Bakgrund: Att bli mamma till ett för tidigt fött barn (<37 gestationsveckor) innebär en oväntad stress vilket påverkar hela familjen. Under de senaste årtionden har stora förbättringar skett inom perinatal vård och numera är chansen till överlevnad stor. Att barnet efter födseln vårdas på neonatal intensivvårdsavdelning (NICU) får konsekvenser för mamman både känslomässigt och i omvårdnaden av barnet. Syfte: Att undersöka föräldrastress och beskriva faktorer som påverkar tidig föräldrastress hos mammor till för tidigt födda barn när barnet är två månader i korrigerad ålder. Metod: Studien utfördes på fyra NICU i Sverige. Inklusionskriterierna för studien var att barnet var för tidigt fött samt vårdades på neonatalavdelning i minst 72 timmar. För att mäta upplevd föräldrastress fick mammorna (n=276) svara på enkäten Swedish Parental Stress Questionnaire (SPSQ) när barnet var två månader i korrigerad ålder. Resultat: Mammor vars barn inte vårdades på en samvårdsavdelning, som hade barn i kuvös, mammor till barn med äldre syskon, var äldre, rökte och/eller ammade helt upplevde mer föräldrastress än övriga mammor. Slutsats: Studien visar att faktorer i framför allt i miljön samt hos mamman har betydelse för upplevd föräldrastress. Våra resultat innebär att omhändertagandet bör bli bättre, både under tiden på neonatalavdelning men även efter utskrivning. Då studien också påvisar vikten av samvårdsavdelning bör förbättringar ske i den fysiska vårdmiljön för att minimera upplevelsen av föräldrastress. / Background: When an infant is born preterm (<37 gestational weeks) unexpected stresses affect the whole family. Significant improvements in the perinatal care has been made in the recent decades and now the chance of survival is high. To become a mother in a Neonatal Intensive Care Unit (NICU) entail consequences for the mother emotionally and in her care for her infant. Aim: To investigate parental stress and describe factors associated to early parenting stress in mothers of preterm infants at two months of corrected age. Method: The study was conducted in four NICUs in Sweden. The inclusion criteria were that the infant was born prematurely and had a hospital stay for at least 72 hours. To measure perceived parental stress, the mothers (n=276) answered the Swedish Parental Stress Questionnaire (SPSQ) at two months of corrected age. Results: Mothers whose infants were not cared for in a NICU with co-care, whose infants were cared for in an incubator, who were multiparous, older, who smoked and/or who were breastfeeding exclusively, experienced more stress than their counterparts in various dimensions explored. Conclusion: The study shows that factors relating to the environment and the mother are associated to parental stress among mothers’ of preterm infants. These findings show the need for improved support, both during the NICU stay and after discharge. These findings also highlight the need for improvements in the physical environment of the NICUs to reduce the risk for parental stress.

Thesis (Ph.D.)--University of Western Sydney, 2009. / A thesis presented to the University of Western Sydney, College of Health and Science, School of Computing and Mathematics, in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographies.

Title from title page of PDF (University of Missouri--St. Louis, viewed March 3, 2010). Includes bibliographical references (p. 86-99).

Kangaroo Mother Care (KMC) is a fairly new concept to the patients and personnel at the R. K. Khan Hospital. Arising from one of the Governmental initiatives, KMC was introduced to KwaZulu Natal in 2001. The personnel at this hospital were briefly introduced to this alternate method of care for a low birth weight baby, by means of symposia and in-service. Soon after this in-service education, the personnel were requested to implement KMC. This study was undertaken to explore the perceptions of carers for the preparation and experience of KMC and to describe the experiences of the carers who have implemented KMC. Furthermore, this study determined whether carers received support during the implementation of KMC and in so doing to identify the sources of this support. The selection of this particular field of study arose out of the researcher's professional role in educating personnel in the theory and practice of midwifery. The lack of documented evidence to problems that they may have been encountered and management strategies to deal with these prompted this study. The intention was to obtain empirical findings so that personnel would be provided with appropriate and precise information on the subject. A phenomenological approach was used. The sample was obtained from the R. K. Khan Hospital neonatal unit. This is a regional hospital that is located in Chatsworth, Durban. The sample comprised often mothers who were practicing KMC in the post-natal ward, or mothers who were discharged and were still practicing KMC for the past two to four weeks. Data were collected by means of face-to-face interviews. Interviews were conducted using a semistructured interview guide. These interviews provided the researcher with rich, personal and narrative experiences of the carers before and during KMC. The results of this study indicated that KMC was indeed new to most of the mothers and this evoked apprehension, doubt and fear, but once the mothers had tried it and were successful, they felt a sense ofjoy. Nursing personnel formed part of the supportive environment for the mothers practicing KMC. The latter is a prerequisite for the success of KMC. Since KMC is associated with many benefits to the mother, the baby and the institution, for the future it could be incorporated into the midwifery curriculum for student midwives. Recommendations concerning nursing practice, nursing education and nursing research were made at the end of the study including the limitations affecting the study. / Thesis (M.Cur.)-University of Natal, Durban, 2003.

The birth of a child diagnosed with congenital diaphragmatic hernia (CDH) involves significant intensive care at the beginning of life and the need for surgery. Parents’ experiences during the acute phase of hospitalization for a critically ill infant not born premature is currently limited in the literature; in particular, there is no literature describing parents’ experiences of nursing care for having a infant with CDH in the Neonatal Intensive Care Unit (NICU). Using narrative inquiry this study explores stories of parents’ early experiences of nursing care in the NICU for an infant born with CDH. A thematic analysis revealed a main overarching theme of “not knowing” with three interrelated subthemes related to parents’ need for information and open communication; participation, power and partnership; and nursing presence to transition from not knowing to knowing their infant. The findings from this study suggest that parents want to be recognized as key members within the multidisciplinary team and that the nurse has the ability to facilitate aspects of care to impact parents positively or negatively. Implications for practice focus on supporting parents through evolving empowerment and participation in the care of their infant. / Graduate / 0569

This thesis presents the development and evaluation of a computerized physician-parent decision support tool for a neonatal intensive care unit (NICU), known as Physician and Parent Decision Support (PPADS). The NICU is a specialized hospital unit that treats very-ill neonates. Many difficult care decisions are made daily for this vulnerable population. The PPADS tool aims to augment current NICU decision-making by helping parents and physicians make more informed decisions, improving physician-parent communication, increasing parent decision-making satisfaction, decreasing conflict, and increasing decision efficiency. The development of the PPADS tool followed a five-step methodology: assessing the clinical environment, establishing the design criteria, developing the system design, implementing the system, and performing usability testing. Usability testing of the PPADS tool was performed on neonatologists and on parents of neonates who have graduated (survived) from a tertiary level NICU. The usability testing demonstrated the usefulness and ease of use of the tool.

This research study seeks to better understand the experience of South Asian immigrant women in the Neonatal Intensive Care Unit (NICU). The information gathered cannot be generalized to all South Asian and other immigrant populations nor is it the intent of this study. Instead, by examining the individual NICU experiences and challenges faced during this experience, themes emerge that can prompt neonatal nurses to examine their own practice with immigrant families. The main, overall theme identified in all participant responses was, Fear of the Unknown. Three subthemes that emerged from discussions regarding how participants experience nursing care were Trust, Teaching and Advocating. In terms of what participants identified as their most critical concerns while their infant was in the NICU, the three subthemes that arose were Language Barriers, Lack of Knowledge about the NICU and A More Comfortable NICU. On a broader scale, it is hoped that this research study will inspire all nurses to examine their interactions with all immigrant families in order to provide care that is holistic and individualized to the needs of their immigrant patient. / Graduate

Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment. The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B). Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V). This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.

"Improved survival rates for premature infants have resulted in extended hospital stays in neonatal nurseries with consequent challenges for mothers assuming a parental role. Additionally, maternal medical complications associated with surgical birth, and a need to locate themselves in unfamiliar clinical environments, exacerbate women's experiences and transition to a maternal role competes with other roles at this time. For women living in rural and regional areas, who experience premature birth, there is additional hardship due to isolation, distance and limited support services. There has been little research on women's experiences with infants in special care nurseries in regional Australia."--(leaf ii). / Master of Nursing

"Improved survival rates for premature infants have resulted in extended hospital stays in neonatal nurseries with consequent challenges for mothers assuming a parental role. Additionally, maternal medical complications associated with surgical birth, and a need to locate themselves in unfamiliar clinical environments, exacerbate women's experiences and transition to a maternal role competes with other roles at this time. For women living in rural and regional areas, who experience premature birth, there is additional hardship due to isolation, distance and limited support services. There has been little research on women's experiences with infants in special care nurseries in regional Australia."--(leaf ii). / Master of Nursing