From alienation to familiarity: experiences of mothers and fathers of preterm infants

Mothers and Fathers in NICU: The Impact of Preterm Birth on Parental Distress

Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85) and 19 fathers (age = 34.92 ± 4.58) of preterm infants (GA = 30.96 ± 2.97) and 20 mothers (age = 40.08 ± 4.76) and 20 fathers (age = 40.32 ± 6.77) of full-term infants (GA = 39.19 ± 1.42) were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers’ responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay) and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.

Establishment of the Relationship Between Fathers and Premature Infants in Neonatal Units

BACKGROUND

Parents and their preterm infants (born between 32-37 weeks of gestation) are often overlooked by the healthcare system. And very little attention is given to the relationship parents develop with their infants in the neonatal unit (NNU). Specifically, very few studies focused on fathers and how they establish a relationship with their infants. However, we know that the father-infant relationship is extremely important for their future social development and more.

PURPOSE

This article presents the results of a qualitative study of the establishment of the father-premature infant relationship in an NNU.

METHODS/SEARCH STRATEGY

The study's theoretical framework was Bell's model of the parent-infant relationship, which encompasses discovery, physical proximity, communication, involvement, and emotional attachment. Ten fathers of premature infants (gestational age: 32-37 weeks) participated in 2 semistructured interviews (1 individual and 1 "in situ," ie, at the infant's bedside) during the first week following the premature birth.

FINDINGS/RESULTS

The results confirm the emergence of different components of the relationship between fathers and their children from the first days of hospitalization in the NNU. The commitment component is the basis for the development of other components in the relationship with their children. Furthermore, involvement influences the deployment of emotional attachment, discovery, physical proximity, and communication toward premature infants. Similarly, the 5 themes of the model can be seen as forming a dynamic nexus in which each theme influences the others.

IMPLICATIONS FOR PRACTICE

For neonatal nurses, this model of the early father-child relationship helps the understanding of the deployment of that relationship according to 5 components. Similarly, it provides awareness of the experiences of fathers so that nurses can be better equipped to support and individualize interventions tailored to their specific needs, thus helping them develop and sustain the relationship with their children.

IMPLICATIONS FOR RESEARCH

This study allows us to better understand fathers' experience regarding the establishment of the relationship to their premature infants born between 32 and 37 weeks of gestation. However, there is little understanding about the early paternal experience and more research on this dyad is necessary in neonatology.

Parenting very preterm infants and stress in Neonatal Intensive Care Units

BACKGROUND

Assessing parental stress during infants' hospitalization in Neonatal Intensive Care Units (NICU) is essential to identify parents at risk for immediate and extended physical and emotional burden.

AIMS

To identify sources of stress in mothers and fathers of very preterm infants hospitalized in NICU, and their association with sociodemographic, obstetric and infants' characteristics.

STUDY DESIGN

Observational and cross-sectional study conducted between July 2013 and June 2014.

SUBJECTS

Parents of very preterm infants hospitalized in all level III NICU in the Northern Health Region of Portugal were consecutively and systematically invited to participate in this study, being included 120 mothers and 91 fathers (participation rate: 96.8%).

OUTCOME MEASURES

The Portuguese version of the Parental Stressor Scale: Neonatal Intensive Care Unit was used.

RESULTS

The overall experience of hospitalization was classified as more stressful than the median for the subscales. "Change in parental role" was classified as the most stressful subscale by mothers (Median (P25-P75): 4.1(3.2-4.7)) and fathers (Median (P25-P75): 3.2(2.4-4.0)). Mothers scored significantly higher in all subscales. For mothers, multiple pregnancy was associated with lower levels of stress regarding "change in parental role" (β=-0.597; 95% CI=-1.020 to -0.174) and "overall stress" (β=-0.603; 95% CI=-1.052 to -0.153). Being ≥30years old was found to be a significant predictor for decreased fathers' stress.

CONCLUSIONS

This study raises awareness for the need to develop sensitive instruments that take notice of gender, social support and family-centered care. The implementation of interventions focused on reducing parental stress is crucial to diminish disparities in family health.

A life uncertain - My baby's vulnerability: Mothers' lived experience of connection with their preterm infants in a Botswana neonatal intensive care unit

BACKGROUND

Preterm and low-birth weight infants are often separated from their mothers when admitted to neonatal units for stabilisation of body temperature and technological support.

OBJECTIVES

The aim of the study was to explore and describe the lived experiences of mothers regarding care of their hospitalised preterm infants in a neonatal unit in a public hospital in Gaborone, Botswana.

METHOD

This study utilised a qualitative exploratory and descriptive phenomenological study design. Mothers of hospitalised preterm infants were purposefully selected, with whom there was extensive engagement. Two in-depth interviews were conducted with each participant (P).

RESULTS

Mothers were shocked by the sudden birth of a preterm infant and found the neonatal environment intimidating. This increased their fear and anxiety and delayed development of a relationship with their infants. Support from staff, other mothers in the neonatal unit and family members enabled the mothers to overcome their fear and to develop an emotional connection with their infants.

CONCLUSION

On-going supportive communication with the mothers by healthcare professionals promotes their confidence and competence in caring for their preterm infants, which in turn promotes mother-infant attachment.

Differences and similarities between mothers and fathers of premature children: a qualitative study of parents' coping experiences in a neonatal intensive care unit

Background

The aim of this study was to explore and describe the coping experiences of parents to children admitted to a neonatal unit.

Methods

A qualitative research approach was chosen, using in-depth interviews with eight fathers and eight mothers.

Results

The main findings were that parents with previous complicated births had more difficulties in coping compared to those parents with no experience with complications. Coping seemed easier where parents’ opinions were heard regarding their baby’s care and when both parents were present in the neonatal intensive care unit (NICU). The main similarities between mothers and fathers were the reluctance to speak their opinions on childcare, and both experienced a sense of alienation and problems in bonding with the baby. They also needed a limitation on the number of visitors in the NICU. Differences between mothers and fathers were that fathers tried hard to be the strong partner in the relationship, and were more concerned with the mother if she was seriously ill postpartum, while mothers were more concerned for their baby. Mothers’ postpartum period was felt as more stressful if the father was not present, but mothers were also better at welcoming support from the health personnel.

Conclusion

This study highlights the parent’s coping experiences in NICUs. Coping seemed easier where parents’ opinions were heard. Nurses in the NICU should take the former experiences of the parents into consideration when nursing in the NICU and planning for discharge.

Mothering a Preterm Infant Receiving NIDCAP Care in a Level III Newborn Intensive Care Unit

The purpose of the study is to describe the unique meaning and significance of the essential elements of mothering a preterm infant receiving Newborn Individualized Developmental Care and Assessment Program (NIDCAP) care in a level III NICU. The overall aim was to promote an increased understanding among healthcare practitioners of the experience of this group of women.

DESIGN AND METHODS

The authors utilized an existential-phenomenologic method to investigate the experience of 7 mothers of a preterm infant 30weeks gestation or less at birth.

RESULTS

Analysis of interview transcripts revealed one overarching theme, parenting with permission, and three essential themes with nine underlying subthemes: choosing to participate (subthemes: managing, settling in, making friends), dealing with people (subthemes: meeting needs, facing judgment, and recognizing not everyone is 'on board,' and coming to feel like a mother (subthemes: overcoming fear, gaining understanding, and feeling empowered).

CONCLUSIONS/PRACTICE IMPLICATIONS

Mothers universally praised NIDCAP for the education and support it provided them. However findings also suggest that great sensitivity and patience is required by professionals to assist mothers to overcome their fear, gain confidence, and participate in NIDCAP without feeling judged. In addition private rooms were found to hold great significance for mothers and should be maintained for the entire hospitalization whenever possible. Finally, ongoing NIDCAP education/support for staff and regular team meetings to discuss and problem-solve concerns are suggested. This might address inconsistent adherence to the NIDCAP care plan by some nurses, which is the greatest source of maternal conflict and frustration.

“I thought he was ugly”: Mothers of extremely premature children narrate their experiences as troubled subjects

This article explores the ways in which mothers of extremely premature children make sense of their negative feelings towards their newborn child and their strategies for performing “proper motherhood”. The analysis was guided by discursive psychology and the feminist debate on attachment, mother–infant bonding, and “good motherhood”. The empirical material was created within a sub-study that set out to explore mothers’ and fathers’ experiences of having a premature child and was part of a project investigating the need for support for premature children and their families. Parents were interviewed about the pregnancy, their experiences of the birth and hospital period, the process of going home, the experiences of pre-school and school, and thoughts about the future. The stories of four mothers, which dealt with negative feelings towards their child and the guilt and distress related to this, were selected for analysis. The mothers handled their troubled positions as subjects unable to feel “motherly love” by referring to notions of attachment and bonding, and good motherhood as being loving and caring. Yet, the mothers also talked about motherhood as being socially constructed, as duties that can be performed without the “right motherly feelings”, and as something that men could also perform.

Needs Perceived by Parents of Preterm Infants: Integrating Care Into the Early Discharge Process

The birth of a preterm infant can have a great emotional impact on the parents when the length of stay is long. Early discharge programs facilitate the transition to the home and have beneficial effects on both the parents and children. However, only a few studies have been conducted to identify the real needs of parents of preterm infants and to determine whether early discharge programs meet such needs. The main objective of this study was to identify the experiences and obstacles, during hospitalization and after discharge, of fathers and mothers of preterm infants who did or did not participate in an early discharge program.

METHOD

A qualitative study using semi-structured interviews was performed and included 23 parents of preterm infants. Thematic analysis was performed with the assistance of Atlas.ti 6.2 software.

RESULTS

Two main themes were identified: the emotional experience and obstacles to care during hospitalization and the emotional experiences and obstacles at home related to the early discharge program. The results indicated that preterm birth initially has a deep emotional impact on parents.

DISCUSSION

There is a remarkable lack of coordination regarding the information provided to parents on their infant's health status. Being first-time parents seems to be an important factor, although further evidence supporting this notion should be provided.

CONCLUSION

Parents considered early discharge programs to be very useful in addressing the emotional aspects of hospitalization and the acquisition of neonatal care skills. Parents claim that the coordination and the information provided should be improved.

A Qualitative Study: NICU Nurses as NICU Parents

BACKGROUND

The neonatal intensive care unit (NICU) nurse who has become a NICU mother is in a unique position to evaluate the NICU experience. Because of her professional experience, she has an understanding of the NICU and healthcare environment.

PURPOSE

This study examines the lived experiences of these women, how they coped with their roles as professionals and parents, and how their responses differed from those of NICU mothers without professional NICU experience.

METHODS

A narrative qualitative design was utilized to examine the lived experiences of study participants. Face-to-face taped interviews were conducted. Responses were transcribed, then analyzed using both computer-assisted data analysis and manual analysis.

RESULTS

Six nurses participated. Their responses were grouped into 6 categories on the basis of previous research. These participants experienced many of the same issues as NICU mothers without professional experience. However, there were meaningful differences. NICU nurses were vocal advocates from the first day of admission. They were also knowledgeable about how to negotiate and work around the system.

IMPLICATIONS FOR PRACTICE

NICU nurses who have had the experience of having an infant in the NICU have seen the healthcare system from both sides and can be advocates for family-centered care, helping their coworkers understand what works and what does not work for NICU families.

IMPLICATIONS FOR RESEARCH

Qualitative research focused on the experiences of healthcare team members who utilize the healthcare system as patients or family members can provide an articulate and educated insight into the experiences of all who use the healthcare system.

Anxiety levels of mothers with newborns in a Neonatal Intensive Care Unit in Turkey

Objective:

To compare the anxiety levels of mothers with newborns in a Neonatal Intensive Care Unit (NICU) and mothers with healthy newborns in a postpartum care service (PCS).

Methods:

This descriptive study was conducted in state and medical school hospitals located in Eskisehir and Afyon, Turkey. The first 200 mothers, including mothers with newborns in a PCS (n=100) and mothers with newborns in a NICU (n=100); participants were followed starting March 1, 2014. Questionnaires to determine the characteristics of mothers and newborns were used as data collection tools, including the State-Trait Anxiety Inventory Scale (STAI TX-1 – STAI TX-2).

Results:

Trait anxiety levels were not significantly different between mothers with newborns in the NICU and mothers with newborns in PCS (t=0.588, p=0.557), whereas state anxiety levels were significantly different between the two groups (t=-5.109, p=<0.001). The state anxiety levels of mothers whose infants were in the NICU were determined to be higher compared to those of mothers whose infants were in PCS.

Conclusion:

Being a mother of a sick newborn can elevate anxiety and lead to in mothers. During this challenging time, the support of nurses can increase mothers’ abilities to cope with the stress of a sick newborn.

Web Camera Use of Mothers and Fathers When Viewing Their Hospitalized Neonate

BACKGROUND

Mothers and fathers of neonates hospitalized in a neonatal intensive care unit (NICU) differ in their experiences related to NICU visitation.

PURPOSE

To describe the frequency and length of maternal and paternal viewing of their hospitalized neonates via a Web camera.

METHODS/SEARCH STRATEGY

A total of 219 mothers and 101 fathers used the Web camera that allows 24/7 NICU viewing from September 1, 2010, to December 31, 2012, which included 40 mother and father dyads. We conducted a review of the Web camera's Web site log-on records in this nonexperimental, descriptive study.

FINDINGS/RESULTS

Mothers and fathers had a significant difference in the mean number of log-ons to the Web camera system (P = .0293). Fathers virtually visited the NICU less often than mothers, but there was not a statistical difference between mothers and fathers in terms of the mean total number of minutes viewing the neonate (P = .0834) or in the maximum number of minutes of viewing in 1 session (P = .6924). Patterns of visitations over time were not measured.

IMPLICATIONS FOR PRACTICE

Web camera technology could be a potential intervention to aid fathers in visiting their neonates. Both parents should be offered virtual visits using the Web camera and oriented regarding how to use the Web camera.

IMPLICATIONS FOR RESEARCH

These findings are important to consider when installing Web cameras in a NICU. Future research should continue to explore Web camera use in NICUs.

Relação pai-bebê no contexto da prematuridade: gestação, internação do bebê e terceiro mês após a alta hospitalar

O presente estudo buscou compreender o impacto do nascimento pré-termo na relação pai-bebê. Participaram do estudo três pais de bebês nascidos pré-termo, com idade entre 27 e 45 anos e que residiam com a mãe do bebê. Foi utilizado um delineamento longitudinal de estudo de caso coletivo, envolvendo entrevistas sobre a relação do pai com o bebê no período gestacional, no período de internação da criança e no terceiro mês após a alta hospitalar. Os relatos foram analisados por meio de análise de conteúdo qualitativa. De modo geral, constataram-se expressivas transformações na interação pai-bebê no lapso de tempo compreendido entre a gestação e o terceiro mês após a alta hospitalar. Além disso, os resultados revelaram a importância das visitas frequentes ao bebê durante a internação, para o estabelecimento daquela relação. Por outro lado, ficou evidente o receio de contato físico, em especial nas primeiras semanas de hospitalização, o que deve ser considerado nas intervenções pai-bebê durante a internação.

Becoming the parent of a preterm infant: A meta-ethnographic synthesis

Introduction

The adoption of family-centred care within neonatal intensive care has been increasing in profile. However, there has been limited exploration of the concept of parenting as an occupation as a means of supporting parent engagement.

Method

A meta-ethnographic synthesis was conducted to explore the body of literature regarding experiences in the neonatal intensive care unit that enable parents to participate in parenting occupations. Five databases were systematically searched with 35 identified studies appraised using the Critical Appraisal Skills Programme tool and included in the synthesis.

Findings

Eight themes emerged from the synthesis: relinquishing the anticipated role of parent; feeling vulnerable and powerless; juggling roles and responsibilities; (re)claiming an alternative parental role; navigating environmental boundaries; developing partnerships with staff; coming to know the baby; and adapting to parenting.

Conclusion

The experiences that enable parents to participate in parenting occupations are multi-faceted, and explicate the process of occupational adaptation that occurs in relation to parenting a preterm infant. These findings provide occupational therapists with greater insight into the experiences of parents of preterm infants in the neonatal setting.

Parental presence on neonatal intensive care unit clinical bedside rounds: randomised trial and focus group discussion

BACKGROUND

There are limited data to inform the choice between parental presence at clinical bedside rounds (PPCBR) and non-PPCBR in neonatal intensive care units (NICUs).

METHODS

We performed a single-centre, survey-based, crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay >11 days. Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period. At the conclusion of each arm, parents completed the 'NICU Parental Stressor Scale' (a validated tool) and a satisfaction survey. After completion of the trial, we surveyed all healthcare providers who participated at least in one PPCBR rounding episode. We also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR.

RESULTS

A total of 72 parents were enrolled in this study, with 63 parents (87%) partially or fully completing the trial. Of the parents who completed the trial, 95% agreed that parents should be allowed to attend clinical bedside rounds. A total of 39 healthcare providers' surveys were returned and 35 (90%) agreed that parents should be allowed to attend rounds. Nine healthcare providers and 8 parents participated in an interview or focus group, augmenting our understanding of the ways in which PPCBR was beneficial.

CONCLUSIONS

Parents and healthcare providers strongly support PPCBR. NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns.

TRIAL REGISTRATION NUMBER

Australia and New Zealand Clinical Trials Register number, ACTRN12612000506897.

Parents' experiences of communication with neonatal intensive-care unit staff: an interview study

Background

An infant’s admission to a neonatal intensive-care unit (NICU) inevitably causes the parents emotional stress. Communication between parents and NICU staff is an essential part of the support offered to the parents and can reduce their emotional stress. The aim of this study was to describe parents’ experiences of communication with NICU staff.

Methods

A hermeneutic lifeworld interview study was performed with 18 families whose children were treated in the level III NICU at a university hospital in Sweden. The interviews were analysed to gain an interpretation of the phenomenon of how parents in the NICU experienced their communication with the staff, in order to find new ways to understand their experience.

Results

Parents’ experience of communication with the staff during their infant’s stay at the NICU can be described by the main theme ‘being given attention or ignored in their emotional situation’. The main theme derives from three themes; (1) meeting a fellow human being, (2) being included or excluded as a parent and (3) bearing unwanted responsibility.

Conclusions

This study shows that parents experienced communication with the NICU staff as essential to their management of their situation. Attentive communication gives the parents relief in their trying circumstances. In contrast, lack of communication contributes to feelings of loneliness, abandonment and unwanted responsibility, which adds to the burden of an already difficult situation. The level of communication in meetings with staff can have a decisive influence on parents’ experiences of the NICU.

The staff should thus be reminded of their unique position to help parents handle their emotional difficulties. The organization should facilitate opportunities for good communication between parents and staff through training, staffing and the physical health care environment.

Prevalence and factors associated with depressive symptoms in mothers with infants or toddlers

BACKGROUND

The objective of this study is to explore the prevalence of and factors associated with depressive symptoms in mothers with young children.

METHODS

This is a cross-sectional face-to-face study performed between January 1, 2010 and June 30, 2011. Mothers of premature infants with a gestational age of less than 37 weeks were recruited. Premature infants with any congenital anomaly or severe congenital heart disease were excluded. Controls were mothers of full-term infants with birth weight over 2500 g and without admission to a neonatal intensive care unit. Outcome measures included the Center for Epidemiologic Studies Depression Scale for maternal depressive symptoms, the Family Apgar Index for family support, and the Chinese Maudsley Personality Inventory for personality traits.

RESULTS

A total of 102 mothers of preterm infants and 111 mothers of full-term infants were recruited. The prevalence of depressive symptoms was 27.7% (59/213) in all mothers of this study, 29.4% (30/102) in mothers of preterm infants, and 26.1% (29/111) in mothers of full-term infants. Predictors of maternal depressive symptoms included the following: extended family structure, lack of postpartum confinement, low family support, and a personality characterized by neuroticism.

CONCLUSION

Depressive symptoms were common among mothers of young children. Family function and neurotic personality were highly correlated with depressive symptoms in mothers caring for young children. Pediatric health care providers are suggested to screen for maternal depressive symptoms and provide family-oriented support in Taiwan.

Releasing the flood: a qualitative case study of one high-risk father's journey through the labor unit and neonatal intensive care unit

Fatherhood is a turning point in the life of many men, but for fathers from fragile backgrounds, the birth of a premature child may be the catalyst for a fresh start. This case study details the experience of a young black man from a high-risk background during the pregnancy, birth, and hospitalization of his premature son. Fathers from backgrounds marked by violence and chaos may find the stability they crave in a hospital environment that provides comfort, familial cohesion, and an empowering sense of purpose. Fathers who lack male role models in their lives may benefit from mentoring relationships formed with male nurses in the neonatal intensive care unit. Longstanding neglected needs for available presence and guidance can be met by caring healthcare professionals who take the time to listen to these fathers and share personal experiences. While the struggle to break patterns of the past is complicated by low self-worth, healthcare providers can reinforce a sense of personal value both by providing a specific role for fathers and by engaging them in meaningful conversation. Findings provide valuable information on the lifeworld of black fathers from socially compromised urban neighborhoods and implications for healthcare practitioners working with this population.

Parents' experiences of their premature infants' transportation from a university hospital NICU to the NICU at two local hospitals

The aim of this study was to describe how the parents of premature infants experience the transportation of their baby from the neonatal intensive care unit at a university hospital (NICU-U) to such a unit at a local hospital (NICU-L). This descriptive qualitative study comprises interviews with nine sets of parents and two mothers. The qualitative content analysis resulted in one theme: living in uncertainty about whether the baby will survive, and three categories: being distanced from the baby; fearing that something would happen to the baby during transportation; and experiencing closeness to the baby. The results also revealed that the parents experienced developmental, situational and health-illness transitions.

Reorganizing life: A qualitative study of fathers' lived experience in the 3 years subsequent to the very preterm birth of their child

This is the second part of a study that is following eight Swedish fathers of very preterm children using qualitative interviews. The aim was to illuminate fathers' lived experience of the 3 years since the birth of their very preterm child using a hermeneutic phenomenological method. The fathers described their lived experience as a process of reorganizing life, which constituted the overarching theme. They described a journey from the past to the present in which they adapted ordinary family life. The sub-themes identified were struggling to endure, experiencing empowerment, and building a secure base. The results may serve as a basis for neonatal staff to optimize care for both fathers and mothers during the child's hospitalization, as well as subsequent to their discharge.

Preterm birth and maternal psychological health

Studies have shown that preterm birth significantly influences mothers' psychological health. This study aimed to identify factors associated with preterm birth and assess postnatal depression and anxiety symptoms in mothers of preterm infants (n = 75) compared to mothers who delivered at term (n = 125) in a Greek sample. Multiple pregnancies, assisted reproduction technology, caesarean section, non-Greek ethnicity and smoking during pregnancy were associated with preterm delivery. Moreover, preterm infants' mothers had higher depression, state anxiety and trait anxiety scores. These findings suggest that addressing preventable causes of preterm delivery is crucial, while mothers of preterm infants should receive postnatal support.

The effect of person-centred communication on parental stress in a NICU: a randomized clinical trial

AIM

To investigate the effect of the Guided Family-Centred Care intervention, developed by the lead author, on parental stress in a neonatal intensive care unit (NICU).

METHODS

Parents (n = 134) of infants born ≤34 weeks gestational age were randomly assigned to a standard care group (n = 60) or intervention group (n = 74) between April 2011 and August 2012. Guided Family-Centred Care components used were as follows: scheduled nurse-parent dialogues, semi-structured reflection sheets and person-centred communication. Parental stress was assessed at discharge using parent-reported outcomes on the Nurse Parent Support Tool and the Parental Stressor Scale: Neonatal Intensive Care Unit.

RESULTS

The total stress scores reported by parents did not vary significantly between the intervention and standard groups, with a mean (SD) of 2.70 (0.67) versus 2.84 (0.71), respectively. However, the confidence interval included the prespecified clinical significance level. Subscale and Nurse Parent Support Tool scores did not differ between the groups. Overall, mothers reported more stress than fathers (p < 0.001).

CONCLUSION

Our study was unable to demonstrate the effect of person-centred communication using the Guided Family-Centred Care intervention. It may be necessary to replicate the design to address the risk of contamination and add instruments sensitive to human interaction.

Enhancing person-centred communication in NICU: a comparative thematic analysis

AIMS AND OBJECTIVES

Aims of this article were (a) to explore how parents of premature infants experience guided family-centred care (GFCC), and (b) to compare how parents receiving GFCC versus standard care (SC) describe nurse-parent communication in the neonatal intensive care unit.

BACKGROUND

Family-centred care (FCC) is acknowledged as fundamental to supporting parents of premature infants, and communication is central to this practice. Accordingly, nurses need good communication skills. GFCC is an intervention developed to improve nurse-parent communication in the neonatal intensive care unit. This intervention helps nurses to realize person-centred communication as an approach to optimize contemporary practice.

DESIGN

Our qualitative study had a descriptive and comparative design using semi-structured interviews to explore the parent's experience of GFCC.

METHODS

We conducted 10 dyad interviews with parents (n = 20) and two individual interviews with mothers of premature infants (n = 2). Parents in the intervention group versus SC group were 13 versus 9. Thematic analysis was applied.

FINDINGS

GFCC was generally experienced as supportive. Three interrelated themes were identified that illustrated how the intervention helped parents cope as persons, parents and couples: (a) discovering and expressing emotions, (b) reaching a deeper level of communication, and (c) obtaining mutual understanding. In contrast, SC communication was more superficial and less structured. Factors such as inaccessibility of nurses, inability to ask for assistance and parent popularity impaired successful communication.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Our study suggested that compared to SC, GFCC provided structured delivery of supportive communication between nurses and parents of premature infants. The intervention promoted the discovery of the parents' individual preferences and concerns, which enabled more focused communication, and set the stage for better nurse-parent and parent-parent understanding. We recommend GFCC as a method to improve communication in the neonatal intensive care unit.

Preparing for NICU discharge: mothers' concerns

PURPOSE

To quantify mothers' concerns in anticipation of their infant's discharge from the NICU.

DESIGN

An exploratory, cross-sectional survey design was used.

SAMPLE

A convenience sample of 150 mothers.

MAIN OUTCOME VARIABLE

The focus was the mothers' concerns about their infant's impending discharge.

RESULTS

The mothers expressed confidence in their ability as a caregiver but expressed concern about being tired, the need for readmission to the hospital, and missing a change in the infant's conditions.

Maternal satisfaction with administering infant interventions in the neonatal intensive care unit

OBJECTIVE

To examine mothers' satisfaction with administering interventions for their preterm infants and with the helpfulness of the study nurse by comparing massage with auditory, tactile, visual, and vestibular stimulation (ATVV intervention), kangaroo care, and education about equipment needed at home and to explore whether mother and infant characteristics affected maternal satisfaction ratings.

DESIGN

Three-group experimental design.

SETTING

Four neonatal intensive care units (NICUs) (two in North Carolina, two in Illinois).

PARTICIPANTS

Two hundred and eight (208) preterm infants and their mothers.

METHODS

When the infant was no longer critically ill, mother/infant dyads were randomly assigned to ATVV, kangaroo care, or the education group all taught by study nurses. At discharge and 2 months corrected age, mothers completed questionnaires.

RESULTS

All groups were satisfied with the intervention and with nurse helpfulness, and the degree of satisfaction did not differ among them. Intervention satisfaction, but not nurse helpfulness, was related to recruitment site. Older, married, and minority mothers were less satisfied with the intervention but only at 2 months. Higher anxiety was related to lower intervention satisfaction at discharge and lower ratings of nurse helpfulness at discharge and 2 months. More depressive symptoms were related to lower nurse helpfulness ratings at 2 months.

CONCLUSIONS

Mothers were satisfied with interventions for their infants regardless of the intervention performed. Maternal satisfaction with the intervention was related to recruitment site, maternal demographic characteristics, and maternal psychological distress, especially at 2 months. Thus, nursing interventions that provide mothers with a role to play in the infant's care during hospitalization are particularly likely to be appreciated by mothers.

The parental experience of having an infant in the newborn intensive care unit

The purpose of this systematic review was to explore and describe the experience of parents with an infant in the newborn intensive care unit (NICU). A literature search covering the period 1998-2008 was conducted. Fourteen articles reporting qualitative studies describing parental experiences and meeting the inclusion criteria were evaluated and themes were identified. Findings revealed that parents with an infant in the NICU experience depression, anxiety, stress, and loss of control, and they vacillate between feelings of inclusion and exclusion related to the provision of health care to their neonate. Nursing interventions that promote positive psychosocial outcomes are needed to decrease parental feelings of stress, anxiety, and loss of control. Interventions need to focus on family-centered and developmentally supportive care.

Caring for a preterm infant at home: a mother's perspective

The purpose of this phenomenological study was to examine the experiences of mothers of preterm infants during the first 6 months at home following discharge from a neonatal intensive care unit (NICU). A purposeful sample of 8 mothers was gathered and interviews were conducted over a 4-month period. Each interview was audio recorded and took place in the study participant's home or another place of her choosing. Interviews were transcribed verbatim and analyzed independently with themes being identified and organized for each participant. From these analyses, the themes of fear, exhaustion, determination, and thankfulness were identified as being common to all study participants and became the basis for developing the essence of the phenomenon. The essence of this experience for these mothers was their resolve to do whatever was necessary to ensure the best possible outcomes for their infants. The data gathered from these personal interviews will serve to further inform our understanding of this important time from the perspective of those who experienced it, as well as aid in the design of interventions to address the specific needs of these mothers prior to NICU discharge.

Parents' perceptions regarding readiness for their infant's discharge from the NICU

PURPOSE

To identify what parents need to feel ready for the discharge of their infant from the neonatal intensive care unit (NICU).

DESIGN

Qualitative.

SAMPLE

20 parents of infants admitted to a Canadian Level III NI CU were interviewed (2011-2012) and asked to identify what they require to feel ready for discharge. Interview transcripts underwent qualitative content analysis to produce a descriptive summary of parents' perceptions of their needs.

RESULTS

Parents indicated a need for information and hands-on experience to enhance their readiness for discharge. Observations of their infant and of the NI CU environment impacted parents' perceptions of their infant's readiness for discharge, which influenced perceptions of their own readiness for discharge. Finally, parents require tailoring of information and experiences to meet the unique needs of their family.

Parental perceptions and experiences after childbirth: a comparison between mothers and fathers of term and preterm infants

BACKGROUND

Parents experience a lot of positive and negative feelings and emotions after birth. The main purpose of this study was to compare perceptions and experiences of mothers and fathers with term, moderately and very preterm infants.

METHODS

We included 202 infants with both parents, divided into three groups: 1) term infants (≥ 37 weeks' gestation), 2) moderately preterm infants (≥32-<37 weeks' gestation) and 3) very preterm infants (< 32 weeks' gestation). The Clinical Interview for Parents of High-risk Infants (CLIP) was used to examine parental perceptions and experiences in eight areas: 1) Infant's current condition, 2) Course of the pregnancy, 3) Labor and delivery, 4) Relationship with infant and feelings as a parent, 5) Reactions to hospital and staff, 6) Support system, 7) Discharge and beyond, and 8) Quality of narratives during the interview.

RESULTS

The lower the gestational age of the infant, the more negative parental experiences and perceptions were on the following five areas: infant's current condition, pregnancy course, labor and delivery, relationship with the infant, and discharge and beyond. No differences were found between maternal and paternal perceptions on any of the eight CLIP areas.

CONCLUSIONS

Negative parental perceptions and experiences were mainly associated with the gestational age of the infant and not at all with the gender of the parent. These findings resulted in several recommendations to optimize care for parents after preterm birth.

Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants

OBJECTIVE

To investigate the influence of co-care facilities and amount of skin-to-skin contact during Neonatal Intensive Care Unit (NICU) stay on maternal stress in mothers of preterm infants at two months corrected age.

METHODS

A prospective cohort study that involved 300 mothers of pre-term infants was conducted in four NICUs (two with co-care facilities and two with non co-care) in Sweden. Data on duration of skin-to-skin contact per day for all days admitted to the NICU were collected using self-reports. Maternal stress was measured by the Swedish Parental Stress Questionnaire (SPSQ) at two months of infant's corrected age.

RESULTS

Mothers whose infants were cared for in a NICU with co-care facilities reported significantly lower levels of stress in the dimension of 'incompetence' compared to mothers whose infants had been cared for in non co-care NICUs. The amount of skin-to-skin experienced during the neonatal stay was not significantly associated with levels of maternal stress at two months corrected age.

CONCLUSION

The finding that mothers who do not experience co-care facilities experience greater levels of stress in relation to feelings of incompetence is of concern. Improvements to NICU environments are needed to ensure that mother-infant dyads are not separated.

Factors affecting parents' presence with their extremely preterm infants in a neonatal intensive care room

AIM

To describe parents' experiences of factors that influenced their stay with their extremely preterm infants in a neonatal intensive care unit (NICU).

METHODS

This study has a qualitative descriptive design based on semistructured interviews conducted with seven mothers and six fathers.

RESULTS

Opportunities to stay overnight together with their infant facilitated parental presence, and opportunities for taking over their infant's care empowered the parents in their parental role and increased their motivation to stay. Kangaroo mother care helped them to feel in control and feel needed, which increased their presence. High levels of illumination and noise rendered it difficult for parents to sleep and stay overnight with the infant. Low staffing levels limited their use of kangaroo mother care when they had to wait for assistance to transfer the infant from the incubator. Several participants perceived the performance of painful procedures on their child as stressful and as an obstacle to their presence.

CONCLUSION

Kangaroo mother care and active involvement in the infant's care gave parents a sense of control and strengthened their motivation to be with their infant. High levels of noise and illumination and a dismissive staff attitude were obstacles to parents' presence.

Nursing Behaviors which Facilitate the Grief Work of Parents with Premature Infants in Neonatal Intensive Care Unit: A Comparison of Mothers and Fathers

Background:

The birth of a child is an event to be remembered. However, a premature birth may shock the parents and cause their grief. Understanding differences between mothers and fathers can help nurses in providing nursing supports.

Objectives:

This study was performed with the aim of comparing nursing behaviors which facilitate grief work for parents of premature infants hospitalized in the NICU from perspectives of mothers and fathers.

Patients and Methods:

This comparative descriptive design was conducted among 40 pairs of mothers and fathers selected by convenience sampling method. The study was performed in 2011 using the Fordham Scale (1989). Data were analyzed with "wilcoxon ranks test" by using SPSS software version 13.

Results:

The mean scores of nursing behaviors which facilitate grief work were 2.81 ± 0.16 and 2.82 ± 0.29 in the perspectives of mothers and fathers, respectively. The Wilcoxon test did not show any statistically significant difference between mothers and fathers (P = 0.55).

Conclusions:

Despite expectations, provided nursing behaviors in mothers and fathers showed no difference in this study. Therefore, nursing policymakers and directors should take measures in order to provide appropriate services to the parents.

Mothers' stressor as the day of discharge from the NICU approaches

The purpose of this study was to determine the occurrence of stress and the areas of stress experienced by mothers as they prepare for their infants' transition from the neonatal intensive care unit to the home setting. A descriptive survey study was used to study mothers of infants anticipating discharge to home within 5 days. The author used a descriptive survey research design using the Parental Stressor Scale: Infant Hospitalization tool and a global measure of stress. The highest area of stress was parental role alterations. All mothers in the study reported experiencing stress related to their infants' anticipated discharge, with extremely high levels of stress reported by 34% of participants. These findings support the position that nurses are to provide guidance to mothers that strengthens their parenting role and relationship with their infants.

Integrating a sense of coherence into the neonatal environment

BACKGROUND

Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes.

DISCUSSION

In this paper we present a new perspective to neonatal care based on Aaron Antonovksy's Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed.

SUMMARY

Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned.

Becoming a parent to a child with birth asphyxia-From a traumatic delivery to living with the experience at home

The aim of this study is to describe the experiences of becoming a parent to a child with birth asphyxia treated with hypothermia in the neonatal intensive care unit (NICU). In line with the medical advances, the survival of critically ill infants with increased risk of morbidity is increasing. Children who survive birth asphyxia are at a higher risk of functional impairments, cerebral palsy (CP), or impaired vision and hearing. Since 2006, hypothermia treatment following birth asphyxia is used in many of the Swedish neonatal units to reduce the risk of brain injury. To date, research on the experience of parenthood of the child with birth asphyxia is sparse. To improve today's neonatal care delivery, health-care providers need to better understand the experiences of becoming a parent to a child with birth asphyxia. A total of 26 parents of 16 children with birth asphyxia treated with hypothermia in a Swedish NICU were interviewed. The transcribed interview texts were analysed according to a qualitative latent content analysis. We found that the experience of becoming a parent to a child with birth asphyxia treated with hypothermia at the NICU was a strenuous journey of overriding an emotional rollercoaster, that is, from being thrown into a chaotic situation which started with a traumatic delivery to later processing the difficult situation of believing the child might not survive or was to be seriously affected by the asphyxia. The prolonged parent-infant separation due to the hypothermia treatment and parents' fear of touching the infant because of the high-tech equipment seemed to hamper the parent-infant bonding. The adaption of the everyday life at home seemed to be facilitated by the follow-up information of the doctor after discharge. The results of this study underline the importance of family-centered support during and also after the NICU discharge.

Parents' experiences of information and communication in the neonatal unit about brain imaging and neurological prognosis: a qualitative study

AIM

To explore parental information and communication needs during their baby's care in the neonatal unit with a focus on brain imaging and neurological prognosis.

METHODS

Eighteen parents recruited from one neonatal unit in the United Kingdom participated in semi-structured qualitative interviews using a grounded theory approach. The topic guide focused on information received about neonatal brain imaging, diagnosis and prognosis, emotional impact and support.

RESULTS

Parents expressed different information needs influenced by their history, expectations, coping strategies and experiences. Most felt they initially were passive recipients of information and attempted to gain control of the information flow. Nurses were the main providers of information; doctors and other parents were also valuable. Attending ward rounds was important. Some parents felt accessing specific information such as the results of brain imaging could be difficult. Concerns about long-term developmental outcomes and the need for information did not diminish over time. The emotional impact of having a preterm baby had a negative effect on parents' ability to retain information, and all had an ongoing need for reassurance.

CONCLUSION

The findings provide insights about the needs and experiences of parents who have a continuing requirement for information about their infant's care, development and prognosis.