Subject(s)
Infant Welfare , Maternal Welfare , Female , Humans , Infant , Infant, Newborn , Intensive Care Units, Neonatal , Mother-Child Relations , Pregnancy , Prenatal CareABSTRACT
PURPOSE: To identify the process by which parents of premature infants seek information, the kinds of information they seek, and the resources they use to meet their educational and support needs. DESIGN/SAMPLE: Descriptive study using 19 parent interviews and 64 questionnaires. MAIN OUTCOME VARIABLE; The process parents use to obtain information and support. RESULTS: Parents of premature infants make a transition from being passive recipients of information to actively seeking it. They spend 10-20 hours a week gathering information during the first month of the baby's hospitalization. They desire more information than is provided, particularly in the areas of infant health, infant care, and coping. Family is the primary source of support prior to birth and after discharge, but during the infant's convalescence, nurses are the main source of support and help for parents in understanding and adapting to their baby. Many parents would use a computer-based resource for information if it were available to them.
Subject(s)
Infant, Premature , Parents/education , Parents/psychology , Patient Acceptance of Health Care/psychology , Patient Education as Topic/methods , Social Support , Adaptation, Psychological , Adult , Communication , Computer-Assisted Instruction , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Intensive Care, Neonatal/methods , Intensive Care, Neonatal/psychology , Internet , Male , Needs Assessment , Neonatal Nursing/methods , Nursing Methodology Research , Surveys and Questionnaires , Time FactorsABSTRACT
The manner in which the contextual dynamics of the neonatal intensive care unit (NICU) culture influence decisions around withholding and withdrawing treatment for very low birth weight infants is examined based on sociological studies of the NICU culture. The influence of these dynamics on nurse and parent participation in treatment decisions is discussed. Steps toward increasing nurses' role in decision making and ability to empower the participation of parents include (a) using an understanding of the dynamics of the individual NICU to establish a collaborative team culture, and (b) demonstrating that data obtained through relationship with the infant make an important and valid contribution to ethical decision making.
Subject(s)
Ethics, Medical , Ethics, Nursing , Intensive Care Units, Neonatal , Neonatal Nursing , Withholding Treatment , Decision Making , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Parents/psychologyABSTRACT
The purpose of this study was to determine whether an individualized approach to handling very low birth weight (VLBW) infants designed to support development would result in less motor disorganization than the task-oriented approach in traditional use. Using a quasi-experimental crossover design, motor responses were investigated in 38 infants (< or = 1700 g, 53% male, 89% white) observed at 28, 32, and 36 weeks post-conceptional age. Subjects served as their own controls. Motor responses were coded from direct observation and videotapes. Results demonstrated that during developmental handling, (1) the overall amount of movement was less, the number of organized movements was greater, and the number of disorganized movements was less than during traditional handling; and (2) the amount of movement increased over time, but in the traditional condition, it peaked at 32 weeks. Results support positive effects of developmental handling and suggest the potential for reducing the prevalence of minor motor impairments in VLBW infants.
Subject(s)
Caregivers , Child Rearing , Motor Skills Disorders/etiology , Motor Skills Disorders/therapy , Age Factors , Cross-Over Studies , Female , Humans , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Male , Video RecordingABSTRACT
Interactive behavior of 30 mothers of infants with mental delay and 30 comparison mothers and infants was examined in relation to child age (first and second year), context (feeding versus teaching), maternal characteristics (family stress, coping resources), and family social system (maternal education). Groups were compared from two perspectives: with infants matched on mental age (9 and 19 months MA), and on chronological age (8 and 18 months CA). Study mothers scored lower than comparison mothers during teaching but not during feeding in year 1 with both MA and CA match, but only with the CA match in year 2. Study infants scored lower than comparison infants in both contexts in year 1, but not in year 2. Groups did not differ on maternal or family measures. In year 1, group status, coping, and maternal education were predictive of mother interaction. In year 2, only maternal education was predictive. Results confirm the importance of type of match, context, and family system variables in understanding effects of child mental delay on maternal interactive behavior.
Subject(s)
Developmental Disabilities , Mother-Child Relations , Adaptation, Psychological , Adult , Age Factors , Educational Status , Feeding Behavior , Female , Humans , Infant , Male , Stress, PsychologicalABSTRACT
The purpose of this study was to determine whether modifying care to reduce stressors in the neonatal intensive care unit and support infant development affected physiological, motor, and behavioral state organization. Twenty-one infants weighing less than 1501 g were studied prior to a nursing staff-training program (control) and 24 infants were studied posttraining (study). Nurses were taught to lower environmental stress, reduce procedural stress, and facilitate motor and sleep-wake organization. Oxygen saturation, motor activity, posture, and sleep-wake states were measured biweekly during routine care. Study infants showed higher oxygen saturation levels, fewer disorganized and jerky movements, more flexor movements, more flexed posture, and more alert-wakefulness than controls. Results suggest that this approach to care may have potential to improve behavioral organization during the preterm period.
Subject(s)
Behavior , Child Development , Infant Care , Infant, Low Birth Weight , Behavior/physiology , Child Development/physiology , Female , Gestational Age , Humans , Infant , Infant Care/methods , Infant, Newborn , Intensive Care Units, Neonatal , Male , Neonatal Nursing/methods , Stress, Physiological/nursing , Stress, Physiological/physiopathology , Stress, Physiological/prevention & controlABSTRACT
Numerous aspects of the intensive care environment are stressful for low birth weight infants and may play a role in adverse developmental and behavioral outcome. The purpose of this study was to determine whether staff education in care protocols designed to make the environment less stressful and thereby support the infant's development would improve short-term outcomes. Twenty-one infants (less than 1,501 gms) were studied during the preeducation period and 24 infants were studied following staff education. The educational program successfully altered nursing care. Experimental infants had more optimal respiratory and feeding status, lower levels of morbidity, shorter hospitalization, and improved behavioral organization.
Subject(s)
Infant, Low Birth Weight , Intensive Care, Neonatal/methods , Nursing Methodology Research , Analysis of Variance , Education, Nursing, Continuing , Female , Humans , Infant, Newborn , MaleABSTRACT
Sleep behavior has been related to both child and environmental factors, but the relative importance of these factors is not yet clear. This study was an examination of the relation of diurnal sleep patterns to perinatal risk, infant temperament, home environment, parenting stress, emotional support, and social class. Twenty-three adolescent and 23 single adult mothers and infants were assessed in the home at 4 and 12 months. Percent sleep during the night was most strongly related to parenting stress and variability of night sleep to emotional support. Emotional support mediated effects of stress at 4 months. Results support the value of clinical assessment of sleep behavior.
Subject(s)
Circadian Rhythm , Mother-Child Relations , Psychology, Child , Single Parent/psychology , Sleep Wake Disorders/psychology , Adaptation, Psychological , Adolescent , Adult , Female , Humans , Infant, Newborn , Maternal Age , Models, Psychological , Nursing Assessment , Sleep Wake Disorders/nursing , Social Support , Stress, Psychological/epidemiology , Stress, Psychological/psychology , TemperamentABSTRACT
Measures of infant attention may be more indicative of cognitive status than scores from standardized developmental tests. The purpose of this study of 56 full-term infants was to determine whether measures of attention taken from the Brazelton Neonatal Behavioral Assessment Scales (NBAS) at 2 days and the Bayley Infant Behavior Record (IBR) at 2 months would be internally consistent and would be related to developmental status at 2 months. Attention measures were internally consistent. The IBR measure was significantly related to 2-month developmental status; the NBAS measure was not. Results support attention as an important focus for nursing assessment of development.
Subject(s)
Attention , Child Development , Cognition , Nursing Assessment/methods , Autonomic Nervous System , Habituation, Psychophysiologic , Humans , Infant, Newborn , Nursing Assessment/standards , Orientation , Psychometrics , ReflexABSTRACT
The relationship of adolescent mothers' knowledge of infant development and perceptions of infant behavior to stress experienced during pregnancy were examined using a comparison group of adults of similar marital status. Relationships with maternal age across groups also were examined. Adolescents underestimated developmental rate and perceived some infant behaviors less optimally, but did not differ in levels of stress. Stress was related to several parenting subscores. Some support for a linear relationship with maternal age was found. Results suggest the need for further research to determine how level of maturity affects translation of knowledge into maternal action.
Subject(s)
Child Behavior , Child Development , Mothers/psychology , Pregnancy in Adolescence , Single Person , Adolescent , Adult , Female , Humans , Infant, Newborn , Male , Maternal Age , Perception , Pregnancy , Psychology, Adolescent , Stress, PsychologicalSubject(s)
Infant, Newborn , Mothers/psychology , Perception , Single Person/psychology , Adolescent , Adult , Child Development , Female , Humans , Pregnancy , Pregnancy in AdolescenceABSTRACT
The sleep and waking states of infants are described from direct behavioral observations made in the home for a 7-hour period on weeks 2, 3, 4, and 5. States were analyzed separately for two contexts: infant alone and infant with the mother. States analyzed included Alert, Waking (Non-Alert) Activity, Fussing or Crying, Drowse or Sleep-Wake Transition, Active Sleep, Quiet Sleep, and Unclassified Sleep. Individual state profiles for each context were obtained for each week. A quantitative measure of profile consistency over weeks was calculated as an index of stability of state organization. Infants showed considerable range in state stability over weeks. State stability when alone was significantly correlated with state stability when with the mother (r = .67), even though there were differences in sleep-wake distributions and in level of stimulation in these contexts. These findings demonstrate within-individual consistency in CNS control of behavioral states, across sleep and wakefulness and throughout the diverse activities of the caretaking environment.
