for Parents of High-Risk Neonates Improves Family Adjustment at Home
Finds Managed Care Not Always Better for Preventive Medicine
CPR training can relieve stress for parents and improve survival outcomes for infants at
high risk for cardiopulmonary arrest, a new study has found. The training is most
effective when delivered in the format that includes CPR training combined with continued
telephone support by a health care professional, said Kathleen Dracup, RN, DNSc, lead
author of the study, professor and dean of the UCSF School of Nursing.
Though parents of
infants hospitalized in the neonatal intensive care unit are routinely taught CPR as part
of the preparation for transition home, few data existed about the manner in which CPR
should be taught to parents, explained Dracup. "The manner of teaching CPR is
important because changes in healthcare financing have translated into higher infant-staff
ratios in neonatal and pediatric intensive care units, making it more difficult to do
one-to-one CPR instruction," she said.
In the study, which appears in the September issue of Critical Care Medicine (the
journal for The Society of Critical Care Medicine), researchers also analyzed the
psychosocial consequences of teaching CPR to ethnically diverse parents. They measured
parents levels of adjustment to caring for a high-risk newborn, anxiety and
depression. "On the one hand, parents feel reassured by receiving CPR training
because it provides them with concrete skills to use in an emergency," Dracup said.
However, other research has indicated that CPR training may increase the stress parents
already feel, by reminding them that their infant may experience a sudden cardiac arrest
at home, she explained.
The researchers compared the effects of three different types of CPR training on
parental anxiety and adjustment: CPR given by an instructor, CPR video with no instructor
present, and CPR given by an instructor combined with a social support intervention.
Anxiety decreased significantly over time in all groups except the CPR-Video group, she
explained. Overall, the CPR-social support group fared best with regard to adjustment and
anxiety reduction, followed by the CPR-instructor group, she said.
The CPR-instructor and CPR-social support groups were modeled after standard CPR
classes offered in community settings. The CPR-social support group was different in that
the instructor began the class with a brief discussion of the feelings involved in
bringing home an infant with special health needs. In this group, CPR training was
followed by a 30-minute discussion among participants about fears related to learning CPR
and about caring for the infant at home. The social support intervention was continued in
the form of weekly telephone calls for one month and then monthly for another five months
by the same clinical nurse specialist who taught the initial CPR class.
The findings of the six-month study support the positive effects of helping parents
prepare for a home emergency by teaching CPR, either in combination with social support or
in the more traditional format with an instructor, said Dracup. "Our findings
demonstrate that CPR training does not add to the burden facing parents of high-risk
newborns when they take their children home." At the one year follow-up after CPR
training, 13 cardiac arrests occurred at home. In all 13 cases, infants were successfully
resuscitated, she said.