NICU and postpartum nurse perspectives on involving fathers in newborn care: a qualitative study

Parental experience of neonatal pain research while participating in the Parental touch trial (Petal)

ABSTRACT

Parental involvement in neonatal comfort care is a core component of family-centred care. Yet, parents experience a range of positive and negative feelings when providing pain-relieving interventions for their infants. Parents of infants who participated in the Parental touch trial ( Petal ), a multicentre randomised controlled trial investigating the impact of gentle parental touch on neonatal pain, were asked to complete an anonymous survey. This survey aimed to (1) explore parent-reported motivations in deciding to participate in the Petal trial; (2) understand parent-reported experiences related to trial participation; (3) understand parents' willingness to participate in future studies; and (4) evaluate parent-reported feelings while they were delivering a gentle touch intervention either before or after a clinically necessary blood test. One hundred six parents (1 parent per infant) took part in the survey. Primary motivators for participation were altruistic. Parents most frequently reported that they wanted their child to take part in the research because it has a potential benefit to babies in the future and because they wanted to improve scientific understanding. Parents reported that providing gentle touch to their children during painful procedures was associated with positive emotions, such as feeling "useful" (64%) and "reassured" (53%). Furthermore, nearly all parents (98%) were pleased to have participated in the Petal trial and would consider, or maybe consider, participating in further research studies. These results underscore the importance of structuring trials around parental involvement and providing opportunities for parents to be involved in providing comfort to their infants during necessary painful clinical procedures.

Community-based postnatal care model: Catalyst for management of mothers and neonates

BACKGROUND

 Early postnatal discharge is perceived as a factor that contributes to the possibilities of the maternal, neonatal complications and deaths. The implementation of the community-based postnatal care model is crucial to mitigate the morbidity and mortality of postnatal women and neonates during the first weeks of delivery. A community-based postnatal care model was developed for the management of neonates during the postnatal care period in the community.

OBJECTIVES

 The study aims to share the developed community-based postnatal care model that could assist postnatal women in the management of neonates.

METHOD

 Empirical findings from the main study formed the basis for model development. The model development in this study was informed by the work of Walker and Avant; Chinn and Kramer Dickoff, James and Wiedenbach; and Chinn and Jacobs.

RESULTS

 The results indicated that there was no community-based postnatal care model developed to manage neonates. The model is described using the practice theory of Dickoff, James and Wiedenbach elements of agents, recipients, context, process, dynamics and outcomes within the community context of the postnatal care period. The model was further described by Chinn and Krammer following the assumptions of the model, concept definition, relation statement and nature of structure.

CONCLUSION

 The utilisation of the model is critical and facilitates the provision of an enabling and supportive community-based context by primary caregivers for the effective management of neonates.Contribution: This study provides a reference guide in the provision of community-based postnatal care by postnatal women after discharge from healthcare facilities.

Fathers' experiences of caring for children living with cerebral palsy: A qualitative study in a low resourced socioeconomic context, Ghana

BACKGROUND

In Ghana, little is known about fathers' experiences caring for children with cerebral palsy.

PURPOSE

The purpose of this study is to explore a. the caregiving demand and burden on fathers of children with cerebral palsy and b. describe the caregiving consequences and coping strategies of fathers of children with cerebral palsy.

DESIGN AND METHODS

The study utilized an exploratory, descriptive qualitative approach with a sample size of fifteen fathers purposively selected. The study used a semi-structured interview guide to conduct a one-on-one interview with participants. The analysis performed was thematic and content analysis.

RESULTS

The results revealed complexities of care demand and burden; thus, meeting the child's needs resulted in physical and mental exhaustion, frequent hospital visits, and substantial financial implications for fathers.

CONCLUSIONS

We conclude that the family, particularly fathers, need support to embrace the challenging care roles as parents to children with cerebral palsy. It is evident that caring for children is mainly reserved for mothers in the African context. However, the demanding nature of care for a child with a developmental disability requires the involvement of both parents to meet the child's care needs and reduce the caregiver's care burden.

PRACTICE IMPLICATIONS

Health professionals, particularly nurses must initiate and advocate for fathers' active participation in daily childcare. Tailored supportive care for families with children with disabilities in sub-Saharan Africa is required.

Father Groups in the Neonatal Intensive Care Unit: A Supportive Intervention

BACKGROUND

Parents' participation in the neonatal intensive care unit (NICU) reduces length of stay and positively affects infants' psychological, cognitive, and behavioural outcomes. Healthcare professionals in the NICU focus on both parents, but tend to have the main focus on the mother and the infant. Therefore, fathers may experience a lack of support and feel that they are being disregarded in the NICU.

PURPOSE

To study fathers' experiences with father groups during NICU admission with their preterm infant. The father group is a 90-minute intervention based on dialogue between fathers and a male healthcare professional.

METHODS

A qualitative content analysis was conducted using 10 online semistructured interviews with fathers participating in a father group. The study was reported according to the Standards for Reporting Qualitative Research.

RESULTS

The overall theme emerging from our analysis was "Emotional support, encouragement, and an enhanced capacity to deal with the situation and with life in the NICU." This theme emerged from the categories "Meeting with peers and sharing reflections" and "Fathers' territory" based on 5 subcategories.

IMPLICATIONS FOR PRACTICE

Participation in father groups gives fathers recognition for being important as parents in the NICU, improves fathers' mental well-being, and enhances their coping capacity. Father groups support fathers in the NICU and can be integrated into NICU practices and policies to enhance a family-centered approach.

IMPLICATIONS FOR RESEARCH

This study revealed a need for further research to determine whether participation in a father group has a measurable effect on clinical outcomes.

The experience of fathers whose infants were hospitalized in Neonatal Intensive Care Unit in South Korea: A scoping review

PROBLEM

The purpose of this scoping review was to map and organize the previous studies conducted among fathers whose infants experienced admission to neonatal intensive care units (NICUs) in South Korea.

ELIGIBILITY CRITERIA

A scoping review was conducted based on Arksey and O'Malley using the JBI template. The review was described by PRISMA-ScR. The studies were reviewed through five electronic databases (PubMed, CINAHL, Web of Science, RISS and KMbase) since 1996. Each study was analyzed, extracted, and summarized into the following domains: general characteristics (language, design, data collection methods, intervention, data collection site, and time) and fathers' characteristics (types of fathers, mean age, variables related to the fathers, and measurements).

SAMPLE

A total of 290 studies were identified after screening titles and abstracts, and 32 full-text articles were retrieved for eligibility. Finally, 15 articles were included in the review.

RESULTS

Four themes were derived after review: paternal stress, paternal attachment, fathers' adaptation, and fathers' support needs.

CONCLUSIONS

Infants' hospitalization in NICUs causes stress for fathers but they overcome difficulties and play multiple roles as guardians, caregivers, and decision-makers of their spouses and infants over time. Paternal attachment increases significantly after participating in tactile and educational interventions. Fathers rely on nurses and they want to receive support from nurses.

IMPLICATIONS

It is necessary for NICU nurses to understand and support fathers whose infants are hospitalized in NICUs. Medical institutions should provide nursing interventions and education for fathers to relieve their stress, help their adaptation, and improve attachment.

The Response of the Infant to the Father's Voice: An Evidence-Based Review

BACKGROUND

Premature infants are at increased risk for language delays. The auditory system hears sounds at 25 weeks' gestation; therefore, infants in the neonatal intensive care unit (NICU) may miss crucial language exposure during the period when neural pathways for language processing are developing. Supporting the synergistic relationship between fathers and newborns promotes connections through early language to strengthen engagement and promote infant neurodevelopment.

PURPOSE

To determine what is known about preterm infants' response to the male voice.

DATA SOURCES

Three databases and forward searching of reference lists were used to locate articles addressing the clinical question: "What strategies can be used in the NICU to support purposeful language development?"

STUDY SELECTION

Empiric, primary research studies were included if they were published in English without date restriction.

DATA EXTRACTION

The authors evaluated each study's quality using a validated 16-item assessment tool (QATSDD) developed for studies with diverse designs; data were extracted and organized following Garrard's Matrix Method.

RESULTS

The aim of this evidence-based review is to report the way an infant responds to the paternal voice. Findings promote a better understanding of individual infant response to paternal voice, including conversational turns and engagement behaviors. Although informative, this review highlights a clear gap in the evidence, supporting standardized methodology.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Fathers should be encouraged to communicate vocally early and often to facilitate bonding in the NICU. Encouraged future study of father-infant communication to support bonding, relationship building, and neurodevelopmental outcomes is paramount.

Not being able to hug our baby before the cables: Early experiences of parents with premature babies

BACKGROUND

The nursing care provided after the intensive care period and discharge can contribute to the optimal growth and development of the baby while protecting the mental health of the parents.

OBJECTIVE

The aim of this study is to examine in detail the experiences of parents with premature babies about having a premature baby and their experiences with the hospitalization process of their babies in the neonatal intensive care unit (NICU).

DESIGN

The methodological approach was informed by Van Manen's hermeneutic phenomenological methodology. The sample consisted of 15 parents who had a preterm baby in the NICU of a state hospital in Turkey.

RESULTS

The data obtained from this study were categorized under four themes: having a preterm baby, perception of intensive care, feelings toward nurses, emotions about discharge and home care.

CONCLUSIONS

Health professionals should know what the parents' perception of being a parent and having a premature baby is.

Opportunities and challenges for family-centered postpartum care during the COVID-19 pandemic: a qualitative study of nurse perspectives

Background

The global COVID-19 pandemic has forced the health care sector to make wide-ranging changes to protect patients as well as providers from the risk of infection. Many of these changes are likely to have greatest impact in contexts of care that employ family-centered care (FCC) models, including perinatal and maternity care. Research conducted in perinatal care settings during the pandemic has shown that some of these restrictions have negatively impacted patient and family experiences and outcomes, while others have been perceived as beneficial. The present qualitative study aimed to understand what changes have occurred in postpartum nursing practice during the pandemic, and how these changes have affected nurses, women and families during their stay in the hospital following a new birth.

Methods

Structured interviews were completed with 20 postpartum nurses from five hospitals across Texas. The interview protocol was designed to elicit information about changes to hospital policies in postpartum units during the pandemic, nurses’ attitudes about these changes, perceived benefits and challenges for performance of their duties, and perceived effects on patients and their families. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by video conference using Zoom and lasted approximately 30 to 45 min. Data were analyzed using a qualitative descriptive approach.

Results

Participants reported that their hospitals placed restrictions on the number and mobility of support persons allowed to stay with the mother in the unit and prohibited all other visitation. Some challenges of these policies included reduced opportunities for hands-on learning and an increased number of patients opting for early discharge. Perceived benefits for patient education and outcomes included improved frequency and effectiveness of nurse-family communication, increased father involvement, and greater opportunities for maternal rest, breastfeeding, skin-to-skin care and family bonding.

Conclusions

Study findings suggest that some limitations on postpartum hospital visitation may achieve important, family-centered goals. Protected time for family-bonding, maternal rest, breastfeeding, father involvement and individualized education are critical to quality FCC. Research must examine which visitation policies maximize these benefits while preserving patient access to family and social support.

Social support needs of first-time parents in the early-postpartum period: A qualitative study

Background

The early postpartum period is a critical time for first-time parents as they adapt to their new role. Perceived lack of social support is a risk factor for developing mental health problems. Insufficient or inappropriate professional support for both parents has been reported by many studies. Social support that appropriately meets parents' needs is an important protective factor for parents' wellbeing; however, little is known about the social support needs of both first-time parents.

Aims and objectives

To describe both first-time parents' formal social support needs in the early postpartum period.

Method

Individual semi-structured interviews were conducted with first-time parents recruited on the postpartum ward of a Swiss university hospital. Thematic analysis was used to identify themes and sub-themes.

Results

Fifteen mothers and eleven fathers were interviewed. Twelve themes were identified. Mothers' themes were "experiencing postpartum changes," "creation of a family unit," "self-esteem," "emotional needs," "difficulty in communicating their needs," and "the postpartum stay." Fathers' themes were "to be included in care procedures on the postpartum ward," "to be reassured," "to anticipate their postpartum stay" and "to consider their need as non-priority." Parental shared needs were: "to care for their newborn," and "returning home."

Conclusion

Mothers' and fathers' needs differed. Mothers needed more emotional support than fathers and fathers considered themselves as the main support for their partner. Fathers wanted to be integrated in the care of their newborn.

Fathers' involvement in perinatal healthcare in Australia: experiences and reflections of Ethiopian-Australian men and women

Background

Family-centred maternity care models include the expectation that fathers prepare for and attend the birth. In Australia over 20% of the population is from a culturally and linguistically diverse background. Public policies espouse culturally competent healthcare. Little is known about the experiences of perinatal health care of men from culturally and linguistically diverse (CALD) communities living in high income countries. The aim was to understand the experiences, attitudes and beliefs about father’s inclusion in perinatal healthcare, from the growing, and recently settled community of Ethiopian families living in Australia.

Methods

A qualitative study using semi-structured individual interviews with Ethiopian-Australian men and women who had experienced Australian maternity care and were sampled for diversity of time since migration, and parity. Interviews were in English, audio-recorded, transcribed and then analysed thematically.

Results

Participants were seven women and six men all born in Ethiopia, including two couples. Key themes included: the loss of extended family through migration, new roles for both parents and the need to establish ‘family-like’ relationships with friendship groups in Australia. There was a willingness to involve male partners in the Ethiopian community in Australia, although it was recognised as a cultural change. Experiences of male partner involvement were mixed among healthcare types, with men attending Maternal and Child Health (MCH) appointments less frequently than antenatal (ANC) appointments.

Conclusions

Results suggests men may be missing out on the education provided during antenatal appointments and may benefit from an alternative. There were not universally high levels of cultural competency among healthcare professionals, with further training still required. Commitment to paid employment remains a barrier to men’s involvement, suggesting that flexible working conditions and increased paternity leave would support their involvement. Alternatively services could utilise flexible delivery methods such as phone and zoom to include fathers.