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Willmeroth T. Nurses' and Parents' View on Neonatal Intensive Care Unit Diaries: A Qualitative Study and Framework Conceptualization. Am J Perinatol 2024; 41:e1800-e1812. [PMID: 37207660 DOI: 10.1055/s-0043-1768959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The birth of a premature or critically ill newborn can be a traumatic event for the entire family. In these situations, the neonatal intensive care unit (NICU) diary is a relevant coping intervention to support family members. However, a profound theoretical concept is lacking, and there is little evidence about how it is applied by nurses in clinical practice. Therefore, this study aims to investigate how NICU diaries are used by nurses to support family members cope with their experiences and to develop an evidence-guided and theory-based framework for conceptualizing diary usage in the NICU. STUDY DESIGN A qualitative study design containing 12 narrative interviews with nurses from six different hospitals and two focus group interviews with nine parents from two different hospitals was chosen. The qualitative data were analyzed via content analysis inductively and separately and brought together via graphical coding in a second step. RESULTS Four main categories emerged from the analyzed data to describe the NICU diary in nursing practice. Regarding diary (1) "usage," three different types of NICU diaries were identified, which seem to be established largely intuitive. The (2) "content" is constituted by the diary's title, introduction, textual, and nontextual components. Taking into account the diary (3) "function" for the parental coping process, three subcategories emerge: (a) strengthening the parental role, (b) supporting understanding of events, and (c) bringing joy and normality to the situation. (4) "Challenges" address an appropriate writing style, the reading of parental entries by nurses and limited resources. Based on these results and taking into account relevant literature, a framework for conceptualizing NICU diaries was developed. CONCLUSION NICU diaries show great potential to support the parental coping process. Nevertheless, diary conceptualization should be based on a theoretical framework to clarify its usage for nurses and parents. KEY POINTS · NICU diaries are an established intervention used by nurses to support parental coping.. · In nursing practice, different types of NICU diaries emerge.. · Writing styles, content, and reading of entries are reported heterogeneously.. · A conceptualizing framework for NICU diaries is needed..
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Affiliation(s)
- Tabea Willmeroth
- Fachbereich Gesundheit, FH Münster, University of Applied Sciences, Witten, Germany
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2
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Implementation and Practice Barriers of Family-Centered Care Encountered by Neonatal Nurses. Adv Neonatal Care 2022; 22:432-443. [PMID: 34596093 DOI: 10.1097/anc.0000000000000948] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Approximately 7 out of every 100 births in the United States result in admission to the neonatal intensive care unit (NICU), which contributes to a delay in initial physical contact between the parents and their newborn. While family-centered care (FCC) increases opportunities for parent-infant connection, implementation barriers persist in clinical practice. Research has yet to examine whether organizational and nursing factors of empowerment and compassion fatigue (CF) in the NICU are associated with FCC practice. PURPOSE The aim of this study was to determine the relationship between empowerment, CF, and FCC practices among NICU nurses. METHODS This quantitative portion of a mixed-methods study used a cross-sectional, descriptive correlational design. Bedside NICU nurses with at least 6-month experience were recruited to complete an anonymous online survey using established, valid, and reliable instruments. RESULTS Except for organizations with Magnet status, there were no significant differences in FCC practice within individual and institutional characteristics. Hierarchical linear regression model indicated nurse empowerment was a strong predictor of FCC practice (β= 0.31, R2 = 0.35, P < .001). There was only a weak, inverse association between CF and FCC practices ( r =-0.199, P < .001). IMPLICATION FOR RESEARCH AND PRACTICE Further qualitative research will integrate these findings to understand the process by which neonatal nurses engage in FCC practices in the context of NICU setting. Future studies should examine facilitators and barriers of FCC practice in the NICU. Strategies (eg, policies and trainings) to increase nurse empowerment and support for FCC implementation should be developed and evaluated.
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Mause L, Hoffmann J, Reimer A, Dresbach T, Horenkamp‐Sonntag D, Klein M, Scholten N, Müller A, Hellmich M, Samel C, Woopen C, Jannes C, Kuntz L, Spiecker gen. Döhmann I, Bretthauer S, Krankenkasse T, Wobbe‐Ribinski S. Trust in medical professionals and its influence on the stress experience of parents of premature infants. Acta Paediatr 2022; 111:527-535. [PMID: 34779058 DOI: 10.1111/apa.16187] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
AIM To examine parents' perceptions of stress and their trust in physicians and nursing staff and to investigate whether trust influences the parental perceptions of potential stressors resulting from their infant's hospitalisation in a neonatal intensive care unit. METHODS Parents of very and extremely low birth weight infants were surveyed in a nationwide retrospective cross-sectional study 6-18 months after their child's birth. Parental stress was measured utilising the PSS:NICU_German/2-scales, and trust was measured by the scales Trust in Physicians and Trust in Nursing Staff. In addition to descriptive analyses, multiple linear regression models were conducted. RESULTS The change in parents' anticipated roles was assessed as more stressful than their infant's appearance and behaviour. Trust in nursing staff significantly influenced the parental stress level. Although the level of trust in physicians was rated higher than trust in nursing staff, trust in physicians did not yield a significant effect on the parental stress experience. CONCLUSION Efforts to foster parental trust in nursing staff may reduce the parental stress level and hence enable parents to better cope with the situation. The parental resources unleashed in this way can be employed to enhance parenting.
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Affiliation(s)
- Laura Mause
- Institute of Medical Sociology Health Services Research and Rehabilitation Science Faculty of Human Sciences and Faculty of Medicine University of Cologne and University Hospital Cologne Cologne Germany
| | - Jan Hoffmann
- Institute of Medical Sociology Health Services Research and Rehabilitation Science Faculty of Human Sciences and Faculty of Medicine University of Cologne and University Hospital Cologne Cologne Germany
| | - Alinda Reimer
- Institute of Medical Sociology Health Services Research and Rehabilitation Science Faculty of Human Sciences and Faculty of Medicine University of Cologne and University Hospital Cologne Cologne Germany
| | - Till Dresbach
- Department of Pediatrics University Hospital Bonn Bonn Germany
| | | | | | - Nadine Scholten
- Institute of Medical Sociology Health Services Research and Rehabilitation Science Faculty of Human Sciences and Faculty of Medicine University of Cologne and University Hospital Cologne Cologne Germany
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Eeles AL, Burnett AC, Cheong JL, Aldis A, Pallot L, Polonidis T, Rust K, Hunt RW, Delany C, Spittle AJ. Identifying research priorities in newborn medicine: a Delphi study of parents' views. BMJ Open 2021; 11:e044836. [PMID: 34836894 PMCID: PMC8628322 DOI: 10.1136/bmjopen-2020-044836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Neonatal conditions can have lifelong implications for the health and well-being of children and families. Traditionally, parents and patients have not been included in shaping the agenda for research and yet they are profoundly affected by the neonatal experience and its consequences. This study aimed to identify consensus research priorities among parents/patients of newborn medicine in Australia and New Zealand. DESIGN Parents/patients with experience of neonatal care in Australia and New Zealand completed an online Delphi study to identify research priorities across four epochs (neonatal admission, early childhood, childhood/adolescence and adulthood). Parents/patients first generated key challenges in each of these epochs. Through inductive thematic analysis, recurring topics were identified and research questions generated. Parents/patients rated these questions in terms of priorities and a list of questions consistently rated as high priority was identified. PARTICIPANTS 393 individuals participated, 388 parents whose children had received neonatal care and 5 adults who had received neonatal care themselves. RESULTS Many research questions were identified as high-priority across the lifespan. These included how to best support parental mental health, relationships between parents and neonatal clinical staff (including involvement in care and communication), bonding and the parent-child relationship, improving neonatal medical care and addressing long-term impacts on child health and neurodevelopment. CONCLUSIONS Parents with experience of newborn medicine have strong, clear and recurring research priorities spanning neonatal care practices, psychological and other impacts on families, and impacts on child development. These findings should guide neonatal research efforts. In addition to generating new knowledge, improved translation of existing evidence to parents is also needed.
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Affiliation(s)
- Abbey L Eeles
- Clinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Alice C Burnett
- Clinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Neonatal Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jeanie Ly Cheong
- Clinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Neonatal Services, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Alex Aldis
- Consumer Advisory Group, Murdoch Childrens Research Institute Centre of Research Excellence in Newborn Medicine, Parkville, Victoria, Australia
| | - Louise Pallot
- Consumer Advisory Group, Murdoch Childrens Research Institute Centre of Research Excellence in Newborn Medicine, Parkville, Victoria, Australia
| | - Tien Polonidis
- Consumer Advisory Group, Murdoch Childrens Research Institute Centre of Research Excellence in Newborn Medicine, Parkville, Victoria, Australia
| | - Krista Rust
- Consumer Advisory Group, Murdoch Childrens Research Institute Centre of Research Excellence in Newborn Medicine, Parkville, Victoria, Australia
| | - Rod W Hunt
- Clinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Department of Neonatal Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Clare Delany
- Children's Bioethics Centre, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Clinical Sciences Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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Abstract
Background: In the neonatal intensive care unit, immigrant parents may experience even
greater anxiety than other parents, particularly if they and the nurses do
not share a common language. Aim: To explore the complex issues of trust and the nurse–mother relationship in
neonatal intensive care units when they do not share a common language. Design and methods: This study has a qualitative design. Individual semi-structured in-depth
interviews and two focus group interviews were conducted with eight
immigrant mothers and eight neonatal intensive care unit nurses,
respectively. Data analysis was based on Braun and Clarke’s thematic
analytic method. Ethical considerations: Approval was obtained from the hospital’s Scientific Committee and the Data
Protection Officer. Interviewees were informed in their native language
about confidentiality and they signed an informed consent form. Results: Trust was a focus for mothers and nurses alike. The mothers held that they
were satisfied that their infants received the very best care. They seemed
to find the nurses’ care and compassion unexpected and said they felt
empowered by learning how to care for their infant. The nurses discussed the
mother’s vulnerability, dependency on their actions, attitudes and
behaviour. Discussion: Lack of a common language created a challenge. Both parties depended on
non-verbal communication and eye contact. The nurses found that being
compassionate, competent and knowledgeable were important trust-building
factors. The mothers were relieved to find that they were welcome, could
feel safe and their infants were well cared for. Conclusion: The parents of an infant admitted to the neonatal intensive care unit have no
choice but to trust the treatment and care their infant receives. Maternal
vulnerability challenges the nurse’s awareness of the asymmetric
distribution of power and ability to establish a trusting relationship with
the mother. This is particularly important when mother and nurse do not
share a verbal language. The nurses worked purposefully to gain trust.
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Affiliation(s)
- Nina Margrethe Kynø
- Lovisenberg Diaconal University College, Norway; Oslo University Hospital, Norway
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6
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Eeles AL, Gibbs D. Tool to Enhance Relationships Between Staff and Parents in the Neonatal Unit. J Obstet Gynecol Neonatal Nurs 2020; 49:593-604. [PMID: 32979323 DOI: 10.1016/j.jogn.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore the experiences of neonatal nurses in the implementation of a tool to enhance relationships between staff and parents in the neonatal unit: the You and Your Baby Nursery Guide. DESIGN Qualitative descriptive design with focus groups. SETTING The study took place in a Level 4, 20-bed neonatal unit in Melbourne, Victoria, Australia. PARTICIPANTS Purposive sample of seven registered nurses who worked day or afternoon shifts. METHODS We conducted two semistructured focus groups after a 4-week implementation period of the You and Your Baby Nursery Guide. Participants completed a weekly reflective journal throughout the implementation period. We audiotaped and transcribed the focus groups and qualitatively analyzed the interview data with the use of thematic analysis. RESULTS Use of the guide helped transform the relationships between parents and staff. The use of the guide enhanced communication, promoted participants' personal reflection on their clinical skills and style/approach to parent engagement, and directly affected the care participants provided to infants and families. CONCLUSION The You and Your Baby Nursery Guide was a useful resource to facilitate the delivery of family-centered, developmentally supportive care.
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Widding U, Hägglöf B, Adamsson M, Farooqi A. Parents of extremely and moderately preterm children reported long-lasting impressions of medical care and the hospital environment. Acta Paediatr 2020; 109:1772-1777. [PMID: 31876043 DOI: 10.1111/apa.15149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022]
Abstract
AIM Few studies have examined the parents of moderately preterm children. The aim of this study was to investigate the experiences of parents of both extremely and moderately preterm children. METHODS Qualitative telephone interviews were conducted in 2013-2014 with 13 mothers and 10 fathers of extremely preterm children and with 11 mothers and seven fathers of moderately preterm children. The children were born between 2000 and 2003. Data were analysed with a narrative approach. RESULTS Parents of extremely preterm children recounted dramatic birth stories that, for most, ended positively. Parents of moderately preterm children presented more neutral birth stories, and most recounted that their children did not receive attention for prematurity from medical staff. Parents from both groups described staff members' treatment in terms of long-lasting impressions, and they were deeply affected by the hospital environment and the other parents and children admitted. Parents whose children died or were disabled recounted dramatic stories and endless fights for support. CONCLUSION Parents from both groups reported long-lasting impressions of the medical staff and the hospital environment, which they found important to talk about, even a decade after the birth of their child/children.
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Affiliation(s)
| | - Bruno Hägglöf
- Umeå University Umeå Sweden
- Umeå University Hospital Umeå Sweden
| | - Marie Adamsson
- Umeå University Umeå Sweden
- Umeå University Hospital Umeå Sweden
| | - Aijaz Farooqi
- Umeå University Umeå Sweden
- Umeå University Hospital Umeå Sweden
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8
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Yoon S, Park J, Lee H, Min A. Influence of Partnerships with Nurses and Social Support on Readiness for Discharge among Mothers of Premature Infants. CHILD HEALTH NURSING RESEARCH 2019; 25:417-424. [PMID: 35004433 PMCID: PMC8650988 DOI: 10.4094/chnr.2019.25.4.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/02/2019] [Accepted: 05/10/2019] [Indexed: 01/29/2023] Open
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Brødsgaard A, Pedersen JT, Larsen P, Weis J. Parents' and nurses' experiences of partnership in neonatal intensive care units: A qualitative review and meta‐synthesis. J Clin Nurs 2019; 28:3117-3139. [DOI: 10.1111/jocn.14920] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/22/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Brødsgaard
- Department of Pediatrics and Adolecent Medicine Copenhagen University Hospital Hvidovre Copenhagen Denmark
- Department of Public Health, Section for Nursing University of Aarhus Aarhus Denmark
| | | | - Palle Larsen
- Department of Nursing University College Lillebaelt Svendborg Denmark
| | - Janne Weis
- Department of Neonatology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Human dignity is grounded in basic human attributes such as life and self-respect. When people cannot stand up for themselves they may lose their dignity towards themselves and others. The aim of this study was to elucidate if dignity remains intact for family members during care procedures in a children’s hospital. A qualitative approach was adopted, using open non-participation observation. The findings indicate that dignity remains intact in family-centred care where all concerned parties encourage each other in a collaborative relationship. Dignity is shattered when practitioners care from their own perspective without seeing the individual in front of them. When there is a break in care, family members can restore their dignity because the interruption helps them to master their emotions. Family members’ dignity is shattered and remains damaged when they are emotionally overwhelmed; they surrender themselves to practitioners’ care, losing their self-esteem and self-respect.
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Affiliation(s)
- Anita Lundqvist
- Department of Health Sciences, Division of Nursing, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
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12
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Widding U, Farooqi A. “I thought he was ugly”: Mothers of extremely premature children narrate their experiences as troubled subjects. FEMINISM & PSYCHOLOGY 2016. [DOI: 10.1177/0959353516636149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the ways in which mothers of extremely premature children make sense of their negative feelings towards their newborn child and their strategies for performing “proper motherhood”. The analysis was guided by discursive psychology and the feminist debate on attachment, mother–infant bonding, and “good motherhood”. The empirical material was created within a sub-study that set out to explore mothers’ and fathers’ experiences of having a premature child and was part of a project investigating the need for support for premature children and their families. Parents were interviewed about the pregnancy, their experiences of the birth and hospital period, the process of going home, the experiences of pre-school and school, and thoughts about the future. The stories of four mothers, which dealt with negative feelings towards their child and the guilt and distress related to this, were selected for analysis. The mothers handled their troubled positions as subjects unable to feel “motherly love” by referring to notions of attachment and bonding, and good motherhood as being loving and caring. Yet, the mothers also talked about motherhood as being socially constructed, as duties that can be performed without the “right motherly feelings”, and as something that men could also perform.
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13
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Tourigny J, Chartrand J. Partnering with parents in a pediatric ambulatory care setting: a new model. ACTA ACUST UNITED AC 2015; 38:105-17. [DOI: 10.3109/01460862.2015.1031623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Tallon MM, Kendall GE, Snider PD. Rethinking family-centred care for the child and family in hospital. J Clin Nurs 2015; 24:1426-35. [DOI: 10.1111/jocn.12799] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 12/14/2022]
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Parents' experiences of communication with neonatal intensive-care unit staff: an interview study. BMC Pediatr 2014; 14:304. [PMID: 25492549 PMCID: PMC4276021 DOI: 10.1186/s12887-014-0304-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/28/2014] [Indexed: 11/16/2022] Open
Abstract
Background An infant’s admission to a neonatal intensive-care unit (NICU) inevitably causes the parents emotional stress. Communication between parents and NICU staff is an essential part of the support offered to the parents and can reduce their emotional stress. The aim of this study was to describe parents’ experiences of communication with NICU staff. Methods A hermeneutic lifeworld interview study was performed with 18 families whose children were treated in the level III NICU at a university hospital in Sweden. The interviews were analysed to gain an interpretation of the phenomenon of how parents in the NICU experienced their communication with the staff, in order to find new ways to understand their experience. Results Parents’ experience of communication with the staff during their infant’s stay at the NICU can be described by the main theme ‘being given attention or ignored in their emotional situation’. The main theme derives from three themes; (1) meeting a fellow human being, (2) being included or excluded as a parent and (3) bearing unwanted responsibility. Conclusions This study shows that parents experienced communication with the NICU staff as essential to their management of their situation. Attentive communication gives the parents relief in their trying circumstances. In contrast, lack of communication contributes to feelings of loneliness, abandonment and unwanted responsibility, which adds to the burden of an already difficult situation. The level of communication in meetings with staff can have a decisive influence on parents’ experiences of the NICU. The staff should thus be reminded of their unique position to help parents handle their emotional difficulties. The organization should facilitate opportunities for good communication between parents and staff through training, staffing and the physical health care environment.
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Abstract
BACKGROUND Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. RESEARCH OBJECTIVE The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. RESEARCH DESIGN Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to interpret the data. PARTICIPANTS AND RESEARCH CONTEXT Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. ETHICAL CONSIDERATIONS The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. FINDINGS Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. DISCUSSION A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. CONCLUSION The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care.
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Korhonen A, Kangasniemi M. Nurses' narratives on termination of primary nursing relationship with parents in neonatal intensive care. Scand J Caring Sci 2013; 28:716-23. [PMID: 24252116 DOI: 10.1111/scs.12101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary nursing working model in the neonatal intensive care unit enables a long-lasting caring relationship with the infants and their parents. Terminating this kind of relationship is seldom discussed. AIM The aim of the study was to describe nurses' experiences of terminating the primary nursing relationship with the parents in neonatal intensive care. METHODS Qualitative design using narrative method was used because there is a little knowledge relating to the topic. The data were collected with active interviews and analysed with narrative analysis. Seven nurses with experience of neonatal intensive care and primary nursing were recruited by convenience sampling. The approval was granted according to the hospital guidelines. RESULTS The results gave rise to the three narratives that described the relationship between the primary nurse and the parents as the nursing relationship ends. All narratives shared a common plot, 'regulation of the closeness on nursing relationship', but it was manifested in different ways in each narrative. The plot in the narratives changed on a closeness-distance axis according to how the primary nurse regulated the nursing relationship and its termination. In the first narrative, the regulation of the relationship promoted distance, in the second connection and in the third closeness and connection. CONCLUSIONS The long-lasting nature of the primary nursing working model may allow different caring relationships which will be revealed in terminating phase of care. This phenomenon is poorly recognised. It is important to study the caring relationship between the primary nurse and the parents of a hospitalised child, because the caring relationship is the core of nursing and needs to be considered in research and supported in practice.
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Affiliation(s)
- Anne Korhonen
- Department of Pediatric and Adolescence, Oulu University Hospital, Oulu, Finland
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Ives-Baine L, Lindsay G, Wel EV, Barker C, Saini J, Cross N. Essential Engagement: Nicu Nurses' Relationships within End-of-Life Care. ACTA ACUST UNITED AC 2013. [DOI: 10.2190/il.21.4.c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lindsay, Cross, and Ives-Baine (2012) explored the experiences of neonatal intensive care (NICU) nurses with infants at end-of-life and their families. In keeping with our research agreement, the findings were presented to the rest of the NICU staff at two sets of education days. The nurses affirmed the research pattern of essential engagement through telling stories of grief and professional growth. We conceptualized how nurses construct relationships through conscious engagement, dialogue, and reflection and reframing. Connecting the original findings with the nurses' responses from the education days has led to innovative actions within this NICU. This article also examines the development of an End-of-life Resource Team and Voicing Space as well as addressing ideas for further research.
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Affiliation(s)
- Lori Ives-Baine
- The Hospital for Sick Children, Toronto, Canada and University of Ontario Institute of Technology, Oshawa, Canada
| | - Gail Lindsay
- University of Ontario Institute of Technology, Oshawa, Canada
| | | | | | | | - Nadine Cross
- York University-UHN Nursing Academy, Toronto, Canada
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Dahl BM, Clancy A, Andrews T. The meaning of ethically charged encounters and their possible influence on professional identity in Norwegian public health nursing: a phenomenological hermeneutic study. Scand J Caring Sci 2013; 28:600-8. [DOI: 10.1111/scs.12089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 09/15/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Berit Misund Dahl
- Nordic School of Public Health Gothenburg Sweden
- Department of Health Sciences Aalesund University College Ålesund Norway
| | - Anne Clancy
- School of Nursing Department of Health and Social Work Harstad University College Harstad Norway
| | - Therese Andrews
- Nordland Research Institute University of Nordland Bodø Norway
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Understanding neurodevelopmental outcomes of prematurity: education priorities for NICU parents. Adv Neonatal Care 2013; 13 Suppl 5:S21-6. [PMID: 24042181 DOI: 10.1097/anc.0000000000000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
NICU nurses have an important role to play in many aspects of parent education. This article stresses the need for an increased focus on teaching parents about the central role that self-regulation will play in their infant's neurobehavioral development not only during the early infancy period but throughout all of childhood and adolescence. Suggestions are made about how to conceptualize the relation between cognition and emotions in humans and how to help parents understand that continued vigilance concerning potential problems in attention and self-regulation will be necessary.
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Dellenmark-Blom M, Wigert H. Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study. J Adv Nurs 2013; 70:575-86. [DOI: 10.1111/jan.12218] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Michaela Dellenmark-Blom
- Division of Paediatric Emergency Care and Paediatric Surgery; The Queen Silvia Children's Hospital; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Helena Wigert
- Institute of Health and Care Sciences; The Sahlgrenska Academy at the University of Gothenburg; Sweden
- Division of Neonatology; Sahlgrenska University Hospital; Gothenburg Sweden
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Kymre IG, Bondas T. Balancing preterm infants' developmental needs with parents' readiness for skin-to-skin care: a phenomenological study. Int J Qual Stud Health Well-being 2013; 8:21370. [PMID: 23849269 PMCID: PMC3710397 DOI: 10.3402/qhw.v8i0.21370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 11/14/2022] Open
Abstract
The aim of this article is to articulate the essence and constituents of neonatal intensive care unit (NICU) nurses’ experiences in enacting skin-to-skin care (SSC) for preterm newborns and their parents. SSC is commonly employed in high-tech NICUs, which entails a movement from maternal–infant separation. Parents’ opportunities for performing the practice have been addressed to NICU staff, with attitude and environment having crucial influence. The study was carried out with a reflective lifeworld research approach. Data were collected in Denmark, Sweden, and Norway by open-dialogue interviews with a purposive sample of 18 NICU nurses to achieve the essence of and variation within the phenomenon. NICU nurses experience balancing what they consider preterm newborns’ current and developmental needs, with readiness in both parents for SSC. They share an experience of a change in the history of NICU care to increased focus on the meaning of proximity and touch for the infants’ development. The phenomenon of enacting SSC is characterized by a double focus with steady attention to signals from both parents and newborns. Thereby, a challenge emerges from the threshold of getting started as the catalyst to SSC.
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Affiliation(s)
- Ingjerd Gåre Kymre
- Center for Practical Knowledge and Institute for Nursing and Health, PHS, University of Nordland/UiN, Bodø, Norway.
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Wigert H, Dellenmark MB, Bry K. Strengths and weaknesses of parent-staff communication in the NICU: a survey assessment. BMC Pediatr 2013; 13:71. [PMID: 23651578 PMCID: PMC3651269 DOI: 10.1186/1471-2431-13-71] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/02/2013] [Indexed: 01/01/2023] Open
Abstract
Background Parents of infants hospitalized in the neonatal intensive care unit (NICU) find themselves in a situation of emotional strain. Communication in the NICU presents special challenges due to parental stress and the complexity of the highly technologized environment. Parents’ need for communication may not always be met by the NICU staff. This study aimed to describe strengths and weaknesses of parent–nurse and parent–doctor communication in a large level III NICU in Sweden in order to improve our understanding of parents’ communication needs. Methods Parents were asked to complete a survey consisting of sixteen questions about their experiences of communication with nurses and doctors in the NICU. In each question the parents evaluated some aspect of communication on a five- or six-point Likert scale. They also had the opportunity on each question to comment on their experiences in their own words. Data were analyzed using IBM SPSS Statistics 20.0 and qualitative manifest content analysis. Results 270 parents (71.4%) completed the survey. Parents generally rated communication with the staff in the NICU positively and appreciated having received emotional support and regular information about their child´s care. Although a large majority of the parents were satisfied with their communication with doctors and nurses, only about half of the parents felt the nurses and doctors understood their emotional situation very well. Some parents would have desired easier access to conversations with doctors and wanted medical information to be given directly by doctors rather than by nurses. Parents’ communication with the staff was hampered when many different nurses were involved in caring for the infant or when the transfer of information in connection with shift changes or between the maternity ward and NICU was poor. Parents also desired to be present during doctors’ rounds on their infant. Conclusions Training both doctors and nurses in communication skills, especially in how to meet parents’ emotional needs better, could make communication at the NICU more effective and improve parental well-being. Creating a framework for the parents of what to expect from NICU communication might also be helpful. In addition, our results support the use of primary nurse teams to improve continuity of care and thereby promote successful communication.
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Affiliation(s)
- Helena Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, Gothenburg, SE 405 30, Sweden.
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Altimier L, Phillips RM. The Neonatal Integrative Developmental Care Model: Seven Neuroprotective Core Measures for Family-Centered Developmental Care. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2012.12.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hall EOC, Brinchmann BS, Aagaard H. The challenge of integrating justice and care in neonatal nursing. Nurs Ethics 2011; 19:80-90. [DOI: 10.1177/0969733011412101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore neonatal nurses’and mothers of preterm infants’experiences of daily challenges. Interviews took place asking for good, bad and challenging experiences. Data were analysed using qualitative content analysis and findings were clustered in two categories: good and challenging experiences, each containing three themes. The good experiences were: managing with success as a nurse, small things matter for mothers, and a good day anyhow for mothers and nurses. The challenging experiences were: mothering in public, being pulled between responsibilities, and adverse things stick under the nurses’skin. The study shows that small daily clinical matters become big issues and could lead to moral distress, and that nurses integrate ethics of justice and ethics of care while mothers are concerned about health and well-being of their specific infant only. The challenge for nursing to integrate fairness and sensitive care in family-oriented neonatal care is discussed.
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Affiliation(s)
- Scott M Klein
- VNS-NY Hospice, 1250 Broaway, 7th Floor, New York, NY 10001, USA.
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Walking the line between the possible and the ideal: lived experiences of neonatal nurses. Intensive Crit Care Nurs 2010; 26:307-13. [PMID: 20864347 DOI: 10.1016/j.iccn.2010.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/13/2010] [Accepted: 08/14/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the lived experiences of neonatal nurses, that is, what it is like to be a neonatal nurse after developmental care is introduced in the unit. METHODS The study was designed as a qualitative interview study with a hermeneutic-phenomenological approach. Participants were seven neonatal nurses working in an 18-bed level 2 and 3 neonatal unit at a tertiary university hospital in Denmark. Developmental care was recently introduced in the unit, parents spend many hours a day with their baby and stay overnight in guestrooms at the hospital. RESULTS The essential theme of the phenomenon being a neonatal nurse is found to be 'walking the line between the possible and the ideal'. Five themes illuminate this essence. They are: 'being attentive to the infant and the mother-infant dyad', 'the body tells', 'time is everything', 'working in a quiet and caring, crowded and distressing space', and 'teamwork - demanding or smooth and helpful'. CONCLUSION Introducing developmental care in a neonatal unit changes neonatal nurses' experiences of caring for infants and mother-infant dyads. The meaning of body, time, space and relationships are decisive and deserve to be included in nurses' and nurse leaders' discussion about developmental and family centred neonatal care.
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Understanding neurodevelopmental outcomes of prematurity: education priorities for NICU parents. Adv Neonatal Care 2010; 10:188-93; quiz 194-5. [PMID: 20697216 DOI: 10.1097/anc.0b013e3181e9414b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
NICU nurses have an important role to play in many aspects of parent education. This article stresses the need for an increased focus on teaching parents about the central role that self-regulation will play in their infant's neurobehavioral development not only during the early infancy period but throughout all of childhood and adolescence. Suggestions are made about how to conceptualize the relation between cognition and emotions in humans and how to help parents understand that continued vigilance concerning potential problems in attention and self-regulation will be necessary.
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Fegran L, Helseth S. The parent-nurse relationship in the neonatal intensive care unit context--closeness and emotional involvement. Scand J Caring Sci 2009; 23:667-73. [PMID: 19000088 DOI: 10.1111/j.1471-6712.2008.00659.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND BACKGROUND Family-centred care, which acknowledges parents as partners in care, is a desirable and essential part of neonatal nursing. There has been extensive research on parents' experiences of parenting in neonatal intensive care units (NICU), but there is little research on nurses' experiences of being in these enduring close relationships. The aim of this paper is to explore parents' and nurses' experiences of the close parent-nurse relationship when a premature child is hospitalized. METHOD The design was exploratory with a hermeneutic approach. The methods used were participant observation and in-depth interviews with six mothers, six fathers and six nurses in a Norwegian 13-bed NICU. Eighteen individual interviews and 160 hours of observations were conducted over 27 weeks from 2003 to 2004. This study complies with the principles of the Declaration of Helsinki. The Regional Committee for Medical Research Ethics, the Ombudsman for Privacy in Research at the Norwegian Social Science Data Services and the hospital's research department approved the study protocol. RESULTS The NICU context is a technological environment where human interaction is a crucial issue. The character of the context and the ongoing interactions drive parents and nurses into close relationships. Closeness increases the emotional involvement and the boundary between the professional and the personal approach is threatened. The commitment of being close, combined with the emotional involvement, can be an emotional burden to both parents and nurses. CONCLUSION Parent-nurse closeness in NICU is desirable; however, the emotional burden of this closeness seems to be seldom problematized. Awareness about the need to strike a balance between closeness and distance can positively influence parents' independence and nurses' ability to maintain professional relationships with their primary care parents.
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Affiliation(s)
- Liv Fegran
- Faculty of Health and Sports, University of Agder, Kristiansand, Norway.
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Mårtenson EK, Fägerskiöld AM, Runeson IV, Berterö CM. The ethical demand in nursing: a scandinavian perspective. Nurs Sci Q 2009; 22:281-8. [PMID: 19567735 DOI: 10.1177/0894318409338681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this column the authors discuss the ethics of information exchange in nursing practice with children. Five concepts identified in three Swedish grounded theory studies and a content analysis that used the theoretical framework of ethical demand were analyzed. A simultaneous concept analysis found five related concepts: being interconnected, acting according to accepted procedure, completeness, interdependence, and social intercourse. These concepts are synthesized in the concept of intergrade, which emphasizes the value of maintaining the integrity of all involved in information exchange.
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Hall EO, Brinchmann BS. Mothers of preterm infants: Experiences of space, tone and transfer in the neonatal care unit. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.jnn.2009.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fegran L, Fagermoen MS, Helseth S. Development of parent-nurse relationships in neonatal intensive care units - from closeness to detachment. J Adv Nurs 2008; 64:363-71. [DOI: 10.1111/j.1365-2648.2008.04777.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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The universe of developmental care: a new conceptual model for application in the neonatal intensive care unit. Adv Neonatal Care 2008; 8:141-7. [PMID: 18535418 DOI: 10.1097/01.anc.0000324337.01970.76] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Developmental care for high-risk infants is practiced in most neonatal units around the world. Despite its wide acceptance, inconsistency in its definition and application has resulted in criticism regarding its scientific merit. The universe of developmental care model proposed in this article is the first major reformulation of neonatal developmental care theory since Als' synactive theory. Neither the developing brain nor the environment exists in isolation, and therefore are dependent on each other for all caregiving activities. Central to this model is the concept of a shared surface, manifested most obviously by the skin that forms the critical link between the body/organism and environment and becomes the focal point for human interactions. The components of the model and its theoretical underpinnings, its practical application and direction for future clinical practice, education, and research are presented.
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Aagaard H, Hall EOC. Mothers' experiences of having a preterm infant in the neonatal care unit: a meta-synthesis. J Pediatr Nurs 2008; 23:e26-36. [PMID: 18492543 DOI: 10.1016/j.pedn.2007.02.003] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 02/02/2007] [Indexed: 12/21/2022]
Abstract
Neonatal nurses today are challenged not only to provide the best possible developmental care for a preterm infant but also to help the mother through an uncertain motherhood toward a feeling of being a real mother for her preterm baby. An increasing interest in mothers' experiences of having a preterm baby is seen. A meta-synthesis of 14 qualitative research studies on mothers' experiences of having a preterm baby in the neonatal intensive care unit, published from 2000 onward, was conducted. Noblit and Hare's methodological approach was used. The meta-synthesis revealed five metaphors that captured the mothers' experiences. These metaphors centered on reciprocal relationships that consisted of mother-baby relationship ("from their baby to my baby"), maternal development (a striving to be a real normal mother), the turbulent neonatal environment (from foreground to background), maternal caregiving and role reclaiming strategies (from silent vigilance to advocacy), and mother-nurse relationship (from continuously answering questions through chatting to sharing of knowledge). Implications of the meta-synthesis for neonatal nursing are addressed.
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Affiliation(s)
- Hanne Aagaard
- Institute of Public Health, Department of Nursing Science, University of Aarhus, Aarhus, Denmark.
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Fegran L, Helseth S, Fagermoen MS. A comparison of mothers’ and fathers’ experiences of the attachment process in a neonatal intensive care unit. J Clin Nurs 2008; 17:810-6. [DOI: 10.1111/j.1365-2702.2007.02125.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Hemsley B, Balandin S, Togher L. Narrative analysis of the hospital experience for older parents of people who cannot speak. J Aging Stud 2007. [DOI: 10.1016/j.jaging.2006.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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