Establishment of the Relationship Between Fathers and Premature Infants in Neonatal Units

Effects of parents' voice on reducing heel puncture pain in high-risk newborns: A randomized controlled trial

BACKGROUND

High-risk newborns, such as premature or severely ill infants, often experience painful treatments and separation from their parents. While previous studies have focused on the positive impacts of a mother's voice on newborns' physiology and pain response, research on the father's voice and vocal acoustics in high-risk newborns is limited.

AIM

To examine whether parents' voices reduce heel puncture pain in high-risk newborns and the relationship between parents' vocal acoustics, physiological parameters and pain response.

STUDY DESIGN

A randomized controlled clinical trial was conducted with 105 high-risk newborn-parent dyads. Participants were randomly assigned to three groups: recorded mother's voice, recorded father's voice or control group without any recorded voice. Outcome measures included heart rate, respiratory rate, oxygen saturation and pain response assessed using the Neonatal Infant Pain Scale. Data analysis utilized generalized estimation equations, and parents' vocal acoustics were analysed using Praat voice credit software.

RESULTS

The mother's voice group exhibited significantly lower heart rates at 1, 5 and 10 min after the procedure, along with lower respiratory rates and pain levels at 5 and 10 min after the procedure compared with the control group. Similarly, the father's voice group demonstrated significantly lower heart rates at 1 and 5 min after the procedure, decreased respiratory rates at 5 and 10 min after the procedure and reduced pain levels at 1 and 5 to 10 min after the procedure compared with the control group. Higher minimum and mean pitches in parents' voices correlated with slower heart rates, while slower parental speech was associated with reduced newborn pain.

CONCLUSION

Both maternal and paternal vocal interventions alleviated pain during heel puncture procedures among high-risk newborns.

RELEVANCE TO CLINICAL PRACTICE

The noninvasive intervention serves as a reference for parental participation in care. Nurses can help parents to intervene with the acoustic characteristics that alleviate pain among high-risk newborns.

Transition in the Context of Parental Participation in Caring for Infants in Neonatal Intensive Care Units: An Evolutionary Concept Analysis

While participating in the care for a baby in a neonatal intensive care unit, parents experience a transition in which they adapt to changes and reconstruct their roles and identities. However, there is no clear explanation for this concept of transition. The purpose of this study was to clarify this concept using Rodgers' evolutionary approach. The identified attributes of the concept were a process of learning, repeated undulating emotions, balancing a caring relationship with nurses, and embracing new roles and responsibilities. The findings can provide a knowledge base for future research aimed at enhancing nurses' understanding of transition and promoting parental participation.

The Effect of Kangaroo Care on Paternal Attachment: A Randomized Controlled Study

BACKGROUND

During the first interaction between the father and the infant, touch can be very important especially father-infant skin-to-skin contact. Few studies have focused on the effect of kangaroo care (KC) on paternal attachment.

PURPOSE

This randomized controlled study was conducted to determine the effect of KC on paternal attachment.

METHODS

A total of 90 fathers of healthy newborns, including 45 in the intervention group and 45 in the control group who met the inclusion criteria, were included randomly in the study. Data were collected using the Introductory Information Form at study admission and the Father-Infant Attachment Scale (FIAS) at 3 months of age. T test, Mann-Whitney U test, and Kruskal-Wallis test were used for statistical analysis.

RESULTS

The mean FIAS scores for the intervention group (I) were higher than for the control group (C) (I: 80.57 ± 13.70; C: 56.76 ± 13.23) ( P < .05). Patience and tolerance (I: 13.70 ± 1.18; C: 11.57 ± 2.30), pleasure in interaction (I: 29.50 ± 2.86; C: 17.13 ± 5.93), and love and pride (I: 37.37 ± 2.85; C: 28.06 ± 5.82) mean scores for FIAS subdimensions in the intervention group were also higher than in the control group ( P < .05).

IMPLICATIONS FOR PRACTICE AND RESEARCH

Findings of this study demonstrate that KC has the potential to increase paternal attachment. Healthcare providers should provide discharge education for fathers on KC to increase father-infant attachment. There is a need for studies with larger samples in different cultures on the factors related to parents that affect father-infant attachment and evidence-based practices that increase attachment.

Involving families in the care of Indigenous infants: A philosophical exploration of Indigenous ways of knowing to inform nursing research and practice in the neonatal intensive care unit

AIMS AND OBJECTIVES

To explore the use of Indigenous philosophies and ways of knowing as a means to critique, understand and improve the care of Indigenous infants and families in the neonatal intensive care unit (NICU).

BACKGROUND

The ability of health professionals to provide culturally safe and equitable care to Indigenous infants and their families can affect infant development and long-term health outcomes. Research suggests that family involvement in care benefits both the infant and their family, but there is limited research that addresses the experience of Indigenous families in the NICU and advances understanding of how nurses involve Indigenous families in their infants' care.

DESIGN

A discursive, critical review will be presented to outline the assumptions of Indigenous philosophies and to explore how the consideration and implementation of Indigenous ways of knowing can improve the nursing care of Indigenous infants and their families in the NICU.

METHOD

First, our subjective positioning as Indigenous nurses and as health researchers is described. Second, our understanding of Indigenous philosophical frameworks and how these approaches fit in the context of the philosophy of science is defined. Third, the key elements of an Indigenous philosophical paradigm are described. Fourth, an application of Indigenous paradigms to supporting the care of Indigenous infants and families in the NICU context is made.

CONCLUSIONS

An Indigenous philosophical approach to nursing is ideal for understanding and improving the experiences of Indigenous infants and families in the NICU. This approach allows nurses to critically analyse the history and legacy of colonialism and its impact on the health and wellbeing of Indigenous peoples. By prioritising the voices and concerns of Indigenous families in the clinical setting and in nursing research, nurses can better understand the experiences of these families in the NICU and use strengths-based approaches to facilitate family involvement in care.

RELEVANCE TO CLINICAL PRACTICE

The application of Indigenous philosophies in the nursing context can be used to inform the care of Indigenous infants and families in the NICU. Potential benefits include improved therapeutic relationships between nurses and Indigenous families, and increased uptake of parent-led interventions in nursing practice, which may lead to improved health outcomes for Indigenous infants in the NICU and throughout their subsequent development.

Emotional Closeness Among NICU Fathers: A Qualitative Descriptive Study

BACKGROUND

The unique perspective of fathers with an infant in the neonatal unit on the development of emotional closeness toward their infant is not well understood. The purpose of this study is to explore experiences and instances of emotional closeness from the perspective of fathers as well as factors influencing emotional closeness during an infant's hospitalization in the neonatal unit.

METHODS

This qualitative descriptive study employed one-on-one interviews with fathers recruited in a level 3 neonatal unit. The interview data were analyzed with thematic analysis, and emerging themes and subthemes were organized according to dimensional analysis.

RESULTS

Eight fathers agreed to take part in this study. According to the participants, emotional closeness was a complex process composed of multiple dimensions. More specifically, emotional closeness was a difficult-to-describe, mixed, and growing feeling influenced by multiple factors such as the environment, co-parenting, and the father-infant relationship. It occurred in the contexts of presence and separation in the neonatal unit and was part of the development of the father-infant relationship.

IMPLICATIONS FOR PRACTICE

The results presented in this article are important for neonatal intensive care unit nurses who support fathers in the development of their fathering role. By knowing more about the process and dimensions of emotional closeness, nurses can direct their interventions with fathers to enhance emotional closeness and better understand their experience.

IMPLICATIONS FOR RESEARCH

No previous study has addressed emotional closeness as a complex process with multiple components like the current study. These findings contribute to our understanding of the process of emotional closeness for fathers.

Juggling Multiple Roles amidst Uncertainty: The Asian Father's Perspective of an Infant in Neonatal Intensive Care Unit

OBJECTIVE

Parents of preterm, very low birthweight (VLBW) infants in neonatal intensive care units (NICU) undergo emotional turmoil. Studies on parent's experiences typically focus on the maternal perspective. The purpose of the study is to explore the emotional needs and experiences of fathers of VLBW neonates in the NICU and to identify ways to improve their experiences.

STUDY DESIGN

This was a qualitative descriptive design study undertaken at the NICU of a tertiary university hospital. Convenience sampling with predefined inclusion and exclusion criteria was used to identify prospective participants. Semi-structured interviews were conducted with 15 fathers of infants until data saturation was reached. The COREQ (Consolidated Criteria for Reporting Qualitative Studies) checklist was used.

RESULTS

Father's experiences were classified into the topics of concerns, roles, and perspectives. Uncertainty was a predominant theme in each of these. Fathers assume multiple roles toward the child, wife, self, and family. Their concerns were multifaceted involving the child, family, work, and finances; they experienced a myriad of emotions, but these evolved into resilience eventually.

CONCLUSION

Fathers have unique concerns pertinent to having an infant in the NICU. They juggle multiple roles and transition to emotions of resilience. It is imperative to acknowledge the uncertainty and diverse roles of fathers, provide them with customized information, and develop more balanced parent-support groups.

KEY POINTS

· Fathers juggle multiple roles with a child in NICU.. · Uncertainty is a key part of their experience.. · Acknowledging their role and emotions is important..

NICU Fathers: Improving the Quality of Paternal Support in the NICU

BACKGROUND

Parental support in the neonatal intensive care unit (NICU) is critical; yet, the nursing staff may struggle to provide optimal support to NICU fathers. Generally, fathers are not viewed as equally competent caregivers when compared with mothers, and fathers often impart these beliefs on themselves. Increasing the nursing staff's knowledge and understanding of paternal support can change attitudes and foster positive behavior changes, enhancing the perception of support received by NICU fathers.

PURPOSE

To implement a needs assessment and educational intervention for the nursing staff designed to increase the perception of nursing support received by NICU fathers.

METHODS

The Nurse Parents Support Tool (NPST) was administered to the clinical nursing staff and fathers in a pre/posttest design comparing support given by nurses with the fathers' perception of received support. Data from the preintervention assessment was used to design an educational intervention on improving fathers' support. Following the intervention, a postintervention NPST was administered to fathers to determine whether there was an improvement in support perception.

FINDINGS/RESULTS

Improvement in the NICU fathers' perception of nursing staff support was noted between father groups. In addition, the NPST can be used to assess paternal support needs and develop staff education.

IMPLICATIONS FOR PRACTICE

Support provided to NICU fathers can enhance the father's perception of himself as an equal and competent caregiver, leading to improved father-infant bonding as the child ages. Educational interventions targeting father support should be a routine part of nursing staff training.

IMPLICATIONS FOR RESEARCH

Future research should examine the long-term effects of early paternal support on psychosocial, cognitive, and developmental outcomes of NICU infants.

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.

A framework synthesis reviewing the impact of neonatal care unit admission on early caregiver-infant relationships

AIMS

To critically review and synthesize qualitative research pertaining to the establishment of early caregiver-infant relationships in the neonatal care unit (NCU).

BACKGROUND

It is well-established that bonding and attachment, established across the prenatal and early childhood periods, affect child cognitive and behavioural development. Proximity, reciprocity, and commitment are key to the formation of these early relationships. It is intuitively likely that an admission to the NCU may affect early reciprocal caregiver-infant relationships.

DESIGN

A qualitative best-fit framework synthesis.

DATA SOURCES

A systematic search of four databases (PsycINFO, MEDLINE, British Nursing Index and CINAHL) was conducted, from January 2000-December 2018.

REVIEW METHODS

The RATS quality appraisal tool was used to evaluate study quality. To ensure reliability, 20% of studies were randomly selected for independent rating. A "best-fit" synthesis approach using an existing framework of early parent-infant attachment and bonding was adopted to synthesize the review findings.

FINDINGS

Twenty studies, from an original 3,526 unique articles, were included in the review. Studies varied in the extent to which they demonstrated transparency of procedures and in the quality of recruitment information provided. The meta-synthesis demonstrated that proximity, reciprocity, and commitment were affected by admission to a NCU and identified that parental reflections on bonding and the role of staff in this process, were important factors to consider.

CONCLUSIONS

Caregiver-infant relationships are affected by admission to the NCU. The review theoretically supports moves to Family Integrated Care. Units should evaluate caregiver emotional state and consider the role of peer support.

IMPACT

The synthesis revealed that areas typically implicated in the formation of attachment and bonds were affected by admission to a NCU. Results have implications on the clinical care delivered as part of neonatal care.

Parents' experiences of emotional closeness to their infants in the neonatal unit: A meta-ethnography

BACKGROUND

Physical and emotional parent-infant closeness activate important neurobiological mechanisms involved in parenting. In a neonatal care context, most research focuses on physical (parental presence, skin-to-skin contact) aspects; insights into emotional closeness can be masked by findings that overemphasise the barriers or challenges to parenting an infant during neonatal care.

AIM

To explore existing qualitative research to identify what facilitates and enables parents' experiences of emotional closeness to their infants while cared for in a neonatal unit.

STUDY DESIGN

A systematic review using meta-ethnographic methods. Search strategy involved searches on six databases, author runs, and backward and forward chaining. Reciprocal translation was used to identify and compare key concepts of parent-infant emotional closeness.

RESULTS

Searches identified 6992 hits, and 34 studies from 17 countries that involved 670 parents were included. Three overarching themes and associated sub-themes were developed. 'Embodied connections' describes how emotional closeness was facilitated by reciprocal parent-infant interactions, spending time as a family, and methods for parents to feel connected while physically separated. 'Inner knowing' concerns how knowledge about infant and maternal health and understanding the norms of neonatal care facilitated emotional closeness. 'Evolving parental role' relates to how emotional closeness was intertwined with parental identities of contributing to infant health, providing direct care, and being acknowledged as a parent.

CONCLUSION

Parent-infant closeness evolves and is facilitated by multifaceted biopsychosocial factors. Practice implications include creating private and uninterrupted family time, strategies for parents to maintain an emotional connection to their infant when separated, and neurobiology education for staff.

Comparative Evaluation of Parental Stress Experiences Up to 2 to 3 Years After Preterm and Term Birth

Parenting stress after preterm birth (PTB) has negative long-term effects on parenting. Research about parental experiences after PTB and on parenting stress in early childhood has focused on mothers.

Do early parental postnatal depression, attachment style and perceived social support affect neurodevelopmental outcomes of premature infants?

BACKGROUND

The birth of a premature infant is both a stressful event for both parents and associated with an increased rate of postnatal depression (PND). Additionally some mothers may have delayed feelings of attachment to their babies because of the medical procedures or possible medical complications. Social support is known as an important factor for well-being in the postnatal period. However there is scarce data about these factors for fathers. We aimed to identify the impact of parental PND, attachment style and social support on premature infant development considering the prematurity degree and risk groups.

METHODS

This prospective study was conducted by including 96 infants who were born preterm. Mothers and fathers were given Edinburgh Postnatal Depression Scale (EPDS), Adult Attachment Style Scale (AASS), and Multidimensional Scale of Perceived Social Support (MSPSS) to fill out when their infants' corrected age was 3 months. The developmental evaluation was conducted with Bayley III at the corrected 6 months and 18 months of age.

RESULTS

Postnatal depression scores were more in mothers than fathers, the rates of secure attachment and social support were similar between mothers and fathers. Factors associated with the neurodevelopmental outcomes including prematurity degree and risk groups, EPDS, AASS and MSPSS scores were analyzed for both parents. In multivariate analysis, fathers' depression scores were inversely associated with cognitive development (p = 0.030, R² = 0.080, B=-0.283) and mothers' anxious/ambivalent attachment style was inversely associated with language development (p = 0.011, R² = 0.108, B=-0.329) at the age of corrected 6 months old.

CONCLUSIONS

Our findings underscore that the efforts to improve developmental outcomes of premature infants should include parental well-being taking into account new fathers' depressive symptomatology and maternal anxious/ambivalent attachment.

Finding My Way: A Phenomenology of Fathering in the NICU

BACKGROUND

Historically, the relationship between infant and mother in the neonatal intensive care unit (NICU) has been the main focus of parenting research, leaving a gap in the literature regarding the paternal experience.

PURPOSE

The purpose of this study was to gain an understanding of the lived experience of fathering an infant born at less than 28 weeks' gestation admitted to a level III NICU.

METHODS

Seven fathers of premature infants (25-27 weeks' gestation) participated in a semistructured interview about the experience of becoming a father to a premature infant at least 1 to 2 weeks after the NICU admission. Data were collected in 2015.

FINDINGS

The primary themes identified were looking in, persevering, holding, and finding my way. Fathers in this study described feeling like an outsider in the NICU while learning to trust strangers, protect the mother and the child, and continue to work and provide for the family. Holding for the first time is pivotal in this journey, as the moment of solidifying the connection with the child.

IMPLICATIONS FOR PRACTICE

The findings from this study bring awareness of the experiences of fathers during the NICU journey of having a premature infant. Nurses should encourage paternal participation and involvement, visitation, and facilitate kangaroo care opportunities early and often.

IMPLICATIONS FOR RESEARCH

The findings from this study allow nurses to better understand the paternal experience of having a premature infant born at less than 28 weeks. However, future research should continue to investigate the paternal experience with other gestational ages as well as the influence of stress of fathers during this experience.

Bonding in neonatal intensive care units: Experiences of extremely preterm infants' mothers

BACKGROUND

The birth of an extremely preterm infant can disrupt normal mother-infant physical contact and the care provided by the mother. This situation has an impact on the process of bonding between the mother and the child.

AIM

The objective of this study was to describe and understand the experiences of mothers who have extremely preterm infants admitted in Neonatal Intensive Care Units with regard to their bonding process.

METHODS

An interpretive, qualitative research methodology using Gadamer's philosophical hermeneutics was carried out. A focus group and eleven in-depth, semi-structured interviews were conducted. Data were collected between June and September of 2016.

FINDINGS

Sixteen women with a mean age of 34.4 years participated in the study. Two themes emerged from the data analysis: (1) premature labour and technological environment, a distorted motherhood, with the subthemes 'feeling of emptiness and emotional crisis' and 'the complexity of the environment and care generate an emotional swing'; (2) learning to be the mother of an extremely preterm infant, with the subthemes "the difficulty of relating to a stranger" and 'forming the bond in spite of difficulties'.

CONCLUSIONS

The bonding with extremely preterm infants is interrupted after giving birth. The maternal emotional state and the environment of the neonatal intensive care unit limit its development. Nursing care can facilitate mother-infant bonding by encouraging communication, participation in care, massaging or breastfeeding.

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.