Perception of Stress and Styles of Coping with It in Parents Giving Kangaroo Mother Care to Their Children during Hospitalization in NICU

Effects of kangaroo mother care combined with nurse-assisted mindfulness training for reducing stress among mothers of preterm infants hospitalized in the NICU: a randomized controlled trial

BACKGROUND

Kangaroo mother care (KMC) can have a positive effect on the mental well-being of a mother. However, there are specific challenges associated with the process that may contribute to increased anxiety for the mother. By integrating nurse-assisted mindfulness training alongside KMC guidance, nurses may effectively alleviate maternal stress to a greater extent.

METHODS

A single-centre randomized controlled trial was conducted to investigate the effects of KMC combined with nurse-assisted mindfulness training. The study included preterm infants with a gestational age of less than 32 weeks or a birth weight of less than 1500 g and their mothers, who were randomly divided into two groups. The intervention group consisted of mothers who received KMC combined with nurse-assisted mindfulness training for 14 days. The control group comprised mothers who received only KMC for 14 days. Data from both groups were collected and compared for analysis.

RESULTS

Forty-seven infants and their mothers were included in the intervention group, whereas 44 pairs were included in the control group. After the intervention, the parental stressor scale scores for the neonatal intensive care unit (PSS: NICU) (3), PSS: NICU (4), and Hospital Anxiety and Depression Scale (HADS) scores for the intervention group were lower than those for the control group, whereas the Five Facet Mindfulness Questionnaire (FFMQ) (1), FFMQ (4), and FFMQ (5) scores for the intervention group were higher. The degree of change in the PSS: NICU and HADS scores was inversely correlated with the degree of change in the FFMQ score. The breast milk feed rate and weight gain rate were greater in the intervention group than in the control group. No adverse reactions were observed in either group.

CONCLUSIONS

Kangaroo mother care combined with nurse-assisted mindfulness training is an acceptable, feasible, and effective procedure for reducing anxiety in mothers of preterm infants in the NICU, with potential benefits for the short-term prognosis of these infants.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900023697, registered on June 8, 2019, retrospectively registered.

Behavioral and physiological pain structures of PIPP-R and parental stress: structural equation modeling approach

BACKGROUND

Although most non-acute pain assessment tools are multi-dimensional (behavioral and physiological measures) in their approach, the outputs of such tools are considered unidimensional. This study aimed to explore and determine the behavioral and physiological pain structures of Premature Infant Pain Profile-Revised (PIPP-R) for neonates and its association with parental stress.

METHODS

This cross-sectional study was conducted in 2022-2023 in Isfahan, Iran. We recruited 400 pre-term infants, i.e. with gestational age (GA) of less than 37weeks who were admitted to the NICU of educational hospitals. PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) were used for data gathering. The latent structures of pain and its association with parental stress were explored using latent variable modeling approach.

RESULTS

A two-factor model, i.e. behavioral and physiological pain factors, was extracted, explaining 65% of the total variance. The results of confirmatory factor analysis showed that the identified structures in the exploratory factor analysis could be nearly replicated (CFI = 0.99، TLI = 0.98, RMSEA = 0.001). Behavioral pain structure, independent from gestational age had a significant direct association with parental stress score (β = 0.005, SE = 0.002, p = 0.026).

CONCLUSIONS

The PIPP-R assesses both behavioral and physiological pain factors. We also found that behavioral pain factor was associated with parental stress.

IMPACT

These results may provide a potential clue for physicians, nurses, and parents to manage the pain in preterm infant. The PIPP-R scores in preterm infants consist of "Behavioral and Physiological" pain factors. Single dependence on behavioral indicators (such as facial expression) has some limitations. Multidimensional tools may be the optimal method in detecting pain in preterm infants. Parental stress can affect behavioral pain structure in preterm infants. Intensive care nurses play an effective role in reducing the parental stress and pain severity of these preterm infants by including the help of mothers in procedures and providing them with psychological support.

Measuring experience of and satisfaction with newborn care: a scoping review of tools and measures

BACKGROUND

Standardised measures on experience of care are essential to understanding the care women and newborns receive and to designing appropriate interventions and responses. This review builds on ongoing work in the realm of maternity care and complements it by reviewing existing tools and measures to assess experience of and satisfaction with the care of the newborn.

METHODS

We conducted a scoping review of published literature to identify measures and tools of experience (physiological or indirect) and satisfaction with newborn care. We systematically searched five bibliographic databases from 1 January 2010 through 1 December 2022 and contacted professional networks. Using a predefined evidence template, we extracted data on the studies and the tools' characteristics. We mapped the tools and measures against the WHO quality of care frameworks to identify the most frequent measured domains of care and to highlight existing gaps.

RESULT

We identified 18 292 records of which 72 were eligible. An innovative finding of this review is the inclusion of newborn perspectives through behavioural responses, physiological signals, pain profiles as well as other non-verbal cues as markers of newborn experience. Domains related to parental participation and decision-making, ensuring continuity of care and receiving coordinated care, were the most measured across the included tools.

CONCLUSION

Comprehensive and validated instruments measuring all aspects of care are needed. Developing a robust theoretical ground will be fundamental to the design and utilisation of standardised tools and measures.

PROTOCOL REGISTRATION DETAILS

This review was registered and published on protocol.io (dx.doi.org/10.17504/protocols.io.bvk7n4zn).

We are facing some barriers: A qualitative study on the implementation of kangaroo mother care from the perspectives of healthcare providers

Health systems at all levels are under pressure to provide comprehensive and high quality of care based on the best evidencebased interventions. The kangaroo mother care (KMC) is one way to care for Low Birth Weight babies (LBW) especially in developing country where the rates of preterm and LBW neonates are higher and the resources are limited. The purpose of this paper is to explore healthcare providers’ perspectives of kangaroo mother care implementation in perinatology ward in the rural surgical hospital of East Java Province, Indonesia. We conducted an in-depth interviews to identify KMC implementations. Ten healthcare providers engaged with KMC were interviewed. Data was analyzed using a thematic analysis. Healthcare providers reported positives perceptions of KMC and acknowledged their important roles to give education. The barriers in implementing the KMC including the level of knowledge and the age of the mother of LBW babies. KMC as a method of treating LBW babies is effective intervention care of preterm and LBW babies. This research provides information regarding the need of supports from all levels in KMC implementation.

Stressful Experiences of Parents in the Paediatric Intensive Care Unit: Searching for the Most Intensive PICU Stressors

Hospitalization of a child in the paediatric intensive care unit (PICU) is extremely stressful, both for the child and for his or her family. The purpose of this study was to gain deeper insight into the stressful experiences of parents of children hospitalized in the PICU. This study included 96 parents. The data were collected using a translated and standardized scale "The Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU)". This study confirms high exposure of parents to numerous PICU stressors. The most intense PICU stressor for parents was child's breathing depending on the ventilator (4.22 ± 1.17), and the least intense was child's demanding behaviour (1.17 ± 0.33). A significant positive correlation between the level of parents' perceived stress and the number of their children was recorded (r = 0.240, p = 0.02), while there was no significant correlation between the level of stress and other sociodemographic variables. A significantly higher level of stress was experienced by parents with primary school education (p = 0.032) and parents who are not healthcare professionals (p < 0.01). It is necessary to establish a system that will enable continuous assessment of parents' stress levels and timely prevention of stressful experiences for parents in the PICU.

Factors affecting how parents cope with their preterm infant's pain: A cross-sectional study

AIMS AND OBJECTIVES

This study examined the relationships between parents' catastrophising about their infants' pain, parental self-efficacy in the management of their infants' pain, perceived social support and the parental coping strategies for their infants' pain-related stress.

BACKGROUND

Preterm infants hospitalised in the neonatal intensive care unit experience painful procedures causing stress to their parents. Coping with stress may be emotion- or problem-focused. Adults' coping with their own pain has been associated with pain catastrophising, pain management self-efficacy and social support. However, little is known about the associations between parents' catastrophising, their self-efficacy to manage, their perceived social support and their coping strategies when dealing with their infants' pain.

DESIGN

This was a cross-sectional, correlational study design.

METHODS

The STROBE guidelines for cross-sectional studies were followed. Participants included 149 parents of preterm infants hospitalised in a neonatal intensive care unit. They completed measures to assess infant pain catastrophising, self-efficacy regarding infant pain management, social support and emotion- and problem-focused coping.

RESULTS

Positive associations were found between parental self-efficacy regarding infant pain management, social support, parental catastrophising about their infants' pain and problem-focused coping. Parental catastrophising was positively associated with emotion-focused coping. Gender moderated the relationships between parental self-efficacy regarding infant pain management and emotion-focused coping. Specifically, amongst mothers, the higher their level of self-efficacy, the lower their emotion-focused coping. Amongst fathers, the relations were reversed.

CONCLUSIONS

Parents coping with their preterm infants' pain were associated with catastrophising about their infants' pain, self-efficacy regarding infant pain management and social support. Mothers had different ways to cope emotionally to that of fathers in relation to their self-efficacy in managing their infants' pain.

RELEVANCE TO CLINICAL PRACTICE

Nursing interventions that provide support to parents and promote parental self-efficacy in managing their infants' pain may allow parents to more effectively cope with their infants' pain.

PATIENT OR PUBLIC CONTRIBUTION

Patients or public were not involved in setting the research question, the outcome measures and the design or implementation of the study. Parents of preterm infants answered the research questionnaires.