Predictors of needs in mothers with infants in the neonatal intensive care unit

A Feasibility Study to Test the NICU Paternal Needs Inventory

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.

The risk of low risk: First time motherhood, prematurity and dyadic well-being

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth-relatively unexplored in the literature-is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers' meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.

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.

Needs of parents in a surgical neonatal intensive care unit

AIM

While there is evidence of parental needs in the neonatal intensive care unit (NICU), parents of newborns admitted for general surgery are an under-researched population. This study aimed to identify needs in parents of newborns admitted to the NICU for general surgery and whether health-care professionals meet these needs.

METHODS

This was a prospective cohort study of 111 parents (57% mothers) of newborns admitted to a surgical NICU for general surgery in Australia from January 2014 to September 2015. Parents completed the Neonatal Family Needs Inventory (NFNI), comprising 56 items in five subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge, as well as the Social Desirability Scale (SDS). Data were analysed using parametric and non-parametric techniques.

RESULTS

At both admission and discharge, parents rated Assurance (M = 3.8, standard deviation (SD) = 0.24) needs as the most important, followed by Proximity (M = 3.6, SD = 0.32) and Information (M = 3.5, SD = 0.38). Mothers rated Assurance significantly more important than fathers (P < 0.02). Overall, parents' most important needs were having questions answered honestly (M = 3.96, SD = 0.19), seeing their infant frequently and knowing about the medical treatment (both M = 3.95, SD = 0.23). The 10 most important needs were met for more than 96% of parents, with no evidence of response bias.

CONCLUSIONS

Reassurance is a priority need for parents in the surgical NICU. Mothers' and fathers' needs may be best met by practices based on family-centred, individualised care principles.

The Needs of Parents of Preterm Infants in Iran and a Comparison With Those in Other Countries: A Systematic Review and Meta-Analysis

Context

Proper accountability to needs of preterm infants’ parents requires recognition of these needs and how they change in different conditions. The aim of this study was to assess the needs of parents of preterm infants in Iran, as compared to those in other regions in the world.

Evidence Acquisition

A search of Iranian databases (Iran Medex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) was conducted, with no time limitations, to 5 October 2014. Using standard tools, all quantitative studies that considering the parental needs of preterm infants and parental support were extracted. The STROBE checklist was used for the evaluation of the studies. Thirty-one studies were extracted in the qualitative evaluation, of which 17 were included in the meta-analysis. The variance between the studies was analyzed using tau-squared (Tau²) and review manager 5 software.

Results

The results obtained using the nurse-parent support tool (NPST) showed that mothers considered that all the fields of support were of great importance. The parental needs in Iran were similar to those of parents in other regions worldwide. However, the mean score for Iranian parents’ assessment of the support they received was 2.20 ± 0.06, whereas it was 3.84 ± 0.72 for other countries. The mean scores for parents’ assessment of the provision of emotional, informational appraisal, and instrumental support in Iran were 1.73 ± 0.06, 2.1 ± 0.06, 1.54 ± 0.6, and 3.44 ± 0.04, respectively, compared to 3.18 ± 1.34, 4.11 ± 0.5, 4.26 ± 0.18, and 4.51 ± 0.14, respectively, in other countries.

Conclusions

Parents always prefer the priorities of their babies to their individual needs. Given the lower scores for the parental assessment of received support in Iran, it is important to focus on these specific items in providing interventions to meet the needs of Iranian parents.

Parental expectations of maternal and child health services

This article reports on survey research (N = 1,418) aimed at examining whether parental expectations of maternal and child health (MCH) services are influenced by group characteristics (e.g., socioeconomic status [SES], ethnicity, at risk of poverty) and/or individual parenting context variables (e.g., received social support) in a context where these services are available to all. The findings reveal that parents have different expectations about the technical and relational expertise of MCH nurses. However, the authors found only very weak associations between family characteristics and parental expectations, suggesting that individual differences matter more than SES and other more traditional distinctions. Implications for MCH services are made.

The psychosocial functioning of mothers of infants admitted to the neonatal intensive care unit in the north of Jordan

The primary aim of this study was to assess the effect of admission of infants to neonatal intensive care unit (NICU) on the psychosocial functioning of their mothers. The secondary aim was to compare the psychosocial functioning of the mothers of infants admitted to NICU and the mothers of infants born at term and not admitted to NICU. A total of 75 consecutive mothers of infants admitted to NICU and 75 consecutive mothers of infants born at term and not admitted to NICU were included in the study. Mothers completed State-Trait Anxiety Inventory for Adults and Edinburgh Postnatal Depression Scale in three large hospitals in Irbid, Jordan in the period between November 2010 and June 2011. The results showed that mechanical ventilation, lower birth weight and lower gestation age were predictors of higher anxiety level and depression among mothers of infants admitted to NICU. Both groups (mothers of infants admitted to NICU and mothers of infants born at term and not admitted to NICU) scored high in Edinburgh Postnatal Depression Scale.

The role of satisfaction with social support in perceived burden and stress of parents of six-month-old infants with a congenital anomaly: Actor and partner effects

This exploratory study examined the role of satisfaction with support from family and friends on the burden and stress of parents of infants with a congenital anomaly (CA). The effects of social support were examined within the couple (actor and partner effects). A total of 36 couples whose six-month-old infant has a CA participated in this study. The parents completed questionnaires regarding satisfaction with support, burden (Impact on Family Scale - Revised), and parenting stress (Parenting Stress Index). The results showed that fathers directly benefited from the support they received from friends in reducing their burden, while mothers only indirectly benefited from it through the father's adjustment. The pattern was different for stress: mothers directly benefited from the support they received from their family in reducing their stress levels, while fathers benefited both directly from the support they received from friends and indirectly from the support that their partners received from family. These results highlight that (1) the different support needs of mothers and fathers (due to their different roles during transition to parenthood) and (2) the diffusion of benefits of social support within the couple should be taken into account when developing strategies to promote support to families of six-month-old infants with a CA.

Art-Based Occupation Group Reduces Parent Anxiety in the Neonatal Intensive Care Unit: A Mixed-Methods Study

OBJECTIVE. We examined whether an art-based occupation group using scrapbooking in the neonatal intensive care unit (NICU) would reduce parent stress, operationalized as anxiety. We also wanted to understand the parents’ lived experience of the group.

METHOD. Forty parents from a Level 3 NICU in a large metropolitan hospital participated. We administered the State–Trait Anxiety Inventory preactivity and postactivity along with a brief interview.

RESULTS. The decline in parents’ mean state anxiety (12.7 points, SD = 11.8; p &lt; .0001) was clinically significant. The decline in mean trait anxiety (2.6 points, SD = 5.2; p = .0036) was statistically significant but not clinically meaningful. Parents said that participation offered distraction and engagement, pleasure, relaxation, a sense of hope, and an opportunity to share.

CONCLUSION. An art-based occupation group using scrapbooking was an effective brief intervention to reduce parent anxiety in the neonatal intensive care unit; parent interviews suggested that participation has broad clinical implications for parent well-being.

Mothers' experiences of infants discharge in Iranian NICU culture: a qualitative study

PURPOSE

This study examined mothers' experiences of the preparation of their infants for discharge in the Iranian neonatal intensive care unit (NICU) culture.

SUBJECTS AND SETTING

Participants included 16 mothers who had preterm infants who were hospitalized in Iranian NICUs.

DESIGN

A qualitative study was used to describe mothers' experiences of infant discharge from the NICU.

METHODS

Data collection was done by interviewing mothers who were in NICUs of Iranian University Hospitals. The qualitative data analysis package was used for coding and categorizing.

RESULTS

Four themes were identified: learning from multiple sources, conditional discharge, enabled mother, and continued nightmares.

CONCLUSION

This study highlighted several issues regarding mothers' experiences of infants' discharge plan. Nurses should be aware of these themes to support the mothers during preparation of their infants for discharge from NICUs.

Anxiety among Black and Latina Mothers of Premature Infants at Social-Environmental Risk

Anxiety is heightened for mothers of premature infants, potentially interfering with early mothering. This study describes relationships among race/ethnicity, language, and anxiety for women at social-environmental risk who deliver a premature infant. Postnatal baseline interview data from a randomized trial testing a behavioral intervention for mothers and infants (29-34 weeks gestational age) were used to examine maternal state (STAI-Y1) and trait (STAI-Y2) anxiety among blacks and Latinas, and by language preference. Latinas (n = 97) had an elevated prevalence of high (≥ 40) state anxiety compared to blacks (n = 97), with Latinas preferring a Spanish to an English interview reporting the highest levels of state anxiety. Trait anxiety did not differ across groups. Culturally appropriate interventions are needed to reduce anxiety among Latina mothers delivering premature infants, especially among those with limited English language proficiency. A racially/ethnically diverse workforce, bilingual healthcare providers, and trained medical interpreters may help to ensure better outcomes.

Parental interaction with infants treated with medical technology

BACKGROUND

It is well established that parents must interact with their new-born babies to facilitate attachment. However, very little is known about how parents perceive different types of medical technology products commonly used in the neonatal intensive care unit (NICU) as barriers to their wish to interact with their infants.

AIM

This study aims to examine to what extent the different medical technology products commonly used in the NICU are perceived by parents to be obstacles in their wish to interact with their babies.

DESIGN AND METHODS

In 2010, a cross-sectional survey, using a questionnaire specifically developed for this study, was conducted among the parents of children who were discharged from any of the five NICUs of the Västra Götaland region in Sweden. A consecutive sample of 248 parents participated, and multiple regressions and t-tests were used to analyse the data.

RESULTS

The parents generally perceived the various medical technology products differently, according to the perceived level of obstruction. The variables of gender, age, educational level, origin, gestational age, previous experience of being a parent, and the offer of accommodation at the NICU were significantly associated with the perceived level of obstruction in the parents' wish to interact with their baby while the baby was being treated with different medical technology products.

CONCLUSION

The primary implication for practice is that to facilitate attachment, nurses should involve different categories of parents in different ways in the care of their children, depending on the equipment being used in the treatment of the children. Thus, the individual care plan should explicitly include the details of the specific medical equipment, because although its use is medically beneficial for the child, it is associated with potential liabilities regarding parent-child interaction and, consequently, regarding parent-child attachment.