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

"I was doubtful of being the true father of the preterm baby": factors affecting fathers' involvement in the care of preterm babies admitted in the neonatal unit at Kawempe National Referral Hospital, Uganda. a qualitative study

BACKGROUND

Fathers' involvement in the care of preterm babies has been associated with good health outcomes for the mother and the baby. However, fathers' involvement in the Neonatal Unit (NU) in Uganda remains sub-optimal and factors influencing this are not well understood. Therefore, this study aimed at exploring the factors affecting fathers' involvement in the care of preterm babies admitted in neonatal unit at Kawempe National Referral Hospital (KNRH).

METHODS

This was a qualitative exploratory study conducted in the NU at Kawempe National Referral Hospital between April and July 2023. It included fathers whose preterm babies were admitted in the NU and were stable at the time of study. Data was collected using an in-depth interview guide with 24 fathers of preterm babies and key informant interview guide with the nine health workers who were working in the NU. Data was analyzed using manual thematic analysis.

RESULTS

The fathers in this study had a mean age of 33 years, most of them were married and were employed in the informal sector. The perceived and actual roles of fathers of admitted preterm babies reported in this study mostly included providing financial support, direct childcare activities, providing emotional and physical support to the mother. The key facilitators to fathers' involvement in the care of the preterm babies were; at individual level; improvement in health condition of the preterm baby, desire to fulfil responsibility, at interpersonal level, support from friends and relatives; at health facility level, the good quality of service delivery; and at community level, the positive cultural and religious beliefs. Barriers included the fear of preterm babies, financial constraints, busy work schedules of fathers, discouragements from peers, poor relationship between couples; poor attitude of hospital staff, long hospital stay and inhibiting interaction between the father of preterm and mother-in-law.

CONCLUSION

Most perceived roles were actually played by fathers whose preterm babies were admitted in the NU and various facilitators encouraged them to get involved in the care. However, fathers faced multiple barriers which needed to be resolved to increase their involvement.

Australian fathers' experiences of caring for their preterm infants

Fathers and/or non-birthing partners are now actively involved in child-rearing globally; however some experience emotional difficulties during the perinatal period. With the birth of a preterm infant, parents experience additional stress beyond that normally engendered by having a baby, which can impact on parent-infant relationship and infant development. In Australia, there is limited evidence on fathers' experiences of preterm birth. Thus, this study aimed to explore the experiences of Australian fathers of preterm infants including their emotional and physical wellbeing when they have a preterm infant. Narrative inquiry guided the study; 13 fathers whose preterm infant was admitted to Australian neonatal units participated in in-depth interviews lasting 22-72 min. Data analysis generated four themes: (i) emotional response, (ii) fathers' wellbeing, (iii) fathering in neonatal unit and during transition home (iv) fathers' needs in the neonatal unit. The findings revealed that fathers felt emotionally overwhelmed, had specific needs but their role in the neonatal unit was not well defined and they felt mothers were given more attention. Despite feeling excluded, many continued to support their partner and infant. Health professionals must be aware of their unconscious biases toward gender roles in the neonatal unit and utilize strategies to actively include fathers and non-birthing partners.

Understanding the experience of the mothers' ability to take care of their preterm infants related to in-hospital and post-discharge: a qualitative content analysis

BACKGROUND

Preterm infants may experience many health and developmental issues, which continue even after discharge from the neonatal intensive care unit. Once home, the mother, as a non-professional and the primary caregiver will be responsible for the essential care of her preterm infant.

PURPOSE

Understanding the take care ability in mothers with preterm infants.

METHODS

The content analysis method was used. The data were collected using in-depth and semi-structured interviews from April 2021 to February 2022. Eleven mothers, two fathers, two grandmothers, one neonatal nurse, and two neonatologists with a mean age of 36.05 ± 10.88 years were selected using purposeful and snowballing sampling in Tehran, Iran. Allocating adequate time for data collection, gathering data through different methods, peer checking by two qualitative researchers, long interaction with the settings, maximum variation sampling, appropriate quotations, and showing the range of facts fairly and honestly were considered to ensure the trustworthiness of this study. The data were analyzed through Lindgren et al.'s approach using MAXQDA software.

RESULTS

Based on the findings and participants' experiences in 18 deep interviews, the mothers with desirable care ability have adequate ability as described by 17 subcategories and are categorized into five dimensions. The care ability of the mothers of preterm infants upon neonatal intensive care unit discharge consisted of five categories including maternal identity, infant's needs, cognitive ability, technical ability, and psychological ability.

IMPLICATIONS FOR PRACTICE AND RESEARCH

In the mothers of preterm infants, maternal identity and the infant's needs are antecedents of the care ability concept. The care ability of the mothers with preterm infants is distinct from those of other caregivers. This is a multi-dimensional concept and trait related to maternal cognitive ability, technical ability, and maternal psychological ability. Professional neonatal nurses should assess their care ability from multiple perspectives: cognitive, technical, and psychological abilities. They should be considered in designing empowerment and engagement programs for the improvement of the care ability of the mothers of preterm infants. Both mothers and professional neonatal nurses should take responsibility for improving the mothers' ability to take care of their preterm infants.

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.

Quality of couple relationship and associated factors in parents of NICU-cared infants during the first year after birth

OBJECTIVE

To describe factors associated with quality of couple relationships among parents of infants cared for in neonatal intensive care units (NICUs) 1 year after birth and examine the trajectory of the relationship quality compared to parents from maternity units (MUs).

STUDY DESIGN

Longitudinally comparative cohort design. Parents answered surveys during the first year after discharge about the couple relationship, social support, and depressive symptoms.

RESULTS

Better social support and a hospital stay of 7-14 days were positively associated with the couple relationship in NICU mothers, whereas not having slept together with the partner and infant during hospitalization were negatively associated. Depressive symptoms were negatively associated with the relationship among NICU fathers. There were no differences in trajectory of the relationship quality between NICU and MU parents.

CONCLUSION

To strengthen couple relationships, it could be important to improve social support, facilitate space and time for support, and enable togetherness during hospitalization.

"I Was Broken and Still Had to Stay Strong. I Cannot Be Weak": Understanding Parental Role Conflicts Following a Premature Birth

BACKGROUND

The challenging transition to parenthood affects both mothers and fathers; yet, the strain intensifies with a premature birth in the neonatal intensive care unit (NICU), underscoring the importance of acknowledging and addressing potential differences in parental roles.

PURPOSE

This paper aimed to investigate how parental role conflicts among mothers and fathers of preterm-born infants hospitalized in German NICUs manifest and investigated potential parental resources.

METHODS

Twenty-four participants, 17 mothers, and seven fathers of very low birth-weight infants were interviewed. A thematic content analysis was performed at a semantic level.

RESULTS

Fathers feel pressured to fulfill the role expectations, often leading to the suppression of paternal feelings and needs. For mothers, deviating from societal expectations regarding their expressive roles can be distressing, as they worry that such deviation might hinder their infants from having a successful start in life. Consulting with healthcare professionals shows to ease challenges for both parental roles.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Maternal and paternal challenges are often rooted in expectations placed on their societal roles. Highlighting these challenges can be essential for increasing awareness and effectively addressing them. Tailored nursing practices may have the potential to facilitate individuals' navigation of uncertainties and fulfillment of caregiving roles.

Supporting Fathers in the Neonatal Intensive Care Unit: A Scoping Review

PURPOSE

This scoping review explores the critical yet often overlooked role of fathers in the neonatal intensive care unit (NICU) environment, particularly during the emotionally tumultuous period following the birth of a critically ill infant.

BACKGROUND

The birth of an infant significantly disrupts family dynamics and may impact the role of each parent. Fathers in the NICU are frequently overlooked, leading to feelings of isolation and stress. Fathers often face confusion, stress, and a sense of exclusion, which are compounded by the trauma of having a critically ill infant.

DISCUSSION

Using the Preferred Reporting Item for Systematic Reviews and Meta-analysis model, the authors identified 18 articles that provide guidance on potential solutions to supporting an inclusive NICU environment for families, including fathers. The articles also consider the need for staff and provider training for a sustainable and inclusive NICU environment. Outcomes from the scoping review highlight the need for inclusive support for fathers, emphasizing that their involvement is crucial for the well-being of the infant and the family.

IMPLICATIONS FOR PRACTICE

Creating a welcoming NICU environment, training staff to address fathers' needs, and providing flexible policies can improve paternal engagement. Effective communication and support systems, including peer-led groups, are vital.

PRECIS STATEMENT

Inclusive practices, better communication, and tailored support for fathers in the NICU can enhance paternal involvement and engagement.

The posttraumatic growth of fathers of preterm infants: protocol for a qualitative study in China

Background

Prematurity presents a significant life crisis for families, often exceeding their expectations. Fathers of premature infants face the burden of multiple caregiving roles and undergo psychological changes. When confronted with such crises, individuals often engage in self-evaluation and may experience positive transformations. This study aims to employ a qualitative research methodology to explore the experiences of fathers of preterm infants.

Materials and methods

A phenomenological approach design will be utilized, drawing upon semi-structured in-depth interviews informed by existing literature. Thematic analysis will be employed, adhering to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. In-depth individual interviews, lasting 40-60 minutes, will be conducted with fathers of preterm infants to understand their experiences. The thematic analysis process will facilitate a comprehensive understanding of the factors contributing to post-traumatic growth among these fathers. This methodology provides a structured approach to investigating the experiences and influences on post-traumatic growth in fathers of preterm infants.

Results

This study will highlight changes in post-traumatic growth among fathers of preterm infants.

Discussion

Research on the post-traumatic growth (PTG) of fathers of preterm infants is crucial to understanding the unique challenges and psychological transformations they experience. This study aims to explore the factors contributing to PTG in these fathers and how cultural contexts in China influence this process. By elucidating these aspects, the findings can inform targeted interventions and support systems tailored to the needs of fathers of preterm infants. The results may also contribute to developing guidelines and policies to promote psychological well-being and resilience among this population in the healthcare system.

Ethics and dissemination

This study adheres to the International Ethical Guidelines for Biomedical Research and the Declaration of Helsinki. Approval has been obtained from the People's Hospital of Deyang Human Research Ethics Committee (No: 2019-04-150-K01). The research follows the principles of open science, and the findings will be published while ensuring participants' confidentiality.

Becoming first time father of premature newborn during the first wave of the pandemic: a case study approach

Introduction

The aim of this paper is to delve into the emotional and psychological challenges that fathers face as they navigate the complexities of having a preterm infant in the NICU and in an unprecedented sanitary context.

Methods

We used three data collection methods such as interviews (narrative and the Clinical Interview for Parents of High-risk Infants- CLIP) and the Edinburgh Postnatal Depression Scale (EPDS) to gain a comprehensive understanding of the cases.

Results

The following analysis explores two individuals' personal experiences of becoming a first-time father during the first wave of the COVID-19 pandemic through a close examination of two superordinate themes: "A series of separations through the experienced COVID- 19 restrictions" and "Moments of connection." The transition to fatherhood is essentially with a medicalized form of connection with their newborn and the perceived paternal identity. In terms of temporality, these fathers experienced a combination of concerns about their infants' long-term development and COVID-19 health concerns. Furthermore, they showed indications of phobic or hypochondriac tendencies using a psychoanalytic framework, along with an increased risk of postpartum depression.

Parental representations after preterm birth: a narrative review

Preterm birth accounts for nearly 15 million births annually worldwide and constitutes a considerable risk factor for atypical development. This birth context is a source of stress for the parents and often leads to an early separation between their child and them. Research on the influence of the birth status on the infant's attachment style has shown no systematic link between preterm birth and the development of insecure attachment in children born preterm. This has opened up research perspectives in understanding the role of environmental factors. A literature review was conducted to present an overview of the current findings on parental representations (PR), particularly maternal ones, and their role in the context of preterm birth. PR quality appears to be associated with specific dyadic interaction patterns, thus exposing vulnerability factors. Studies exploring PR have pointed out the importance of considering parental mental elaboration mechanisms and contextual moderators in supporting socio-emotional development among children born preterm. We discussed the challenges of investigating PR in the context of preterm birth for future studies and emphasized the need for research studies to be conducted according to a developmental and non-deterministic perspective. This narrative review also aimed to highlight the importance of family centered care interventions in the context of a public policy focused on the child's "First 1,000 days" of life.

Parenting stress and needs for social support in mothers and fathers of deaf or hard of hearing children

Introduction

Hearing parents of deaf or hard of hearing (DHH) children may experience parenting stress and social support could be a buffer to this stress. Differences in levels of these two indicators may exist between mothers and fathers. This study focuses on the parenting stress and social support needs of mothers and fathers of DHH children.

Methods

Twenty-seven French parental couples of DHH children completed the Parenting Stress Index and the Family Needs Survey, a questionnaire on social support needs.

Results

Their overall stress scores showed no difference, but subdomain scores show that mothers and fathers are more stressed by the child's hyperactivity, and fathers by the child's adaptability, than parents of children with normal hearing. Mothers are more stressed than fathers by role restriction; they feel less free because of their parenting role. Fathers have a lower quality of attachment to their child than mothers. Parents have a high social support need, especially for obtaining information about their child's individual characteristics and health situation. The ranking of mothers and fathers in the top 10 needs reveals different needs profiles. Parenting stress profiles show that mothers and fathers with higher-than-normal stress levels have a greater overall need for social support than mothers and fathers with lower than normal stress levels.

Discussion

This study highlights the value of assessing parenting stress and social support needs in parents of DHH children for a better understanding of their situation in research and its clinical implications, as well as the importance of differentiating outcomes for mothers and fathers.

Family Resilience as an Emerging Concept in Neonatology: Evidence From a Metasummary Review

BACKGROUND

Family resilience can be observed through specific resilience-promoting processes, namely, shared belief systems, communication, and organizational processes, but the concept remains mostly unstudied in neonatology. This metasummary aims to evaluate the frequency of family resilience processes in qualitative scientific literature to illustrate how family resilience is exhibited in the neonatal intensive care unit (NICU) setting.

METHODS

A search among 4 databases yielded 7029 results, which were reviewed for inclusion. Following Sandelowski and Barroso's qualitative metasummary method, findings from each study were independently coded and frequency effect size was calculated.

RESULTS

Forty-six primary qualitative studies published between 2016 and 2022 conducted with parents of preterm infants who discussed their NICU hospitalization experience were included in this metasummary. All 9 of Walsh's family resilience processes were identified in the literature, and their frequency effect size ranged from 4% to 91%. Four additional themes emerged pertaining to specific family resilience behaviors exhibited by NICU families.

CONCLUSION

This analysis sheds new light on the most recent qualitative evidence of parents' experiences in the NICU by analyzing it through the lens of family resilience and posits family resilience as a promising concept in relation to the predominance of the family-centered care philosophy in neonatal units.

Developing and Implementing a Father-Friendly Neonatal Intensive Care Unit Improved Nurses' Self-Efficacy

BACKGROUND

The need for paternal support is rarely addressed in neonatal intensive care units (NICUs). Neonatal nurses often primarily focus on the needs of the mother and infant and may not be trained in support of fathers.

PURPOSE

To investigate nurses' self-efficacy (SE) in guiding and supporting fathers after implementing a father-friendly NICU.

METHODS

Nurses from the intervention NICU and 13 control NICUs were included in a before-and-after intervention study. Questionnaires measuring nurses' SE regarding support of fathers and mothers were obtained when starting the development process, before and 18 months after the implementation. The primary outcome was the difference between nurses' SE scores for father and mother questions in the intervention group compared with the control group.

RESULTS

In total, 294, 330, and 288 nurses responded to the first, second, and third questionnaires, respectively. From the first to third questionnaires, the intervention group showed a significantly higher increase in SE scores for father questions compared with the control group (0.53 vs 0.20, P = .005) and a nonsignificantly higher increase for mother questions (0.30 vs 0.09, P = .13). In the third questionnaire, the intervention group showed a higher SE score for father questions compared with the control group (9.02 vs 8.45, P = .002) and the first questionnaire (9.02 vs 8.49, P = .02).

IMPLICATIONS FOR PRACTICE AND RESEARCH

By implementing a father-friendly NICU, nurses' SE for providing support to fathers increased significantly. Training in a father-friendly approach increases nurses' ability to support both parents.

How does stress affect maternal and paternal perceptions of relationship strain after a preterm birth? Results of a retrospective survey study

AIM

Strain on couple relationships is associated with a lower well-being. As premature birth is known to pose stress to parents, this study explores whether interparental relationship strain comes to pass within mothers and fathers during their infant's stay in a neonatal intensive care unit.

METHODS

A retrospective cross-sectional survey was conducted with parents who experienced a preterm birth (September to December 2020). Linear regression was used to analyse associations between stress and relationship strain.

RESULTS

The study included 437 mothers and 301 fathers. Fathers experienced lower relationship strain (M = 2.49, SD = 1.00) than mothers (M = 3.37, SD = 1.04). Overall, a significant association between relationship strain and stress due to the infant's behaviour and appearance was found for mothers (β = 0.16, p = 0.02) and fathers, with a significantly higher association for fathers (β = 0.27, p ≤ 0.002). With regard to parental role alterations, only mothers showed a significant association (β = 0.21, p ≤ 0.001).

CONCLUSION

Although mothers showed higher levels of stress and relationship strain, stress may also have an impact on fathers. Therefore, research should focus on stress prevention measures to meet both maternal and paternal needs.

"My baby is fine, no need for more clinic visits." Facilitators and barriers for utilisation of follow-up services for children born preterm in low-resource setting: Parents' perceptions

OBJECTIVES

We sought to understand the facilitators and barriers impacting utilisation of follow-up services for children born preterm as perceived by parents in a low-resource setting.

METHODS

We conducted a qualitative study at Mulago Hospital, Uganda, with parents of children born preterm and aged 22-38 months at the time of the study. We collected data using five in-depth interviews and four focus group discussions. Data were analysed using thematic analysis informed by the social-ecological model.

RESULTS

Ten subthemes emerged that could be grouped into three main themes: (1) Individual: parents' knowledge, parenting skills, perception of follow-up and infant's condition; (2) Relationship: support for the mother and information sharing; (3) Institution: facility setup, cost of care, available personnel and distance from the facility. Parents of preterm infants perceived receiving timely information, better understanding of prematurity and its complications, support from spouses, availability of free services and encouragement from health workers as facilitators for utilisation of follow-up services. Limited male involvement, parents' negative perception of follow-up, stable condition of infant, health facility challenges especially congestion at the hospital, distance and care costs were key barriers.

CONCLUSION

An interplay of facilitators and barriers at individual, interpersonal and health system levels encourage or deter parents from taking their preterm children for follow-up services. Improving utilisation of services will require educating parents on the importance of follow-up even when children are not sick, eliciting maternal support from spouses and peers and addressing health system gaps that make follow-up unattractive and costly.

Torn between two worlds: parental experiences of neonatal follow-up for infants with hypoxic ischaemic encephalopathy in India-a qualitative study using interpretative phenomenological analysis

OBJECTIVE

This study aimed to understand the barriers and facilitators of a neonatal follow-up programme, as perceived by parents of infants born with hypoxic ischaemic encephalopathy (HIE).

DESIGN

This study applied a qualitative study design using interpretative phenomenological analysis. It included focus group discussions, face-to-face in-depth interviews and telephonic interviews. Data were analysed using thematic content analysis.

SETTING

Neonatal follow-up clinic of a tertiary hospital in South India. The study was conducted between March and December 2020.

PARTICIPANTS

Five fathers and eight mothers of infants with HIE.

RESULTS

Parents of children with HIE are torn between two worlds-an atmosphere of support and one of criticism. Three main themes were identified: (1) neonatal intensive care unit (NICU) stay: distressful versus reassuring experiences; (2) parenthood: supportive versus unsupportive environments; and (3) neonatal follow-up: adherence versus non-adherence.

CONCLUSION

Parents of children with HIE experience sociocultural barriers in the NICU, after discharge and during the follow-up period. These lead to a complex array of emotional and physical consequences that affect parenting and follow-up care.