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

Parental satisfaction with care given in neonatal intensive care units, multicentre referral hospitals in eastern Ethiopia

Background

Parental satisfaction is an important dimension of the quality of a child's care and has been shown to improve health outcomes, including adherence to therapeutic regimens and understanding of medical information. Parental satisfaction is low in resource-limited countries like Ethiopia, with the paucity of evidence. This study aimed to determine the magnitude of parental satisfaction with care given in neonatal intensive care and its associated factors among parents of neonates admitted to neonatal intensive care units (NICUs) at referral hospitals in eastern Ethiopia from June to August 2023.

Method

A facility-based cross-sectional study was conducted among 418 parents whose new-borns were admitted to the NICU and who were selected using a systematic random sampling technique. A pretested semi structured questionnaire was used to collect the data through face-to-face interviews with participants, and a checklist was used to review the charts/records by trained and experienced bachelor nurse/midwife data collectors. The data were coded, entered into Epi-Data version 4.6, and transferred to SPSS version 25 for analysis. We used binary logistic regression analysis to identify factors associated with the outcome variable. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the findings, and a p-value ≤0.05 was considered to indicate statistical significance.

Results

The magnitude of parental satisfaction with care given in the NICU was 50.5% (95% CI: 45.6-55.5). Being a rural resident (AOR = 2.13; 95% CI: 1.33-3.43), having a shorter hospital stay (AOR = 4.25, 95% CI: 2.08-8.69), being able to breastfeed (AOR = 2.46; 95% CI: 1.48-4.09), having a single birth (AOR = 4.16; 95% CI: 1.91-9.03), and the availability and quality of the family room (AOR = 2.36; 95% CI:1.40-3.99) were significantly independent associated factors with parental satisfaction with care given in the NICU.

Conclusion

Only one in two parents were satisfied with the care given in the NICU. The present study highlights that shortening hospital stays, mothers' ability to breastfeed their newborns, having a single birth, and the availability and quality of the family room contribute to enhancing parental satisfaction with care given in the NICU in eastern Ethiopia.

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.

Effects of a Noncontact Visit Program in the NICU for the Prevention of COVID-19

BACKGROUND

With the spread of COVID-19, neonatal intensive care units restricted visiting hours to prevent infection. As a result, mothers of high-risk newborns were restricted from making contact with their children. Various problems could be encountered for hospitalized children and mothers of high-risk newborns due to restrictions on visits in the neonatal intensive care unit. Therefore, during the pandemic, continuous nursing support for mothers of high-risk newborns was needed.

METHODS

In this study, a nonequivalent control group non-synchronized design was employed. The subjects of the study were 36 mothers of high-risk neonates (20 in the experimental group and 16 in the control group) in E University Hospital, D Metropolitan City, from July to September 2022. The experimental group received a 10 min program performed by a nurse from 7:00 p.m. to 9:00 p.m. three times per week.

RESULTS

There were significant differences in nurses' support between the experimental and control groups (F = 25.594, p < 0.001), changes over time (F = 16.178, p < 0.001), and time-group interactions (F = 9.663, p = 0.003).

CONCLUSIONS

It was interpreted that the real-time noncontact visitation program could transcend time and space for many mothers of high-risk newborn babies, who suffered psychologically due to restrictions and bans on visitations during the COVID-19 pandemic.

Maternal stress experiences with neonatal intensive care unit admissions

Background

Mother experiences variety of stressors related to premature birth, baby’s medical condition, unpleasant neonatal intensive care unit (NICU) environment and intuit liability of the infant. Identifying factors that causes stress may be useful in assisting health personnel in understanding their importance and in improving the quality of care. Objective of the study is to assess the stress levels of mothers whose neonate is admitted to the NICU as measured by Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU).

Methods

This prospective analytical study was conducted in NICU of a tertiary care hospital over a period of 12 months after obtaining permission from the institutional ethics committee. The self-administered questionnaire comprising questions on: sights and sounds experienced in NICU, baby’s looks and behaviour, parental role and relationship with her baby were collected. The mean score and standard deviation were calculated for each component of PSS: NICU Scale and mean scores are compared.

Results

Mothers having full term babies have experienced more stress than those having pre-term babies. As measured by PSS-NICU scale the highest mean scores of 2.3 ± 0.57, 4.36 ± 0.53, 4.43 ± 0.58 were obtained for questions “The other sick babies in the room” component of Sight and Sound, “Seeing my baby looking sick” Component of Looks and Behaviour, “Being separated from my baby” Component of Parental Role and Relationship respectively.

Conclusion

Present study summarises the overall impact of NICU environmental stressors affecting mothers in a developing country and also emphasises the need for further studies in this area for identification of factors that contribute to maternal stress. It may enable health professionals to facilitate mothers’ adaptation, thereby promoting optimal mother–infant relationships and subsequent infant development.

The Effect of Supportive-Educational Interventions on Stress and Adaptation to Maternal Role: A Quasi-Experimental Study

BACKGROUND

Preterm delivery is a stressful event and stress can affect adaptation to maternal role. The purpose of this study is to determine the effect of supportive-educational interventions on stress and adaptation to the maternal role among women with premature infants hospitalized in the neonatal intensive care unit.

METHODS

This quasi-experimental study was conducted on 60 women with premature infants hospitalized in the neonatal intensive care unit. A control group (n = 30) was initially selected from eligible female participants. Sampling was stopped for three weeks and then the intervention group was sampled. The entire sampling process was carried out from December 2018 to June 2019. The control group received usual care at the hospital and the intervention group (n = 30) received three sessions of supportive-educational intervention in addition to routine care. Data were collected through the perceived stress and the maternal role adaptation questionnaires completed by both groups at the time of infant discharge, and also at the follow-up period (one month after discharge).

RESULTS

The results showed that maternal stress score changed considerably over time and a significant difference between the two groups was observed (P < 0.05). Additionally, adaptation to the maternal role changed substantially over time and the difference between the two groups was statistically significant (P < 0.05).

CONCLUSION

The supportive-educational program reduced the stress of mothers with premature infants hospitalized in the neonatal intensive care unit and increased their adaptation to the maternal role.

Nursing support perceived by mothers of preterm infants in a neonatal intensive care unit in South Korea

Purpose

The aim of this study was to clarify and define the concept of nursing support as perceived by mothers of preterm infants.

Methods

The research was conducted using Schwartz-Barcott and Kim's hybrid model. Sixteen articles were analyzed during the theoretical phase. In-depth interviews were conducted with 10 mothers of preterm infants in the fieldwork phase. In the final analytical phase, the attributes of nursing support were defined.

Results

There were four themes and 10 attributes of nursing support as perceived by mothers of preterm infants. Professional care and emotional care for the baby were identified as attributes of baby care support. Information related to the disease, inpatient environment, baby's daily hospital life, and mother-centered care were identified as attributes of information delivery support. Empathy for mothers and therapeutic communication with the mother were identified as attributes for mental care support. Lastly, providing a chance for the mother to take care of the baby and reinforcement of the maternal role were identified as attributes of maternal role support.

Conclusion

The 10 attributes of this study could provide a base for the development of a nursing support instrument and practical guidelines for mothers in neonatal intensive care units.

Follow-up Plan as a Necessity for Nursing Care: A Decrease of Stress in Mothers with their Children in Pediatric Surgical Units

Introduction: Children are vulnerable to damage. Health problems in children, especially if necessitate hospitalization, can cause stress in their parents that may persist even long after discharge. This study aimed to investigate the effect of implementing follow-up care plans on stress in mothers of children discharged from pediatric surgical units.

Methods: A quasi-experimental study was conducted on 64 mothers whose children were hospitalized in the surgical wards of two educational hospitals affiliated to Isfahan University of Medical Sciences, Iran. The participants were randomly assigned into two groups of control and experimental. The data collection tools included a demographic data questionnaire and stress response inventory (SRI). The interventions were performed using a four-stage follow-up care plan. The data were analyzed using SPSS software version 13 and descriptive statistics, independent t-test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) test.

Results: The mean (SD) stress scores of the experimental group were 64.1 (28.8), 20.4 (12.4), and 11.6 (7.5) before, one week, and one month after the intervention, respectively. In the control group, these scores were 61.2 (29.2), 59.9 (25.5), and 46.7 (19.1), respectively. The results showed the mean score was significantly lower than that of the control group at one week and one month after the intervention in the experimental group.

Conclusion: Our results demonstrated that a follow-up care plan can decrease the stress levels of mothers as a continuity of patient care even after discharge.

Preterm Parents' Stress and Coping Strategies in a Neonatal Intensive Care Unit in a University Hospital of Central Greece

BACKGROUND

The early birth of a newborn and the hospital care in the intensive care causes stress to parents.

OBJECTIVE

The main objective of this study was to investigate preterm parents' level of stress and which coping strategies do they use in a Neonatal Intensive care Unit in a University Hospital of Central Greece.

METHODS

This cross-sectional study used a group of 82 preterm parents in the Neonatal Intensive care unit in a University Hospital of Central Greece. They were asked to answer a questionnaire with the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU), Coping Orientation to Problems Experienced (BRIEF/COPE), Daily Spiritual Experience Scale (DSES). The McNemar test was used to compare fathers 'and mothers' views on psychological support. The paired t-test or the Wilcoxon-signed rank test was used to compare scores between fathers and mothers. The levels of importance are bilateral and the statistical importance was defined as 0.5. For the analysis SPSS 22.0 was used.

RESULTS

The most common cause of admission to NICU was low birth weight. The severity of the preterm's condition was found to be independently correlated with PSS-NICU score due to "sights and sounds" and due to "Infant Appearance and behaviour" in the NICU. The severity of the child's condition and the parents' DSES score were found to be independently correlated to the stress score due to their "parent-infant relationship". Mothers 'and fathers' scores on the dimensions of the Brief-COPE Questionnaire were similar, suggesting a similar way of managing stress. Substance use, religion, humor were found to correlate with total score of PSS-NICU. More specifically PSS-NICU correlated negatively with substance use (r=-0.30 p=0.009) and humor (r=-0.28 p=0.016) while it correlated positively with religion (r=0.29 p=0.011).

CONCLUSION

Mothers and fathers of preterm need support. Spirituality and religion, helps then face the challenges of having their baby hospitalized in a NICU.

Health care staff support for mothers in NICU: a focused ethnography study

BACKGROUND

Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU.

METHODS

A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework.

RESULT

Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained.

CONCLUSION

The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU.

Reviewing recordings of neonatal resuscitation with parents

BACKGROUND

Recording of neonatal resuscitation, including video and respiratory parameters, was implemented for research and quality purposes at the neonatal intensive care unit (NICU) of the Leiden University Medical Center, and parents were offered to review the recording of their infant together with a neonatal care provider. We aimed to provide insight in parental experiences with reviewing the recording of the neonatal resuscitation of their premature infant.

METHODS

This study combined participant observations during parental review of recordings with retrospective qualitative interviews with parents.

RESULTS

Parental review of recordings of neonatal resuscitation was observed on 20 occasions, reviewing recordings of 31 children (12 singletons, 8 twins and 1 triplet), of whom 4 died during admission. Median (range) gestational age at birth was 27+5 (24+5-30+3) weeks. Subsequently, 25 parents (13 mothers and 12 fathers) were interviewed.Parents reported many positive experiences, with special emphasis on the value for getting hold of the start of their infant's life and coping with the trauma of neonatal resuscitation. Reviewing recordings of neonatal resuscitation frequently resulted in appreciation for the child, the father and the medical team. Timing and set-up of the review contributed to positive experiences. Parents considered screenshots/copies of the recording of the resuscitation of their infant as valuable keepsakes of their NICU story and reported that having the screenshots/video comforted them, especially when their child died during admission.

CONCLUSION

Parents consider reviewing recordings of neonatal resuscitation as valuable. These positive parental experiences could allay concerns about sharing recordings of neonatal resuscitation with parents.

Power and Efficacy of Maternal Voice in Neonatal Intensive Care Units: Implicit Bias and Family-Centered Care

INTRODUCTION

Implicit bias can lead medical professionals in Neonatal Intensive Care Units (NICUs) to disregard mothers who are Black and economically disadvantaged as they advocate for their infants' health. Disregard can weaken underlying communication principles within the Family-Centered Care (FCC) model of pediatric health in NICUs and increase maternal distress. This study is the first to address communication disregard by examining mothers' perceived power and efficacy of voice with NICU doctors and nurses. We hypothesized that mothers who are Black and economically disadvantaged would report lower efficacy of voice and higher levels of distress as compared to White mothers with higher income.

METHODS

During pre-assessment within a small clinical trial of a parenting intervention, 33 racially and economically diverse mothers, from three Midwest NICUs serving the urban poor, responded to a 14-item measure of maternal power and efficacy of voice and measures of somatization, depression, anxiety and eating/sleeping disorders. Nonparametric examinations assessed the relation of power and efficacy of voice to maternal race, income, and distress.

RESULTS

In contrast to White, higher-income mothers, Black, economically disadvantaged mothers reported lower perceived efficacy of voice with doctors (U = 74.5, d = 0.65) and nurses (U = 74.0; d = .0.66). These mothers with lower perceived efficacy with doctors and nurses, reported higher levels of somatization (U = 16.5, d = 1.14; U = 13.5, d = 1.38, respectively) and eating disorders (U = 14.0, d = 1.29; U = 12.0, d = 1.48, respectively).

DISCUSSION

Study results are discussed within the framework of implicit bias in FCC in the NICU, expanding our understanding of effective communication with economically stressed, Black mothers.

Self-reinforcement: Coping strategies of Iranian mothers with preterm neonate during maternal role attainment in NICU; A qualitative study

INTRODUCTION

Having a preterm neonate in the neonatal intensive care unit (NICU) is one of the most stressful experience for parents. In facing these stressors, mothers need to find ways to adapt and control resources to maintain stability. The aim of this paper is to report coping strategies of mothers with preterm neonate during maternal role attainment in NICU.

METHODS

This paper reports a part of the findings of a grounded theory study that investigated how the mothers of preterm neonates go through maternal role attainment. The data were collected through in-depth semi-structured interviews with 12 mothers with preterm neonate admitted to the NICU and 5 nurses working in NICU. Data were analyzed according to Corbin and Strauss's (2015) approach using constant comparative analysis technique.

FINDINGS

Four themes, emerged from experiences of the participants, formed the concept of "Self-reinforcement" as the prominent strategy of mothers: "support seeking", "Spiritual getting in the mood", "Hope creation" and "Getting energy from the baby".

CONCLUSION

These findings showed that mothers use strategies to calm and support themselves and their neonates, and recognize that their lives had changed and need to adjust to their new circumstances.

Stressors and support system among parents of neonates hospitalised with systemic infections: qualitative study in South India

OBJECTIVE

To explore stressors and support system for families with a neonate admitted with a systemic infection.

DESIGN

Qualitative study using in-depth interviews (IDIs), based on principles of grounded theory.

SETTING

A busy level III neonatal unit of a tertiary care teaching hospital in coastal Karnataka, India, between May 2018 and January 2019.

PARTICIPANTS

Parents and accompanying attendants of neonates admitted to the neonatal unit with one or more systemic infections.

METHODS

Using purposive sampling, semi-structured IDIs were audio recorded, transcribed verbatim and a thematic analysis was performed.

RESULTS

Thirty-eight participants were interviewed, lasting between 30 and 59 min. Babies' hospitalisation with sepsis was an unprecedented, sudden and overwhelming event. Stressors related to uncertainties due to the information gap inherent to the nature of illness, cultural rituals, financial constraints, barriers to bonding and others. Parents reported experiencing insomnia, gastric disturbances and fatigue. Support (emotional and/or financial) was sought from families and friends, peers, staff and religion. Availability and preference of emotional support system differed for mothers and fathers. In our context, families, peers and religion were of particular importance for reinforcing the available support system. Participant responses were shaped by clinical, cultural, financial, religious and health service contexts.

CONCLUSION

Designing a family-centred care in our context needs consideration of stressors that extend beyond the immediate neonatal intensive care unit environment and interactions. Understanding the influence of the nature of illness, financial, familial and cultural contexts helps identify the families who are particularly vulnerable to stress.

Parental Experiences Caring for Their Hospitalized Medically Fragile Infants: A Description of Grief, Stress, and Coping

BACKGROUND

Advances in care have increased survival and improved outcomes of infants with complex and chronic diseases. These medically fragile infants require long-term hospitalization and depend on technology for survival. Parents of these infants experience stress and difficulties adapting to their parental role.

PURPOSE

To present an account of parental experiences as they provided care for their hospitalized medically fragile infant.

METHODS

This study was part of a larger constructivist grounded theory study to provide a holistic understanding of the processes of care for medically fragile infants. For this sub-study, 21 parents of hospitalized medically fragile infants were recruited from a pediatric hospital in Western Canada. Parents participated in face-to-face, semi-structured interviews, which were transcribed and analyzed using initial and focused coding.

RESULTS

Parents of hospitalized medically fragile infants grieved the loss of parenting a healthy infant, and they experienced multiple stressors. Parents utilized various coping strategies to manage their grief and stressors. Some parents were unable to cope, which exacted a heavy toll on their physical and mental health. Parents recommended psychological support, access to physical activity, primary nursing, and health system navigators.

CONCLUSIONS

Parental recommendations can inform the design of interventions for parents of hospitalized medically fragile infants.

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.

Mutual trust in infant care: the nurses and mothers experiences

The relationship between healthcare providers and parents of infants in neonatal intensive care unit is based on trust and constitutes a core measure of family-centred care and health. The aim of the present qualitative study was to explore mothers and nurses experiences of trust in one another around the caregiving of the hospitalised infant in intensive neonatal care unit. Focused ethnographic research study conducted through observations and in-depth interviews with 20 mothers and 16 nurses in NICU of Tabriz (Iran) in 2017. Two main themes of 'gradual and fragile trust of mother-to-nurse' (subthemes: Primary trust-mistrust, mother's trust to responsible nurse, mother trust Increase with skilful nurse performance, and vulnerability to trust) and 'gradual and fragile trust of nurse-to-mother' (subthemes: Nurse's initial assessment of trust to mother's readiness to participate, Development of trust to mother, and vulnerability of nurse's trust to mother) were obtained. The present study revealed that mutual trust between the nurse and the mother in the care of the infant was a gradual and progressive process that was achieved over time. Complexities around the care of a hospitalised infant influenced how fragile or vulnerable the trust became between nurse and mother. Findings from this research can be used in supporting increased maternal participation in infant care and improvement of family-centred care in the neonatal intensive care unit.

Parental anxiety regarding premature infants and factors affecting parental concern

PURPOSE

Premature births have a great impact on the parents. The purpose of this study was to investigate the anxieties of parents of premature infants regarding infantile diseases and to help medical staff better communicate with parents of premature infants.

DESIGN AND METHODS

This study included premature infants <37 weeks of age who were admitted to the Neonatal Intensive Care Unit of Kosin University Gospel Hospital between August 1, 2017, and December 31, 2017. The eligible subjects included 51 premature infants with their 75 parents (45 mothers and 30 fathers) listed in the children's medical records. Parental anxieties regarding the infants were determined by retrospective interviews at various time points as follows: before and after the birth, on postnatal Days 3 and 7, before discharge, in the first week after discharge, and at "whenever" time point.

RESULTS

The highest parental anxiety during all time points was regarding the respiratory system of the premature infants. Parental concerns regarding the metabolic-endocrine system of their infants significantly correlated with the presence of maternal diabetes mellitus. Parental anxiety significantly differed depending on the use of resuscitation after birth. A statistically significant difference in parental anxiety was observed in relation to the birth weight before discharge. The premature infants with bronchopulmonary dysplasia showed a significant difference in the level of parental anxiety concerning the infant's illness in the first week after discharge.

CONCLUSIONS

The parents of the premature infants were greatly concerned about their infants' respiratory system. Careful prenatal counseling and support are needed for mothers with diabetes.