1
|
Stefana A, Barlati S, Beghini R, Biban P. Fathers' experiences of nurses' roles and care practices during their preterm infant's stay in the neonatal intensive care unit. Intensive Crit Care Nurs 2024; 85:103803. [PMID: 39173552 DOI: 10.1016/j.iccn.2024.103803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/21/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents. AIM Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU. DESIGN Qualitative study using ethnographic data collection techniques. METHODS Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis. RESULTS Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities. CONCLUSION Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial. RELEVANCE TO CLINICAL PRACTICE Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities. REPORTING METHOD Adherence to the COREQ guidelines.
Collapse
Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, Mother and Child Department, University Hospital of Verona, Verona, Italy
| | - Paolo Biban
- Pediatric Emergency Room, Department of Neonatal and Pediatric Critical Care, University of Verona, Verona, Italy
| |
Collapse
|
2
|
van Wyk L, Majiza AP, Ely CSE, Singer LT. Psychological distress in the neonatal intensive care unit: a meta-review. Pediatr Res 2024:10.1038/s41390-024-03599-1. [PMID: 39327462 DOI: 10.1038/s41390-024-03599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/14/2024] [Accepted: 09/07/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Parental psychological distress (PD) (anxiety, depression, stress and post-traumatic stress syndrome) can adversely affect parents' own physical and mental health as well as their children's long-term health and development. Numerous studies have addressed PD in mothers of infants admitted to NICU, with interventions proposed, but few have addressed the impact on fathers or other family members. The present review examined systematic reviews that addressed PD in NICU and potential interventions. METHODS A meta-review was performed by searching various databases between 2000 and May 2024. RESULTS Fifty-four studies were included. The incidence of maternal PD varied depending on the screening tool used (13-93%), as did paternal PD (0.08-46%). The incidence of PD in sexual, racial and gender minorities, siblings, grandparents and those in lower-middle income countries is not known. Numerous screening tools were used with a wide variety of cut-off values. Various intervention programmes were evaluated and showed contradictory evidence regarding their effect on PD. DISCUSSION Routine screening should be implemented together with a combination of interventional programmes, specifically family-centred interventions. More research is required for PD in siblings, sexual and gender minority parents as well as parents living in low middle income countries. IMPACT STATEMENT Psychological distress is high in NICU, affecting parents and siblings. Maternal psychological distress may have long lasting effects on infant health and differs from that of fathers, who require as much attention as mothers Little is known about emotional stress in siblings and sex and gender minority group peoples Few interventions showed conclusive effectiveness in reducing psychological distress with combination interventions showing more effectiveness than single interventions.
Collapse
Affiliation(s)
- Lizelle van Wyk
- Department Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
| | - Athenkosi P Majiza
- Department Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Cordelia S E Ely
- Department Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Lynn T Singer
- Departments of Population and Quantitative Health Sciences, Pediatrics, Psychiatry and Psychological Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
3
|
Merritt L, Verklan MT. A Feasibility Study to Test the NICU Paternal Needs Inventory. Adv Neonatal Care 2024; 24:86-93. [PMID: 38096431 DOI: 10.1097/anc.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND There has been little research exploring paternal needs while experiencing a neonatal intensive care unit (NICU) stay. Some tools exist to measure paternal needs, but do not incorporate items to capture important information about how fathers cope with stress differently, and may have different needs. Therefore, an instrument is needed to measure and prioritize what needs are important to fathers to help facilitate the development of nursing interventions to help fathers cope with the NICU environment. PURPOSE The purpose of this study was to conduct a feasibility study before large-scale pilot testing the instrument, the NICU Paternal Needs Inventory (NPNI), so we could then determine what are the physical, emotional, and psychological needs of fathers. METHODS A nonexperimental, quantitative, and descriptive design was used to address the study's aims. Fathers were recruited from a level IV NICU and asked to complete an online survey (consisting of a demographic survey and the NPNI). RESULTS Needs rated 100% were knowing infant's progress, directions on caring for infant, flexible visitation, and assurance receiving the best care. The remainder showed a wide range of responses suggesting that needs of fathers are individual and varied. IMPLICATIONS FOR PRACTICE AND RESEARCH Use of the NPNI to evaluate a father's unique and individual needs would allow for the nurse to develop father-specific, individualized interventions. Findings support that the NPNI is feasible to accomplish measuring fathers' needs, but a larger study is needed to test the reliability and validity of this tool.
Collapse
Affiliation(s)
- Linda Merritt
- Quinnipiac University, North Haven, Connecticut (Dr Merritt); Texas Woman's University, Dallas (Dr Merritt); and The University of Texas Medical Branch, Galveston (Dr Verklan)
| | | |
Collapse
|
4
|
Chan SH, Shorey S. Effectiveness of psychosocial interventions on the psychological outcomes of parents with preterm infants: A systematic review and meta-analysis. J Pediatr Nurs 2024; 74:23-34. [PMID: 37988885 DOI: 10.1016/j.pedn.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Parents of preterm infants are often thrown unexpectedly into the care of their vulnerable infant, causing them to be stressed and overwhelmed. Social support has been previously highlighted as a crucial factor in helping parents cope with stress. Several psychosocial interventions have thus been developed to support parents of preterm babies, which warrant further investigations. OBJECTIVES To evaluate the effectiveness of psychosocial interventions in reducing stress (primary outcome), anxiety, depression, pediatric medical traumatic stress (PMTS) and increasing social support among parents with preterm infants. METHODS A systematic-review and meta-analysis were conducted. Eight electronic databases were searched for relevant studies from their respective inception dates till September 2023. Meta-analysis was performed with RevMan, using the random-effects model. Heterogeneity was investigated using Cochran Q and I2 tests, and publication bias was assessed using funnel plots. Subgroup analyses were conducted for follow-up measurement, gender of parent, type of intervention provider, and setting. FINDINGS Eighteen studies were included in this review, and all studies were meta-analysed. Participants who received psychosocial interventions reported significantly lower stress and depression in comparison to control group participants. Psychosocial interventions delivered by psychologists and trained researchers were more effective compared to the nurses. The GRADE assessment indicated that the certainty of evidence for all outcomes were very low. CONCLUSION Psychosocial interventions effectively reduce stress and depression levels in parents with preterm infants. Our findings encourage the implementation of psychosocial interventions to improve parental psychological wellbeing. Future higher quality trials are needed to measure psychological outcomes among parents, especially fathers.
Collapse
Affiliation(s)
- Sian Hui Chan
- Nursing Division, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074.
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore.
| |
Collapse
|
5
|
Shaw RJ, Moreyra A, Simon S, Wharton E, Dowtin LL, Armer E, Goldman LW, Borkovi T, Neri E, Jo B, Hintz S, Van Meurs K, Horwitz SM. Group trauma focused cognitive behavior therapy for parents of premature infants compared to individual therapy intervention. Early Hum Dev 2023; 181:105773. [PMID: 37119727 PMCID: PMC10182567 DOI: 10.1016/j.earlhumdev.2023.105773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The current study compares results of a group-based intervention developed to reduce symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants with a prior study using an individual version of the treatment manual. METHODS 26 mothers of preterm infants (25-34 weeks' gestational age; >600 g) received 6 sessions of trauma-focused cognitive behavior therapy (CBT). Outcomes were compared with those of a previously published RCT, which tested an individual therapy based on the same model in a group of 62 mothers. Results were also compared across in-person and telehealth treatment. RESULTS From baseline to follow up, the individual intervention showed greater improvement in trauma symptoms assessed with the Davidson Trauma Scale (d = 0.48, p = 0.016), although both conditions showed clinically significant improvement. Similar patterns were found for maternal depression and anxiety. In-person treatment was found to be superior to telehealth treatment administered during the COVID-19 pandemic, although the difference was not significant. CONCLUSIONS Group-based trauma focused CBT is an effective treatment modality for parents of premature infants with symptoms of psychological distress but not as effective as individual therapy using the same treatment model.
Collapse
Affiliation(s)
- Richard J Shaw
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States of America.
| | - Angelica Moreyra
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, United States of America
| | - Stephanie Simon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Emily Wharton
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - LaTrice L Dowtin
- PlayfulLeigh Psyched, Silver Spring, MD, United States of America
| | - Erin Armer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | | | - Tonyanna Borkovi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Susan Hintz
- Department of Pediatrics, Stanford University School of Medicine, United States of America
| | - Krisa Van Meurs
- Department of Pediatrics, Stanford University School of Medicine, United States of America
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States of America
| |
Collapse
|
6
|
Risanger LI, Kofoed PE, Noergaard B, Vahlkvist S. Parents’ Perception of Staff Support in a Father-Friendly Neonatal Intensive Care Unit. CHILDREN 2023; 10:children10040673. [PMID: 37189922 DOI: 10.3390/children10040673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
Healthcare professionals, especially nurses, play a central role in supporting parents during their stay in neonatal intensive care units (NICUs). Fathers often have their own support needs; however, studies have shown that these needs are rarely met to the same degree as those of the mothers. We developed a “father-friendly NICU” with the aim of providing good-quality care to the entire family. To evaluate the impact of this concept, we adopted a quasi-experimental design; using the Nurse Parent Support Tool (NPST), we investigated the differences in the fathers’ (n = 497) and mothers’ (n = 562) perception of the nursing support received on admission and discharge between before and after the intervention. In the historical control and intervention groups, the fathers’ median NPST scores at admission were 4.3 (range, 1.9–5.0) and 4.0 (range, 2.5–4.8), respectively (p < 0.0001); at discharge, these scores were 4.3 (range, 1.6–5.0) and 4.4 (range, 2.3–5.0), respectively (difference not significant). In the historical control and intervention groups, the mothers median NPST scores at admission were 4.5 (range, 1.9–5.0) and 4.1 (range, 1.0–4.8), respectively (p < 0.001); at discharge, these scores were 4.4 (range, 2.7–5.0) and 4.4 (range, 2.6–5), respectively (difference not significant). The parental perception of support did not increase after the intervention; however, the parents reported a high level of staff support both before and after the intervention. Further studies should focus on parental support needs during the different phases of hospitalization (i.e., admission, stabilization, and discharge).
Collapse
Affiliation(s)
- Linn Iren Risanger
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
- H.C. Andersens Children’s Hospital, Odense University Hospital, 5000 Odense, Denmark
| | - Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Betty Noergaard
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Signe Vahlkvist
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| |
Collapse
|