Clinical specialist pre- and postdischarge teaching of parents of very low birth weight infants

Mothers' involvement in assessing feeding skills of premature infants

OBJECTIVE

Among the problems faced by premature infants after birth are weakness in oral-motor skills and an inability to achieve oral feeding independence. The Early Feeding Skills (EFS) Assessment is a tool for identifying infant's feeding ability level and determining the levels at which an infant requires support for safe and efficient feeding. Given the effective role of mothers and their involvement in taking care of premature infants and the importance of examining the psychometric properties of tools used for assessing infant's feeding, this study aimed at evaluating inter-rater reliability (between mother and rater) using the EFS Instrument.

METHODS

This is a cross-sectional study. Participants in this study included 30 mothers with premature infants admitted to the NICU ward of Imam Khomeini Hospital in Ahvaz, Iran. To evaluate the inter-rater reliability of the "Early Feeding Skills (EFS) Assessment Instrument", feeding skills of the infants were evaluated by the mother and a rater. Statistical analysis was carried out using Intraclass Correlation Coefficients (ICC) in SPSS software (Ver. 22).

RESULTS

The inter-rater reliability of the total score for each section of the EFS Instrument was good (ICC >0.75). ICC values for inter-rater agreement in assessing Oral Feeding Readiness, Ability to Maintain Engagement in Feeding, Ability to Organize Oral-Motor Functioning, Ability to Coordinate Swallowing, Ability to Maintain Physiologic Stability, and Oral Feeding Recovery were 0.87, 0.94, 0.91, 0.85, 0.95 and, 0.80, respectively.

CONCLUSION

If mothers are appropriately trained on the EFS assessment, they can actively participate with the health care professionals providing care to their children. Furthermore, remote participation is possible. The findings of this study revealed significant inter-rater reliability.

[Development and evaluation of an e-learning program for mothers of premature infants]

PURPOSE

It has been attempted to support mother of premature infants by providing information of premature infant care using e-learning because premature infants need continuous care from birth to after discharge.

METHOD

The e-Learning Program for mother of premature was developed with Xpert, Namo web editor, Adobe Photoshop, and PowerPoint and applied for 4 weeks from 4 to 30 September 2006.

RESULT

1) We found that the contents of information which premature infants' need when being in the hospital and after discharge were the definition of a premature infant, orientation of NICU, care of premature infants, care of premature infants' common diseases, the connection of healthcare resources, exchange of information, and the management of rearing stress. 2) The program content consisted of cause of premature birth, comparison to full-term baby, physiology character, orientation of NICU, common health problems, follow up care, infection control, feeding, normal development physically and mentally, weaning method, and vaccination.

CONCLUSION

Considering the results, this program for mother of premature is a useful means to provide premature-care information to mothers. This information can be readily accessible and can be varied and complex enough to be able to help mothers to the information and assistance they require.

Social and Professional Support for Pregnant and Parenting Women

PURPOSE

A literature review to contrast the role of social and professional support in improving maternal and infant outcomes in pregnant and parenting women. In addition, recommendations are made for future research and policy and program development concerning support needed by pregnant and parenting women.

DATA SOURCES

Data were limited to published studies. Searches of computerized databases, hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched (CINAHL, Medline, PsychLit, Social Sciences Abstracts, Social Sciences Citation, and Social Work Abstracts).

STUDY SELECTION

The studies focused on outcomes of social support and professional support to pregnant and parenting women. The samples of the studies included pregnant women and parenting women up to 2 years postpartum. Studies reviewed were conducted in the United States or Canada and included maternal and/or infant outcomes. All ages and races of pregnant and parenting women were considered.

DATA EXTRACTION

Data were extracted from each study concerning the theoretical framework, variables, sample, design, measuring instruments, interventions, and outcomes.

DATA SYNTHESIS

Social support outcomes were summarized in paragraphs while a table was used to summarize professional support intervention outcomes.

CONCLUSIONS

Outcomes associated with specific support interventions should be clearly identified, informed by theory, and include assisting the pregnant and parenting woman to improve her social support.

State of the Science: Achievements and Challenges Across the Spectrum of Care for Preterm Infants

The spectrum of care for preterm infants includes the perinatal and immediate neonatal periods, the initial hospitalization period including neonatal intensive care, transition to discharge, and from discharge through the first year of life. Care issues are sometimes lifelong. Advances and achievements of the past 20 years, particularly during the perinatal period and in neonatal intensive care, have resulted in significant increases in survivability of even the smallest and least mature infants. Challenges remain, particularly in establishing evidence-based standards of nursing practice in areas such as transition to oral feedings, breastfeeding in the intensive-care nursery, and developmentally based care, and in reducing short- and long-term morbidities in children born prematurely. This article illustrates achievements and challenges across the spectrum of care for preterm infants in the 1st year of life.

Is paternal age associated with an increased risk of low birthweight, preterm delivery, and multiple birth?

OBJECTIVE

To determine if paternal age elevates the risk of low birthweight (< 2500g, LBW), preterm birth (< 37 weeks gestation), and multiple gestation among mothers whose age does not predict an elevated risk.

DESIGN/METHODS

Population data on birth outcome, maternal age and paternal age was obtained from Alberta Health and Wellness for all births 1990-1996.

RESULTS

Among women aged 25 to 29, regardless of parity, there was no linear relationship between paternal age and preterm birth or LBW. However, multiple birth rates increased with increased paternal age (p < 0.01). Among singleton births, advanced paternal age (>50 years) increased the risk of LBW and preterm birth (p < 0.05).

CONCLUSIONS

Paternal age is not a risk factor for LBW or preterm delivery among low risk women. The increased risk of multiple birth with increased paternal age, regardless of parity, requires confirmation among other populations.

Posttraumatic stress symptoms in mothers of premature infants

OBJECTIVE

To examine mothers' responses to having a premature infant in the neonatal intensive-care unit and to determine the degree to which they appear similar to a posttraumatic stress response.

DESIGN

Mothers were enrolled in this descriptive, correlational study shortly before the infant was discharged from the hospital. Data were collected at enrollment and when the infant was 6 months old, corrected for prematurity.

PARTICIPANTS

A convenience sample of 30 mothers of high-risk premature infants.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

A semistructured interview of the mothers was conducted at 6 months corrected age. Interview responses were analyzed to identify three symptoms related to posttraumatic stress disorder: re-experiencing, avoidance, and increased arousal. Other measures focused on maternal psychological well-being--neonatal intensive-care unit stress, depressive symptoms, and worry about the infant--and demographic characteristics. Infant illness severity included birth weight, length of mechanical ventilation, multiple birth, and the severity of neurological insults.

RESULTS

All mothers interviewed had at least one posttraumatic symptom, 12 had two, and 16 had three symptoms. Twenty-six mothers reported increased arousal; re-experiencing and avoidance were reported by 24 mothers each. The number, but not the type, of posttraumatic stress symptoms was related to maternal psychological well-being. Maternal demographic characteristics, except marital status, and infant illness severity, were unrelated to posttraumatic stress symptoms.

CONCLUSIONS

These mothers appeared to be experiencing emotional responses similar to posttraumatic stress reactions at 6 months after their child's expected birth date. Since maternal emotional responses may affect the parenting of premature infants, additional nursing research is needed provide a basis for interventions with these highly vulnerable mothers and infants.

Challenges mothers identify in bottle feeding their preterm infants

PURPOSE

To describe the challenges mothers identify in bottle feeding their preterm infants prior to discharge from the NICU.

DESIGN

Mothers bottle fed their infants in the NICU while being videotaped. Following the feeding, a semifocused interview was conducted with the mother using playback of the videotaped feeding to enhance exploration of the experience of feeding.

SAMPLE

The participants were 22 mothers of preterm infants (< or = 1,500 grams).

MAIN OUTCOME VARIABLE

Mothers' challenges in feeding preterm infants.

RESULTS

Mothers identified three major categories of challenge: ensuring safety during the feeding, ensuring adequate intake of calories, and advancing the feeding plan once home. Mothers described strategies they used to meet these challenges and discussed the implications some of these strategies held for them.

Teaching new mothers: priorities of nurses and postpartum women

OBJECTIVE

To identify the most important content areas to include when teaching postpartum women, either in the hospital or at home, from the perspective of both nurses and postpartum women.

DESIGN

Descriptive design using scaled response surveys.

SETTING

Data for nurses were collected through mailed surveys. Data for new mothers were collected in the hospital within 24 hours after delivery and through mailed surveys.

PARTICIPANTS

Seventy-one registered nurses who provided in-hospital maternity nursing care; 53 registered nurses who provided postpartum follow-up home care visits; and 103 low-risk postpartum women.

MAIN OUTCOME MEASURES

Perceived importance of teaching topics related to care of mothers and their newborns. Comparisons between responses of nurses and new mothers were analyzed.

RESULTS

Statistically significant differences were noted between the perceptions of nurses and new mothers regarding the priority of teaching content for new mothers. Nurses give priority to teaching about infant care, whereas new mothers give priority to their own care.

CONCLUSIONS

These data suggest that new mothers may have opinions that differ from those of nurses as to what is important to learn about caring for themselves and for their newborns during the early postpartum period.

Postpartum teaching priorities: the viewpoints of nurses and mothers

OBJECTIVE

To compare mothers' and nurses' perceptions of postpartum learning needs and effective teaching modalities.

DESIGN

Cross-sectional research design. Mothers were given a questionnaire during their postpartum stay to rate how important it was for them to learn about 44 maternal-infant topics before discharge. Nurses rated similar items on the basis of their perception of what is most important for mothers to learn during their postpartum stay.

SETTING

Postpartum units in six hospitals that are part of a large midwestern health care system.

PARTICIPANTS

English-speaking women who delivered either vaginally or by cesarean section without complications and the nurses on their postpartum units.

MAIN OUTCOME MEASURES

Identification of preferred topics and methods for postpartum teaching.

RESULTS

Mothers and nurses agreed that topics related to immediate physical health needs were most important. Unmarried mothers considered topics related to personal care and mobility as particularly important. First-time mothers rated more topics as important than did experienced mothers. Individual teaching was rated most effective by both groups. Classroom teaching and the use of audiovisual media were considered less effective.

CONCLUSIONS

This study supports postpartum education that focuses on the physical needs of mothers and infants, as well as individual teaching models. The special learning needs of new mothers, including those who are not married, must be considered.

Parenting the prematurely born child: pathways of influence

Recognizing the importance of parents in the lives of preterm infants, investigators and clinicians have increasingly focused on the needs of parents during the period when their infant is hospitalized in a neonatal intensive care unit and the impact of this experience on their subsequent parenting. The purpose of this report is to summarize research findings from over two decades of research, present a framework for understanding the various influences on parents of prematurely-born children, and suggest clinical interventions that are important in helping parents both in the hospital and after discharge.

Mastery of stress in mothers of preterm infants

PURPOSE

To explore the relationships among stress, social support, mastery, and depression.

DESIGN

Descriptive correlational study.

SETTING

60-bed, Level 3 NICU in an urban medical center in a Mid-Atlantic state.

PARTICIPANTS

31 mothers who delivered infants born between 26 and 36 weeks gestation. Inclusion criteria included no maternal illness or complications requiring hospitalization beyond four days, and no report of a recent major stressful life event other than the birth of the child.

MAJOR OUTCOME MEASURES

The Mastery of Stress Instrument, the Account of Social Resources Inventory, and the Center for Epidemiologic Studies-Depression Scale.

RESULTS

Social support was positively related to mastery and inversely related to depression.

CONCLUSIONS

Mothers of preterm infants experienced significant levels of stress and depression in the early postpartum period.

The transition to home for mothers of healthy and initially ill newborn babies

Mothers' difficulties with the transition of their baby from hospital to home have been studied for several years. An examination of a number of studies from the USA, Canada, and the UK has shown a remarkable similarity in the findings despite the demographic and cultural differences in the sample characteristics. It appears, then, that maternal responses to the transition to home are more tied to the experience than to the setting. The purpose of this paper is to place these findings within a framework that would provide a means for midwives and nurses to help mothers make this transition more comfortably and confidently than in the past. The framework chosen is the Transition Model as developed by Kenner (1988). This model suggests the problems with transition to home can be addressed under the following categories: 1. information needs; 2. grief; 3. parent-child development; 4. stress and coping; 5. social support.

Major concerns of women after cesarean delivery

OBJECTIVE

To identify women's major physiologic, psychologic, and life-style concerns at 2 and 8 weeks after cesarean delivery.

DESIGN

Descriptive study with open-ended interviews.

SETTING

Large urban hospital affiliated with a major university.

PARTICIPANTS

One hundred six women who had unplanned cesarean deliveries and delivered live, full-term neonates. The mean maternal age was 28.7 years.

MAIN OUTCOME MEASURES

The major physiologic, psychologic, and life-style concerns.

RESULTS

Seven women reported no concerns at both data points. The number of physiologic concerns that the women expressed decreased markedly from 2 to 8 weeks postdelivery, but the number of psychologic and life-style concerns did not.

CONCLUSIONS

These findings reinforce the need for prenatal teaching and postnatal follow-up regarding these concerns.

Parent Preparation for the NICU-to-Home Transition: Staff and Parent Perceptions

Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided.

Anxiety and depression in mothers of low birthweight and very low birthweight infants: birth through 5 months

The purpose of this study was to compare two common psychologic stress responses, anxiety and depression, in 27 mothers of very low birthweight (VLBW; less than or equal to 1500 grams) preterm infants and 35 mothers of low birthweight (LBW; 1501-2500 grams) preterm infants from the time of the infant's birth until the infants reached 5 months adjusted gestational age. There were significant differences in the patterns of anxiety and depression experienced by mothers of LBW and VLBW infants over time. Mothers of VLBW infants had higher anxiety and depression until 2 months adjusted gestational age while mothers of LBW infants had higher anxiety and depression at 3 and 4 months. Nursing interventions designed to decrease stress during the first postpartal week and to counsel mothers about patterns of anxiety and depression they may experience over time may be useful.