Parents of infants admitted to the neonatal intensive care unit (NICU) frequently experience high levels of psychological distress, including anxiety, depression and reduced parental self-efficacy. These challenges can negatively affect parent–infant bonding, parental engagement in care and longer-term infant and family outcomes. Digital health solutions offer a scalable opportunity to provide tailored psychosocial support, enhance parental confidence, and improve family-centered care within the NICU context. Although increased parenting self-efficacy is associated with improved psychosocial health for parents and better outcomes for infants, no studies have been adequately powered to determine effective interventions aimed at enhancing parental self-efficacy for families with infants requiring NICU care. The CONNECT Study is designed to evaluate the effectiveness and implementation of a structured health solution aimed at improving parenting self-efficacy, psychosocial outcomes and infant health outcomes. The primary objective is to evaluate the effectiveness of Chez NICU Home + (CNH+) eHealth tool with standard care (vs. care alone) to enhance parental self-efficacy at NICU discharge. This study is a Hybrid-1 multicentre stepped-wedge cluster randomized controlled trial (SWC-RCT) across four Canadian NICUs. Following ethical approval, baseline data on current care practices are to be collected across sites. Following baseline data collection, every five months one of the sites will transition into the intervention phase by implementing an eHealth solution called Chez NICU Home® (CNH), a platform which provides web-based, parent-targeted educational tools, virtual communication, and text message support throughout their infant’s NICU stay. A total of 600 parents (300 per arm) and their infants, who are expected to stay at least 14 days in the NICU, will be recruited to detect a 0.60 SD difference (MD of 6.52 points) from pre-post intervention on the Perceived Maternal Parenting Self-Efficacy (PMPS-E) (80% power and alpha of 0.05 and ICC 0.1 for clustering at site levels). Secondary outcomes include parental psychosocial and infant health outcomes. Implementation effectiveness outcomes include adoption, fidelity, penetration, feasibility, acceptability, satisfaction, appropriateness, sustainment and cost. Findings will be disseminated through peer-reviewed publications and stakeholder engagement. The study is currently enrolling with anticipated recruitment to be complete by Spring 2027. The CONNECT Study protocol outlines a pragmatic, scalable approach to supporting families in the NICU through an integrated health solution. If effective, this intervention may contribute to improved parenting self-efficacy, psychosocial and health outcomes for parents, infants, and enhanced family-centred care practices in neonatal settings ClinicalTrials.gov, NCT05853666, https://clinicaltrials.gov/study/NCT05853666

OBJECTIVE:To map existing evidence on the needs and roles of grandparents of infants in the NICU. DATA SOURCES:We searched five databases: CINAHL, MEDLINE, Scopus, APA PsycNet, and ProQuest Dissertations and Theses Global. We also reviewed reference lists and explored unpublished studies and gray literature. We included sources in which the authors described the needs and roles of grandparents of infants in the NICU as described by grandparents, parents, and health care professionals. STUDY SELECTION:Two independent reviewers screened titles and abstracts and then assessed full texts using predefined inclusion and exclusion criteria. We resolved disagreements through discussion or adjudication by the first author. We selected 22 publications, including quantitative, qualitative, and mixed-methods studies; a meta-review; and opinion papers. DATA EXTRACTION AND SYNTHESIS:We extracted the following data: authors, publication year, country, aims, study design, methods, sample, data collection tools, and key findings. We created a summary table and wrote a narrative synthesis to connect findings with our objective. CONCLUSION:Through the scoping review, we found that grandparents needed to be involved in the care of their grandchildren and to understand the NICU environment. As they sought to bond with their grandchildren, grandparents also provided key emotional and practical support for parents. To meet the needs of grandparents, health care professionals in the NICU should answer their questions within the bounds of privacy limitations and offer tailored interventions. Because recent research on this topic remains limited, we recommend further studies to address this gap and strengthen family-centered care in NICUs.

A significant number of parents experience disrupted sleep following their infant's discharge from the neonatal unit. However, the extent of sleep disruption among both mothers and fathers of preterm infants after hospital discharge remains poorly documented. Few studies have assessed parental sleep quality using objective measures such as actigraphy. Similarly, limited research has examined the sleep quality of infants after discharge from the neonatal unit. This study aimed to describe the sleep patterns of preterm infants and their parents one month after discharge from the NICU. It also sought to compare mothers' and fathers' sleep. Thirty families participated in this descriptive study. One month post-discharge, parents and infants wore an actigraph for three consecutive days and nights to monitor sleep. Each parent completed a sleep diary and self-report questionnaires about their own sleep, while one parent recorded the infant's sleep. Results indicated that although both parents experienced sleep disturbances, mothers spent more time awake during the night and had lower sleep efficiency compared to fathers. Infants' sleep duration was consistent with current guidelines. Healthcare professionals should consider the sleep characteristics of both parents following hospital discharge to better support families and improve access to community resources.

Background Intervention adaptation, the deliberate modification of the design or delivery of interventions to a new context, is more resource efficient than de novo development. However, adaptation must be approached methodically, as some modifications, such as those to the core components, may compromise the intervention’s initial efficacy. While adaptation frameworks have been published, none have been identified as more likely to result in successful adaptations. Further, frameworks lack the step-by-step details needed for operationalization. Therefore, the goal of this paper is to share our experience in addressing these methodological limitations in intervention adaptation. The objectives were to describe: 1) our development of a step-by-step, theoretically and empirically driven approach to intervention adaptation labelled the ConsoLidated AppRoach to Intervention adaptatiON (CLARION), 2) the application of CLARION in adapting a depression self-management intervention, 3) the facilitators and challenges encountered when using CLARION. Methods The development of CLARION was informed by the Medical Research Council guidance, the Method for Program Adaptation through Community Engagement (M-PACE), and a published scoping review identifying the key steps in existing adaptation frameworks. M-PACE was selected for its patient-oriented research principles, its application to a similar complex intervention, and for offering some of the specificity needed for execution. However, the scoping review indicated that M-PACE lacked three critical steps: selecting a candidate intervention, understanding its core components, and pre-testing the adapted intervention. These were added to form CLARION, which was structured in two stages: the first involves selecting an intervention, identifying core components, and deciding on modifications; the second stage solicits interest stakeholder feedback to assess the acceptability of the preliminary adapted intervention (pre-test). Results Once CLARION was developed, it was put into action to adapt a depression self-management intervention. CLARION demonstrated several strengths: 1) clearly articulating core components before deciding on modifications, 2) mobilizing a diverse steering committee of experts, including patient partners and developers of the original intervention, which balanced input and efficiency, and 3) establishing committee decision-making rules prior to adjudication (specific criteria and 75% supermajority). Key challenges included defining the types of modifications requiring committee input, determining the extent of the committee’s involvement, and prioritizing the presence of all committee members at meetings to avoid difficulties integrating incongruent feedback. Conclusions The development of CLARION contributes to best practices for intervention adaptation by identifying step-by-step guidance as well as facilitators and barriers to its application.

Objective: The objective of this review is to synthesize the qualitative evidence on factors that influence direct breastfeeding of preterm infants in neonatal wards and the provision of breastfeeding support. Introduction: Breastmilk is critical for the health of preterm neonates, and infants who directly feed at the breast are more likely to receive breastmilk exclusively for longer periods. Direct breastfeeding is associated with improved maternal coping and development of maternal identity. Preterm infants are significantly less likely to breastfeed than their term counterparts. An understanding of barriers and facilitators of direct breastfeeding and breastfeeding support in neonatal wards is lacking. Inclusion criteria: The proposed qualitative systematic review will include studies using qualitative methods and mixed methods, exploring the perceptions of breastfeeding parents, neonatal health care staff, and/or support people about the barriers and facilitators to direct breastfeeding (ie, suckling breastmilk directly from the parent’s breast) among preterm infants (infants born at less than 37 weeks’ gestation) admitted to a neonatal ward. Articles written in English or French will be considered. Methods: MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), PsycINFO (Ovid), Scopus, and the Cochrane Library will be searched, with no time restrictions applied. Two independent reviewers will screen and extract data using a tool developed for this purpose. The findings will be coded and pooled using the meta-aggregation approach. The findings will be mapped to specific domains of the Theoretical Domains Framework using an iteratively developed coding manual. Studies will be appraised using the JBI critical appraisal tool for qualitative research, and confidence in the overall findings will be assessed using the ConQual approach. Review registration: PROSPERO CRD42024557250

AIM:Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda. METHODS:Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints. RESULTS:Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers. CONCLUSION:Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.

Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda. Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints. Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers. Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.

Purpose To identify contextual as well as individual (personal and professional) factors influencing the practice of skin-to-skin contact (SSC) by nurses as a pain management intervention for preterm infants. SSC is among the most effective non-pharmacological interventions to manage procedural pain in preterm infants. Methods In this secondary analysis of a comparative international cross-sectional design study, 202 nurses were recruited and completed self-administered questionnaires. A mixed model was conducted. Results The contextual factors correlated with the use of SSC for pain management included the country (p < 0.001) and work shift (p < 0.001). Individual nurse factors were level of education (p < 0.001), motherhood history (p < 0.001) as well as self-reported skin-to-skin practices [p < 0.001] (positive attitudes, education, and implementation). Conclusion Many factors may contribute to explain the differences in the use of SSC for pain management by nurses. These factors could be of relevant to consider when implanting SSC to manage procedural pain in preterm neonates.

BACKGROUND:Family Integrated Care (FICare) integrates parents as partners in neonatal intensive care unit care. Our team adapted and implemented this approach in a Ugandan unit for hospitalized neonates.PURPOSE:This qualitative descriptive study examined the perceptions of mothers and healthcare professionals (HCPs) of the benefits and challenges of this new approach to care.METHODS:Fifty-one mothers of hospitalized neonates born weighing greater than 2000 g participated in the program. They were taught to assess neonate danger signs, feeding, and weight. After discharge, a subsample (n = 15) participated in focus groups to explore benefits and challenges of their participation in care. Interviews with 8 HCPs were also conducted for the same purpose. Transcripts from focus groups and interviews were analyzed using inductive content analysis to describe the benefits and challenges from the perspectives of mothers and HCPs.RESULTS:For mothers a benefit was decreased stress. Both mothers and HCPs reported that the knowledge and skills mothers acquired were a benefit as was their ability to apply these to the care of their neonate. Improved relations between mothers and HCPs were described, characterized by greater exchange of information and HCPs' attentiveness to mothers' assessments. Mothers felt ready for discharge and used their knowledge at home. HCPs noted a decrease in their workload. Challenges included the need for mothers to overcome fears about performing the tasks, their own well-being and literacy skills, and access to equipment.IMPLICATIONS FOR PRACTICE:Mothers' participation in their neonates' care can have benefits for them and their neonate.

Abstract Background: Family Integrated Care (FICare) is a model of care developed in a Canadian Neonatal Intensive Care Unit that engages parents to be active participants in their infant’s care team. FICare has the potential to have the greatest impact in low-income countries, where the neonatal mortality rate is disproportionately high and the health workforce is severely strained. This manuscript details the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda Methods: Focus groups of ten mothers and interviews of eight workers were conducted to identify facilitators and constraints to the implementation of FICare in Uganda. Transcripts were analyzed using inductive content analysis. An adaptation team of key stakeholders developed Uganda FICare in the Special Care Nursery in Jinja Regional Referral Hospital based on the results from the focus groups and interviews. Results: The potential to reduce the healthcare provider workload, the desire to empower mothers and the pursuit to improve neonatal outcomes were identified as key facilitators. Maternal difficulty in learning new skills, lack of trust from healthcare providers and increased maternal stress were cited as potential barriers. Uganda FICare focused on task-shifting important but often neglected patient care tasks from healthcare providers to mothers. Healthcare providers were taught how to respond to maternal concerns. All intervention material was adapted to prioritize images over text. Mothers familiar with FICare were encouraged to provide peer-to-peer support and guidance to mothers with newly hospitalized infants. Conclusions: Engaging stakeholders to identify the facilitators and constraints to local implementation is a key step in adapting an intervention to a new context. Uganda FICare shares the core values of the original FICare but is adapted to enhance its feasibility in low-resource settings.

Skin-to-skin contact (SSC) consists of positioning the diaper-clad infant against the parent's chest and is considered a nursing practice rooted in family-centered care (FCC).1 SSC implies simultaneous parental presence and helps to facilitate their involvement from the earliest hours of their preterm infants' lives as this intervention is delivered by parents.1 FCC has gained worldwide popularity in recent years to promote parental presence and active participation of parents in care during neonatal intensive care units (NICUs) hospitalization.2 Both practices relate to developmental care (DC), which regroups specific interventions aimed at reducing stress and improving infant neurological development.3 It is well recognized that promoting SSC and FCC are recommended in the NICU, given its many health benefits for preterm infants and parents. SSC has been found to favor maternal attachment, enhance paternal role achievement and interactive behavior, reduce maternal and paternal anxiety, and promote infants' long-term cognitive development.4, 5 On the other hand, FCC can improve the clinical outcomes of preterm infants such as greater weight gain, as well as the psychological well-being of the parents.6 More specifically, parental involvement in NICU care is associated with reduced infants' length of hospital stay and collaboration with professionals increased parental satisfaction.7 Daily maternal presence during NICU hospitalization is associated with a decrease in emotional and behavioral problems in school-age children.8 Noteworthy, parental presence during NICU hospitalization with more frequent holding of their infant in their arms, is associated with better infants' neurobehavioral development, such as better quality of movements and reduced arousal, at term equivalent age.9 Given their benefits and driven by the DC philosophy, nurses should encourage SSC as well as FCC to provide parents with opportunities for collaboration and care involvement in the NICU. Yet, significant barriers may impede nurses from implementing SSC and FCC in the NICU, namely the lack of adequate training for nurses about SSC.10 As optimal implementation of FCC and SSC may depend on the nurses' perceptions of these DC practices, along with the training and education about these practices provided in the NICU, the aim of this manuscript is to explore the association between NICU nurses' perceptions about SSC and FCC and their unit's ability to provide FCC and SSC. Secondary analysis was performed from a larger comparative international study that was conducted between October 2017 and July 2018, where 202 NICU nurses completed paper or online questionnaires on their perceptions about their unit provision of FCC and SSC.11 Prior to the beginning of the study, ethical approval was obtained in both Canada (MP-21-2018-1854) and France (20181306005 and CNIL 2211490 v0). Nurses were recruited from four level III university-affiliated NICUs (intensive and intermediate care) in Canada and France admitting infants born between 23 and 40 weeks of gestational age. Total number of beds ranged from 30 to 65 in Canada and from 26 to 54 in France. The number of nurses working in the NICUs in France varied from 60 to 100 and in Canada from 113 to 190. Nurses' mean age was 33.9 ± 9.1 years, and they had a mean of 8.1 ± 7.0 years of neonatal care experience, and a mean of 7.1 ± 6.9 years on the sampled unit. Most were women (97.5%, 197/202) and almost half of the sample worked during the day (49.7%, 94/189) followed by the night (27.0%, 51/189), the evening (7.9%, 15/189), and rotation across the three shifts (15.30%, 29/189). Eighty-five nurses (42.1%, 85/202) in our sample had completed a bachelor's degree. The SSC questionnaire evaluated NICU nurses' attitudes and knowledge about SSC as well as their perception of their unit's SSC training and education in addition to implementation.12 It contained 20 items with a five-point Likert scale ranging from 1 "never" to 5 "always". It is separated into four subscales: knowledge (five items), personal attitudes and beliefs (four items), staff training and education (five items), as well as the unit-level implementation of SSC (six items). Training and education, and implementation refer to several aspects of the practice of SSC, including the availability of guidelines for its practice, proper training of health care professionals in SSC, interdisciplinary collaboration in supporting SSC, and adequate implementation on the unit.12 Higher scores reflect more favorable perceptions. The FCC questionnaire inquires as to the nurses' perceptions of whether the unit staff respects families, collaborates with them, and provides support.13 It included 20 items with a four-point Likert scale ranging from 1 "never" to 4 "always" divided among three subscales: respect (six items), collaboration (nine items), and support (five items). Scores of the subscales could vary from 6 to 24 (respect), 9 to 36 (collaboration), and 5 to 20 (support) while the total score could range from 20 to 80. Higher scores on each subscale in addition to the total score indicate more favorable perceptions that their unit is providing these aspects of FCC. Both questionnaires had adequate validity and reliability in French and English versions.12-14 Descriptive analyses (mean, standard deviation) were calculated for the subscales of each questionnaire as well as for the FCC questionnaire total score. Associations between subscale and total scale scores of FCC and SSC questionnaires were explored using Pearson's correlations. Descriptive analyses were also computed to describe the demographic data of the sample. Statistical analysis was done using SPSS v.26 with an alpha of 0.05. The nurses' mean scores for all subscales and total scores of the SSC and FCC questionnaires were shown in Table 1 and the correlations among these scores were shown in Table 2. Nurses' total FCC score (64.79/80), in addition to their SSC attitude subscale score (18.24/20) and knowledge subscale score (21.53/25) were high (Table 1). Results show that the nurses' FCC total score was significantly correlated with all SSC subscales scores, ranging from weak (0.17) to moderate (0.30) correlations (Table 2). Our findings indicated that the nurses' favorable perceptions that their unit is providing FCC are minimally associated with greater SSC personal knowledge (0.17) and attitudes (0.19), as well as with their better perceptions of their unit performance in terms of training and education (0.24) along with SSC implementation (0.30). Among all subscales of both practices, the highest correlations were found between the nurses' perceptions of their NICU providing support to families (FCC support subscale score) and SSC available training and education (0.29) as well as between the FCC support subscale score and SSC implementation on their unit (0.31). In addition, a similar association (0.30) was found between the nurses' perceptions of their unit's implementation of SSC and the total score of care being family-centered in their NICU. This secondary analysis offers an exploration of how nurses' perceptions about their NICU's ability to provide FCC are associated with SSC and brings new knowledge to guide neonatal practice. Overall nurses considered that their unit performed well with respect to FCC and their knowledge and attitudes about SSC were favorable. It is interesting to note the associations between the nurses' perceptions that their NICU provides support to parents and the staff training and education as well as implementation of SSC in the NICU. These findings might be interpreted to indicate that when SSC training and education are available and provided to nurses in addition to being well implemented in their neonatal unit, nurses have more favorable perceptions that their NICU supports FCC and vice versa. Enhancement of DC practices not only requires positive nurses' perceptions but also high professional competency in addition to favorable organizational structures which can be maintained through educational nursing training on DC as well as proper management support.15 A recent study showed that a virtual education program can improve NICU nurses' DC perceptions and knowledge.16 Accordingly, fostering the implementation of these practices in NICU settings could be accomplished through implementation science research related to either FCC or SSC. Nurses embracing favorable perceptions regarding their unit performance of FCC and SSC might translate into positive health outcomes for preterm infants and their parents. Interventions during NICU hospitalization such as SSC should be implemented in addition to other DC practices as these interventions encourage parents' presence and involvement in the care of their infant.17 As our study nurses worked mostly on the day shift, our findings may be explained by possibly greater parental presence and care involvement during the day where parents may request these practices, which in return may facilitate FCC and support nurses' favorable attitudes towards SSC. The nurses' knowledge and favorable attitudes concerning SSC may also be accounted for by their educational level as a higher degree of education has been associated with more SSC knowledge and favorable attitudes18 and close to 45% of our sample of nurses had completed a bachelor's nursing degree. As one component of FFC, SSC is credited as one of the most powerful interventions that is performed by parents with benefits for both parents and preterm infants.1 Although SSC and FCC could be considered as separate practices in DC, this secondary analysis shows that NICUs promoting one of those practices appear to also support the other. Hence, nurses who perceive that their unit performs well in providing FCC to parents also perceive their unit implements SSC and provides training and education about SSC. Highlighting this relationship is essential from theoretical and practical perspectives to better understand DC as a concept with integrated rather than independent components. This view of DC philosophy could guide neonatal clinical practices and encourage nurses to promote one intervention by supporting the other. As such, nurses who would aim to help parents achieve SSC in NICU are also supporting FCC, and therefore expose infants and parents to the combined known benefits of both practices. Noteworthy, an intervention about teaching staff how to work collaboratively with parents was found to increase parental presence in the NICU and SSC19 in addition to the quality of FCC according to both parents' and nurses' perceptions.20 Accordingly, focusing on training nurses to be able to work in collaboration with parents to provide care and enhance the implementation of DC practices. Future research should also consider investigating the relationship between any of these DC practices to build on evidence to support this unified view of DC interventions. The ethical approval was obtained in both Canada (MP-21-2018-1854) and in France (20181306005) and CNIL 2211490 v0). Thank you the Réseau de recherche en interventions infirmières du Québec/Quebec Network on Nursing Intervention Research [RRISIQ] for funding. The authors declare no conflict of interest.

Background: While hospitalized in the neonatal intensive care unit (NICU), infants and their families undergo multiple transitions, and these have been found to be a source of stress for families. Although mixed-room NICU designs allow for infants to benefit from different room types as their needs evolve during their stay, these can necessitate a transfer from one room type to another, which represents a transition for families. As some NICUs change to mixed-room designs, there is a need to better understand the factors impacting these particular transitions from the perception of parents. Purpose: Examine parent perceptions of factors affecting the transition from a 6-bed pod to single family room in a mixed-room design NICU. Methods: Using a qualitative descriptive design, semistructured interviews were conducted with 17 parents whose infant had transitioned from a 6-bed pod to single family room. Interviews were transcribed verbatim and then analyzed using content analysis. Results: Four categories of factors were identified: (1) framing, timing, and comprehensiveness of information provided by staff regarding the transition; (2) parents' perception of advantages and disadvantages of the new space; (3) parent's own well-being and quality of support from staff; and (4) parent's previous NICU and parenting experience. Implications for Practice: Staff should frame the information they provide about this transition in a positive way to help parents adjust. A family-centered approach should also be used to provide tailored information and support to individual families. Implications for Research: Future studies are needed into intraunit transfers including sources of support for parents, as well as staff perceptions of these transitions.

Background:As some neonatal intensive care units (NICUs) shift toward mixed-room designs, with different room types available throughout family's stays, there is a need to better understand parent perceptions of this transition.Methods:This study used a qualitative descriptive design to describe parent perceptions of transitioning from a 6-bed pod to a single family room in a mixed-room design NICU. Purposive sampling was used to recruit 10 mothers and 7 fathers who were regularly present on the unit before and after the transition. Semistructured telephone interviews were conducted a minimum of 2 days after the transition occurred. Interviews were transcribed and then analyzed using reflexive thematic analysis.Findings:Four themes were identified: going into the unknown; approaching the finish line; becoming comfortable in the new reality and seeing the benefits; and gaining autonomy and confidence in parenting.Conclusion:These results further our understanding of the transition process from a 6-bed pod to a single-family room for parents in the NICU. Staff should be sensitized to this experience to provide tailored information and support for parents throughout the transition.

Background: Families experience psychological distress when their preterm infant is in the Neonatal Intensive Care Unit. A tailored educational intervention may be beneficial for their psychological well-being. Unfortunately, existing websites have moderate to low information quality and there is no educational website for French-speaking parents.Aim: To measure the acceptability and feasibility of a digital educational intervention designed to improve the psychological well-being of parents with a preterm infant, as well as the acceptability and feasibility of the study methods used.Methods: A pilot randomized controlled trial was conducted. Participants were randomized to have access to either an educational website or information pamphlet. They were invited to complete an online questionnaire about stress and depressive symptoms 2 and 4 weeks after recruitment. An online questionnaire regarding the acceptability of the intervention and the data collection process was completed 5 weeks after recruitment.Results: Twenty parents participated. All participants with access to the website considered it was acceptable in terms of the appropriateness, convenience, and efficiency to meet their informational needs. 85% of participants assigned to the website viewed it 1 to 3 times per day during the data collection period and 69.4% consulted the website for 5 to 20 minutes each time. The data collection process was acceptable for 85% to 95% of participants.Discussion: The educational website was an acceptable and feasible intervention and the data collection process used was acceptable according to participants.

Background Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice. Objective The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients. Methods A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients’ preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery. Results Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited. Conclusions Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors. Trial Registration ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224 International Registered Report Identifier (IRRID) DERR1-10.2196/40760

In the neonatal intensive care unit, preterm infants undergo many painful procedures. Although these can impair their neurodevelopment if not properly managed, only half of the painful procedures are optimally handled. This cross-sectional study aimed to evaluate nurses' perceptions of preterm infants' pain, to evaluate nurses' pain assessment and management practices, as well as to identify the individual and contextual factors that influence nurses' assessments and interventions for pain management. Secondary analyses, including a mixed-model analysis, were performed with data from a larger study (n = 202 nurses). Nurses were found to have attitudes and perceptions in favor of preterm infants' pain management, although they reported using few standardized instruments to assess pain. Nurses stated that they widely used sucrose, non-nutritive sucking, and positioning as pain management interventions, while skin-to-skin contact was rarely practiced. Nurses' attitudes and perceptions influenced their pain assessment practices, which predicted their implementation of interventions. Several contextual (country, level of care, and work shift) and individual factors (age, level of education, had a preterm infant, perceptions of family-centered care, and skin-to-skin contact) also predicted nurses' pain assessment and management practices.

Aim We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU). Methods This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother-infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single-family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files. Results The infants were born at a mean age of 29.8 +/- 3.1 weeks. Greater family-centred care during early hospitalisation (p = 0.01) and greater breastfeeding self-efficacy in the period before discharge (p = 0.04) were significantly associated with higher readiness for discharge. The unit design was not significantly associated with readiness for discharge. Conclusion The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.

We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU). This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother–infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single-family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files. The infants were born at a mean age of 29.8 ± 3.1 weeks. Greater family-centred care during early hospitalisation ( p  = 0.01) and greater breastfeeding self-efficacy in the period before discharge ( p  = 0.04) were significantly associated with higher readiness for discharge. The unit design was not significantly associated with readiness for discharge. The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.