The role of peer support in the development of maternal identity for "NICU Moms"

Understanding the experience of the mothers' ability to take care of their preterm infants related to in-hospital and post-discharge: a qualitative content analysis

BACKGROUND

Preterm infants may experience many health and developmental issues, which continue even after discharge from the neonatal intensive care unit. Once home, the mother, as a non-professional and the primary caregiver will be responsible for the essential care of her preterm infant.

PURPOSE

Understanding the take care ability in mothers with preterm infants.

METHODS

The content analysis method was used. The data were collected using in-depth and semi-structured interviews from April 2021 to February 2022. Eleven mothers, two fathers, two grandmothers, one neonatal nurse, and two neonatologists with a mean age of 36.05 ± 10.88 years were selected using purposeful and snowballing sampling in Tehran, Iran. Allocating adequate time for data collection, gathering data through different methods, peer checking by two qualitative researchers, long interaction with the settings, maximum variation sampling, appropriate quotations, and showing the range of facts fairly and honestly were considered to ensure the trustworthiness of this study. The data were analyzed through Lindgren et al.'s approach using MAXQDA software.

RESULTS

Based on the findings and participants' experiences in 18 deep interviews, the mothers with desirable care ability have adequate ability as described by 17 subcategories and are categorized into five dimensions. The care ability of the mothers of preterm infants upon neonatal intensive care unit discharge consisted of five categories including maternal identity, infant's needs, cognitive ability, technical ability, and psychological ability.

IMPLICATIONS FOR PRACTICE AND RESEARCH

In the mothers of preterm infants, maternal identity and the infant's needs are antecedents of the care ability concept. The care ability of the mothers with preterm infants is distinct from those of other caregivers. This is a multi-dimensional concept and trait related to maternal cognitive ability, technical ability, and maternal psychological ability. Professional neonatal nurses should assess their care ability from multiple perspectives: cognitive, technical, and psychological abilities. They should be considered in designing empowerment and engagement programs for the improvement of the care ability of the mothers of preterm infants. Both mothers and professional neonatal nurses should take responsibility for improving the mothers' ability to take care of their preterm infants.

Development and psychometric evaluation of "Caring Ability of Mother with Preterm Infant Scale" (CAMPIS): a sequential exploratory mixed-method study

BACKGROUND

Caring ability is one of the most important indicators regarding care outcomes. A valid and reliable scale for the evaluation of caring ability in mothers with preterm infants is lacking.

OBJECTIVE

The present study was conducted with the aim of designing and psychometric evaluation of the tool for assessing caring ability in mothers with preterm infants.

METHOD

A mixed-method exploratory design was conducted from 2021 to 2023. First the concept of caring ability of mothers with preterm infants was clarified using literature review and comparative content analysis, and a pool of items was created. Then, in the quantitative study, the psychometric properties of the scale were evaluated using validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 401 mothers with the mean age of 31.67 ± 6.14 years to assess the construct validity.

RESULT

Initial caring ability of mother with preterm infant scale (CAMPIS) was developed with 64 items by findings of the literature review, comparative content analysis, and other related questionnaire items, on a 5-point Likert scale to be psychometrically evaluated. Face, content, and construct validity, as well as reliability, were measured to evaluate the psychometric properties of CAMPIS. So, the initial survey yielded 201 valid responses. The three components: 'cognitive ability'; knowledge and skills abilities'; and 'psychological ability'; explained 47.44% of the total observed variance for CAMPIS with 21 items. A subsequent survey garnered 200 valid responses. The confirmatory factor analysis results indicated: χ2/df = 1.972, comparative fit index (CFI) = 0.933, and incremental fit index (IFI) = 0.933. These results demonstrate good structural, convergent, discriminant validity and reliability. OMEGA, average inter-item correlation (AIC), intraclass correlation coefficients (ICC) for the entire scale were at 0.900, 0.27 and 0.91 respectively.

CONCLUSION

Based on the results of the psychometric evaluation of CAMPIS, it was found that the concept of caring ability in the Iranian mothers with preterm infants is a multi-dimensional concept, which mainly focuses on cognitive ability, technical ability, and psychological ability. The designed scale has acceptable validity and reliability characteristics that can be used in future studies to assess this concept in the mothers of preterm infants.

'We are suffering. Nothing is changing.' Black mother's experiences, communication, and support in the neonatal intensive care unit in the United States: A Qualitative Study

OBJECTIVES

Black mothers experience markedly disproportionate maternal morbidity and mortality in the United States, with racism often cited as the root cause manifesting through several pathways. The study examined Black mothers' perceived provider communication, support needs, and overall experiences in the neonatal intensive care unit (NICU).

DESIGN

This study used grounded theory embedded in the Black feminist theoretical (BFT) framework to generate new ideas grounded in the data. Data was collected through semi-structured interviews using videoconferencing, with questions related to the mother's overall NICU experiences, communication within the NICU, and perceived support needs. Data were analyzed using thematic analysis.

RESULTS

Twelve mothers participated in the study; most were married (n = 10), had a cesarean birth, had a previous pregnancy complication (e.g., diabetes, hypertension), had attained a graduate degree or more (n = 9), earned an annual household income of $75,000 or more, and were between 35-44 years of age (n = 7). Three broad domains with several accompanying themes and sub-themes were identified, explicating the mother's experiences in the NICU. Specifically, factors influencing NICU hospitalization for mothers included maternal care/nursing experiences, interactions in the NICU, and the perceived support need that might attenuate negative care and birthing experiences. .

CONCLUSION

The study adds to the growing literature championing Black maternal health equity and multilevel quality improvement strategies to foster equitable maternal health. Our study reinforces the need for racially congruent interventions and policy reformations to protect Black birthing people regardless of socioeconomic factors and social class using life course, holistic approaches, and intersectionality mindset. Importantly, using the BFT, this study calls for culturally sensitive research to capture the nuances associated with the multiplicity of experiences of Black people.

Effect of a Multifaceted Approach on Perceived Support Among Mothers of Preterm Infants: A Quasi-Experimental Study

Introduction

Mothers of preterm infants need support to deal with the issues caused by the early birth of their infants.

Objective

The authors examined the impact of a multifaceted supportive approach on the mothers' perceived support levels.

Methods

The present quasi-experimental study was performed on 143 mother-preterm infant pairs, in two neonatal intensive care units (NICUs) of referral and educational hospitals in Tehran, Iran. The base of developed interventions was known to support system patterns of mothers with preterm infants. Different supportive interventions (appraisal, instrumental, emotional, and informational) of mothers were implemented during three months. The Nurse Parent Support Tool was applied for assessing perceptions of perceived support by mothers. Routine care was provided for the control group. The results were analyzed by STATA software 13. Categorical variables were analyzed by chi-square test, t-test, and inverse probability treatment weights.

Results

Following adjustments of mean differences of outcomes between study groups (95% confidence interval), all support scores, such as instrumental support, -1.23 (95% CI -1.04 to -1.43), total support, -1.83 (95% CI -1.6 to -2.06), appraisal support, -2.01 (95% CI -1.73 to -2.29), emotional support, -1.87 (95% CI -2.15 to 1.6), and informational support, -2.12 (95% CI -1.82 to -2.43), were significantly higher in the interventional group than in the control group (p < .001).

Conclusions

Support received by mothers of preterm infants determines maternal/neonatal health. Information sharing and effective ways to support are essential elements in the mother's ability to deal with the new, stressful situation. This multifaceted supportive approach considerably improved mothers' perceived support.

A Mobile App to Promote Breastfeeding Self-Efficacy in Preterm Infants' Mothers: Development and Validation

Improving breastfeeding rates is a global goal. To achieve it, actions targeting modifiable factors that influence the breastfeeding experience, such as maternal self-efficacy, could be a promising path, especially with preterm infants' mothers. Considering the current ubiquitous technology, we developed a mobile application for mothers of preterm infants to constitute a breastfeeding information and support platform. The study was developed in three phases: a survey to determine characteristics and preferences of preterm infants' mothers; the app development by an interdisciplinary team, following the principles of Disciplined Agile Delivery; and the face and content validation by 10 professionals. The app contains 80 screens and 11 strategies to address prematurity, lactation, breastfeeding, peer support, maternal emotions, resilience, and motivation. Nurses can apply their expertise by designing mHealth-based interventions, employing scientific evidence, and considering the interests and preferences of the target population. Future studies will assess the user experience, the effect on breastfeeding self-efficacy, and breastfeeding rates, and develop a culturally adapted English version of the app for women in Canada.

Supporting Disclosure of Unmet Mental Health Needs among Parents of Critically Ill Infants

OBJECTIVE

To characterize (1) the prevalence of mental health discussion and (2) facilitators of and barriers to parent disclosure of mental health needs to clinicians.

STUDY DESIGN

Parents of infants with neurologic conditions in neonatal and pediatric intensive care units participated in a longitudinal decision-making study from 2018 through 2020. Parents completed semi-structured interviews upon enrollment, within 1 week after a conference with providers, at discharge, and 6 months post-discharge. We used a conventional content analysis approach and NVIVO 12 to analyze data related to mental health.

RESULTS

We enrolled 61 parents (n = 40 mothers, n = 21 fathers) of 40 infants with neurologic conditions in the intensive care unit. In total, 123 interviews were conducted with 52 of these parents (n = 37 mothers, n = 15 fathers). Over two-thirds of parents (n = 35/52, 67%) discussed their mental health in a total of 61 interviews. We identified two key domains when approaching the data through the lens of mental health: (1) self-reported barriers to communicating mental health needs: parents shared uncertainty about the presence or benefit of support, a perceived lack of mental health resources and emotional support, and concerns about trust; (2) self-reported facilitators and benefits of communicating mental health needs: parents described the value of supportive team members, connecting to peer support, and speaking to a mental health professional or neutral third party.

CONCLUSIONS

Parents of critically ill infants are at high risk of unmet mental health needs. Our results highlight modifiable barriers and actionable facilitators to inform interventions to improve mental health support for parents of critically ill infants.

Understanding the Domains of Experiences of Black Mothers with Preterm Infants in the United States: A Systematic Literature Review

OBJECTIVE

To report the domains of Black mothers' experiences with preterm infants in the neonatal intensive care unit (NICU) and to determine the frameworks used.

METHODS

A systematic review of the literature using the PRISMA guideline was performed. An electronic database search of published literature between 2000 and 2022 was conducted based on predetermined search terms and parameters.

RESULTS

Twenty-seven articles met the inclusion and exclusion criteria. Eleven articles focused on feeding practices, ten reported on nursing/maternal care experiences, five reported mental health/social support, and only one focused on mother-infant relationships. Only five papers reported using any frameworks, comprising grounded theory framework (n = 2), theory of planned behavior (n = 1), research justice framework (n = 1), and the patient and public engagement protocol (n = 1).

DISCUSSION

A holistic approach to understanding the multifactorial experiences of Black mothers with preterm infants needs to be socio-culturally competent to ensure their diverse intersections and identities are accurately represented and understood. Rigorous research at the intersection of Black maternal health and the NICU hold promises for advancing maternal health equity in the United States.

Improving the Implementation of Family-Centered Care Within the Neonatal Care Unit: Empowering Parents to Participate in Infant Care

BACKGROUND

Internationally, approximately 15 million babies are born prematurely every year. In New Zealand, 1 neonatal ward may care for 1000 infants annually. Family-centered care (FCC) is a philosophy used in neonates to enhance positive outcomes for infants, parents, and staff by recognizing the strengths and needs of infants and their families.

OBJECTIVE

This research assessed how a neonatal environment could be improved to ensure parents feel welcomed and empowered to participate in their infant's care.

PARTICIPANTS

Survey data from 67 health professionals and 51 parents of infants who received neonatal care for more than 7 days. Four in-depth interviews with parents and 5 with health professionals.

METHODS

A mixed-methods research design was used. Phase 1 collected quantitative data using the Family-Centered Care Questionnaire. Phase 2 composed of face-to-face interviews with health professionals and parents.

RESULTS

Implementing FCC practices to improve health outcomes for infants, parents, and staff is important. Recommendations for improvement were formulated from the themes.

CONCLUSION

The perspectives of parents and health professionals have enabled the development of recommendations to improve the implementation of FCC practice in the neonatal environment. These may lead to better parental experience and improved infant health outcomes.

Parent-infant interaction in the NICU: Challenges in measurement

BACKGROUND

Parent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues.

AIM

To improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues.

METHOD

Twenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34-48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS.

RESULTS

Seventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01).

CONCLUSION

It remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.

Maternal Distress in Disclosing a Nonlethal Fetal Anomaly Diagnosis to Family and Friends

PURPOSE

To describe experiences of women disclosing a nonlethal fetal anomaly diagnosis to family and friends from initial prenatal diagnosis through postpartum.

STUDY DESIGN AND METHODS

A descriptive, qualitative approach was used to explore women's perceptions of nonlethal fetal anomaly diagnosis in a high-risk obstetric clinic. In-depth interviews were conducted with 10 pregnant women, followed by postpartum interviews with 8 women. Data were analyzed using thematic analysis.

RESULTS

Analysis of semistructured interviews revealed an overarching theme, Pregnancy Forever Changed, which captured the experience when expectant women first heard the news about their fetus. Prenatal themes were News of a Diagnosis, No Going Back; A Mother's Response: Managing Information; and Words from Others Matter. Women's struggles continued into postpartum, The Journey Continues: Echoing Past Concerns; and Not the Journey We Planned.

CLINICAL IMPLICATIONS

Women with a nonlethal fetal anomaly diagnosis experienced distress and stigma about disclosure of the diagnosis to others. Distress with disclosure continued throughout the pregnancy and extended into postpartum. Women described negative responses from others and ongoing management of information as stressful and painful. Clinicians are aware disclosing a lethal diagnosis is distressing for women but may not understand the experience of women with a nonlethal diagnosis. An appreciation of women's distress on disclosure of nonlethal fetal anomaly diagnoses can guide practice for maternity, neonatal, and pediatric nurses providing interventions that include information and anticipatory guidance.

Psychiatric Symptoms, Posttraumatic Growth, and Life Satisfaction Among Parents of Seriously Ill Infants: A Prospective Case-Controlled Study

We evaluated psychiatric symptoms, posttraumatic growth, and life satisfaction among the parents (n = 34) of newborns (n = 17) requiring therapeutic hypothermia or urgent surgery (interest group). Our control group included 60 parents of healthy newborns (n = 30). The first surveys were completed soon after diagnosis or delivery and the follow-up surveys 1 year later (participation rate 88% in the interest group and 70% in the control group). General stress was common in both groups but was more prevalent in the interest group as were depressive symptoms, too. Anxiety was more common in the interest group, although it showed a decrease from the baseline in both groups. Life satisfaction had an inverse correlation with all measures of psychiatric symptoms, and it was lower in the interest group in the early stage, but similar at 12 months due to the slight decline in the control group. Mothers in the interest group had more anxiety and depressive symptoms than fathers in the early stage. Mothers had more traumatic distress than fathers at both time points. Half of the parents experienced substantial posttraumatic growth at 12 months. In conclusion, the serious illness of an infant substantially affects the well-being of the parents in the early stages of illness and one year after the illness.

Exploring Adjustment and Parent-Infant Relations in Mothers of Premature Infants: Thematic Analysis Using a Multisensory Approach

Objective

The aim of the study was to explore mothers’ experiences of having an infant born prematurely (28–32 weeks gestation). In particular, the study aimed to explore the developing parent–infant relationship 12–30 months since birth and the developing parental identity during hospitalization and discharge.

Methods

Twelve mothers, aged between 22 and 43, participated in the semi-structured interviews. The mean age of infants was 19 months. Interviews comprised open-ended questions and visual stimuli consisting of photographs brought by participants, word selection, and card sorting techniques. Data were analyzed using Braun and Clarke’s thematic analysis (Braun & Clarke, 2013).

Results

Three themes arose from a clustering of 10 subthemes: (a) Emotional Impact, (b) Searching for Parent Identity, and (c) Moving Beyond Adversity. Participants expressed experiencing heightened emotional distress during the time of their infants’ birth and hospitalization and initially not feeling like parents. Their parental identity strengthened as they became more involved in the care of their infant and began to accept the situation. Participants described parenting their premature infants differently compared with parents of full-term infants, and described adjusting to this difference over time.

Conclusions

The findings highlight the emotional experience and adjustment of mothers of premature infants, from hospital and postdischarge. The need for psycho-educational interventions postdischarge and parent-partnered models during hospitalization is discussed. In addition, the study demonstrates the use of integrating visual stimuli in qualitative data collection procedures, to elicit further meaning and interaction from participants with the interview process.

Needs and Perceptions Relative to Emotional Support in Parents With Preterm Infants

Objectives of this study were to explore parents' needs for emotional support and how such support could be best delivered during admittance to a neonatal unit. This study took place at 6 neonatal units in Sweden. Forty-two semistructured interviews were analyzed using qualitative content analysis: 26 individual telephone interviews with mothers of preterm infants 6 to 10 months after discharge and 16 face-to-face interviews with parents of preterm infants admitted to neonatal units. The main category to emerge was needs and preferences for emotional support , which consisted of 2 generic categories: emotional needs and preferences for potential support interventions . Emotional needs define the importance of comprehending the new situation, finding meaning, and managing the situation through resources. Preferences for potential support interventions identify possible ways to deliver emotional support in the form of parental group, diary writing, professional counseling, and Internet support. The results highlight the importance of supporting parents' sense of coherence in their situation and parenthood by offering different interventions according to parent preferences. Parental groups could serve as a keystone for emotional support with the possibility to combine with other support mechanisms.

The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents' Experience

Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.

Self-reinforcement: Coping strategies of Iranian mothers with preterm neonate during maternal role attainment in NICU; A qualitative study

INTRODUCTION

Having a preterm neonate in the neonatal intensive care unit (NICU) is one of the most stressful experience for parents. In facing these stressors, mothers need to find ways to adapt and control resources to maintain stability. The aim of this paper is to report coping strategies of mothers with preterm neonate during maternal role attainment in NICU.

METHODS

This paper reports a part of the findings of a grounded theory study that investigated how the mothers of preterm neonates go through maternal role attainment. The data were collected through in-depth semi-structured interviews with 12 mothers with preterm neonate admitted to the NICU and 5 nurses working in NICU. Data were analyzed according to Corbin and Strauss's (2015) approach using constant comparative analysis technique.

FINDINGS

Four themes, emerged from experiences of the participants, formed the concept of "Self-reinforcement" as the prominent strategy of mothers: "support seeking", "Spiritual getting in the mood", "Hope creation" and "Getting energy from the baby".

CONCLUSION

These findings showed that mothers use strategies to calm and support themselves and their neonates, and recognize that their lives had changed and need to adjust to their new circumstances.

An integrative review of maternal distress during neonatal intensive care hospitalization

To synthesize literature addressing maternal distress and associated variables in response to infant hospitalization in the NICU. CINAHL, Medline, PubMed, PsychINFO, and Scopus were searched for studies addressing maternal distress during NICU hospitalization published between January 2009 and August 2019. The initial literature search yielded 862 articles. Articles were included for analysis if (a) they were peer-reviewed, (b) maternal distress was defined or measured, and (c) maternal distress occurred in the NICU. Ultimately, 33 articles were included for analysis. Distress symptoms were not consistently measured across the literature by one specific instrument. However, despite the variety of instruments, distress was prevalent in this population. Individual elements of maternal distress in the NICU include depression, anxiety, trauma, and post-traumatic stress symptoms. These elements often occur together and tend to follow a specific trajectory during hospitalization. This body of literature was inconsistent regarding the timing of distress measurement as well as the relationship between relevant associated variables (e.g., marital status or infant illness severity) and maternal distress. Additionally, researchers often excluded mothers of non-preterm infants and infants with congenital anomalies from investigation. Researchers and clinicians should carefully consider timing and instrumentation in their interpretations of maternal distress measurement during a NICU hospitalization. Future work should focus on developing a comprehensive, valid, and reliable screening tool for clinicians and researchers to use to identify maternal distress in the NICU. Additionally, future research should address gaps in the populations included in studies.

Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units

Very low birth weight (VLBW; <1500 g birth weight) infants are substantially more likely to be born to black than to non-black mothers, predisposing them to potentially preventable morbidities that increase the risk for costly lifelong health problems. Mothers' own milk (MOM) may be considered the ultimate "personalized medicine" since milk composition and bioactive components vary among mothers and multiple milk constituents provide specific protection based on shared exposures between mother and infant. MOM feedings reduce the risks and associated costs of prematurity-associated morbidities, with the greatest reduction afforded by MOM through to NICU discharge. Although black and non-black mothers have similar lactation goals and initiation rates, black VLBW infants are half as likely to receive MOM at NICU discharge in the United States. Black mothers are significantly more likely to be low-income, single heads of household and have more children in the home, increasing the burden of MOM provision. Although rarely considered, the out-of-pocket and opportunity costs associated with providing MOM for VLBW infants are especially onerous for black mothers. When MOM is not available, the NICU assumes the costs of inferior substitutes for MOM, contributing further to disparate outcomes. Novel strategies to mitigate these disparities are urgently needed. IMPACT: Mother's own milk exemplifies personalized medicine through its unique biologic activity. Hospital factors and social determinants of health are associated with mother's own milk feedings for very low-birth-weight infants in the neonatal intensive care unit. Notably, out-of-pocket and opportunity costs associated with providing mother's own milk are borne by mothers. Conceptualizing mother's own milk feedings as an integral part of NICU care requires consideration of who bears the costs of MOM provision-the mother or the NICU?

Mothers' Perceptions of Quality of Family-Centered Care and Environmental Stressors in Neonatal Intensive Care Units: Predictors of and Relationships with Psycho-emotional Outcomes and Postpartum Attachment

OBJECTIVES

Maternal attachment to promote role development in mothers of preterm infants is critical for babies' optimal growth and development. However, few models specify how neonatal intensive care units (NICUs) and their environments work to foster postpartum attachment (PPA) after preterm birth. We investigated relationships of quality of family-centered care and NICU environmental stressors with maternal PPA, to determine whether these are mediated by mothers' psycho-emotional response and whether pathways to PPA are moderated by developmental immaturity (gestation, birthweight).

METHODS

A cross-sectional study using structural equation modeling was conducted on 294 mothers of premature infants with experience in NICUs in over 49 tertiary hospitals in 12 cities or provinces of South Korea. Data were collected using Korean versions of instruments including the Quality of Family-centered Care, Parental Stressor Scale: NICU, and Maternal Postpartum Attachment Scale.

RESULTS

Maternal self-representation was a key predictor of PPA (β = .68), accounting for 42.2% of variance. Multi-group analysis indicated that NICU environmental stressor sensitivity (β = .26) and maternal self-representation (β = .67) were predictive of PPA in mothers of moderately preterm and low birthweight (32-36 weeks' gestation, 1500-2499 g birthweight) infants. Quality of family-centered developmental care (β = .11) and NICU environmental stressor sensitivity (β = - .16) had significant indirect effects on PPA through psycho-emotional responses.

CONCLUSIONS FOR PRACTICE

Healthcare professionals should be aware of the importance of family-centered interventions focusing on psychosocial support and family participation in baby care, based on their environmental role in promoting PPA.

Strategies to increase the use of mother's own milk for infants at risk of necrotizing enterocolitis

High-dose mother's own milk (MOM) feedings during the first 14 days post birth reduce the risk of necrotizing enterocolitis in very low birthweight (VLBW; <1500 g birthweight). However, high-dose MOM feedings are only possible if mothers provide sufficient quantities of MOM in a timely manner, and data indicate that the lack of MOM during the early post-birth period is a global problem. This paper reviews the modifiable and unmodifiable barriers to accessing adequate quantities of MOM during the early post-birth period and proposes evidence-based strategies to increase and improve the use of MOM during the neonatal intensive care unit (NICU) hospitalization with an emphasis on the critical first 2 weeks post birth.

Maternal Role Attainment in Mothers with Term Neonate: A Hybrid Concept Analysis

Background

A review of the literature shows that there is little consensus on the practical definition of maternal role attainment in the field of neonatal nursing care. The initial interaction between mother and neonate most often begins in the hospital and can be influenced by neonatal nurses, so it is necessary to clarify this concept in nursing. The purpose of this study was to show the basic characteristics and practical definition of maternal role attainment in mothers with term neonate in a new context.

Materials and Methods

This study used a hybrid model three-step concept analysis: theoretical, fieldwork, and final analysis phases. At theoretical phase, articles indexed in credential databases were searched using keywords. Totally, 33 articles were analyzed. At fieldwork phase, 12 participants were interviewed. At final phase, the findings of the two earlier phases were analyzed. The study lasted from August to November 2018. After determining the attributes, antecedents, and consequences, a final definition of maternal role attainment was introduced.

Results

The concept of maternal role attainment was defined as "a developmentally, interactive, adaptive, and committed multi-dimensional process based on the discovery of pregnancy, characteristics of the mother, receiving social support, which leads to maternal identity, formation of maternal skills, resiliency, development of newborn, improvement of mother-newborn interactions and increased well-being of the mother".

Conclusions

This study identifies the concept of maternal role attainment in nursing, providng a good basis for evaluating and applying this concept.

A pilot study demonstrating the impact of the supporting and enhancing NICU sensory experiences (SENSE) program on the mother and infant

AIM

To explore differences in maternal mental health and infant neurobehavioral outcome among infants who received and did not receive the Supporting and Enhancing NICU Sensory Experiences (SENSE) program.

STUDY DESIGN

Eighty preterm infants (50 receiving standard-of-care and 30 receiving the SENSE program) born ≤32 weeks gestation were enrolled within the first week of life in a prospective quasi-experimental design, using a historical control group for comparison. Standard-of-care consisted of tactile (skin-to-skin, touch, holding) and olfactory (scent cloth, close maternal contact) interventions as determined to be appropriate by health care professionals and parents. The SENSE group received specific doses of tactile (skin-to-skin care, holding, massage, touch), auditory (human speech, music), olfactory (scent cloth, close maternal contact), kinesthetic/vestibular (movement, rocking/transfers), and visual (dim or cycled light) exposures, based on the infant's postmenstrual age and tailored to medical status and infant cues according to the SENSE program. The SENSE program includes the intentional delivery of positive, age-appropriate sensory exposures by parents (or a sensory support team, when parents are unavailable) each day of NICU hospitalization. Infant neurobehavioral outcome, as well as maternal mental health and confidence, were assessed prior to NICU discharge, using standardized measures.

RESULTS

Seventy-three infants were included in the final analysis. Mothers whose infants received the SENSE program demonstrated higher scores on the Maternal Confidence Questionnaire (p = 0.01). Infants who received the SENSE program demonstrated less asymmetry on the NICU Network Neurobehavioral Scale (p = 0.02; mean difference 0.9) and higher scores on the Hammersmith Neonatal Neurological Evaluation (p < 0.001; mean difference 4.8).

DISCUSSION

Preliminary evidence demonstrates improvements in maternal confidence and infant neurobehavioral performance following SENSE implementation.

Emotional Work of Neonatal Nurses in a Single-Family Room NICU

OBJECTIVE

To describe the emotional work of neonatal nurses in a single-family room NICU.

DESIGN

Qualitative interpretive description.

SETTING

A single-family room NICU in the mid-Atlantic region of the United States.

PARTICIPANTS

Fifteen nurses who worked in the single-family room NICU.

METHODS

Data were collected from 110 hours of direct observation and 11 interviews over a 6-month period. We focused on emotional demands using triangulation between interviews and observations to identify themes. Conceptualization of emotional work informed interpretation.

RESULTS

Four themes emerged: Parents Living on the Unit, Isolation of Infants in Rooms, Nurses' Ability to Form Bonds and Establish Trust With Parents, and Sheltering Nurses and Parents From Stressful Events on the Unit. Parents living on the unit and the isolation of infants in private rooms increased the emotional work of nurses. Forming trust and bonds with parents and sheltering parents and themselves from stressful events on the unit decreased nurses' emotional work.

CONCLUSION

Care should be taken in NICU design because unit layout can affect the emotional work of nurses. Understanding how neonatal nursing practice is affected by unit layout can help nurses and those who design NICUs to create and promote optimal practice environments.

[Factors Influencing Post-traumatic Growth in Mothers with Premature Infants Admitted to the Neonatal Intensive Care Unit]

PURPOSE

Caring for a vulnerable premature baby is a challenging task, but some mothers experience growth through that process. The purpose of this study was to investigate the factors influencing post-traumatic growth in mothers with premature infants admitted to the neonatal intensive care unit.

METHODS

A correlational research design was used and 105 mothers of premature infants were recruited from an online community. Data were collected from January 15 to January 25, 2019. Post-traumatic growth was measured using the Korean version of the Posttraumatic Growth Inventory. Data were analyzed using descriptive statistics, the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical multiple regression.

RESULTS

The final model developed in this study explained 45.5% of post-traumatic growth (F=13.66, p<.001). Resilience (β=.54, p<.001) was the strongest predictor of post-traumatic growth, followed by the age of the mother when giving birth (β=.17, p=.028) and current employment status (β=.17, p=.049).

CONCLUSION

For mother with premature infants to grow psychologically after their experience, it may be needed to support them to develop and strengthen their resilience through either education or their own support network.

Transitioning Into the Role of Mother Following the Birth of a Very Low-Birth-Weight Infant: A Grounded Theory Pilot Study

This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of "reconstructing normal" emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development, maternal caregiving and role-reclaiming strategies, and infant developmental milestones. Findings from this study suggest that women found the transition into motherhood following the birth of a VLBW infant as a multidimensional and dynamic process. Further research is warranted to confirm these results and to further explore mothering issues with VLBW infants.

Facilities for presence and provision of support to parents and significant others in neonatal units

AIM

To describe parental facilities for staying in neonatal units, visiting policies and access to emotional support during hospitalisation.

METHODS

A cross-sectional design was used in which a survey was presented to all neonatal units in Sweden; 34 out of 38 units participated (89%).

RESULTS

The findings showed that in 50% of the units, parents could stay 24/7 for the infant's entire hospital stay. In 32% of the units, siblings could stay the night with their parents. Units had policies on restrictions for visits by siblings (80%), grandparents (59%), friends and relatives (71%). All units offered counselling to parents, and some units offered peer-to-peer groups (24%), diaries (35%), relaxation techniques (6%) or Internet parental forums (6%). All units enabled parents to be at home with their infant and to visit the unit for check-ups (35%) or to have staff visits at home (65%).

CONCLUSION

Facilities for parents to stay with their infant during hospitalisation and to have significant others visit are good, but there is room for improvement. During the transitional phase to being at home, parents are facilitated in being at home before the infant is discharged and are supported by the unit, which must be considered beneficial for parents.

Development and Evaluation of a Blood Glucose Monitoring YouTube Video for Marshallese Patients Using a Community-Based Participatory Research Approach

The purpose of this study was to (a) describe the development of a culturally appropriate glucose monitoring video using a community-based participatory research approach and (b) assess the cultural appropriateness and effectiveness of the video. The topic of the video-using a glucometer and the importance of performing blood glucose checks-was chosen by Marshallese community stakeholders. The video was produced in Marshallese with English subtitles and disseminated through YouTube. Participants were recruited from August 16, 2016 to September 12, 2016 in a diabetes clinic that serves Marshallese patients in northwest Arkansas. Fifty participants completed a survey at pre- and postintervention, with questions capturing demographic information and questions on glucose monitoring self-efficacy using an adapted version of the Stanford Patient Education Research Center's Diabetes Self-Efficacy Scale. Twenty of those participants who completed the survey also completed semistructured interviews that assessed cultural appropriateness and effectiveness of the video. Participants reported significant increases in self-efficacy related to glucometer use and the importance of performing blood glucose checks (p < .001) and a 1.45% reduction in A1C between preintervention and 12 weeks postintervention (p = .006). Qualitative results indicated the video was both culturally appropriate and effective. The findings of this study were consistent with evidence in the literature, which shows health education videos can be effective at improving health behaviors. Using a community-based participatory research approach to prioritize video topics, and including members of the community in the creation and dissemination of the videos, could aid in ensuring the videos are effective and culturally appropriate.

Barriers to Providing Mother's Own Milk to Extremely Preterm Infants in the NICU

BACKGROUND

Mothers' own milk (MOM) has more than nutritional benefits for extremely preterm infants (<28 weeks). However, mothers encounter barriers that make it difficult to provide their own milk to their extremely preterm infants.

PURPOSE

The aim of this study was to describe and understand the experiences of mothers of extremely preterm infants regarding barriers to providing their own milk during infant hospital stay in the neonatal intensive care unit (NICU).

METHODS

This study followed a qualitative, interpretative design using Gadamer's hermeneutic approach and included 15 in-depth semistructured interviews. The data were analyzed using a modified form of the steps described by Fleming.

RESULTS

Fifteen mothers of extremely preterm infants participated in the study. The following themes were extracted from the data analysis: (1) "unexpected and unusual lactation," including the subthemes "the extremely preterm birth and the decision to provide MOM," "the battle to produce milk," and "my job was to make milk"; and (2) "providing MOM to a tiny infant in an unknown technological environment," with the subthemes "the limitations of providing MOM in the NICU" and "the difficulties of having an extremely preterm infant."

IMPLICATIONS FOR PRACTICE

To provide MOM to an extremely preterm infant, there is a need for informational and practical counseling by neonatal nurses educated in breastfeeding according to mothers' requirements and emotional needs.

IMPLICATIONS FOR RESEARCH

Future research may analyze the parents' and neonatal nurses' experience about facilitators to improve MOM provision and the influence of women's sociodemographic characteristics in providing MOM to the extremely preterm infants.

Maternal Distress in the Neonatal Intensive Care Unit: A Concept Analysis

BACKGROUND

The neonatal intensive care unit (NICU) can cause significant psychological distress in a mother. There is no common definition of maternal distress in the NICU currently in use.

PURPOSE

To develop a clear conceptual understanding of maternal distress in the NICU using conceptual definitions and empirical findings.

METHODS/SEARCH STRATEGY

A literature search was conducted using EBSCOhost, MEDLINE, CINAHL, PsychINFO, and Google Scholar. The concept analysis was guided by Walker and Avant's (2011) guide.

FINDINGS/RESULTS

Maternal distress in the NICU consists of a combination of depressive, anxiety, trauma, and posttraumatic stress symptoms. The symptoms occur together on a spectrum and present differently in each mother. The antecedents to maternal distress are a NICU hospitalization and a perceived interruption to the transition to motherhood. Consequences of maternal distress in the NICU are issues with developing a healthy maternal-infant bond, adverse infant development, and decreased maternal quality of life.

IMPLICATIONS FOR PRACTICE

A complete understanding of maternal distress in the NICU will lead to increased awareness of adverse mental health states in this population.

IMPLICATIONS FOR RESEARCH

Identification of mothers at risk for maternal distress in the NICU, as well as the identification of antecedents and consequences related to the mother and the infant from maternal distress in the NICU. Using a single, clear definition of maternal distress in the NICU population will lead to a more cohesive body of literature.

Priorities for Contraception and Lactation Among Breast Pump-Dependent Mothers of Premature Infants in the Neonatal Intensive Care Unit

Objective: Determine the knowledge and priorities for postpartum contraception and lactation in mothers of premature infants. Design: Twenty-five mothers of premature infants (mean gestational age = 29.9 weeks) hospitalized in a tertiary neonatal intensive care unit (NICU) participated in a multi-methods study using a multiple-choice contraceptive survey and qualitative interview in the first 2 weeks postpartum. Data were analyzed using content analysis and descriptive statistics. Results: Although 60% of mothers planned to use contraception, all questioned the timing of postpartum contraceptive counseling while recovering from a traumatic birth and coping with the critical health status of the infant. All mothers prioritized providing mothers' own milk (MOM) over the use of early hormonal contraception because they did not want to "take any risks" with their milk. They had limited knowledge of risks for repeat preterm birth (e.g., prior preterm birth: n = 13, 52%; multiple birth: n = 9, 36%; no knowledge: n = 3, 12%); only two mothers (0.08%) were counseled about the risks of a short interpregnancy interval. Conclusion: The context of the infants' NICU admission and the mother's desire to "do what is best for the baby" by prioritizing MOM should be integrated into postpartum contraceptive counseling for this population.

The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care

There is increasing recognition that parents play a critical role in promoting the health outcomes of low birthweight and preterm infants. Despite a large body of literature on interventions and models to support family engagement in infant care, parent involvement in the delivery of care for such infants is still restricted in many neonatal intensive care units (NICUs). In this article, we propose a taxonomy for classifying parent-focused NICU interventions and parent-partnered care models to aid researchers, clinical teams, and health systems to evaluate existing and future approaches to care. The proposed framework has three levels: interventions to support parents, parent-delivered interventions, and multidimensional models of NICU care that explicitly incorporate parents and partners in the care of their preterm or low birthweight infant. We briefly review the available evidence for interventions at each level and highlight the strong level of research evidence to support the parent-delivered intervention of skin-to-skin contact (also known as the Kangaroo Care position) and for the Kangaroo mother care and family integrated care models of NICU care. We suggest directions for future research and model implementation to improve and scale-up parent partnership in the care of NICU infants.

Perspectives of time: a qualitative study of the experiences of parents of critically ill newborns in the neonatal nursery in North Queensland interviewed several years after the admission

DESIGN

A qualitative study informed by grounded theory principles to explore the experiences of parents who had extremely preterm or babies with antenatally diagnosed life-threatening diagnoses who were cared for in a regional tertiary neonatal unit. The study was conducted when the child was old enough to be diagnosed with long-term neurodevelopmental or medical sequelae.

SETTING

North Queensland is a large area in Eastern Australia of 500 000 km², which is served by one tertiary neonatal unit.

PARTICIPANTS

Seventeen families representing 21 extremely preterm babies and one baby with congenital malformations who was not expected to survive prior to delivery (but did) were interviewed using grounded theory principles. Interviews were coded and themes derived.

RESULTS

Parents who recollect their neonatal experiences from 3 to 7 years after the baby was cared for in the neonatal intensive care described negative themes of grief and loss, guilt and disempowerment. Positive enhancers of care included parental strengths, religion and culture, family supports and neonatal unit practices. Novel findings included that prior pregnancy loss and infertility formed part of the narrative for parents, and hope was engendered by religion for parents who did not usually have a religious faith.

CONCLUSIONS

An understanding of both the negative aspects of neonatal care and the positive enhancers is necessary to improve the neonatal experience for parents. Parents are able to contextualise their previous neonatal experiences within both the long-term outcome for the child and their own life history.

Maternal Immigrant Status and Readiness to Transition to Home From the NICU

BACKGROUND AND OBJECTIVES

Evaluate effects of immigrant status on perceptions of discharge readiness in mothers of preterm infants <37 weeks' gestation and identify the impact of primary language and years in the United States.

METHODS

Immigrant (n = 176) and native (n = 556) mothers of preterm infants cared for in the NICU for >5 days between 2012 and 2015 completed the Fragile Infant Parental Readiness Evaluation (FIPRE), a NICU-discharge readiness questionnaire. Group comparisons were made on the basis of immigrant status. Regression models examined effects of immigrant status, primary language, and years in the United States on discharge readiness.

RESULTS

Immigrant mothers were more likely to be older, gravida >1, multiracial or people of color, and non-English speaking; have less than a high school education; and receive Medicaid but less likely to have child protective services involvement, substance abuse, and mental health disorder (MHD). Whereas rates of non-English primary language, low education, and Medicaid decreased, rates of MHDs increased with years in the United States. At NICU discharge, immigrant mothers had poorer perceptions of infant well-being, maternal well-being, maternal comfort, and time impact. In adjusted analyses, immigrant status, non-English primary language, and MHD predicted unfavorable scores. Among immigrant mothers, increased years in the United States and MHD predicted unfavorable scores.

CONCLUSIONS

Although findings suggest acculturation with increased years in the United States, immigrant mothers perceived less discharge readiness in multiple domains, highlighting the need for culturally competent care and discharge services specifically tailored to help this vulnerable population.

Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes

In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.

Infant, Maternal, and Neighborhood Predictors of Maternal Psychological Distress at Birth and Over Very Low Birth Weight Infants' First Year of Life

OBJECTIVE

To use a social-ecological conceptualization to analyze change of maternal distress, defined as depression, anxiety, and perinatal-specific post-traumatic stress (PPTS), across very low birth weight (VLBW) infants' first year of life and to identify infant, maternal, and neighborhood predictors of these changes over time.

METHODS

Mothers of VLBW infants (n = 69) completed psychological distress questionnaires 2 to 4 weeks after infant birth, 2 weeks before infant discharge from neonatal intensive care unit, and at infants' 4- and 8-month corrected age (age adjusted for prematurity). Infant and maternal sociodemographic data were collected from medical chart review. Neighborhood data were obtained through US census data. Multilevel linear growth modeling was used to (1) predict unstandardized estimates of mothers' initial levels of depression, anxiety, and PPTS at the time of infant's birth and the rate of change of these markers of distress over time and (2) model unstandardized estimates of infant, maternal, and neighborhood as predictors of distress at infants' birth and change over time.

RESULTS

Unstandardized estimates from multilevel linear growth modeling revealed depression (-2.8), anxiety (-1.4), and PPTS (-0.7) declined over infants' first year of life (<0.001). Mothers residing in lower-income homes and neighborhoods, respectively, reported lower anxiety (-11.2, p = 0.03) and PPTS (-31.1, p = 0.01) at infant birth. Greater infant birth weight predicted both lower anxiety (-0.02, p = 0.02) and lower PPTS (-0.02, p = 0.005).

CONCLUSION

Mothers psychologically recover over VLBW infants' first year of life. Results add to a building literature about socioeconomically disadvantaged mothers of preterm infants, reporting lower distress; this warrants additional research.

Paid Family Leave to Enhance the Health Outcomes of Preterm Infants

Prematurity is the largest contributor to perinatal morbidity and mortality. Preterm infants and their families are a significant vulnerable population burdened with limited resources, numerous health risks, and poor health outcomes. The social determinants of health greatly shape the economic and psychosocial resources that families possess to promote optimal outcomes for their preterm infants. The purposes of this article are to analyze the resource availability, relative risks, and health outcomes of preterm infants and their families and to discuss why universal paid family leave could be one potential public policy that would promote optimal outcomes for this infant population. First, we discuss the history of family leave in the United States and draw comparisons with other countries around the world. We use the vulnerable populations conceptual model as a framework to discuss why universal paid family leave is needed and to review how disparities in resource availability are driving the health status of preterm infants. We conclude with implications for research, nursing practice, and public policy. Although health care providers, policy makers, and other key stakeholders have paid considerable attention to and allocated resources for preventing and treating prematurity, this attention is geared toward individual-based health strategies for promoting preconception health, preventing a preterm birth, and improving individual infant outcomes. Our view is that public policies addressing the social determinants of health (e.g., universal paid family leave) would have a much greater impact on the health outcomes of preterm infants and their families than current strategies.

Posttraumatic Stress in Mothers While Their Preterm Infants Are in the Newborn Intensive Care Unit: A Mixed Research Synthesis

In this mixed research synthesis on posttraumatic stress in mothers related to their preterm infants' stay in the newborn intensive care unit (NICU), we synthesized and integrated a total of 37 studies, 25 of which were quantitative and 12 were qualitative studies. The prevalence rates of NICU mothers with elevated posttraumatic stress symptoms ranged from 18% in the United States to 81% in Turkey. Nine of the 12 studies testing interventions to decrease mothers' stress related to their NICU experiences reported significant results. Content analysis of the qualitative studies' findings revealed 5 themes: stark contrast to images of joyous motherhood, cultural overlay, issues of ownership and control, support, and learning to be a NICU mother.

Evaluation of the Multidisciplinary Assistance provided in a Public Neonatal Care Unit from mothers` perception

Abstract Objectives: this study aimed to investigate the evaluation of mothers about the care provided by the multidisciplinary team in a Public Neonatal Care Unit located in the Federal District/Brazil. Methods: this is a descriptive, quantitative and cross-sectional study. The sample consisted of 57 mothers and data were collected from April to September 2015. The instrument used for data collection was a questionnaire with questions distributed in three main domains, such as accessibility and accommodation; communication and relationship with the team and assistance received. Results: the result showed an association of mothers’ satisfaction with the variables “income” and “length of hospital stay”, and demonstrated that the majority of the mothers evaluated the unit positively. However, it was highlighted the need to improve communication between neonatal staff and mothers, and to implement a more flexible visiting policy in order to allow the presence of other family members in the mentioned Unit more frequently. Conclusions: data obtained from this research may contribute to improve the quality of care in the NICUs, in view of the importance of evaluation of assistance so that better care to mothers is available.

Supports and Barriers to the Provision of Human Milk by Mothers of African American Preterm Infants

BACKGROUND

Mother's own milk (MOM) provides significant health benefits to very low birth-weight infants (VLBW, ≤1500 g). However, 60% of African American (AA) women initiate lactation, and less than 35% provide MOM 6 months following the birth of their infant. Previous research focuses on term infants and is not specific to AA mothers of VLBW infants.

PURPOSE

To qualitatively describe supports and barriers experienced by AA mothers while providing MOM for their VLBW infants.

METHODS

In this qualitative, descriptive study, we conducted semistructured interviews with AA mothers who provided MOM for their VLBW infant. Interviews were transcribed and manually coded concurrently with enrollment until theoretical saturation was achieved. Infant charts were reviewed for demographics, and triangulation with notes from the medical record by bedside nurse lactation consultants and other providers was performed to increase validity. Member checks were completed to ensure true meaning of responses.

RESULTS

Theoretical saturation was achieved after 9 interviews. Themes perceived to support provision of MOM included (1) Being a Mother; (2) Neonatal intensive care unit environment; (3) Community support; and (4) Useful resources. Themes that emerged as barriers to the provision of MOM were: (1) Maternal illness; (2) Milk expression; (3) Challenging home environment; and (4) Emotional distress.

IMPLICATIONS FOR PRACTICE

African American mothers report supports similar to published data but faced challenges not previously reported. These factors warrant attention by professionals who support lactation in this population.

IMPLICATIONS FOR RESEARCH

Future research will address perceived barriers to improve provision of MOM and the quality of the lactation journey of AA mothers of preterm infants.

Elevated maternal anxiety in the NICU predicts worse fine motor outcome in VLBW infants

AIM

The literature is sparse with respect to the impact of elevated maternal psychological distress in the neonatal intensive care unit (NICU) on later neurodevelopmental outcome in VLBW infants. The objective of this study is to examine the impact of elevated maternal distress, defined as elevated depression, anxiety and perinatal-specific post-traumatic stress, during the NICU hospitalization on VLBW infant ND outcome at 20months corrected age (CA).

METHODS

This was a prospective study of 69 mothers and their VLBW infants recruited in 2011-2012. Elevated maternal distress was collected by maternal questionnaire in the NICU. Elevated depression was quantified with the Center for Epidemiological Studies-Depression Scale, anxiety with the Spielberger State-Trait Anxiety Inventory and perinatal-specific post-traumatic stress with the Modified Perinatal Posttraumatic Stress Disorder Questionnaire. VLBW infant ND outcome was assessed using the Bayley Scales of Infant & Toddler Development-III at 20months CA. Regression analyses determined the impact of elevated distress on ND outcome after adjusting for infant medical and maternal sociodemographic variables.

RESULTS

After controlling for infant and maternal covariates, elevated maternal anxiety in the NICU predicted lower fine motor scores at 20months CA.

CONCLUSION

Elevated maternal anxiety in the NICU is associated with adverse ND outcome in VLBW infants in the 2nd year of life. NICU-based support services may help mothers' quality of life and VLBW infant outcome.

Parent Support Programs and Coping Mechanisms in NICU Parents

BACKGROUND

Many neonatal intensive care unit (NICU) parents experience emotional distress leading to adverse infant outcomes. Parents may not cope positively in stressful situations, and support programs often are underutilized.

PURPOSE

To determine coping mechanisms utilized by NICU parents, and types of support programs parents are likely to attend. To determine whether sociodemographic and length-of-stay differences impact coping mechanisms utilized, and types of support programs preferred.

METHODS

A correlational cross-sectional survey design was used. The 28-item Brief COPE tool, questions about demographics and preferred support program styles, was distributed to a convenience sample of NICU parents in a level IV NICU in the southeastern United States.

RESULTS

One hundred one NICU parents used coping mechanisms, with acceptance emotional support, active coping, positive reframing, religion, planning, and instrumental support being the most common. Preferred support classes were infant development and talking with other NICU parents. Caucasians more commonly coped using active coping, planning, emotional support, acceptance, instrumental support, and venting compared with other races. Women utilized self-blame coping mechanisms more often compared with men. Younger parents were more likely to use venting and denial coping mechanisms. Parents with a shorter stay utilized self-distraction coping and preferred the class of talking with other parents.

IMPLICATIONS FOR PRACTICE

Support program preference, type of coping mechanism utilized, and sociodemographic factors may be used to guide the creation of NICU support programs.

IMPLICATIONS FOR RESEARCH

Additional studies are needed to determine whether support program offering according to preferences and sociodemographic characteristics increases attendance and decreases emotional distress.

Parental perception of child vulnerability among mothers of very low birth weight infants: psychological predictors and neurodevelopmental sequelae at 2 years

OBJECTIVE

The objective of this study was to examine the impact of maternal psychological distress on the development of parental perception of child vulnerability (PPCV) in mothers of very low birth weight (VLBW) infants; and to examine the impact of PPCV on neurodevelopmental outcome in VLBW infants in the second year of life.

STUDY DESIGN

This is a prospective study of 69 mothers and their VLBW infants recruited from 2011 to 2012 for whom maternal psychological data were collected during the neonatal intensive care unit (NICU) hospitalization. Maternal PPCV was assessed at 4 months corrected age (CA). Neurodevelopmental outcome was assessed at 20 months CA. Regression analyses modeled the development of PPCV and the impact of PPCV on neurodevelopmental outcome.

RESULTS

PPCV at 4 months CA was predicted by maternal anxiety and history of previous fetal loss reported during the NICU stay. Higher PPCV at 4 months CA was associated with lower language scores at 20 months CA.

CONCLUSION

Targeted interventions aimed at reducing PPCV in the NICU are supported.

Evidence-Based Methods That Promote Human Milk Feeding of Preterm Infants: An Expert Review

Best practices translating the evidence for high-dose human milk (HM) feeding for preterm infants during neonatal intensive care unit (NICU) hospitalization have been described, but their implementation has been compromised. Although the rates of any HM feeding have increased over the last decade, efforts to help mothers maintain HM provision through to NICU discharge have remained problematic. Special emphasis should be placed on prioritizing the early lactation period of coming to volume so that mothers have sufficient HM volume to achieve their personal HM feeding goals. Donor HM does not provide the same risk reduction as own mother's HM.

Neonatal Nurses NICU Quality Improvement: Embracing EBP Recommendations to Provide Parent Psychosocial Support

BACKGROUND

The neonatal intensive care unit (NICU) can be a stressful environment for infants, their families, and the healthcare team. There is an immediate need for neonatal nurses to embrace and translate the new National Perinatal Association recommendations for psychosocial support of NICU parents into clinical practice to demonstrate best practices for infants, their families, and the whole team.

PURPOSE

To summarize the current evidence-based practice recommendations and to provide suggestions for team members to develop strategies to adopt and implement them through quality improvement (QI) projects.

METHODS

Literature reviews were conducted by the original 6 National Perinatal Association workgroup teams and covered all levels of available evidence (eg, qualitative, quantitative, and clinical research, guidelines, and clinical and parental expertise). Evidence was synthesized to formulate this set of recommendations published in December 2015. We describe their applicability to the vital role of neonatal nurses, while elucidating QI projects that track measurements of change to translate these recommendations into practice.

RESULTS

Neonatal nurses are in an ideal position to transform systems of support for NICU parents through the adoption of these recommendations at the bedside, and further to identify areas for QI to enhance implementation.

IMPLICATIONS FOR PRACTICE

Neonatal nurses are integral to problem solving and identifying QI strategies for translating these recommendations into NICU clinical practice to improve parent psychosocial support.

IMPLICATIONS FOR RESEARCH

This article disseminates evidence and encourages scientific investigation into various methods of supporting emotional health of NICU parents to create better health outcomes.

Human Milk Provision Experiences, Goals, and Outcomes for Teen Mothers with Low-Birth-Weight Infants in the Neonatal Intensive Care Unit

INTRODUCTION

Breastfeeding rates are virtually unknown for teen mothers whose low-birth-weight (LBW; <2500 gm) infants are hospitalized in the neonatal intensive care unit (NICU). The objective was to examine the infant feeding experiences, goals, and outcomes of teen mothers of LBW infants.

METHODS

We conducted a multimethod study using a qualitative research design, survey, and infant medical records. The primary data source was individual interviews conducted with teen mothers of LBW infants hospitalized in a tertiary NICU. Content analysis and descriptive statistics were used for data analysis.

RESULTS

All 15 teen mothers (12 black, 3 Hispanic) wanted what was best for their infants and initiated lactation by breast pump. However, maintaining lactation was challenging and the following barriers were identified: fear of being judged; body image issues; influence of the maternal grandmother; and disorganized thought processes about combining pumping with returning to school or work. Despite these barriers, 50% of the teen mothers met their goals for human milk provision at NICU discharge.

CONCLUSION

Most of the teen mothers' lactation barriers reflected their adolescent developmental stage. Potential interventions are identified and include focus groups with teen mothers and maternal grandmothers and lactation support by NICU-based teen breastfeeding peer counselors.

Parents and nurses balancing parent-infant closeness and separation: a qualitative study of NICU nurses' perceptions

BACKGROUND

When a newborn requires neonatal intensive care unit (NICU) hospitalization, parent and infant experience an unusual often prolonged separation. This critical care environment poses challenges to parent-infant closeness. Parents desire physical contact and holding and touching are particularly important. Evidence shows that visitation, holding, talking, and skin to skin contact are associated with better outcomes for infants and parents during hospitalization and beyond. Thus, it would be important to understand closeness in this context. The purpose of this study was to explore from nurses' perspective, what do parents and nurses do to promote parent-infant closeness or provoke separation.

METHODS

Qualitative methods were utilized to attain an understanding of closeness and separation. Following ethics approval, purposive sampling was used to recruit nurses with varying experience working different shifts in NICUs in two countries. Nurses were loaned a smartphone over one work shift to record their thoughts and perceptions of events that occurred or experiences they had that they considered to be closeness or separation between parents and their hospitalized infant. Sample size was determined by saturation (18 Canada, 19 Finland). Audio recordings were subjected to inductive thematic analysis. Team meetings were held to discuss emerging codes, refine categories, and confirm these reflected data from both sites. One overarching theme was elaborated.

RESULTS

Balancing closeness and separation was the major theme. Both parents and nurses engaged in actions to optimize closeness. They sought closeness by acting autonomously in infant caregiving, assuming decision-making for their infant, seeking information or skills, and establishing a connection in the face of separation. Parents balanced their desire for closeness with other competing demands, such as their own needs. Nurses balanced infant care needs and ability to handle stimulation with the need for closeness with parents. Nurses undertook varied actions to facilitate closeness. Parent, infant and NICU-related factors influenced closeness. Consequences, both positive and negative, arose for parents, infants, and nurses.

CONCLUSION

Findings point to actions that nurses undertake to promote closeness and help parents cope with separation including: promoting parent decision-making, organizing care to facilitate closeness, and supporting parent caregiving.

Sacred Spaces: Religious and Secular Coping and Family Relationships in the Neonatal Intensive Care Unit

BACKGROUND

Preterm birth is an unanticipated and stressful event for parents. In addition, the unfamiliar setting of the intensive care nursery necessitates strategies for coping.

PURPOSE

The primary study objective of this descriptive study was to determine whether secular and religious coping strategies were related to family functioning in the neonatal intensive care unit.

METHODS

Fifty-two parents of preterm (25-35 weeks' gestation) infants completed the Brief COPE (secular coping), the Brief RCOPE (religious coping), and the Family Environment Scale within 1 week of their infant's hospital admission.

FINDINGS

This descriptive study found that parents' religious and secular coping was significant in relation to family relationship functioning. Specifically, negative religious coping (ie, feeling abandoned or angry at God) was related to poorer family cohesion and use of denial.

IMPLICATIONS FOR PRACTICE

These findings have relevance for interventions focused toward enhancing effective coping for families.

IMPLICATIONS FOR RESEARCH

Further study of religious and secular coping strategies for neonatal intensive care unit families is warranted in a larger more diverse sample of family members.