Mothers in the NICU: Outsider to partner
The College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA. Pediatric nursing
01/2006; 31(3):176-81, 200.
The emerging care delivery model for Neonatal Intensive Care Units (NICU) is family-focused, developmentally supportive care. The purpose of this study was to explore and describe mothers' experience of becoming a mother while their infants were receiving care in the NICU. A qualitative research design was used. Interviews with 15 mothers whose infants were in a Level III NICU were analyzed using Spradley's domain analysis approach. Mothers developed from outsider to engaged parent along four continua: (1) focus: from NICU to baby; (2) ownership: from their baby to my baby; (3) caregiving: from passive to active; and (4) voice: from silence to advocacy. Mothers entered the continua at different points and moved at different rates toward "engaged parenting." The final stage, partnering, required active participation of nurses. Mothers' development evolved in predictable patterns. The results of this study can be considered in implementation and evaluation plans for NICUs moving to family-focused developmental care.
Available from: Zahra Shahkolahi
- "Similarly, rules of the NICU, the infants’ appearance and behavior, separation of the infants from the family due to their critical conditions, changes in the expected parental role, and inability to protect the infant will all contribute to the parents’ feelings of grief, loss, fear, anger, guilt, and helplessness. Such stress and mental suffering will often lead to persistent problems such as depression, anxiety disorders, and impaired parenting, even after the baby is discharged from the hospital. Consequently, parents having to deal with a preterm infant and his/her admission to the NICU will undoubtedly require support. "
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Preterm infants constitute a large proportion of the newborn population in the neonatal intensive care units (NICUs). Parents, as the main members of the care team, are not adequately supported as the focus is chiefly on infant care. The present study aimed to evaluate the effect of a family support intervention on the stress levels among the parents of preterm infants in NICU.
Materials and Methods:
In this quasi-experimental study, convenience sampling method was used to select 50 parents of preterm infants. The subjects were allocated to two groups of intervention and control (n = 25 pairs in each). While the control group received routine care, the intervention group benefitted from a two-stage family support program (including informational and observational phases in the first stage and emotional supportive intervention in the second). The Parental Stressor Scale-NICU (PSS-NICU) was completed by both fathers and mothers of the two groups (before and after intervention). Descriptive and inferential statistics were employed to analyze data in SPSS version 18.
Before the intervention, the mean total scores of PSS-NICU and also the mean scores of its three subscales were not significantly different between the two groups. However, after the intervention, significant differences were observed between the two groups. The scores of the intervention group showed significant reduction following the intervention, but such a difference was not detected in the control group.
Apparently, early educational and emotional support for parents of preterm infants decreased their stress. Similar interventions may thus be effective in empowering parents for caring of their infant and playing their parental role.
Available from: Ingrid Egerod
- "Such personalised information instils feelings of being good parents and promotes adaptive parenting concordant with empowerment (Cox & Bialoskurski 2001, Lundqvist et al. 2002). Conversely, ineffective communication causes parents to feel like outsiders, while experiencing that their concerns and grief are not acknowledged (Lupton & Fenwick 2001, Heermann et al. 2005, Wigert et al. 2006). Too much general information may overwhelm parents, who become unable to decide what is relevant to the care of their infant (Bruns & McCollum 2002, Shields et al. 2007). "
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ABSTRACT: Aims and objectivesTo evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit.Background
Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication.DesignQualitative and quantitative data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care.Methods
Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification.ResultsImplementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders and nonguided-family-centred-care-trained nurses.Conclusions
An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators.Relevance to clinical practiceInsights gained from our pioneering work might help nurses in a similar context to reach their goals of improving family-centred care.
Available from: Fiona Dykes
- "An ‘ownership of the baby’ as a result of physical closeness, has a fundamental impact on the experience of maternal identity
[17,32]. When the place is constructed so that a mother has a sense of ownership of place/space this in turn helps to facilitate her in feeling ownership of her body and baby and supports her in feeling important as a mother and as a person
[33,34]. Thus, when space and place is designed so that the mother’s own emotional and physical needs are met and where she can be ‘present’ emotionally it facilitates an attunement in which there is a shared awareness and a balance between the mother and her baby. "
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ABSTRACT: Becoming a parent of a preterm baby requiring neonatal care constitutes an extraordinary life situation in which parenting begins and evolves in a medical and unfamiliar setting. Although there is increasing emphasis within maternity and neonatal care on the influence of place and space upon the experiences of staff and service users, there is a lack of research on how space and place influence relationships and care in the neonatal environment. The aim of this study was to explore, in-depth, the impact of place and space on parents' experiences and practices related to feeding their preterm babies in Neonatal Intensive Care Units (NICUs) in Sweden and England.
An ethnographic approach was utilised in two NICUs in Sweden and two comparable units in England, UK. Over an eleven month period, a total of 52 mothers, 19 fathers and 102 staff were observed and interviewed. A grounded theory approach was utilised throughout data collection and analysis.
The core category of 'the room as a conveyance for an attuned feeding' was underpinned by four categories: the level of 'ownership' of space and place; the feeling of 'at-homeness'; the experience of 'the door or a shield' against people entering, for privacy, for enabling a focus within, and for regulating socialising and the; 'window of opportunity'. Findings showed that the construction and design of space and place was strongly influential on the developing parent-infant relationship and for experiencing a sense of connectedness and a shared awareness with the baby during feeding, an attuned feeding.
If our proposed model is valid, it is vital that these findings are considered when developing or reconfiguring NICUs so that account is taken of the influences of spatiality upon parent's experiences. Even without redesign there are measures that may be taken to make a positive difference for parents and their preterm babies.
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