Fathers' support to mothers of medically fragile infants

Maternal perception of spousal support in raising children with developmental disability in the context of family and child variables

OBJECTIVE

The purpose of this study was to examine the relationship between the variables of mental, physical, and emotional problems in children with developmental disabilities (DDs) and the spousal support perceived by the mothers of those children.

METHODS

One hundred forty-three children diagnosed with autism spectrum disorder (ASD, n:43), intellectual disability (ID, n:28), cerebral palsy (CP, n:47), or Down syndrome (DS, n:25) were included in this study. The support that mothers received from their spouses was evaluated using the Spousal Support Scale (SSS). Aggressive behavior in the children was evaluated using the anger-aggression subscale of the Social Competence and Behavior Evaluation Scale (SCBE-30). The data obtained were then subjected to statistical comparisons.

RESULTS

Multiple comparisons revealed no significant difference between the DD diagnosis groups (ID, CP, ASD, and DS) in terms of spousal support or spousal support sub-dimension scores (p > 0.05). Significant negative correlation was found between anger-aggression subscale scores and SSS sub-parameters (emotional support r = -0.315 p < 0.001, financial and informational support r = -0.285 p < 0.001, appreciation r = -0.299 p < 0.001, social support r = -0.381 p < 0.001, and spouse support score r = -0.389 p < 0.001).

CONCLUSION

Children's anger-aggression levels were adversely affected by a lack of spousal support for their mothers.

Personality traits and subjective well-being among fathers of preterm infants in Taiwan: a cross-sectional study

OBJECTIVE

This study examined the association of personality traits and paternal/infant background characteristics with subjective well-being (SWB) among fathers of preterm infants.

BACKGROUND

While studies of parental care of preterm infants have focused on mothers or both parents, studies focusing specifically on fathers are relatively rare. In this study, we provide new information on the personality traits and paternal/infant background characteristics and their association with SWB among fathers of preterm infants.

METHODS

This study used a cross-sectional design. Participants included fathers of preterm infants hospitalised in the neonatal intensive care unit, neonatal intermediate care nursery, or postpartum ward of a medical centre in northern Taiwan within 5 days of birth. The Personality Inventory Scale and Subjective Well-being Scale were administered and background characteristics of fathers and preterm infants were measured.

RESULTS

A total of 104 fathers participated, of whom 73.1% showed a moderate level of SWB. Fathers with higher extraversion and openness exhibited higher SWB, while fathers with higher neuroticism exhibited lower SWB. SWB was also predicted by age, infant weight, family structure, and paternal education level. These factors cumulatively accounted for 48% of the variance in SWB.

CONCLUSION

Fathers' SWB was associated with extraversion, openness, neuroticism, age, education, family structure, and infant weight. The personality traits of fathers should be considered when developing plans for family support after following preterm infant birth. In addition to focusing on maternal well-being, programmes to increase paternal well-being would benefit the families of preterm infants.

A scoping review of parental experiences caring for their hospitalised medically fragile infants

AIM

To synthesise and summarise evidence from published research articles regarding parental experiences caring for their hospitalised medically fragile infant.

METHODS

We searched four electronic databases in April 2018 using three main concepts individually and in combination: infant, medically fragile, parents. We examined articles about experiences of parents caring for the medically fragile infant in a hospital setting. We conducted thematic analysis on the 34 included articles.

RESULTS

Parents experienced high rates of depressive symptoms, depression, stress, anxiety, distress and post traumatic stress. Parent-infant interactions were disrupted. Parents experienced loss and worry in response to the diagnosis of their infant, which altered or delayed parental role attainment. Supports and coping were key for parents to manage their stress.

CONCLUSION

Parents of medically fragile infants experience multiple stressors, elevated levels of mental health difficulties, trouble attaining their parental role and often struggle to cope. Development of interventional research is needed to test targeted strategies aimed at reducing parental stress and mental health difficulties. Interventions should include: screening for parental mental health, psychological support, healthcare professional education, strategies to enhance parent-infant interactions and improved relationship competencies among healthcare professionals.

The effect of narrative writing on fathers' stress in neonatal intensive care settings

Objective: This study was conducted to examine the effect of narrative writing on fathers' stress in the Neonatal Intensive Care Units (NICUs) during infants' hospitalization.Methods: A quasi-experimental study was conducted among two groups of fathers with preterm infants in the NICUs of two teaching hospitals of Gorgan University of Medical Sciences. Pre- and post-tests were administered to a sample size of 70 during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods.Results: The mean total stress score was 74.05 ± 17.39 in the control and 80.11 ± 15.82 in the intervention group on the 3rd day, suggesting no significant difference. In other words, both groups had a similar stress level before the intervention (p-value = .13, t = 1.52). However, the mean total stress score was 85.45 ± 16.91 in the control group and 48.00 ± 10.49 in the intervention group on the 10th day, suggesting a significant reduction in the stress level in the intervention group following the intervention (p-value = .001, t = -11.01).Conclusion: According to the findings, the narrative writing may be considered as an efficient supportive intervention to reduce the fathers' stress in the NICUs. However, more research is needed to justify its implementation.

NICU infant health severity and family outcomes: a systematic review of assessments and findings in psychosocial research

Many infants (7-15%) spend time in the neonatal intensive care unit (NICU) and continue to experience medical issues after discharge. Family psychological responses range widely depending on burden of care, access to resources, and parental characteristics. The current systematic review examined how infant health severity is assessed and related to family psychological (e.g., mental health) and social (e.g., parent-infant attachment) outcomes. Seventy articles were deemed relevant. Infant health was operationalized in several ways including validated assessments, indices of infant health (e.g., diagnosis, length of stay), or novel measures. Parents of infants with increased medical complications reported greater family impact, increased stress, and more intrusive parenting style. A validated assessment of infant health that utilizes parent report is warranted to allow for more accessible and easily disseminated research across medical centers. Understanding NICU infant health severity and family outcomes can be used to identify families at risk for negative psychosocial sequelae.

The relationships between father involvement and parental acceptance on the psychological adjustment of children and adolescents: The moderating effects of clinical status

This study analyzes how a child's clinical condition modifies the relationship of father involvement, parental (fathers and mothers) acceptance and the child´s psychological adjustment, including the internalizing and externalizing problems. The cohort studied was composed of 226 subjects (61.94% males) with a mean age of 14.08 years, of which 113 children were from an incidental clinical sample and 113 from the general population. Both groups were matched by sex, age and family status, and the data show that the same structure of parent-child relationships that predict the child´s psychological adjustment can be accepted for both the clinical and non-clinical groups of children. However, the intensity of the relationships between the variables father involvement, parental acceptance and the child´s outcomes differed in function of the child's clinical status. Specifically, in the clinically-referred sample compared to non-clinical sample father involvement had a stronger effect on the children´s internalizing (but not the externalizing) problems and on their global psychological adjustment via their perceived maternal acceptance. The role of father involvement in the family relationships of clinical children is discussed. This study provides important evidence to support the need for enhanced paternal participation in the intervention programs for families.

Motivations and Features of Co-Parenting an Infant With Complex Congenital Heart Disease

This study described co-parenting motivations and quality of co-parenting features for parents of infants with complex congenital heart disease (CCHD), including differences over time by illness severity. Existing transcripts of parenting experience at infant age 1 and 12 months for 23 parent couples were analyzed using directed content analysis. Data were quantitized for additional description. Six co-parenting motivations and five co-parenting features were identified. Two co-parenting motivations had not been previously described: Developing the Co-Parenting Relationship and Maintaining the Couple Relationship. Variability in quality of co-parenting features was evident. However, the majority of parents showed high ratings. Motivations and quality of co-parenting features changed over time and were related to illness severity. Our findings increase the understanding of what parents are working on as a couple to parent an infant with CCHD and the quality of this co-parenting. Several questions for further study are presented.

Supporting of the Fathers to Visit Their Infants in Neonatal Intensive Care Unit Decreases Their Stress Level: A Pretest-Posttest Quasi-Experimental Study

It is known that fathers whose infants are hospitalized in NICUs (Neonatal Intensive Care Units) are severely stressed. This study was conducted for the purpose of determining the effect of supporting and visiting infants in NICUs on stress levels of Turkish fathers. This was a pretest-posttest quasi-experimental study. The population of the study consisted of 47 fathers who had their infants receiving treatment in NICU at a state hospital in the eastern Turkey and agreed to participate in the study. The data were collected by using "Father-Infant Introductory Information Form" and "Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU". When comparing the PSS:NICU total mean scores of the fathers before and after interventions; it was determined that their mean scores were higher before visits compared to those obtained after interventions and the difference between them was significant at advanced level. It was found that the fathers visiting and supporting their infants in NICUs had the decreased stress levels. It is a useful nursing intervention to support fathers to visit their babies in NICUs and establish environments where they could spend time with their babies.

Experiences of fathers shortly after the birth of their preterm infants

OBJECTIVE

To explore the experiences of fathers shortly after the birth of their preterm infants.

DESIGN/METHOD

A focused ethnography conducted over 33 months (2003–2006) in the neonatal intensive care unit (NICU) of a large U.K. National Health Trust (NHS) teaching hospital. Data were collected through participant observation, in-depth interviews with fathers (n = 10), and an ethnographic survey distributed to NICU staff (n = 87). Practices and relationships with fathers were concurrently analyzed thematically through the conceptual perspective of emotion work.

FINDINGS

Fathers' emotional reactions to their experiences were described in three themes: emotional withdrawal and control, stereotyping, and mixed feelings. Fathers' emotional behaviors were governed by complex, culturally determined conventions and expectations.

CONCLUSIONS

Fathers engaged in considerable effort to manage their emotions as they attempted to reconcile the tension between what they wanted to feel and what they thought others expected them to feel. The results of this study support the view that focusing on emotional externalities alone tends to underplay the amount of emotion work carried out by less expressive individuals; this "silent emotion work" was characteristic of the fathers in this study.

The experience of premature birth for fathers: the application of the Clinical Interview for Parents of High-Risk Infants (CLIP) to an Italian sample

Aim: The study explored fathers’ experience of premature birth during the hospitalization of their infants, analyzing levels of depressive and anxiety symptoms as compared with mothers. Moreover the Italian version of the Clinical Interview for Parents of High-Risk Infant (CLIP) was tested through confirmatory factor analysis.

Methods: Couples of parents (N = 64) of preterm infants (gestational age < 37 weeks) were administered a socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the CLIP after the admission to the Neonatal Intensive Care Unit (NICU).

Results: Significant levels of anxiety and depressive symptoms and high percentages of subjects above the corresponding risk thresholds were found among fathers and mothers with higher scores among the latters. Confirmatory factor analysis of the CLIP showed an adequate structure, with better fit for mothers than for fathers.

Conclusion: Results highlighted the importance for nurses and clinicians working in the NICU to consider not only the maternal difficulties but also the paternal ones, even if these are often more hidden and silent. In addition the CLIP may be considered an useful interview for research and clinical purposes to be used with parents of high-risk infants.

Paternal and maternal concerns for their very low-birth-weight infants transitioning from the NICU to home

This study examines qualitatively the concerns and coping mechanisms of fathers and mothers of very low-birth-weight (VLBW; <1500 g) neonatal intensive care unit (NICU) infants as they transition to home from the NICU. In-depth, semistructured phone interviews were conducted with a sample of fathers and mothers of VLBW NICU infants in the Chicago area who had transitioned home, and parental concerns were examined during the transition to home. Phone interviews lasting 30 to 60 minutes were transcribed verbatim, and all interviews were coded using content and narrative analysis. Twenty-five parents (10 fathers, 15 mothers) of 16 VLBW infants who had an average gestational age of 29.5 weeks and an average NICU stay of 58.38 days completed the interview. Overriding concerns included pervasive uncertainty, lingering medical concerns, and partner-related adjustment concerns that differed by gender. A variety of resilient coping methods during this stressful transition are also described. Fathers and mothers of VLBW NICU graduates have evolving but often differing concerns as they transition from the NICU to home. Many of these concerns can be addressed with improved discharge information exchanges and anticipatory guidance. Supporting parents during this stressful and often difficult transition may lead to decreased family stress, improved care, and better infant outcomes.

Parental perceptions and experiences after childbirth: a comparison between mothers and fathers of term and preterm infants

BACKGROUND

Parents experience a lot of positive and negative feelings and emotions after birth. The main purpose of this study was to compare perceptions and experiences of mothers and fathers with term, moderately and very preterm infants.

METHODS

We included 202 infants with both parents, divided into three groups: 1) term infants (≥ 37 weeks' gestation), 2) moderately preterm infants (≥32-<37 weeks' gestation) and 3) very preterm infants (< 32 weeks' gestation). The Clinical Interview for Parents of High-risk Infants (CLIP) was used to examine parental perceptions and experiences in eight areas: 1) Infant's current condition, 2) Course of the pregnancy, 3) Labor and delivery, 4) Relationship with infant and feelings as a parent, 5) Reactions to hospital and staff, 6) Support system, 7) Discharge and beyond, and 8) Quality of narratives during the interview.

RESULTS

The lower the gestational age of the infant, the more negative parental experiences and perceptions were on the following five areas: infant's current condition, pregnancy course, labor and delivery, relationship with the infant, and discharge and beyond. No differences were found between maternal and paternal perceptions on any of the eight CLIP areas.

CONCLUSIONS

Negative parental perceptions and experiences were mainly associated with the gestational age of the infant and not at all with the gender of the parent. These findings resulted in several recommendations to optimize care for parents after preterm birth.

Nursing's contribution to research about parenting children with complex chronic conditions: an integrative review, 2002 to 2012

Children with complex chronic conditions (CCC) need extensive, costly care, usually provided at home by parents. These children often rely on technology to survive or avoid complications. Children with CCC receive nursing care in hospital, community, and home settings. An integrative review of 22 nursing studies, from 2002 to 2012, of parenting for children with CCC was conducted to synthesize nursing research addressing parenting a child with a CCC and identify promising areas for future inquiry and development of supportive interventions and policies. Criteria for sampling in these studies were reviewed, and an updated definition for children with CCC is offered to replace an outdated definition of "medically fragile" children. Findings include the extensive impacts of providing complex care at home, including the tension between the difficulties and recognition of the rewards of providing that care. Disruptions occurred in emotional, role development, social, and moral realms.

Nursing Behaviors which Facilitate the Grief Work of Parents with Premature Infants in Neonatal Intensive Care Unit: A Comparison of Mothers and Fathers

Background:

The birth of a child is an event to be remembered. However, a premature birth may shock the parents and cause their grief. Understanding differences between mothers and fathers can help nurses in providing nursing supports.

Objectives:

This study was performed with the aim of comparing nursing behaviors which facilitate grief work for parents of premature infants hospitalized in the NICU from perspectives of mothers and fathers.

Patients and Methods:

This comparative descriptive design was conducted among 40 pairs of mothers and fathers selected by convenience sampling method. The study was performed in 2011 using the Fordham Scale (1989). Data were analyzed with "wilcoxon ranks test" by using SPSS software version 13.

Results:

The mean scores of nursing behaviors which facilitate grief work were 2.81 ± 0.16 and 2.82 ± 0.29 in the perspectives of mothers and fathers, respectively. The Wilcoxon test did not show any statistically significant difference between mothers and fathers (P = 0.55).

Conclusions:

Despite expectations, provided nursing behaviors in mothers and fathers showed no difference in this study. Therefore, nursing policymakers and directors should take measures in order to provide appropriate services to the parents.

Forgotten parent: NICU paternal emotional response

PURPOSE

To evaluate and compare the presence of perceived paternal stress and depressive symptomatology in fathers of preterm infants over time.

SUBJECTS

Fathers of NICU infants born before 30 weeks of gestation.

DESIGN

Prospective convenience sample.

METHODS

Consenting fathers were given 2 self-report questionnaires: Center for Epidemiologic Studies-Depression Scale (CES-D) and Parent Stressor Scale: Infant Hospitalization (PSS:IH) on 7th (time 1), 21st (time 2), and 35th (time 3) days of life. Objective measurement of illness severity was quantified by Score for Neonatal Acute Physiology. Statistical methods included generalized linear estimating equation and mixed linear modeling.

MAIN OUTCOME MEASURES

Stress and depressive symptomatology in fathers of preterm infants.

RESULTS

Stress scores (PSS:IH) were unchanged over time (P = .62) indicating that fathers (n = 35) remain significantly stressed. Individual subcomponents of stress (parent role alteration, infant appearance/behavior, NICU sights/sounds) also remained constant over the study period (P = .05 for each). Stress scores over time were not modified by demographic characteristics (marriage, education, insurance). Mean depressive symptomatology scores (CES-D) decreased over time (P = .04). The percentage of fathers with elevated CES-D scores (>16) decreased from a baseline 60% but did not diminish between times 2 (39%) and 3 (36%). Parent Stressor Scale: Infant Hospitalization stress scores were correlated with CES-D depressive symptomatology scores (P < .01). Socioeconomic factors influenced initial CES-D scores, but only marriage ameliorated subsequent changes in measurements. Objective measurement of infant illness (Score for Neonatal Acute Physiology) did not influence paternal CES-D or PSS:IH scores.

CONCLUSION

Fathers of premature infants in a medical NICU demonstrated elevated levels of stress that persisted across time for all domains of measured stress. Paternal self-reported stress and depressive symptomatology was independent of infant illness. One third of fathers had persistently elevated CES-D scores. If these findings are representative of general NICU population, then the emotional needs of our fathers are not being fully addressed.

Paternal support and preterm birth, and the moderation of effects of chronic stress: a study in Los Angeles county mothers

Maternal psychosocial stress is an important risk factor for preterm birth, but support interventions have largely been unsuccessful. The objective of this study is to assess how support during pregnancy influences preterm birth risk and possibly ameliorates the effects of chronic stress, life event stress, or pregnancy anxiety in pregnant women. We examined 1,027 singleton preterm births and 1,282 full-term normal weight controls from a population-based retrospective case-control study of Los Angeles County, California women giving birth in 2003, a mostly Latina population (both US-born and immigrant). We used logistic regression to assess whether support from the baby's father during pregnancy influences birth outcomes and effects of chronic stress, pregnancy anxiety, and life event stress. Adjusted odds of preterm birth decreased with better support (OR 0.73 [95%CI 0.52, 1.01]). Chronic stress (OR 1.46 [95%CI 1.11, 1.92]), low confidence of a normal birth (OR 1.57 [95% CI 1.17, 2.12]), and fearing for the baby's health (OR 1.67 [95%CI 1.30, 2.14]) increased preterm birth risk, but life events showed no association. Our data also suggested that paternal support may modify the effect of chronic stress on the risk of preterm birth, such that among mothers lacking support, those with moderate-to-high stress were at increased odds of delivering preterm (OR 2.15 [95%CI 0.92, 5.03]), but women with greater support had no increased risk with moderate-to-high chronic stress (OR 1.13 [95%CI 0.94, 1.35]). Paternal support may moderate the effects of chronic stress on the risk of preterm delivery.

Fathers' experiences in the neonatal intensive care unit: a search for control

OBJECTIVE

This qualitative study aimed at understanding the experiences of fathers of very ill neonates in the NICU.

METHODS

Sixteen fathers of very ill and/or very preterm infants who had been in the NICU for >30 days were interviewed by a male physician. Fathers were asked about their level of comfort with or concerns about staff communication regarding their infant, about accessing information, and about more general perceptions of their experience in the neonatal intensive care unit. Interviews were audiotaped and transcribed for analysis. Coding used content analysis with construction of themes by 3 researchers.

RESULTS

The overarching theme for fathers was a sense of lack of control. Their world view, as a "backdrop" theme, provided context for all of the themes. Four other interrelated subthemes were identified, including information; communication, particularly with the health care team; fathers' various roles; and external activities. Fathers reported that relationships with friends/family/health care team, receiving information consistently, and receiving short written materials on common conditions were ways of giving them support. The fathers said that speaking to a male physician was a positive and useful experience.

CONCLUSIONS

Fathers experience a sense of lack of control when they have an extremely ill infant in the NICU. Specific activities help fathers regain a sense of control and help them fulfill their various roles of protectors, fathers, partners, and breadwinners. Understanding these experiences helps the health care team offer targeted supports for fathers in the NICU.

The influence of maternal and child characteristics and paternal support on interactions of mothers and their medically fragile infants

The influences of maternal characteristics, infant characteristics, and paternal support on maternal positive involvement and developmental stimulation were examined over time in 59 mothers and their medically fragile infants using an ecological framework. Higher maternal education was associated with greater maternal positive involvement. More maternal depressive symptoms, more infant technological dependence, and lower birthweights were associated with less maternal positive involvement at 6 months but greater involvement at 12 months. Higher paternal helpfulness facilitated positive involvement in mothers with low depressive symptoms but not in those with elevated symptoms. Higher maternal education and more depressive symptoms were associated with more developmental stimulation. Thus, maternal interactive behaviors are affected by maternal, infant, and environment factors, and these effects change over time.

Correlates of mother–premature infant interactions

This study's purpose was to examine whether child characteristics, child illness severity, maternal characteristics, maternal psychological well-being, and paternal support influenced interactions between 108 premature infants and their mothers. Mothers with singletons or more infant illness stress showed more positive involvement. Mothers with less infant illness stress, less education, or less participation in caregiving by fathers showed more negative control. First-time mothers and mothers of singletons provided more developmental stimulation. Children of younger and White mothers showed more social behaviors. Less maternal education and shorter period of mechanical ventilation were associated with greater developmental maturity. Greater maternal worry was related to more child irritability. These findings are consistent with the developmental science view that the mother-premature relationship is a complex, reciprocal process.