Parent-infant closeness after preterm birth and depressive symptoms: A longitudinal study.

Background: Preterm birth increases the risk for postpartum depression in both mothers and fathers, calling for strategies to alleviate and prevent depressive symptoms in parents of preterm infants. The aim of this study was to assess the association between early parent-infant closeness and later depressive symptoms among parents of preterm infants. We hypothesized that longer duration of closeness associate with fewer depressive symptoms in both parents. Methods: This prospective cohort study included 23 neonatal intensive care units (NICUs) from 15 countries in 2018 to 2020. Each unit recruited families with preterm infants aiming to 30 families. The total duration of parents' presence in the NICU, and separately parent-infant skin-to-skin contact and holding, were measured using a Closeness Diary up to 14  days. The Edinburgh Postnatal Depression Scale (EPDS) was used at discharge and at 4  months corrected age of the infant. Results: The study included 684 mothers and 574 fathers. The median presence was 469  min (Q1 258 and Q3 1,087) per 24   h for the mothers and 259   min (Q1 100 and Q3 540) for the fathers; mean EPDS scores were 9.2 (SD 5.0) and 6.3 (SD 4.4) at discharge and 6.6 (4.7) and 4.3 (4.2) at 4  months, respectively. Parents' presence and depressive symptoms varied greatly between the units. Parents' presence as the total measure, or skin-to-skin contact and holding separately, did not associate with depressive symptoms in either mothers or fathers at either time point (adjusted). Conclusion: No association was found between the duration of parent-infant closeness in the neonatal unit and parents' depressive symptoms. The beneficial effects of family-centered care on parents' depression seem to be mediated by other elements than parent-infant physical closeness. More research is needed to identify the critical elements which are needed to alleviate parents' depression after NICU stay.

Developing family-centred care in a neonatal intensive care unit: An action research study.

AIM: To develop, implement and evaluate family-centred interventions to promote parental involvement in caregiving in a Neonatal Intensive Care Unit. METHODOLOGY: A participatory action research approach was used to implement two changes in practice a) improved skin-to-skin contact b) unlimited parental presence at the cot-side. The changes were underpinned by a family-centred philosophy of care and education. Data were collected from staff using a questionnaire, focus groups and interviews, and from parents using focus groups and interviews. Qualitative data were analysed using Framework and quantitative data analysed using descriptive and t-test statistics. SETTING: A Neonatal Intensive Care Unit in England. FINDINGS: Changes in practice were successfully implemented. Nurses reported positively on improvements in Family Centred Care; most notably information-sharing with parents, providing family support, enabling parental participation in care and improved competence supporting parents in care-giving. These changes were reflected in parental feedback. CONCLUSION: Understanding the context of the neonatal unit can support cultural change when change is actively facilitated and owned by the staff concerned. Acknowledging parents as the main caregiver can be challenging for nurses and they require support and education to enable them to manage the changes necessary to provide Family-Centred Care.

Developing family-centred care in a neonatal intensive care unit: an action research study protocol.

AIM: The aim of this study was to develop, implement and evaluate evidence-based family-centred interventions and to promote parental involvement in the care of infants in neonatal intensive care. BACKGROUND: Parental involvement in the care of their infants in Neonatal Intensive Care Units leads to improved neonatal outcomes. Although research identifies the benefits of individual interventions to promote family-centred care, little is known about how they might be implemented in everyday practice. DESIGN: Participatory action research. METHODS: Funding commenced in January 2015. The study comprises three phases: (i) Exploration: Baseline measures of staff and parental satisfaction with care and parental stress will be obtained using validated survey instruments. Baseline infant data includes breast feeding and skin-to-skin contact. Staff focus groups and interviews will provide insight into the context of parental involvement and perceived barriers to change. Parent focus groups and diaries will provide insight into factors influencing parental involvement in care. The data will inform the development of the evidence-based intervention; (ii) INTERVENTION: Three action research cycles and ongoing data collection from parents and staff will inform the further development of the intervention and change process; (iii) EVALUATION: Baseline measures will be repeated to identify changes. Focus groups and interviews with staff and parents will provide insight into their perceptions of the success of the initiative in promoting family-centred care. DISCUSSION: This study will contribute new knowledge about approaches to actively involve parents in the care of their infant on neonatal intensive care units. Greater understanding of the impact of family-centre care on staff and parents will be gained with the potential to inform future policy and practice.

Parental involvement in neonatal pain management: reflecting on the researcher-practitioner role.

AIM: The objective of this paper is to identify and explore some of the ethical and professional issues facing the clinical researcher-practitioner and to discuss how these were addressed in one particular study. BACKGROUND: The author's experience of undertaking ethnographic research in the organisation in which she works as a nurse consultant highlighted a number of ethical and professional dilemmas. This paper discusses how some of these issues, particularly relating to informed consent, confidentiality, practice concerns and exploitation were addressed. DATA SOURCES: Doctoral research (DMedSCi) with Sheffield University. DISCUSSION: This paper discusses the ethical and professional dilemmas and some of the advantages associated with the researcher-practitioner role. CONCLUSION: This paper identifies and discusses the need to: Remember who the research is about and whom it should benefit. Include a wide research team. Acknowledge the researcher's responsibility towards the participants. Identify and act on problems as they arise. IMPLICATION FOR RESEARCH/PRACTICE: The need to keep the participant as the focus of the research, to involve a wide research team and to reflect constantly on the process.

Parental involvement in neonatal comfort care.

OBJECTIVE: To explore how parents interact with their infants and with nurses regarding the provision of comfort care in a Neonatal Intensive Care Unit (NICU). DESIGN: Focused ethnography. SETTING: A regional NICU in the United Kingdom. PARTICIPANTS: Eleven families (10 mothers, 8 fathers) with infants residing in the NICU participated in the study. METHODS: Parents were observed during a caregiving interaction with their infants and then interviewed on up to four occasions. Twenty-five periods of observation and 24 semistructured interviews were conducted between January and November 2008. RESULTS: Five stages of learning to parent in the NICU were identified. Although the length and duration of each stage differed for individual parents, movement along the learning trajectory was facilitated when parents were involved in comforting their infants. Transfer of responsibility from nurse to parents for specific aspects of care was also aided by parental involvement in pain care. Nurses' encouragement of parental involvement in comfort care facilitated parental proximity, parent/infant reciprocity, and parental sense of responsibility. CONCLUSION: Findings suggest that parental involvement in comfort care can aid the process of learning to parent, which is difficult in the NICU. Parental involvement in infant comfort care may also facilitate the transfer of responsibility from nurse to parent and may facilitate antecedents to parent/infant attachment.

Interviewing women: using reflection to improve practice.

Caryl Skene uses a model of reflection to revisit her experience as a novice researcher In doing so, she highlights the skills required to undertake qualitative research and suggests that nursing experience alone does not equip a researcher with those skills. A significant part of her reflection concentrates on the relationship between the researcher and the research, and the impact it may have on the research process and on those involved in it.