Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines

Parenting in the Neonatal Intensive Care Unit: A Qualitative Study

BACKGROUND

This qualitative study is aimed at describing parental feelings, their readiness during discharge, and their needs while their infant is in the neonatal intensive care unit.

METHODS

The study was conducted with the parents of infants being monitored in a neonatal intensive care unit. A total of 30 in-depth interviews were conducted with 15 parents. This qualitative study was carried out using the Gadamerian-based research method. After parents were informed about the study, written and verbal consent was obtained from them.

RESULTS

The content analysis of the interview data resulted in six themes: 'sense of trust and cocoon effect, anxiety and conflicting emotions, parent-infant bonding and breastfeeding, fear of providing care, readiness/unreadiness and support needs and recommendations'.

CONCLUSION

Parents often feel anxious and fearful about harming their vulnerable infants, with added stress surrounding their ability to provide care and the discharge process.

Fathers' Involvement in a Surgical Neonatal Intensive Care Unit: A Prospective Cohort Study

AIM

To date, studies exploring patterns of fathers' involvement in their neonate's care in the neonatal intensive care unit (NICU) and barriers to involvement have utilised qualitative approaches, which can be time- and resource-consuming. This study aimed to explore the fathers' involvement in a surgical NICU using a novel tool along with identifying potential facilitators and barriers to fathers' involvement in their neonate's care.

METHODS

This single-centre prospective cohort study was conducted at a surgical NICU (SNICU). A novel questionnaire, Fathers' Involvement Questionnaire: Neonatal Intensive Care Unit (FIQ:NICU) comprising four sections, was developed based on current evidence and expert consensus. Study data were collected and managed using REDCap electronic data capture tools. Involvement scores are reported for individual items, subscales (Physical contact, Verbal Interaction, During Procedures, Cares/Feeding, Participation in rounds), and total score (possible range 0-92). Associations between subscales and total FIQ scores and confidence levels were explored using bivariate correlation (Pearson's r).

RESULTS

Thirty-two fathers participated. Total FIQ:NICU scores ranged from 20 to 74, mean score 55.1 (95% confidence interval 49.9-60.2), SD 14.24. Fathers reported the highest level of involvement in 'During Procedures' subscale (M = 2.88, SD = 1.00) and the lowest involvement in 'Cares/Feeding' (M = 1.67, SD = 0.83). All fathers reported support from their partner (100%) as a facilitator, followed by support from nurses (71.9%). The most frequently reported barrier was lines and tubes on their neonate (46.9%), followed by work/job commitments (34.4%).

CONCLUSIONS

Support from healthcare professionals, psychologists and peers can increase father's involvement in their neonate's care in SNICU.

Fathers' experiences of nurses' roles and care practices during their preterm infant's stay in the neonatal intensive care unit

INTRODUCTION

Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents.

AIM

Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU.

DESIGN

Qualitative study using ethnographic data collection techniques.

METHODS

Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis.

RESULTS

Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities.

CONCLUSION

Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial.

RELEVANCE TO CLINICAL PRACTICE

Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities.

REPORTING METHOD

Adherence to the COREQ guidelines.

The Effect of Implementation of Skin Care Guidelines on Nurses' Knowledge Regarding Skin Care and Incidence of Skin Injuries Among Neonates at a Private Tertiary Care Hospital

BACKGROUND

Skin care of sick newborns is important because skin acts as a barrier to prevent neonates from infections which may lead to neonatal morbidity and mortality. The highly technological environment of the neonatal intensive care unit (NICU) makes them vulnerable to loss of skin integrity. In acute care setting maintenance of skin integrity is considered as an established quality indicator representing nursing care.

AIM OF STUDY

The study aimed to determine the effect of skin care guidelines on nurses' knowledge related to skincare and the incidence of skin injuries among neonates.

METHODOLOGY

Pre-post quasi-experimental study was conducted in the NICU of a private tertiary care hospital. A consecutive sampling technique was used. The intervention comprised educational sessions and demonstrations of skin care practices from AWHONN skin care guidelines. The data on the nurses' knowledge were collected through self-developed and self-administered questionnaires. Skin injuries were recorded on a checklist through observation for 1 month before and after the intervention. A paired sample t-test was used for comparing knowledge and continuous demographical variables. While the incidence density ratio was calculated for skin injuries.

RESULTS

There was a statistically significant improvement in the nurses' knowledge of skin care from pre (mean 15.06 ± 5.16) to post (mean19.40 ± 5.17) measurement P -value .001. Incidence density rate of skin injuries reduced from 19% to 3% after the implementation of skin care guidelines.

CONCLUSION

Through the implementation guidelines nurses' knowledge and practices regarding skin care improved while skin injuries among neonates were reduced.

Maternal Reports of Preterm and Sick Term Infants' Settling, Sleeping and Feeding in the 9 Months after Discharge from Neonatal Nursery: An Observational Study

The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU.

Considering the Influence of Social Determinants of Health on Parent Feeding Practices: A Case Example

BACKGROUND

Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. SDOH can be grouped into 5 domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. SDOH impact people's health and quality of life but may also contribute to disparities in access to food, education, and healthcare. SDOH uniquely influence parent feeding practices in the neonatal intensive care unit (NICU) in a variety of ways, ranging from logistical considerations for parent visitation to cultural beliefs such as family perception of human milk feeding.

EVIDENCE ACQUISITION

A hypothetical case example of a preterm infant with a feeding disorder in the NICU is used to connect SDOH that influence prenatal health, parental lived experience, and postnatal medical care to maternal and infant outcomes with implications for feeding practices. Barriers and facilitators to successful feeding practices in the NICU and at discharge are considered for each SDOH domain.

RESULTS

This case example increases awareness of SDOH and how they influence parent feeding practices in the NICU, focusing on the intersection of SDOH, parent stress, and oral feeding outcomes. Examples were provided for how to support applying findings into practice.

IMPLICATIONS FOR PRACTICE AND RESEARCH

By being creating a culture of SDOH awareness, NICU staff can assist families in overcoming barriers by putting supports in place to increase equitable participation in developmentally supportive feeding practices during the NICU stay.

Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: Systematic review and meta-analysis evidence available from India

The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J-Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta-analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy.

Mother's mental health and the interaction with her moderate preterm baby in the NICU

INTRODUCTION

Moderate preterm infants, born between 320/7 and 336/7 weeks, represent a significant number of preterm-born infants; however, they remain a poorly studied group despite their vulnerability. The objective of this correlational study is to describe the impact of having a moderate preterm infant hospitalised in the NICU on the mothers' mental health and how this relates to the interaction between the dyad.

METHOD

During the hospitalisation period, 85 moderate preterm mother-infant dyads participated in this study. The participants provided self-reports of depression, parental stress, and skin to skin and breastfeeding practices. Also, mother-infant interaction was assessed in the NICU with an observational scale.

RESULTS

Mothers evidenced high levels of stress and depressive symptoms during the hospitalization. The stress experienced by these women was significant, although weakly, associated with the interaction with their babies; and mothers of small for gestational age babies showed difficulties in this area.

CONCLUSIONS

The results of this study could represent a contribution to a better understanding of the relation between the characteristics of moderate preterm babies, maternal emotional wellbeing, and the quality of mother-infant interactions in NICU settings.

Randomized Controlled Trial on the Effect of the Neonatal Nurse Navigator Program on Maternal Stress and Neonatal Cortisol Levels

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.

A Feasibility Study to Test the NICU Paternal Needs Inventory

BACKGROUND

There has been little research exploring paternal needs while experiencing a neonatal intensive care unit (NICU) stay. Some tools exist to measure paternal needs, but do not incorporate items to capture important information about how fathers cope with stress differently, and may have different needs. Therefore, an instrument is needed to measure and prioritize what needs are important to fathers to help facilitate the development of nursing interventions to help fathers cope with the NICU environment.

PURPOSE

The purpose of this study was to conduct a feasibility study before large-scale pilot testing the instrument, the NICU Paternal Needs Inventory (NPNI), so we could then determine what are the physical, emotional, and psychological needs of fathers.

METHODS

A nonexperimental, quantitative, and descriptive design was used to address the study's aims. Fathers were recruited from a level IV NICU and asked to complete an online survey (consisting of a demographic survey and the NPNI).

RESULTS

Needs rated 100% were knowing infant's progress, directions on caring for infant, flexible visitation, and assurance receiving the best care. The remainder showed a wide range of responses suggesting that needs of fathers are individual and varied.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Use of the NPNI to evaluate a father's unique and individual needs would allow for the nurse to develop father-specific, individualized interventions. Findings support that the NPNI is feasible to accomplish measuring fathers' needs, but a larger study is needed to test the reliability and validity of this tool.

Parental perceptions and experiences of care in the surgical neonatal intensive care unit

BACKGROUND

Parents endure significant stress when their newborns require surgery while in the neonatal intensive care unit (NICU). Our study aims to explore the surgical NICU experience from the parents' perspective and identify areas that may improve this experience. A secondary objective was to integrate their feedback to refine the implementation strategy of the neonatal enhanced recovery after surgery (ERAS®) guideline.

METHODS

In December 2019, five surgical NICU parents participated in a focus group. Conversation surrounded parents' perspectives and experiences of the surgical NICU. Inductive analysis was performed to identify data, themes, and concepts that emerged from the discussion.

RESULTS

Participants identified four major interrelated themes that impacted the surgical parents' NICU experience. These themes include (1) parental state, both physical and emotional, (2) the altered parental caregiver role which necessitates identifying alternative meaningful parental experiences, (3) the care team dynamic, incorporating consistency and effective communication, and (4) the discharge process which may be significantly eased through graduated, hands-on training.

CONCLUSION

Key elements of the neonatal ERAS® guideline address major themes and stressors identified by parents. The parental perspective may help clinicians appreciate the parent surgical NICU experience and assist in improving family-centered care to surgical infants and their families.

Psychometric testing of a Danish version of the empowerment of parents in the intensive care - Neonatology questionnaire has confirmed validity

AIM

Investigating parent satisfaction with care is important to guide quality development. In this study, we translated and validated a Danish version of the empowerment of parents in the intensive care - neonatology (EMPATHIC-N) questionnaire to determine validity in Danish contexts.

METHOD

A psychometric study design was applied. Translation was performed according to recommended international standards. Confirmatory factor analyses including standardised factor loadings, Cronbach's α reliability estimates, congruent validity and non-differential validity testing were applied. The study was performed from June 2017 to November 2019 at a 33-bed level IV neonatal intensive care unit.

RESULTS

Participants were 311 parents (response rate = 42,8%). Confirmative factor analyses disclosed a moderate model fit of the instrument with Comparative Fit Index (CFI) values of 0.83-0.92. Cronbach's α showed good reliability (0.82-0.93). Congruent validity showed good positive correlations (0.48-0.71) between the instrument domains and four overall satisfaction indicators. In search of improved model fit, a version including 27 items was tested. This version showed a better model fit with CFI values of 0.92-0.99 and satisfactory Cronbach's α values.

CONCLUSIONS

Model fit for the Danish full EMPATIC-N was moderate. The shorter version showed better psychometric properties.

Factors affecting stress levels in parents of surgical neonates: A prospective observational study

BACKGROUND

There is a paucity of research focusing on the stress levels in parents of newborns undergoing surgery. Resource challenged systems have to deal with overcrowding, a shortage of workforce along with demographic and socioeconomic issues like delayed presentations and out of pocket expenses. The primary objective of this study was to understand the factors associated with stress in the parents of these congenitally malformed neonates.

METHODOLOGY

This was a prospective cohort study, which was conducted in a neonatal surgical ICU of a tertiary care teaching hospital. Factors affecting stress levels in parents of surgical neonates were studied in 100 participants. A multi-dimensional questionnaire - The PSS: NICU score was utilized in the study. The parents were interviewed on Day 3-5 after surgery.

RESULT

59% of the respondents were fathers. The majority of the parents were in the age bracket of 24 to 35 years. The mean scores for the subscales sights and sounds, looks and behavior and alteration in the parental role were 3.24±0.8, 3.52±0.63, 3.55±0.8 and 2.8 ± 0.9 respectively. The highest level of stress was found in the domains of alteration of parental role and infant appearance and behavior. Comparisons showed significantly higher maternal scores in all the domains. Overall stress scores were highest for abdominal wall defects.

CONCLUSION

Parents of neonates undergoing surgery suffer from significant stress levels and appropriate counseling targeted towards specific stressors is required to allay this important parental issue.

Perceptions and expectations of parents regarding their position in a French NICU: quantitative and qualitative approaches

OBJECTIVES

To assess perceptions, expectations, and concerns of parents of preterm infants regarding their position during hospital admission in the neonatal intensive care unit.

DESIGN

Data were analysed from two studies, using complementary methods (quantitative and qualitative). Study I surveyed parents via a questionnaire, and study II was a reanalysis of interviews with fathers, collected in a previous study.

SETTING

Neonatology department in a French tertiary care university hospital that promotes the Newborn Individualised Care and Assessment Program (NIDCAP).

PARTICIPANTS

In both studies, participants had a premature child admitted for any level of care in the neonatal intensive care unit.

RESULTS

For study I, about half (33) of eligible families participated in the questionnaire survey, and for study II, we reanalysed interviews with 20 fathers. In both analyses, parents were satisfied overall with their involvement in the care of their child. In both studies, however, they expressed that they had expected to be better informed about their child's condition and more involved in medical decision-making. Parents also reported relational issues with some healthcare practitioners who made them feel judged, unheard or not competent to discuss their child's case. These concerns were not reported for NIDCAP staff. Respondents in both studies also described insufficient contact with physicians and an inability to obtain rest in the room with their child.

CONCLUSION

Provision of training to healthcare practitioners regarding information that parents request and doing so respectfully might be keys to fulfilling parent-reported needs. Such improvements could facilitate parental empowerment and involvement.

Engaging Parents of Fragile Infants in the Design and Appraisal of Health Literature: An Español Toolkit for Necrotizing Enterocolitis

WHAT WAS OBSERVED OR INVESTIGATED

The increased morbidity of diverse infants is unacceptable, and methods to reduce necrotizing enterocolitis (NEC) in their communities are needed. This article discusses the importance of the Español toolkit; provides a backstory of how the Español toolkit came about and how it was verified and validated; and concludes with impressions from involving parents in the research process.

SUBJECTS AND METHODS

After research evidence was translated from English into Spanish, a cross-sectional exploratory, descriptive, mixed-methods study was conducted, guided by the knowledge translation into practice (Translating Research Into Practice [TRIP]) framework. Twenty bilingual English-Spanish parents of fragile infants evaluated the NEC-Zero Español toolkit from a single neonatal intensive care unit.

RESULTS AND CONCLUSIONS

The NEC-Zero Español toolkit was found to be easy-to-use and useful and provided information that can be used to augment information sharing. Having access to health information offers a meaningful way to start a conversation and may even impact positive behaviors such as breastfeeding promotion. To lessen Spanish speakers' linguistic barriers, providing materials in Spanish can help meet their information needs and initiate conversations with healthcare providers. This is particularly important because Hispanic infants are at high risk for NEC.

The Postpartum Specific Anxiety Scale: Confirmatory factor analyses and relationships with birth experience

The Postpartum Specific Anxiety Scale [PSAS] was developed and validated as a research tool with a four-factor structure; with predictive validity corroborated in studies examining infant-feeding and maternal bonding outcomes. The PSAS has not been examined in relation to birth experiences. We aimed to confirm the PSAS four-factor structure and examine these domains of anxiety in relation to subjective and objective birth experiences. Postpartum mothers (≤ 12-months; N = 500) completed the PSAS alongside measures of subjective birth satisfaction and objective obstetric interventions/complications. Confirmatory factor analyses [CFA] tested eight models, theoretically derived from the preceding exploratory work. Structural equation modelling [SEM] tested associations between each PSAS factor and birth experience variables in the best-fitting model. An identical 51-item four-factor model fits the data well. SEM analyses revealed associations between lower perceptions of quality of intrapartum care and increased maternal competence and attachment anxieties, practical infant care anxieties, and infant safety and welfare anxieties. High subjective stress and negative emotional response to labour were associated with increased psychosocial adjustment to motherhood anxieties. Specific associations were found between neonatal care unit admission and practical infant care anxieties; and infant asphyxia and infant safety and welfare anxieties. Findings confirm construct and convergent validity of the four-factor PSAS and its use in measuring postpartum anxiety. Unique associations were also identified, indicating specific subjective and objective experiences occurring during birth may elicit a differential anxiety response, in that they are related to specific forms of postpartum anxiety which occur during the first postpartum year.

COVID-19 lockdown impacts the wellbeing of parents with infants on a Dutch neonatal intensive care unit

PURPOSE

Parents of infants admitted to a neonatal intensive care unit (NICU) experience additional stress due to restrictions on their presence and visits by other family members during the COVID-19 pandemic. Our study aims to describe how this impacted parents and how NICU staff could support them.

DESIGN AND METHODS

This was a cross-sectional study in which 25 parents (16 mothers, 9 fathers) of infants admitted to our NICU during the first COVID-19 lockdown completed online questionnaires with socio-demographic questions, the Parental Stressor Scale:NICU (PSS:NICU) and questions related to COVID-19.

RESULTS

Being separated from, and not being able to hold their infant at all times were among the most important PSS:NICU stressors. Parents experienced additional stress because other family members were not allowed to visit. They indicated that NICU staff could support them by clearly explaining the reasons for visitor restrictions and by ensuring that they felt heard. Most parents supported the restrictions, but also mentioned that less strict measures would really help them.

CONCLUSIONS

Parents who participated in this study found it very stressful that they could not be with their infant together with their partner and other family members. Furthermore, parents recommended the hospital management to continuously reconsider whether particular restrictions could be lifted in case of a new lockdown. Together with clear communication, this would result in less parenteral stress.

PRACTICE IMPLICATIONS

Hospital management should be cautious on restricting the presence of parents and other family members and scale restrictions back whenever possible.

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.

Support needs of parents in neonatal intensive care unit: An integrative review

BACKGROUND

Having an infant in the neonatal intensive care unit (NICU) is associated with intense emotional stress for both mothers and fathers. However, with the right support from staff, this stress can be reduced significantly. Although evidence on needs of parents in the neonatal unit exists, there is lack of a systematic integrative review on the support needs of parents in the neonatal unit. Current review evidence is needed to support busy neonatal unit clinicians in their practice.

AIM AND OBJECTIVES

The purpose of this integrative review is to explore the current available evidence to describe and understand the support needs of parents of infants in the NICU.

METHODS

The integrative review process of Whittemore and Knafl (2005) was used to guide this study. Six databases-MEDLINE, CINHAL, PubMed, Scopus, Google Scholar and PsycINFO-were searched for eligible studies using relevant keywords. Primary studies published in English language from 2010 to 2021 were reviewed following a pre-determined inclusion criteria. Studies that met the inclusion criteria were critically appraised using the Mixed Methods Appraisal Tool (MMAT). The review report is guided by the PRISMA 2020 checklist for systematic reviews.

RESULTS

Overall, 24 primary qualitative, quantitative and mixed methods studies were included in the review. Analysis of included studies resulted in six themes that demonstrate the support needs of parents in the NICU; 1. Information needs; 2. Emotionally intelligent staff; 3. Hands-on support; 4. Targeted support; 5. Emotional needs; and 6. Practical needs.

CONCLUSION

This review has presented the current evidence on the needs of parents from their own perspective. Healthcare workers' understanding and supporting these needs in the NICU is likely to increase parental satisfaction and improve health outcomes for parents, infants and their family.

RELEVANCE TO CLINICAL PRACTICE

Parents of infants in the NICU require staff support to enhance their experiences, well-being, caring and parenting confidence during admission and post-discharge. As parents are in constant need for informational, emotional and practical support, continuing professional development for NICU staff should place emphasis on effective communication strategies, enhancing emotional intelligence and empathy among staff. NICU staff should build positive ongoing relationships with parents and provide targetted support for mothers and fathers.

Beliefs and needs of fathers of newborns hospitalised in a neonatal unit: A descriptive correlational study

BACKGROUND

Transition to parenthood is a wonderful yet stressful period especially when it involves the newborn's hospitalisation. To support and facilitate this transition, it is essential to understand parental beliefs and needs. The father's perspective remains an understudied yet fundamental question.

OBJECTIVES

The objective of the study was to measure beliefs and needs of fathers of newborns hospitalised in a neonatal intensive care unit (NICU) and their correlations with sociodemographic variables.

METHODS

Fathers with a newborn hospitalised for 4-15 days in a level III NICU in Western Switzerland completed the NICU Parental Beliefs Scale and the short form of the NICU Family Needs Inventory. For each item of the NICU Family Needs Inventory, fathers also answered with regard to their satisfaction level. Additional needs were collected with an added open-ended question. Simple linear regressions were used to correlate beliefs, needs, and the sociodemographic data.

RESULTS

Seventy fathers were included. The average score for paternal beliefs was 68.44 (standard deviation = 10.29), indicating a good perception of their role. The majority (77%) considered all needs as very important or important, and 70% were very satisfied or satisfied. Fathers described communication as a very important, but unmet, need. Fathers' beliefs were higher in those who were not first-time fathers (71.88 ± 8.27 vs 66.06 ± 10.97, p = 0.028), who had a paternity leave (72.68 ± 10.19 vs 66.05 ± 9.68, p = 0.014), and who were of foreign nationality (71.86 ± 9.39 vs 63.85 ± 9.80, p = 0.002).

CONCLUSIONS

Fathers with a newborn hospitalised in the neonatal unit had good paternal beliefs. Most of the listed needs were perceived as very important and had a good level of satisfaction. Significant differences between Swiss fathers and fathers of foreign nationality were measured. Reasons of these differences should be explored in a forthcoming study.

Predictors of parental stress from admission to discharge in the neonatal special care unit

BACKGROUND

Exacerbated parental stress during a stay in the neonatal intensive care unit can negatively impact the development of the hospitalized infant, strain the dyadic relationship and put parents at risk for poor mental health. It is therefore important to identify risk factors of stress throughout the duration of a hospitalization. This longitudinal study aimed to investigate sources of stress for mothers and fathers who had a baby in the neonatal special care unit.

METHODS

Parents of 57 singletons and 11 twins (68 infants) admitted to a neonatal special care unit (46% for prematurity) were recruited. Sixty-four mothers and 20 fathers were assessed at admission, and 60 mothers and 16 fathers at discharge. Participants reported their satisfaction with hospital information and completed the Perceived Stress Scale, the Brief Illness Perception Questionnaire and the Dyadic Adjustment Scale.

RESULTS

Parents demonstrated similar stress trajectories, with stress on average declining over time. Higher maternal stress at admission was associated with a belief that the baby's illness would have a longer timeline, lower perceptions of treatment efficacy and lower satisfaction with the information received from medical staff. Younger age and lower levels of education predicted higher maternal stress at discharge. Fathers had higher stress at discharge when they were older, had a baby born at younger gestation and felt they had less control. At admission, information satisfaction was positively associated with parental beliefs about treatment efficacy and understanding the infant's condition. At discharge, information satisfaction was negatively associated with beliefs about illness severity and the likely time frame of the illness.

CONCLUSION

The findings highlight that parents' perceptions of their baby's illness and treatment at admission and discharge have a significant association with stress. Clinical staff can use these factors to identify parents who are at risk of exhibiting a greater level of stress over the hospitalization period.

An Integrative Review of Fathers' Needs in the Neonatal Intensive Care Unit

Having a child admitted to the neonatal intensive care unit (NICU) is traumatic for both parents, but mothers and fathers may have different experiences, and thus, different needs. The purpose of this integrative review was to identify the needs of fathers of premature infants. A systematic review of 7 databases was conducted, and studies were evaluated by the Critical Appraisal Programme checklist. To provide structure for searching and reporting findings, the Whittemore and Knafle interpretive methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology were used. A total of 19 articles were identified. The resulting themes included: need to be close to infant and involved in infant's care; need for information; need for a better NICU environment; need for emotional support; and need for a relationship with the NICU staff.

Simulation to Enhance Communication Skills in Neonatal Nursing Practice

Effective communication is essential to the delivery of safe, quality health care. Handoff reporting, situational reporting, interprofessional collaboration, caregiver communication, and team huddles are forms of status reporting and communication common in a neonatal nursing practice. Adequate training for health care professionals on effective communication techniques is often lacking. Simulation provides a method to develop and refine necessary communication skills for neonatal health care professionals and affords the opportunity for the learner to immerse into realistic clinical scenarios. The purpose of this article is to review communication techniques in the neonatal setting and describe methods of utilizing simulation to enhance communication skills for neonatal nursing practice.

Herausforderungen und Bedürfnisse von Familien mit Neugeborenen mit Zwerchfellhernie - Musiktherapie als unterstützende Maßnahme?

Challenges and needs of families of newborns with congenital diaphragmatic hernia - Music therapy as a supportive intervention? Abstract. Background: Newborns with diaphragmatic hernia (CDH) spend the first weeks of their lives in intensive care, which is extremely stressful for them and their families. Music therapy is already used in neonatology for premature infants to stabilize the child, to support the parents and to strengthen attachment and bonding. However, the benefits for term infants receiving intensive care and their families has not yet been comprehensively investigated. Aim: The aim of this paper was to investigate the specific needs, challenges and experiences of children with CDH and their parents and to derive appropriate music therapy interventions. Methods: Using the CAQDAS software f4analyse 15 parents' reports were examined with a qualitative content structuring analysis. Music therapy aspects were illustrated using a hypothetical case example. Results: Parents suffer above all from organisational and emotional challenges. They want to take care of their child and seek to be close despite limited influence on health and treatment. They are supported by their social environment and the medical staff. Protective factors include successful self-care, detachment and trust in a positive outcome. Conclusion: Additional to medical aspects like the withdrawal, bonding and attachment and parental well-being are of great importance. Music therapy literature offers the description of interventions, which address these aspects.

Current Resources for Evidence-Based Practice, September 2020

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of “spin” in scientific reporting and its effect on summaries and syntheses of the literature and commentaries on reviews about early versus late amniotomy as part of labor induction protocols and the economic burden associated with maternal morbidity.

Stressors of parents of infants undergoing neonatal surgery for major non-cardiac congenital anomalies in a surgical neonatal intensive care unit

AIM

As more babies survive major neonatal surgery, the quality of life of the whole family is a major focus of health care. While there is evidence suggesting that parents of babies admitted to neonatal intensive care units (NICUs) experience high levels of stress, little is known about stressors in parents whose infants also require neonatal surgery. This study identified fathers' and mothers' stressors in a surgical NICU.

METHODS

Parents of infants admitted for general surgery to the NICU at a tertiary children's hospital from February 2014 to September 2015 were eligible for enrolment. Parents completed the Parental Stressor Scale: NICU to measure levels of stress related to three subscales: sights and sounds, infant appearance and parental role alteration, using a 5-point Likert scale.

RESULTS

Data for 111 parents (57% mothers) showed parental role alteration as the greatest stressor for parents (M = 2.98, standard deviation (SD) = 0.89), particularly for mothers, followed by infant appearance (M = 2.84, SD = 0.95). Both fathers and mothers rated feeling helpless (M = 4.1, SD = 1.0), unable to protect their baby (M = 4.1, SD = 0.9) and seeing their baby in pain (M = 3.9, SD = 1.2) the most common, most stressful experiences and highest contributors to overall stress in the surgical NICU environment.

CONCLUSION

Parental role alteration is the greatest stressor for parents in the surgical NICU. Reducing stress for parents of infants undergoing neonatal surgery requires management of the infant's pain and strategies to support parents in their role in the NICU.