Neonatal Tele-Homecare

Bidragets oversatte titel: Telemedicinsk tidligt hjemmeophold

Publikation: AfhandlingPh.d.-afhandling

Abstrakt

Neonatal homecare (NH) implies that parents manage tube feeding and care of their preterm infant at home supported by home visits from neonatal nurses, to monitor infant growth and the well-being of the family. Home visits are costly and time consuming in rural areas. The overall aim of this study was to develop a telehealth service for NH without home visits - neonatal tele-homecare (NTH) and test it in an observational study. Participatory design (PD) methods were conducted to facilitate involvement of the end-users (parent of preterm infants and clinicians) in the development of the telehealth service. The thesis includes three study phases.
In the first phase of the study (paper I) the aim was to identify the needs of the parents and clinicians related to existing NH. Home visits of NH were observed, parents with preterm infants assigned to NH were interviewed and focus groups with clinicians and parents of preterm infants in the NICU were conducted. Analysis revealed that parents and clinicians requested access to videoconferences and the possibility of timely written e-mail communication. Further, parents sought an online knowledge base with information regarding infant care. Finally, the analysis identified the need for NH to support the parents at home instead of in the NICU, as NH was highly demanded by the parents.
The aim in the second phase of the study was to test, develop and design a telehealth service for NH (paper II). A creative workshop was conducted to generate ideas based on the identified needs in phase one. Participants in the creative workshop were parents, infants, clinicians, researchers, an IT-company and innovation engineers. Parents requested an app, which should gather all the requested functionalities; however, the clinicians were concerned of increased workload in terms if increased documentation. Following the creative workshop, a technical workshop was conducted with participation from parents, infants, clinicians and the IT-company. The aim of the technical workshop was to test different videoconference equipment. The technical workshop did not provide any solutions, so further testing was continued in the NICU. The final telehealth service was developed as an app connected to the electronic medical record in the NICU and contained the requested functionalities. In the medical record a tab was designed for the clinicians to use for communication to the app.
Third phase of the study was an observational study to test the developed telehealth service during NTH. 49 parents of the NTH infants were interviewed regarding their experience with NTH (paper III). Parents experienced the telehealth service as a personal lifeline to clinical expertise and that NTH facilitated them in being the primary care givers for their infant and that they became more empowered. Overall, NTH facilitated an experience of family-centred care (FCC).
A number of 96 preterm infants were included and two historical control groups were used for comparison of breastfeeding rates and growth (paper IV). The telehealth service was frequently used for communication between the clinicians and the parents. More NTH infants were fully breastfed at final discharge, and the difference was statistically significant (p=0.03) for the infants born before 32 weeks of gestation. Six percent of the NTH infants were readmitted to the NUCI, but they all resumed to NTH after hospital-treatment for different reasons. The overall study identified that a new developed telehealth service could be used for NTH for preterm infants and their parents. Further research on larger populations on NTH is needed to have stronger estimates regarding to breastfeeding rates, infant growth and overall safety
Bidragets oversatte titelTelemedicinsk tidligt hjemmeophold
OriginalsprogEngelsk
Udgiver
StatusUdgivet - 2017

Note vedr. afhandling

Grad tildelt d. 15-12 2017

Citationsformater

Holm, K. G. (2017). Neonatal Tele-Homecare. Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet.