Purpose or Background or Introduction: An infant born with critical congenital heart disease (CCHD) requires extensive postoperative recovery and specialized home care needs. Caregivers of critically ill neonates are at an increased risk for stress, which may interfere in their ability to learn how to provide home care. There are limited studies examining the use of technology-enhanced learning for caregivers of infants with CCHD. The purpose of this pilot study is to determine the feasibility and effectiveness of an interprofessional led low-fidelity simulation program on caregivers’ perceived stress, developed for caregivers of infants with CCHD who require cardiac surgery after birth.

Project Design or Methods: Caregivers were enrolled in the simulation program (n=14) during the prenatal period. Data was collected at prenatal, hospitalization, and discharge home time points. A low-fidelity simulation scenario was delivered in the prenatal period and during CICU admission. The third time point included the Rooming-In practice. A comparison group (n=42) was identified from a study with comparable data collection time points but no simulation program. Categories were created to indicate a change in stress at each time point. Stress scores were examined descriptively, and Fisher’s exact tests were used to examine differences in change categories between the simulation and comparison groups.
 
Results or Discussion: The analytic sample consisted of 12 caregivers from the simulation group and 21 caregivers from the comparison group who had complete data. Over half of caregivers were White, non-Hispanic in both the simulation (58.33%, n=7) and comparison groups (52.38%, n=11). Caregivers were all self-reported female. Regarding perceived stress score, caregivers in the simulation group showed a steady decrease over time, with a mean of 12.75 (SD=6.08) at Time 1, 11.08 (SD=6.10) at Time 2, and 9.83 (SD=5.47) at Time 3. In the comparison group, caregivers showed a decrease from Time 1 (M=18.00, SD=6.40) to Time 2 (M=13.10, SD=7.29) and an increase from Time 2 to Time 3 (M=19.10, SD=2.51). These differences in change over time were reflected in the analysis of the groups by change category. There were no statistically significant differences in change category by group from Time 1 to Time 2 (p=.84). However, from Time 2 to Time 3, the comparison group had unfavorable stress category changes in 42.86% (n=9) of caregivers, and the simulation group caregivers had no unfavorable changes, a statistically significant difference (p=.01).

Conclusions: This is the first known study to determine the feasibility and effectiveness of a low-fidelity simulation program, developed for caregivers of infants with CCHD who require cardiac surgery after birth. The caregivers’ perceived stress was the primary outcome variable. The findings in this study indicate that caregivers receiving the simulation program had a decrease in stress over the course of an average of 9.6 weeks compared to the comparison group, which showed a short-term decrease but overall increase. Findings in this study have the potential to improve caregiver stress from prenatal diagnosis of CCHD to discharge home after cardiac surgery, which can translate to better patient and family outcomes through implementation of an interprofessional led simulation program during three critical time points (fetal period, CICU admission, before discharge home). Future work should include random treatment assignment to assess causal relationships.