerable to injury from their medical care. Campaigns are underway to integrate patients and family members into patient safety. This study aimed to describe how parents of infants in the NICU conceptualise patient safety and what kinds of concerns they have about safety.
This mixed-methods study employed questionnaires, interviews and observation with parents of infant patients in an academic medical centre NICU. Measures included parent stress, family-centredness and types of safety concerns.
46 parents completed questionnaires and 14 of these parents also participated in 10 interviews (including 4 couple interviews). Infants had a range of medical and surgical problems, including prematurity, congenital diaphragmatic hernia and congenital cardiac disease. Parents were positive about their infants' care and had low levels of concern about the safety of procedures. Parents reporting more stress had more concerns. We identified three overlapping domains in parents' conceptualisations of safety in the NICU, including physical, developmental and emotional safety. Parents demonstrated sophisticated understanding of how environmental, treatment and personnel factors could potentially influence their infants' developmental and emotional health.
Parents have safety concerns that cannot be addressed solely by reducing errors in the NICU. Parent engagement strategies that respect parents as partners in safety and address how clinical treatment articulates with physical, developmental and emotional safety domains may result in safety improvements.
关于父母如何看待新生儿重症监护病房（NICU）的安全性，我们知之甚少。由于生理上不成熟且体型较小，NICU中的婴儿特别容易受到医疗护理造成的伤害。目前正在开展相关活动，将患者及其家庭成员纳入患者安全工作中。本研究旨在描述NICU中婴儿的父母如何理解患者安全，以及他们对安全有哪些担忧。
这项混合方法研究对一家学术医疗中心NICU中婴儿患者的父母进行了问卷调查、访谈和观察。测量指标包括父母压力、以家庭为中心的程度以及安全担忧的类型。
46名父母完成了问卷调查，其中14名父母还参与了10次访谈（包括4次夫妻访谈）。婴儿存在一系列内科和外科问题，包括早产、先天性膈疝和先天性心脏病。父母对婴儿的护理持积极态度，对操作安全性的担忧程度较低。报告压力较大的父母有更多担忧。我们在父母对NICU安全的概念化理解中确定了三个重叠的领域，包括身体安全、发育安全和情感安全。父母对环境、治疗和人员因素如何可能影响婴儿的发育和情感健康表现出深刻理解。
父母的安全担忧不能仅通过减少NICU中的差错来解决。将父母视为安全合作伙伴并解决临床治疗如何与身体、发育和情感安全领域相联系的父母参与策略，可能会提高安全性。
