Parents of preterm-born children; sources of stress and worry and experiences with an early intervention programme – a qualitative study

BMC Nursing

Tonje Gundersen⁶  Anne Mari Torgersen¹  Nina Aarhus Smeby³  Rolf Lindemann²  Ingrid Helen Ravn⁴  Nina M Kynø⁵ 

[1] Faculty of Social Science, Department of Psychology, University of Oslo, Oslo, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Nursing and Health Science, Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Neonatal Intensive Care, Women and Childrens´ Division, Oslo University Hospital, Oslo, Norway;Lovisenberg Diaconal University College, Faculty of Post-graduate Nursing Education, Oslo, Norway;Norwegian Social Research (NOVA), Oslo, Norway

关键词: Thematic analyses;    Public health nurses;    Preterm infant;    Parental stress;    NICU;    Neonatal intensive care unit;    Focus group interviews;    Early intervention;   

Others  :  1091473
DOI  :  10.1186/1472-6955-12-28

 received in 2013-06-27, accepted in 2013-12-04,  发布年份 2013

【 摘 要 】

Background

Preterm-born children are at increased risk of adverse developmental outcomes, and their parents may experience increased stress levels. The Mother–Infant Transaction Program (MITP) is an early intervention that aims to enhance the parent–infant relationship and child development. The present study investigated differences in parents’ experience of stress and concerns about caring for their preterm-born child according to whether they participated in the programme. Parental satisfaction with the intervention was also explored.

Methods

As part of a follow-up study at 36 months, a randomized controlled trial of the MITP—14 parents of 11 children from the intervention group, and 17 parents of 14 children from the control group were interviewed by the use of semi-structured focus group interviews. The interviews were analysed thematically.

Results

The intervention parents reported that the knowledge, advice, guidance and emotional support given during the intervention made them feel less stressed and more confident, competent and secure caring for their preterm born child than they would otherwise have been. The control parents described feeling less involved and emotionally supported, and seemed more anxious about their child’s development than the intervention parents. All parents were vigilant and alert to their child’s needs and monitored developmental milestones carefully.

Conclusion

This qualitative exploration of the influences of the MITP revealed a positive impact of the intervention and seems to be an important educational and supportive initiative. Thus, reducing parental stress and enhancing confidence in the parental role.

【 授权许可】

   
2013 Kynø et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Miles MS, Holditch-Davis D: Parenting the prematurely born child: pathways of influence. Semin Perinatol 1997, 21:254-266.
• [2]Ravn IH, Lindemann R, Smeby NA, Bunch EH, Sandvik L, Smith L: Stress in fathers of moderately and late preterm infants: a randomised controlled trial. Early Child Development and Care 2012, 182:537-552.
• [3]Lau R, Morse CA: Stress experiences of parents with premature infants in a special care nursery. Stress and Health 2003, 19:69-78.
• [4]Indredavik MS, Vik T, Heyerdahl S, Romundstad P, Brubakk AM: Low-birthweight adolescents: quality of life and parent–child relations. Acta Paediatr 2005, 94:1295-1302.
• [5]Zwicker JG, Harris SR: Quality of life of formerly preterm and very low birth weight infants from preschool age to adulthood: a systematic review. Pediatrics 2008, 121:e366-e376.
• [6]Kerstjens JM, de Winter AF, Bocca-Tjeertes IF, ten Vergert EM, Reijneveld SA, Bos AF: Developmental delay in moderately preterm-born children at school entry. J Pediatr 2011, 159:92-98.
• [7]Boyle EM, Poulsen G, Field DJ, Kurinczuk JJ, Wolke D, Alfirevic Z, et al.: Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ 2012, 344:896. Ref Type: Online Source
• [8]Quigley MA, Poulsen G, Boyle E, Wolke D, Field D, Alfirevic Z, et al.: Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study. Archives of Disease in Childhood, Fetal Neonatal Edition 2012, 97:167-173.
• [9]Kinney HC: The near-term (late preterm) human brain and risk for periventricular leukomalacia: a review. Semin Perinatol 2006, 30:81-88.
• [10]Chaudhari S: Neonatal intensive care practices harmful to the developing brain. Indian Pediatr 2011, 48:437-440.
• [11]Brown G: NICU noise and the preterm infant. Neonatal Netw 2009, 28:165-173.
• [12]Rauh VA, Nurcombe B, Achenbach T, Howell C: The mother-infant transaction program. The content and implications of an intervention for the mothers of low-birthweight infants. Clin Perinatol 1990, 17:31-45.
• [13]Ravn IH, Smith L, Lindemann R, Smeby NA, Kyno NM, Bunch EH, et al.: Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial. Infant Behavior and Development 2011, 34:215-225.
• [14]Kyno NM, Ravn IH, Lindemann R, Fagerland MW, Smeby NA, Torgersen AM: Effect of an early intervention programme on development of moderate and late preterm infants at 36 months: a randomized controlled study. Infant Behav Dev 2012, 35:916-926.
• [15]Symington A, Pinelli J: Developmental care for promoting development and preventing morbidity in preterm infants. Cochrane Database Syst Rev 2006, 2:CD001814.
• [16]Spittle A, Orton J, Anderson P, Boyd R, Doyle LW: Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev 2012, 12:CD005495.
• [17]Als H: Developmental care in the newborn intensive care unit. Curr Opin Pediatr 1998, 10:138-142.
• [18]Feldman R, Eidelman AI, Sirota L, Weller A: Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics 2002, 110:16-26.
• [19]Nyqvist KH, Anderson GC, Bergman N, Cattaneo A, Charpak N, Davanzo R, et al.: State of the art and recommendations. Kangaroo mother care: application in a high-tech environment. Breastfeed Rev 2010, 18:21-28.
• [20]Koldewijn K, Van WA, Wolf MJ, Meijssen D, Houtzager B, Beelen A, et al.: A neurobehavioral intervention and assessment program in very low birth weight infants: outcome at 24 months. J Pediatr 2010, 156:359-365.
• [21]Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al.: Reducing premature infants' length of stay and improving parents' mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics 2006, 118:e1414-e1427.
• [22]Rauh VA, Achenbach TM, Nurcombe B, Howell CT, Teti DM: Minimizing adverse effects of low birthweight: four-year results of an early intervention program. Child Dev 1988, 59:544-553.
• [23]Achenbach TM, Howell CT, Aoki MF, Rauh VA: Nine-year outcome of the vermont intervention program for low birth weight infants. Pediatrics 1993, 91:45-55.
• [24]Sameroff AJ, Fiese BH: Transactional regulation: the developmental ecology of early intervention. In Handbook of Early Childhood Intervention. 2nd edition. Edited by Shonkoff JS, Meisels SJ. Cambridge: Cambridge University Press; 2000:135-159.
• [25]Olafsen KS, Kaaresen PI, Handegard BH, Ulvund SE, Dahl LB, Ronning JA: Maternal ratings of infant regulatory competence from 6 to 12 months: influence of perceived stress, birth-weight, and intervention: a randomized controlled trial. Infant Behavior and Development 2008, 31:408-421.
• [26]Newnham CA, Milgrom J, Skouteris H: Effectiveness of a modified mother-infant transaction program on outcomes for preterm infants from 3 to 24 months of age. Infant Behavior and Development 2009, 32:17-26.
• [27]Ravn IH, Smith L, Smeby NA, Kynoe NM, Sandvik L, Bunch EH, et al.: Effects of early mother-infant intervention on outcomes in mothers and moderately and late preterm infants at age 1 year: a randomized controlled trial. Infant Behavior and Development 2012, 35:36-47.
• [28]Kaaresen PI, Ronning JA, Ulvund SE, Dahl LB: A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics 2006, 118:9-19.
• [29]Kaaresen PI, Ronning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB: A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. Early Hum Dev 2008, 84:201-209.
• [30]Kitzinger J: Qualitative research, Introducing focus groups. BMJ 1995, 311:299-302.
• [31]Braun V, Clarke V: Using thematic analysis in psychology. [References]. Qualitative Research in Psychology 2006, 3:77-101.
• [32]Krueger RA: Analyzing & Reporting Focus Group Results; Focus Group Kit 6. Thousand Oaks, Calif: Sage; 1998.
• [33]Tessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz-Palaez JG, et al.: Kangaroo mother care and the bonding hypothesis. Pediatrics 1998, 102:e17.
• [34]Erlandsson K, Fagerberg I: Mothers' lived experiences of co-care and part-care after birth, and their strong desire to be close to their baby. Midwifery 2005, 21:131-138.
• [35]Warren PL: First-time mothers: social support and confidence in infant care. J Adv Nurs 2005, 50:479-488.
• [36]Jotzo M, Poets CF: Helping parents cope with the trauma of premature birth: an evaluation of a trauma-preventive psychological intervention. Pediatrics 2005, 115:915-919.
• [37]Affonso DD, Hurst I, Mayberry LJ, Haller L, Yost K, Lynch ME: Stressors reported by mothers of hospitalized premature infants. Neonatal Netw 1992, 11:63-70.
• [38]Stevens DC, Helseth CC, Khan MA, Munson DP, Reid EJ: A comparison of parent satisfaction in an open-bay and single-family room neonatal intensive care unit. HERD 2011, 4:110-123.
• [39]Brett J, Staniszewska S, Newburn M, Jones N, Taylor L: A systematic mapping review of effective interventions for communicating with, supporting and providing information to parents of preterm infants. BMJ Open 2011, 1:e000023.
• [40]Abidin RR: Parenting Stress Index: Professional Manual. 3rd edition. Odessa, FL: Psychological Assessment Resources, Inc.; 1995.