Subject(s)
Education, Veterinary , Veterinary Medicine , Animals , Health Promotion , Humans , Schools, Veterinary , UniversitiesABSTRACT
AIMS: This pilot study explored how maternal stress experienced in the neonatal intensive care unit (NICU) is affected by the individual nursing structure and the network that provides care to extremely preterm infants. BACKGROUND: Mothers experience high stress when their extremely preterm infants are hospitalized in the NICU. This often translates into maladaptive parenting behaviours that negatively affect the long-term cognitive, social, and emotional development of the infant. Efforts to identify modifiable sources of maternal stress in the NICU could lead to improvement in maternal engagement and, ultimately, long-term neurodevelopmental outcomes. METHOD: Time- and date-stamped nursing shift data were extracted from the medical record and transformed into five structural nursing metrics with resultant nurse data networks. These were then analysed for associations with maternal stress outcomes on the Parental Stressor Scale (PSS: NICU). RESULTS: Infants experienced highly variable nursing care and networks of nurses throughout their hospitalization. This variability is associated with the PSS: NICU (a) Sights and Sounds and (b) Altered Parental Role subscales. CONCLUSION: Nursing structure and the resultant caregiving network have an impact on maternal stress. IMPLICATIONS FOR NURSING MANAGEMENT: Changing the pattern of nurse staffing may be a modifiable intervention target for reducing maternal stress in the NICU.
Subject(s)
Mothers/psychology , Social Networking , Stress, Psychological/complications , Adult , Electronic Health Records/statistics & numerical data , Female , Humans , Infant , Infant, Extremely Premature/psychology , Infant, Newborn , Intensive Care Units, Neonatal/organization & administration , Male , Pilot Projects , Prospective Studies , Quality of Health Care/standards , Shift Work Schedule/adverse effects , Shift Work Schedule/psychology , Stress, Psychological/psychology , Surveys and QuestionnairesABSTRACT
OBJECTIVES: The primary objective of the study was to investigate how patterns of skin-to-skin care might impact infant early cognitive and communication performance. DESIGN: This was a retrospective cohort study. SETTING: This study took place in a level-IV all-referral neonatal intensive care unit in the Midwest USA specialising in the care of extremely preterm infants. PARTICIPANTS: Data were collected from the electronic medical records of all extremely preterm infants (gestational age <27â weeks) admitted to the unit during 2010-2011 and who completed 6-month and 12-month developmental assessments in the follow-up clinic (n=97). OUTCOME MEASURES: Outcome measures included the cognitive and communication subscales of the Bayley Scales of Infant Development, Third Edition (Bayley-III); and skin-to-skin patterns including: total hours of maternal and paternal participation throughout hospitalisation, total duration in weeks and frequency (hours per week). ANALYSIS: Extracted data were analysed through a multistep process of logistic regressions, t-tests, χ2 tests and Fisher's exact tests followed with exploratory network analysis using novel visual analytic software. RESULTS: Infants who received above the sample median in total hours, weekly frequency and total hours from mothers and fathers of skin-to-skin care were more likely to score ≥80 on the cognitive and communication scales of the Bayley-III. However, the results were not statistically significant (p>0.05). Mothers provided the majority of skin-to-skin care with a sharp decline at 30â weeks corrected age, regardless of when extremely preterm infants were admitted. Additional exploratory network analysis suggests that medical and skin-to-skin factors play a parallel, non-synergistic role in contributing to early cognitive and communication performance as assessed through the Bayley-III. CONCLUSIONS: This study suggests an association between early and frequent skin-to-skin care with extremely preterm infants and early cognitive and communication performance.
Subject(s)
Cognition/physiology , Communication , Critical Care/methods , Infant Care/methods , Infant, Extremely Premature/physiology , Touch Perception/physiology , Child Development/physiology , Cohort Studies , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Male , Retrospective Studies , Touch/physiologyABSTRACT
AIM: To identify variables associated with maternal visitation and participation in skin-to-skin care (SSC) with their extremely premature (<27 weeks) neonate. METHODS: In an all referral level IIIc, 32 extremely premature neonates and their mothers were studied. Standardized instruments were the Parental Stressor Scale: NICU and the Parent-Staff Communication Rating Scale. Unstandardized Tools included a self-report demographics sheet and a self-report parent SSC log. RESULTS: Using regression analysis, two factors were identified that were significantly associated with the amount of time that mothers visit and participate in SSC: the amount and type of stress that mothers experience and their perceived level of communication with medical staff. CONCLUSION: Future interventions for increasing SSC should involve education about the NICU environment and neonatal behaviour along with methods for enhancing communication between mothers and healthcare providers.
