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Helmer CS, Thornberg UB, Abrahamsson T, Mörelius E. Mothers' experiences of a new early collaborative intervention, the EACI, in the neonatal period: A qualitative study. J Clin Nurs 2022; 32:2892-2902. [PMID: 35702001 DOI: 10.1111/jocn.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore mothers' experiences of the EArly Collaborative Intervention. BACKGROUND Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers' experiences of the new intervention were explored. DESIGN A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript. RESULTS Two main overarching themes were constructed. The first theme, 'mothers' feelings evoked from the EArly Collaborative Intervention' describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm baby's behaviour increased, and the intervention helped the parents to communicate around their baby's needs. The second theme, 'based on the preterm baby's behavior', describes experiences of the provision and the learning process about their preterm baby's needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby. CONCLUSIONS Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their baby's well-being. Furthermore, the intervention felt strengthening for their relationship with the other parent. RELEVANCE TO CLINICAL PRACTICE The EArly Collaborative Intervention can support parents' abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well-being.
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Affiliation(s)
- Charlotte Sahlén Helmer
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Crown Princess Victoria Children´s Hospital, Linköping University hospital, Linköping, Sweden
| | - Ulrika Birberg Thornberg
- Department of Rehabilitation Medicine, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Division of Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Thomas Abrahamsson
- Crown Princess Victoria Children´s Hospital, Linköping University hospital, Linköping, Sweden.,Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Perth Children's Hospital, Nedlands, Western Australia, Australia
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Mörelius E, Sahlén Helmer C, Hellgren M, Alehagen S. Supporting Premature Infants’ Oral Feeding in the NICU—A Qualitative Study of Nurses’ Perspectives. Children 2021; 9:children9010016. [PMID: 35053641 PMCID: PMC8774582 DOI: 10.3390/children9010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022]
Abstract
One major task in the neonatal intensive care unit (NICU) involves ensuring adequate nutrition and supporting the provision of human milk. The aim of this study was to explore nurses’ experiences of the oral feeding process in the NICU when the infant is born extremely or very preterm. We used a qualitative inductive approach. Nine nurses from three family-centered NICUs were interviewed face-to-face. The interviews were transcribed verbatim and analyzed using content analysis. Five sub-categories and two generic categories formed the main category: ‘A complex and long-lasting collaboration.’ The nurses wished to contribute to the parents’ understanding of the feeding process and their own role as parents in this process. The nurses’ intention was to guide and support parents to be autonomous in this process. They saw the family as a team in which the preterm infant was the leader whose needs and development directed the feeding and the parents’ actions in this process. Written and verbal communication, seeing all family members as important members of a team and early identification of the most vulnerable families to direct the emotional and practical feeding support accordingly can strengthen the feeding process in the NICU.
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Affiliation(s)
- Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia
- Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83 Linköping, Sweden; (C.S.H.); (M.H.); (S.A.)
- Correspondence:
| | - Charlotte Sahlén Helmer
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83 Linköping, Sweden; (C.S.H.); (M.H.); (S.A.)
| | - Maria Hellgren
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83 Linköping, Sweden; (C.S.H.); (M.H.); (S.A.)
| | - Siw Alehagen
- Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health, Linköping University, 581 83 Linköping, Sweden; (C.S.H.); (M.H.); (S.A.)
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Helmer CS, Thornberg UB, Mörelius E. An Early Collaborative Intervention Focusing on Parent-Infant Interaction in the Neonatal Period. A Descriptive Study of the Developmental Framework. Int J Environ Res Public Health 2021; 18:ijerph18126656. [PMID: 34205660 PMCID: PMC8296427 DOI: 10.3390/ijerph18126656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023]
Abstract
Moderate to late preterm infants are at risk of developing problems later in life. To support attachment and infants’ development, high quality parent-infant interaction is important. Parent-infant interaction is known to improve through intervention programs but since no such intervention program is addressed directly to moderate to late preterm infants, a tailor-made intervention was developed. The aim was to describe the rationale, development, framework and practical provision of a new early collaborative intervention program. This study has a descriptive design and the intervention is described using the Template for Intervention Description and Replication. During an intervention-session, the preterm infant’s cues are made visible to the parents as they perform an everyday care-taking procedure. Instant feedback is delivered to give the parents the opportunity to notice, interpret and respond to cues immediately. The infant’s response to the parent’s action is discussed in a dialogue to instantly guide parents´ awareness of the preterm infant’s subtle cues. This study describes a new early collaborative intervention, developed to support interaction between parents and their moderate to late preterm infants starting in the neonatal intensive care unit. Clinical studies evaluating parental experiences as well as the effects of the early intervention are ongoing, ClinicalTrials.gov NCT02034617.
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Affiliation(s)
- Charlotte Sahlén Helmer
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden;
- Correspondence:
| | - Ulrika Birberg Thornberg
- Department of Behavioural Science and Learning, Linköping University, SE-581 83 Linköping, Sweden;
| | - Evalotte Mörelius
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden;
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6027, Australia
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Mörelius E, Olsson E, Sahlén Helmer C, Thernström Blomqvist Y, Angelhoff C. External barriers for including parents of preterm infants in a randomised clinical trial in the neonatal intensive care unit in Sweden: a descriptive study. BMJ Open 2020; 10:e040991. [PMID: 33277288 PMCID: PMC7722364 DOI: 10.1136/bmjopen-2020-040991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Performing randomised controlled trials (RCTs) in neonatal intensive care is challenging in many ways. While restrictive inclusion criteria or busy study protocols are obvious barriers, external barriers leading to termination of a study are seldom discussed. The aim of this study was to describe barriers for inclusion of families in neonatal intensive care in an RCT aiming to evaluate the effects of continuous skin-to-skin contact on mood and sleep quality in parents of preterm infants, as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge. DESIGN A descriptive study. SETTING Three out of seven tertiary neonatal intensive care units in Sweden participated in a two-arm RCT that was terminated because of low inclusion rate. PARTICIPANTS Before termination of the study, 11 out of 242 families assessed for eligibility were included for participation. RESULTS The major barriers for inclusion in this RCT were external due to (1) lack of intensive care beds in the neonatal ward, causing medically stable infants to be transferred back to the referring hospital quicker than expected, (2) moving directly from the delivery room to a family room without passing an open bay intensive care room or (3) transferring from one neonatal ward to another with the same care level to increase availability of intensive care beds where needed. Other barriers were the inclusion criteria 'single-birth' and 'Swedish-speaking parent'. CONCLUSIONS The major barriers for including participants were external constituted by transferals between neonatal wards and cities due to lack of intensive care beds. This is a multifactorial issue related to organisational structures. However, since this affects the possibilities to perform research this study highlights some suggestions to consider when planning prospective intervention studies within a neonatal setting. TRIAL REGISTRATION NUMBER NCT03004677.
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Affiliation(s)
- Evalotte Mörelius
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Emma Olsson
- School of Health Sciences, Örebro University, Örebro, Sweden
- Department of Pediatrics, University Hospital Örebro, Örebro, Sweden
| | | | - Ylva Thernström Blomqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Neonatal Intensive Care Unit, Uppsala University Hospital, Uppsala, Sweden
| | - Charlotte Angelhoff
- Crown Princess Victoria's Child and Youth Hospital and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Angelhoff C, Blomqvist YT, Sahlén Helmer C, Olsson E, Shorey S, Frostell A, Mörelius E. Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial. BMJ Open 2018; 8:e021606. [PMID: 30068615 PMCID: PMC6074633 DOI: 10.1136/bmjopen-2018-021606] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge. METHODS AND ANALYSIS A randomised intervention study with two arms-intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents' gender. ETHICS AND DISSEMINATION The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89-31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings. TRIAL REGISTRATION NUMBER NCT03004677.
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Affiliation(s)
- Charlotte Angelhoff
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | | | - Charlotte Sahlén Helmer
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
- Department of Clinical and Experimental Medicine and Department of Paediatrics, Linköping University, Linköping, Sweden
| | - Emma Olsson
- Department of Pediatrics and Centre for Health Care Sciences, Örebro University, Örebro, Sweden
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Anneli Frostell
- Division of Psychology, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden
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