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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

What Support Systems do Women Caring for Preterm Infants at Home Require in Urban Ghana? A Qualitative Study

INTRODUCTION

Caring for preterm infants and ensuring their survival beyond neonatal intensive care units remain a challenge in many low-income settings. While studies highlight the difficulties of caring for preterm infants at home, few have focused on the forms, sources, and accessibility to support systems. This study explored the forms of support systems women caring for preterm infants at home in urban Ghana require, and their accessibility to such support systems.

METHODS

An explorative cross-sectional qualitative study was conducted. A total of 19 women who were caring for preterm infants aged 2-6 months at home were purposively sampled. In-depth interviews were conducted and thematic content analysis used to analyse the data.

RESULTS

Women reported four main forms of support which they require: psychosocial support, practical support, material support and spiritual support. However, accessibility to these support systems was highly unequal, often depended on one's social status and the quality of one's family and interpersonal relationships prior to giving birth to a preterm infant.

CONCLUSION

Women caring for preterm infants at home require a variety of support systems; but effective accessibility remains a challenge for many in urban settings. Interventions to strengthen community and home-based support for women caring for preterm infants at home, including use of social media-based peer support groups, are urgently needed.

Maternal experiences of caring for preterm infants in a vulnerable South African population

Background

Caring for a preterm infant is known to be a stressful experience as these infants are at a high risk of medical sequelae and developmental delays. Early intervention is imperative for the best developmental outcome for the infant. Such interventions are often delivered through the mother or primary caregiver; however, healthcare professionals are seldom aware of all the factors that influence maternal well-being, potentially influencing her ability to provide optimal care.

Aim

To explore the experiences of a group of vulnerable women, namely, isiXhosa-speaking mothers of preterm infants living in low socio-economic circumstances in the Western Cape province of South Africa, regarding having, caring for and feeding their preterm infants within the first 6 months of the infant’s life.

Setting

A follow-up clinic for preterm infants and their mothers at a public tertiary hospital in Cape Town, South Africa.

Methods

The study employed a qualitative, cross-sectional design that was explorative and contextual in nature. A discussion schedule was used to guide 15 in-depth interviews with mothers that were later thematically analysed.

Results

Social support and religion positively influenced maternal coping. The infant’s medical stability was the main concern for mothers and concerns regarding the infant’s development did not arise. Prematurity influenced mothers’ decisions to use traditional medicines and hospital care affected some traditional practices.

Conclusion

The study findings highlighted the influence of traditional and religious beliefs, the importance of the cultural education of medical staff members and a support system to improve maternal experiences.

Contribution

The findings provide insights into maternal experiences with implications for healthcare practitioners’ continued education in an ethnically diverse setting.

Health workers' views on factors affecting caregiver engagement with bubble CPAP

Background

Severe respiratory distress is a leading cause of mortality among neonates in Malawi. Despite evidence on the safety, cost effectiveness and efficacy of bubble continuous positive airway pressure (CPAP) in managing the condition, its use in Malawian health facilities is limited and little is known about caregivers’ engagement with perspectives of bubble CPAP. The purpose of this study was to explore caregiver perspectives for bubble CPAP at both central and district hospitals and key factors that enable effective caregiver engagement in Malawi.

Methods

This was a descriptive qualitative study employing secondary analysis of 46 health care worker in-depth interviews. We interviewed the health workers about their thoughts on caregiver perspectives regarding use of bubble CPAP. We implemented the study at a tertiary facility and three district hospitals in southern Malawi. This was a part of a larger study to understand barriers and facilitators to implementing neonatal innovations in resource-constrained hospitals. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Health workers were purposively selected to include nurses, clinicians and district health management involved in the use of bubble CPAP.

Results

Emerging issues included caregiver fears around bubble CPAP equipment as potentially harmful to their new-borns and how inadequate information provided to caregivers exacerbated knowledge gaps and was associated with refusal of care. However, good communication between health care providers and caregivers was associated with acceptance of care. Caregivers’ decision-making was influenced by relatives and peer advocates were helpful in supporting caregivers and alleviating fears or misconceptions about bubble CPAP.

Conclusions

Since caregivers turn to relatives and peers for support, there is need to ensure that both relatives and peers are counselled on bubble CPAP for improved understanding and uptake. Health workers need to provide simplified, accurate, up-to-date information on the intervention as per caregivers’ level of understanding. Notably, contextualised comprehensible information will help alleviate caregivers’ fear and anxieties about bubble CPAP.

Experiences of mothers with preterm babies at a Mother and Baby Unit of a tertiary hospital: A descriptive phenomenological study

Aim

To describe the lived experiences of mothers with preterm babies at a Mother and Baby Unit (MBU) of a tertiary hospital.

Design

A descriptive phenomenological approach.

Method

Ten mothers were purposively sampled during the month of May, 2017 to describe their experiences of having preterm babies. Recorded in-depth individual interviews were transcribed verbatim; codes were generated and inductively organised into themes.

Results

Four themes were actively generated: 'Emotional experiences of mothers', 'Mother-baby interaction', 'Perception on care and support' and 'Challenges within Mother and Baby Unit environment'. Mothers were anxious about the premature delivery and were afraid of possible infant's death. They cherished interactions with their babies during kangaroo mother care and breastfeeding. Mothers applauded the nurses for their professional competence. They expressed concerns about inadequate accommodation, high cost of care, the frequency and duration of mother-baby interactions.

Coping strategies of mothers with preterm babies admitted in a public hospital in Cape Town

BACKGROUND

Most pregnancies run a normal course, ending in a healthy mother-infant relationship, but sometimes, it can also be a life-threatening and stressful condition. The stress levels of mothers are more aggravated when they deliver preterm babies.

OBJECTIVES

To explore the coping strategies of mothers of preterm babies with the stress of preterm delivery and subsequent admission of the preterm neonate to a neonatal care unit.

METHOD

A qualitative research approach applying an exploratory and descriptive design was applied to explore the coping strategies of mothers with preterm babies admitted in a neonatal care unit. The study applied a purposive sampling technique to select mothers with preterm babies. The population for this study included women who delivered preterm babies and whose babies were admitted in the neonatal care unit at a public hospital in Cape Town. Semi-structured interviews were conducted until data saturation was reached, and 11 mothers with preterm babies in the selected public hospital participated in the study. Data were analysed manually using thematic content analysis with an inductive approach.

RESULTS

Results were deductively interpreted and supported by the Brief COPE model. The main themes that emerged from data analysis included praying, attachment with baby and acceptance of the situation. Under praying the following subthemes emerged, namely praying for God's strength, God's grace, babies' survival and thanksgiving to God for babies' health and preferred gender. The theme of attachment with the baby emerged with the following subthemes: bonding with the baby and seeing the baby. The last theme that was acceptance of the situation emerged with the following subtheme: perseverance in the situation and mother's awareness of her responsibility.

CONCLUSION

Even though the mothers of preterm babies cope differently after delivery, their coping abilities, which included praying, attachment to baby and acceptance of the situation, were greatly determined by the condition of their babies as well as the support they receive from significant others.

Effect of Preterm Infant Massage by the Mother on the Mood of Mothers Having Preterm Infants

Objective

The purpose of this study was to determine the effect of preterm infant massage by the mother on the mood state of mothers of preterm infants.

Methods

This experimental study assessed 52 mothers of preterm infants (born at 30-37 weeks of gestation) hospitalized in the neonatal intensive care unit of Afzalipour Hospital of Kerman University of Medical Sciences, Iran. Recruitment was done using the convenience sampling method, and participants were randomly assigned into intervention and control groups. In the intervention group, massage therapy was done once a day for 5 consecutive days. Infants in the control group received the usual care. Data were collected using a questionnaire of demographic information and the Profile of Mood State questionnaire and analyzed using SPSS version 19 (IBM Corp, Armonk, New York) and Kruskal-Wallis, Mann-Whitney U, Wilcoxon, and χ² tests.

Results

Comparison of the mothers' mean mood scores between the intervention and control groups showed no significant difference before the intervention (P = .51), whereas mean scores differed significantly after the intervention between the groups (P = .005). Mothers' mean mood scores improved significantly in the control group (P = .02) and the intervention group (P < .001), whereas the intervention group showed a greater improvement (-4.155 vs -2.238).

Conclusion

Those mothers performing massage on their preterm infants showed greater improvement in their mood compared with those in the control group. Teaching massage to the mothers of these infants could be considered as a possible intervention to enhance a mother's mood and the quality of care she provides to her infant.