Assessing the feasibility and acceptability of an intervention to reduce anxiety and enhance sensitivity among mothers of very low birth-weight infants

Child development education in the Neonatal Unit: Understanding parent developmental literacy needs, priorities and preferences

OBJECTIVE

To describe child development knowledge needs, priorities, and preferences for education to enhance developmental literacy among parents with children admitted to the neonatal unit (NNU).

METHODS

Two separate cohorts completed a survey; 1) Parents with children graduated from Australian NNUs (n = 316); 2) Parents with infants' inpatient at two South Australian NNUs (n = 209).

RESULTS

Parents considered it extremely important to understand child development (Graduates: 80%; Inpatients: 71%). Inpatient parents reported lower child development knowledge. Almost half (42%) of graduate parents described the child development education provided by neonatal staff as poor or inadequate. There was consistency in preferences for developmental literacy education provision. Parents desired education to commence during NNU and continue post discharge. Priorities included content specific to preterm birth and how to support child development over the first two years of life. Individualised education by a Neonatal Nurse/Midwife was most preferred.

CONCLUSION

Mothers and fathers value guidance to support their child's development during NNU admission and early childhood. Our study highlights the importance of improved early developmental literacy education for parents with children admitted to the neonatal unit.

PRACTICE IMPLICATIONS

Our findings can be used to inform the creation of future educational resources targeting improved parent developmental literacy.

Developing a health education comic book: the advantages of learning the behaviours of a target audience

The objective of this study was to determine the positive and negative coping mechanisms practiced by parents of paediatric inpatients and outpatients in order to prepare a health educational comic aimed at improving these response mechanisms. Data were collected from parents visiting general paediatric outpatient clinics or hospitalisation units, at a children's hospital in a metropolitan city. Data analysis was based on 258 completed surveys received from 308 (83.77%) respondents. Each parent completed a survey that included the Brief-COPE-Coping Orientation to Problems Experienced questionnaire that encompassed 14 subscales of positive and negative coping mechanisms. Parents used both positive and negative coping mechanisms in outpatient clinics and hospitalisation units. Scores involving negative coping mechanisms were increased and associated with the severity of a child's reason for visiting a children's hospital. The lowest scores were reported by parents whose children were seen at outpatient clinics, whereas the highest scores were reported by parents whose children were treated in critical care units. Learning about parents' coping mechanisms provided key information for preparing an electronic health education comic book (electronically distributed free of charge) and can be used to teach and promote the reinforcement of positive rather than negative coping mechanisms.

Parent Coping Support Interventions During Acute Pediatric Hospitalizations: A Meta-Analysis

CONTEXT

Parents may experience psychological distress when a child is acutely hospitalized, which can negatively affect child outcomes. Interventions designed to support parents' coping have the potential to mitigate this distress.

OBJECTIVE

To describe interventions designed to provide coping support to parents of hospitalized children and conduct a meta-analysis of coping support intervention outcomes (parent anxiety, depression, and stress).

DATA SOURCES

We searched Pubmed, Embase, PsycINFO, Psychiatry Online, and Cumulative Index to Nursing and Allied Health Literature from 1985 to 2016 for English-language articles including the concepts "pediatric," "hospitalization," "parents," and "coping support intervention."

STUDY SELECTION

Two authors reviewed titles and abstracts to identify studies meeting inclusion criteria and reviewed full text if a determination was not possible using the title and abstract. References of studies meeting inclusion criteria were reviewed to identify additional articles for inclusion.

DATA EXTRACTION

Two authors abstracted data and assessed risk of bias by using a structured instrument.

RESULTS

Initial searches yielded 3450 abstracts for possible inclusion. Thirty-two studies met criteria for inclusion in the systematic review and 12 studies met criteria for inclusion in the meta-analysis. The most commonly measured outcomes were parent depression, anxiety, and stress symptoms. In meta-analysis, combined intervention effects significantly reduced parent anxiety and stress but not depression. Heterogeneity among included studies was high.

LIMITATIONS

Most included studies were conducted at single centers with small sample sizes.

CONCLUSIONS

Coping support interventions can alleviate parents' psychological distress during children's hospitalization. More evidence is needed to determine if such interventions benefit children.

Systematic Review of Interventions to Reduce Psychiatric Morbidity in Parents and Children After PICU Admissions

OBJECTIVE

To describe and evaluate interventions aimed at reducing psychiatric morbidity in parents and children discharged from PICU.

DATA SOURCES

A systematic review of the literature was undertaken, searching EMBASE, PSYCHinfo, MEDLINE, and CINAHL. Experts in the field were contacted to identify unpublished studies.

STUDY SELECTION

Exclusion criteria: Studies with participants above age 18 or drawn from a neonatal ICU, studies not in English, and those not measuring psychopathology.

DATA EXTRACTION

Seven hundred fifty-three articles initially identified were hand searched which identified three studies, with a further three studies found by contacting experts in the field. Of these, three were randomized controlled trials and three feasibility studies.

DATA SYNTHESIS

The interventions primarily targeted parents (particularly mothers), with the aim of reducing psychopathology especially posttraumatic stress disorder. Findings from these few studies demonstrated that interventions can lead to a reduction in parent and child psychopathology. Key ingredients of these interventions included psychoeducation, parent support after discharge, offering intervention to those families at high risk of developing psychopathology as identified by screening at the point of discharge, follow-up of all families with the aim of case finding, and specific interventions to target posttraumatic stress disorder symptoms.

CONCLUSIONS

Intervention studies are few but do lead to reductions in parent and child psychopathology. There is sufficient information to suggest some of these interventions could be supported and further evaluated.

Palliative care in neonatal intensive care, effects on parent stress and satisfaction: a feasibility study

CONTEXT

Approximately 1 in 10 infants require neonatal intensive care unit (NICU) hospitalization, which causes parental stress. Palliative care (PC) provides an opportunity to alleviate suffering and stress.

OBJECTIVES

This study examines the effects of PC on NICU parent stress and satisfaction.

METHODS

A prospective cohort design compares stress and satisfaction among families receiving or not receiving PC.

RESULTS

No significant differences in stress scores were found (P = .27-1.00). Palliative care parents (100%) were more likely to report being "extremely satisfied" with care than usual-care parents (50%).

CONCLUSION

This study supports the feasibility of evaluating NICU PC services. Infants referred for PC typically have higher morbidity/mortality; therefore, higher parental stress scores may be expected. Stress levels were similar in both cohorts, thus PC did not increase stress and may decrease PC parent stress.

Review of interventions to reduce stress among mothers of infants in the NICU

Nearly half a million preterm infants are born each year in the United States. Preterm delivery has significant psychosocial implications for mothers, particularly when their baby spends time in the neonatal intensive care unit (NICU). The decrease in length of gestation causes mothers to have to parent prematurely, without the less time for emotional preparation than mothers of full-term infants. Parents of NICU infants experience stress related to feelings of helplessness, exclusion and alienation, and lack sufficient knowledge regarding parenting and interacting with their infants in the NICU. There are a number of interventions that nurses can do that help reduce the stress of mothers of infants in the NICU.

Prevention of postpartum traumatic stress in mothers with preterm infants: manual development and evaluation

Premature birth has been associated with multiple adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants who are premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent, both as infants and as they get older. In response to these findings, a number of educational and behavioral interventions have been developed that target maternal psychological functioning, parenting, and aspects of the parent-infant relationship. The current study aimed to both develop and evaluate a treatment that integrates, for the first time, effective interventions for reducing symptoms of posttraumatic stress disorder (PTSD) and enhancing maternal-infant interactions. Conclusions from the study indicate that the intervention is feasible, able to be implemented with a high level of fidelity, and is rated as highly satisfactory by participants. Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.

A guided feeding intervention for mothers of preterm infants: two case studies

PURPOSE

The purpose of this study was to determine how mothers of preterm infants perceive the feasibility and acceptability of a guided feeding intervention.

DESIGN AND METHODS

In this multiple case study design, feasibility was assessed by retention of participants through all intervention sessions. Acceptability was assessed with a semi-structured interview.

RESULTS

Participants found the intervention useful for demonstrating and explaining behaviors that facilitate feeding, and helpful in dispelling previous, erroneous understandings about infant behaviors.

PRACTICE IMPLICATIONS

The results are encouraging. The intervention was found to be both feasible and acceptable. The effectiveness of this intervention needs to be assessed in a randomized controlled trial.

Effectiveness of therapeutic behavioral interventions for parents of low birth weight premature infants: A review

Premature birth has been associated with a number of adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who were premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. Since the last comprehensive review of this topic in 2002, there have been a significant number of developments in the quality of the studies conducted and the theoretical models that address the experience of parents of premature infants. In the current review, eighteen new interventions were identified and grouped into four categories based on treatment length and the target of the intervention. Findings suggest a trend towards early, brief interventions that are theoretically based, specifically target parent trauma, and utilize cognitive behavioral techniques. Although it is difficult to generalize study findings, conclusions from the review suggest that targeted interventions may have positive effects on both maternal and infant outcomes.

The evidence base for the cues program for mothers of very low birth weight infants: an innovative approach to reduce anxiety and support sensitive interaction

Very low birth weight (VLBW) infants, born weighing less than 1,500 g, are at risk for several developmental problems. Consequently, there has been interest in developing intervention programs to prevent such problems. This article describes the empirical evidence that guided the development of an innovative, multicomponent intervention program for mothers of VLBW infants, as well as the program content and features. Based on the evidence, the program was designed to include six sessions and commence shortly after birth to reduce maternal psychological distress during the infant's hospitalization in the neonatal intensive care unit and to promote sensitive mother-infant interaction. The program incorporates various learning activities, including written materials, observational exercises, discussion, and video feedback.

The cues and care randomized controlled trial of a neonatal intensive care unit intervention: effects on maternal psychological distress and mother-infant interaction

OBJECTIVE

This study tested the efficacy of a brief intervention (Cues program) with mothers of very low birth weight (VLBW <1500 g) infants. The primary hypothesis was that mothers in the Cues program would report lower levels of anxiety compared with mothers in the control group. Secondary hypotheses examined whether Cues mothers would report less stress, depression, and role restriction, and exhibit more sensitive interactive behavior, than control group mothers.

METHODS

A total of 121 mothers of VLBW infants were randomly assigned to either the experimental (Cues) intervention or an attention control (Care) condition. The Cues program combined training to reduce anxiety and enhance sensitivity. The control group received general information about infant care. Both programs were initiated during the neonatal intensive care unit stay. Maternal anxiety, stress, depression, and demographic variables were evaluated at baseline, prior to randomization. Postintervention outcomes were assessed during a home visit when the infant was ∼6 to 8 weeks of corrected age.

RESULTS

Although mothers in the Cues group demonstrated greater knowledge of the content of the experimental intervention than mothers in the Care group, the groups did not differ in levels of anxiety, depression, and symptoms of posttraumatic stress. They were similar in their reports of parental role restrictions and stress related to the infant's appearance and behavior. Cues and Care group mothers were equally sensitive in interaction with their infants.

CONCLUSION

Nonspecific attention was as effective as an early skill-based intervention in reducing maternal anxiety and enhancing sensitive behavior in mothers of VLBW infants.

Análise da produção científica acerca da atenção ao recém-nascido de baixo peso em UTI

O objetivo deste estudo foi analisar a natureza e tendência dos artigos na temática saúde do recém nascido de baixo peso. Trata-se de uma revisão integrativa desenvolvida em agosto de 2009, a partir dos descritores: "recém-nascido de baixo peso" or "recém-nascido de muito baixo peso" and "unidades de terapia intensiva neonatal", no recorte temporal 1990-2008. A amostra de 608 resumos foi submetida à análise de conteúdo temática. Nos resultados, os estudos de natureza clínico-epidemiológica contemplam os fatores de risco do baixo peso e morbimortalidade neonatal e os de tendência assistencial contribuem com as rotinas e cuidados prestados. Evidenciam-se os avanços na atenção a saúde do recém-nascido, a complexidade clínica e as implicações para sua assistência. Destaca-se a lacuna de pesquisas que aponte a subjetividade, o apoio e a inclusão das famílias nos cuidados e no enfrentamento dessa situação.

Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit

This correlational study examined how mother's posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother-infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers' PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant.