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在三级新生儿重症监护病房扩大家庭综合护理模式:实施方法与努力的系统途径

Scaling Up the Family Integrated Care Model in a Level IIIC Neonatal Intensive Care Unit: A Systematic Approach to the Methods and Effort Taken for Implementation.

作者信息

Moreno-Sanz Bárbara, Montes María Teresa, Antón Marta, Serrada María Teresa, Cabrera Marta, Pellicer Adelina

机构信息

Department of Neonatology, La Paz University Hospital, Madrid, Spain.

Hospital La Paz Institute for Health Research-IdIPAZ, La Paz University Hospital, Madrid, Spain.

出版信息

Front Pediatr. 2021 Jun 9;9:682097. doi: 10.3389/fped.2021.682097. eCollection 2021.

Abstract

Family Integrated Care (FICare) integrates parents in the direct care of their child while the healthcare personnel act as teachers and guides. To this date, most reports on the feasibility of this model refer to stable preterm infants admitted to Neonatal Intensive Care Units (NICUs). To scale up and adapt FICare to make it suitable in level IIIC NICUs, which care for extreme prematurity and other complex medical or surgical neonatal conditions. Step 1 was the creation of the FICare implementation team (FICare-IT) and baseline analysis of current procedures for critical care to identify needs, wishes, and requirements; we aimed for protocol elaboration tailored to our cultural, architectural, and clinical context (March 2017 to April 2018). Step 2 as a dissemination strategy by FICare-IT acting as primary trainers and mentors to ensure the education of 90% of nursing staff (May 2018 to July 2018). Step 3 involved piloting and evaluation with the aim to refine the procedure (July 2018 to December 2020). A rigorous but flexible protocol was edited. The FICare educational manual included two curricula: for healthcare professionals/staff (Training the trainers) and for families (Education of caregivers), the latter being categorized in two intervention levels (basic and advanced), depending on the infant care needs and parent's decision. In total, 76 families and 91 infants (74.7% preterm; 18.7% complex surgery; 6.6% others) were enrolled in the pilot. No differences in acceptance rate (overall 86.4%) or in the number of infant-family dyads in the program per month were observed when considering the pre- and post-Covid-19 pandemic periods. All families, except for one who dropped out of the program, completed the agreed individualized training. Mothers spent more time in NICU than fathers ( < 0.05); uninterrupted time spent by mothers in NICU was longer during the pre-pandemic period ( < 0.01). Observed time to reach proficiency by task was within the expected time in 70% of the program contents. The parents revealed educational manuals, workshops, and cot-side teaching sessions as essential for their training, and 100% said they would accept entry into the FICare program again. The principles of the FICare model are suitable for all levels of care in NICUs. Leadership and continuous evaluation/refinement of implementation procedures are essential components to achieve the objectives.

摘要

家庭综合护理(FICare)模式将父母纳入对其子女的直接护理中,而医护人员则充当教师和指导者。迄今为止,关于该模式可行性的大多数报告都涉及入住新生儿重症监护病房(NICU)的病情稳定的早产儿。为了扩大FICare模式的应用范围并使其适用于三级NICU,这类病房负责护理极早产儿以及其他患有复杂内科或外科疾病的新生儿。第一步是组建FICare实施团队(FICare-IT)并对当前的重症护理程序进行基线分析,以确定需求、愿望和要求;我们的目标是制定适合我们文化、建筑和临床背景的方案(2017年3月至2018年4月)。第二步是FICare-IT作为主要培训人员和指导者的传播策略,以确保90%的护理人员接受培训(2018年5月至2018年7月)。第三步是进行试点和评估,以完善程序(2018年7月至2020年12月)。编辑了一份严格但灵活的方案。FICare教育手册包括两个课程:针对医护专业人员/工作人员(培训培训人员)和针对家庭(照顾者教育),后者根据婴儿护理需求和父母的决定分为两个干预级别(基础和高级)。共有76个家庭和91名婴儿(74.7%为早产儿;18.7%接受复杂手术;6.6%为其他情况)参与了试点。在考虑新冠疫情前后时期时,未观察到接受率(总体为86.4%)或每月参与该项目的婴儿-家庭二元组数量存在差异。除了一个退出该项目的家庭外,所有家庭都完成了商定的个性化培训。母亲在NICU的时间比父亲长(<0.05);在疫情前时期,母亲在NICU的不间断时间更长(<0.01)。在70%的项目内容中,观察到的达到熟练完成任务所需的时间在预期时间内。父母表示教育手册、工作坊和床边教学课程对他们的培训至关重要,100%的父母表示他们会再次接受加入FICare项目。FICare模式的原则适用于NICU的所有护理级别。领导力以及对实施程序的持续评估/完善是实现目标的重要组成部分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c9dd/8219911/f099f1c1d29a/fped-09-682097-g0001.jpg

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本文引用的文献

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Improving infant outcomes through implementation of a family integrated care bundle including a parent supporting mobile application.
Arch Dis Child Fetal Neonatal Ed. 2020 Mar;105(2):172-177. doi: 10.1136/archdischild-2018-316435. Epub 2019 Jun 21.
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Long-Term Impact of Preterm Birth: Neurodevelopmental and Physical Health Outcomes.
Clin Perinatol. 2017 Jun;44(2):305-314. doi: 10.1016/j.clp.2017.01.003. Epub 2017 Mar 18.
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Systematic review of qualitative studies exploring parental experiences in the Neonatal Intensive Care Unit.
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