Basics of qualitative research: Grounded theory procedures and techniques

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Applied Longitudinal Data Analysis Modeling Change And Event Occurrence

Historically women have been attended and supported by other women during labour and birth However in many countries, as more women are giving birth in hospital rather than at home, continuous support during labour has become the exception rather than the norm This may contribute to the dehumanisation of women's childbirth experiences Modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour Supportive care during labour may involve emotional support, comfort measures, information and advocacy These may enhance physiologic labour processes as well as women's feelings of control and competence, and thus reduce the need for obstetric intervention The review of studies included 23 trials (22 providing data), from 16 countries, involving more than 15,000 women in a wide range of settings and circumstances The continuous support was provided either by hospital staff (such as nurses or midwives), women who were not hospital employees and had no personal relationship to the labouring woman (such as doulas or women who were provided with a modest amount of guidance), or by companions of the woman's choice from her social network (such as her husband, partner, mother, or friend) Women who received continuous labour support were more likely to give birth 'spontaneously', ie give birth with neither caesarean nor vacuum nor forceps In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours Their babies were less likely to have low five-minute Apgar scores No adverse effects were identified We conclude that all women should have continuous support during labour Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial In comparison with having no companion during labour, support from a chosen family member or friend appears to increase women's satisfaction with their childbearing experience

Continuous support for women during childbirth.

Objective:To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.Methods:We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We a

/pdf/guidelines-for-family-centered-care-in-the-neonatal-3kja37jlgs.pdf

Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.

Background
Administration of oral sucrose with and without non-nutritive sucking is the most frequently studied non-pharmacological intervention for procedural pain relief in neonates.

Objectives
To determine the efficacy, effect of dose, method of administration and safety of sucrose for relieving procedural pain in neonates as assessed by validated composite pain scores, physiological pain indicators (heart rate, respiratory rate, saturation of peripheral oxygen in the blood, transcutaneous oxygen and carbon dioxide (gas exchange measured across the skin - TcpO2, TcpCO2), near infrared spectroscopy (NIRS), electroencephalogram (EEG), or behavioural pain indicators (cry duration, proportion of time crying, proportion of time facial actions (e.g. grimace) are present), or a combination of these and long-term neurodevelopmental outcomes.

Search methods
We used the standard methods of the Cochrane Neonatal. We performed electronic and manual literature searches in February 2016 for published randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 1, 2016), MEDLINE (1950 to 2016), EMBASE (1980 to 2016), and CINAHL (1982 to 2016). We did not impose language restrictions.

Selection criteria
RCTs in which term or preterm neonates (postnatal age maximum of 28 days after reaching 40 weeks' postmenstrual age), or both, received sucrose for procedural pain. Control interventions included no treatment, water, glucose, breast milk, breastfeeding, local anaesthetic, pacifier, positioning/containing or acupuncture.

Data collection and analysis
Our main outcome measures were composite pain scores (including a combination of behavioural, physiological and contextual indicators). Secondary outcomes included separate physiological and behavioural pain indicators. We reported a mean difference (MD) or weighted MD (WMD) with 95% confidence intervals (CI) using the fixed-effect model for continuous outcome measures. For categorical data we used risk ratio (RR) and risk difference. We assessed heterogeneity by the I2 test. We assessed the risk of bias of included trials using the Cochrane 'Risk of bias' tool, and assessed the quality of the evidence using the GRADE system.

Main results
Seventy-four studies enrolling 7049 infants were included. Results from only a few studies could be combined in meta-analyses and for most analyses the GRADE assessments indicated low- or moderate-quality evidence. There was high-quality evidence for the beneficial effect of sucrose (24%) with non-nutritive sucking (pacifier dipped in sucrose) or 0.5 mL of sucrose orally in preterm and term infants: Premature Infant Pain Profile (PIPP) 30 s after heel lance WMD -1.70 (95% CI -2.13 to -1.26; I2 = 0% (no heterogeneity); 3 studies, n = 278); PIPP 60 s after heel lance WMD -2.14 (95% CI -3.34 to -0.94; I2 = 0% (no heterogeneity; 2 studies, n = 164). There was high-quality evidence for the use of 2 mL 24% sucrose prior to venipuncture: PIPP during venipuncture WMD -2.79 (95% CI -3.76 to -1.83; I2 = 0% (no heterogeneity; 2 groups in 1 study, n = 213); and intramuscular injections: PIPP during intramuscular injection WMD -1.05 (95% CI -1.98 to -0.12; I2 = 0% (2 groups in 1 study, n = 232). Evidence from studies that could not be included in RevMan-analyses supported these findings. Reported adverse effects were minor and similar in the sucrose and control groups. Sucrose is not effective in reducing pain from circumcision. The effectiveness of sucrose for reducing pain/stress from other interventions such as arterial puncture, subcutaneous injection, insertion of nasogastric or orogastric tubes, bladder catherization, eye examinations and echocardiography examinations are inconclusive. Most trials indicated some benefit of sucrose use but that the evidence for other painful procedures is of lower quality as it is based on few studies of small sample sizes. The effects of sucrose on long-term neurodevelopmental outcomes are unknown.

Authors' conclusions
Sucrose is effective for reducing procedural pain from single events such as heel lance, venipuncture and intramuscular injection in both preterm and term infants. No serious side effects or harms have been documented with this intervention. We could not identify an optimal dose due to inconsistency in effective sucrose dosage among studies. Further investigation of repeated administration of sucrose in neonates is needed. There is some moderate-quality evidence that sucrose in combination with other non-pharmacological interventions such as non-nutritive sucking is more effective than sucrose alone, but more research of this and sucrose in combination with pharmacological interventions is needed. Sucrose use in extremely preterm, unstable, ventilated (or a combination of these) neonates needs to be addressed. Additional research is needed to determine the minimally effective dose of sucrose during a single painful procedure and the effect of repeated sucrose administration on immediate (pain intensity) and long-term (neurodevelopmental) outcomes.

/pdf/sucrose-for-analgesia-in-newborn-infants-undergoing-painful-31o1aun6rt.pdf

Sucrose for analgesia in newborn infants undergoing painful procedures

Objective To determine factors explaining lack of response by preterm newborns to heel stick for blood sampling. Design A cross-sectional design based on secondary analysis of the control session of a randomized crossover design. Setting Four Level III neonatal intensive-care units of university teaching hospitals. Participants 120 preterm newborns with an average age of 28 weeks postconceptional age. Intervention 24 newborns who showed a “no change” response according the Premature Infant Pain Profile were compared to the remaining 96 newborns who had shown a pain response. Main Outcome Measures Age (postconceptional age at birth, postnatal age at study), Apgar score at 5 minutes, severity of illness, sex, race, wake/sleep state, previous study sessions, total number of painful procedures since birth, and time since last painful procedure. Results After stepwise logistic regression analysis the variables remaining in the final model that explained the difference between the groups were postnatal age at time of study, postconceptional age at birth, time since last painful procedure, and wake/sleep state. Conclusions Newborns who were younger, asleep, and had undergone a painful event more recently were less likely to demonstrate behavioral and physiologic indicators of pain.

https://www.jognn.org/article/S0884-2175(15)33781-3/pdf

Factors Explaining Lack of Response to Heel Stick in Preterm Newborns

ContextNorth American cesarean delivery rates have risen dramatically since
the 1960s, without concomitant improvements in perinatal or maternal health.
A Cochrane Review concluded that continuous caregiver support during labor
has many benefits, including reduced likelihood of cesarean delivery.ObjectiveTo evaluate the effectiveness of nurses as providers of labor support
in North American hospitals.DesignRandomized controlled trial with prognostic stratification by center
and parity. Women were enrolled during a 2-year period (May 1999 to May 2001)
and followed up until 6 to 8 postpartum weeks.SettingThirteen US and Canadian hospitals with annual cesarean delivery rates
of at least 15%.ParticipantsA total of 6915 women who had a live singleton fetus or twins, were
34 weeks' gestation or more, and were in established labor at randomization.InterventionPatients were randomly assigned to receive usual care (n = 3461) or
continuous labor support by a specially trained nurse (n = 3454) during labor.Main Outcome MeasuresThe primary outcome measure was cesarean delivery rate. Other outcomes
included intrapartum events and indicators of maternal and neonatal morbidity,
both immediately after birth and in the first 6 to 8 postpartum weeks.ResultsData were received for all 6915 women and their infants (n = 6949).
The rates of cesarean delivery were almost identical in the 2 groups (12.5%
in the continuous labor support group and 12.6% in the usual care group; P = .44). There were no significant differences in other
maternal or neonatal events during labor, delivery, or the hospital stay.
There were no significant differences in women's perceived control during
childbirth or in depression, measured at 6 to 8 postpartum weeks. All comparisons
of women's likes and dislikes, and their future preference for amount of nursing
support, favored the continuous labor support group.ConclusionsIn hospitals characterized by high rates of routine intrapartum interventions,
continuous labor support by nurses does not affect the likelihood of cesarean
delivery or other medical or psychosocial outcomes of labor and birth.

https://jamanetwork.com/journals/jama/articlepdf/195299/joc20397.pdf

Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.

Objectives To pilot test a newly developed breastfeeding self‐efficacy intervention Design Pilot randomized controlled trial (RCT). Setting An acute care hospital located in Northwestern Ontario that is the sole provider of maternity care for the city and referral center for the region Participants One‐hundred‐and‐fifty primiparous women intending to breastfeed their healthy, term, singleton infant Intervention A standardized, individualized nursing intervention protocol was designed and administered to increase mothers' breastfeeding self‐efficacy. Participants were randomly allocated to the intervention group or control group using sealed, opaque envelopes. Participants in the intervention group received three individualized, self‐efficacy enhancing sessions with the researcher: two in‐hospital and one by telephone. Participants in the control group received standard in‐hospital and community care Main Outcome Measures Feasibility, compliance, and the acceptability of the breastfeeding self‐efficacy intervention. Other outcomes assessed were breastfeeding self‐efficacy, duration, and exclusivity Results Findings suggest that the intervention was feasible; there was a high degree of protocol compliance, and the majority of mothers reported that the intervention was beneficial. Mothers in the intervention group had higher rates of breastfeeding self‐efficacy, duration, and exclusivity at 4 and 8 weeks postpartum. However, the differences between groups were not statistically significant Conclusion The pilot RCT provided valuable information in examining the feasibility of the trial design and intervention

https://www.jognn.org/article/S0884-2175(15)30518-9/pdf

A Pilot Randomized Controlled Trial of a Breastfeeding Self‐Efficacy Intervention With Primiparous Mothers

The purpose of this randomized clinical trial was to test the efficacy of repeated versus single dose sucrose to decrease pain from routine heel stick procedures in preterm neonates. Infants (n = 48) in the first week of life with a mean gestational age of 31 weeks received 0.05 ml of 24% sucrose solution or sterile water by mouth (1) 2 min prior to actual lancing of the heel; (2) just prior to lancing, and (3) 2 min after lancing. The single-dose group received sucrose for the first dose and water for the second and third dose; the repeated-dose group received sucrose three times, and the placebo group received only water. The Premature Infant Pain Profile (PIPP) scores were obtained for five 30-second blocks from lancing. Both sucrose groups had lower PIPP scores (single sucrose pain scores, 6.8-8.2, p = 0.07; repeated sucrose pain scores, 5.3-6. 2, p < 0.01) than water (pain scores 7.9-9.1), and in the last block, the repeated dose had lower scores than the single dose (6.2 vs. 8. 2, p < 0.05).

Effect of Repeated Doses of Sucrose during Heel Stick Procedure in Preterm Neonates

The pilot study provides a unique opportunity to identify and prepare for the challenges of evaluating an intervention. Ultimately, it will enhance the scientific rigour and value of the full-scale study. Although some journals publish reports of pilot studies, little attention has been given to the types of research questions and issues specific to these studies. This article focuses on the utility of a pilot randomized controlled trial (RCT) as a first step towards conducting an RCT. Three major objectives of a pilot RCT are discussed: assessing the feasibility and acceptability of the intervention, assessing the feasibility and acceptability of the design and procedures, and facilitating the determination of effect sizes for use in sample-size calculations.

https://cjnr.archive.mcgill.ca/article/download/2194/2188

Robyn Stremler

Papers

Factors Explaining Lack of Response to Heel Stick in Preterm Newborns

Effectiveness of nurses as providers of birth labor support in North American hospitals: a randomized controlled trial.

A Pilot Randomized Controlled Trial of a Breastfeeding Self‐Efficacy Intervention With Primiparous Mothers

Effect of Repeated Doses of Sucrose during Heel Stick Procedure in Preterm Neonates

The importance of piloting an RCT intervention.