Many parents experience high levels of stress after the birth of a premature infant admitted to a neonatal intensive care unit (NICU) given the often fragile status of their infant and the numerous medical interventions necessary to stabilize the infant. Previous research has found that parents of very preterm (VPT; <32 weeks‟ gestation) infants often experience high levels of stress, particularly in relation to feelings of having lost their parental role. Of particular concern are findings which suggest that such symptoms may last beyond the immediate hospitalization period to have an adverse effect on the parental ability to provide quality infant care-giving at home. However, little is known about the paternal NICU stress response, the role of stressors external to the NICU environment and the perceptions of NICU staff. Against this background, aims of this thesis were: 1) to describe and compare sources of NICU stress for mothers and fathers of VPT infants, 2) to identify key predictors of parental NICU stress, 3) to describe staff perceptions of parental NICU stress, and 4) to identify parental stressors external to the NICU. Two cohorts of parents of VPT infants were studied: 11 mothers and 10 fathers of VPT infants (<32 weeks' gestation) admitted to a level III NICU, Christchurch Women's Hospital; and 68 mothers and 68 fathers of VPT infants (<30 weeks' gestation) who participated in the Victorian Infant Brain Studies, admitted to the Royal Women‟s Hospital NICU, Melbourne. Twenty-three NICU nurses from Christchurch Women‟s Hospital, level III NICU were also interviewed. The Parental Stressors Scale: NICU (PSS: NICU) determined sources of stress among parents. NICU nurses completed an adapted version of the PSS: NICU that measured nursing staffs‟ perceptions of parental NICU stress. Parents also completed the Life Events Scale on upsetting life events from the previous 12 months. An external stressors scale which measured stress relating to finances, transport and childcare was developed and completed by parents and staff. Familial demographic and infant clinical information was collected from birth records and hospital databases. Results showed across both cohorts studied that mothers reported significantly higher levels of NICU stress than fathers on the “sights and sounds”, “infant appearance”, and “loss of parental role” subscales on the PSS: NICU (p < .05). The number of upsetting life events (B = .33, p = .01)) and paternal level of NICU stress predicted maternal NICU stress (B = .23, p = .03). Maternal NICU stress also predicted paternal NICU stress (B = .37, p = .01). Staff consistently overestimated parental stress levels (p < .05). The most stressful item on the external stressors scale reported by parents and staff was “fitting in everything else I have to do”. Findings emphasize the need for increased awareness of NICU-specific and NICU-external factors contributing to parental stress. Research into the extent to which staff perceptions of parent experiences may affect the quality of staff-parent relations in the NICU is also warranted. These findings contribute to our understanding of the parental experience of having a preterm infant in the NICU and implications for practice and future research are discussed.

L’objectif de cette étude est d’appréhender le vécu psychoaffectif des pères de bébés prématurés (Lindberg & al., 2008), leurs relations avec le bébé (Morisod-Harari & al., 2013 ; Ibanez & al., 2006), leur conjointe (Frascarolo, 2001) et les professionnels (Tombeur & al., 2007; Fegran & Helseth, 2009) selon l’approche écosystémique (Bronfenbrenner, 2005). Plus spécifiquement, le modèle opérationnel Processus-Personne-Contexte-Temps (Bronfenbrenner, 1996) sur lequel nous prenons appui, a permis, de manière originale, de procéder à l’analyse de la contribution de facteurs d’ordre individuel, familial et contextuel au vécu psychoaffectif de ces pères. Au plan méthodologique, 48 pères ont participé à notre étude au moyen d’un entretien semi-directif basé sur l’Entretien Clinique pour les parents à risque (CLIP) (Meyer, Zeanah, Boukydis & Lester, 1993) et d’une série de questionnaires. Nous avons utilisé des tests standardisés et des questionnaires adaptés à notre problématique : l’Inventaire de l’Alliance Parentale (Abidin & Brunner, 1995), le Parent Medical Interview Satisfaction Scale (P-MISS) (Lewis, Scott, Pantell & Wolf, 1986), le Parenting Sense of Competence Scale (PSOC), (Johnston & Mash, 1989), l’Echelle de Stress Parental : Unité de Néonatologie (Miles, Funk & Carlson, 1993), le Questionnaire Périnatal du Stress Post-traumatique (Quinnell & Hynan, 1999), le Coping Health Inventory for Parents, CHIP (McCubbin, McCubbin, Patterson, Cauble, Wilson & Warwick, 1983) et l’échelle du soutien familial et social, FSS (Dunst, Jenkins & Trivette, 1984). Nos principaux résultats indiquent que les pères construisent un premier lien avec leur bébé mais témoignent également d’un vécu traumatique lié à la prématurité. Les pères présentent une alliance coparentale coopérative et une satisfaction élevée vis-à-vis du personnel soignant. Par ailleurs, les résultats révèlent que le sentiment de compétence paternelle est moins élevé chez les pères de notre échantillon comparé à celui de la population générale. Ils mettent aussi en évidence que le stress paternel est élevé et qu’il va induire un état de stress post-traumatique dès leur séjour dans le service. Pour autant, la majorité des pères adopte des stratégies de coping, telles que le maintien de la cohésion familiale et la communication avec le personnel soignant et les autres parents dans le service. Enfin, nous avons mis en évidence l’influence des caractéristiques du contexte, à savoir le soutien familial et le soutien extrafamilial fourni par l’équipe soignante et les autres parents dans le service, sur l’ensemble de nos variables. L’ensemble des résultats obtenus permet de proposer des perspectives de recherche et des pistes d’intervention auprès des pères de bébés prématurés au sein des services concernés. / The aim of this study is to analyse the life experiences of fathers of prematurely-born infants (Lindberg & al., 2008), their relationship with the baby (Morisod-Harari & al., 2013; Ibanez & al., 2006), their partner (Frascarolo, 2001) and the medical staff (Tombeur & al., 2007; Fegran & Helseth, 2009) based on the theoretical eco-systemic approach (Bronfenbrenner, 2005). Specifically the operational model « Process-Person-Context-Time » (Bronfenbrenner, 1996), on which we are building, in an original manner, to analyse the contribution of personal, contextual and family-related factors on the fathers’ life experiences. As per our methodology, 48 fathers of prematurely-born infants participated in our study through a semi-structured interview, based on the Clinical Interview for parents of high risk infants (Meyer, Zeanah, Boukydis & Lester, 1993), as well as a series of questionnaires. We used standardised tests as well as questionnaires adapted to our study purposes: the Parenting Alliance Inventory (PAI)(Abidin & Brunner, 1995) and the Parent Medical Interview Satisfaction Scale (P-MISS) (Lewis, Scott, Pantell & Wolf, 1986) in order to analyze the proximal processes. Fathers were asked to evaluate their life experiences by completing the Parenting Sense of Competence Scale (PSOC), (Johnston & Mash, 1989), the Parent Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) (Miles & Davis, 1993), the Perinatal Post-traumatic Questionnaire (PPQ) (Quinnell & Hynan, 1999) and the Coping Health Inventory for Parents (CHIP) (McCubbin, McCubbin, Patterson, Cauble, Wilson & Warwick, 1983). The family and extra family support were measured by the Family Support Scale (FSS) (Dunst, Jenkins & Trivette, 1984). Our principal results indicate that fathers construct an early bond with the infant but also admit to being traumatised by the premature birth. The fathers also exhibit a cooperative parenting alliance with and a high level of satisfaction towards the medical staff. However, the results reveal an inferior sense of paternal competence by the fathers within our sample compared to the general population. The results also show that paternal stress is high and will induce post-traumatic stress symptoms during the hospitalisation of the infant. Though, most fathers adopt a coping strategy, such as maintaining family cohesion and communication with the medical staff and other fathers in the unit. Finally, the impact of the context’s characteristics on all our variables is highlighted, namely family support and extra-family support provided by the medical staff and other parents in the neonatal unit. The results obtained allow us to suggest research themes as well as intervention schemes within the relevant services, towards the fathers of prematurely-born infants.