Parents' experiences of caring for preterm infants after discharge with grandmothers as their main support

Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana

BACKGROUND

Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.

METHODS

A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.

RESULTS

Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.

CONCLUSION

A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.

Family-Focused Nursing Research in WHO Afro-Region Member States: A Scoping Review

Although family nursing research has become an important focus for over the past 20 years, the evolution and extent of family nursing research in the World Health Organization (WHO) Afro-regions is less explored. The purpose of this scoping review was to map the evidence of family-focused nursing research using the Joanna Briggs Institute Scoping Review methodology. A systematic electronic search of articles was carried out for the period January 1, 2000 to December 31, 2020. The review process culminated in 85 articles, evidencing an increase in publications particularly in 2019 (n = 12). Eighteen countries were involved, with the Southern African region contributing 52% of the studies. Family members were predominantly described as parents, siblings, and children, with the most focused area of study being family experiences (n = 52). The majority of studies (n = 59) used qualitative methodologies. Despite the recent increase in family-focused nursing research in the WHO Afro-regions, further qualitative research, including more complex methodologies and interventions are still required to build contextualized evidence-based family-focused nursing.

Psychosocial factors associated with mother-infant bonding in Indonesian samples

BACKGROUND

Mother-infant bonding is an important factor that supports an infant's socio-emotional development. Therefore, every family member should acknowledge these processes, especially in an extended family set-up like in Indonesia. The general study objective was to predict several socio-demographic factors associated with mother-infant bonding in Indonesian samples.

METHOD

This is a cross-sectional study. The participants included 168 mothers who had infants aged 0 to 36 months and willingly joined the study by signing the informed consent form. The Indonesian version of mother-infant bonding scale and a socio-demographic questionnaire were administered to all mothers. Logistic regression was applied to identify the socio-demographic factors that had any association with the mother-infant bonding scale. The data were analyzed using the SPSS program version 21 for Mac.

RESULTS

The study showed that 13.1% of the participants were categorized as having a moderate-to-high level of impaired mother-infant bonding. Logistic regression analysis showed that vaginal or normal delivery mode was 4.07 (95% CI [1.27, 13.09]) times more likely to exhibit low levels of impaired mother-infant bonding compared to a cesarean section. The model explained 18.6% (Nagelkerke R²) of the variance in impaired mother-infant bonding and accurately classified 86.9% of cases.

CONCLUSION

The findings support prior studies that have been conducted in several countries. Psychoeducation on supporting mother-infant bonding may consist of several topics, such as the advantages of vaginal delivery mode and the importance of family support. It may be delivered in the early adulthood period and, hopefully, basic knowledge during those periods may help strengthen the understanding of mother-infant dyad issues among all family members.

Experiences of families and health professionals along the care continuum for low-birth weight neonates: A constructivist grounded theory study

AIMS

To explore the experiences of health professionals and families concerning supporting low-birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care.

DESIGN

A constructivist grounded theory.

METHOD

Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis.

RESULTS

The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important.

CONCLUSION

To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non-linear faction. This can help LBW infants to thrive and to reach their full developmental potential.

IMPACT

The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context-tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families.

PATIENT OR PUBLIC CONTRIBUTION

Caregivers and providers participated by granting in-depth interviews. Care providers further contributed through their feedback on preliminary findings.

Socio-family support for parents of technology-dependent extremely preterm infants after hospital discharge

Parents of extremely preterm infants (<28 weeks of gestation) report high levels of stress and anxiety related to daily needs after hospital discharge. Social support has a significant role in reducing the negative psychological impact of preterm birth and parents' adaptation to caregiving. We conducted a hermeneutic phenomenological study using Gadamer's approach to explore and describe the experiences of parents of technology-dependent extremely preterm infants of socio-family support after hospital discharge. The study was conducted in four several Spanish organizations for families with preterm infants. It includes 17 semi-structured interviews (12 mothers and 5 fathers). Three main themes emerged from the analysis: post-discharge formal support for extremely preterm infants and families, home neonatal care: family support, and a thread of hope: parent-to-parent support. The parents' main support resources to deal with everyday difficulties are healthcare professionals, their partners, grandmothers, and peer parents of extremely preterm infants. The findings may be used to guide healthcare professionals in the creation of a support program according to preferences and needs of parents.

Parents' friends and families in neonatal intensive care units: A cross-national qualitative study on staff perceptions and experiences

AIMS AND OBJECTIVES

This study aimed to explore staff attitudes and experiences of parents' friends and families' social presence and involvement in neonatal intensive care units (NICUs).

BACKGROUND

In NICUs, parents need emotional and practical support during infant hospitalisation. Friends and families of parents may constitute the most significant providers in this support, but few studies are available on when and how these 'important others' can be present and involved.

DESIGN

This qualitative descriptive study was based in the philosophical tenets of naturalistic inquiry.

METHODS

Seven focus groups were conducted where 67 staff from Denmark, Finland, Iceland and Sweden participated. Data were analysed using thematic analysis. The study was reported following the COREQ guidelines and checklist.

RESULTS

The overarching theme showed that 'important others' were an unaddressed group of potential supporters in the periphery. The five identified themes described how staff recognised 'important others' as the parents' territory, but that 'important others'' presence and involvement needed to be negotiated with staff. Although the staff regarded 'important others' as necessary for parents' emotional, practical and social support, they felt less obligated to support them as part of their work remit. The staff also felt that inclusion of 'important others' was an essential step forward in achieving family centred care.

CONCLUSIONS

The findings indicate that 'important others'' involvement was primarily guided by proactive parents and unit care culture rather than by staff's formal written guidelines or guidance. Single-family rooms seemed to enhance the presence and involvement of 'important others'.

RELEVANCE TO CLINICAL PRACTICE

There is a need for more staff resources to enable and support the participation of 'important others'. Parents need to be included during the development of policies to provide their experiences. Finally, more research is needed on what parents wish from their 'important others'.

A Study of Maternal Competence in Preterm Birth Condition, during the Transition from Hospital to Home: An Early Intervention Program's Proposal

The study was conducted with 104 mothers (average age 32.5 years, SD 6.1) of preterm infants (very and moderately preterm but still healthy) to monitor the perceived maternal role competence from the time of hospitalisation to post-discharge, in order to define an intervention program to support mothers during this transition. A targeted Q-Sort tool (Maternal Competence Q-Sort in preterm birth) was applied at two different times as a self-observation tool for parenting competence in neonatology. A tendency towards dysregulation of the maternal role competence was detected, mainly in terms of low self-assessment and was found to worsen during post-discharge, particularly with regard to caregiving ability. This study suggests the importance of accompanying parenting competence in preterm birth conditions, not only during hospitalisation in the Neonatal Intensive Care Unit (NICU) but also following discharge in order to promote the development of premature infants. This paper reports in the last part a specific integrated psychoeducational intervention program (psychologist and nurses), which we defined precisely in light of the suggestions offered by the study data on perceived maternal competence created with the Q-sort.

Grandmothers - a neglected family resource for saving newborn lives

Across the globe, the well-being of newborns is significantly influenced by the knowledge and practices of family members, yet global health policies and interventions primarily focus on strengthening health services to save newborn lives. Predominant approaches to promote newborn survival in non-western cultures across the Global South are based on a western, nuclear family model and ignore the roles of caregivers within wider family systems, whose attitudes and practices are determined by culturally prescribed strategies. In this paper, I review evidence of a neglected facet of newborn care, the role and influence of senior women or grandmothers.

Based on a family systems frame, I reviewed research from numerous settings in Africa, Asia and Latin America that provides insight into family roles related to newborn care, specifically of grandmothers. I identified primarily published studies which provide evidence of grandmothers’ role as culturally designated and influential newborn advisors to young mothers and direct caregivers. Research from all three continents reveals that grandmothers play similar core roles in newborn care while their culturally specific practices vary. This review supports two main conclusions. First, future newborn research should be conceptualised within a family systems framework that reflects the structure and dynamics of non-western collectivist cultures. Second, newborn interventions should aim not only to strengthen health services but also influential family caregivers, particularly grandmothers and the indigenous social support networks of which they are a part, in order to improve family-level newborn practices and save newborn lives.

Mothers' experiences of caring for preterm babies at home: qualitative insights from an urban setting in a middle-income country

Background

Preterm delivery is the birth of a baby before 37 weeks of gestation. This global phenomenon is a critical issue of concern especially in developing countries that are resource-constrained when it comes to the management of preterm babies. Complications associated with prematurity contribute significantly to under-five mortality and are linked with feelings of despair, grief, and anxiety among mothers.

Methods

This was a qualitative descriptive study in an urban setting in the Greater Accra region of Ghana. Eleven mothers whose babies had been discharged from the neonatal intensive care unit in a major hospital and resided in Accra were interviewed in their homes using a semi-structured interview guide. Data were audiotaped, transcribed verbatim, and analyzed inductively by content analysis.

Results

All the mothers had formal education and the mean maternal age was 27.9 years. The majority of the mothers were multiparous. The gestational age at birth ranged from 32 to 34 weeks and the average birth weight of their babies was 1.61 kg. Four major themes emerged which included: Around the clock care; mothers’ self-perceptions and attitudes of significant others; mothers’ health and wellbeing; and support. Most of the mothers experienced physical exhaustion from the extra demands involved with care, had negative emotions, and unmet social needs.

Conclusions

The findings indicate that home management of preterm babies poses multiple stressors and is associated with poor psychological and physical wellbeing among mothers. Hence, the need for extensive education and identification of other social support systems to augment facility-based care for mothers and their preterm babies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03872-9.

Ações de cuidado e necessidades essenciais de prematuros após a alta hospitalar: revisão de escopo

Resumo Objetivo identificar e analisar as ações de cuidado às crianças nascidas prematuras, após a alta hospitalar, realizadas pelos familiares e profissionais de saúde. Método revisão de escopo, desenvolvida em dezembro de 2019, segundo as orientações do Joanna Briggs Institute e do guia internacional PRISMAScR. Foram investigados estudos originais, publicados em inglês, espanhol ou português, de 2013 a 2019, nas bases CINAHAL, Medline, LILACS, Cochrane, Scopus, Web of Science. Os 21 artigos incluídos foram submetidos à análise direcionada de conteúdo apoiada pelo referencial das necessidades essenciais das crianças. Resultados predominaram ações para proteção física e segurança (20 artigos), comunidades estáveis e amparadoras (dez artigos), seguidas de relacionamentos sustentadores contínuos (seis artigos), experiências que respeitem as diferenças individuais (quatro artigos) e experiências adequadas ao desenvolvimento (dois artigos). Ações para o estabelecimento de limites, organização e expectativas não foram identificadas nos estudos. Conclusões e implicações para a prática as ações de cuidado contemplam, principalmente, a dimensão física. Ao considerar o cuidado integral e os achados desta revisão são necessários avanços nas ações para o atendimento de outras dimensões da vida dos prematuros como a emocional e a social.

Sociocultural Practices Affecting the Care of Preterm Infants in the Ghanaian Community

Introduction

Although culture is an integral part of health, there is scarcity of evidence on the influence of culture on caregiving experiences of parents of preterm infants. The aim of this study was to explore the influence of sociocultural practices on caring for preterm infants in the Ghanaian community.

Method

Narrative inquiry was utilized to explore the influence of sociocultural practices on the care of preterm infants from 21 mothers, 9 fathers, and 12 household members. Data were collected through face-to-face semistructured interviews and observations at participants’ homes.

Results

Analysis of data resulted in three threads/themes—respect for the elderly, use of herbal medicines, and communal living.

Discussion

Community and extended family members have great influence on the care of preterm infants. Traditional herbal medicines are considered effective in treating traditional illnesses among preterm infants. Understanding the influence of culture on the care of vulnerable preterm infants in the community is essential in developing interventions for infant survival.

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.