Preterm Birth: Implications for Family Stress and Coping

Parental Beliefs About the Motor Development of Dutch Infants Born Very Preterm: A Cohort Study

PURPOSE

To explore the influence of preterm birth on parental beliefs about gross motor development and parents' supportive role in infants' motor development.

METHODS

Prospective cohort study: Parents of infants born very preterm (VPT) (gestation ≤32 weeks, birth weight <1500 g, without perinatal complications) and parents of healthy infants born full-term (FT) completed the Parental Beliefs on Motor Development questionnaire.

RESULTS

Questionnaires from 37 parents of infants born VPT, aged 3.5 to 7.5 months (corrected), and 110 parents of infants born FT, aged 3.5 months, were analyzed. Parents of infants born VPT believed stimulating motor development to be more important than parents of infants born FT (F = 5.22; P = .024; ηp2 = 0.035). Most parents of infants born VPT (82.4%) and FT (85.2%) acknowledged their role in supporting motor development. More parents of infants born VPT (41.2% vs 12.0%) believed they should follow their infant's natural developmental pace.

CONCLUSION

Knowledge of parental beliefs and parents' supporting role in motor development is relevant for tailoring pediatric physiotherapists' interventions with families.

Starting parenting in isolation a qualitative user-initiated study of parents' experiences with hospitalization in Neonatal Intensive Care units during the COVID-19 pandemic

BACKGROUND

Worldwide, strict infection control measures including visitation regulations were implemented due to the COVID-19 pandemic at Neonatal Intensive Care Units (NICUs). These regulations gave restricted access for parents to their hospitalized infants. The consequence was limited ability to involve in the care of their infants. At Oslo University Hospital entry to NICU was denied to all except healthy mothers in March 2020. The absolute access ban for fathers lasted for 10 weeks. The aim of this study was to explore parental experiences with an infant hospitalized in the NICU during this absolute visitation ban period.

METHODS

We invited post discharge all parents of surviving infants that had been hospitalized for at least 14 days to participate. They were interviewed during autumn 2020 using an explorative semi-structured interview approach. Data were analyzed via inductive thematic analysis.

RESULTS

Nine mothers and four fathers participated. The COVID-19 regulations strongly impacted the parent's experiences of their stay. The fathers' limited access felt life-impacting. Parents struggled to become a family and raised their voices to be heard. Not being able to experience parenthood together led to emotional loneliness. The fathers struggled to learn how to care for their infant. The regulations might lead to a postponed attachment. On the other hand, of positive aspect the parents got some quietness. Being hospitalized during this first wave was experienced as exceptional and made parents seeking alliances by other parents. Social media was used to keep in contact with the outside world.

CONCLUSIONS

The regulations had strong negative impact on parental experiences during the NICU hospitalization. The restriction to fathers' access to the NICU acted as a significant obstacle to early infant-father bonding and led to loneliness and isolation by the mothers. Thus, these COVID-19 measures might have had adverse consequences for families.

Stress Management among Parents of Neonates Hospitalized in NICU: A Qualitative Study

Introduction: Infant hospitalization is stressful event for parent in NICU. Parents think that they have lost control because of unfamiliar environment. Therefore, stress management is very important in this period. The family as the main factor of strength and protection for infant is required as the bases of standard care in NICU. Therefore the aim of this study was to investigate stress management in Iranian NICU Parents.

Methods: Using qualitative content analysis approach helped to collect and analysis data for open coding, classification, and theme abstraction. Twenty one parents with hospitalized neonates, physicians and nurses in the city of Isfahan were purposely recruited and selected for in-depth interviews.

Results: The analyzed content revealed unique stress management approaches among the parents. The main themes were: 1) spirituality, 2) seeking information, 3) Seeking hope, 4) maintaining calm, 5) attachment to infant, and 6) communicating with the medical team

Conclusion: Findings of this study highlights the importance of medical team’s attention to stressed parents who are trying to make adjustment or adapt to the hospitalization of their infant. A revised management approach to address the emotional needs of parents of neonates in Iran seems essential for improving communication with physicians and nurses.

The effect of narrative writing of mothers on their satisfaction with care in the neonatal intensive care unit

AIM

This study was conducted to evaluate the effect of narrative writing on the satisfaction of the mothers with care in the neonatal intensive care unit (NICU) during their neonates' hospitalization.

MATERIALS AND METHODS

This quasi-experimental study with pretest and posttest were administered to a sample size of 70 mothers with preterm neonates. The Neonatal Index of Parental Satisfaction questionnaire was used. Descriptive and analytical statistics were used for data analysis.

RESULTS

The satisfaction level of the mothers was 113.1 ± 17.5 on the 3rd day and 102.3 ± 25.6 on the 10th day of the study in the control group. Paired t-test (p values < 0.011) in the control group showed a significant difference in the satisfaction level of the mothers. In the intervention group, the satisfaction level of the mothers was 107.5 ± 21.5 on the 3rd day and 137 ± 15.2 on the 10th day of the study. Paired t-test (p values < 0.001) showed a significant difference in the satisfaction level of the mothers between the 3rd and 10th day of the study. The results of independent t-test showed a significant difference in satisfaction between the intervention and control groups on the 10th day of the study (p < 0.001).

CONCLUSION

We suggest that narrative writing may be considered as an efficient supportive intervention to increase the mothers' satisfaction in the NICUs.

Family-centered care during acute neonatal transport

PURPOSE

To evaluate current transport team communication practices and identify areas for improvement from the parents' perspective. We also sought to determine whether parents perceived that they were active participants in the care of their infants during the transport process, consistent with the concepts of providing family-centered care (FCC).

SUBJECTS

Purposeful sampling of mothers and fathers (or maternally designated support person if the father was not involved) of 25 infants who were transported for acute care to a level III neonatal intensive care unit (NICU) between October 1, 2012, and September 18, 2013.

DESIGN

This quality improvement project used quantitative and qualitative analysis of a parent questionnaire.

METHODS

Mothers and fathers (or the support person) of transported infants were invited to complete a questionnaire consisting of yes/no and open-ended questions within the first 2 weeks of their infants' transport to a level III NICU. The questions were related to the communication and information parents received and their ability to participate in the transport process.

RESULTS

Twenty-seven parents completed the questionnaire. Responses to yes/no questions identified areas for improvement for the transport team. These included providing parents the opportunity to view an informational video; ensuring that mothers had the opportunity to provide colostrum or breast milk before transport; and providing an explanation to parents about their role as active participants in their infants' care. Responses to the open-ended questions indicated that approximately 40% of parents felt they had received adequate information about their infants' care during the transport and many parents (40%) cited separation from their infants as very concerning and causing distress. More than one-third (40%) of the parents specifically stated that at least 1 parent should accompany the infant during the transport. One father in this sample had been able to accompany his infant to the tertiary center.

CONCLUSIONS

The integration of FCC core concepts during an acute neonatal transport is important to parents. The orientation of parents to FCC during the transport process may facilitate communication and help them become active participants in their infants' care.

The emotional experiences and supports for parents with babies in a neonatal nursery

PURPOSE

The experience of the neonatal intensive care unit (NICU) for parents can be anxiety-provoking, fearful, and distressing. To help parents cope with these overwhelming feelings, a number of interventions, including parent support groups, are typically offered. It is hoped that the provision of these groups and other forms of emotional support lessen the distressing experience for parents and lessen the anxiety of hospital discharge. This study focuses on the emotional reactions during the transition to home from the NICU for parents who participated in one such support group.

METHODS

Parents were interviewed 4 to 6 months after discharge of their baby from hospital.

RESULTS

Themes from these interviews included anxiety and concern about the baby's readiness for discharge, concerns about the risks of further illness and rehospitalization, and whether the parent felt prepared sufficiently to care for his or her baby at home. Recalling their time in the nursery was distressing for parents, but despite this, they identified that positive staff interactions helped them through the hardest times in the NICU.

CONCLUSIONS

The support group was reported to be effective and helpful for parents. Parents often maintained social contact with other parents and recalled advice and supportive information from the group as needed. Participants recommended that the support group continue to assist other parents.

Enhancing person-centred communication in NICU: a comparative thematic analysis

AIMS AND OBJECTIVES

Aims of this article were (a) to explore how parents of premature infants experience guided family-centred care (GFCC), and (b) to compare how parents receiving GFCC versus standard care (SC) describe nurse-parent communication in the neonatal intensive care unit.

BACKGROUND

Family-centred care (FCC) is acknowledged as fundamental to supporting parents of premature infants, and communication is central to this practice. Accordingly, nurses need good communication skills. GFCC is an intervention developed to improve nurse-parent communication in the neonatal intensive care unit. This intervention helps nurses to realize person-centred communication as an approach to optimize contemporary practice.

DESIGN

Our qualitative study had a descriptive and comparative design using semi-structured interviews to explore the parent's experience of GFCC.

METHODS

We conducted 10 dyad interviews with parents (n = 20) and two individual interviews with mothers of premature infants (n = 2). Parents in the intervention group versus SC group were 13 versus 9. Thematic analysis was applied.

FINDINGS

GFCC was generally experienced as supportive. Three interrelated themes were identified that illustrated how the intervention helped parents cope as persons, parents and couples: (a) discovering and expressing emotions, (b) reaching a deeper level of communication, and (c) obtaining mutual understanding. In contrast, SC communication was more superficial and less structured. Factors such as inaccessibility of nurses, inability to ask for assistance and parent popularity impaired successful communication.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Our study suggested that compared to SC, GFCC provided structured delivery of supportive communication between nurses and parents of premature infants. The intervention promoted the discovery of the parents' individual preferences and concerns, which enabled more focused communication, and set the stage for better nurse-parent and parent-parent understanding. We recommend GFCC as a method to improve communication in the neonatal intensive care unit.

Understanding Parenting Occupations in Neonatal Intensive Care: Application of the Person-Environment-Occupation Model

The adoption of family-centred care principles within neonatal intensive care, including support for the development of the parental role, has been increasing in profile over the past decade. During this period, occupational therapy has also had an emerging role in the provision of services within neonatal intensive care. However, there has been limited exploration of the concept of parenting as an occupation as a means of supporting parental role development within the neonatal intensive care unit (NICU). In accordance with the philosophy of family-centred care, opportunities exist to determine how the occupational efforts of parents and preterm infants can best be supported.

This paper provides a review of the current literature and its application to the Person-Environment-Occupation (PEO) Model as a framework for illuminating the acquisition of parenting occupations in the NICU. Illustration is provided of how the application of the PEO Model can be used to direct occupational therapy practice to incorporate a focus on family-centred care and the development of an occupation-based approach through which practice can be enhanced, ensuring that both the infant's and the family's needs are recognised and addressed.