The relationship between maternal confidence and mother-infant behaviors in premature infants

"It Shook My Whole Parenting Plan": Parents' Experiences of Being at Home with Their Newborn Baby During the COVID-19 Pandemic

A cross-sectional online survey was undertaken (July-August 2020) to ascertain parents' experiences during the COVID-19 pandemic of being at home with their newborn baby in the first 6 weeks. Participants (n = 371) were mostly biological mothers (n = 369, 99.4%), white British (n = 351, 94,5%), first baby (n = 186, 50%). A statistically significant positive correlation was found between maternal confidence and number of children (rho (369) = 0.295, p < .001) and baby's age at time of participation (rho (369) = 0.139, p = .009). Participants without higher educational qualifications (median = 62, SIQR = 3.5) had statistically significant higher confidence (U = 11831.500, p < .001) than participants with higher educational qualifications (median = 58, SIQR = 2). Parents of babies without health issues at birth (median, 61, SIQR = 3.5) had statistically significant higher confidence (U = 13213.500, p < .001) than parents of babies with health issues at birth (median = 58, SIQR = 5). Three qualitative themes have emerged: the impact of "no partner" restrictions; mixed emotions and lack of information and support. In conclusion, parenting during a pandemic created anxiety and fear, affected by "no partner" restrictions, not being allowed to appointments, scans, and during labor. Some parents were more confident and indicated benefits including heightening bonding with baby and partner during social distancing.

Effects of digital parenting interventions on self-efficacy, social support, and depressive symptoms in the transition to parenthood: A systematic review and meta-analysis

BACKGROUND

Parenting self-efficacy is essential for the transition to parenthood. As digital parenting educational interventions are rapidly being developed, their effects have not been examined by pooling available randomized controlled trials (RCTs).

OBJECTIVES

To comprehensively investigate the effects of digital educational interventions on parents' self-efficacy, social support, and depressive symptoms in the first year after childbirth and identify the significant associated factors.

METHODS

This study searched six electronic databases for relevant RCTs examining the efficacy of digital parenting interventions from inception to September 2022. The studied outcomes included changes in parent's self-efficacy, social support, and depressive symptoms observed after participating in a digital parenting program. The random-effects model was used to pool results. Subgroup and moderator analyses were performed.

RESULTS

In total, seven RCTs enrolling 1342 participants were included. The parents who received digital parenting interventions had higher parenting self-efficacy (standardized mean difference [SMD]: 1.06, 95 % confidence interval [CI]: 0.40-1.71, p =.002) and social support (SMD: 2.72, 95 % CI: 0.38-5.07, p =.02) and decreased depressive symptoms at 3 months postpartum (SMD: -0.39, 95 % CI: -0.73 to - 0.04, p =.03). Providing the interventions for ≥ 6 weeks (SMD: 1.62, 95 % CI: 1.18-2.06, p <.001), providing in-person orientation (SMD: 1.88, 95 % CI: 1.32-2.44, p <.001), including a guided curriculum (SMD: 2.00, 95 % CI: 1.78-2.22, p <.001), and conducting interventions in Organisation for Economic Co-operation and Development countries (SMD: 1.98, 95 % CI: 1.78-2.19, p <.001) were identified as significant moderators.

CONCLUSIONS

Digital parenting interventions significantly increase parenting self-efficacy and social support as well as alleviate depressive symptoms for parents during their first year after childbirth. Such interventions can be beneficial for parents who prefer online education. Future studies investigating the long-term effects of these interventions are warranted.

REGISTRATION

The protocol for this systematic review and meta-analysis is registered in PROSPERO (registration number: CRD42021243641).

Parents' Journeys of Mastery and Knowledge Construction After Their Infant's First Stage of Surgery for Complex Congenital Heart Disease

BACKGROUND

A growing body of conceptual evidence over the last decade has increased our understanding of parents' experiences of having an infant with complex congenital heart disease. These concepts include parents' feelings of uncertainty, fear, excitement, and mastery. However, little is known about parents' experiences, confidence, and knowledge acquisition during transition from hospital to home with their infant after the first stage of complex cardiac surgery. A theoretical framework to assess, plan and implement child and family centered care would assist children's cardiac nurses responsible for parental education, discharge planning and coordination.

AIM

To explore parents' experiences of the transition from hospital to home with their infant, following the first stage of cardiac surgery.

DESIGN

A prospective mixed methods longitudinal design. Semi-structured interviews were undertaken, including administration of the Maternal Confidence Questionnaire at four timepoints: before discharge following stage one cardiac surgery (T0), 2 weeks' post discharge (T1), 8 weeks' post discharge (T2) and after stage two surgery (T3). Qualitative data were thematically analyzed. Descriptive statistics were used to characterize the sample and non-parametric repeated measures analysis of variance was used to analyze changes over time in maternal confidence scores.

RESULTS

Sixteen parents of 12 infants participated. Four "patterns of transition experience" emerged, the fourth "Mastery", is discussed in this paper. Mastery can be contextualized in terms of the parents' journeys of knowledge construction, gaining confidence and reflection. Learning was dynamic and transformational, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. Confidence at T0 was significantly lower than at T1 (p = .011), T2 (p = .018) and T3 (p = .012). There were no significant differences between scores at T1, T2 and T3. Liminality, as a concept, described the between and betwixt time that parents experienced as they were preparing for discharge from hospital; excitement to be going home balanced with the fear of being alone and confidence in looking after their fragile infant.

CONCLUSION

Parents of infants with complex congenital heart disease obtain knowledge, confidence, and mastery dependent upon their transition experience and their personal journey through pre-liminal, liminal, and post-liminal phases of discharge from hospital to home. A conceptual framework "Parenting through Transitions - hospital to home" emerged that could assist in structuring assessment of parents' knowledge and support needs within a coordinated discharge process. Identifying individualized support would promote adaptation and adjustment during transition from the pre to post liminal phase, following their infant's first stage of complex cardiac surgery.

From co-regulation to self-regulation: Maternal soothing strategies and self-efficacy in relation to maternal reports of infant regulation at 3 and 7 months

This study, conducted in Germany, examines the role of maternal soothing strategies to explain the association of maternal self-efficacy with infant regulation (crying and sleeping behavior). Questionnaire data of 150 mothers, living in Germany, with mixed ethnic and educational backgrounds were collected when infants were 3 and 7 months old. Two types of maternal soothing strategies were distinguished: close soothing, involving close physical and emotional contact, and distant soothing, involving physical and emotional distancing from the infant. A cross-sectional SEM at 3 months indicated that maternal self-efficacy is associated with reported infant regulation through distant soothing strategies. Low maternal self-efficacy was associated with frequent maternal use of distant soothing, which in turn was related to reported infant regulation problems, that is, non-soothability and greater crying frequency. Frequent use of close soothing was associated with reported infant sleeping behavior, that is, frequent night-time awakenings. A longitudinal SEM further indicated that the effects of close soothing persisted at least until the infants' age of 7 months. The study showed how low maternal self-efficacy, increased use of distant soothing, and reported early infant regulation problems are intertwined and that, due to their persisting positive effect on infant soothability, close soothing better supports infant development.

What works for whom? Mother's psychological distress as a moderator of the effectiveness of a home visiting intervention

Attachment-based home visiting programs that serve new mothers experiencing psychological distress may advance health equity by helping families systemically exposed to adversity. This study examined whether one such program (Promoting First Relationships/PFR) had particularly beneficial effects on maternal and child relationship outcomes for mothers reporting the greatest psychological distress. A randomized controlled trial of the PFR program included a low-income sample of 252 Spanish- and English-speaking mother-child dyads referred prenatally for mental health concerns. The sample of mothers was 65.5% White, 17.5% Black, and 17.1% multiracial or other racial groups; 47.2% reported Hispanic ethnicity. The moderating variable of psychological distress was measured using maternal-reported screening tools for symptoms of depression, anxiety, anger, post-traumatic stress, and interpersonal sensitivity. Outcomes included observed parenting sensitivity and self-reported understanding of infants/toddlers, caregiving confidence, and child externalizing behavior. Results showed a significant treatment condition by baseline psychological distress interaction for observed parenting sensitivity such that differences in outcomes favoring the PFR condition were greatest among those with high baseline psychological distress (baseline child age 6-12 weeks). In a low-income sample of new mothers, those with the greatest need, as indicated by high psychological distress, showed greater improvements in their sensitive and responsive caregiving if they were randomized to the PFR treatment condition.

Parent-infant interaction in the NICU: Challenges in measurement

BACKGROUND

Parent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues.

AIM

To improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues.

METHOD

Twenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34-48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS.

RESULTS

Seventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01).

CONCLUSION

It remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.

The Association between Parenting Confidence and Later Child Mental Health in the Area Affected by the Fukushima Nuclear Disaster: The Fukushima Health Management Survey

After the 2011 Fukushima Daiichi Nuclear Power Station accident, the Fukushima Health Management Survey was conducted to assess children's lifestyle and mental health conditions. The participants in this study were 1126 children, aged 0 to 3 years, living in the evacuation zone at the time of the disaster. The parenting confidence of their mothers was assessed using a self-administered questionnaire as a baseline in 2013. We examined the association of parenting confidence level at baseline, using a total difficulty score of the Strengths and Difficulties Questionnaire (SDQ) and reluctance to attend school among children in a follow-up study in 2016 and 2017. As a result, no confidence was reported by 178 (15.8%) mothers, while 477 (42.4%) responded with "not sure" and 471 (41.8%) were confident. In the multiple logistic analysis, after adjusting for covariates such as the child's sex, age, and current health condition, the group lacking parenting confidence demonstrated a significantly higher risk level for SDQ total difficulties (OR, 2.8; 95% CI, 1.59-4.93) and reluctance to attend school (OR = 1.98, 95% CI: 1.24-3.18) than the confident mothers. After a major disaster, which can have long-term effects on communities, intensive psychological care for mothers with young children is needed to prevent various mental health problems in their children.

Randomized trial of promoting first relationships for new mothers who received community mental health services in pregnancy

The effectiveness of Promoting First Relationships (PFR), a 10-week home visiting program with video feedback, was tested in a randomized controlled trial involving 252 mothers and their 8- to 12-week-old infants. Mothers were eligible if they initiated treatment after mental health screening (depression, anxiety, posttraumatic stress disorder [PTSD]) at a community or public health primary care center in pregnancy. At baseline, 51% had mild to severe depression symptoms, 54% had mild to severe anxiety, and 35% had PTSD. Their ages ranged from 18 to 42 years. Mothers were 66% White, 18% Black, and 16% other races. Forty-seven percent identified as Hispanic, and 33% preferred to read and speak in Spanish. The median family annual income was less than $20,000. The PFR program or receipt of a resource packet (control condition) followed the baseline assessment and randomization; we assessed outcomes when infants were age 6 and 12 months. Compared to mothers in the control condition, mothers in the PFR condition had significantly (ps < .05) higher observed sensitivity scores at both follow-up time points (d = .25, d = .26), had improved understanding of infant-toddler social-emotional needs at both time points (d = .21, d = .45), and reported less infant externalizing behavior at age 12 months (d = .28). This study is the fourth completed randomized controlled trial of the PFR program, all involving populations experiencing adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effectiveness of parenting education for expectant primiparous women in Asia: a systematic review

OBJECTIVE

This review evaluated the effectiveness of antenatal parenting education versus usual care for maternal confidence, maternal depressive symptoms, and parenting stress among expectant primiparous women in Asia.

INTRODUCTION

Previous reviews on parenting education have mostly examined practices in non-Asian countries and found that no single parenting education program met the needs of all parents. Given that there may be some common characteristics in Asian cultures, such as grandparents' involvement with child care, this review focused on specific interventions in determining the effects of practices on particular outcomes in these populations, so that providers of antenatal education can tailor interventions that are more culturally appropriate for Asian women.

INCLUSION CRITERIA

Studies published in English or Japanese that included expectant primiparous women and couples in Asia who received antenatal parenting education were considered. The outcomes were maternal confidence, maternal depressive symptoms, and parenting stress.

METHODS

The authors searched for English-language articles up to February 2019 using MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and PsycINFO. They also searched Ichushi-Web for Japanese articles. A gray literature search was conducted using Google Scholar and ProQuest Health and Medical Collection. Two independent reviewers selected studies, and a critical appraisal was undertaken using appropriate JBI tools. Data were presented in narrative form owing to the heterogeneity of the included studies.

RESULTS

Four studies involving 652 pregnant women were included: three were randomized controlled trials, and one was a quasi-experimental study. The studies were conducted in China, Hong Kong, and Taiwan, and included the following antenatal parenting education interventions: interpersonal, psychotherapy-oriented childbirth education; childbirth psychoeducation based on the concept of learned resourcefulness; and Internet newborn-care education based on self-efficacy theory. Overall, the methodological quality of the included studies was moderate. Meta-analysis was not possible owing to the heterogeneity, including small sample sizes and differences in intervention content, populations, and follow-up times. A subsequent narrative synthesis was undertaken for each outcome. Of three studies with maternal confidence as an outcome (n = 496), two showed significantly higher maternal confidence at six weeks' (P = 0.000, Cohen's d = 1.41) and three months' postpartum (P = 0.016, Cohen's d = 0.35) in the intervention groups; however, one study showed no significant group differences. Of three studies with maternal depressive symptoms as an outcome (n = 534), two found significantly fewer depressive symptoms at three months' (P = 0.018, Cohen's d = -0.34) and six months' postpartum (P = 0.005, Cohen's d = -0.42) in the intervention groups; however, one study revealed no significant group differences. Parenting stress was examined in one study (n = 156); it showed significantly lower parenting stress (P = 0.017, Cohen's d = 0.38) immediately after the intervention.

CONCLUSIONS

There is insufficient evidence to support the effectiveness of a specific type of antenatal parenting education for maternal confidence, maternal depressive symptoms, and parenting stress for expectant primiparous women in Asia. However, the findings suggest that specific theory-oriented antenatal parenting education is potentially effective for those women. Further high-quality studies are needed for antenatal parenting education among expectant primiparous women, especially in Asia.

Maternal Confidence and Emergency Department Utilization Among Infants

OBJECTIVES

To determine if maternal confidence affects emergency department (ED) utilization in the first year of life.

METHODS

This retrospective cohort study examined the Maternal Confidence Questionnaire responses from a longitudinal birth cohort study and ED visits for these subjects across all Inova hospitals from January 2012 to July 2017 for full-term children 12 months or younger at the time of visit. Using logistic regression, maternal confidence, maternal race/ethnicity, age, education, parity, and insurance were evaluated against Emergency Severity Index acuity levels and ED visit frequency.

RESULTS

Of 2429 participants in the longitudinal study, 316 subjects visited the ED and met inclusion criteria. Medicaid status was the main factor associated with any ED visit. Low maternal confidence did not correlate with more frequent or nonurgent ED visits. Higher maternal confidence scores were seen in Hispanic or Latino mothers and mothers with parity greater than 1. Hispanic or Latino mothers were more likely to have Medicaid and more likely to bring their child to the ED. Mothers with college education had lower maternal confidence scores, were less likely to visit the ED, but had higher acuity level visits.

CONCLUSIONS

Low maternal confidence did not correlate with frequent ED visits or nonurgent visits. Medicaid status was the main factor associated with any ED visit. Hispanic or Latino mothers had higher maternal confidence scores, were more likely to have Medicaid and more likely to bring their child to the ED.

Effectiveness of parenting education for expectant primiparous women in Asian countries: a quantitative systematic review protocol

REVIEW QUESTION

What is the effect of antenatal parenting education on parenting stress, maternal depressive symptoms and maternal confidence, compared to usual care, for expectant primiparous women in Asian countries?

Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design

BACKGROUND

For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent-infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers' mother-infant interaction quality and parenting sense of competence.

METHODS

Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother-infant interactions.

RESULTS

We observed an increase in the quality of mother-infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother-infant interaction.

CONCLUSIONS

Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants' abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction.

Patterns of Transition Experience for Parents Going Home from Hospital with their Infant after First Stage Surgery for Complex Congenital Heart Disease

PURPOSE

The purpose of this study was to explore parents' experiences of one specific timepoint in their infant's journey: the transition from hospital to home, following the first stage of their infant's cardiac surgery for complex congenital heart disease.

DESIGN AND METHODS

A prospective longitudinal mixed methods study, underpinned with Middle Range Transition Theory (Meleis, Sawyer, Im, Hilfinger Messias, & Schumacher, 2000). Face to face and telephone interviews were conducted and self-report forms completed by parents at four-time points: before discharge (T0), 2weeks after discharge (T1), 8weeks after discharge (T2) and after stage two surgery (T3). Interviews were transcribed verbatim before inductive thematic analysis.

RESULTS

Parents were recruited over a 15-month period from 2013 to 2015. Twelve mothers and 4 fathers took part. The infants had functionally univentricular heart (left n=10, right n=1) and a systemic shunt dependent lesion, tetralogy of Fallot (n=1). Dynamic constructivist and constructionist social processes occurred for all parents, involving physical, physiological, psychological and cognitive elements within four 'patterns of experience', two of which 'safety and security' and 'love and support' are presented in this paper.

IMPLICATIONS

Parental support is essential; parents need to be engaged in discharge planning process and given the opportunity to express their needs to ensure that discharge care is truly patient and family centered.

CONCLUSIONS

Transition from hospital to home was complex and multi-faceted, with unanticipated physical and emotional transitions superimposed upon those that were expected.

Delineating Among Parenting Confidence, Parenting Self-Efficacy, and Competence

This article examined the concepts of parenting self-efficacy, parenting confidence, and competence. Using Morse's method of concept delineation, a literature review of each concept was conducted to uncover commonalities, distinctions, and measurement overlaps between concepts and provide conceptual boundaries. Findings revealed that parenting confidence and parenting self-efficacy describe a parents' internal attribution or beliefs about their ability to engage in parenting behaviors. Both terms have similar antecedents, attributes, and consequences, whereas competence is a concept that should be used as an objective measure by someone other than the parent to assess parenting quality.

Clinical, Social, and Genetic Factors Associated with Obesity at 12 Months of Age

OBJECTIVE

To examine genomic, social, and clinical risk factors of ≥85 weight for length percentile (WFLP) at 12 months.

STUDY DESIGN

Children in this study had whole-genome sequencing, and clinical and social data were collected. WFLPs at 12 months of age were grouped as follows: (1) <85th, (2) ≥85th to <95th, (3) ≥95th to <99th, and (4) ≥99th. Whole-genome sequencing data were used to analyze rare and common variants, and association of clinical and social factors was examined.

RESULTS

A total of 690 children were included; WFLPs were 422 (61.2%) <85th, 112 (16.2%) ≥85th-<95th, 89 (12.9%) ≥95th-<99th, and 67 (9.7%) ≥99th. Family-related risk factors associated with greater WFLP were greater paternal body mass index, WFLP ≥99th OR 1.10 (1.03-1.16), and greater than recommended weight gain in pregnancy, WFLP ≥85th-<95th OR 1.90 (1.09-3.26). More breast milk at 6 months was protective factor: WFLP ≥85th-<95th, OR 0.98 (0.97-0.99), WFLP ≥95th-<99th OR 0.98 (0.97-0.99), and WFLP ≥99th OR 0.98 (0.96-0.99). Although none of the variants reached genome-wide significance, there was a trend toward increased prevalence of genetic variants within or near genes previously associated with obesity in children with WFLP ≥99th.

CONCLUSION

This cross-sectional study identified several modifiable factors, including increased weight gain in pregnancy and decreased breast milk at 6 months, associated with greater WFLP at 12 months. Strong genetic factors were not identified.

Enhancing first-time parents' self-efficacy: A systematic review and meta-analysis of universal parent education interventions' efficacy

BACKGROUND

Poor adjustment during early parenthood often leads to low feelings of parental self-efficacy, which influences parents' behaviours towards their infants. The long-term consequences on infant development warrant the need for more attention on the efficacy of universal parent education interventions to empower parents and enhance their self-efficacy.

OBJECTIVES

To synthesise available evidence and explore the efficacy of universal parent education interventions on the parental self-efficacy of first-time parents.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

A literature search of 10 databases was conducted to identify randomised controlled trials from each database's point of inception to November 2016.

METHODS

Based on the inclusion criteria, 24,062 articles were screened for their titles and abstracts. Two hundred and eighty articles were identified for full-text screening. Risks of bias posed by the selected articles were assessed using Cochrane's Risk of Bias instrument. Meta-analyses were conducted using RevMan 5.3. The overall intervention effect was evaluated using z tests at p < 0.05, while I² and Cochran Q tests were used to measure heterogeneity.

RESULTS

Ten randomised controlled trials were selected; eight trials were combined in meta-analyses and two trials were synthesised narratively. A meta-analysis revealed that universal parent education interventions significantly enhanced parental self-efficacy (p < 0.001) among first-time parents and these effects were also maintained over time (p < 0.001). The extent of improvement in parental self-efficacy was affected by the duration of the interventions.

CONCLUSION

This review provides sufficient evidence to support the use of universal interventions to enhance new parents' self-efficacy. While intervention effects were sustained at the two-month follow-up, further research using randomised controlled trials and longitudinal studies are needed to determine long-term effects. The findings serve as an impetus for hospitals and healthcare professionals to integrate universal interventions in perinatal care to guide first-time parents' transition into parenthood.

Mother's level of confidence in caring for her late preterm infant: A mixed methods study

AIM AND OBJECTIVES

To examine what it means to be a mother of a late preterm infant including a mother's level of confidence in caring for her late preterm infant over time and the effect of maternal depression of this experience.

BACKGROUND

Little is known about mothers' experiences of caring for their late preterm infants in the community, including their level of confidence and parenting stress within the context of a supported care environment by public health nurses.

DESIGN

A mixed methods study, sequential explanatory quantitative and qualitative study.

METHODS

A convenience sample of mothers with LPIs (n = 71) completed questionnaires on maternal confidence (3-4 weeks and 6-8 weeks), parenting stress (6-8 weeks), social support (6-8 weeks) and postpartum depression (6-8 weeks). A purposive sample of mothers (n = 11) underwent in-depth, semi-structured interviews.

RESULTS

Maternal confidence decreased from 3-4 weeks-6-8 weeks after delivery, and similar results were found for mothers who reported depressive symptoms. Narratives of the mothers suggested the decrease in maternal confidence over time was influenced by the demanding characteristics of the late preterm infant, the prospect of their rehospitalisation and the mother's reported interactions with public health nurses. Depression had an effect on maternal confidence; that is, the depressed mothers demonstrated less confidence about their caretaking role than the nondepressed mothers at 6-8 weeks. Mothers did not discuss mental health issues, which may reflect the protective effects of social support on emotional instability or an inability to recognise postpartum depression.

CONCLUSION

The confidence of mothers with LPIs decreased over the first 2 months following delivery and being home with their infants. Assisting mothers to meet their personal needs and the needs of their infant should promote maternal skills, which will likely increase maternal confidence related to the care of their late preterm infant.

RELEVANCE FOR CLINICAL PRACTICE

Characteristics of LPIs contributed more to parenting stress score than parent characteristics; mothers however attempted to normalise the late preterm infant in order to minimise the parenting stress. Evidence-informed brief interventions tailored based on late preterm infant and parent characteristics may improve maternal confidence over time. Healthcare professional should provide education and anticipatory guidance prior to discharge, consistent care in hospital and postdischarge as this may impact maternal level of confidence. Future research needs to examine standards of care for discharge of LPIs and adherence to these standards.

Maternal self-confidence during the first four months postpartum and its association with anxiety and early infant regulatory problems

Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R=.583, F_3,96=15.950, p<.001). Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.

Soutien social et expérience paternelle des pères de nouveau-nés prématurés

Cadre de la recherche : Plusieurs études ont montré que le vécu parental lors d’une naissance prématurée peut être de nature traumatique avec un impact sur la qualité de la relation parent-enfant (Lindberg, Axelsson et Ohrling, 2008). Cependant, force est de constater que les processus en jeu chez le père restent relativement inexplorés.

Objectifs : L’objectif de cette étude exploratoire est de développer un modèle de compréhension de l’expérience paternelle de nouveau-nés prématurés. Celle-ci est appréhendée par la relation avec le nourrisson (Blomqvist et al., 2012 ; Helth et Jarden, 2013) et l’expérience du devenir père (Zaouche Gaudron et al., 2003 ; Zaouche Gaudron et al., 2005) mais également par la relation avec l’équipe soignante (Fegran et Helseth, 2009). La gravité de la prématurité est également examinée (Ibanez et al., 2006).

Méthodologie : L’échantillon se compose de 48 pères de bébés prématurés. Un entretien semi-directif basé sur le Clinical Interview for Parents of High Risk Infants (Meyer et al., 1993) a été adapté et utilisé pour le recueil de données. Les axes réfèrent à la grossesse de la conjointe, à l’accouchement, à la relation avec le nourrisson et au soutien social.

Résultats : Nos principaux résultats indiquent que les pères construisent un premier lien avec leur bébé par le contact du peau-à-peau et par l’accordage du regard. Ils témoignent, par ailleurs, d’un vécu traumatique lié à la prématurité décrit par des sentiments ambivalents, comme la peur, le stress mais également le bonheur. La source la plus importante de soutien social, hormis la famille, est l’équipe soignante et les autres parents dans le service.

Conclusions : Les principales conclusions permettent d’amener des propositions quant aux pratiques professionnelles afin de soutenir le processus de paternalisation dans ce contexte particulier de prématurité.

Contribution : Dans une approche qualitative, cette étude apporte un éclairage concernant l’expérience paternelle dans le contexte particulier qu'est la prématurité du nouveau-né.

Self-Report Measures of Parental Self-Efficacy: A Systematic Review of the Current Literature

Parenting self-efficacy (PSE) describes a parent's belief in their ability to perform the parenting role successfully. Higher levels of PSE have consistently been shown to be correlated with a wide range of parenting and child outcomes. Consequently, many parenting interventions aim to improve PSE. PSE measurement has typically been via self-report measures. However, the wide range of available measures has resulted in their limited use, inconsistent terminology and ambiguous theoretical grounding. The purpose of this systematic review was to examine the psychometric and administrative qualities of the available PSE measures and offer clarity to the terminology and the theory underpinning their use so that the future use of PSE measures can be appropriate. Eleven electronic databases were searched. Articles were included if they introduced a new measure or were psychometric evaluations of an available measure of PSE for parents of children (from infancy until 18 years of age). Thirty-four measures were identified and their psychometric and administrative qualities were examined. Overall, the quality of the available measures was varied. Whilst this review makes recommendations regarding PSE measures for parents of infants through to adolescents, some caution should be applied when choosing the most appropriate measure. The theoretical grounding of each measure was clarified so that appropriate measures can be chosen under the relevant circumstances. The implications of refinement of the available measures are discussed and further research into improving PSE measurement is identified.

Perceived Needs of Parents of Premature Infants in NICU

To investigate the needs of parents of premature infants hospitalized in a neonatal intensive care unit (NICU) and explore associated factors. This study includes a convenience sample of 198 parents of premature infants hospitalized in a NICU in Chenzhou, Hunan province, China. Parents completed a study-specific questionnaire and the Chinese version of Critical Care Family Need Inventory (CCFNI). Analysis was conducted by multiple linear regression. Parents rated 30 of 45 items on the Chinese version of the CCFNI as important or very important. Items on the assurance, information, and proximity subscales were perceived as the most important, while items on the comfort subscale were the least important. Gender of parents and experience of visiting a NICU were significantly associated with the total needs of the parents. These insights should be used to inform clinical practice in the NICU.

Differences in infant temperament between Chile and the US

Temperament refers to individual differences in reactivity and self-regulation and is influenced by genetic and experiential variation and maturation. Temperament reflects biologically based individual differences that emerge in early life and remain relatively stable thereafter. Given the growing interest in cultural variation in infant temperament, this study examined the temperament of 12-month-old children in Chile and the US. The aims were to validate a version of the Infant Behavior Questionnaire - Revised - Very Short Form in Spanish for Chile and to compare Chilean and US infants' temperament. For the first aim, 150 Chilean infants aged 10-15 months were assessed, and 73 US infants aged 10-15 months were examined for the second aim. The children's parents completed a demographic questionnaire and the IBQ-R-VSF, which measures three dimensions of temperament: Surgency, Negative Affectivity, and Effortful Control. The reliability of each dimension for the Chilean sample was between 0.70 and 0.75, and significant differences between Chilean and US infants emerged. Parents of Chilean infants reported higher levels of Effortful Control, whereas US parents reported that their infants exhibited higher levels of Negative Affectivity. A relationship between parents' higher educational level and infants' higher levels of Surgency was found for both countries. No gender or age differences were observed for any of the three temperament dimensions. These results and their implications for cultural studies are discussed.

Toddler Emotional States, Temperamental Traits, and Their Interaction: Associations with Mothers' and Fathers' Parenting

We investigated the degree to which toddlers' observed emotional states, toddlers' temperamental traits, and their interaction accounted for variance in mothers' and fathers' parenting. Main effects of two emotional states (positive emotion and negative emotion), three temperamental traits (negative affectivity, effortful control, and surgency) as well as state-by-trait interactions, were examined in relation to parental sensitivity, positive affect, and negative affect. The hypothesis that toddlers' temperamental traits would moderate the association between their observed emotional states and parenting was partially supported. Significant state-by-trait interactions were found in models predicting the probability that mothers and fathers expressed negative affect towards their toddlers. For parental sensitivity and positive affect, only main effects of temperament and/or emotion expression accounted for variance in parenting.

The influence of geographic isolation on late preterm infant and mother outcomes

PURPOSE

Risk of adverse outcome in late-preterm infants (born between 34 and 36 weeks and 6 days' gestation) is heightened for those living in geographic isolation (GI). We examined the relationships between GI and several mother and infant outcomes.

SUBJECTS AND DESIGN

This was a tricenter cross-sectional study of 38 English-speaking late-preterm infant/mother dyads admitted to neonatal intensive care in a predominately rural Midwestern state. Eligibility for the study included English-speaking mothers and their biologically born late-preterm infants with no known anomalies. METHODS AND MAIN OUTCOME: Outcomes included maternal knowledge of infant development (Knowledge of Infant Development Inventory) and competence (Competence in Preterm Infant Care questionnaire), maternal perception of vulnerability (Vulnerable Baby Scale ([VBS]), risk, and temperament (Pictorial Assessment of Temperament ([PAT]). Infant readmission and follow-up data were also examined. Potential covariates included any use of the Internet for healthcare information, demographic data, and mother and infant health history and were obtained from medical records and from the mother. Level of GI was determined by time and distance traveled (minutes) from the mother's primary residence to the closest regional healthcare center.

RESULTS

Study participants traveled 61 ± 58 miles and 72 ± 62 minutes on average. The Mean ± SD scores on assessment were as follows: Knowledge of Infant Development Inventory 77 ± 10, and Competence in Preterm Infant Care questionnaire 90 ± 14, VBS 27.5 ± 3.5, and PAT 17.5 ± 3. Bivariate associations were observed between distance and time and VBS scores (P = .03 for both). Multiple regression analysis showed significant relationship between time (P = .02) and PAT scores when maternal education (0.09) and the number of hours spent in the NICU (P = .01) were entered into the model. The association between time traveled and VBS scores became marginally significant when maternal age and Internet use were entered into the regression models. The odds for a mother to perceive her infant at risk for suboptimal outcomes were 6 times greater for each 1-hour additional travel time (odds ratio = 6.0; 95% confidence interval: 1.3-36; P = .001). There was no association between GI and readmission rate and follow-up care. Readmission rate was 8%, and anticipatory guidance was found to be inadequate.

CONCLUSION

Remote access to appropriate healthcare services elicits more than legitimate concerns for the late preterm infant and warrants further investigation with consideration for how services might be more easily accessed for this at-risk group.

Development of an innovative NICU teen parent support program: one unit's experience

This article describes our creation of an innovative neonatal intensive care unit Teen Parent Support Program using a collaborative, family-centered, interdisciplinary team approach. Program development, educational content, implementation, and outcomes are reported. The success of this program is due in part to a dedicated group of interdisciplinary professionals who volunteer their expertise to provide education and support to our teen parents and families. The results of the program demonstrate an increase in parent engagement and confidence. This Teen Parent Support Program also received The March of Dimes Leading Practices Award in July 2012.

Prematurity and parental self-efficacy: the Preterm Parenting & Self-Efficacy Checklist

There is a lack of research investigating parental self-efficacy in parents of infants born preterm as well as a paucity of parental self-efficacy measures that are domain-specific and theoretically grounded. This study aimed to compare parental self-efficacy in parents of infants born term, preterm and very preterm as well as to test whether parental self-efficacy mediates the relationship between psychological symptoms and parental competence. In order to achieve this, a new measure of parental self-efficacy and parental competence relevant for the preterm population and consistent with Bandura's (1977, 1986, 1989) conceptualisation of self-efficacy was developed. Participants included 155 parents, 83 of whom were parents of very preterm (GA<32 weeks), 40 parents of preterm (GA<37 weeks) and 32 parents of term born infants. Parents completed the Preterm Parenting & Self-Efficacy Checklist (the new measure), Family Demographic Questionnaire, Depression Anxiety Stress Scale and Self-Efficacy Questionnaire. This initial study indicates that the Preterm Parenting & Self-Efficacy Checklist has adequate content validity, construct validity, internal consistency and split half reliability. Contrary to expectations, parents of very preterm infants did not report significantly lower overall levels of parental self-efficacy or significantly higher levels of psychological symptoms compared to parents of preterm and term infants. Parental self-efficacy about parenting tasks mediated the relationship between psychological symptoms and self perceived parental competence as predicted. Clinical implications of the results and suggestions for future research are discussed.

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.

Characteristics of HIV-infected mothers associated with increased risk of poor mother-infant interactions and infant outcomes

INTRODUCTION

The current study aimed to investigate the relationship between individual and familial characteristics of HIV-infected mothers and their psychological health as it relates to parenting as well as their parenting beliefs/abilities.

METHOD

A descriptive correlational design was used. Seventeen HIV-infected mothers and their infants were recruited from a university clinic in Alabama. Assessments were gathered at the infant's pediatric clinic appointments (approximately 6 weeks after delivery) and included a demographic questionnaire, the Beck Depression Inventory-II, the Maternal Confidence Questionnaire, the Parenting Stress Index-Short Form, and the Questionnaire About Physical Contact.

RESULTS

Dysfunctional parent-child interactions significantly correlated with maternal confidence, parent stress, and overall feeling about physical contact. Difficult child temperament correlated with overall and current feelings of physical contact and parent stress. Significant correlations were found between parent distress, parent stress, and maternal depression.

DISCUSSION

Beyond the need to assist HIV-infected mothers with stress and depression, an intervention is needed to facilitate optimal parent-child interactions and improve both child psychosocial and cognitive outcomes.

Effects of infant massage on HIV-infected mothers and their infants

PURPOSE. To determine the feasibility of implementing an infant massage intervention and to evaluate the preliminary effects of infant massage on HIV-infected mothers and their infants. DESIGN AND METHODS. In this two-group, randomized controlled pilot study, intervention group mothers were taught to perform infant massage daily for 10 weeks. RESULTS. Infant massage training had a positive impact on maternal depression, parental distress, and infant growth along with facilitating more optimal parent-child interactions. PRACTICE IMPLICATIONS. Infant massage, a quick, easy, and inexpensive intervention, is feasible in a clinic setting and may benefit human immunodeficiency virus-infected mothers and their infants.

The effectiveness of an early parenting intervention for mothers with infants with sleep and settling concerns: a prospective non-equivalent before-after design

AIM

The study aim was to compare changes in maternal confidence, competence, depression, anxiety and settling behaviours and children's sleep and settling behaviours for mothers and infants (4-6 months of age) attending a Day Stay intervention at an early parenting centre in Western Australia and a community group.

BACKGROUND

Infant difficulties in getting to sleep and frequent night waking are concerns for parents. Techniques are available to assist parents with infants exhibiting behavioural sleep problems; however, parents often lack confidence to consistently initiate sleep interventions.

DESIGN

The study incorporated a prospective non-equivalent before-after design.

METHOD

The conceptual framework guiding this intervention emphasised the development of parental confidence and competence through connection with practitioners to promote change. Both groups provided baseline data (time 1) and four weeks postbaseline (time 2). Recruitment occurred between July 2007-July 2009.

RESULTS

The Ngala group (n = 93) and community group (n = 85) were not equivalent for infant age and maternal parity; there were more multiparous mothers in the community group, with infants on average one week older. The Ngala group, the majority of which were primiparous women, had significantly higher levels of competence and confidence four weeks following their Day Stay visit. There were no significant differences between groups at time 2 for time to settle the infant at night, infant night waking and maternal depression and anxiety scores.

CONCLUSIONS

Although both groups demonstrated an improvement in depression and anxiety scores, with decreased sleep and settling concerns, the results indicate parental inconsistency in settling approaches. Given links between inconsistent infant settling approaches and infants' difficulty with sleep self-initiation, further exploration is warranted.

RELEVANCE TO CLINICAL PRACTICE

The conceptual framework guiding the Ngala practitioners was effective in developing confidence and competence for the sample.

Effectiveness of applying empowerment strategies when establishing a support group for parents of preterm infants

AIMS

The objectives of this study were to apply empowerment strategies to the establishing of a support group for parents of preterm infants who were recently discharged home and to examine its effectiveness in terms of self-efficacy, perceived stress and depression among the parents.

BACKGROUND

While the concept of empowerment has been applied when establishing various patient support groups, it has not been explicitly used for parents of preterm infants.

DESIGN

This study applied a quasi-experimental design.

METHOD

The inclusion criteria were parents of infants with a birth gestational age of <37 weeks who were expected to be discharged home within one week. A total of 70 parents of preterm infants participated in this study, made up of 35 participants each in the intervention and in the control groups. The intervention group received three months of support applying empowerment strategies, while the control group received usual care only.

RESULTS

The results, relative to the control group at post-test, demonstrated that the intervention group showed significantly higher scores for self-efficacy when using resources as well as significantly decreased scores for depression. For parents of preterm infants with a very low birth weight, the intervention group showed a significant decrease in perceived stress relative to controls, but this was not seen in parents of preterm infants without very low birth weight. There was no significant difference in the scores for self-efficacy when performing parental roles.

CONCLUSIONS

his study demonstrated the effectiveness of support groups for parents of preterm infants that apply empowerment strategies, which decreased parental depressive symptomatology and increased parental self-efficacy when utilising resources. The intervention also effectively decreased the perceived stress level in parents of infants with very low birth weight.

RELEVANCE TO CLINICAL PRACTICE

Health professionals should apply empowerment strategies when establishing parental support groups for preterm infants.

Further Psychometric Testing and Use of the Maternal Confidence Questionnaire

Research results can be better interpreted and used when reliable and valid instruments are used to measure concepts. Researchers and clinicians, especially those from locations outside the United States, have difficulty locating existing instruments for use in their research studies. The dilemma is further exaggerated when such instruments are not published and when the author of the instrument cannot be located. This review looked at the results of 20 studies which have utilized the Maternal Confidence Questionnaire (MCQ) (Zahr, 1991) with the purpose of familiarizing researchers and clinicians with its flexibility, reliability, and validity. Examples of specific published studies which have used the instrument are discussed along with unpublished studies which have used the instrument.

Infant responsiveness and maternal confidence in the neonatal period

Responsiveness in prematurely and term-born infants was studied cross-sectionally in relation to maternal confidence. Orientation and arousal were measured in 140 prematurely (mean BW 1,398 g, GA 30.1 weeks) and 75 term-born infants (mean BW 3,613 g, GA 39.3 weeks) with the Neonatal Behavioral Assessment Scales. Mothers filled out the Maternal Confidence Questionnaire and a modified version of the Parenting Stress Index. Prematurely born infants had a significantly lower level of arousal than term-born neonates. Responsiveness was not associated with maternal confidence. Lower confidence was associated with primiparity in both groups of mothers. Multiparous mothers of prematurely born infants had significantly lower levels of confidence than multiparous mothers of term-born infants. Confidence was significantly associated with stress for mothers of prematurely and term-born infants, and may be focused in follow-up after giving birth. Prematurely born infants should be examined more thoroughly in aspects of arousal at the time of discharge.

Transition to home from the newborn intensive care unit: applying the principles of family-centered care to the discharge process

Increasingly newborn intensive care units (NICUs) are embracing family-centered care principles. Family-centered newborn intensive care requires that families are welcomed as partners in caregiving and decision making. Traditionally, discharge planning has been done without significant family involvement. In fact, parent participation in caregiving may still be limited until discharge is imminent. By increasing parental involvement in caregiving throughout hospitalization and working with families to facilitate the discharge process, parents may emerge from the NICU experience with increased competence and confidence in infant caregiving. This article reviews common discharge practices and processes in the NICU and offers strategies to assist nurses in integrating a family-centered approach into discharge planning.

Self-efficacy in Infant Care Scale: Development and psychometric testing

The Self-Efficacy in Infant Care Scale (SICS) is a self-administered measure to assess maternal judgments about the ability to care for the baby during the first year of life. The SICS was initially composed of 67 items and was tested on 397 Thai mothers with infants < 12 months old. The test demonstrated adequate internal consistency and test-retest reliability. Factor analysis yielded 42 items with five dimensions of self-efficacy in infant care. With an acceptable model fit using confirmatory factor analysis, a final version of the SICS contained 40 items with four dimensions of self-efficacy in infant care: developmental promotion, general health care, safety, and diet. This preliminary test for the psychometric properties revealed that the SICS has potential uses for both research and clinical purposes. However, the model selected must be viewed as tentative; further refinement is suggested.

Maternal confidence in China: association with infant neurobehaviors but not sociodemographic variables

OBJECTIVE

To examine the relations of sociodemographic factors and infant neurobehaviors to maternal confidence in China.

METHODS

The Brazelton Neonatal Behavioral Assessment Scale, Family APGAR, and Maternal Confidence in Caring for the Newborn scales were administered to 40 healthy, full-term neonates.

RESULTS

Range and regulation of state, autonomic stability, and reflex cluster scores were positively correlated; the autonomic stability cluster score was negatively correlated with maternal confidence in meeting the infant's social and instrumental needs. Educational level, age, income, satisfaction with family conditions, and infant sex were not associated with maternal confidence. Range of state and autonomic stability cluster scores predicted maternal confidence.

CONCLUSIONS

The infant's abilities to tolerate stimuli, and to be consoled, were associated with maternal confidence. Also, maternal confidence was related to the recognition of infant autonomic cues. Family and sociodemographic variables were not associated with maternal confidence. The sex of the newborn did not affect maternal confidence.

Fathers’ Perceptions of the Immediate Postpartal Period

PURPOSE

To describe the perceptions of first-time fathers regarding critical moments of the immediate postpartum period.

DESIGN

Qualitative study.

SETTING

Data were collected through semistructured interviews with the fathers, using the critical incident technique; this was done in their home, within the first 12 days following the birth of their child.

PARTICIPANTS

Sample consisted of 13 first-time fathers.

RESULTS

A qualitative analysis allowed for the identification of five domains, five categories, and 12 subcategories of critical incidents within the first 96 hours of the postpartum period. The five domains of incidents relate to self and others: as individuals, as a couple, and as parents in relationship with the environment and with the nursing personnel. On the basis of a combined score of fathers' presence on the maternity ward, we were able to define three subgroups. All groups of fathers were sensitive to interactions with their baby and with the nurses. Highly involved fathers reported not feeling supported by the hospital environment policies in regard to engaging in behaviors that could favor their involvement with their baby.

CONCLUSIONS

Increased awareness of fathers' experiences during the immediate postpartum period will enable nurses to respond more effectively to the fathers' needs.

Parent visiting and participation in infant caregiving activities in a neonatal unit

BACKGROUND

Active parent involvement in caring for their infants in the neonatal care unit is thought to improve parent-infant attachment and to moderate the psychological stress for parents, but few recent studies have examined parent visiting patterns and participation in infant caregiving. The study purposes were to describe the frequency and duration of parent visiting and participation in infant caregiving activities, and to identify parent and infant factors associated with parental participation.

METHODS

Parental visiting frequency, duration, and participation in social, cleaning, and feeding activities with their infant (n=110) were recorded on 12 days during a 3-month period in a tertiary neonatal unit.

RESULTS

Mothers visited more frequently (85% vs 45% of possible days) and for longer than fathers, and visited less frequently if the infant had other siblings, if the infant was over age 1 month, or if fathers made fewer visits. Fathers visited less frequently if the infant was over age 7 days and more frequently if the mothers visited more frequently. All mothers and most (96%) fathers carried out social activities, such as talking, stroking or holding, during their visits. Over 75 percent of mothers engaged in infant cleaning and feeding activities during visits in contrast with less than 20 percent of fathers. Mothers' participation in infant feeding was best predicted by the duration of their visit and their participation in infant cleaning. Fathers' participation in infant feeding was only related to their participation in infant cleaning.

CONCLUSIONS

Significant differences were found in this neonatal unit between mothers' and fathers' visiting patterns and infant caregiving activities. Neonatal unit staff should consider factors that may influence parental visiting and explore strategies to improve parental involvement in caregiving.

Weighing preterm infants before & after breastfeeding: does it increase maternal confidence and competence?

PURPOSE

To determine whether weighing preterm infants before and after breastfeeding ("test weighing") affects maternal confidence and competence.

METHODS

A longitudinal, repeated measures control group study. Sixty mothers of preterm infants were randomly assigned to a test weight or nontest weight group. In the test weight group, nurses weighed infants before and after every breastfeeding while they were in hospital. Maternal confidence and competence were measured four times: (a) at 3 days after the initiation of breastfeeding, (b) at infants' discharge from hospital, (c) at 1 week postdischarge, (d) at 4 weeks postdischarge.

RESULTS

No significant differences in maternal confidence and competence at any of the measurement times were found. When change over time was examined using MANOVAs, the levels of competence and confidence in both groups had increased significantly.

CLINICAL IMPLICATIONS

The development of maternal confidence and competence in this group was independent of test weighing during hospitalization and calls into question claims that such interventions are necessary to develop competence or confidence in mothers of preterm infants.

Mothers' Decision‐Making Processes Regarding Health Care for Their Children

This research study explored mothers' decision-making processes regarding health care for their children. Identifying how decisions are made by mothers about health care for their children will assist health care professionals to be appropriate advocates for mothers, to improve quality of life, and to contain costs of health care for children. A sample of 114 rural mothers (51 with one child, 63 with more than one child) completed questionnaires identifying demographics, social support, client and professional interaction elements, self-determinism, competence in problem-solving skills, and relationships to responses to health care scenarios. Qualitative data were also gathered by structured in-depth interviews of 7 subjects. ANOVA, correlations, and factor analysis were completed to analyze data. Most of the mothers' decisions were based on the perceived degree of seriousness, mother's degree of fear of the child's condition, attitude of the health care provider, previous experience with the situation, and social support for the mother. There were no significant differences in decision-making processes by first time mothers and by mothers with more than one child. Implications include teaching mothers assessment skills to identify serious versus nonserious situations and to utilize other social supports.

Caregiving and help seeking by mothers of low birthweight infants and mothers of normal birthweight infants

The purpose of this research was to describe perceptions of infant health, caregiving at home, and help seeking by mothers of low birthweight (LBW) infants (n = 30) and mothers of normal birthweight infants (n = 30). In this descriptive study, data were analyzed through multiple regression, t tests, and content analysis of responses to researcher-constructed questionnaires. There were statistically significant relationships between: infant health and both confidence in caregiving (R2 = 0.18, p<0.001) and caregiver burden (R2 = 0.29, p<0.001); preparation for caregiving and confidence in caregiving (R2 = 0.10, p<0.05); and confidence in caregiving and caregiver burden (R2 = 0.12, p<0.01). Compared with mothers of normal birthweight infants, mothers of LBW infants perceived poorer infant health, t (58) = -2.02, p = <0.05, and more caregiver burden, t (58) = 3.50, p = <0.001. Mothers reported seeking help from a variety of resources, mostly nonprofessional for questions on infant care or nonserious infant health problems, and mostly physicians for questions on serious infant health problems. Nurses can use knowledge of mothers' perceptions of infant health, caregiving, and help seeking to facilitate mothers' management of caregiving and resource use.

The nature of attachment in a neonatal intensive care unit

Attachment is defined as the formation of a relationship between a mother and her newborn infant. The concept of attachment has been inadequately defined and often confused with feelings associated with love, instinct, engrossment, and being connected to others. Prematurity and associated maternal-infant separation at birth can affect the attachment process. In this article, a research project, using Leninger's ethnonursing approach is described. Leninger's method was chosen to study the phenomenon of attachment in a neonatal intensive care unit (NICU). Ethnonursing has been found to be a suitable approach for the study of complex situations. Ethnonursing is based on an observation, participation in care, and reflection model. Qualitative data for this study were collected by observation, participation in care, and interviews of mothers (N = 25) in a tertiary NICU. Data were analyzed by comparison of narratives from field notes and transcripts. Findings from the analysis indicate the process of attachment was not automatic. Attachment should be considered as an individualized process. Two dichotomies associated with attachment were identified through the research. These were overt and covert attachment processes and may be dependent on the health status of the infant and the mother, environmental circumstances, and on the quality of care the infant receives.