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Sessions KL, Ruegsegger L, Mvalo T, Kondowe D, Tsidya M, Hosseinipour MC, Lufesi N, Eckerle M, Smith AG, McCollum ED. Focus group discussions on low-flow oxygen and bubble CPAP treatments among mothers of young children in Malawi: a CPAP IMPACT substudy. BMJ Open 2020; 10:e034545. [PMID: 32404389 PMCID: PMC7228516 DOI: 10.1136/bmjopen-2019-034545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the acceptability of bubble continuous positive airway pressure (bCPAP) and low-flow oxygen among mothers of children who had received either therapy. SETTING A district hospital in Salima, Malawi. PARTICIPANTS We conducted eight focus group discussions (FGDs) with a total of 54 participants. Eligible participants were mothers of children 1 to 59 months of age with severe pneumonia and a comorbidity (HIV-infection, HIV-exposure, malnutrition or hypoxaemia) who, with informed consent, had been enrolled in a randomised clinical trial, CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial), comparing low-flow oxygen and bCPAP treatments (ClinicalTrials.gov, NCT02484183). PRIMARY AND SECONDARY OUTCOME MEASURES FGDs assessed mothers' attitudes and feelings towards oxygen and bCPAP before and after therapy along with general community perceptions of respiratory therapies. Data was analysed using inductive thematic analysis to assess themes and subthemes of the transcripts. RESULTS Community perceptions of oxygen and bCPAP were widely negative. Mothers recounted that they are told that 'oxygen kills babies'. They are often fearful of allowing their child to receive oxygen therapy and will delay treatment or seek alternative therapies. Mothers report limiting oxygen and bCPAP by intermittently removing the nasal cannulas or mask. After oxygen or bCPAP treatment, regardless of patient outcome, mothers were supportive of the treatment their child received and would recommend it to other mothers. CONCLUSION There are significant community misconceptions around oxygen and bCPAP causing mothers to be fearful of either treatment. In order for low-flow oxygen treatment and bCPAP implementation to be effective, widespread community education is necessary.
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Affiliation(s)
- Kristen L Sessions
- Pediatrics, McGaw Medical Center of Northwestern University, Chicago, Illinois, United States
| | - Laura Ruegsegger
- Project Malawi, University of North Carolina System, Lilongwe, Malawi
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Davie Kondowe
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Mercy Tsidya
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Mina C Hosseinipour
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Infectous Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Norman Lufesi
- Acute Respiratory Infection Unit, Ministry of Health, Lilongwe, Malawi
| | - Michelle Eckerle
- Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Andrew Gerald Smith
- Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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Lisanti AJ, Golfenshtein N, Medoff-Cooper B. The Pediatric Cardiac Intensive Care Unit Parental Stress Model: Refinement Using Directed Content Analysis. ANS Adv Nurs Sci 2018; 40:319-336. [PMID: 28990967 PMCID: PMC5664220 DOI: 10.1097/ans.0000000000000184] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This descriptive, qualitative study used directed content analysis to explore and clarify specific foci of parental stress for mothers of infants with complex congenital heart disease in the pediatric cardiac intensive care unit (PCICU). The PCICU Parental Stress Model was used as the guiding theoretical framework. Three focus groups were conducted with 14 mothers of infants who were being cared for in a PCICU at a large mid-Atlantic children's hospital. Data provided themes to support and refine the PCICU Parental Stress Model that can be used to guide practice, education, and future research in this unique population and setting.
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Affiliation(s)
- Amy Jo Lisanti
- University of Pennsylvania, School of Nursing
- Children’s Hospital of Philadelphia
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Foster J, Taylor C, Patterson T, Psaila K. Experiences of new graduate nurses working in a neonatal intensive care setting: a systematic review protocol of qualitative evidence. ACTA ACUST UNITED AC 2018; 14:105-111. [PMID: 27846121 DOI: 10.11124/jbisrir-2016-003169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The overall objective of this systematic review is to identify, critically appraise and synthesize the experiences of new graduate nurses in the neonatal intensive care unit (NICU). The specific review question is: what are the experiences of new graduate nurses working in a NICU setting?
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Affiliation(s)
- Jann Foster
- 1School of Nursing and Midwifery, Western Sydney University, Sydney, Australia 2Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School/Sydney Nursing School, University of Sydney, Sydney, Australia 3The New South Wales Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence 4Ingham Institute for Applied Medical Research, Liverpool, Australia
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Roles and Experiences of Parents in Necrotizing Enterocolitis: An International Survey of Parental Perspectives of Communication in the NICU. Adv Neonatal Care 2017; 17:489-498. [PMID: 29166294 DOI: 10.1097/anc.0000000000000438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although partnering with parents is important to improving neonatal outcomes, no studies have investigated what parents are taught, remember, or experience when their child is afflicted with necrotizing enterocolitis (NEC). PURPOSE To characterize parental perceptions of communication and support they were given about NEC. METHODS An online survey was developed, reviewed for face validity, and then administered to parents whose child had experienced NEC. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using a qualitative descriptive approach. FINDINGS Parents (N = 110) wanted to know the risk factors and warning signs for NEC and wanted to be told as soon as their child was admitted to the neonatal intensive care unit (NICU). Information provided before diagnosis was felt to be poor by the majority of families, with only 32% feeling satisfied or very satisfied. No parent wrote that they were "scared" by information provided to them about NEC; in fact, parents were dissatisfied when they received "sugar-coated" information. Engaged parents were significantly more satisfied than those who were not informed, had their concerns and suggestions dismissed, or who had to advocate for their baby against clinician opposition (eg, activating the chain of command). IMPLICATIONS FOR PRACTICE Areas for quality improvement include better communication and collaboration with parents through early engagement in NEC prevention using modalities beyond verbal instruction. IMPLICATIONS FOR RESEARCH More research is needed on how best to engage parents, especially to engage in prevention, and how doing so affects satisfaction and outcomes.
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Lisanti AJ, Allen LR, Kelly L, Medoff-Cooper B. Maternal Stress and Anxiety in the Pediatric Cardiac Intensive Care Unit. Am J Crit Care 2017; 26:118-125. [PMID: 28249863 DOI: 10.4037/ajcc2017266] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Mothers whose infants are born with complex congenital heart disease (CCHD) experience stress during their infant's hospitalization in a pediatric cardiac intensive care unit (PCICU). OBJECTIVES This study addressed 2 research questions: (1) What are the parental stressors for mothers whose infants with CCHD are in the PCICU? And (2) What are the relationships of trait anxiety and 3 parental stressors to the parental stress response of state anxiety in mothers whose infants with CCHD are in the PCICU? METHODS This descriptive correlational study included 62 biological mothers of infants admitted to a PCICU within 1 month of birth who had undergone cardiac surgery for CCHD. Maternal and infant demographics and responses to the Parental Stressor Scale: Infant Hospitalization and the State-Trait Anxiety Inventory were collected at 3 major PCICUs across the United States. RESULTS Mothers' scores revealed that infant appearance and behavior was the greatest stressor, followed by parental role alteration, then sights and sounds. The combination of trait anxiety and parental role alteration explained 26% of the variance in maternal state anxiety. Mothers with other children at home had significantly higher state anxiety than did mothers with only the hospitalized infant. CONCLUSIONS Results from this study revealed factors that contribute to the stress of mothers whose infants are born with CCHD and are hospitalized in a PCICU. Nurses are in a critical position to provide education and influence care to reduce maternal stressors in the PCICU, enhance mothers' parental role, and mitigate maternal state anxiety.
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Affiliation(s)
- Amy Jo Lisanti
- Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children’s Hospital of Philadelphia
| | - Lois Ryan Allen
- Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children’s Hospital of Philadelphia
| | - Lynn Kelly
- Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children’s Hospital of Philadelphia
| | - Barbara Medoff-Cooper
- Amy Jo Lisanti is a postdoctoral fellow at the University of Pennsylvania School of Nursing, and a clinical nurse specialist/nurse researcher at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. Lois Ryan Allen and Lynn Kelly are professors emeritus of nursing, Widener University School of Nursing, Chester, Pennsylvania. Barbara Medoff-Cooper is a professor, University of Pennsylvania School of Nursing, and a nurse scientist at Children’s Hospital of Philadelphia
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Abstract
BACKGROUND Hospitalised newborn neonates frequently undergo painful invasive procedures that involve penetration of the skin and other tissues by a needle. One intervention that can be used prior to a needle insertion procedure is application of a topical local anaesthetic. OBJECTIVES To evaluate the efficacy and safety of topical anaesthetics such as amethocaine and EMLA in newborn term or preterm infants requiring an invasive procedure involving puncture of skin and other tissues with a needle. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase and CINAHL up to 15 May 2016; previous reviews including cross-references, abstracts, and conference proceedings. We contacted expert informants. We contacted authors directly to obtain additional data. We imposed no language restrictions. SELECTION CRITERIA Randomised, quasi-randomised controlled trials, and cluster and cross-over randomised trials that compared the topical anaesthetics amethocaine and eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy and safety in newborn term or preterm infants requiring an invasive procedure involving puncture of skin and other tissues with a needle DATA COLLECTION AND ANALYSIS: From the reports of the clinical trials we extracted data regarding clinical outcomes including pain, number of infants with methaemoglobin level 5% and above, number of needle prick attempts prior to successful needle-related procedure, crying, time taken to complete the procedure, episodes of apnoea, episodes of bradycardia, episodes of oxygen desaturation, neurodevelopmental disability and other adverse events. MAIN RESULTS Eight small randomised controlled trials met the inclusion criteria (n = 506). These studies compared either EMLA and placebo or amethocaine and placebo. No studies compared EMLA and amethocaine. We were unable to meta-analyse the outcome of pain due to differing outcome measures and methods of reporting. For EMLA, two individual studies reported a statistically significant reduction in pain compared to placebo during lumbar puncture and venepuncture. Three studies found no statistical difference between the groups during heel lancing. For amethocaine, three studies reported a statistically significant reduction in pain compared to placebo during venepuncture and one study reported a statistically significant reduction in pain compared to placebo during cannulation. One study reported no statistical difference between the two groups during intramuscular injection.One study reported no statistical difference between EMLA and the placebo group for successful venepuncture at first attempt. One study similarly reported no statistically significant difference between Amethocaine and the placebo group for successful cannulation at first attempt.Risk for local redness, swelling or blanching was significantly higher with EMLA (typical risk ratio (RR) 1.65, 95% confidence interval (CI) 1.24 to 2.19; typical risk difference (RD) 0.17, 95% CI 0.09 to 0.26; n = 272; number needed to treat for an additional harmful outcome (NNTH) 6, 95% CI 4 to 11; I2 = 92% indicating considerable heterogeneity) although not for amethocaine (typical RR 2.11, 95% CI 0.72 to 6.16; typical RD 0.05, 95% CI -0.02 to 0.11, n = 221). These local skin reactions for EMLA and amethocaine were reported as short-lasting. Two studies reported no methaemoglobinaemia with single application of EMLA. The quality of the evidence on outcomes assessed according to GRADE was low to moderate. AUTHORS' CONCLUSIONS Overall, all the trials were small, and the effects of uncertain clinical significance. The evidence regarding the effectiveness or safety of the interventions studied is inadequate to support clinical recommendations. There has been no evaluation regarding any long-term effects of topical anaesthetics in newborn infants.High quality studies evaluating the efficacy and safety of topical anaesthetics such as amethocaine and EMLA for needle-related pain in newborn term or preterm infants are required. These studies should aim to determine efficacy of these topical anaesthetics and on homogenous groups of infants for gestational age. While there was no methaemoglobinaemia in the studies that reported methaemoglobin, the efficacy and safety of EMLA, especially in very preterm infants, and for repeated application, need to be further evaluated in future studies.
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Affiliation(s)
| | - Christine Taylor
- University of Western SydneyParramatta Campus, Bldg EI G15Locked Bag 1797PenrithAustralia2751
| | - Kaye Spence
- The Children's Hospital at WestmeadGrace Centre for Newborn CareLocked Bag 4001WestmeadAustralia2145
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Schappin R, Wijnroks L, Uniken Venema MMAT, Jongmans MJ. Rethinking stress in parents of preterm infants: a meta-analysis. PLoS One 2013; 8:e54992. [PMID: 23405105 PMCID: PMC3566126 DOI: 10.1371/journal.pone.0054992] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 12/20/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress. METHODS AND FINDINGS A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants. CONCLUSIONS Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself.
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Affiliation(s)
- Renske Schappin
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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Abstract
BACKGROUND It is well established that parents must interact with their new-born babies to facilitate attachment. However, very little is known about how parents perceive different types of medical technology products commonly used in the neonatal intensive care unit (NICU) as barriers to their wish to interact with their infants. AIM This study aims to examine to what extent the different medical technology products commonly used in the NICU are perceived by parents to be obstacles in their wish to interact with their babies. DESIGN AND METHODS In 2010, a cross-sectional survey, using a questionnaire specifically developed for this study, was conducted among the parents of children who were discharged from any of the five NICUs of the Västra Götaland region in Sweden. A consecutive sample of 248 parents participated, and multiple regressions and t-tests were used to analyse the data. RESULTS The parents generally perceived the various medical technology products differently, according to the perceived level of obstruction. The variables of gender, age, educational level, origin, gestational age, previous experience of being a parent, and the offer of accommodation at the NICU were significantly associated with the perceived level of obstruction in the parents' wish to interact with their baby while the baby was being treated with different medical technology products. CONCLUSION The primary implication for practice is that to facilitate attachment, nurses should involve different categories of parents in different ways in the care of their children, depending on the equipment being used in the treatment of the children. Thus, the individual care plan should explicitly include the details of the specific medical equipment, because although its use is medically beneficial for the child, it is associated with potential liabilities regarding parent-child interaction and, consequently, regarding parent-child attachment.
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Affiliation(s)
- Björn Lantz
- Department of Industrial Engineering, University of Borås, Borås, Sweden.
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Capdevila Cogul E, Sánchez Pozón L, Riba García M, Moriña Soler D, Ríos Guillermo J, Porta Ribera R, Molina Morales V. Valoración de la satisfacción de los padres en una unidad neonatal. An Pediatr (Barc) 2012; 77:12-21. [DOI: 10.1016/j.anpedi.2011.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 09/29/2011] [Accepted: 11/05/2011] [Indexed: 11/16/2022] Open
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Buckmaster A, Arnolda G, Wright I, Foster J. Targeted oxygen therapy in special care nurseries: is uniformity a good thing? J Paediatr Child Health 2012; 48:476-82. [PMID: 22300612 DOI: 10.1111/j.1440-1754.2011.02220.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM There is wide variation in the commencement of inspired oxygen (FiO2) and the oxygen saturation (SpO(2) ) targets set in special care nurseries (SCNs). Evidence supports minimising unnecessary oxygen exposure. Does the introduction of a protocol advocating the uniform approach of commencing FiO2 at 30% and targeting SpO2 of 94-96% for infants ≥ 33 weeks gestation with respiratory distress reduce oxygen exposure? METHODS A 'Before After' study was undertaken in three SCNs. Data were recorded for all infants admitted to the SCNs who required oxygen over a 3-year period. Infants were analysed in gestational age groups: 33-36 weeks (late preterm) and +37 weeks (term/post-term). RESULTS Of the 19,830 infants born, 868 (4%) were treated with oxygen. The introduction of an oxygen-targeting protocol resulted in a statistically and clinically significant reduction in the proportion of infants who were treated with any oxygen for 1 h or more, 4 h or more and in the proportion who received >30% FiO2 for 1 h or more (all P ≤ 0.01). This reduction was significant for infants of both gestational age groups. The median duration of oxygen for term/post-term infants was reduced from 12 h pre-protocol to 10 h post-protocol (P= 0.01); however, no significant difference was found for the preterm group (reduced from 11 to 8 h, P= 0.07). CONCLUSION Introduction of a uniform oxygen protocol in SCNs for infants ≥ 33 weeks gestation with respiratory distress reduces the number of infants receiving oxygen and, in term infants, the duration of oxygen exposure.
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Affiliation(s)
- Adam Buckmaster
- Department of Paediatrics, Gosford District Hospital, Northern Sydney Central Coast Area Health Service, Gosford, Australia.
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The experience of mothers whose very low-birth-weight infant requires the delivery of supplemental oxygen in the neonatal intensive care unit. Adv Neonatal Care 2011; 11:54-61. [PMID: 21285658 DOI: 10.1097/anc.0b013e318206d0d3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE This study examines the experience of mothers whose very low-birth-weight infants require the delivery of supplemental oxygen during their hospitalization in the neonatal intensive care unit (NICU). SUBJECTS Eleven mothers of very low-birth-weight infants who have received various supplemental oxygen delivery methods in the NICU for a minimum of 7 days were selected for interview. DESIGN Qualitative descriptive. METHODS One semistructured interview exploring mothers' experiences surrounding oxygen delivery methods was conducted. Qualitative content analysis was undertaken to describe mothers' experience. PRINCIPLE RESULTS Four themes emerged related to the oxygen therapy and the various methods of delivery: Oxygen therapy is a positive, worries about the adverse effects for my baby now and in the future, a learning experience, and the delivery of supplemental oxygen is a barrier to mothering. CONCLUSION Mothers balanced the positive aspects of oxygen therapy with their fears of the negative consequences. They were able to adapt to the equipment and trajectory of having their infant on supplemental oxygen delivery methods. Mothers were particularly distressed by the physical barriers created by oxygen delivery methods (ie, unable to hold, hear, or see their baby). Nurses in the NICU should support mothers' positive reframing as a way of coping, provide education about the consequences of this therapy, encourage mothers to touch and hold their infants, and provide opportunities for them to see their infants' faces.
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Franck LS. In response to Foster J., Bidewell J., Buckmaster A., Lees S. & Henderson-Smart D. (2008) Parental stress and satisfaction in the non-tertiary special care nursery. Journal of Advanced Nursing61(5), 522-530. J Adv Nurs 2008; 62:389-90. [PMID: 18426464 DOI: 10.1111/j.1365-2648.2008.04685.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Linda S Franck
- Centre for Nursing and Allied Health Professions Research, Great Ormond Street Hospital for Children, London, UK.
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