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Despite all the advances in healthcare technology and all the care services in the field of neonates, many infants die in neonatal intensive care units (NICUs). This qualitative study investigated socio-cultural factors influencing the care for bereaved parents in three main NICUs of northwest Iran between March 2018 and April 2019. The purposeful sampling method with the maximum variation was used, and data collection was continued until obtaining rich data to answer the research question. Twenty-eight interviews were conducted with 26 healthcare providers. The thematic analysis method was applied to analyze the data, and two main themes, including "Religious context as a restriction on the parental involvement in the infant's end-of-life care" and the "Socio-cultural challenges of the grieving process among parents", were generated accordingly. The religious and socio-cultural contexts in the NICUs of Iran are a restriction to the presence of parents at their infants' end-of-life phase, and health care providers are less inclined to have parents in the NICU at the time of infant death. [ABSTRACT FROM AUTHOR]

Purpose: Grief after infant death is a common experience of bereaved parents often seen in the neonatal intensive care unit (NICU). The NICU staff tend to focus more on the mother's support, and fathers are often not treated equally as mothers. This study aimed to investigate the circumstance of caring for parents facing infant death in NICUs. Methods: Twenty-eight face-to-face in-depth interviews were conducted between March 2018 and April 2019 in the northwest of Iran. Participants were selected via purposive sampling. An inductive thematic approach was used for data analysis. Results: Three main themes and 7 subthemes were extracted. The main themes were: "the father—the missing piece of the puzzle in the mourning process," "restricted presence of fathers due to religious and traditional beliefs," and "the father—the patience stone." Conclusion: Due to cultural-religious backgrounds, traditional beliefs, structural problems, and organizational restrictions, fathers in NICUs do not receive adequate support, particularly when faced with their infant's death. Bereaved fathers need to receive more support and attention from healthcare providers. Therefore, there is a need for changing the care providers' attitudes regarding the role of fathers and the quality of support that fathers should receive in the Muslim populations. [ABSTRACT FROM AUTHOR]

Objectives: Moral distress (MD), which is affected by several factors such as futile care provision and is considered the cause of adverse effects such as job dissatisfaction and decreased care quality, is a new concept attracting increasing academic interest. This study aims to assess the correlation between nurses' perception of futile care and MD in neonatal care units. Material and Methods: This descriptive-correlational study was carried out among 115 nurses working in the neonatal intensive care units and neonatal special care units of two hospitals in West Azerbaijan Province during 2020. A demographic information form, the 21-item MD-Pediatric version scale, and the 17-item perception of futile care questionnaire were used to collect data and analysed using SPSS 16 software. Results: The results confirmed the direct correlation between MD and the perception of futile care. In addition, MD and the nurses' perceptions of futile care were estimated to be moderate. Conclusion: The results of this study provide evidence to emphasise the need for further studies to investigate other causes of MD in neonatal units and find the solutions to make the work environment more ethical. Furthermore, the results provide the platform needed for hospital and university managers to make the necessary decisions and create the required changes in the educational curriculum of nursing students and provide the appropriate courses for neonatal unit nurses to improve their ability to cope with the MD caused by providing futile care. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate physicians' and nurses' perspectives on the challenges of implementing the FCC in the neonatal intensive care unit. The study employed a qualitative design to conduct five focus groups with 25 nurses and 15 physicians (n = 40). All of the nurse participants identified as female; 73% held a bachelor's degree in nursing and 59% had been working as a neonatal nurse for >10 years. Of the physicians, 55% identified as male, 43% held positions as neonatologists and 39% had a minimum of 3 years of experience in neonatal intensive care. Three themes, power imbalance , psychosocial issues , and structural limitation , and related sub-themes were constructed using thematic analyses. The implementation of family-centered care in the neonatal intensive care unit in Iran is shaped by the health care provider, cultural, legal and operational challenges. To optimize effective and sustained implementation, these influential factors must be addressed. Organizational, managerial and operational changes are required for FCC implementation. Nurses and physicians are well-positioned as leaders and facilitators of family-centered care implementation within the neonatal intensive care unit. • Family-centered care is widely accepted as an ideal caring approach and standard of care in the NICUs. • In the Iranian NICU context, there are different challenges which restrict implementation of family-centered care. • Program development from the individual to organizational levels is needed to establish the FCC approach in Iranian NICUs. [ABSTRACT FROM AUTHOR]

Nurses in the Neonatal Intensive Care Unit (NICU) have an important role in implementing family-centered care (FCC). The aim of the study was to explore the lived experiences of NICU nurses on implementing FCC. An interpretative phenomenological study was conducted and 11 employed nurses were interviewed from April 2015 to February 2016. The data were analyzed through the Diekelmann, Allen, and Tanner approach. Four main themes of "strain to achieve stability," "bewildered by taking multiple roles," "accepting the family," and "reaching bright horizon" were extracted. This study provided deeper understanding about nurses' perceptions of FCC implementation. In Muslim developing countries, FCC implementation is challenging and nurses are under extra pressure because of a shortage in nursing workforce; however, having positive experiences with family participation and valuing theism beliefs allowed them to support family involvement. Support of nurses to take FCC strategies in the NICU is needed by officials overseeing the health care system. [ABSTRACT FROM AUTHOR]

Background: Premature neonates admitted to the neonatal intensive care unit (NICU) undergo sleep disorder due to various manipulations. The present study aimed to investigate the effect of clustered nursing care on sleep behaviors in premature neonates admitted to NICUs. Methods: This clinical trial study was conducted on 60 neonates selected through convenience sampling method out of the infants admitted to the NICU. First, in the control group, a constant nurse took care of the neonates in a complete shift. The nurse observed the neonates sleep behaviors every two min for 45 min and recorded them in the questionnaire. The intervention group was investigated one week after the control group. The neonates 'sleep behaviors were observed and recorded every two min by Prechtl instrument. All the data were analyzed by the Mann- Whitney U test using SPSS software version 16. Results: The mean sleep times in the control group were as follow: quiet sleep 5 min and 86 millisecond, active sleep 21 min and 50 milliseconds, quiet wake 4 min and 6 milliseconds,alertness9 min and 6 milliseconds, and cry1 min and 76 millisecond .On the other hand, in the neonates who received clustered care in the intervention group, the mean timings were as follow: quiet sleep time 19 min and 33 millisecond, active sleep 24 min and 66 millisecond, quiet wake 1 min and 76 millisecond,alertness2 min and 76 millisecond, and cry0.13 min. According to the mentioned times, it could be concluded that the neonates in the test group had a quiet and active sleep (P <0.05). Conclusion: Findings of this study demonstrate that cluster care can significantly increase the time of quiet and active sleep in the newborns. Based on the result, it is recommended that this kind of care be provided in the NICU program, as well as in the syllabus of students and nursing retraining. [ABSTRACT FROM AUTHOR]

Background: The basic principles of family-centered care in neonatal intensive care unit (NICU) include the unlimited presence of parents and their participation in infant's care. Nurses play a central role in encouraging parental attachment with their infant.Purpose: This study was carried out with the aim of understanding NICU nurses' lived experiences of family participation in family-centered care.Methods: This interpretative phenomenological study was conducted on the basis of Heideggerian philosophy. The data were collected using semistructured interviews and field notes and analyzed through the 7-stage Diekelmann, Allen, and Tanner approach.Findings: Two overarching themes emerged including "mother's centrality in the care chain" and "fathers; the lost ring in the care chain" each of which consisted of 3 and 4 subthemes, respectively. Interviews indicated that in Iran's NICUs, conditions for the presence of parents were appropriate for the mothers and they were encouraged to engage in family-centered care but the fathers' participation was limited due to traditional attitudes, cultural-religious background, and difficulties relating to the hospitals' organizational rules.Implications For Practice: Fathers' participation in family-centered care seems to be enhanced through providing facilities, altering the organizational rules, attempting to modify traditional social attitudes, and educating parents and nurses.Implications For Research: Future research should explore the experience of mothers and fathers of infants in NICU in Iran to achieve a comprehensive understanding of their role in family-centered care. [ABSTRACT FROM AUTHOR]

Introduction: Clinical competence of nurses working in the neonatal intensive care units together with advancements in medical science and technology increased the survival rate of newborns that need specialized care. To ensure the quality of care and provide the safety of patients, evaluating the clinical competence of nurses seems necessary. This study aimed to evaluate the clinical competence of nurses in the neonatal intensive care units. Methods: In this cross-sectional study, 117 nurses working in the neonatal intensive care units of the hospitals affiliated to Tehran University of Medical Sciences were selected by census method. The research tool was Development of Competency Inventory for Registered Nurses questionnaire which completed by self-assessment. The mean clinical competence scores of participants categorized into 3 levels: weak: <225, moderate: 225-273 and good: >273. Data were analyzed by SPSS version 13 using the Pearson correlation coefficient, t-test and Chi-square test. Results: The highest levels of competence were related to critical thinking and research attitude and interpersonal relationships, and the lowest level was related to training and mentoring. There was a direct statistically significant relationship between marital status, employment status, level of interest in working in the neonatal intensive-care units and the clinical competence of nurses. Conclusion: Since the clinical competence of nurses in the Neonatal Intensive Care Units is vital, some variables such as interest in the nursing profession, employment status, the neonatal intensive theoretical and practical training courses and the amount of overtime working hours should be taken into consideration. [ABSTRACT FROM AUTHOR]