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

Rethinking stress in parents of preterm infants: a meta-analysis

BACKGROUND

With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress.

METHODS AND FINDINGS

A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants.

CONCLUSIONS

Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself.

Family support and education

Family involvement is essential to the developmental outcome of infants born into Neonatal Intensive Care Unit (NICU). In this article, evidence has been presented on the parent's perspective of having an infant in the NICU and the context of family. Key points to an educational assessment are also reviewed. Throughout, the parent's concerns and the educational needs of the family are shared, and strategies are given to help therapists enhance their teaching skills and ways to partner with parents. This article also introduces the NICU Discharge Path for parents "Preparing for Your Baby to Come Home". The Path educates parents on the steps towards home and encourages their participation in the process.

The father at the bedside: patterns of involvement in the NICU

Father's involvement is important to child development, yet little is known about how fathers are involved with their newborns in neonatal intensive care. The purpose of this study was to describe patterns of fathers' involvement with their infants during hospitalization. Eighteen fathers of infants hospitalized were interviewed and asked to describe how they were involved with their infants. Interview, sociodemographic, and infant medical data were analyzed using cross-case analysis to describe patterns of involvement. Three patterns were identified. Equal to mother fathers perceived their involvement to be the same as the mothers'. They were intrinsically motivated, not working, and spent many hours daily with their infants. They engaged in skin-to-skin care and bathed their infants. Mother more important fathers viewed the mothers' role as more important. They were working, visited a few hours most days, and perceived their role as supporting the mothers. Reluctant fathers were reticent to become involved, described extrinsic sources of motivation, and were fearful of handling their infants. Not all fathers wish to be involved to the same extent with their infants. Nurses need to assess fathers' preferences and facilitate involvement to the extent that they feel comfortable.

Neonatal nurses' perspectives of family-centred care: a qualitative study

AIMS AND OBJECTIVES

The aim of this study is to explore neonatal nurses' perspectives of their role in facilitating family centred care in the neonatal intensive care unit.

BACKGROUND

The philosophy of family centred care focuses on the health and wellbeing of the newborn and their family, through the development of a respectful partnership between the health care professional and the infant's parents. Many studies report family centred care in the context of paediatric care; however, few studies explore neonatal nurses' perspective of family centred care in the context of neonatal care.

DESIGN

Qualitative interpretative approach.

METHODS

Four focus groups and five individual face-to-face interviews were conducted with neonatal intensive care nurses (total n=33) currently practicing in a tertiary Neonatal Intensive Care Unit in Australia. Each focus group and face to face interview was audio-taped and transcribed. Data was analysed using thematic analysis.

RESULTS

Four dominant themes emerged from the data: (1) Getting to know parents and their wishes (2) Involving family in the day to day care (3) Finding a 'happy' medium (4) Transitioning support across the continuum.

CONCLUSION

These findings revealed a general understanding of family centred care principles. Nurses reported the potential benefits and challenges of adopting a family centred care approach to deliver optimal care for neonates and their families. The study highlighted that nurses need ongoing organisation support, guidance and further education to assist them in delivering family centred care effectively.

RELEVANCE TO CLINICAL PRACTICE

Family centred care is a central tenet underpinning neonatal care. Understanding neonatal nurses' perspectives will be useful when developing strategies to strengthen family centred care in the neonatal intensive care unit, and potentially improve neonatal care and family outcomes.

Closeness and separation in neonatal intensive care

In this paper, we highlight the need for acknowledging the importance and impact of both physical and emotional closeness between the preterm infant and parent in the neonatal intensive care unit. Physical closeness refers to being spatially close and emotional closeness to parental feelings of being emotionally connected to the infant (experiencing feelings of love, warmth and affection). Through consideration of the literature in this area, we outline some of the reasons why physical closeness and emotional closeness are crucial to the physical, emotional and social well-being of both the infant and the parent. These include positive effects on infant brain development, parent psychological well-being and on the parent–infant relationship. The influence of the neonatal unit environment and culture on physical and emotional closeness is also discussed.

The evidence base for the cues program for mothers of very low birth weight infants: an innovative approach to reduce anxiety and support sensitive interaction

Very low birth weight (VLBW) infants, born weighing less than 1,500 g, are at risk for several developmental problems. Consequently, there has been interest in developing intervention programs to prevent such problems. This article describes the empirical evidence that guided the development of an innovative, multicomponent intervention program for mothers of VLBW infants, as well as the program content and features. Based on the evidence, the program was designed to include six sessions and commence shortly after birth to reduce maternal psychological distress during the infant's hospitalization in the neonatal intensive care unit and to promote sensitive mother-infant interaction. The program incorporates various learning activities, including written materials, observational exercises, discussion, and video feedback.

The effectiveness of early intervention on paternal stress for fathers of premature infants admitted to a neonatal intensive care unit

AIM

This article is a report of a study to evaluate the effectiveness of an intervention on fathering ability, perceived nurse's support and paternal stress after a preterm infant's admission to a neonatal intensive care unit.

BACKGROUND

The birth of a premature infant who is admitted to a neonatal intensive care unit is a stressful experience. Due to the maternal postpartum practice in Taiwan, the father is the main visitor of the infant during the first few weeks, but interventions have rarely focused on the father.

DESIGN

A historical comparison study.

METHODS

Between August 2009-July 2010, 35 fathers in the comparison group received routine care; 34 fathers in the intervention group received a booklet designed for the fathers during their visits to the neonatal intensive care unit and nurses' guidance based on the contents of the booklet. Fathering ability, perceived nurse's support and paternal stress were measured.

FINDINGS

The intervention group had a significantly higher fathering ability and perceived nurse support than the comparison group. In the intervention group, the increased fathering ability reduced paternal stress. After adjusting for severity of illness, an significant moderating effect of perceived nurse support on the relationship between fathering ability and paternal stress was found, accounting for 59·5% of variance.

CONCLUSION

Designing a supportive intervention which provides informational, emotional, instrumental, and esteem support for the father can effectively empower his fathering ability and reduce his stress. The intervention should be initiated from the early admission of the premature infant to the neonatal intensive care unit.

Parent's confidence as a caregiver

PURPOSE

The purpose of this study was to describe the parent's self-reported confidence as a caregiver. The specific research questions were as follows: • What is the parent's perceived level of confidence when performing infant caregiving activities in the neonatal intensive care unit (NICU)? • What is the parent's projected level of confidence about performing infant caregiving activities on the first day at home?

SUBJECTS

Participants were parents of infants with an anticipated discharge date within 5 days. Inclusion criteria were as follows: parent at least 18 years of age, infant's discharge destination is home with the parent, parent will have primary responsibility for the infant after discharge, and the infant's length of stay in the NICU was a minimum of 10 days.

DESIGN/METHOD

Descriptive, survey research.

MAIN OUTCOME MEASURES

Participants perceived themselves to be confident in all but 2 caregiving activities when caring for their infants in the NICU, but parents projected a change in their level of confidence in their ability to independently complete infant care activities at home.

PRINCIPAL RESULTS

When comparing the self-reported level of confidence in the NICU and the projected level of confidence at home, the levels of confidence decreased for 5 items, increased for 8 items, and remained unchanged for 2 items. All of the items with a decrease in score were the items with the lowest score when performed in the NICU. All of these low-scoring items are caregiving activities that are unique to the post-NICU status of the infant. Interestingly, the parent's projected level of confidence increased for the 8 items focused on handling and interacting with the infant.

CONCLUSIONS

The findings of this research provide evidence that nurses may need to rethink when parents become active participants in their infant's medical-based caregiving activities.

Time of initiation of skin-to-skin contact in extremely preterm infants in Sweden

AIM

To describe the time of first skin-to-skin contact in extremely preterm infants in a national perspective and to investigate possible factors affecting the time of first skin-to-skin contact.

METHODS

A population-based prospective descriptive study of extremely preterm infants (n = 520) in seven regional hospitals in Sweden.

RESULTS

Extremely preterm infants in Sweden experience first skin-to-skin contact with the parent at a median of six postnatal days (range 0-44). Low gestational age, a high score on the clinical risk index for babies, and the number of days on a ventilator tended to delay first skin-to-skin contact. A statistically significant difference was also found between regional hospitals.

CONCLUSION

There is a difference in the time of first skin-to-skin contact based on the infant's medical condition and the tradition in the neonatal intensive care unit at the regional hospital where the infant is born.

Hospital-to-home transition of mothers of preterm infants

PURPOSE

To describe mothers' experiences during the first month after their preterm infant's hospital discharge.

STUDY DESIGN AND METHODS

Descriptive phenomenology with a sample of 10 mothers who were mostly single, under 25, and African American. Institutional review board approval and informed consents were obtained. Data were collected two times. First, mother's demographic data were collected before the infant's hospital discharge. Second, an in-depth interview was conducted between 2 and 4 weeks after the infant's discharge. Interviews were digitally audio-taped and transcribed verbatim. Data were analyzed using the Colaizzi seven-step process.

RESULTS

There were five theme clusters that described mothers' experiences: dealing with an expected pregnancy outcome; experiencing the reality of taking care of a baby alone; struggling to adjust to the maternal role; enhancing maternal inner strength; and changing the maternal lifestyle.

CLINICAL IMPLICATIONS

This study's findings reveal that mothers value teaching and coaching from nursery care providers. However, a more structured and individualized approach to discharge preparation including assessment of mother's competence in infant care may be needed.

Attitudes of Swedish midwives towards management of extremely preterm labour and birth

OBJECTIVE

the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals.

DESIGN

this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis.

PARTICIPANTS

the answers from midwives (n=259) were collected in a prospective SWEMID study.

SETTING

the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden.

FINDINGS

in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents.

KEY CONCLUSIONS

midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience.

IMPLICATIONS FOR PRACTICE

based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth.

The challenge of integrating justice and care in neonatal nursing

The aim of this study was to explore neonatal nurses’and mothers of preterm infants’experiences of daily challenges. Interviews took place asking for good, bad and challenging experiences. Data were analysed using qualitative content analysis and findings were clustered in two categories: good and challenging experiences, each containing three themes. The good experiences were: managing with success as a nurse, small things matter for mothers, and a good day anyhow for mothers and nurses. The challenging experiences were: mothering in public, being pulled between responsibilities, and adverse things stick under the nurses’skin. The study shows that small daily clinical matters become big issues and could lead to moral distress, and that nurses integrate ethics of justice and ethics of care while mothers are concerned about health and well-being of their specific infant only. The challenge for nursing to integrate fairness and sensitive care in family-oriented neonatal care is discussed.

Parental psychological well-being and cognitive development of very low birth weight infants at 2 years

AIM

To assess the associations between cognitive development of very low birth weight (VLBW) infants and measures of parental psychological well-being.

METHODS

In this prospective cohort study, 182 VLBW infants born 1/2001-12/2006 at the Turku University Hospital, Finland, were followed up. At 2 years corrected age, cognitive development of the child was assessed using the Mental Development Index of Bayley Scales, and both parents filled in validated questionnaires defining parental psychological well-being (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale).

RESULTS

The cognitive delay of the infant was associated with paternal symptoms of depression (p = 0.007) and parenting stress (p = 0.03). Mothers of the infants with cognitive delay reported increased parenting stress related to the difficulty to accept the child (p = 0.001). Weak sense of coherence predicted depressive symptoms in both parents (p < 0.0001).

CONCLUSION

Even if the fathers of VLBW infants experienced depressive symptoms less often than the mothers, the ability of the fathers to cope was significantly associated with the cognitive development of the infant. In addition, the fathers reported more parenting stress if the infant had a cognitive delay. The mothers reported more parenting stress related to accepting the VLBW infant with cognitive delay.

Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role

AIM

This article is a report on a descriptive study of fathers’ experiences of providing their preterm infants with Kangaroo Mother Care.

BACKGROUND

During neonatal intensive care, fathers describe the incubator as a barrier and the separation from their infant as stressful. Fathers consider it important to be close to the infant, and performing Kangaroo Mother Care makes them feel an important participant in their infants' care.

METHOD

Individual interviews conducted in 2009 with seven fathers who performed Kangaroo Mother Care were analysed using qualitative content analysis.

RESULTS

The fathers' opportunity for being close to their infants facilitated attainment of their paternal role in the neonatal intensive care unit. Kangaroo Mother Care allowed them to feel in control and that they were doing something good for their infant, although the infant's care could be demanding and stressful. As active agents in their infant's care, some fathers stayed with the infant during the whole hospital stay, others were at the neonatal intensive care unit all day long. Despite the un-wished-for situation, they adapted to their predicament and spent as much time as possible with their infants.

CONCLUSION

Fathers' opportunities for Kangaroo Mother Care helped them to attain their paternal role and to cope with the unexpected situation. The physical environment and conflicting staff statements influenced their opportunity for, and experience of, caring for their preterm infants.

Gaining confidence and perspective: a phenomenological study of mothers' lived experiences caring for infants at home after neonatal unit discharge

AIM

This paper is a report of a descriptive study of mothers' experiences in caring for preterm or term infants following discharge from a neonatal unit, including how they manage infant pain/discomfort.

BACKGROUND

Few studies have focused on the transition that parents experience after infants are discharged home and little is known about parents' caregiving experiences when their infant has pain/discomfort. Greater knowledge about these issues will help healthcare professionals to better support parents.

METHOD

Nine mothers were interviewed in 2007-2008 about their caregiving experiences in the months following neonatal unit discharge. Interviews were conducted using a descriptive phenomenological approach and analysed using Giorgi's framework.

FINDINGS

Six themes formed mothers' experiences: apprehension, confidence, responsibility, awareness, normalcy and perspective. Mothers had apprehension about their infants' fragile health, losing support of the neonatal team, and performing medical procedures. They developed confidence as infant health improved. Responsibility for performing infant medical care often dominated mothers' experiences. Awareness of infant needs was described as a learning process utilizing external resources, trial-and-error, and an internal intuitive sense; particularly in identifying and dealing with infant pain/discomfort. During the transition to prior social environments, concerns about normalcy arose. Over time, mothers' gained a philosophical perspective and saw their experiences in a positive light.

CONCLUSION

The apprehension-confidence continuum model provides a framework for nursing assessment of mothers' needs following their infants' discharge from a neonatal unit. Factors such as infant health, medical procedures, and family or health professional support may influence the degree of apprehension or confidence.

O father, where art thou? Parental NICU visiting patterns during the first 28 days of life of very low-birth-weight infants

To study the frequency and duration of parental visits to neonatal intensive care units (NICU) during the first 28 days of life of preterm infants in relation to medical variables, sociodemographic factors, and subsequent outpatient follow-up examinations. Retrospective chart review of 127 infants with a birth weight less than 1500 g born between Jan 1, 2009, and Dec 31, 2009, at 2 tertiary NICUs. The average frequency of parental visits during the first 28 days of life declined significantly over time (P < .05) while the duration of visits remained constant. Average frequency and duration of visits per day were consistently lower in fathers than in mothers (median [interquartile range]: 0.6 [0.4-1.0] per day vs 1.1 [0.9-1.4] per day, 72.5 [32.1-108.9 [min/d vs 133.4 [75.4-174.3] min/d). While a history of treatment for infertility was correlated with significantly more frequent and longer parental NICU visits in the first 2 weeks, having older children at home was correlated with shorter visits during the first week. Visiting patterns showed no relation to attendance at follow-up examinations at 6 months corrected age. Mothers spend more time with their preterm infants in NICUs than fathers. We suggest measures to increase paternal involvement with hospitalized preterm infants.

The perceived parenting self-efficacy of first-time fathers caring for very-low-birth-weight infants

OBJECTIVE

Although the period after the birth of their infant is a difficult and complex time for first-time parents who have to attain new abilities, knowledge, and skills, parents of very-low-birth-weight (VLBW) infants (<1500 g) face even greater challenges. Parenting self-efficacy has been found to play a key role in the transition to parenthood and has been linked with positive behavioral outcomes. Although many studies have attempted to describe the needs and experiences of mothers in this area, very little is yet known about fathers.

DESIGN

Using a qualitative, descriptive method, this study explored the factors that first-time fathers of a VLBW infant perceive to influence their parenting self-efficacy beliefs.

SETTING

The study was conducted though a neonatal follow-up clinic in an urban setting in Canada.

PARTICIPANTS

Five participants were recruited though convenience sampling.

RESULTS

Thematic coding analysis revealed five key themes that fathers identified as influencing their perceived self-efficacy: learning from capable role models, personal experiences, the importance of personal beliefs and traits, positive reinforcement, and infant health status.

CONCLUSIONS

The study results highlight the needs of first-time fathers of VLBW infants in the early period after birth and offer guidance to nurses as to how they might foster self-efficacy during this time.

Experience with videoconferencing between a neonatal unit and the families' home from the perspective of certified paediatric nurses

Parents of preterm-born infants need support after returning to their homes with their baby. We studied the experience of certified paediatric nurses (CPNs) with the use of videoconferencing between the neonatal intensive care unit and the families' home. Families were given a home videoconferencing unit, which allowed them to contact staff at the neonatal unit, day and night. Over a period of 12 months, ten families used the videoconferencing equipment. Families made a median of 4 telemedicine calls each (range 2-30). Narrative interviews were performed with 10 CPNs after the study ended. Qualitative thematic content analysis was applied to the interview data and one theme was identified: smoothing the transition of infants from the neonatal unit to the families' home. The CPNs found that videoconferencing helped them to assess the overall situation at home and facilitated the relationship between parents and the infant. The CPNs felt that they were able to provide security to the family. The use of videoconferencing was considered as a generally positive experience and as a tool to improve nursing care at home.

Recognition and management of the infant with Beckwith-Wiedemann Syndrome

Beckwith-Wiedemann Syndrome (BWS) is the most common overgrowth syndrome in infancy. The characteristic findings are macroglossia, abdominal wall defects, and macrosomia. Genetic studies in infants with BWS demonstrate 3 major subgroups of patients: familial, sporadic, or chromosomally abnormal. Recognition in the neonatal period is important because of the high incidence of childhood malignant tumors associated with BWS. This article provides an overview of the syndrome and discusses its etiology, physical findings, and diagnostic evaluation. Management and clinical implications including family support will also be discussed.

Discharge teaching in the NICU: are parents prepared? An integrative review of parents' perceptions

BACKGROUND

At the end of their infant's NICU stay, parents are expected to assume full responsibility for their infant's care. It is important to look at discharge practices from the parents' points of view to see whether our strategies are effective.

OBJECTIVES

Review the literature for studies that give insight into parents' perceptions of the discharge process in order to assist health care providers in evaluating the available research and to identify any gaps in the literature.

METHOD

A literature search was performed to identify published studies that discuss parental perceptions related to their preparedness for their infant's discharge home from the NICU.

RESULTS

Data from the parents' perspective were lacking. There are limitations in the data that are available. Parents are not prepared for discharge and have unanswered questions. Parental perceptions are different from health care professionals' perceptions.

DISCUSSION

The studies that have been done need to be repeated in different centers, with greater sample sizes, and with subjects of different cultures, ethnicities, and socioeconomic status. There is a need for more research into parental perceptions of preparedness for their infant's discharge and ways to increase parental preparedness for discharge home from the NICU.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 2: Grasping the early parenting experience--the insider view

PURPOSE

The purpose of this integrative review is to systematically and critically synthesize nursing scholarship on parents' perspectives of the parent-child relationship during infancy.

CONCLUSION

Research has shown that the process of establishing the parent-child relationship is highly individualized and complex. Numerous barriers and facilitators influencing this relationship have been identified that are relevant to nursing.

PRACTICE IMPLICATIONS

Nurses have an important opportunity to positively affect the developing parent-infant relationship. Screening parents for depression and providing parents with resources and support are key nursing interventions supporting the parent-infant relationship.

A gender perspective on the extent to which mothers and fathers each take responsibility for care of a child with high and intermediate imperforate anus

Imperforate anus is a malformation of the child's anus. Parents' experiences of responsibility for care of the child may differ. The aim of this study was to evaluate a gender perspective on the extent to which mothers and fathers each take responsibility for the care of a child with high and intermediate imperforate anus. Parents of children with imperforate anus and two control groups of children and parents participated. Data collection with questionnaires focusing on responsibility was performed. In conclusion, our study revealed additional evidence of unevenly divided parental responsibility for care of a child with a chronic condition. The mothers in this study were shown to be the primary caregiver.

Parents as their infant's primary caregivers in a neonatal intensive care unit

The aim was to explore parents' and professionals' opinions about parental performance of care in a neonatal intensive care unit. Forty-three parents and 85 nurses completed questionnaires composed of a list of 95 caregiving activities; 14 nurses and 4 neonatologists participated in four focus group interviews. Considerable differences appeared in parents' and nurses' responses about parents' participation in their infants' care. All listed activities were marked as optional by at least a few parents. Agreement was reached about parents as their infants' primary caregivers, based on individual assessment of parents' willingness and ability, with nurses acting as educators and supporters instead of caregivers.

Experiences of having a prematurely born infant from the perspective of mothers in northern Sweden

OBJECTIVES

The aim of this study was to describe the mothers' experience of having a prematurely born infant, with the focus on the birth itself and during the time immediately following the birth.

STUDY DESIGN

A qualitative design was chosen to achieve the aim of this study.

METHODS

Six mothers, whose infants were born prematurely and thereby needed care on a neonatal intensive care unit (NICU), participated in the study. Narrative interviews were conducted and the mothers were encouraged to freely narrate their experiences of having an infant born preterm. A qualitative content analysis was used to analyse the interviews.

RESULTS

The results show that mothers were not prepared for having prematurely born infants and that initially they had difficulties feeling like a mother. Having an infant born preterm was dominated by feelings of anxiety. Feeling closeness to the child was important, and separation from the child was a very stressful experience. Family life was affected, but mothers felt they were able to handle the situation if they received support from their partner and hospital staff, and if they were equipped with knowledge regarding the birth and care of a premature infant. Furthermore, it was important for the mothers to be involved in their infants' care.

CONCLUSIONS

Support and knowledge made it possible for mothers to handle having a premature infant. Mothers' situations could be facilitated if nurses had increased knowledge and understanding about how mothers experience this situation.

Taiwanese women's experiences of becoming a mother to a very-low-birth-weight preterm infant: a grounded theory study

BACKGROUND

Significant improvements have occurred in the survival rates of small preterm infants. As more infants survive their preterm birth, the number of parents associated with this experience has also increased. Clearly, the birth of very-low-birth-weight (VLBW) preterm infants poses considerable challenges for all mothers. These challenges are further compounded in Taiwan, where women are traditionally required to practise the cultural ritual (Zuo Yue Zi) which includes confinement to the house with a special balanced diet for the first month postnatally. Moreover, there is a deficit of information on mothers' experiences when their preterm infants are in neonatal intensive care units (NICUs).

AIMS

The aim of this study was to explore Taiwanese mothers' (n=26) parenting experiences when their preterm infants were in NICUs.

DESIGN

A qualitative research approach, grounded theory, was used to explore the mothers' lived reality of these experiences.

METHODS

In-depth interviews and participant observations were conducted to gain insight into the experience of parenting.

FINDINGS

A theoretical model was formulated from the findings delineating Taiwanese mothers' parenting experiences during their preterm infants stay in hospital. The findings indicated that the preterm birth, together with the admission of their infants to a NICU, presented mothers with an unexpected crisis. The particular cultural postnatal ritual posed this group of Taiwanese mothers with an additional difficulty in establishing physical interactions. However, the Taiwanese mothers created alternative channels of contact with their hospitalised infants using emotional connections, while the physical interactions were certainly limited. Despite all the difficulties this group of Taiwanese mothers faced and resolved, they all gradually captured and embraced the parenting role. The finding of this study further indicated that the support the mothers received from the healthcare professionals and the social networks the mothers made helped to create the connections that developed between the mothers and infants, making their journey towards parenthood possible.

CONCLUSION

The theoretical model developed in this study is the first of its kind to contribute to the field of neonatal nursing in Taiwan. This would help Taiwanese women come to terms with becoming mothers of VLBW infants and subsequently enhance their parenting role.

Engaging fathers in the NICU: taking down the barriers to the baby

The technological intensive care environment of the neonatal intensive care unit (NICU) presents a challenge for nurses to integrate care that supports the development of premature infants while facilitating and supporting parents as collaborators in the care of their infant. Engaging mothers in talking to and providing care for their infants is, for the most part, the focus of family nursing interventions in this intense environment. Engaging fathers at the bedside in the NICU is a much more difficult task. The purpose of this article is to identify potential barriers in the NICU perceived by fathers and intervene so that fathers are more likely to engage in being present for their infant and significant other. This is a part of the ongoing nursing assessment that identifies family care needs and weaves interventions into the developmental plan of care.

Mothers' experiences of having a preterm infant in the neonatal care unit: a meta-synthesis

Neonatal nurses today are challenged not only to provide the best possible developmental care for a preterm infant but also to help the mother through an uncertain motherhood toward a feeling of being a real mother for her preterm baby. An increasing interest in mothers' experiences of having a preterm baby is seen. A meta-synthesis of 14 qualitative research studies on mothers' experiences of having a preterm baby in the neonatal intensive care unit, published from 2000 onward, was conducted. Noblit and Hare's methodological approach was used. The meta-synthesis revealed five metaphors that captured the mothers' experiences. These metaphors centered on reciprocal relationships that consisted of mother-baby relationship ("from their baby to my baby"), maternal development (a striving to be a real normal mother), the turbulent neonatal environment (from foreground to background), maternal caregiving and role reclaiming strategies (from silent vigilance to advocacy), and mother-nurse relationship (from continuously answering questions through chatting to sharing of knowledge). Implications of the meta-synthesis for neonatal nursing are addressed.

Adjusting to being a father to an infant born prematurely: experiences from Swedish fathers

The aim of this study was to describe the experiences of being a father to a prematurely born infant. Eight fathers of prematurely born children were interviewed using a narrative approach, and a thematic content analysis was used to analyse the interviews. The fathers described that the preterm birth gave them the chance to get to know their infant as they had to spend time at the intensive care unit. They also felt better educated by professionals who helped them take care of their infant. Their feelings and attachment for their infant increased over time and the fathers felt that they had a stronger bond with their child compared with friends who had babies born at term. As time passed, they became more confident as a father. In spite of the strain, the experience made them change as a person and they expressed having different values. The relationship with their partner was strengthened as they handled this situation together as a couple. However, the fathers felt fortunate despite everything and described having managed a prematurely born infant rather well. Although there are similarities between being a father to a child born at term and to one born preterm, it is significant to gain further knowledge about the specific experiences of fathers of prematurely born infants. The results of this study have implications for nurses working with families who have children born prematurely.

A change in life as experienced by first-time fathers

Research suggests that the attitude of men towards pregnancy, childbirth and child-caring is different from that of women. Up to now, research has focused mainly on motherhood. The aim of this study was to explore first-time fathers' experiences during early infancy of their children. Grounded theory and constant comparative method were used and 20 fathers aged 20-48 participated. Interviews were carried out in 2002-2003. 'Changing life' emerged as the core category consisting of the categories: becoming a father, alternating between work and home, changing relationship towards partner and developing relationship with their child. Changing life implied that they have left bachelor life and become responsible for a child. Becoming a father was much more fantastic than they could have imagined and they suggested that they performed childcare to the same extent as the mother when both parents were at home. Still fathers viewed the mother as the main parent, partly because of their alternating between work and home and because the mothers breast-feed the infants. Fathers' attitude towards breast-feeding seemed to be ambiguous; it was a matter of necessity, but made them feel insignificant. Changing relationship towards partner was common but it was not necessarily for the worst and often resulted in a more closely united relationship. However, tiredness because of lack of sleep could result in increased irritability towards problems. Developing relationship with their child implied increasing possibilities to learn to know the infant's signals. Fathers are one of two parents, and hence are important for their child's growth and development, emotional health and cognitive development. Knowledge about first-time fathers' experiences during the early infancy of their children may bring about increased support from midwives and child health nurses.

Fathers' experiences in the neonatal intensive care unit: a search for control

OBJECTIVE

This qualitative study aimed at understanding the experiences of fathers of very ill neonates in the NICU.

METHODS

Sixteen fathers of very ill and/or very preterm infants who had been in the NICU for >30 days were interviewed by a male physician. Fathers were asked about their level of comfort with or concerns about staff communication regarding their infant, about accessing information, and about more general perceptions of their experience in the neonatal intensive care unit. Interviews were audiotaped and transcribed for analysis. Coding used content analysis with construction of themes by 3 researchers.

RESULTS

The overarching theme for fathers was a sense of lack of control. Their world view, as a "backdrop" theme, provided context for all of the themes. Four other interrelated subthemes were identified, including information; communication, particularly with the health care team; fathers' various roles; and external activities. Fathers reported that relationships with friends/family/health care team, receiving information consistently, and receiving short written materials on common conditions were ways of giving them support. The fathers said that speaking to a male physician was a positive and useful experience.

CONCLUSIONS

Fathers experience a sense of lack of control when they have an extremely ill infant in the NICU. Specific activities help fathers regain a sense of control and help them fulfill their various roles of protectors, fathers, partners, and breadwinners. Understanding these experiences helps the health care team offer targeted supports for fathers in the NICU.

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.

From distance toward proximity: fathers lived experience of caring for their preterm infants

Open interviews with 13 fathers were performed, using a hermeneutic phenomenological method, to illuminate their lived experience of caring for their preterm infant. Their lived experience was expressed as a process moving from initial feelings of distance toward feelings of proximity. The process was described as a pendulum that was easily disturbed. Feelings of distance included experiences of living beside reality, becoming an outsider, and living with worry. Feelings of proximity included experiences of returning to reality, becoming a family, and facing the future. Illumination of the father-infant interaction adds to the family-centered body of knowledge in neonatal nursing.