Introduction: Past studies have indicated that nursing support reduces parental stress and anxiety during a child’s NICU hospitalisation and therefore fosters the parents’ abilities to cope with the difficulties they are facing. The importance of parental support has been emphasised in numerous studies in Western countries, however the nursing support which is responsive to the parents may vary between different cultures. The cultural norms of medical and nursing care environments can affect parental stress-related experiences as well as nursing roles in the NICUs across different countries. The aims of this study are, first, to compare the medical and nursing care environments of the two NICUs. Second, the study establishes any similarities and differences in sources of parental stress in the two NICUs. Third, the study illustrates the underlying philosophy of Doane and Varcoe’s (2005) relational approach to family nursing and highlights the importance of relational inquiry in the process of determining the parental support which best responds to individual families’ needs in the NICU. Methods: This study analyses the nursing roles that support parents of children hospitalised in a Neonatal Intensive Care Unit (NICU). It is a cross-cultural comparison between two NICUs, one in Christchurch, New Zealand and the other in Tokyo, Japan, with both quantitative and qualitative components. Thirty-one families participated voluntarily in the study from each NICU (n=121). The three main sources of data were a NICU staff interview, parental interview, and parental questionnaire using the Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) (Miles, 2002). A thematic analysis was used in order to examine parental comments. Results: The differences between the two NICUs in terms of the NICU care environment, including NICU regulations and routine nursing care, were identified by the staff interviews, highlighting the contrasting dominant ideologies of individualism and collectivism reflected in each culture. The three sources of parental stress, measured by PSS: NICU: Sights and Sounds; Baby’s Appearance and Behaviour; the Parental Role Alteration, were examined. The sources most responsible for parental stress differed between the four groups of parents. Overall, The Tokyo parents seemed to be most concerned about the infant’s condition. The Christchurch parents, however, perceived the change in parental role to be most stressful. Additionally, only the Tokyo fathers experienced stress in association with Sights and Sounds more often than other areas of stress. The infant’s medical/nursing care requirements, oxygen therapy and/or tube feeding, were associated with a high degree of stress for each of the parents’ groups except that of the Christchurch fathers. There was a positive relationship between parental NICU visiting and stress level among the Tokyo parents while this was not the case for the Christchurch parents. The infants’ and parental characteristics were found to be associated with stress level for the Tokyo mothers and Christchurch fathers only. The thematic analysis of interview data revealed three key themes of NICU parental experiences: Uncertainty, NICU contexts and Communication with staff. These themes were identical between the two NICUs. Discussion: This study highlighted the influence of the norms of each NICU, particularly the NICU regulations and nursing care on parental stress-related experiences, and the importance of reflecting upon these norms to critique those professional beliefs which may hamper parental coping abilities. The areas of parental support needing attention were different between the two NICUs. These areas were: the establishment of oral feeding, and infants’ nursing care-related decision-making for the Christchurch NICU whilst parental information/involvement in the early stage of hospitalisation, the influence of visiting regulations, and importing Western-based NICU intervention for the Tokyo NICU. In providing these areas of parental support, the importance of effective, meaningful communication between parents and staff was equally evident in the two NICU settings. In the light of the relational approach to family nursing, this study demonstrated that how nurses communicate with families is not universal: one way to reach across the differences is to listen to parents, and this, it is clear, is crucial to the role of nurses in NICU settings.

Despite conflicting evidence regarding advanced motor behaviour in black African infants, very few comparative studies have been published. Reliable developmental norms for local populations are essential for the early identification of developmental disabilities. In this study the sample consisted of 681 black and 741 white infants drawn proportionally from the Child Health Care Clinics in the northern areas of greater Cape Town. Babies were sampled in specified age-intervals between the ages of 16 and 1170 days. Variables studied were sex, birth-ranking, weight-percentile at the time of testing, marital status of the mother, parents' education and occupation, family size and family income. The demographic characteristics of the sample were compared with those of the population as a whole, based upon the 1980 census. The testing instruments were the gross and fine motor-adaptive sections of the Denver Developmental Screening Test, supplemented by another 21 items representing reflex reactions or specific components of movement. These supplementary items were pre-tested for inter- and intra-observer reliability. The percentage of children responding to the different tests at different ages was determined by probit analysis or, where more appropriate, by non-parametric logistic regression. Differences between the black and white South African infants were subjected to further statistical analysis, as was the contribution of the different variables to the attainment age. Comparison of the performance of the South African infants with the Denver norms showed that both black and white babies were in advance of the Denver children on the majority of fine motor items. The black infants were also considerably advanced in gross motor behaviour; the white infants less markedly so. In the very few (3) items in which the Denver children excelled, doubts exist regarding either scoring criteria or cultural suitability. Comparative analysis of the two South African samples identified certain consistent developmental trends. The black infants performed better on basic grasping patterns whereas the white infants were advanced in manipulative skills. The black infants were advanced on gross motor behaviour in the first year but were overtaken by the white group on learned gross motor skills in the second and third year, with the exception of items requiring physical strength. Very little correlation could be shown between motor achievement and socio- economic factors. Differences appear to be largely due to child-handling practices and experiential learning, but ethnic characteristics may well play a role in the advanced early gross motor development of the black infant. Heavier infants also performed better in both groups, indicating nutritional influences. The clinical implications of the findings are discussed and recommendations made for implementation and for further research.