Assessing the needs of grandparents of preterm infants in neonatal intensive care units: a cross-sectional study

Background

Globally, there is an increasing trend in the incidence of premature births and low birth weight. Neonatal intensive care unit (NICU) care has become indispensable for these newborns. Nevertheless, this mode of care poses substantial economic, psychological, and health challenges to the families of preterm infants. Despite abundant evidence concerning the parents' needs in the NICU, the needs of grandparents-vital family members-are frequently disregarded. This exploratory study aimed to assess the grandparents' needs of preterm infants in the NICU, exploring the impact of demographic elements on these needs to offer guidance for clinical care practices.

Methods

This study employed a cross-sectional design and the Chinese version of the NICU Family Needs Inventory (NICU-FNI) to investigate the needs of grandparents. A total of 280 grandparents participated in the study, providing data by completing structured questionnaires related to their demographic profiles and needs. Statistical analyses were utilized to analyze the data, including descriptive statistics, chi-square tests, Pearson's correlation, and multiple linear regression.

Results

Six items about Assurance emerged as significant among the top 10 important needs, with two items for Information, one for Proximity, and one for Support; among the least important needs, nine items related to Comfort and Support were identified. The subscale "Assurance" achieved the highest mean score of 4.07 ± 0.49, followed by the subscales of "Information" and "Proximity," registering mean scores of 3.50 ± 0.47 and 3.50 ± 0.46, respectively. This explorative study identified a correlation between the needs for Assurance and employment status, place of residence, gestational age, and birth weight (p < 0.05). Employment status, place of residence, and gestational age were identified as significant correlates for Assurance (p < 0.05).

Conclusion

The foremost need identified by grandparents is Assurance of quality care for preterm infants, closely followed by the demand for thorough Information and the ability to be in Proximity to the infant. This exploratory study highlights that mitigating the strain on families with preterm infants, as well as recognizing and meeting the needs of grandparents, is of paramount importance.

Breastfeeding needs of mothers of preterm infants in China: a qualitative study informed by the behaviour change wheel

BACKGROUND

Although breastfeeding is strongly recommended, the breastfeeding rate of preterm infants in China remains significantly low. In addition to the global structural challenges to breastfeeding and the physiological immaturity of preterm infants, Chinese mothers of preterm infants face unique challenges of maternal-infant separation after birth. Moreover, little is known about Chinese mothers' specific needs in coping with the difficulties posed by these challenges. This study utilized the Behaviour Change Wheel to investigate the breastfeeding needs of Chinese preterm mothers that may facilitate its practice in the future.

METHOD

A qualitative descriptive design was implemented in Wuhan in 2022. Based on purposeful sampling, 13 preterm mothers were recruited from a NICU in a Grade III Class A hospital in Wuhan, China. Face-to-face semi-structured interviews were conducted to collect data using the interview guide developed by the Theoretical Domains Framework. Theoretical Thematic Analysis was used to review the data in 6 steps to identify themes.

RESULTS

Five major themes emerged: (1) capability: ability to interpret infants' cues and identify problems, and need for breastfeeding knowledge and skills training; (2) physical opportunity: cleanliness and quietness in household environment, private lactation spaces and breastfeeding tools in workplaces and hospitals; (3) social opportunity: family support, peer support, and authoritative support from healthcare providers; (4) reflective motivation: information on health impacts of breastfeeding; (5) automatic motivation: maternal-infant bonding, free of aversive stimulus.

CONCLUSION

Preterm mothers' needs to enable breastfeeding were diverse, including increasing their capability, physical and social opportunities, and reflective and automatic motivation. People, resources and environments associated with these needs should be engaged together to stablish a conducive structural environment for breastfeeding. The policy change for "zero separation" and implementation of kangaroo care should also be implemented in Chinese neonatal intensive care units. Future studies are needed to design effective interventions according to mothers' specific needs.

A comparative study of the effects of Kangaroo care by mothers and maternal grandmothers on the vital signs of hospitalized preterm newborns: a randomized controlled clinical trial study

BACKGROUND

Kangaroo care (KC) is an effective technique to prevent injury in newborns due to prematurity and hospitalization. Mothers of preterm newborns experience their own set of physical and mental problems. Such circumstances call for another family member to take care of the newborn. This study compared the effect of KC by mothers and maternal grandmothers on the vital signs of preterm newborns.

METHODS

This parallel randomized controlled trial was done at the neonatal and NICU departments of the hospital in Kuhdasht in Iran. Eighty preterm neonates were selected through convenience sampling according to the eligibility criteria, then by stratified block randomization allocated to two groups. The control group received KC from the mother, and the intervention group received KC from the maternal grandmothers on the vital signs of preterm newborns. Vital signs were assessed 15 min before, during, and after the KC as the primary outcome. The data collection tools included a demographic questionnaire and a form to record the vital signs. Vital signs were measured by a pulse oximeter, an electronic thermometer, and observation. Data were analyzed by the chi-square test, the independent t-test, and the repeated measures ANOVA.

RESULTS

The vital signs of newborns in each group showed a significant difference before, during, and after receiving KC (P < 0.05). Nevertheless, the vital signs of the newborns did not differ significantly between the mother and the maternal grandmother KC groups (P > 0.05).

CONCLUSION

KC by maternal grandmother may stabilize the vital signs of preterm newborns as much as when this type of care is provided by the mother. We, therefore, recommend the provision of KC by the maternal grandmother, as a support and substitute for the mother whenever she is incapable of being at the hospital and to enable the mother to rest.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20211225053516N1, March 31, 2022.

Exploring cultural determinants to be integrated into preterm infant care in the neonatal intensive care unit: an integrative literature review

BACKGROUND

Cultural practices are an integral part of childrearing and remain a significant aspect for healthcare professionals to ensure culturally sensitive care, particularly in the neonatal intensive care unit.

OBJECTIVE

To synthesise literature on the cultural determinants that can be integrated into care of preterm infants admitted into the neonatal intensive care unit.

METHODS

The current review followed the integrative literature review steps proposed by Lubbe and colleagues. The registration of the review protocol was in PROSPERO. There was a literature search conducted in the EBSCOhost, PubMed, ScienceDirect and Scopus databases using the search string developed in collaboration with the librarian. Three reviewers employed a three-step screening strategy to screen the articles published in English between 2011 and 2021 that focused on culturally sensitive care. The Johns Hopkins Nursing Evidence-Based Practice Evidence critical appraisal toolkit assessed the methodological quality of the articles included at the full-text screening level.

RESULTS

There were 141 articles retrieved, and 20 included on the full-text screening level; the exclusion of one article was due to a low critical appraisal grade. Four topical themes emerged from 19 articles: spiritual care practices, intragenerational infant-rearing practices, infant physical care practices, and combining treatment practices.

CONCLUSION

Overall, the findings indicated that parental cultural beliefs and practices mostly influenced infant-rearing practices, emphasising the significance of integrating cultural practices when rendering healthcare services. The recommendation is that healthcare professionals understand various cultural determinants, mainly those specific to the community they serve, to provide culturally sensitive care.

Exploring the Influence of a Mindfulness Intervention on the Experiences of Mothers with Infants in Neonatal Intensive Care Units

Objectives

Mothers with infants in the neonatal intensive care unit (NICU) are at increased risk of psychological distress, which can have lasting negative impacts on both mother and infant. However, few interventions are available to promote these mothers' mental health and wellbeing. In the context of a pilot randomized controlled trial testing a mindfulness intervention for mothers with infants in the NICU, we explore the experiences of the mothers participating in the mindfulness-based intervention, with mothers in the control group as comparison, and the ways they felt it influenced their time in the NICU.

Method

Twenty-six participants (15 participants in the intervention arm and 11 participants in the control arm) recruited from two NICUs in an urban center in Eastern United States completed semi-structured interviews. Interviews explored the mothers' NICU experience as well as experience with the mindfulness and health education (control) programs. Data was analyzed using an iterative, thematic constant comparison process informed by grounded theory.

Results

Mothers reported that participation in the mindfulness intervention helped them to calm the chaos through recentering and fostering connections, find comfort through non-judgmental acceptance, gain perspective on the situation, and facilitate self-care. These were experienced only among the mothers in the intervention arm. These themes did not vary based on demographics of the mothers in the mindfulness study arm or their pre-study awareness of mindfulness.

Conclusions

Mindfulness interventions may foster new practices and perspectives for mothers with infants in the NICU, potentially leading to improved mental health wellbeing.

NEO-SPEAK: A conceptual framework that underpins breaking bad news in neonatology

OBJECTIVE

Breaking bad news in neonatology is a frequent and difficult challenge. Although there are guidelines for communicating with parents in pediatrics and neonatology, the specific framework for breaking bad news in neonatology has not been studied in more detail. Therefore, we aimed to identify determinants that are important for successful managing breaking bad news in neonatology from professionals' perspective and to develop a conceptual framework that underpins this challenging task.

METHODS

We conducted seventeen semi-structured interviews with senior neonatologists of six perinatal centers of the highest level of care in Germany. The transcripts were analyzed according to Mayring's method of qualitative content analysis using inductive and deductive coding.

RESULTS

Eight determinants of breaking bad news in neonatology could be identified from the interviews. From these, we developed the conceptual framework NEO-SPEAK. The first three determinants, Neonatal prognostic uncertainty, Encounter in (triangular-)partnerships, Organization and teamwork (NEO) are directly related to the specific care situation in neonatology, whereas the others, Situational stress, Processuality, Emotional burden, Attention to individuality, Knowledge and experience, play a role for difficult conversations in general, but are subject to special modifications in neonatology (SPEAK). In addition, the results show that the context in neonatology as well as reciprocal effects on the team and the individual level of the physicians are important influencing factors in breaking bad news.

CONCLUSION

On the one hand, the constitutional framework NEO-SPEAK shows which special aspects play a role in neonatology for the delivery of bad news, and on the other hand, it can help to identify and consider these aspects in clinical routine and training. Considering or reinforcing each NEO-SPEAK element when planning or delivering bad news may guide healthcare professionals through communication with parents of critically ill or premature newborns and support the resilience of the caring team.

Fathers' experiences of supporting their partners during their preterm infant's stay in the neonatal intensive care unit: a multi-method study

OBJECTIVE

To explore how the fathers experience their role as a support for their partner and the relationship with them during their preterm infant's stay in the NICU.

STUDY DESIGN

Multi-method longitudinal study involving ethnographic observation, semi-structured interviews, self-report questionnaires, and clinical information. Twenty fathers of preterm infants hospitalized in a level-III-NICU were included. Data were analyzed using thematic continent analysis.

RESULTS

Three main themes were identified: support for mother (subthemes: putting mother's and infant's needs first; hiding worries and negative emotions; counteracting the sense of guilt; fear that the mother would reject the child), mother's care for the infant (subthemes: observing mother engaged in caregiving; mother has "something extra"), and couple relationship (subthemes: collaboration; bond).

CONCLUSION

Fathers supporting their partners during the stay in the NICU experience emotional distress and the need for being supported that often are hidden. This demands a great deal of emotional and physical energy.

Childbearing culture: a prominent context in the process of maternal role attainment in Iranian mothers with preterm neonates

Transition to the role of mothering is one of the most important events in a woman's life. While childbirth is a biological event, pregnancy and the experiences around it are more influenced by social structure, which is shaped by cultural perceptions and practices. The aim of this study was to explore cultural context during maternal role attainment in neonatal intensive care units (NICUs) in Iran. The study was part of a grounded theory study on how the mothers of preterm neonates go through maternal role attainment. Data collection was carried out by purposeful sampling from 20 participants (15 mothers of preterm neonates and 5 NICU nurses). Data were analysed according to Corbin and Strauss's (2015) approach. Four categories of childbearing culture emerged: 'The necessity of childbearing', 'Childbearing rituals', 'Maternal persistent presence' and 'Attitudes and religious beliefs'. The findings showed that the special beliefs and practices in Iranian culture affected all of the participants' reactions to mothering process. Culture is one of the most important factors affecting the development of motherhood in Iran. In order to provide sensitive and culturally appropriate care, nurses should be aware of the general impact of cultural norms and values on the process of maternal role attainment and strive to meet the cultural needs of all mothers.

An active pursuit of reassurance-coping strategies of fathers with infants in the Neonatal Intensive Care Unit

OBJECTIVE

This study aims to explore coping strategies of fathers of very low birth weight (VLBW) infants in the neonatal intensive care unit (NICU).

STUDY DESIGN

A qualitative descriptive study among fathers of VLBW babies. Semi-structured interviews were conducted with 15 fathers until data saturation was achieved. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist was used for reporting.

RESULTS

The overarching theme was an active pursuit of reassurance. Coping strategies revolved around identifying specific stressors and then making deliberate efforts to address them. Based on the main stressors identified, three subthemes were derived: pursuing information amidst uncertainty, bonding with the infant for normalcy and seeking emotional support in the midst of anxiety. Fathers took on a predominantly problem-focused approach.

CONCLUSIONS

Empowering fathers with knowledge and emotional support, facilitating bonding with the infant and addressing their concerns are important in supporting them while having an infant in the NICU.

Determinants of maternal role adaptation in mothers with preterm neonates

OBJECTIVE

Becoming a mother is an innate process, without any culture-dependent instruction. While it is a pleasant experience, it can sometimes be associated with problems resulted from baby caring. Preterm birth can be a challenge for the maternal role adaptation (MRA). Therefore, the present study was conducted to determine the maternal role adaptation in mothers with preterm neonates.

METHODS

The present study is cross-sectional, with a sample including 114 mothers of preterm infants in the NICU. We collected the data using a two-section questionnaire. The first section was a demographic questionnaire and the second section was a standardized questionnaire? "Maternal role adaptation scale in mothers with preterm neonates admitted to neonatal intensive care units" (MRAS: NICU). We ran the statistical analysis using descriptive and inferential statistical methods with the SPSS 21 software.

RESULTS

The total MRA score was strong in half of the participants. The participants had a university education, were employed and satisfied with their economic status, and had a high score on adaptation to the maternal role. There are different domains to the MRA, the highest score was allocated to the participation in care (56.24±0.13), and the lowest score was allocated to growth and development (3.12±0.28).

CONCLUSIONS

According to the results of this study, the most important factors associated with MRA are the mother's age, education, and economic satisfaction. Determining the factors related to the mothers' adoption of premature infants could increase the ability of mothers to cope with problems and negative emotions, and enhance the adoption of maternal roles.

Identification of the Range of Nursing Skills Used to Provide Social Support for Mothers of Preterm Infants in Neonatal Intensive Care

Background

Hospitalization of preterm infants in neonatal intensive care units (NICUs) is a stressful experience for parents. Iranian NICUs do not have specified levels of care, nor do they integrate supportive methods of parent support such as family-centered care approaches. This study investigated the range and types of neonatal nursing support, as perceived by mothers of preterm infants, and its association with mothers' satisfaction with infant care in the NICU.

Methods

This is a descriptive, correlational study of mothers of preterm infants who were hospitalized in three different NICUs in Iran. A convenience sampling method was used. Data were collected using three questionnaires that identified (i) demographic information; (ii) social support available; and (iii) parent satisfaction with infant care.

Results

Mothers (N = 110) generally rated the support from nurses as being moderate. Correlation analysis identified a moderate association of neonatal nurse social support domains for affirmational (r = 0.44) and concrete aid (r = 0.41), a moderately strong association for affectional support (r = 0.64), and total social support (r = 0.60) with mothers' satisfaction.

Conclusion

There were positive associations between social support from nurses and mothers' satisfaction with the care of their infants. Therefore, planning to promote and create opportunities for neonatal nurses to support mothers in NICU is important to promote increased maternal satisfaction in infant care.

Stigma toward small babies and their mothers in Ghana: A study of the experiences of postpartum women living with HIV

Infants born to HIV-infected mothers are more likely to be low birthweight (LBW) than other infants, a condition that is stigmatized in many settings worldwide, including sub-Saharan Africa. Few studies have characterized the social-cultural context and response to LBW stigma among mothers in sub-Saharan Africa or explored the views of women living with HIV (WLHIV) on the causes of LBW. We purposively sampled thirty postpartum WLHIV, who had given birth to either LBW or normal birthweight infants, from two tertiary hospitals in Accra, Ghana. Using semi-structured interviews, we explored women's understanding of the etiology of LBW, and their experiences of caring for a LBW infant. Interviews were analyzed using interpretive phenomenology. Mothers assessed their babies' smallness based on the baby's size, not hospital-recorded birthweight. Several participants explained that severe depression and a loss of appetite, linked to stigma following an HIV diagnosis during pregnancy, contributed to infants being born LBW. Women with small babies also experienced stigma due to the newborns' "undesirable" physical features and other people's unfamiliarity with their size. Consequently, mothers experienced blame, reluctance showing the baby to others, and social gossip. As a result of this stigma, women reported self-isolation and depressive symptoms. These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants. LBW stigma appeared to attenuate with increased infant weight gain. A few of the women also did not breastfeed because they thought their baby's small size indicated pediatric HIV infection. Among WLHIV in urban areas in Ghana, mother and LBW infants may experience LBW-related stigma. A multi-component intervention that includes reducing LBW incidence, treating antenatal depression, providing psychosocial support after a LBW birth, and increasing LBW infants' weight gain are critically needed.

Nurses' Perception of Family-Centered Care in Neonatal Intensive Care Units

Family-centered care (FCC) is one of the important elements of care in neonatal intensive care units (NICUs). The aim of this study was to understand the nurses' perception of FCC in NICUs. This qualitative study was performed using conventional content analysis. Participants in this study included 18 nurses who were selected by a purposeful method. Semistructured, in-depth and face-to-face interviews were conducted with the participants. All interviews were written down, reviewed, and analyzed. Two categories were identified after the data analysis: (1) prerequisite for providing FCC and (2) parents' participation. Prerequisite for providing FCC consisted of two subcategories namely suitable facilities and adequate personnel. Parents' participation included subcategories of parents: neonate's attachment and parents' training. Nurses' perception of FCC in NICUs can facilitate an appropriate condition for the participation of family members in the care of neonates.

The Challenges of Implementing Family-Centered Care in NICU from the Perspectives of Physicians and Nurses

PURPOSE

The purpose of this study was to investigate physicians' and nurses' perspectives on the challenges of implementing the FCC in the neonatal intensive care unit.

DESIGN AND METHOD

The study employed a qualitative design to conduct five focus groups with 25 nurses and 15 physicians (n = 40). All of the nurse participants identified as female; 73% held a bachelor's degree in nursing and 59% had been working as a neonatal nurse for >10 years. Of the physicians, 55% identified as male, 43% held positions as neonatologists and 39% had a minimum of 3 years of experience in neonatal intensive care.

RESULTS

Three themes, power imbalance, psychosocial issues, and structural limitation, and related sub-themes were constructed using thematic analyses.

CONCLUSION

The implementation of family-centered care in the neonatal intensive care unit in Iran is shaped by the health care provider, cultural, legal and operational challenges. To optimize effective and sustained implementation, these influential factors must be addressed.

IMPLICATIONS

Organizational, managerial and operational changes are required for FCC implementation. Nurses and physicians are well-positioned as leaders and facilitators of family-centered care implementation within the neonatal intensive care unit.

Acceptability of a family-centered newborn care model among providers and receivers of care in a Public Health Setting: a qualitative study from India

BACKGROUND

Family-centered care (FCC), based on collaborative participation of the family along with a team of health care providers, is found to increase the well-being of sick infants in neonatal critical care units. Over the last 4 years, the neonatal unit of Dr. Ram Manohar Lohia Hospital in Delhi has innovated and developed an implementation framework for FCC. This qualitative study assessed the acceptability of family-centered care among providers and family members of neonates to identify gaps and challenges in implementation.

METHODS

In-depth interviews were conducted among a purposive sample of twelve family members of admitted neonates and six providers to examine their perceptions and experiences regarding FCC.

RESULTS

Family members and providers expressed a positive perception and acceptance of FCC based on the competencies and knowledge acquired by parents and other caregivers of essential newborn care. Family members reported being satisfied with the overall health care experience due to the transparency of care and allowing them to be by their baby's bedside. Limitations in the infrastructure or lack of facilities at the public hospital did not seem to dilute these positive perceptions. Providers also perceived FCC as a good practice to be continued in spite of concerns around sharing of nursery space with parents, the need for constant vigilance of parents' practices in handling of their newborns, and the need for separate, designated nursing staff for FCC.

CONCLUSION

Both providers and receivers of neonatal care found FCC to be an acceptable form of care. Providers identified challenges and suggested possible solutions, such as need of periodic provider sensitization on FCC, improved staff organization, and provision of mother-friendly facilities to enable her to provide around-the-clock care by her baby's bedside. Overcoming these challenges would allow for better integration of FCC within general clinical care in neonatal care units.

An Investigation of the Needs of Saudi Parents of Preterm Infants in the Neonatal Intensive Care Unit

Objective This study aimed to identify the needs of Saudi parents who had an infant in a neonatal intensive care unit (NICU) in one of five hospitals in Riyadh City, Saudi Arabia. Materials and methods Data were collected using a questionnaire that comprised questions about demographic characteristics and a modified version of the NICU Family Needs Inventory. A convenience sample of 36 Muslim Saudi mothers and fathers completed a self-reported questionnaire. Parents were asked to rate 52 statements in the NICU Family Needs Inventory as not important, somewhat important, important or very important. Results Saudi parents ranked the needs for assurance, proximity, and information as the most important needs. The comfort and support needs were ranked as the least important. Moreover, the highest top-ranked items were related to assurance of pain infant being treated for (86%), infant expected outcome (83%), and infant being handled gently (83%). Conclusion Nurses should create a relationship with parents and provide them with comprehensible and honest assurance and information. Likewise, it is imperative to provide a high-quality holistic care for parents that relies on their needs assessment.

Psychometric Properties of the Italian Perceived Maternal Parenting Self-Efficacy (PMP S-E)

To validate the Italian Perceived Maternal Parenting Self-Efficacy (PMP S-E), the first questionnaire specifically developed for mothers of preterm neonates hospitalized in the Neonatal Intensive Care Unit. Two hundred mothers filled the PMP S-E, the General Self-Efficacy Scale (GSES), the Edinburgh Postnatal Depression Scale (EPDS), the Parental Distress Index (PSI-SF/Pd). The Explanatory Factor Analysis outlined four factors: care-taking procedures, evoking behaviours, reading and managing bodily cues, reading and managing emotional cues. This factor-solution demonstrated adequate goodness of fit when the Confirmatory Factor Analysis was carried out. Internal consistency was high for the overall scale (α = 0.932), and the all the factors (all α > 0.80). There was a moderate correlation with GSES (r = .438; p < .001), while the associations with EPDS (r = .295; p < .001) and PSI-SF/Pd (r = .193; p = .006) were low. Good test-retest reliability was found over 2 weeks (r = .73; p < .001). These findings support the validity and reliability of the Italian PMP S-E.

Mothers' Emotional Experiences Providing Care for Their Infants Within the Culture of an Iranian Neonatal Unit

BACKGROUND

Each year, 5% to 8% of Iranian newborns require care in a neonatal unit (NU). Reasons for admission include prematurity, infection, and congenital anomalies. Little research has been conducted on the culture of Iranian NUs and the impact this has on mothers' emotional caregiving experiences.

PURPOSE

To explore the emotional caregiving experiences of mothers in an Iranian NU.

METHODS

Focused ethnography was used for this study. Mothers (n = 19) of term and preterm infants participated. Data were collected using observations and interviews. Roper and Shapira's 5-step framework was used to analyze the data.

FINDINGS

Four major themes emerged: (a) fear, (b) loneliness, (c) competence, and (d) pleasure. Fear occurred when mothers felt unprepared to care for their infants. They were afraid of harming their infant or repeating previous mistakes. Loneliness consisted of bearing the burden of care while feeling alone. Competence occurred when the mothers experienced an increasing ability to provide care for their infants and a growing self-confidence. Finally, the mothers described pleasure as they began to feel worthiness as mothers and intense love for their infants.

IMPLICATIONS FOR PRACTICE

The sense of fear and loneliness shared by these mothers has significant implications for practice. While it may be a challenge for nurses to provide adequate support for mothers due to the heavy workload of Iranian NUs, close relatives and other support persons may play a key role.

IMPLICATIONS FOR RESEARCH

Future research should be conducted on the impact of maternal support on mothers' NU experiences in Iran.

Fathers' Stress in the Neonatal Intensive Care Unit: A Systematic Review

BACKGROUND

Admission to the neonatal intensive care unit (NICU) is stressful for parents. Nurses often focus on maternal well-being and fail to acknowledge the stress of fathers. Research on fathers' psychological stress is limited.

PURPOSE

A systematic review of the literature was completed to examine the extent of psychological stress and types of stressors in fathers with infants admitted to the NICU.

METHODS/SEARCH STRATEGY

A search of Ovid MEDLINE, Cochrane Library, PsycINFO, CINAHL, and EMBASE was conducted to identify descriptive and observational studies reporting father-specific stress in the NICU. Studies using observational and descriptive designs, published in English, and reporting father-specific stress outcomes during a NICU admission were eligible for inclusion. Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used for quality assessment.

RESULTS

Fifteen studies met inclusion criteria. Fathers find the NICU environment stressful and are more stressed than fathers of full-term, healthy infants. Parental role alteration, infant appearance, NICU environment, and staff communication are stressors.

IMPLICATIONS FOR PRACTICE/RESEARCH

By recognizing the extent and types of psychological stress in fathers, nurses can provide better support for fathers in their new role. Younger fathers and those with very low birth-weight premature infants may need additional support and resources. Future research on fathers' stress should include larger sample sizes, diverse populations, and tool development and evaluation.

Stress, Anxiety, Depression and Sleep Disturbance among Jordanian Mothers and Fathers of Infants Admitted to Neonatal Intensive Care Unit: A Preliminary Study

PURPOSE

To investigate the stressors and stress levels among Jordanian parents of infants in the NICU and their relationship to three factors: anxiety, depression and sleep disturbance.

DESIGN AND METHODS

A cross-sectional survey was conducted in two hospitals in Jordan among 310 parents of infants in the NICU by using PSS: NICU and PROMIS.

RESULTS

Both parents experienced high levels of stress, anxiety, depression and sleep disturbance. There was a significant difference in stress level between mothers and fathers [t (308)=3.471, p=0.001], with the mothers experiencing higher stress than the fathers [mean: mothers=108.58; fathers=101.68]. The highest and lowest sources of stress were infant behavior and appearance (M=4.09) and sights and sounds in the NICU (M=3.54), respectively. The correlation between stress levels with anxiety (r=0.79) and depression (r=0.75) was strong and positive while sleep disturbance was significant and moderate (r=0.43).

CONCLUSIONS

The mothers experienced higher levels of stress compared to fathers, with positive correlations between stress and anxiety, depression and sleep disturbance.

PRACTICAL IMPLICATIONS

The findings of this study create nursing awareness of parent stress and its impact, which will help them to improve nursing care for parents.

Stress Management among Parents of Neonates Hospitalized in NICU: A Qualitative Study

Introduction: Infant hospitalization is stressful event for parent in NICU. Parents think that they have lost control because of unfamiliar environment. Therefore, stress management is very important in this period. The family as the main factor of strength and protection for infant is required as the bases of standard care in NICU. Therefore the aim of this study was to investigate stress management in Iranian NICU Parents.

Methods: Using qualitative content analysis approach helped to collect and analysis data for open coding, classification, and theme abstraction. Twenty one parents with hospitalized neonates, physicians and nurses in the city of Isfahan were purposely recruited and selected for in-depth interviews.

Results: The analyzed content revealed unique stress management approaches among the parents. The main themes were: 1) spirituality, 2) seeking information, 3) Seeking hope, 4) maintaining calm, 5) attachment to infant, and 6) communicating with the medical team

Conclusion: Findings of this study highlights the importance of medical team’s attention to stressed parents who are trying to make adjustment or adapt to the hospitalization of their infant. A revised management approach to address the emotional needs of parents of neonates in Iran seems essential for improving communication with physicians and nurses.

Stress in Fathers of Premature Newborns Admitted in a Neonatal Intensive Care Unit

OBJECTIVE

To study stress in fathers of preterm infants admitted in a neonatal intensive care unit.

METHODS

Questionnaire-based study. Questionnaire included domains on infants health, maternal illness, staff behavior, parental role, home affairs and finances. Eligible fathers were repeatedly interviewed on day 7 (n=80), day 17 (n=59) and day 27 (n=28). Raw and standardized stress scores were calculated.

RESULTS

Financial burden was the main stressor at all times. Stress related to staff behavior and altered parental role reduced with time. Birthweight and fathers age, occupation and education independently predicted stress.

CONCLUSION

Fathers of preterm infants admitted in hospital are stressed, primarily due to financial burden.

Factors Influencing Parent Reports of Facilitators and Barriers to Human Milk Supply in Neonatal Intensive Care Units

BACKGROUND

Successful human milk supply in neonatal intensive care units (NICUs) requires the development of family-centered services.

OBJECTIVE

This study aimed to assess parent perceptions of factors that help or hinder providing human milk to very preterm infants (VPI) in the NICU according to sociodemographic, reproductive, and obstetric characteristics.

METHODS

This cross-sectional quantitative study included 120 mothers and 91 fathers of VPI hospitalized in a level 3 NICU located in the Northern Health Region of Portugal (July 2013-June 2014). Interviewers administered structured questionnaires regarding parent characteristics and the provision and perception of factors that help or hinder human milk supply in the NICU, 15 to 22 days after birth.

RESULTS

The main facilitators of human milk supply were its contribution to infant growth and well-being (51.4%) and parents' knowledge of breastfeeding benefits (27.6%). The main barriers were worries related to inadequate milk supply (35.7%), difficulties with expressing breast milk (24.8%), and physical separation from infants (24.3%). Fathers referred less frequently to the contribution of human milk to infant growth and well-being (odds ratio [OR] = 0.57; 95% confidence interval [CI], 0.32-1.00) but more frequently to knowledge of breastfeeding benefits as facilitators (OR = 2.31; 95% CI, 1.23-4.32). Participants with > 12 years of education (OR = 1.91; 95% CI, 1.05-3.47) and those with an extremely low birth weight infant (OR = 1.90; 95% CI, 1.02-3.54) highlighted worries related to inadequate milk supply. Fathers (OR = 2.16; 95% CI, 1.11-4.19) and participants with ≤ 12 years of education (OR = 0.25; 95% CI, 0.11-0.57) more frequently reported difficulties with expressing as the main barrier.

CONCLUSION

The parent's gender and education and the infant's birth weight are crucial considerations for establishing optimal practices for supporting breastfeeding.

Factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit: a qualitative study

AIM

The aim of this study was to explore factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit.

BACKGROUND

Transition to motherhood often causes significant issues in terms of adaptation to the role of motherhood. The main factors leading to parental stress, especially in the neonatal intensive care unit, have shown that the greatest source of stress is the loss of women's role as mothers.

DESIGN

It was a qualitative study with content analysis approach.

METHODS

Semi-structured in-depth interviews were used for data collection. Interviews were conducted with 17 mothers of preterm infants (under 36 weeks) who had been hospitalized for at least one week in the neonatal intensive care unit. Purposive sampling with maximum diversity was used to recruit mothers in Kermanshah province (west of Iran). Data was collected during 2013-2014. Interviews were recorded and transcribed verbatim. Data were analysed using conventional content analysis.

FINDINGS

Explanation of the mothers' perspective towards factors affecting adaptation to the role of motherhood led to two main categories of individual factors (emotional distress, self-efficacy, interaction and alienation) and social factors (support, prejudice).

CONCLUSION

Adaptation to the role of motherhood can be promoted through supporting mothers of preterm infants, empowering them and increasing their self-efficacy, to eliminate negative factors and emotions.

Barriers of Palliative Care in Neonatal Intensive Care Units

Objective:

Neonatal nurses face numerous barriers in providing end-of-life (EOL) care for neonates and their families. Addressing neonatal nurses’ attitudes could provide insight into barriers that impede neonatal palliative care (NPC). This study thus conducted to examine neonatal nurses’ attitude toward barriers in providing NPC in Southeast Iran.

Method:

In this cross-sectional study, a translated modified version of Neonatal Palliative Care Attitude Scale was used to examine attitudes of 70 nurses toward barriers of palliative care in 3 neonatal intensive care units in Southeast Iran.

Results:

Findings indicated that overall 42.63% of nurses were strongly agreed or agreed with the proposed barriers in NPC. Among all categories, the highest and the lowest scores belonged to the categories of “insufficient resources” (3.42 ± 0.65) and “inappropriate personal and social attitudes” (2.33 ± 0.48), respectively. Neonatal nurses who had less education and study regarding NPC reported the presence of more barriers to NPC in the categories of “inappropriate organizational culture” and/or “inadequate nursing proficiency.” Also, younger nurses had more positive attitudes toward the category of inappropriate organizational culture as being a barrier to provision of NPC (4.62).

Conclusion:

The findings suggest that developing a context-based instrument is required to represent the barrier more precisely. Neonatal palliative care can be improved by establishing a special environment to focus on infants’ EOL care. This establishment requires standard palliative care guidelines and adequate NPC-trained nurses.

Systematic review of qualitative studies exploring parental experiences in the Neonatal Intensive Care Unit

AIMS AND OBJECTIVES

To determine the feasibility and utility of a thematic analysis approach to synthesising qualitative evidence about parental experiences in the neonatal intensive care unit.

BACKGROUND

Admission of infants to the neonatal intensive care unit is usually an unexpected event for parents who can cause them to experience psychosocial difficulties. A qualitative systematic review is the best method for exploring these parents' experiences regarding this type of admission.

DESIGN

Systematic review.

METHODS

Qualitative studies in peer-reviewed journals aimed at understanding parental experiences regarding infant neonatal intensive care unit admission were identified in six electronic databases. Three reviewers selected relevant articles and assessed the quality of the methodological studies using the Critical Appraisal Skills Programme. A thematic analysis approach was used to identify the most common themes in the studies describing parental experiences in the neonatal intensive care unit.

RESULTS

A total of eighty articles were identified; nine studies were included in this review. Four studies used semistructured interviews, three used interviews, one used self-reporting and one used both focus group and interview methodologies. Common themes across parents' experiences were the stress of hospitalisation, alteration in parenting roles and the impact of infant hospitalisation on psychological health.

CONCLUSION

Having an infant hospitalised in the neonatal intensive care unit is a stressful experience for parents. This experience is the result of exposure to different stressors related to the infant's condition, an alteration in parenting roles or the neonatal intensive care unit environment and staffing. These parents suffered negative psychological effects, experienced an interrupted development of a healthy parent-infant attachment and/or felt parental role alteration.

RELEVANCE TO CLINICAL PRACTICE

The study's findings are crucial for neonatal intensive care unit nurses to develop intervention strategies and programmes that help parents to decrease the stress of their experience and to support them in facing this stressful situation.

The Obstacles against Nurse-Family Communication in Family-Centered Care in Neonatal Intensive Care Unit: a Qualitative Study

INTRODUCTION

Communication is one of the key principles in Family-Centered Care (FCC). Studies have shown some drawbacks in communication between families and nurses. Therefore, the present study aimed to recognize the obstacles against nurse-family communication in FCC in Neonatal Intensive Care Unit (NICU).

METHODS

This qualitative study was conducted on 8 staff nurses in 2 NICUs affiliated to Shiraz University of Medical Sciences selected through purposive sampling. The data were collected using 8 deep semi-structured interviews and 3 observations. Then, they were analyzed through inductive content analysis.

RESULTS

Data analysis resulted in identification of 3 main categories and 7 subcategories. The first category was organizational factors with 2 subcategories of educational domain (inadequate education, lack of a system for nursing student selection, and poor professionalization) and clinical domain (difficult working conditions, lack of an efficient system for ongoing education and evaluation, and authoritarian management). The second category was familial factors with socio-cultural, psychological, and economic subcategories. The last category was the factors related to nurses with socio-cultural and psycho-physical subcategories.

CONCLUSION

Identification of the obstacles against nurse-family communication helps managers of healthcare systems to plan and eliminate the challenges of effective communication. Besides, elimination of these factors leads to appropriate strategies in NICUs for effective application of FCC.

The lived experience of fathers of preterm infants in the Neonatal Intensive Care Unit: a systematic review of qualitative studies

AIMS AND OBJECTIVES

To systematically review the experience of fathers of preterm infants hospitalised in the Neonatal Intensive Care Unit.

BACKGROUND

Family-centred care is more and more acknowledged in Neonatal Intensive Care Units, advocating for active engagement of both parents in the care journey. Nonetheless, fathers' Neonatal Intensive Care Unit experience has received limited research attention.

DESIGN

Systematic review of qualitative studies.

METHODS

Four electronic databases (CINHAL, ISI Web of Science, PubMed, Scopus) were explored and studies published between 2000-2014 were included. Preferred Reporting Item for Systematic Reviews and Meta-analysis (PRISMA) and Joanna Briggs Institute (JBI) Critical Appraisal Tool for Qualitative Studies guidelines were adopted. Key themes were extracted and synthesised.

RESULTS

Five main themes resuming fathers' experience of preterm birth and Neonatal Intensive Care Unit stay were identified from 14 studies. Themes were: emotional roller-coaster, paternal needs, coping strategies, self-representation and caregiving engagement. These dimensions were found to be dynamically shaped across three critical turning points: preterm birth, Neonatal Intensive Care Unit stay and at home.

CONCLUSIONS

Neonatal Intensive Care Unit fathers of preterm infants experience ambivalence, a set of different needs and coping strategies. They modify their self-representations along the Neonatal Intensive Care Unit journey and needs specific nursing support and intervention to sustain caregiving engagement and transition to parenthood.

RELEVANCE TO CLINICAL PRACTICE

A systematic and deepened understanding of preterms' fathers lived experience in Neonatal Intensive Care Unit would be helpful to inform nursing practice. Specific action priorities are suggested within the frame of family-centred care.

Mothers' strategies in handling the prematurely born infant: a qualitative study

INTRODUCTION

Family, especially mother, is faced with numerous challenges by experiencing a premature birth. Since knowing about mother's efforts regarding prematurely born infant helps us in our comprehensive understanding of the impact of this incident on the family system and its performance. The present study was carried out to explore the mothers' strategies regarding prematurely born infant.

METHODS

In a conventional qualitative content analysis, data was collected through purposive sampling by semi-structured deep interviews with 18 mothers who had prematurely born infant during 2012-2013 in the teaching hospitals of the north and northwest of Iran. All the interviews were recorded, typed, and finally analyzed.

RESULTS

Data analysis resulted in the extraction of categories of "asking for help, elevating capacity and reducing personal responsibilities and commitments". These categories were revealed in mothers respectively by the different sub-categories of "religious appeal and relying on beliefs, seeking information from the treatment and caring team, participating in infant's care, companionship and support of family and friends","focusing on positive thinking and imagination, patience and strength " and "ignoring some routine affairs and reducing role-related activities and duties".

CONCLUSION

Considering the uniqueness of the mother's role in responding to the needs of infants, healthcare system should consider mothers as real target in the intervention strategies in order to promote health and quality of life, so maybe this way, the burden of care and management of critical situations caused by a premature birth on the mother can be reduced.