Parents' Shared Experiences of Separation From Their Newborns After Birth in Denmark

OBJECTIVE

To explore parents' shared experiences of separation from their newborns after birth in Denmark.

DESIGN

Phenomenological hermeneutic design.

SETTING

A NICU in the Capital Region of Denmark.

PARTICIPANTS

Four sets of parents (N = 8) with prematurely born neonates who were admitted to the NICU.

METHODS

We used dyadic interviews for data collection. We applied a phenomenological hermeneutic approach inspired by Ricoeur's theory of interpretation to analyze the data.

RESULTS

Two overarching themes emerged that reflected two distinct temporal phases of separation. Initial separation caused an experience of becoming parents at different paces. Separation based on care needs (i.e., the NICU vs. maternity unit) left parents at the juncture between separation and closeness.

CONCLUSION

Separation from their newborns complicated parents' transitions into parenthood. Their sense of unity was undermined when different units assumed responsibility for the mother and newborn. This challenged family-centered care. Our findings indicate the need to minimize separation through initiatives such as zero separation and couplet care.

Living with a birthmark: Phenomenology of prematurity for mothers in Turkey

BACKGROUND

Mothers of premature infants are in the risk group for having psychological symptoms and attachment-interaction difficulties. Preventing these maternal risks is essential for providing optimal care and health opportunities for infants, consequently improving developmental outcomes.

METHODS

In this study, we aimed to understand how mothers experienced prematurity within four processes retrospectively: (a) the mother's hospitalization after birth, (b) the infant's hospitalization in the Neonatal Intensive Care Unit (NICU), (c) after discharge, and (d) in early childhood. We adopted Max van Manen's phenomenology of practice and interviewed nine mothers whose children were born premature and reached early childhood.

FINDINGS

The themes were as follows: (a) incomplete mother; (b) facing prematurity, uncertainty, natural touch barrier, facing reductive social response, and NICU friendship; (c) being on the alert, a period of complete closure, and fighting with the reductive social response; (d) association to prematurity and (cannot) overcome the difficulties. We expressed the mothers' overall experiences through the metaphor "living with a birthmark." This metaphor represents the longitudinal effects of prematurity. As much as it is apparent and painful at first, it fades over time, and the pain lessens, but the effects of the birthmark remain in early childhood. The birthmark becomes a part of the mother-baby relationship.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Our study contributes to premature infant care and health literature by highlighting the longitudinal experiences of mothers on prematurity.

What is the lived experience of mothers in a Level-IV neonatal intensive care unit?

Rationale

Occupation-based practice in the neonatal intensive care unit may be impacted by a plethora of contextual factors. There is limited literature of the lived experience mothers have with mothering occupations for the care of premature infants in a Level-IV neonatal intensive care unit.

Methodology

A phenomenological design was used to interview mothers of premature infants in a Level-IV neonatal intensive care unit. The eight participants were mothers who had been in the neonatal intensive care unit for at least 1 month. Data was obtained via demographic form, two individual semi-structured interviews for each mother, and fieldnotes.

Results

Thematic analysis yielded five themes and two subthemes which were: unanticipated journey to becoming a mother, emotional rollercoaster, mother’s lost voice, subtheme cultural influences, roadblocks to mothering, unexpected layer to mothering occupations and subtheme support for mothering occupations. Each theme described a mother’s experience with mothering.

Conclusion

There is an importance for neonatal occupational therapists to provide support for mothering occupations for mothers from a variety of demographic and cultural backgrounds. Occupation-based practice in the neonatal intensive care unit continues to need attention for inclusion of all mothers. The findings showed that cultural humility should be practiced in family-centred care in the neonatal intensive care unit.

Parental engagement in early intervention for infants with cerebral palsy-A realist synthesis

BACKGROUND

Emphasis on parental engagement strategies within occupational therapy and physiotherapy early intervention (EI) programmes for infants at high risk of cerebral palsy (CP) has increased. This reflects consensus that increasing parent participation enhances treatment efficacy, potentially improving infant and parent outcomes. However, evaluation of parental engagement in EI is complex. Despite the growing application of parental engagement strategies, aligned with family-centred care practice, theoretical evaluation is currently lacking within the literature. This realist synthesis aimed to identify component theories underlying EI strategies to support parental engagement and to use empirical findings to evaluate how these work in practice.

METHODS

Realist synthesis: Databases Medline, Embase, Amed, CINAHL and PsychInfo were searched (from February 1985 - February 2020); further articles were sourced from reference lists. A data extraction form was used, and a Critical Appraisal Skills Programme tool was used to assess study rigour.

RESULTS

Twenty-six articles were included. Quality of relationships, parent education and intervention co-design were the key themes related to parental engagement strategies. Findings indicate that constructive parent reasoning mechanisms of trust, belief, sense of control, perceived feasibility of home programme delivery and ultimately motivation are linked to the underlying intervention resources afforded by specific strategies (e.g., coaching pedagogy). These responses are precursors to engagement outcomes that include increased parental self-efficacy and adherence. Importantly, parental self-efficacy can initiate a process of change leading to improved parental confidence and anxiety.

CONCLUSIONS

Sensitively designed programme strategies, centred on relational quality between parent, infant and therapist, are fundamental for effective parent connection, involvement and investment within EI for infants with CP.

Mother-Infant Dyadic Synchrony in the NICU Context

BACKGROUND

Dyadic synchrony is a co-constructed social process relating to the back and forth interactions between mothers and infants that are strongly associated with neurodevelopment, self-regulation, and attachment. In the neonatal intensive care unit (NICU), this process may become interrupted because of the physiological state of the infant, the emotional state of the mother, and the physical environment of the NICU.

PURPOSE

In applying Feldman's Biobehavioral Model of Synchrony, this empirical review deconstructs the process of dyadic synchrony in the NICU context and provides a conceptual approach to guide both research and clinical practice.

METHODS

First, we examine the theoretical and empirical literature to explicate the primary structural and biophysiological components of synchrony and relate these constructs to the extant research on premature infants. Next, we synthesize the maternal, infant, and contextual factors that facilitate or inhibit the ontogenesis of dyadic synchrony in the NICU. The final section highlights the state of the science in dyadic synchrony in the NICU including gaps and recommendations for future research.

FINDINGS

An empirical review synthesis presents a visual conceptual framework to illustrate multiple processes that depict maternal, infant, and contextual influences of mother-infant synchrony in the NICU.

IMPLICATIONS FOR PRACTICE/RESEARCH

Despite the challenges posed to mother-infant relationships in the NICU, high-quality mother-infant interactions are possible, dyadic synchrony can emerge, and premature infants can develop secure attachments. Clinicians and researchers can apply this conceptual framework of mother-infant dyadic synchrony in the NICU to promote evidence-based research and clinical practice.

Alberta Family Integrated Care™ and Standard Care: A Qualitative Study of Mothers' Experiences of their Journeying to Home from the Neonatal Intensive Care Unit

Globally, one in ten infants is born preterm. Most preterm infants require care in a level II Neonatal Intensive Care Unit (NICU), which are highly technological critical care environments that can be overwhelming for parents. Alberta Family Integrated Care (AB-FICare™) is an approach to care that provides strategies to integrate parents into their infant’s care team. This sub-study is the first to compare mothers’ experiences in the context of AB-FICare™ and standard care. Semi-structured interviews with mothers from AB-FICare™ (n = 14) and standard care (n = 12) NICUs were analyzed using interpretive description informed by grounded theory methods. We identified a major theme of Journeying to Home with six categories: Recovering from Birth, Adapting to the NICU, Caring for Baby, Coping with Daily Disruption, Seeing Progress, and Supporting Parenting. Mothers in the AB-FICare™ group identified an enhancement to standard care related to building reciprocal trust with healthcare providers that accelerated Journeying to Home.

The experiences of active duty military spouses with advanced degrees in maintaining and advancing their careers

BACKGROUND

Individuals married to active duty military members experience a significantly higher rate of un/underemployment than their civilian counterparts; those with advanced degrees are most impacted. Occupation is central to individual identity and adaptation; therefore, individual occupational struggles can impact family systems. Evidence shows military spouse career concerns impact service member retention, making spouse employment related to national security; however there is limited research on active duty spouses, particularly those with advanced degrees.

OBJECTIVE

This phenomenological study explored the experiences of activity duty military spouses with advanced degrees focusing on maintaining and advancing their careers.

METHODS

Semi-structured face-to-face interviews were used to explore experiences of military spouses with advanced degrees actively seeking to work in their profession. Inductive content analysis was used to derive overarching themes to respond to the research questions.

RESULTS

Four major themes emerged: uniqueness of military life impacts; professional adaptation: flexibility, creativity and reinvention of the professional self; enhanced sense of duty/professional integrity; and need for enhanced forms of career support.

CONCLUSIONS

Military spouses with advanced degrees value and have a right to occupation, including work. Military life presents unique barriers to this. Results have implications for healthcare providers and policy-makers.

Parents' experiences of emotional closeness to their infants in the neonatal unit: A meta-ethnography

BACKGROUND

Physical and emotional parent-infant closeness activate important neurobiological mechanisms involved in parenting. In a neonatal care context, most research focuses on physical (parental presence, skin-to-skin contact) aspects; insights into emotional closeness can be masked by findings that overemphasise the barriers or challenges to parenting an infant during neonatal care.

AIM

To explore existing qualitative research to identify what facilitates and enables parents' experiences of emotional closeness to their infants while cared for in a neonatal unit.

STUDY DESIGN

A systematic review using meta-ethnographic methods. Search strategy involved searches on six databases, author runs, and backward and forward chaining. Reciprocal translation was used to identify and compare key concepts of parent-infant emotional closeness.

RESULTS

Searches identified 6992 hits, and 34 studies from 17 countries that involved 670 parents were included. Three overarching themes and associated sub-themes were developed. 'Embodied connections' describes how emotional closeness was facilitated by reciprocal parent-infant interactions, spending time as a family, and methods for parents to feel connected while physically separated. 'Inner knowing' concerns how knowledge about infant and maternal health and understanding the norms of neonatal care facilitated emotional closeness. 'Evolving parental role' relates to how emotional closeness was intertwined with parental identities of contributing to infant health, providing direct care, and being acknowledged as a parent.

CONCLUSION

Parent-infant closeness evolves and is facilitated by multifaceted biopsychosocial factors. Practice implications include creating private and uninterrupted family time, strategies for parents to maintain an emotional connection to their infant when separated, and neurobiology education for staff.

Finnish Parents' Responsibilities for Their Infant's Care When They Stayed in a Single Family Room in a Neonatal Intensive Care Unit

PURPOSE

To describe parents' perceptions of their responsibilities for their infant's care during admission to a single family room in a neonatal intensive care unit (NICU).

DESIGN AND METHODS

A qualitative study with semi-structured individual interviews conducted at a family-centered level III Finnish NICU in late 2016 and early 2017. The participants were 10 mothers and nine fathers of infants aged from six days to eight months. The data were analyzed with inductive content analysis.

RESULTS

The parents wanted to take responsibility for their infant's care during their stay in a single family room in the NICU, because it prepared them for their infant's discharge. The mothers and fathers reported that their responsibilities supported them as they grew into parenthood and enabled their infants' rights. On the other hand, the parents needed nurses to empower them to commit to, and take, responsibility for their infant's care and share decision making. The nurses also taught the parents caring skills.

CONCLUSIONS

Empowering parents to take responsibility enabled their infant's rights during their stay in a single family room in the NICU. More research is needed about how nurses transfer these responsibilities to parents and how those are connected to the infant's rights and well-being.

PRACTICE IMPLICATIONS

Organizations who provide single family rooms in NICUs need to develop guidelines that facilitate the responsibilities that parents and nurses have to care for the infants. Although parents are the infant's primary caregivers, they depend on nurses to ensure their infant is safely cared for.

Parents' Perspectives: An Expanded View of Occupational and Co-Occupational Performance in the Neonatal Intensive Care Unit

IMPORTANCE

One limitation of occupation-based neonatal practice is the lack of clarity surrounding what parent and infant occupations exist in the neonatal intensive care unit (NICU). Without clear definitions and examples of these constructs, occupational therapists may not recognize or value them as part of practice.

OBJECTIVE

To explore concepts of occupational and co-occupational performance in the NICU and provide richly expanded descriptions of parent and infant occupations in this setting.

DESIGN

Phenomenological study with convenience sampling. Participants engaged in semistructured interviews. Inductive content analysis, in vivo and process coding methods, and cross-case analysis were used. Member checking and expert review of emergent themes were used to ensure authenticity.

SETTING

A metropolitan 48-bed Level 3 NICU with single-family rooms in the midwestern United States.

PARTICIPANTS

Fourteen parents (mean age = 29.7 yr; range = 19-37 yr) volunteered for the study.

RESULTS

Five themes of active occupational engagement emerged: (1) perceiving "they" versus "I"; (2) maintaining proximity; (3) expressing emotions, values, and beliefs; (4) addressing health issues; and (5) analyzing. A matrix framework displayed emergent themes with definitions of parent occupations, infant occupations, and parent-infant co-occupations. Examples of both directly observable and hidden occupations were found at matrix intersections.

CONCLUSIONS AND RELEVANCE

Occupational performance prevalently reflected attempts to balance power differentials and pursue meaningful engagement through observable and hidden participation in caregiving. Findings suggest that beyond typical occupations (e.g., feeding, socializing), neonatal therapists can address the doing, being, and becoming occupations expressed by parents in this study.

WHAT THIS ARTICLE ADDS

Parents described five broad thematic categories of NICU-based occupation and co-occupation, which may be valuable to therapists seeking to strengthen the occupational focus of neonatal intervention. Neonatal therapists may need to advocate for service provision policy change to fully address the observable and nonobservable doing, being, and becoming occupational and co-occupational needs of parents and infants.

Occupational adaptation - analyzing the maturity and understanding of the concept through concept analysis

Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement.Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation.Methods: Four databases were searched using the term 'occupational adaptation' and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept's evolution and analysis of the maturity of its structural features also occurred.Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility.Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility.

Mothering Work and Perinatal Transfer: An Institutional Ethnographic Investigation

BACKGROUND

While maternal or infant transfer is generally the safest course of action when health complications arise, the process of shifting from one hospital to another is stressful for mothers and their infants. There is limited understanding of how institutional processes coordinate patient transfer in ways that increase tensions for women and their families who are trying to navigate the institutional systems during health crises.

METHODS

This institutional ethnographic study explored womens' experience of transfer. Interviews were conducted with a purposive sample of six childbearing women. The analysis highlights tensions and contradictions between patient care and institutional demands and shows how ordinary institutional decision-making practices impacted participants in unexpected ways.

RESULTS

Women experienced uncertainty and stress when trying to convince health-care providers they needed care. Before, during, and after transfer, participants navigated home responsibilities, childcare, and getting care closer to home in difficult circumstances.

CONCLUSION

The effort and skill women need to care for their infants and families as they are transferred is extraordinary. This study offers insight into the resources and support childbearing women need to accomplish the work of caring for their families in the face of perinatal crisis and multiple transfers.

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

RESULTS

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

CONCLUSIONS

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

Clinical relevance of activities meaningful to parents of preterm infants with very low birth weight: A focus group study

Introduction

Parents have a major impact on the outcome of health care of preterm infants. Parents’ engagement in meaningful activities could have an impact on their own health and wellbeing and therefore be relevant in neonatal intensive care. The aim of this study was to explore meaningful activities of parents of very low birth weight (VLBW) preterm infants with the purpose to further the understanding of their clinical relevance and to foster their consideration in clinical practice and research of neonatal intensive care.

Methods

A total of 36 parents of preterm infants born prior to complete 37 weeks of gestation with VLBW (≤1.500 grams) were asked to participate in a focus group interview. Interview transcripts were used to analyse the content of the focus group interviews using meaning condensation method by Steinar Kvale.

Results

Thirty-six parents participated in a total of twelve focus groups. Parents reported that the meaning of certain activities changed due to preterm birth. Meaningful activities, like bathing the baby and gardening, could foster a transition from a feeling of parental immaturity to a feeling of maturity, following health care instructions to possessing health care skills, and a functioning-only state to a balance of activities.

Conclusions

In neonatal intensive care, nurses contribute to delivering parental education and thereby facilitate experiences of being a mature parent and of possessing health care skills. Occupational therapy could be used to help re-engage in meaningful activities and maintain a balance of activities in parents of VLBW preterm infants.

Parents' experiences of neonatal transfer. A meta-study of qualitative research 2000-2017

Transfers of critically ill neonates are frequent phenomena. Even though parents' participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents' experiences of neonatal transfer is lacking. This paper describes a meta-study addressing qualitative research about parents' experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological issues of qualitative studies concerning parents' experiences of neonatal transfer over the course of this meta-study (2000-2017). Meta-theory and meta-method analyses showed that caring, transition, and family-centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta-data-analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified 'wavering and wandering' as a metaphoric representation of the parents' experiences. The findings add knowledge about meta-study as an approach for comprehensive qualitative research and point at the value of meta-theory and meta-method analyses.

Parents' Perspectives of Closeness and Separation With Their Preterm Infants in the NICU

OBJECTIVE

To discover parents' perceptions of closeness to and separation from their preterm infants in the NICU.

DESIGN

Qualitative descriptive.

SETTING

Urban Level III NICU.

PARTICIPANTS

Twenty parents of preterm infants in the NICU.

METHODS

After ethics approval, data were collected with a smartphone application created for this study. Parents recorded their descriptions of moments of closeness and separation over a 24-hour period in the NICU. Data were transcribed verbatim and content was analyzed.

RESULTS

Five themes related to parents' perceptions of closeness and separation were identified: Having a role as a parent: Feeling autonomous and making decisions; Providing for and getting to know the infant: Feeding, holding, and interacting; Support from staff; Reluctantly leaving the infant's bedside; and NICU environment.

CONCLUSION

Autonomy is a key element of a parent's perception of closeness. Staff in the NICU can facilitate autonomy by involving parents in the care of their preterm infants as much as possible to reinforce the parental role. Parents described leaving their infants' bedsides as very difficult.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The acquisition of parenting occupations in neonatal intensive care: A preliminary perspective

Background.

The birth of a preterm infant represents a major crisis for parents that may impact their performance of parenting occupations.

Purpose.

The purpose of the study was to explore the experiences that enable parents to participate in occupations associated with the role of parenting in a neonatal intensive care unit (NICU).

Method.

A paradigmatic analysis of narratives was completed based on interviews conducted with six parents of preterm infants.

Findings.

Six themes were identified: anticipating occupations versus reality, needing emotional resilience, working to reclaim the parental role, navigating the NICU occupation–environment transactions, building and maintaining relationships with staff, and revisioning the future.

Implications.

The use of an occupation-based approach moves parents’ involvement in the NICU beyond basic caregiving occupations. It highlights the importance of providing opportunities for nurturing and caring for their infants in ways that are meaningful to their identity as a parent.