Maureen R. Keefe

Reducing parenting stress in families with irritable infants.

Background: Caring for an infant with unexplained, persistent crying is one of the most stressful events for new parents. Infant irritability, also referred to as infantile colic, occurs in 10-25% of all infants and is the most common parental concern reported in the first year of life. Objective: The aim of this study was to evaluate the effectiveness of a home-based nursing intervention in reducing parenting stress in three groups of families with irritable infants, using data from a larger evaluation study. Methods: A two-site, randomized clinical trial was conducted with 121 infants and their parents. Infants were randomized to a treatment or a control group. A third group of infants (n = 43) was added as a posttest-only comparison. The level of parenting stress was measured by the Parenting Stress Index (PSI) at baseline, after the 4-week intervention, and at the 8-week follow-up visit. Results: A repeated measures analysis of variance (ANOVA) was used to compare the two groups across the three time points (baseline, immediately after the 4-week intervention, and at the 8-week follow-up visit). The results revealed a reduction in total parenting stress over time for both the treatment and control groups. Mothers in the treatment group reported reduced parenting stress on the parent-child dysfunctional interaction subscale (p = .04). Total parenting stress scores were found to be significantly higher for mothers in the posttest-only group (p = .009). Conclusion: Initial parenting stress levels were high in all participants. Parent feedback at the exit interview indicated that the nurse visits for data collection were also viewed as helpful in reducing the stress level associated with parenting these irritable infants. This home-based program was perceived as helpful in improving the interactions between parents and their irritable infants.

A longitudinal comparison of irritable and nonirritable infants.

Infantile colic is characterized by persistent crying, diminished soothability, and excessive activity or restlessness. The purpose of this study was to explore the processes underlying the persistent, recurrent irritability by investigating behavioral and interactional differences in irritable and nonirritable infants. In this two-group longitudinal study, 40 infants and their mothers were followed over the first 4 months of life. Statistically significant differences between the two groups were found, with the irritable infants demonstrating an increase in the amount and intensity of crying, more disruption in sleep-wake states, and less synchrony in mother-infant interaction.

Effectiveness of an Intervention for Colic

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.

Comparison of neonatal nighttime sleep-wake patterns in nursery versus rooming-in environments.

A two-group design was used to compare the state behavior of newborns who roomed-in with their mothers at night with those who were cared for by the traditional nursery-at-night method. Twenty-one full-term, low-risk newborns comprised the study sample. Data were collected using a sleep monitor bassinet for two consecutive nights after delivery. Comparison of the nursery environment with the mothers postpartum room at night revealed greater light and sound levels in the nursery setting. Regarding caregiving practices, rooming-in infants received more contact with the caregiver and care that was more often related to their state behavior. Infants in the mothers room had significantly, p < .001, more quiet sleep (33% vs. 25.4%), less indeterminate (4.8% vs. 11.2%), and less crying (0.6% vs. 7.5%) states than infants who remained in the nursery.

Nurse residency program implementation: the Utah experience.

Recently, nurse residency programs have been shown to improve satisfaction and enhance the retention of new graduate nurses, offering one solution for hospital executives, administrators, and managers searching for innovative ways to address nursing staff shortages. This article identifies crucial lessons that will assist leaders in designing and implementing a nurse residency program in their own institutions. The lessons are drawn from the experience of the successful University of Utah program. Four important practical components of such programs are described: an adaptive curriculum, promotion of autonomy, mentoring, and meeting the needs of participants with associate degrees. Although the lessons are based on the perspective of one nurse residency program, they hold import for the design of nurse residency programs in diverse settings.

Comparison of two measures of parent-child interaction.

BackgroundThe numerous parent-child interaction measures available include few that are appropriate to brief clinical encounters or to research settings where time, cost, space, and subject burden are critical factors. ObjectivesThis study compares the newer Mother-Infant Communication Screening (MICS) with the established Nursing Child Assessment Satellite Training (NCAST) Teaching Scale (NCAT). MethodsTheoretical foundations, development, administration, support, and published psychometrics for the two scales are contrasted. Videotapes of 171 caregiver-child interactions in an urban, Hispanic, high-risk sample (children aged 5 months to 36 months) were scored by two trained coders who had established inter-rater reliabilities of .90 (NCAT) and .85 (MICS). ResultsValidity correlation coefficients were r = .504, p < .001 for total scores and r = .492, p < .001 for the two most comparable subscales. Distress was defined more narrowly by the MICS. Internal consistencies were .89 to .94 (MICS total scores) (depending on choice of subscales used) and .79 (NCAT). ConclusionsThe NCAT has established strengths for use in clinical practice and research and provides dyadic and separate mother and child scores. The MICS is more feasible for brief clinical screening and performed in this study with promising correlate validity and internal consistency across ages (infancy through 3 years). Interpretation would be strengthened if more clinical studies verifying scores with risk categories were performed and if normative data were established.

An intervention program for families with irritable infants.

Purpose:To describe and evaluate a home-based nursing intervention program, the REST routine, which incorporates the use of infant behavior assessment, pattern recognition, individualized infant schedules, specific management strategies, and parent education and support. Study Design and Method:A two-site clinical trial was conducted on 164 healthy full-term infants with excessive unexplained irritability or colic. Infants between the ages of 2 to 6 weeks were randomized to routine care or a home-based intervention program (n = 121). A third group (n = 43) of infants too old at entry for randomization (mean age = 10.4 weeks) were entered into a posttest-only group. Results:Infants in the REST routine treatment group cried 1.3 hours per day on average following the intervention program as compared to the control group crying 3 hours per day (p = .02). Infant irritability was resolved (<1 hour) in 62% of the treatment group while only in 29% of the control group at the time of the 8-week follow-up visit (p = .04). Clinical Implications:Families in both the treatment and control groups reported benefiting from a nurse visiting in their home to inquire about their infant and their well-being. Options for individualizing the program for those most in need of intensive home visiting and other delivery modes for the intervention are areas for further investigation

Informing the design of hemodynamic monitoring displays

In the ICU, an extensive array of variables from the hemodynamic monitoring display is routinely analyzed. However, the development of new display technologies is proceeding without adequate study of the monitoring tasks and behaviors of a primary user group—critical-care nurses. Semistructured interviews focusing on the cognitive aspects of the hemodynamic monitoring task were conducted with 14 critical-care nurses. A systematic content analysis of qualitative data identified cognitive tasks that had applicability to the design of monitoring displays. The cognitive tasks of hemodynamic monitoring were (1) selective data acquisition, (2) applying meaning to the variables and understanding relationships between parameters, (3) controlling hemodynamics by titrating medications and intravenous fluids, and (4) monitoring complex trends of multiple interacting variables and patient response to interventions. Recommendations include designing the monitoring display to match the mental constructs and cognitive tasks of the user by applying conceptual meaning to the variables, highlighting relationships between variables, and presenting a “big picture” view of the patient’s condition. Monitoring displays must also present integrated trends that illustrate the dynamic relationship between interventions and patient response.

Development of a system for monitoring infant state behavior.

The concept of infant state refers to patterns of behavior that comprise the sleep-wake cycle. The infants ability to organize state behavior rhythmically is indicative of central nervous system maturation and predictive of later development. This article describes the development of a noninvasive, computerized infant monitoring system that can be used to categorize the infants sleep-wake behavior into states. Development of the system occurred in two phases: In the first phase of the study, reliability and validity of the infant monitoring system for recording continuous behavioral and physiological data were assessed. These results were then used in the second phase to develop a rule-based computer program to interpret the signal data stored on a micro-diskette and to characterize the infants state throughout the period of monitoring. The capability of computerized data collection and analysis of infant state behavior has expanded the application of this infant monitoring system. Its use as an investigative tool in clinical research is discussed.

Adaptation of a cardiac monitor for collection of infant sleep data and development of a computer program to categorize infant sleep state.

This article describes the adaptation of a cardiac Holter monitor to more conveniently collect and store infant sleep data. The cardiac monitor was first adapted to connect to a sleep mattress, then refined until readable infant sleep signal data were produced. System data were compared to data collected by a live observer of infant sleep (κ = 0.84). The IRB-approved testing used newborn infants, conducted with parental consent. Development of a rule-based computer program was designed to categorize the physiologic data into infant sleep wake states. The cardiac monitor was found to be lightweight, portable, battery powered, nonintrusive, and safe for collecting infant sleep data. Preliminary assessment of the validity of the program in scoring infant sleep was compared to hand scored data (κ = 0.76). Refinement of the system and software program is ongoing and expected to greatly facilitate the study of infant state behavior.