Quality of life and stress in mothers of preterm infant with feeding problems: A cross sectional study

BackgroundThe majority of preterm infants experience some oral feeding problems. The outcomes of preterm infants with feeding problems are not predictable. This study was conducted to determine the quality of life and stress among mothers of preterm infants with feeding problems.Materials and methodsParticipants consisted of mothers with preterm infants. The instruments used to measure infants' feedings, mothers' stress and quality of life, and mothers' and infants’ characteristics included: Infants Feeding Readiness Assessment Scale (POFRAS), Parental Stress Scale: Neonate Intensive Care Unit (PSS - NICU), quality of life questionnaire (SF-36), and a socio-demographic questionnaire.ResultsThere was no correlation between the subscales of the PSS - NICU and the POFRAS or between domains of SF-36 and POFRAS. There was no significant association between general physical health and stress. However, general mental health and overall quality of life of mothers were inversely correlated with all PSS-NICU subscales.ConclusionMost maternal stress was related to the infants' appearance and behaviors. The mental health dimension was affected more than the physical health dimension of quality of life. Health care professionals should teach mothers of premature infants about the NICU environment, parental role, and their infants’ appearance and behaviors.     

Implementation of a simulation-based education for mothers in managing respiratory emergencies in the neonatal intensive care unit

Neonatal Intensive Care Unit (NICU) discharge often causes concern for mothers since they are solely responsible for the care and safety of their infants. This study assesses the feasibility of simulation-based education on managing respiratory emergencies for mothers and investigates changes in mothers' confidence. It used a pilot one-group pre- and post-test design in an NICU. The general estimation equation was used to analyze the effects of simulation-based education and factors affecting mothers' confidence. The simulation-based education increased mothers' confidence in managing respiratory emergencies, and these effects continuedeven after discharge. Mothers with multiple pregnancies and mothers of infants with low birth weight, long gestation, and NICU stays showed increased confidence compared to their counterparts. Teaching using a simulation approach is feasible and significantly improves mothers' confidence in infants’ respiratory emergency management. The findings demonstrate the feasibility of simulation-based education in terms of clinical education for improving infant health outcomes.     

Acceptability to nurses of reducing NICU light and noise levels during skin-to-skin care: A pilot study

IntroductionLight and noise levels may influence preterm infants and their mothers when they are experiencing skin-to-skin contact [SSC] in the Neonatal Intensive Care Unit [NICU].MethodsA pilot randomized controlled trial [RCT] of an intervention aiming at reducing light and noise levels during SSC was conducted. Twenty-one neonatal nurses from a level III NICU completed questionnaires assessing their acceptability of NICU light and noise levels reduction during SSC, whether it interfered with their care delivery, in addition to acceptability of specific interventions reducing these levels.FindingsThe majority of nurses considered that the reduction of NICU light and noise levels during SSC was acceptable in general, did not interfere with their care delivery, and that the nine selected interventions were also acceptable.Conclusion and research implicationsNurses found it acceptable to reduce NICU light and noise levels during SSC. These findings support the conduct of a full-scale RCT to evaluate the effect of such an intervention on preterm infants and mothers' well-being.     

The effect of supportive program on maternal self-confidence in caring of infants with gastrointestinal anomalies: A randomized clinical trial

PurposeThis study aimed to determine the effect of supportive program on maternal self-confidence in caring of infants with gastrointestinal anomalies.MethodsIn this randomized clinical trial, 50 mothers of infants with gastrointestinal anomalies randomly allocated into control and intervention groups. The mothers of intervention group, in addition to the routine care, received supportive program. Maternal self-confidence was measured before and after the intervention, using Karitane Parenting Confidence Scale.ResultsThere was a significant difference in the pre-test and post-test scores of the intervention group (P < 0.001). Also, post-test scores of self-confidence was significant in both intervention and control groups after adjusting pre-test score (P < 0.001).ConclusionThe present study confirms the impact of a supportive program on increasing mothers' confidence. According to this, the four-dimensional support program can be offered as a systematic program in the neonatal units for mothers of infants with gastrointestinal anomalies.     

Bereaved Parents' Perceptions of Infant Suffering in the NICU

ContextIt is challenging to provide supportive intensive care to infants in the neonatal intensive care unit (NICU), giving them every chance for survival, while also trying to minimize suffering for both the infant and parents. Parents who believe their infant is suffering may alter treatment goals based on their perceptions; however, it is unknown how parents come to believe that their infant may be suffering.ObjectivesTo examine bereaved parents' perceptions of infant suffering in the NICU.MethodsParents completed a qualitative interview exploring their perceptions of the level of suffering that their infant experienced at the end of life. Parents whose infant died in a large Midwestern Level IV regional referral NICU from July 2009 to July 2014 were invited to participate. Thirty mothers and 16 fathers from 31 families (31 of 249) participated in telephone interviews between three months and five years after their infant's death.ResultsFour themes emerged from the qualitative analysis: 1) the presence/absence of suffering, 2) indicators of suffering, 3) temporal components of suffering (trajectory), and 4) influence of perceived suffering on parents, infants, and clinical decision making.ConclusionParents used signs exhibited by infants, as well as information they received from the health care team to form their perceptions of suffering. Perceived suffering followed different trajectories and influenced the decisions that parents made for their infant. Soliciting parent perspectives may lead to improvements in the understanding of infant well-being, particularly suffering, as well as how parents rely on these perceptions to make treatment decisions for their infant.     

Fathers' experiences with the skin-to-skin method in NICU: Competent parenthood and redefined gender roles

AimTo explore how fathers of premature infants experience and potentially benefit from using the skin-to-skin (STS) method during their infants' admission to the neonatal intensive care unit (NICU).Methods, participants and settingHermeneutic phenomenological qualitative study. In-depth, semi-structured interviews with five fathers of premature infants in the NICU, Copenhagen University Hospital, Hvidovre Hospital, Denmark.FindingsThree themes emerged: 1) “The competent parenthood”. 2) The paternal role and the division of roles between the parents. 3) Balance between working life and time spent with the infant.ConclusionSTS enhances the fathers' ability to play a caring role in their infant's life. Fathers consider themselves less important, as compared to the mother in relation to their infant. STS enhances an understanding of their own role as a father. Health professionals should focus on promoting the abilities of both parents and on ascribing the fathers an equal and important role in their infant's care.     

The effect of a group discussion about premature newborns between mothers and healthcare team on mother’ stress and coping in neonatal intensive care unit

BackgroundPremature birth is a source of severe stress for parents. The current study aimed to determine the effect of group discussion between mothers and the healthcare team on mothers' stress and coping strategies.MethodsThis non-randomized, prospective, interventional study was conducted in 2017. Eighty mothers with premature infants were enrolled in the study (40 mothers in each group). Four sessions of group discussion focusing on family-centered care were conducted for the intervention group. Parental Stress Scale and the Brief COPE were completed for the first three days and two weeks later, and the data were analyzed using t-test and repeated measure ANOVA.ResultsDifferences in maternal stress reduction between the intervention and control groups were statistically significant (p=0.002). Problem-focused coping strategies were increased significantly in the intervention group (P = 0.01).ConclusionsGroup discussions between mothers and healthcare team members as a way to improve the quality of care in the neonatal intensive care unit (NICU) can help mothers stress reduction and improving positive coping strategies.     

Anxiety,depression, and quality of life in mothers of newborns admitted to the neonatal intensive care unit: A follow-up study from birth to the first two years of life

AimThere is evidence that the Neonatal Intensive Care Unit (NICU) environment can have a negative impact on maternal psychological well-being, especially in low- and middle-income settings. However, most studies on distress and quality of life in mothers of newborns who needed intensive medical care have measured patient-centered outcomes at only one time-point. Here, we evaluated the levels of anxiety, depression, and quality of life in mothers of newborns admitted to the NICU with follow-up throughout the first 2 years of the child's life.MethodsWe performed a longitudinal study in a region with the worst socioeconomic indicators in Brazil. We included mothers who had newborns admitted to the NICU. Our primary outcome of interest was quality of life, as measured by the WHOQOL-BREF instrument. Secondary endpoints included anxiety levels (Spielberger's State-Trace Anxiety Inventory) and depressive symptoms (Beck Depression Inventory).ResultsFifty-four mothers were included. During the first 48 h after NICU admission, the median quality of life score was 62.5 (IQR 56.3–68.8), and severe levels of state anxiety were observed in 61.1% of mothers. A positive relationship was observed between levels of state anxiety (p = 0.003), depressive symptoms (p < 0.001), and length of stay in the NICU. A significant improvement in the mothers' global quality of life score was observed only 12 months after the child's birth, which remained unchanged at the 24-month assessment.ConclusionsOur findings suggested that the admission of newborns to the NICU may have a long-term impact on maternal mental health.     

Evidence based practice,and the spirit of inquiry: The Asian example

Evidence based practice (EBP) does not go unnoticed in the healthcare setting in the 21st century. The valued presence of EBP is recognized by the healthcare professionals, educators, health policy makers, private and public payer systems as well as well-informed patients and their families. However, it is not always easy to grasp how well EBP is integrated into the neonatal nurses' daily practices or how well it is understood in concrete terms by the neonatal nursing work force. In this article, the author attempts to provide relevance of foundational concept of EBP to the daily routine seen in the common neonatal intensive care unit (NICU) setting and invites the readers to welcome the concept of EBP as a friendly presence and begin the process by developing the “spirit of inquiry”. Two recent situations are described as examples of how valuable nurses' inquiries are to the vulnerable infants in the NICU setting. The “spirit of inquiry” found among the nurses in Japan and South Korea are likely to be very similar to the inquiry found in the readers' unit in the western world.     

The relationship of SNAPPE-II score and parental perception of infant illness to parental depression in the neonatal intensive care unit

PurposeTo describe the relationship of severity of infant illness and parental perception of illness to depression in the neonatal intensive care unit (NICU).Subjects174 mothers, 174 fathers, and 188 infants.Design and methodsThe data from this secondary analysis were derived from questionnaires administered to mothers and fathers separately within 96 h of their infants’ admission to the NICU. Main study variables: severity of infant illness, parental perception of infant illness and depression.Principal resultsThis study demonstrated a low correlation between parents’ perceptions of infant illness and severity of illness. Perception of infant illness between mothers and fathers was moderately correlated. Depression was not associated with the actual severity of the infant's illness for either parent.ConclusionsThis study found a limited association among severity of infant illness, depression, and parental perception of illness in the NICU. It is important for health care providers to recognize the potential for incongruency between actual severity of illness and parental perception of infant illness as well as the differences that may exist between the responses by mothers and fathers.     

A survey of how mothers think about and use voice with their hospitalized newborn infant

Short-term family-centered early intervention enhances a mother's capacity for attuned interaction with her hospitalized newborn infant which in turn impacts positively on infant neurodevelopment. This study determined the acceptability of a focus on mothers' own voices to support their hospitalized infant.Sixty mothers of newborn surgical inpatient infants were surveyed about spontaneous vocal behavior in the NICU. Questions included age, education and first experience of parenting, contextualization of voice use relative to other nurturing behaviors, and mother's capacity to imagine or think of a reason for singing to her infant.Sixty percent of mothers sang spontaneously in the NICU. There was strong evidence for an association (p < 0.001) between imagining singing or thinking of a reason for singing, and actually singing. There was no evidence for an association between mothers' spontaneous voice use and their age, education or experience of parenting, and musical heritage. Barriers to singing included being too embarrassed or feeling too obvious in the NICU environment.The snapshot of mothers' beliefs, thoughts and action in using their voices is valuable in creating an efficient family empowerment model.     

Factors associated with haematological cancer survivors experiencing a high level of unmet need across multiple items of supportive care: a cross-sectional survey study

Purpose

This study aimed to identify subgroups of haematological cancer survivors who report a “high/very high” level of unmet need on multiple (≥7) items of supportive care.

Methods

Haematological cancer survivors, aged 18 to 80 years at recruitment were selected from four Australian state-based cancer registries. Eligible survivors were sent a survey containing the Survivor Unmet Needs Survey (SUNS). Logistic regression analysis was used to identify characteristics associated with haematological cancer survivors reporting a “high/very high” level of unmet need on ≥7 items of the SUNS.

Results

Of the 696 survivors included in this study, 175 (n?=?25 %) reported a “high/very high” level of unmet need on seven or more items of the SUNS. Survivors who: had relocated due to their cancer (OR: 2.04; 95 % CI: 1.18, 3.52), had difficulty paying bills (OR: 2.42; 95 % CI: 1.34, 4.38), had used up their savings as a result of cancer (OR: 1.90; 95 % CI: 1.06, 3.40), and were classified as having above normal symptoms of depression (OR: 3.65; 95 % CI: 2.17, 6.15) and stress (OR: 5.94; 95 % CI: 3.22, 10.95) on the Depression Anxiety and Stress Scale-21 (DASS-21) had statistically significantly higher odds of reporting seven or more “high/very high” unmet needs.

Conclusions

Additional and intensive supportive care may be needed for this subgroup of haematological cancer survivors experiencing multiple “high/very high” unmet needs. Assistance with accessing relevant financial support and highly accessible services that provide emotional and information support, such as online and telephone peer support programs may prove beneficial in addressing the needs of this subgroup of haematological cancer survivors. It is suggested that future, methodologically rigorous intervention studies assess such strategies.     

Factors associated with supportive care needs of patients under treatment for breast cancer

PurposeThis study aimed at gaining insight into supportive care needs and cancer treatment-related symptoms, and to determine factors associated with supportive care needs.Breast cancer and its treatment cause emotional trauma and health complaints. These lead to supportive care needs in some patients, while others are more able to cope with these consequences themselves. To be able to address these needs, it is important to identify patients' needs at the time they arise.MethodsWomen (n = 175) with newly-diagnosed breast cancer, under treatment in two Swiss breast cancer clinics, participated in a cross-sectional survey. Standardized instruments were used: Supportive Care Needs Survey, Cancer- and Cancer Treatment-related Symptom Scale, Hospital Anxiety and Depression Scale, Distress Thermometer, and Interpersonal Relationship Inventory.ResultsThe patients' most needed help with psychological issues. Many had treatment-related symptoms like fatigue (87.7%), hot flashes (71.5%), and a changed body appearance (55.8%). The majority suffered from distress (56.2%), fewer from anxiety (24.1%) and depression (12.1%). Physical and social impairment, impaired body image, distress, anxiety and depression, a lack of social support and conflicts in their personal relationships were associated with supportive care needs.ConclusionsThe findings can help to identify more vulnerable patients with unmet needs and a higher demand for support. Assessment of patients enables health care professionals to provide support and counselling. In these assessments, the patients' relationship to close relatives should also be addressed.