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

Parental experiences during the first period at the neonatal unit after two developmental care interventions

AIM

Developmental care has gained increased attention in the individualized care for preterm infants. This study was designed to explore the effect of a basic form of developmental care and the more extended Newborn Individualized Developmental Care and Assessment Program (NIDCAP) on parental stress, confidence and perceived nursing support.

METHODS

Two consecutive randomized controlled trials (RCT's) comparing (1) standard care versus basic developmental care (standardized nests and incubator covers) (n = 133) and (2) basic developmental care versus NIDCAP, including behavioural observations (n = 150). Parents of infants born <32 weeks gestational age (GA) received questionnaires after the first week of admission in the neonatal unit and on average these 2 weeks after the birth of their infant.

RESULTS

No significant differences were found in confidence, perceived nursing support or parental stress. The difference in parental stress between mother and father was less in the NIDCAP intervention group (p = .03), although not significant.

CONCLUSION

Both basic developmental care and NIDCAP had little effect on parental experiences during the first period at the neonatal unit. As a result of increased paternal stress, the NIDCAP intervention tended to decrease the difference in parental stress levels of fathers and mothers, possibly because of the increased involvement of father during the NIDCAP intervention.

The conceptual structure of transition to motherhood in the neonatal intensive care unit

AIM

This paper is a report of a concept analysis of transition to motherhood for mothers with infants in a neonatal intensive care unit.

BACKGROUND

Mothers with infants in a neonatal intensive care unit have more difficulty in their transition to motherhood compared with mothers of healthy infants. The concept of transition to motherhood in the neonatal intensive care unit is not well-understood in nursing, often being confused with mothers' psychological responses in the neonatal intensive care unit.

METHODS

The concept analysis combined Rodgers' evolutionary method with Schwartz-Barcott & Kim's Hybrid method. Thirty-eight studies were reviewed and a purposive sample of 10 Korean mothers with infants in a neonatal intensive care unit was interviewed.

FINDINGS

Three critical attributes of transition to motherhood in the neonatal intensive care unit were identified: (1) time-dependent process, (2) psycho-emotional swirling and (3) hovering around the edge of mothering. These are caused by the antecedents (1) unexpected outcome of pregnancy, (2) awareness of the situation and (3) mother-infant separation. The consequences were: (1) delayed motherhood and (2) developing a sense of meaning concerning family and life. Additionally, five influencing factors to be alleviated were identified: (1) negative meaning attribution, (2) uncertainty, (3) social prejudice, (4) lack of opportunities to make contact with the infant and (5) the neonatal intensive care unit environment.

CONCLUSIONS

This concept analysis should help nurses to understand the process of becoming a mother in a neonatal intensive care unit and plan appropriate interventions for mothers with special needs.

Gender differences and similarities in the experience of parenting a child with a health problem: current state of knowledge

The birth of a child is a transitional situation that triggers stress in the family and each person has to use adjustment strategies allowing them to reposition gradually in relation to themselves and other members of the family, and to make space for the new arrival. When the child has a health problem, the stress on the parents is correspondingly greater. Research shows that fathers and mothers of a child with a health problem experience this ordeal differently. This article reports on the current state of knowledge about the experience of fathers and mothers of a child with a health problem, and suggests new directions for research to provide a fuller understanding of their experience.

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

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

Parental stress and toddler behaviour at age 18 months after pre-term birth

AIM

To describe the parent's judgement of their own stress and the child's behaviour at 18 months after pre-term birth and if there are any correlations between these assessments, the morbidity in the neonatal period, the gestational age at birth and the occurrence of twin/triplet births.

METHOD

Twenty-one mothers and 19 fathers of pre-term infants answered two questionnaires, The Swedish Parenthood Stress Questionnaire (SPSQ) and The Toddler Behaviour Questionnaire (TBQ).

RESULTS

Mothers scored somewhat higher than fathers concerning parental stress. Parents with twins/triplets and of children born in gestational week 25-30 felt more stress, though the differences were not statistically significant. High-risk diagnoses did not correlate to any of the dimensions. The parents judged the behaviour of the children similar except that parents of children born in gestational week 25-30 scored significantly higher for intensity/activity (p = 0.002). The correlation between parental stress and judgement of their children's behaviour did not show any significant association except for the dimension regularity in TBQ (p = 0.016).

CONCLUSIONS

The mothers' and fathers' assessments of their own stress and of the children's behaviour were similar. Parents of very pre-term children felt more stress and judged the children somewhat delayed in their social behaviours, probably due to their low gestational age.

Factors influencing childbearing decisions and knowledge of perinatal risks among Canadian men and women

BACKGROUND

Women age 35 and older account for an increasing proportion of births and are at increased risk of having difficulties conceiving and of delivering a multiple birth, low birth weight infant, and/or preterm infant. Little is known about men's and women's understanding of the maternal age related risks to pregnancy.

OBJECTIVES

1) To determine the factors influencing the timing of childbearing for non-parenting men and women, 2) to determine knowledge among non-parenting men and women about maternal age-related reproductive risks, the consequences of low birth weight and multiple birth, and issues related to infertility, and 3) to determine characteristics associated with limited knowledge of these reproductive risks.

METHODS

An age-stratified random sample of individuals, aged 20-45 years and without children, completed a computer-assisted telephone interview from two urban regions of Alberta, Canada (1006 women and 500 men).

RESULTS

Factors that influenced timing of childbearing for both men and women included: financial security (85.8%) and partner suitability to parent (80.2%). Over 70% of men and women recognized the direct relationship between older maternal age and conception difficulties. Less than half knew that advanced maternal age increased the risk of stillbirth, caesarean delivery, multiple birth and preterm delivery.

CONCLUSIONS

Poor understanding of the links between childbearing after age 35, pregnancy complications and increased risk of adverse infant outcomes limits adults' ability to make informed decisions about timing of childbearing.

Fathers' support to mothers of medically fragile infants

OBJECTIVE

To examine mothers' perceptions of support from fathers over the 1st year after birth of a medically fragile infant.

DESIGN

A descriptive, correlation design based on an ecologic systems view of the family. It was hypothesized that the levels of paternal support would be influenced by factors within the two subsystems: the mother-father system (marital status) and the child subsystem (health and gender).

SETTING

A tertiary care children's hospital.

PARTICIPANTS

Sixty-four mothers of medically fragile term and preterm infants, who were married or living with the father.

MAIN OUTCOME MEASURES

The Stress Support Scale assessed maternal perceptions of helpfulness and satisfaction with paternal support at enrollment, after discharge, and around 1 year of age.

RESULTS

Mothers reported high levels of help from fathers at enrollment. Married mothers did not differ from unmarried mothers in their perceptions of helpfulness of support but were more satisfied with support. Mothers of female infants received more help from fathers than mothers of male infants, and this difference increased over time. However, mothers of female infants were not more satisfied with paternal support. Neither number of technologies nor birthweight related the maternal perceptions of paternal support.

CONCLUSIONS

Family systems factors were more significant in maternal perceptions of paternal support than the health status of the infant.

L’expérience des pères et mères ayant un enfant atteint d’un problème de santé : état actuel des connaissances*

La naissance d’un enfant est une situation transitionnelle qui suscite un stress au sein de la famille et implique la mise en oeuvre de stratégies adaptatives qui permettront graduellement à chacun de se resituer face à lui-même et face à l’autre et de faire une place à ce nouvel être. Lorsque l’enfant présente un problème de santé, le stress ressenti par les parents est d’autant plus important. Les recherches montrent que les pères et les mères d’enfant atteint d’un problème de santé vivent différemment cette expérience. Cet article vise à faire le point sur l’état actuel des connaissances de l’expérience des pères et des mères d’enfant atteint d’une problématique de santé et à proposer de nouvelles avenues de recherche permettant une meilleure compréhension de leur expérience.

Nurses as moral practitioners encountering parents in neonatal intensive care units

Historically, the care of hospitalized children has evolved from being performed in isolation from parents to a situation where the parents and the child are regarded as a unit, and parents and nurses as equal partners in the child's care. Parents are totally dependent on professionals' knowledge and expertise, while nurses are dependent on the children's emotional connection with their parents in order to provide optimal care. Even when interdependency exists, nurses as professionals hold the power to decide whether and to what extent parents should be involved in their child's care. This article focuses on nurses' responsibility to act ethically and reflectively in a collaborative partnership with parents. To illuminate the issue of nurses as moral practitioners, we present an observation of contemporary child care, and discuss it from the perspective of the Danish moral philosopher KE Løgstrup and his book The ethical demand.

Quality of care of the preterm infant--the parent and nurse perspective

AIM

To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given.

SUBJECTS

21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs.

METHODS

A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity-oriented approach, medical-technical competence and socio-cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care.

RESULTS

In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity-oriented approach and medical-technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical-technical competence. High-risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical-technical competence higher than nurses for neonatal care. Mothers and nurses rated identity-oriented approach higher than fathers for CHCs.

CONCLUSION

Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity-oriented approach, medical-technical competence and socio-cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.

How to facilitate parents and their premature infant for the transition home

BACKGROUND

An intervention programme was carried through in a neonatal intensive care unit at the Copenhagen University Hospital in Denmark in 1998/99. It comprised: (1) educational programmes during hospitalization for parents with premature infants; (2) visit and orientation about the neonatal intensive care unit by the family's health visitor; a multidisciplinary and cross-sector discharge conference; and (3) publication of relevant booklets for parents and health care providers.

AIM

To present the parents' experiences from this intervention, concerning support and coordination following delivery of a premature infant.

METHOD

A non-experimental design and descriptive study. The qualitative methods used were semi-structured questionnaires and focus group interviews.

FINDINGS

The parents found that most of the intervention initiatives contributed to increased support and met their needs, including contributing to their confidence in caring for their premature infant and its well-being following discharge. The study contributed to meaningful knowledge about the consequences for parents and premature infants when mother and infant are separated in the beginning of life, mindful of the process of mother-infant bonding.

IMPLICATIONS

Major actions from the intervention programme now form permanent functions in the neonatal intensive care unit as well as in the primary health care sector. The study also confirmed the benefit of the role of the nurse-coordinator.

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

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

The primacy of work and fathering preterm infants: findings from an interpretive phenomenological study

PURPOSE

To improve our understanding of fathers of preterm infants by examining their meanings of work and exploring the impact of their work on their early transition to fatherhood.

SUBJECTS

The sample included 9 white fathers between the ages of 22 and 40 years, who had infants born between 25 and 32 weeks gestation.

DESIGN AND METHODS

This report explores one theme that emerged from a broader interpretive phenomenological study. Fathers were interviewed 6 to 8 times over a 6-month period, beginning within 1 month of the birth of their infant and continuing after neonatal intensive care unit (NICU) discharge. Interview guides were used only to initiate conversation; probing, clarifying questions helped fathers provide detailed stories of what they did, thought, and felt about specific situations. Transcriptions of all 63 interviews were treated as meaningful text and analyzed using interpretive methods.

PRINCIPAL RESULTS

Fathers' narratives revealed the primacy of work in their lives; work remained a pivotal focus even after an early birth. Fathers returned to work quickly after their infant's birth. They approached their work with a renewed sense of fervor in order to provide financially for their families. They found comfort in their work because in the work setting they felt that they were the experts, as opposed to feeling like novices in the NICU. The most stressful aspect of the experience was juggling their time between work and the outside world.

CONCLUSIONS

Fathers may respond to the experience of having a premature infant very differently from mothers. Because fathers' stressors often lie outside the NICU, their stressors may be invisible to healthcare providers. A deeper understanding of fathering must consider the social, familial, and historical processes that shape fathering practices.

"Womb" literacy: reading to infants in the NICU

PROMOTING LITERACY IS NOT generally one of the top priorities in the care of high-risk infants in the NICU. Basic survival and tending to medical needs are obviously the most pressing concerns. However, we know from various studies that high-risk infants are at greater risk for less-than-optimal cognitive outcomes.1–3 For example, preterm infants are at greater risk than term infants for lower overall IQ scores, repeating a grade, and failing to graduate from high school.1,2 Interventions to improve the academic achievement of children are most effective when begun in the preschool years.4