Fatigue in mothers of infants discharged to the home on apnea monitors

A Systematic Review of Studies Using the Multidimensional Assessment of Fatigue Scale

PURPOSE

To review how the Multidimensional Assessment of Fatigue (MAF) has been used and evaluate its psychometric properties.

METHODS

We conducted a database search using "multidimensional assessment of fatigue" or "MAF" as key terms from 1993 to 2015, and located 102 studies.

RESULTS

Eighty-three were empirical studies and 19 were reviews/evaluations. Research was conducted in 17 countries; 32 diseases were represented. Nine language versions of the MAF were used. The mean of the Global Fatigue Index ranged from 10.9 to 49.4. The MAF was reported to be easy-to-use, had strong reliability and validity, and was used in populations who spoke languages other than English.

CONCLUSION

The MAF is an acceptable assessment tool to measure fatigue and intervention effectiveness in various languages, diseases, and settings across the world.

Towards a Definition of Caregiver Fatigue: A Concept Analysis

Using Walker and Avant's approach, a concept analysis was performed to develop a working definition of caregiver fatigue. Defining attributes of caregiver fatigue identified were "fell into role" by default, outside the norm of role expectations, excess caregiving demand, and exposure to prolonged period of caregiving. Model, related, and contrary cases were developed. Antecedent, consequences, and empirical referent of caregiver fatigue were also identified. Lastly, a working definition of caregiver fatigue was developed.

Correlates and Predictors of New Mothers' Responses to Postpartum Thoughts of Accidental and Intentional Harm and Obsessive Compulsive Symptoms

BACKGROUND

Unwanted, intrusive thoughts of infant-related harm are a normal, albeit distressing experience for most new mothers. The occurrence of these thoughts can represent a risk factor for the development of obsessive compulsive disorder (OCD). As the early postpartum period represents a time of increased risk for OCD development, the transition to parenthood provides a unique opportunity to better understand OCD development.

AIMS

The purpose of this study was to assess components of cognitive behavioural conceptualizations of postpartum OCD in relation to new mothers' thoughts of infant-related harm.

METHOD

English-speaking pregnant women (n = 100) participated. Questionnaires were completed at approximately 36 weeks of gestation, and at 4 and 12 weeks postpartum. An interview to assess postpartum harm thoughts was administered at 4 and 12 weeks postpartum. Questionnaires assessed OC symptoms, OC-related beliefs, fatigue, sleep difficulties and negative mood.

RESULTS

Prenatal OC-related beliefs predicted postpartum OC symptoms, as well as harm thought characteristics and behavioural responses to harm thoughts. The severity of behavioural responses to early postpartum harm thoughts did not predict later postpartum OC symptoms, but did predict frequency and time occupation of accidental harm thoughts, and interference in parenting by intentional harm thoughts. Strong relationships between OC symptoms and harm thought characteristics, and concurrent sleep difficulties, negative mood and fatigue were also found.

CONCLUSIONS

Findings provide support for cognitive behavioural conceptualizations of postpartum OCD and emphasize the importance of maternal sleep, fatigue and negative mood in the relationship between OC-related beliefs and maternal cognitive and behavioural responses to postpartum harm thoughts.

Sleep deprivation in parents caring for children with complex needs at home: a mixed methods systematic review

A significant number of children with a range of complex conditions and health care needs are being cared for by parents in the home environment. This mixed methods systematic review aimed to determine the amount of sleep obtained by these parents and the extent to which the child-related overnight health or care needs affected parental sleep experience and daily functioning. Summary statistics were not able to be determined due to the heterogeneity of included studies, but the common themes that emerged are that parents of children with complex needs experience sleep deprivation that can be both relentless and draining and affects the parents themselves and their relationships. The degree of sleep deprivation varies by diagnosis, but a key contributing factor is the need for parents to be vigilant at night. Of particular importance to health care professionals is the inadequate overnight support provided to parents of children with complex needs, potentially placing these parents at risk of poorer health outcomes associated with sleep deprivation and disturbance. This needs to be addressed to enable parents to remain well and continue to provide the care that their child and family require.

Indications for home apnea monitoring (or not)

Although there is a large body of literature describing infants who experience apnea of prematurity and apparent life-threatening events, there is no consensus regarding the use of home monitoring. This article focuses on issues that affect decision making regarding the use of home monitors in these two groups of infants and reviews existing data to guide a decision to discontinue monitoring at hospital discharge or to prescribe monitoring in the home.

Effects of maternal depressive symptoms and infant gender on the interactions between mothers and their medically at-risk infants

OBJECTIVE

To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants.

DESIGN

Longitudinal, descriptive secondary analysis.

SETTING

Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East.

PARTICIPANTS

One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months.

MAIN OUTCOME MEASURES

Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.

RESULTS

The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms.

CONCLUSION

Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants.

Validity of the revised Impact on Family (IOF) scale

OBJECTIVE

To assess psychometric properties of the revised 15-item Impact on Family (IOF) Scale.

STUDY DESIGN

A secondary analysis of items using data collected from 252 parents during an earlier randomized clinical trial.

RESULTS

Exploratory factor analysis and confirmatory factor analysis identified a single factor with factor loadings similar to that of IOF developers. The one factor accounts for 45.7% of the sample variance. An Item Response Theory analysis found that 11 of the 15 items had alpha values greater than 1.00, with good to excellent item characteristic and item information curves. The test information and measurement error curves for the entire IOF were excellent. Construct validity of the IOF also was supported. Parent IOF scores correlated in the expected directions with maternal mood (r = -0.50), sibling behavior problems (r = -0.35), and severity of illness (r = 0.31) and were associated with family socioeconomic status (t = -4.5, all P < .001).

CONCLUSIONS

This study provides independent support for validity and reliability of the revised IOF scale. This scale is a promising, easy-to-use instrument for the measurement of impact of illness and disability on families of children with chronic illness or disability.

A primer on Apnea of prematurity

Apnea, the cessation of respiratory airflow, can begin in many preterm infants in the first week of life and can last until the day of discharge or beyond. This article provides an overview of the complex anatomic, physiological, and developmental mechanisms related to immaturity of both the central nervous system and musculature of the pulmonary system, that contribute to apnea of prematurity. Apnea of prematurity is a diagnosis of exclusion; an array of other conditions and stimuli can also cause apnea, including infections, pulmonary disease, and intracranial pathology. The standard clinical management of apnea, including cutaneous stimulation, methylxanthine therapy, and continuous positive airway pressure or ventilatory support, are discussed as well as newer investigational therapies, such as olfactory stimulation. Emerging evidence on the long-term neurodevelopmental impact of apnea is reviewed. Nursing measures to prevent and manage apnea are reviewed with an emphasis on parent education and preparation for discharge. Apnea resolves in most preterm infants as they approach term corrected gestational age; however, if it does not, options include continued hospitalization or, for infants with stable apnea, discharge with a home apnea monitor.

A community-based intervention for siblings and parents of children with chronic illness or disability: the ISEE study

OBJECTIVE

Siblings of children with chronic illness or disability have been reported to have a 1.6 to 2.0 risk for behavioral and mental health problems. Our objective was to examine the effects of an intervention for siblings (age 7-15 years) of children with chronic illness or disability.

METHOD

A randomized, three-group repeated-measures design was used: full intervention (n=79), partial intervention (n=71), and a waiting list control group (n=102). Outcomes were sibling knowledge about illness, behavior problems, social support, self-esteem, attitude, and mood measured over four postintervention periods. Covariates were family cohesion, maternal mood, socioeconomic status, and well sibling age. The full intervention included structured teaching and psychosocial sessions at a 5-day residential summer camp. The partial intervention included camp only. Treatment effects were estimated by using generalized estimating equation panel analyses.

RESULTS

The full treatment group showed significant improvements on all six outcomes over most periods, the partial treatment group on three outcomes, and the control group on two outcomes. Improvements in outcomes ranged from 5% to 25% increases over baseline measures.

CONCLUSIONS

A dose-response relationship to intervention was found. Treatment gains were sustained over a period of 12 months.

Parenting and Childhood Chronicity: making visible the invisible work

The work required to raise a child with a chronic illness or disability is above and beyond that of raising a typical child. This article presents a model, Parenting and Childhood Chronicity (PACC), that was developed during an interpretive study with 43 parents of 34 children (aged 15 months to 16 years) with various chronic conditions, is presented. "Special needs parenting" describes the additional care that a child needs and includes medical care, parenting plus, and working the systems. "Minimizing consequences" reflects the struggle to balance the rest of family life and includes parenting siblings, maintaining relationships, and keeping yourself going.

Caregiver burden: a concept analysis

The development of the concept of burden for use in research lacks consistent conceptualization and operational definitions. The purpose of this article is to analyze the concept of burden in an effort to promote conceptual clarity. The technique advocated by Walker and Avant is used to analyze this concept. Critical attributes of burden include subjective perception, multidimensional phenomena, dynamic change, and overload. Predisposing factors are caregiver's characteristics, the demands of caregivers, and the involvement in caregiving. The consequences of burden generate problems in care-receiver, caregiver, family, and health care system. Overall, this article enables us to advance this concept, identify the different sources of burden, and provide directions for nursing intervention.

Effect on families and caregivers of caring for a child with laryngomalacia

We used a retrospective chart review and telephone interviews using a standard format to 1) measure the outcome and psychosocial costs of caring for a child with upper airway obstruction due to laryngomalacia and 2) develop an epidemiologic instrument that measures the impact on the lives of families who have a child with laryngomalacia. Forty-four patients had laryngomalacia documented by endoscopy between 1993 and 1997. Complete follow-up information through 1998 was available on 26 patients. Of the 44 patients, 37 were managed expectantly and 7 (16%) required surgical intervention. Polysomnograms were obtained on 11 before neonatal discharge. Twelve patients wore an apnea monitor for at least 1 month. The quality of life analysis found that the majority of caregivers were not substantially affected by caring for the stridorous child. Loss of sleep and heightened anxiety were commonly reported by these caregivers. Younger parents or parents with fewer than 3 other children were more affected by caring for a child with laryngomalacia. There was no substantial loss of workdays, increase in doctor visits, or difficulty in obtaining day care. Caring for a child with laryngomalacia results in minor disruption of a family's lifestyle.