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Grunberg VA, Presciutti A, Vranceanu AM, Lerou PH. Parental Self-Efficacy and Personal Time Help Explain Impact of Parent-Staff Interactions on Parental Distress and Bonding in the Neonatal Intensive Care Unit. J Pediatr 2024; 276:114300. [PMID: 39278533 DOI: 10.1016/j.jpeds.2024.114300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/29/2024] [Accepted: 09/09/2024] [Indexed: 09/18/2024]
Abstract
OBJECTIVES To identify factors that help explain associations between parent-staff interactions and: (1) parental depression, anxiety, and post-traumatic stress; and (2) parent-child bonding in the neonatal intensive care unit. STUDY DESIGN Our cross-sectional mixed methods survey investigated the ways in which parental-staff interactions relate to parental distress and parent-child bonding. Parents with babies in the neonatal intensive care unit (n = 165) completed validated measures and open-ended questions about their experiences with staff. Using a sequential explanatory approach, we examined: (1) whether and how parental self-efficacy and personal time mediated parent-staff interactions on distress and bonding; and (2) parental written accounts of experiences with staff. RESULTS Multiple mediation analyses revealed that parent-staff interactions exhibited an: (1) indirect effect on parental depression (b = -0.05, SE = 0.02, CI [-0.10, -0.01]), anxiety (b = -0.08, SE = 0.04, CI [-0.16, -0.02]), and parent-child bonding (b = -0.26, SE = 0.08, CI [-0.43, -0.11]) through parental self-efficacy; and (2) indirect effect on parental post-traumatic stress (b = -0.08, SE = 0.04, CI [-0.17, -0.00], completely standardized indirect effect = -0.06) through parental personal time. Thematic analyses revealed that emotional and instructional support from staff helped build parental self-efficacy. Trust with staff helped parents feel comfortable leaving the bedside and engage in basic needs (eg, eat, sleep). CONCLUSIONS Family-staff dynamics are the foundation for high quality family-centered care. Staff who empower parents to participate in care, engage in parenting tasks, and take care of themselves may reduce their distress and improve relationships among staff, parents, and babies.
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Affiliation(s)
- Victoria A Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Mass General Brigham, Boston, MA; Harvard Medical School, Boston, MA; Division of Newborn Medicine, Mass General Brigham, Boston, MA.
| | - Alex Presciutti
- Center for Health Outcomes and Interdisciplinary Research, Mass General Brigham, Boston, MA; Harvard Medical School, Boston, MA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Mass General Brigham, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul H Lerou
- Harvard Medical School, Boston, MA; Division of Newborn Medicine, Mass General Brigham, Boston, MA
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Brødsgaard A, Bjerregaard M, Knudsen JB. Parents' Shared Experiences of Separation From Their Newborns After Birth in Denmark. J Obstet Gynecol Neonatal Nurs 2024; 53:534-542. [PMID: 38823787 DOI: 10.1016/j.jogn.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/03/2024] Open
Abstract
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.
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Białas A, Nowak A, Kamecka K, Rasmus P, Timler D, Marczak M, Kozłowski R, Lipert A. Self-Efficacy and Perceived Stress in Women Experiencing Preterm Birth. J Clin Med 2024; 13:4945. [PMID: 39201086 PMCID: PMC11355641 DOI: 10.3390/jcm13164945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Being an unexpected, undesired and life-threatening situation, preterm birth (PTB) is a stress-, anxiety- and depression-generating factor for women delivering prematurely. The aim of this study was to assess the relationship between self-efficacy, coping strategies and perceived stress in mothers who experienced preterm birth and full-term birth, to determine the needs for personalized emotional support. Methods: The study was conducted among 251 women divided into the preterm birth group (PBG) and the full-term birth group (FBG). Data were collected using the following: (1) The State-Trait Anxiety Inventory (STAI) Questionnaire, (2) Generalized Self-Efficacy Scale (GSES) and (3) Coping Inventory for Stressful Situations Questionnaire (CISS), which were distributed online from January 2021 to June 2021. Results: Lower STAI scores were recorded in the preterm birth group (PBG) with high self-efficacy (HSE) when compared to the full-term birth group with HSE. CISS test scores were higher in PBG women with low self-efficacy (LSE) in comparison to women with LSE in FBG (p < 0.001). A positive and strong relationship (0.83; p < 0.05) was found between avoidance-oriented style and strategy of avoidance by engaging in surrogate activities and a positive moderate relationship (0.58; p < 0.05) with the style of looking for social contacts in PBG with LSE. Conclusions: The task-oriented coping style seems to be the most beneficial strategy for mothers, regardless of their preterm or term delivery, as focusing on specific activities increases the sense of self-efficacy and the anxiety level can decrease. Awareness of different styles of coping with stress and a sense of self-efficacy are necessary to plan personalized interventions for premature infants' mothers.
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Affiliation(s)
- Agata Białas
- Department of Preventive Medicine, Medical University of Lodz, 92-213 Lodz, Poland; (A.B.); (A.N.)
| | - Anna Nowak
- Department of Preventive Medicine, Medical University of Lodz, 92-213 Lodz, Poland; (A.B.); (A.N.)
| | - Karolina Kamecka
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (K.K.); (M.M.); (R.K.)
| | - Paweł Rasmus
- Department of Medical Psychology, Medical University of Lodz, 90-131 Lodz, Poland;
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (K.K.); (M.M.); (R.K.)
| | - Remigiusz Kozłowski
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-131 Lodz, Poland; (K.K.); (M.M.); (R.K.)
| | - Anna Lipert
- Department of Preventive Medicine, Medical University of Lodz, 92-213 Lodz, Poland; (A.B.); (A.N.)
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Ghaedi-Heidari F, Izadi M, Seyedbagheri S, Ahmadi A, Sayadi AR, Sadeghi T. The Effect of Mindfulness on Posttraumatic Growth of Mothers of Premature Infants Admitted to Neonatal Intensive Care Unit. J Clin Psychol Med Settings 2024; 31:19-25. [PMID: 37178339 DOI: 10.1007/s10880-023-09961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
The purpose of this study was to determine the effect of Mindfulness-Based Stress Reduction (MBSR) on Posttraumatic Growth (PTG) in mothers of premature infants admitted to the Neonatal Intensive Care Unit (NICU) in Iran. Sixty mothers were selected by convenience sampling and assigned to the intervention and control groups. The intervention group received two MBSR sessions each week over the course of three weeks. The Posttraumatic Growth Inventory (PTGI) was used to collect data before, immediately after, and 1 month after the intervention. Based on repeated measures ANOVA, group-by-time interaction effect was significant and there was a statistically significant difference in the mean PTG scores of mothers in the two groups over time (p = 0.004). MBSR increased PTG in mothers. As a result, it is suggested that this approach be used in psychological support programs for mothers who have premature infants admitted to neonatal intensive care units.
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Affiliation(s)
- Fatemeh Ghaedi-Heidari
- Department of Psychiatric Nursing, Nursing and Midwifery School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoomeh Izadi
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Seyedhamid Seyedbagheri
- Deptartment of Pediatric Nursing, Nursing and Midwifery School, Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| | - Atefeh Ahmadi
- Nursing Research Center, Razi Nursing and Midwifery Faculty, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmadreza-Reza Sayadi
- Social Determinants of Health Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tabandeh Sadeghi
- Non-Communicable Diseases Research Center, Department of Pediatric Nursing, Nursing and Midwifery School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Siva N, Nayak BS, Lewis LES, Velayudhan B, Shenoy RP, Phaneendra M, Shankar R. Randomized Controlled Trial on the Effect of the Neonatal Nurse Navigator Program on Maternal Stress and Neonatal Cortisol Levels. J Obstet Gynecol Neonatal Nurs 2024; 53:185-196. [PMID: 38134967 DOI: 10.1016/j.jogn.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To assess the effect of the Neonatal Nurse Navigator Program (NNNP) compared to usual care on maternal stress and neonatal salivary cortisol level (SCL) in the NICU. DESIGN Randomized control trial. SETTING NICU in a tertiary health care hospital in Manipal, Udupi District, Karnataka, India. PARTICIPANTS Neonates between 34 and 36 weeks gestation and their mothers (N = 120 dyads). METHODS We used block randomization to assign dyads to the intervention or control group. We measured maternal stress using the Parental Stress Scale: Neonatal Intensive Care Unit, and we estimated neonatal stress by measuring SCLs within 24 hours of NICU admission and before discharge from the unit. We conducted a descriptive analysis on participant characteristics and reported maternal stress levels using means and standard deviations. We used the analysis of covariance change score test to determine the difference in maternal and neonatal stress levels between the intervention and control groups. RESULTS The NNNP group exhibited significantly lower maternal stress scores before discharge than the control group, and we observed reductions across all three subscales of the Parental Stress Scale: Neonatal Intensive Care Unit. Mean neonatal salivary cortisol levels were significantly lower in the interventional group than in the control group, F(1.117) = 24.03, 95% confidence interval [7.9, 18.6], p < .001. CONCLUSION Use of the NNNP reduced maternal stress SCLs in high-risk neonates by actively engaging mothers in the care of their neonates in the NICU. We recommend adoption of the NNNP model as a standard care policy in NICUs throughout India.
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McCarty DB, Dusing SC, Gilbert A, LeBlond KD, Soucie M, O'Shea TM. Parent and Therapist Perceptions of the Feasibility, Acceptability, and Benefits of a Weekly Therapist-Led Massage Program for Extremely Preterm Infants in Neonatal Intensive Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1453. [PMID: 37761414 PMCID: PMC10528855 DOI: 10.3390/children10091453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Mothers of extremely preterm infants experience high rates of mental health disorders that impair maternal-infant interaction and lead to worse infant developmental outcomes. Therapist Education and Massage for Parent-Infant Outcomes (TEMPO) is a therapist-led program that standardizes the nature and frequency of parent education through weekly scheduled therapy sessions. Using a family-centered approach, the therapist facilitates positive maternal-infant interactions and massage interventions from birth throughout hospitalization with the goal of improving maternal mental health. This qualitative study presents the results of 19 parent interviews and of a focus group of four TEMPO interventionists to elicit feedback about the program. Overall, parents and therapists viewed the program positively. Parents and therapists valued the focus on parent education and engagement to increase parent competence and bonding opportunities. Both groups acknowledged that infant massage had both infant-centered and parent-centered benefits. One area where parent and therapist views did not align was regarding feasibility of TEMPO. Parents noted multiple logistical challenges to regular NICU visitation, but ultimately agreed that attending weekly therapy sessions was feasible. Therapists noted increased time and effort required of TEMPO and felt that institutional and system-level changes would be necessary to implement weekly parent education as standard of care.
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Affiliation(s)
- Dana B McCarty
- Department of Health Sciences, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
- Rehabilitation Services, University of North Carolina Children's Hospital, Chapel Hill, NC 27599, USA
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90033, USA
| | - Alana Gilbert
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen D LeBlond
- Duke Physical and Occupational Therapy, Duke Health, Chapel Hill, NC 27517, USA
| | - Meredith Soucie
- Rehabilitation Services, University of North Carolina Children's Hospital, Chapel Hill, NC 27599, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine; Chapel Hill, NC 27599, USA
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Chandrasekaran SA, John HB, Ross BJ, Arumugam A, Balan I, Samuel R. Torn between two worlds: parental experiences of neonatal follow-up for infants with hypoxic ischaemic encephalopathy in India-a qualitative study using interpretative phenomenological analysis. BMJ Open 2022; 12:e063732. [PMID: 36424107 PMCID: PMC9693659 DOI: 10.1136/bmjopen-2022-063732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to understand the barriers and facilitators of a neonatal follow-up programme, as perceived by parents of infants born with hypoxic ischaemic encephalopathy (HIE). DESIGN This study applied a qualitative study design using interpretative phenomenological analysis. It included focus group discussions, face-to-face in-depth interviews and telephonic interviews. Data were analysed using thematic content analysis. SETTING Neonatal follow-up clinic of a tertiary hospital in South India. The study was conducted between March and December 2020. PARTICIPANTS Five fathers and eight mothers of infants with HIE. RESULTS Parents of children with HIE are torn between two worlds-an atmosphere of support and one of criticism. Three main themes were identified: (1) neonatal intensive care unit (NICU) stay: distressful versus reassuring experiences; (2) parenthood: supportive versus unsupportive environments; and (3) neonatal follow-up: adherence versus non-adherence. CONCLUSION Parents of children with HIE experience sociocultural barriers in the NICU, after discharge and during the follow-up period. These lead to a complex array of emotional and physical consequences that affect parenting and follow-up care.
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Affiliation(s)
| | - Hima B John
- Neonatology, Christian Medical College, Vellore, India
| | | | - Asha Arumugam
- Neonatology, Christian Medical College, Vellore, India
| | - Indira Balan
- Neonatology, Christian Medical College, Vellore, India
| | - Reema Samuel
- Psychiatry, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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