Parental Psychological Distress and Confidence After an Infant’s Birth: The Role of Attachment Representations in Parents of Infants with Congenital Anomalies and Parents of Healthy Infants

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.

Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments

Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.

Evaluation of the Polish version of the Parenting Sense of Competence Scale in parents of typically developing children and children with autism spectrum disorders

BACKGROUND

Parental self-efficacy describes parents' self-perceived competence in fulfilling their roles. The Parenting Sense of Competence Scale (PSOC) is one of the most commonly used self-report instruments, allowing for parental self-efficacy measurement.

METHODS

This paper summarizes the results of three studies (total N = 2088) conducted to examine factor structure, internal consistency, test-retest reliability and criterion validity of the Polish version of PSOC (PSOC-PL). The studies were carried out among parents (mothers and fathers) of typically developing 14- and 15-year-olds (Study 1, n = 1404) as well as among parents of typically developing children aged 6-16 (Study 2, n = 248), parents of typically developing children and children with a diagnosis of autism spectrum disorder (Study 3, n = 436, ages ranged from 6 to 13).

RESULTS

Confirmatory factor analysis (Study 1) demonstrated an acceptable fit of the theorized two-factor model, with theorized Satisfaction and Efficacy factors. The subscales' internal consistencies were satisfactory across all studies (Studies 1-3), and PSOC's test-retest reliability (Study 2) over a 3-week interval was very high. Parents of children with developmental disorders (Study 3) reported lower efficacy than parents of typically developing children.

CONCLUSIONS

The results of these three studies attest that the Polish version of PSOC is a reliable and valid measure of parental self-efficacy beliefs.

Factors Affecting Paternal Fetal Attachment

AIM

There are very few studies examining how the prenatal attachment of the father to the fetus affects father–infant attachment, while there are numerous studies on maternal–fetal, maternal–infant attachment. The pregnancy period is a potential opportunity to increase the paternal attachment of fathers whose wives are expecting a baby. The aim of this study was to determine paternal–fetal attachment and the factors with an effect.

METHODS

The sample group of this descriptive (comparative) study consisted of expectant fathers accompanied by their wives at 24–36 weeks of pregnancy (n = 182). Ethics committee approval and the necessary permissions were obtained from the relevant institution. The data were collected by the researchers using the Question Form and Paternal Fetal Attachment Scale. The data collected were analyzed using percentage distribution, the Independent samples t test and the one-way analysis of variance (ANOVA) test.

RESULTS

The results of the study showed that the participants who experienced fatherhood for the first time and felt ready to be a father had higher paternal attachment scores than experienced fathers.

CONCLUSION

For the establishment of healthy attachment starting in the prenatal period and continuing thereafter, there are important tasks for healthcare professionals to ensure that fathers can cope with the new roles and responsibilities just as well as the mothers.

Parents' Experiences of Transition From Hospital to Home After Their Infant's First-Stage Cardiac Surgery: Psychological, Physical, Physiological, and Financial Survival

BACKGROUND

The intersurgical stage is a critical time for fragile infants with complex congenital heart disease, but little is known about the impact on parents.

OBJECTIVE

The aim of this study was to explore parents' experiences of the transition from hospital to home with their infant after stage 1 cardiac surgery for complex congenital heart disease.

METHOD

This is a prospective, longitudinal, mixed methods feasibility study using semistructured interviews and self-report instruments at 4 time points: before discharge (baseline), 2 weeks post discharge, 8 weeks post discharge, and after stage 2 surgery. Qualitative data were analyzed thematically; and quantitative data, descriptively.

RESULTS

Sixteen parents of 12 infants participated. All parents described signs of acute stress disorder; 4 parents described symptoms of posttraumatic stress disorder before discharge. Parents' fear and uncertainty about going home were multifaceted, underpinned by exposure to numerous traumatic events. By 8 weeks post discharge, parents' feelings and emotions were positive, relieved, and relaxed. Mean generalized anxiety and depression scores were higher before discharge; most individual anxiety and depression scores decreased over time. Physiological survival included self-care needs, such as eating and sleeping properly. Physical survival included preparation of the home environment and home alterations adapting to their infant's equipment needs. Financial survival was a burden, particularly for those unable to return to work.

CONCLUSION

Patterns of experience in surviving the transition included psychological, physical, physiological, and financial factors. Authors of further longitudinal research could test the effectiveness of psychological preparation interventions, while encouraging early consideration of the other factors influencing parents' care of their infant after discharge from hospital.

Care of infants, children and adults with congenital heart disease

Congenital heart disease refers to an anatomical or physiological defect of the heart that is present at birth. Over the past three decades there have been significant advances in surgical, medical and nursing care for infants and children requiring cardiac surgery for congenital heart disease. This has meant that the number of adults with moderate and complex congenital heart disease now exceeds the number of children with the disease. This article details the background and diagnosis of congenital heart disease. It considers the implications for infants and children with congenital heart disease, as well as their parents, such as screening methods, risk factors, parental stress and psychosocial needs. This article also discusses the care of adults with congenital heart disease, including specialist monitoring and patient education.

Development of parenting self-efficacy in mothers of high-risk infants

PURPOSE

The aim of this prospective, longitudinal study was to (1) examine the development of parenting self-efficacy (PSE), (2) explore the influence of contextual factors (e.g., family functioning, family centered care, and infant medical caregiving complexity) on PSE development, and (3) whether PSE and contextual factors predict parent and infant health outcomes in a high-risk infant population.

METHOD

Mothers (n = 67) of infants diagnosed with a complex medical condition following birth were enrolled within 3 weeks of their infant's diagnosis and admission to intensive care. Participants completed an online study survey at study enrollment (T1), infant discharge (T2), and 3 months after discharge (T3). Change in PSE was examined using mixed modeling and predictors of parent and infant health outcomes were explored using multiple regression.

RESULTS

PSE significantly increased over time (b = 2.08, p < .0001). Family functioning was the only significant contextual factor, where worse family functioning at enrollment was associated with lower confidence over time. Mothers who were older and had more than one child were significant predicators of higher PSE. Interestingly, being married, compared to being single, was associated with decreased PSE. Higher PSE was also predictive of positive maternal psychological wellbeing at 3 months after discharge and a decrease in infant's medical complexity was associated with higher maternal psychological well-being.

CONCLUSION

These are important findings given that PSE is known to contribute to infant development and health status.

Psychometric Properties of the Italian Perceived Maternal Parenting Self-Efficacy (PMP S-E)

To validate the Italian Perceived Maternal Parenting Self-Efficacy (PMP S-E), the first questionnaire specifically developed for mothers of preterm neonates hospitalized in the Neonatal Intensive Care Unit. Two hundred mothers filled the PMP S-E, the General Self-Efficacy Scale (GSES), the Edinburgh Postnatal Depression Scale (EPDS), the Parental Distress Index (PSI-SF/Pd). The Explanatory Factor Analysis outlined four factors: care-taking procedures, evoking behaviours, reading and managing bodily cues, reading and managing emotional cues. This factor-solution demonstrated adequate goodness of fit when the Confirmatory Factor Analysis was carried out. Internal consistency was high for the overall scale (α = 0.932), and the all the factors (all α > 0.80). There was a moderate correlation with GSES (r = .438; p < .001), while the associations with EPDS (r = .295; p < .001) and PSI-SF/Pd (r = .193; p = .006) were low. Good test-retest reliability was found over 2 weeks (r = .73; p < .001). These findings support the validity and reliability of the Italian PMP S-E.

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.

Subjective happiness among mothers of children with disabilities: The role of stress, attachment, guilt and social support

BACKGROUND

Parenting a child with disabilities might affect the happiness of the mothers. Hence we adapted Wallander, Varni, Babani, Banis, and Wilcox's (1989) disability-stress-coping model to examine the impact of risk factors (specific stressors related to the child's disability) on the mother's adaptation (happiness). Intrapersonal factors (attachment) and social-ecological factors (social support) were hypothesized to predict adaptation. Both constitute 'risk-resistant' factors, which are mediated by the mother's perceived general stress and guilt.

METHOD

191 mothers of a child with a developmental disability (ages 3-7) answered questionnaires on happiness, specific and general stress, attachment, guilt and social support.

RESULTS

Attachment avoidance was directly and negatively associated with mothers' happiness. General stress was negatively associated with happiness, and mediated the association between anxious attachment, support, and specific stress with happiness. Guilt was negatively associated with happiness, and served as a mediator between attachment anxiety and support and happiness.

CONCLUSION

The findings of the current research show direct and indirect associations of risk factors with happiness and the role of general stress and feelings of guilt as mediators.

IMPLICATIONS

This study stresses the importance of attachment and social support to happiness and sheds light on the unique role of guilt in promoting or inhibiting happiness.

On Being a Father or Sibling in Light of the Humanbecoming Family Model

The following article provides an updated discussion on two Parse grounded exploratory descriptive studies in light to her recently added humanbecoming family model. The comments of the fathers and siblings from the studies reveal that family life is unpredictable and that family relationships are paradoxical evolutional emergences of shifting hopes and dreams. The humanbecoming family model provided a useful way to consider fathering and being a sibling, as unexpected unfoldings of joy-sorrow reveal purposeful new possibilities. It guides health professionals to avoid the imposition of their views on what is best for the family in favor of bearing witness to the suffering and disappointments that unfold in family life. It is important to remain open to families' sources of meaning, courage, and hope in the moment.