Simulations Help New Parents With Treatment for Special Health Needs
by Lynn Hetzler
Simulating everyday care and worst-case scenarios before discharge from the neonatal intensive care unit (NICU) can boost confidence in parents, according to a new study published in the April 2017 issue of The American Journal of Maternal Child Nursing.
First-time parents can be nervous, especially parents of babies treated in the NICU. Many first-time parents watch in awe as nurses handle these tiniest, most fragile newborns with confidence and ease. Return demonstrations, where the nurses perform a task then observe as parents repeat the procedure, are the traditional means of teaching prior to discharge from the NICU. Still, many parents do not gain the confidence they need to care for a baby with special health needs immediately after discharge.
Lack of confidence can prevent babies from getting the care they need. Nervous parents may back away from their babies, afraid they will do more harm than good. Anxiety can interfere with the bonding process between parent and child, and panic during a medical crisis can have devastating consequences. Instilling confidence helps parents enjoy time with their new baby, and helps them make sound decisions when it really matters.
Simulated care may be the key to improving confidence in these parents, according to the research headed by Deborah Raines, University at Buffalo nursing researcher.
“Simulation has become accepted as a method to increase confidence among health care professionals. We felt it might have similar benefits for parents,” says Raines in a press release issued by University at Buffalo. “These simulations allow parents to rehearse and experience behaviors, consequences and outcomes of caring for a child with various health needs.”
“The simulations allowed them to experience something going wrong. We could allow the babies to throw up, stop breathing or turn blue. And the parents couldn’t turn to the nurse for help,” said Raines, an Associate Professor at University at Buffalo, School of Nursing, Buffalo, NY.
Simulation Provides Important Training for Parents
Using simulators in the education of health professionals allows students to practice medical procedures in an environment that allows for errors without risking patient safety. Simulation in the professional education setting lets students hone clinical skills without harming patients in the process. Simulation is so successful that many hospitals and medical facilities now include it as part of clinical care orientation. Types of simulators include screen-based/PC-based simulation, partial task trainers, human patient simulators, standardized patients and integrated models.
The study by the University of Buffalo researchers found that performing simulations similar to those used by healthcare professionals boosts parents’ confidence in their abilities to care for their children by nearly 30 percent.
In the simulations, parents used the infant simulator Premie HAL that can spit up and cry like a human baby. More importantly, Premie HAL can demonstrate variations in respiratory and cardiac activity that can replicate worst-case scenarios. The simulator features realistic chest wall movements, synchronized chest rise and lung sounds, and even color and vital signs that respond to hypoxic events and interventions.
These features help new parents know the difference between a minor problem and a major one. Simulations also let parents practice interventions; sensors on Premie HAL provide immediate performance feedback that bolsters parental confidence.
Simulations and HELP for Parents of Children Discharged From the NICU
“Parents who are taking babies home from a NICU are not only are taking home a new baby who they need to be parents to, but they are frequently taking home a baby who has health care needs,” said Raines. “You’re mostly a parent, but you’re a little bit of doctor and nurse, too.”
A team of researchers headed by Raines developed the Neonatal Home Environment Learning Program (HELP) to help parents feel more confident before their infant’s discharge from the NICU. This program includes simulation with the use of Premie HAL in home-like settings, which gives parents a chance to practice important everyday and lifesaving activities without the help of a nurse.
Fifteen sets of parents who had a newborn in NICU at one of four Florida hospitals participated in the study. Thirteen of the 15 couples were new parents.
Each couple participated in three 30-minute simulations that increased in difficulty. Tasks included moving the child and medical equipment from a car seat to a crib, preparing and administering daily treatment or medication, and performing emergency resuscitation after respiratory arrest. The researchers tailored the simulation activities to each child’s health needs, with activities ranging from tube feedings to suctioning a tracheostomy.
To simulate a home environment, the participants performed the activities in an apartment setting. Except for emergency resuscitation in which each couple worked together, every participant performed each simulation individually. Participants completed the simulations within a week of their child’s discharge.
Before and after each simulation experience, each participant scored their confidence in performing various activities on a scale of one to ten. Mothers recorded an average confidence score of 6.93 before the activities simulations, while fathers gave themselves an average 6.06 on the confidence scale. Simulations boosted the confidence of both parents, with mothers’ average confidence scores rising to 9.93 and fathers giving themselves an average of 8.8 out of 10.
Confidence was low both before and after emergency response simulations, where parents had to call paramedics and perform CPR. Low confidence during emergency response simulation is understandable among parents with very little or no medical training. Simulations did improve confidence, though, as mothers increased from a confidence score of 4.8 to 6.93 and fathers’ confidence scores rose from 4.46 to 6.53.
“Simulation has become accepted as a method to increase confidence among health care professionals. We felt it might have similar benefits for parents,” says Raines. “These simulations allow parents to rehearse and experience behaviors, consequences and outcomes of caring for a child with various health needs.”
During a debriefing, the participants gave the simulation experience high ratings. The parents frequently said that doing it alone without the help of a nurse was different than they expected and that the simulations helped them feel better prepared.