91 Current Practices and Beliefs Regarding Screening Burn Patients for Acute Stress Disorder and Post-Traumatic Stress Disorder: A Survey of the American Burn Association

Introduction The prevalence of Acute Stress Disorder (ASD) after burn injury may be up to 30% and the prevalence of Post-Traumatic Stress Disorder (PTSD) is as much as 40% at six months post-burn injury. The American Burn Association (ABA) published a consensus statement in 2013 recommending screening for ASD and PTSD in all patients with a burn injury. To our knowledge, the current practices of screening for ASD and PTSD in patients with burns is not known. This study aims to describe the current screening practices and provider beliefs regarding screening for stress disorders in burn patients in the US. Methods Interviews with psychologists and clinicians from our regional burn and injury center were utilized to generate a 31-question survey to assess burn center screening practices and provider beliefs regarding screening for ASD/PTSD. The Survey was approved by the ABA and distributed to its US membership in July 2020. Percentages of responses were generated, and chi-square tests were used to compare answers by profession type. Results There were 121 respondents out of 1500 recipients. The respondents were surgeons (27%), psychologists (6%), therapists or social workers (16%), nurses (31%), and advanced practice providers (13%). About half of the respondents (47%) worked at institutions that admit over 300 adult burn patients a year and had over 10 years of experience (52%). Seventy-five respondents (62%) indicated their institution formally screens for ASD and/or PTSD, 35 do not formally screen, and 11 respondents were unsure. Of the 35 centers that did not screen, the most common reason was a lack of mental healthcare providers (46%), lack of funding (26%) and lack of time (20%). The timing of screening, person administering the screening, and method of screening varied greatly across centers for pediatric and adult patients. Most respondents thought screening pediatric (83%) and adult (87%) patients with burns for ASD/PTSD was important, and 87% thought it should be standard of care. However, only 32% of respondents were comfortable screening pediatric patients and 62% were comfortable screening adults. Conclusions Whereas screening for ASD and PTSD is recommended for patients with burns, our study indicates that, despite general consensus that it should be, screening is not a current standard of care. Lack of mental health providers, funding, and time are contributing factors. Among those institutions that screen, a uniform screening protocol does not exist for pediatric or adult patients.

A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study

Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses’ emotional labor, and organizational culture.

What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units

Background The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers’ perspectives on the barriers and enablers of implementing KC. Methods This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. Results Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. Conclusions A ‘one size fits all’ approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.

Pediatric Residents’ Beliefs and Behaviors About Health Care for Sexual and Gender Minority Youth

Little is known about provider beliefs related to sexual and gender minority (SGM) youth, and how these have changed over time. Our objective was to compare pediatric residents’ beliefs and behaviors about SGM youth to historical data. Forty-eight of 76 (63%) residents completed a survey of items drawn from 2 existing scales. Results were compared with historical data from 1998 to 2012. Compared to historical respondents, residents indicated that they were significantly more likely to take a sexual history from patients under 14 years old and ask about sexual orientation. Residents were significantly less likely to fear offending parents or patients with such discussions. While responses indicated SGM-affirming beliefs, 45% of residents felt they may not know enough about SGM needs to have effective discussions, similar to historical respondents. Ongoing challenges include a perceived lack of knowledge about the needs of SGM youth, representing avenues for future educational intervention.

Birth Plans and Childbirth Education: What Are Provider Attitudes, Beliefs, and Practices?

We describe the perception and practices of obstetric providers on birth plans and childbirth education (CBE) classes. Using a national online survey, we collected provider and patient demographics, practice settings, and perceptions. Of 567 surveys, 77% were physicians and 22% were midwives. This cohort believed prenatal care and CBE were predictors of patient satisfaction, while they had unfavorable views of birth plans. Most providers routinely recommended (69.7%) and had favorable views on CBE (84%). Most providers (66.5%) did not recommend birth plans and 31% felt they were predictors of poor obstetrical outcomes. Further research is needed to bridge the gap between provider beliefs and patient desires about their birth experience as well as to understand how to improve childbirth-related patient satisfaction.