The relationship between maternal needs and priorities in a neonatal intensive care environment

Effective nurse parent communication: a study of parents' perceptions in the NICU environment

OBJECTIVE

This study examined mothers' and fathers' perceptions of effective and ineffective communication by nurses in the neonatal intensive care unit (NICU) environment, using communication accommodation theory (CAT) as the framework.

METHODS

Twenty mothers and 13 fathers participated in a semi-structured interview about their perceptions of effective and ineffective communication with nurses when their infant was in the NICU. The interviews were coded for using the CAT strategies.

RESULTS

Descriptions of effective and ineffective communication differed in terms of the strategies mentioned with effective communication about shared management of the interaction and appropriate support and reassurance by nurses. Ineffective communication was more about the interpretability strategy, particularly for fathers, and these interactions were seen as more intergroup. Mothers emphasised more being encouraged as equal partners in the care of their infant.

CONCLUSION

Effective communication by nurses was accommodative and more interpersonal while ineffective communication was generally under-accommodative and more intergroup.

PRACTICE IMPLICATIONS

The findings provide a framework for communication skills training for nurses that identifies both effective and ineffective communication strategies to use with mothers and fathers.

Comparisons of needs, need responses, and need response satisfaction of mothers of infants in neonatal intensive care units

Providing nursing care to meet the needs of mothers may be unsuccessful because most nurses perceive and prioritize maternal needs differently from how mothers do. In this study, 140 mothers of infants in each neonatal intensive care unit of three hospitals in southern Thailand were interviewed using questionnaires on maternal needs, need responses, and need response satisfaction. Significant differences in mean total scores and mean subscale scores of needs, need responses, and need response satisfaction were found among the three groups of mothers. Significant differences in mean differences of total needs, need responses, and need response satisfaction were found when comparing mothers in each group. The mean rankings of maternal needs, need responses, and need response satisfaction were identified. This study supported the idea of individualized maternal needs and priorities. In providing effective nursing care to meet the needs and satisfaction of mothers, nurses should be concerned with the needs of individuals, their responses to those needs, and need response satisfaction because the satisfaction of these needs is essential for infant well-being.

“I wanted to do a good job”: Experiences of ‘becoming a mother’ and breastfeeding in mothers of very preterm infants after discharge from a neonatal unit

In mothers of preterm infants, the process of becoming a mother is initiated in a public and medical environment, in which the mothers become dependent on the benevolence and support of the staff. This setting and an experience of insecure social bonds impair the ability to become a mother during the infant's stay at the neonatal unit (NU), and breastfeeding may become a duty and not be mutually satisfying. Studies on how women experience becoming a mother and breastfeeding after the infant's discharge are sparse and this question is addressed in the present grounded theory study. Twenty five mothers, whose very preterm infants had received care in seven NUs in Sweden, were interviewed once, 1-12 months after discharge. We propose a model to increase understanding of the process of becoming a mother and breastfeeding, after the infant's discharge from the NU. The mother's emotional expressions in this process showed pendular swings from feeling emotionally exhausted to feeling relieved, from experiencing an insecure to a secure bond, and from regarding breastfeeding as being non-reciprocal to being reciprocal. Unresolved grief, the institutional authority at the NU and experiences of shame were three of the central barriers to a secure and reciprocal relationship. The pendular changes give us a deeper understanding of the variations in both attachment and attunement. Perhaps the negative extremes are more prominent among these mothers on account of their infant's illness and their NU experiences. If our proposed model is valid, it is vital that these findings are considered by those involved in the short- and long-term care in order to support the mothers to establish a secure bond, comprising both attachment and attunement.

Factors influencing implementation of kangaroo holding in a Special Care Nursery

PURPOSE

To describe factors identified by nurses that promote kangaroo holding in the Special Care Nursery (SCN) environment.

STUDY DESIGN AND METHODS

Descriptive survey. Sixty-seven experienced registered nurses completed a survey to identify factors that support the implementation of kangaroo holding, including assessment strategies of the infant and family, staffing requirements, and necessary environmental considerations at a 70-bed tertiary care, Level III SCN.

RESULTS

Although the primary factor for implementing kangaroo holding was the assessed physiologic stability of the infant (stated by 98.5% of nurses), other factors identified as integral components included adequate staffing patterns, maternal readiness, and encouragement from management. Nurses with 5 or more years of SCN practice were more likely to implement kangaroo care (KC) as an intervention to support attachment for any gestational age neonate.

CLINICAL IMPLICATIONS

The nurses in this study identified management support as an essential factor in utilizing KC, including "educational programs," "adequate staffing" (so coworkers could help if necessary), and "encouragement" from management as factors that support the practicing nurse in instituting KC. Nursing managers can use this information to help start KC programs in their settings that include adequate education for staff, appropriate staffing to allow time for parent education, and a supportive approach toward fostering KC among infants and parents.

Use of factor analysis in Journal of Advanced Nursing: literature review

AIM

This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing.

BACKGROUND

Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable.

METHOD

Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study.

RESULTS

One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used.

CONCLUSIONS

Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis.

Being in an alien world: Danish parents' lived experiences when a newborn or small child is critically ill

Parents of critically ill small children have received quite a lot of attention in nursing and allied health literature. However, no documented studies were found from Danish paediatric or neonatal contexts. The aim of the study therefore was to identify Danish parents' lived experiences during a newborn or small child's critical illness. The study was undertaken in a human caring perspective assuming that caring is primary and relational, and that persons are concerned when things matter to them. Thirteen parents were interviewed twice, and data were analysed following Van Manen's phenomenological methodology. The findings revealed that being a parent when a newborn or small child is critically ill resembled being in another world, alien from what they knew and had earlier experienced. The parents wanted to be close to the child, they were seeking for an understanding of what happened, and they felt inexperienced and insecure but at the same time they were attentive and vigilant. The sub-themes that were more prominent were 'a need to be there', 'What is going on?', 'being vigilant', 'being a spectator to your own life', and 'oscillating between hope and hopelessness'. The study implies that the staff needs to help the parents perceive some kind of meaning of what is going on, to instill hope despite not knowing the outcome, and to accept and respect the parents' style of coping with stress and concern for their sick child.

Hope, disclosure, and control in the neonatal intensive care unit

The parents of critically ill newborns who have been admitted to a neonatal intensive care unit (NICU) generally face several challenges. Included in these challenges is the possibility of having access to information and a certain level of disclosure about the diagnosis, treatment options, and prognosis for their newborn. A related challenge is the ability to have some control over the care of their newborn. In this article, I (first author) share my own experiences of having a child admitted to an NICU, and I discuss how a lack of disclosure affected the decision making and involvement I had in my child's care and hindered my ability to find hope. A loss of hope can both contribute to a sense of powerlessness and exacerbate the negative aspects of these NICU experiences. I argue that when health care providers offer parents the disclosure they want and need, as well as a certain amount of control over the care of their child while in the NICU, the ability of parents to find hope will be increased, and they will be better able to cope successfully in the NICU environment.