Intensive care IS a stressful environment and this thesis addresses the controversy as to whether tactile stimulation can mitigate the negative influences in ventilated preterms. There is an underlying assumption throughout the thesis that the pre term infant in intensive care experiences and is able to manifest physical and/or psychological pain. Preterms (n=75) were recruited with parental consent against strict entry criteria. A pre-test, post-test time series, counterbalanced design was used to evaluate the impact of an intervention to alleviate pain. The intervention [Touching and Caressing, Tender in Caring (T AC-TIC)] was compared with a control condition (spontaneous activity). Indicators of pain represented in the experiments were immunologic, physiological, and neurobehavioural. Data were analysed using parametric and non-parametric tests. The ontogeny of the secretory Immune system was investigated (n=70) using an enzyme-linked immunosorbant assay for Secretory Immunoglobulin A (SIgA). Ventilated preterms had significantly lower SIgA than infants requiring no mechanical ventilation. Breast milk fed preterms showed increased SIgA compared to other modes of nutrition. TACTIC increased SIgA in a subsample of ventilated preterms (n=35) with no changes following the control condition. Cardiovascular responses remained stable throughout T AC-TIC and spontaneous activity. No changes in gastric pH were observed in a sub-sample of 18 preterms. A neurobehavioural checklist was used to analyse videos for pain and comfort behaviours (n=29). Significantly more comfort behaviours were reported during T AC-TIC. Analysis of behavioural state indicated that more time was spent inactive sleep during than after TAC-TIC. No differences In state occurred between TAC-TIC and control condition. A ventilated subsample (n=25) of the original cohort was subjected to analysis at individual level for determination of congruence between simultaneously measured outcome variables. T AC-TIC produced increases more often in two or three variables. Pilot work has also been conducted addressing further controversies in tactile stimulation. The results are discussed within the theoretical frameworks of Gottlieb's hierarchical systems model, and Adamson-Macedo's Equilibrium model
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:339912 |
| Date | January 1996 |
| Creators | Hayes, Julie Anne |
| Publisher | University of Wolverhampton |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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