Experiences of fathers with babies admitted to neonatal care units: A review of the literature

Parents' Shared Experiences of Separation From Their Newborns After Birth in Denmark

OBJECTIVE

To explore parents' shared experiences of separation from their newborns after birth in Denmark.

DESIGN

Phenomenological hermeneutic design.

SETTING

A NICU in the Capital Region of Denmark.

PARTICIPANTS

Four sets of parents (N = 8) with prematurely born neonates who were admitted to the NICU.

METHODS

We used dyadic interviews for data collection. We applied a phenomenological hermeneutic approach inspired by Ricoeur's theory of interpretation to analyze the data.

RESULTS

Two overarching themes emerged that reflected two distinct temporal phases of separation. Initial separation caused an experience of becoming parents at different paces. Separation based on care needs (i.e., the NICU vs. maternity unit) left parents at the juncture between separation and closeness.

CONCLUSION

Separation from their newborns complicated parents' transitions into parenthood. Their sense of unity was undermined when different units assumed responsibility for the mother and newborn. This challenged family-centered care. Our findings indicate the need to minimize separation through initiatives such as zero separation and couplet care.

Father Groups in the Neonatal Intensive Care Unit: A Supportive Intervention

BACKGROUND

Parents' participation in the neonatal intensive care unit (NICU) reduces length of stay and positively affects infants' psychological, cognitive, and behavioural outcomes. Healthcare professionals in the NICU focus on both parents, but tend to have the main focus on the mother and the infant. Therefore, fathers may experience a lack of support and feel that they are being disregarded in the NICU.

PURPOSE

To study fathers' experiences with father groups during NICU admission with their preterm infant. The father group is a 90-minute intervention based on dialogue between fathers and a male healthcare professional.

METHODS

A qualitative content analysis was conducted using 10 online semistructured interviews with fathers participating in a father group. The study was reported according to the Standards for Reporting Qualitative Research.

RESULTS

The overall theme emerging from our analysis was "Emotional support, encouragement, and an enhanced capacity to deal with the situation and with life in the NICU." This theme emerged from the categories "Meeting with peers and sharing reflections" and "Fathers' territory" based on 5 subcategories.

IMPLICATIONS FOR PRACTICE

Participation in father groups gives fathers recognition for being important as parents in the NICU, improves fathers' mental well-being, and enhances their coping capacity. Father groups support fathers in the NICU and can be integrated into NICU practices and policies to enhance a family-centered approach.

IMPLICATIONS FOR RESEARCH

This study revealed a need for further research to determine whether participation in a father group has a measurable effect on clinical outcomes.

Neonatal medical trainee doctors' perceptions and parents' self-reported needs and stressors in a surgical neonatal intensive care unit: An individualised approach

AIM

As more infants survive surgery in the newborn period for major congenital anomalies, the focus has shifted to the quality of care for parents as well as infants. In contemporary neonatal intensive care units (NICUs), doctors are encouraged to practice family-centred care and partner with parents in their infant's care. This study explored doctors' perceptions and parents' self-reported needs and stressors in a surgical NICU.

METHODS

From January 2014 to September 2015, parents of infants admitted for general surgery for a major congenital anomaly who were present in the NICU between 48 and 72 h of admission and doctors caring for their infant at the time of data collection were invited to participate. Matched data were provided using the Neonatal Family Needs Inventory and the Parental Stressor Scale:NICU.

RESULTS

Matched data for 12 doctor-parent dyads showed that doctors (neonatal medical trainees) consistently under-rated the importance of parents' needs and identified fewer of mothers' than fathers' most important needs. Doctors also consistently under-rated parents' stressors. They perceived few of fathers', but all of mothers', greatest stressors. Thematic analysis revealed four themes: infant pain management; parental autonomy; empathy; and communicating reassurance and education to parents.

CONCLUSION

The findings suggest incongruences between doctors' perceptions and parents' self-reported needs and stressors. While there is hesitation in making recommendations with this sample size, the findings highlight issues that may inform further research and contribute to a dialogue regarding the role of doctors in family-centred relationship-based models of care in the NICU.

Parental Reflective Functioning as a Moderator of the Link Between Prematurity and Parental Stress

We examined group differences between parents, both mothers and fathers, of premature and full-term infants to determine whether they differed in their reports of subjective parenting stress and in their level of parental reflective functioning (PRF). We also tested whether each parent's reflective functioning moderated the links between birth status (prematurity vs. full-term) and parenting stress. A sample of 73 cohabiting, heterosexual Israeli families with a premature (28-36th week gestational age, N = 34) or full-term infant (37th week and above gestational age, N = 39) participated, comprising the two parents' groups. Infants' age averaged 7.07 months (SD = 1.28). Each parent completed the Parent Stress Inventory (PSI) individually to determine his/her subjective personal and childrearing stress levels. The Parent Development Interview (PDI-R2-S) was used to obtain each parent's PRF (self and child/relation-focused) level. Findings showed that the premature and full-term parents did not differ in their PSI scores or PRF levels. However, mothers' self-focused PRF moderated the link between prematurity and personal parenting stress, whereas fathers' self-focused PRF moderated the link between prematurity and childrearing parenting stress. Furthermore, fathers' and mothers' PRF operated differently in the premature and full-term parents' groups. The findings highlight the importance of mothers' and fathers' PRF in predicting parents' subjective stress in general and particularly in the case of infant prematurity. We discuss these findings and their relevance for preventive and therapeutic perinatal interventions.

Fathers' experiences of supporting their partners during their preterm infant's stay in the neonatal intensive care unit: a multi-method study

OBJECTIVE

To explore how the fathers experience their role as a support for their partner and the relationship with them during their preterm infant's stay in the NICU.

STUDY DESIGN

Multi-method longitudinal study involving ethnographic observation, semi-structured interviews, self-report questionnaires, and clinical information. Twenty fathers of preterm infants hospitalized in a level-III-NICU were included. Data were analyzed using thematic continent analysis.

RESULTS

Three main themes were identified: support for mother (subthemes: putting mother's and infant's needs first; hiding worries and negative emotions; counteracting the sense of guilt; fear that the mother would reject the child), mother's care for the infant (subthemes: observing mother engaged in caregiving; mother has "something extra"), and couple relationship (subthemes: collaboration; bond).

CONCLUSION

Fathers supporting their partners during the stay in the NICU experience emotional distress and the need for being supported that often are hidden. This demands a great deal of emotional and physical energy.

Impact of kangaroo care after caesarean section on paternal-infant attachment and involvement at 12 months: A longitudinal study in Turkey

The mother's first meeting with the baby after the caesarean section is usually delayed due to the reasons arising from the mother and the baby in Turkey. Although there are many benefits of kangaroo care (KC) intervention between the mother and the newborn, there is a limited number of studies on the KC intervention between the newborn and the father after caesarean section in international literature, and there are none in Turkey. This study was carried out to determine the effect of fathers and infants who participated in KC, immediately after birth by caesarean section, on paternal-infant attachment and the fathers' involvement in infant care in the 12th month. The study was conducted as a longitudinal study with a control group. Initially, the sample consisted of 60 fathers. However, the study was completed with 48 fathers. KC intervention was practised to the couple of the father and the infant in the experimental group, while no practice was given to the control group. Fathers in the experimental group were told that they should continue to practice KC intervention at least two times a week until their baby will be 1-year-old. The data collection forms were given to fathers face-to-face in the first interview, and then through phone calls and emails after 12 months. The status of the fathers in the experimental group fathers' involvement in infant care of the baby (p = .005) was significantly higher than the control group. The mean score for the Postnatal Paternal-Infant Attachment Questionnaire (PPAQ), in fathers who participated in KC intervention, was higher than that of fathers who did not participate in the KC intervention (p < .005). The results of this study demonstrated that the paternal-infant attachment and the fathers' participation in infant care were more positive in fathers and babies who performed the KC intervention.

Male involvement in promotion of safe motherhood in low- and middle-income countries: A scoping review

BACKGROUND

Maternal health programmes that focus on the woman alone are limiting in LMICs as pregnant women often relate to maternity services through a complex social web that reflects power struggles within the kinship and the community.

METHODS

A scoping review was conducted to explore the rationale for male involvement in maternal health in LMICs. This review was guided by the question: What is the current state of knowledge regarding the inclusion of men in maternal health services in LMICs? The literature search was conducted using mySearch, Bournemouth University`s iteration of the EBSCO Discovery Service (EDS) tool. The review process used the Preferred Reporting Items for Systematic Reviews to select papers for inclusion.

FINDINGS

Thirty three studies met the inclusion criteria. Findings describe the rationale for involving men in maternity care, alongside the criticisms and challenges inherent in engaging with men in maternal health. Involving men in maternity services can improve health outcomes for women and infants. Health strategies aimed at educating men are relevant in equipping men with knowledge and skills that help men to be supportive of women`s wellbeing during pregnancy and childbirth.

CONCLUSION

Men can serve as advocates for women and reinforce their partner`s choices in accessing skilled care and infant feeding. Further research is required to examine the effect of male involvement on women`s autonomy and to assess health education interventions aimed at mitigating harmful outcomes of involving men in maternity services.

Paternal symptoms of anxiety and depression in the first month after childbirth: A comparison between fathers of full term and preterm infants

BACKGROUND

Although men have a higher risk of developing a mental disorder during the perinatal period, few studies have focused on new fathers' mental health screening. This study compares anxiety and depression symptoms between fathers with newborn infants in the neonatal intensive care unit (NICU) and fathers of healthy full-term infants, assessing the impact of stress caused by the NICU..

METHODS

A longitudinal and prospective study with control (n= 33) and study groups (n=51) was designed. The dependent variables assessed were post-natal depression and anxiety-state while the social and demographic information, health background and the parental stress in the neonatal unit were the independent variables. The fathers were assessed twice during the first month after birth.

RESULTS

Significant differences in the EPDS scores were found between both groups in the first assessment (p = .006) but not in the second assessment (p = .60). Significant differences in STAI scores were found between the groups for both assessments (p = .003 and p = .002). The stress caused by the infant's appearance and behavior was predictive of depression and anxiety in the study group.

LIMITATIONS

The sample was collected at one hospital, immigrants were underrepresented, and no prenatal assessment of paternal mental health is available.

CONCLUSIONS

Our results suggest that the hospitalization of newborn infants increases the risk of developing anxiety or depression disorder in fathers. Health providers should be aware of the emotional changes in men shortly after childbirth and include them in the screening of and support for mental health disorders.

Needs of Socioeconomically Diverse Fathers of Premature Hospitalized Infants: A Multicenter Study

BACKGROUND

To effectively practice true family-centered care (FCC) in the neonatal intensive care unit (NICU) setting, a nurse needs to understand the perceptions and concerns of all fathers. Although research is emerging on fathers' perceptions and experiences, the samples of fathers represented are not from diverse socioeconomic, racial, and ethnic populations, which limit the findings' generalizability.

PURPOSE

The purpose of this study was to determine the needs of NICU fathers and whether these needs differed based on sociodemographic factors.

METHODS

A quantitative, comparative, descriptive design was used to determine the needs of NICU fathers. Additional analysis was conducted to determine whether the needs differed based on education, income, and gestational age, whether the father preferred speaking English or Spanish, and whether these sociodemographic factors could predict needs. To determine sociodemographic factors and needs, a demographic questionnaire and the NICU Family Needs Inventory were administered to 99 fathers in 6 level III NICUs.

RESULTS

Data were analyzed using independent sample t test, 1-way analysis of variance, and multiple linear regression. The results showed that fathers reported a broad span of needs and fathers from disadvantaged populations may have greater needs in certain areas.

IMPLICATIONS FOR PRACTICE

These results emphasize the importance of the nurses' role in assessing the needs of NICU fathers. By understanding fathers' needs, nurses can provide individualized FCC to fathers to help them be more involved in the care and support of their infant.

IMPLICATIONS FOR RESEARCH

Further research is needed to support these findings and test interventions that promote communication between providers and fathers.

Being the Father of a Preterm-Born Child: Contemporary Research and Recommendations for NICU Staff

Background: Most studies on parental reactions to a preterm birth and to hospitalization of the newborn in Neonatal Intensive Care Units (NICUs) have involved mothers. However, emotional responses and behaviors of fathers are equally important. Usually, the father is the first to meet the preterm newborn, to find out information about baby's condition and to communicate to the mother and other family members. In this context he is often left alone and can show psychological difficulties including affective disorders such as depression or anxiety. This paper describes the role of fathers in the NICU, the best practices to support fathers, and to explain the role of a psychologist in the NICU staff. Considerations and suggestions are provided on the difficulties encountered to support parents, with a focus on the role of fathers during the COVID-19 pandemic. Methods and Discussion: Considering contemporary research data and following an attachment perspective, we analyze the role of the father of a preterm-born child in the relation with the partner and in newborn caring. Research has shown that involving fathers in newborn care in NICU and at home is essential not only because it promotes the father/son attachment relationship and has positive effects on the psychological and somatic development of the newborn, but also for the health of the mother and whole family. Conclusion: Recommendations are provided to enhance the functions of fathers in the NICU, promote their involvement in the care of their infant, and interventions to prevent the manifestation of psychological suffering and/or perinatal affective disorders. The commitments of a psychologist in a NICU team are presented and require not only clinical skills, but also the ability to manage the emotional and relational difficulties of fathers, family and NICU staff. Considerations and suggestions are provided on the difficulties encountered by parents in the NICU during the COVID-19 pandemic.

Stressors and support system among parents of neonates hospitalised with systemic infections: qualitative study in South India

OBJECTIVE

To explore stressors and support system for families with a neonate admitted with a systemic infection.

DESIGN

Qualitative study using in-depth interviews (IDIs), based on principles of grounded theory.

SETTING

A busy level III neonatal unit of a tertiary care teaching hospital in coastal Karnataka, India, between May 2018 and January 2019.

PARTICIPANTS

Parents and accompanying attendants of neonates admitted to the neonatal unit with one or more systemic infections.

METHODS

Using purposive sampling, semi-structured IDIs were audio recorded, transcribed verbatim and a thematic analysis was performed.

RESULTS

Thirty-eight participants were interviewed, lasting between 30 and 59 min. Babies' hospitalisation with sepsis was an unprecedented, sudden and overwhelming event. Stressors related to uncertainties due to the information gap inherent to the nature of illness, cultural rituals, financial constraints, barriers to bonding and others. Parents reported experiencing insomnia, gastric disturbances and fatigue. Support (emotional and/or financial) was sought from families and friends, peers, staff and religion. Availability and preference of emotional support system differed for mothers and fathers. In our context, families, peers and religion were of particular importance for reinforcing the available support system. Participant responses were shaped by clinical, cultural, financial, religious and health service contexts.

CONCLUSION

Designing a family-centred care in our context needs consideration of stressors that extend beyond the immediate neonatal intensive care unit environment and interactions. Understanding the influence of the nature of illness, financial, familial and cultural contexts helps identify the families who are particularly vulnerable to stress.

Systematic review of family engagement interventions in neonatal, paediatric, and adult ICUs

AIMS AND OBJECTIVES

The purpose of this systematic review was to evaluate interventions that have been used to engage families in direct care activities (active family engagement) in adult, paediatric, and neonatal intensive care unit (ICU) settings.

BACKGROUND

Family engagement is universally advocated across ICU populations and practice settings; however, appraisal of the active family engagement intervention literature remains limited.

SEARCH STRATEGY

Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were searched for family interventions that involved direct care of the patient to enhance the psychological, physical, or emotional well-being of the patient or family in neonatal, paediatric, or adult ICUs.

INCLUSION/EXCLUSION CRITERIA

Studies were included if an active family engagement intervention was evaluated. Studies were excluded if they were not published in English or reported non-interventional research.

RESULTS

A total of 6210 abstracts were screened and 19 studies were included. Most studies were of low to moderate quality and were conducted in neonatal ICUs within the United States. Intervention dosage and frequency varied widely across studies. The interventions focused on developmental care (neonatal ICU) and involved families in basic patient care. Family member outcomes measured included satisfaction, stress, family-centred care, confidence, anxiety, and depression. Most studies found improvements in one or more outcomes.

CONCLUSIONS

There is a paucity of literature about active family engagement interventions, especially in adult and paediatric populations. The optimal dosage and frequency of family engagement interventions remains unknown. Our systematic review found that data are limited on the relationship between family engagement and patient outcomes, and provides a timely appraisal to guide future research.

RELEVANCE TO CLINICAL PRACTICE

Further research on the efficacy of family engagement interventions is warranted. The translation of active family engagement interventions into clinical practice should also be supported.

Gay Fatherhood in the NICU: Supporting the "Gayby" Boom

BACKGROUND

With advances in reproductive health, gay males are increasingly given the opportunity to reproduce. It is not a common occurrence for infants of gay male fathers to enter the neonatal intensive care unit (NICU); however, this may change and should be acknowledged.

PURPOSE

To give insight into the barriers, perspectives, and stresses of gay male caregivers (families) in their time spent in the NICU and to offer recommendations as to how better to serve them and their families.

METHODS/SEARCH STRATEGY

Searched using PubMed, CINAHL, SCOPUS, and Google Scholar. Key words used were "gay families," "fatherhood," "neonatal intensive care unit," "lesbians," and "surrogacy."

FINDINGS/RESULTS

There remains a very limited amount of data for healthcare providers as these relate to gay male fathers in the NICU, aside from narratives. Most of the research and literature that highlight potential barriers stem from heterosexual fatherhood in the NICU and lesbian parenting in the healthcare system.

IMPLICATIONS FOR PRACTICE

To have an understanding and knowledge to improve support for gay fathers in the NICU.

IMPLICATIONS FOR RESEARCH

Research on gay fathers in the NICU and further research on lower economic gay fatherhood and gay men of color and fatherhood are required. Because of the small sample size, multicentered studies may warranted to aid in clinical significance.

Fathers' needs in a surgical neonatal intensive care unit: Assuring the other parent

Objectives

Fathers of infants admitted to Neonatal Intensive Care Unit (NICU) play an important role and have individual needs that are often not recognised. While there is considerable evidence regarding mothers’ needs in the NICU, information about fathers’ is particularly limited. This study identifies the needs of fathers of newborns admitted to NICU for general surgery of major congenital anomalies, and whether health-care professionals meet these needs.

Methods

Forty-eight fathers of infants admitted for surgery between February 2014 and September 2015 were enrolled in a prospective cohort study. Fathers completed the Neonatal Family Needs Inventory comprising 56 items in 5 subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge and whether these needs were met; as well as the Social Desirability Scale.

Results

Responses showed Assurance was the most important subscale (M 3.8, SD .26). Having questions answered honestly (M 3.9, SD .20) and knowing staff provide comfort to their infant (M 3.94, SD .24) were fathers’ most important needs. By discharge, fathers expressed a greater importance on being recognised and more involved in their infant’s care. More than 91% indicated their ten most important needs were met by the NICU health-care professionals, with no significant changes at discharge. Clergical visits (M 2.08, SD 1.21) were least important.

Conclusions

Reassurance is a priority for fathers of neonates in a surgical NICU, particularly regarding infant pain management and comfort. It is important that health-care professionals provide reliable, honest information and open-access visiting. Notably, fathers seek greater recognition of their role in the NICU—beyond being the ‘other’ parent.

Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines

Having a sick infant in the NICU can be quite stressful and overwhelming to parents. They require support and may have varied needs. A systematic review of qualitative and quantitative studies from 5 electronic databases (Ovid Medline, EMBASE, PsycINFO, CINAHL and Sociological Abstracts), covering January 2001 - March 2016 identified the needs and stressors of parents of term or near-term Infants in the NICU. Six articles addressed the needs and 14 identified the stressors of parents. Parents' most important need was for accurate and honest information. Needs focused around sensitive infant care and involvement in decision-making. The greatest stressor for parents was alteration to the parental role, followed by infant appearance. Fathers and parents of infants undergoing surgery are an under-researched population. Based on the evidence, enhancing staff-parent communication would better meet parental needs and reduce stressors. Our key recommendations highlight the need for family-centred and individualised care practices in the NICU.

Enfoque desde la violencia perinatal: visita del padre a su hijo prematuro durante su hospitalización

Este trabajo reflexiona sobre la participación del padre en las unidades de neonatología, comprendiendo que ser padre/madre de un recién nacido pretérmino es complejo, estresante y puede llenar de temores, ansiedad e incertidumbre. En el contexto actual, se tiende a recargar el rol de cuidado en la madre, lo que limita las oportunidades de participación del padre. El análisis se centra en las experiencias del servicio de neonatología de un hospital de Santiago de Chile, Chile, y en una revisión de la literatura sobre el papel de los padres y su participación en este contexto.

Knowledge, Family Support and Self-Reliance Capital when Caring for Low Birth Weight Babies

Introduction: Low birth weight (LBW) infants are very susceptible to illness.LBW treatment with the principle of preventing infection is very important athome. The purpose of this study was to determine the relationship betweenmaternal knowledge and family support with the prevention of infection at home.Methods: This study used a correlation design. The samples were 160 motherswho had low birth weight infants with inclusion criteria mothers give birth tobabies weighing less than 2,500 grams with ages 0-2 months. The samples wereobtained through purposive sampling. The dependent variable was the mother&#39;sability to prevent infection while the independent variable was the mother&#39;sknowledge and family support. The instruments used were questionnaires. Thisresearch analyzed using Spearman Rho.Results: The results showed that there was a strong correlation betweenknowledge and the ability to prevent infection in treating low birth weight (r =0.696; p = 0.00) and that there was a moderate correlation between familysupport and infection prevention ability when treating a low birth weight (r =0.54. p = 0.000).Conclusion: Factors of maternal knowledge about infection prevention andfamily support need to be considered in increasing the ability of mothers to carefor babies with LBW. The factor of maternal knowledge about prevention ofinfection has a strong correlation value when compared to family support factors.Further research is needed on the model of increasing maternal knowledge aboutLBW infants during home care. 

The Effectiveness of an Intervention Program for Fathers of Hospitalized Preterm Infants on Paternal Support and Attachment 1 Month After Discharge

This aim of this study was to evaluate the effectiveness of an early intervention program to reduce paternal stress and increase fathering ability after a preterm infant's admission to the special care nursery and to influence paternal support for the mother and the father's attachment to the infant 1 month later. A historical comparison study was designed and an empowerment intervention strategy for the fathers of preterm infants was implemented. Forty-one fathers of preterm infants in the control group received routine care, and 41 fathers of preterm infants in the intervention group received an early fatherhood intervention program in the special care nursery. Both groups were followed 1 month after discharge. Fathers in the intervention group had significantly lower stress and higher fathering ability at their infant's discharge, provided better support to the mother in child-rearing, and had better father-infant attachment 1 month after discharge than fathers in the control group. Under cultural and hospitals' common practices, such an intervention can help the father to establish his fatherhood early and later enhance his supporting role to the mother and his relationship to the preterm infant. Nurses should include teaching childcare to fathers of preterm infants.

Fathers' Stress in a Neonatal Intensive Care Unit

BACKGROUND

Healthcare professionals in neonatal intensive care units (NICUs) tend to focus attention on the mothers and the newborn infants. Thus, fathers may find it difficult to establish an optimal father-child relationship and their stress may increase and persist during hospitalization.

PURPOSE

To investigate the impact of a more father-friendly NICU on paternal stress and their participation in childcare.

METHODS

A quasiexperimental design was conducted on Danish-speaking fathers of newborn infants 28 or more weeks' gestational age. The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) was used to measure paternal perceptions of stressors. Paternal participation in childcare was measured using 7 additional items. The questionnaires were distributed on admission to the NICU, at the 14th day of hospitalization, and at the time of discharge. The primary outcome was the difference in the PSS:NICU overall stress score on admission to the NICU and at the time of discharge in the control group compared with the intervention group.

RESULTS

A total of 109 fathers were included. The overall PSS:NICU stress score increased after the intervention. Paternal involvement, staff expectations, and the social expectation to fulfill the traditional role of a breadwinner and additionally of a caregiver may have caused increased stress.

IMPLICATIONS FOR PRACTICE

Healthcare professionals must be aware of the father's need to be an equal coparent. Nurses, as key persons, should motivate and expect fathers to be involved, and support them to establish a father-child relationship, although they might become more stressed.

IMPLICATIONS FOR RESEARCH

More adequate outcome measures are needed to determine the effect of interventions on paternal stress.

Meta-synthesis about man as a father and caregiver for a hospitalized child

ABSTRACT Objective: to identify, analyze and synthesize the father’s experience in care for a hospitalized child from results of primary qualitative studies. Method: this is a qualitative meta-synthesis through which 12 articles were analyzed, selected in the Cumulative Index to Nursing and Allied Health Literature databases, Latin American and Caribbean Literature in Health Sciences, Public Medline, Scopus, PsycINFO and Web of Science, published between 1995 and 2015. The methodological steps proposed by Sandelowski and Barroso were used to systematize the review, as well as concepts from the anthropology of masculinities to analyze and discuss the synthesis. Results: the synthesis was presented by means of two themes: 1) paternal dilemmas - what man feels and faces during the hospitalization of the child, highlighting the emotional involvement and change in the family and work relationship, and 2) paternal identities - masculinities readjusted in view of the child’s illness, which reveals identity marks and repressed fatherhood in the hospital environment. Both themes illustrate the challenges and readjustment of parental identity. Final considerations: to get to know the experiences of the father during the hospitalization of the child and the way in which the challenges for the readjustment of roles related to masculinity could broaden the range of nursing and other health professionals, alerting to the importance of including the father as a protagonist or coadjuvant in the care for hospitalized children.

Fathers' Needs and Masculinity Dilemmas in a Neonatal Intensive Care Unit in Denmark

Background:

Most healthcare professionals in neonatal intensive care units typically focus on the infants and mothers; fathers often feel powerless and find it difficult to establish a father-child relationship. In family-centered healthcare settings, exploring fathers' experiences and needs is important because men's roles in society, especially as fathers, are changing.

Purpose:

To describe fathers' needs when their infants are admitted to a neonatal intensive care unit and to discuss these needs within a theoretical framework of masculinity to advance understanding and generate meaningful knowledge for clinical practices.

Methods:

This qualitative study used participant observation, interviews, multiple sequential interviews, and a focus group discussion. Data were analyzed using grounded theory principles.

Results:

Analysis of the fathers' needs generated 2 primary themes: (1) Fathers as caregivers and breadwinners and (2) fathers and emotions. Fathers wished to be involved and to take care of their infants but have to balance cultural and social norms and expectations of being breadwinners with their wishes to be equal coparents.

Implications for Practice/Research:

Health professionals in neonatal intensive care units must be aware of fathers' need and desire to be equal coparents. Nurses should play a key role by, for example, showing that fathers are as important to their infants as are the mothers, helping them become involved in childcare, and ensuring that they are directly informed about their children's progress. Further research in other cultural settings would contribute to knowledge regarding fatherhood and the role of fathers in childcare.

Creating a Holding Environment for Caregivers

The quality of care that families and infants receive during their time on the neonatal unit will be influenced by the well-being of the people who care for them. The emotional work of caring for infants and families in this demanding setting often goes unrecognized and can result in stress, burnout, and compassion fatigue, which in turn are a threat to the quality of care. Resilience and well-being can be fostered by encouraging self-maintenance, supportive systems organization, providing a healthy working environment, education, and opportunities for reflection.

Participatory Action Research in the Field of Neonatal Intensive Care: Developing an Intervention to Meet the Fathers' Needs. A Case Study

BACKGROUND

In neonatal intensive care units (NICUs) health care professionals typically give most of their attention to the infants and the mothers while many fathers feel uncertain and have an unmet need for support and guidance. This paper describes and discusses participatory action research (PAR) as a method to improve NICUs' service for fathers. Our goal is to develop a father-friendly NICU where both the needs of fathers and mothers are met using an approach based on PAR that involves fathers, mothers, interdisciplinary healthcare professionals, and managers.

DESIGN AND METHODS

This PAR process was carried out from August 2011 to July 2013 and included participant observations, semi-structured interviews, multi sequential interviews, workshops, focus groups, group discussion, and a seminar. The theoretical framework of validity described by Herr and Anderson's three criteria; process-, democratic-, and catalytic validity were used to discuss this PAR.

RESULTS

Twelve fathers, 11 mothers, 48 health professionals and managers participated in the PAR process. The collaboration ensured the engagement for viable and constructive local changes to be used in designing the concept of the father friendly NICU.

CONCLUSIONS

This paper contributed new knowledge of how PAR can be used to ensure that participants engaged in the field are involved in the entire process; consequently, this will ensure that the changes are feasible and sustainable.