Parental presence is believed to improve outcomes for infants hospitalized in the neonatal intensive care unit (NICU). As a result, NICU policies and procedures have evolved to support parental presence, and a growing number of studies examine the role of parental presence in the NICU. However, the measurement of parental presence is not standardized, complicating assessment of its impact on child and parent outcomes across studies. We reviewed 29 studies that presented 27 distinct methods of quantifying parental presence in the NICU and reported associations of presence with patient demographics, parental engagement in the NICU, and outcomes for both infants and parents. This overview provides a foundation for standardizing and improving routine measurement of parental presence in the NICU. Key Points

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Background: Our institution is a nationally known stroke center. The number of stroke patients treated yearly grew from 235 in 2000 to 917 in 2011. We are challenged to provide clinically excellent, ground breaking care in a fiscally responsible manner to this growing population. Purpose: To meet this challenge our institution utilizes Advanced Practice Registered Nurses (APRNs) to improve and streamline stroke care. Methods: An APRN was part of the stroke team at the inception and continues as Coordinator. In 2008 the team implemented an additional APRN role to provide acute inpatient care to stroke and general Neurology patients. There are now 3 Board Certified APRNs who meet Certified Stroke Center requirements and fill this role. Their backgrounds are Emergency Medicine, Intensive Care, and Internal Medicine, and they are Certified Neurology Registered Nurses. They work collaboratively with the Neurologists in 12 hour shifts, 7 days a week. The APRNs complete History and Physicals, participate in research, provide education, assist with acute strokes and perform patient rounds.They address patient and staff concerns, and maintain collaborative care with other disciplines. Results: APRN collaboration assures continuous patient monitoring and allows physicians to address more acute issues. The Interval Summary dictation improves accurate coding of patient visits, assists in documenting core stroke measures, and provides current follow up to referring facilities. The APRNs designed and utilize a Neuroscience History and Physical form, which provides uniform and streamlined documentation. Their productivity logs show during June of 2012, a completion of 139 new consults, 169 routine follow ups, and monitoring of 97 ICU patients. This is in addition to dictation and multiple workplace demands. The Neurologists requested additional APRN coverage and are favorable of collaborative practice. Conclusion: In conclusion, the organized, streamlined, evidenced- based APRN care results in cost effectiveness meeting the challenges of the growing stroke population. Future plans for the APRN role include continued efficient care, educational efforts, preceptors for APRN students and residents, and participation in the hospital APRN Council.

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Objective Parents are increasingly turning to social media for medical recommendations. Our objective was to systematically examine posts on Facebook for parents of infants hospitalized in the neonatal intensive care unit (NICU) to analyze how advice on medical topics was requested and given, and whether this advice was potentially medically inappropriate. Study Design One hundred Facebook groups were screened for study eligibility. In each group, up to 400 posts on medical topics were evaluated. The first 10 comments of each post were classified based on content and presence of medical advice. Appropriateness of advice was evaluated by a neonatologist. Results Of 28 groups meeting study criteria, 10 permitted access for data collection. We identified 729 posts requesting medical advice of which 29% referenced the NICU period. Posts on diagnosis and development (30 and 32% of posts, respectively) were the most common topics, and most likely to receive advice (78 and 76% of posts on these topics, respectively). We identified 238 comments containing potentially inappropriate medical advice and 30 comments recommending going against medical advice. Conclusion Parents are utilizing Facebook as a source of support and medical information. Parents are most likely to give development-related advice from their own parenting experiences. The high percentage of posts requesting advice about diagnosis and development in the post-NICU stage suggests parents seek increased anticipatory guidance. Key Points