Nancy Feeley

Nursing Approaches for Working With Family Strengths and Resources

In recent years, there has been an increasing interest in shifting the focus of clinical practice with families from a deficit to a strengths-based perspective. The concept of individual and family strengths is a central concept of the McGill Model of Nursing, yet there has been little description of the construct and how it can be used in practice. Through an examination of the practice of expert nurses and the approaches used in the assessment of families’ strengths and resources, planning and intervention were elucidated. This article describes how clinicians can identify and provide feedback concerning strengths, identify resources, and help families develop and call forth strengths, mobilize and use resources, and regulate the input of these resources.

Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit

This correlational study examined how mothers posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother-infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant.

Fathers’ perceptions of the barriers and facilitators to their involvement with their newborn hospitalised in the neonatal intensive care unit

AIMS AND OBJECTIVESnTo explore what fathers perceive to be facilitators or barriers to their involvement with their infants.nnnBACKGROUNDnFathers make unique and important contributions to the development of their infants. Fathers of infants in the neonatal intensive care unit often feel that they have a limited role to play in their infants care, and surveys suggest that they are not typically involved in infant caregiving. Paradoxically, qualitative studies have found that fathers do want to be involved, and their lack of involvement is an important source of stress.nnnDESIGNnQualitative descriptive.nnnMETHODSnEighteen fathers of infants, in the neonatal intensive care unit for at least one week, were interviewed and asked to describe what they perceived to be the barriers and facilitators to their involvement. Interviews were audio taped and transcribed, and the data was content analysed.nnnRESULTSnThree major categories of barriers/facilitators were identified: (1) infant factors (size and health status, twin birth and infant feedback), (2) interpersonal factors (the rewards of and attitudes and beliefs regarding fatherhood; family management; previous experiences) and (3) neonatal intensive care unit environmental factors (physical and social). These factors could often be a barrier or facilitator to involvement depending on the context.nnnCONCLUSIONSnThis study provides insights into what factors influence involvement, and how nursing staff can support involvement and best meet fathers needs.nnnRELEVANCE TO CLINICAL PRACTICEnNurses should explore the forms of involvement that a father desires, as well as the demands on their time, and determine what might be done to promote involvement. Fathers should be assisted to maximise the time that they do have with the infant. Nurses must provide clear and consistent information about whether and when caregiving is advisable, and they can explain and demonstrate how fathers can care for their infant.

Parents' Coping and Communication following Their Infant'S Death

The purpose of this study was: 1) to examine whether mothers and fathers utilize similar or different coping strategies to deal with the death of their infant, and 2) to explore whether discordant parental coping was associated with communication difficulties. Twenty-seven couples who had experienced a stillbirth, neonatal death, or Sudden Infant Death within the previous six to twenty-seven months were asked to participate. Two constructs were measured: (a) Coping was assessed with the Ways of Coping Checklist and the Coping with the Death of a Child instrument and (b) Communication was measured with the Marital Communication Inventory. Mothers and fathers independently completed these three questionnaires. Mothers and fathers differed in their use of only three of the fourteen coping strategies examined. Thus, mothers and fathers coping strategies, six to twenty-seven months post-loss, were more concordant than discordant. Mothers used seeking social support, escape-avoidance strategies, and preoccupation to a significantly greater extent than did fathers. Important predictors of mothers coping strategies were the infants age and time since the death, while for fathers the important predictors were the infants gender and the family income level. For couples whose coping was discordant, mothers perceived higher levels of conflict in their communication with their spouses as compared to couples whose coping was concordant.

The father at the bedside: patterns of involvement in the NICU.

Fathers involvement is important to child development, yet little is known about how fathers are involved with their newborns in neonatal intensive care. The purpose of this study was to describe patterns of fathers involvement with their infants during hospitalization. Eighteen fathers of infants hospitalized were interviewed and asked to describe how they were involved with their infants. Interview, sociodemographic, and infant medical data were analyzed using cross-case analysis to describe patterns of involvement. Three patterns were identified. Equal to mother fathers perceived their involvement to be the same as the mothers. They were intrinsically motivated, not working, and spent many hours daily with their infants. They engaged in skin-to-skin care and bathed their infants. Mother more important fathers viewed the mothers role as more important. They were working, visited a few hours most days, and perceived their role as supporting the mothers. Reluctant fathers were reticent to become involved, described extrinsic sources of motivation, and were fearful of handling their infants. Not all fathers wish to be involved to the same extent with their infants. Nurses need to assess fathers preferences and facilitate involvement to the extent that they feel comfortable.

The cues and care randomized controlled trial of a neonatal intensive care unit intervention: effects on maternal psychological distress and mother-infant interaction.

Objective: This study tested the efficacy of a brief intervention (Cues program) with mothers of very low birth weight (VLBW <1500 g) infants. The primary hypothesis was that mothers in the Cues program would report lower levels of anxiety compared with mothers in the control group. Secondary hypotheses examined whether Cues mothers would report less stress, depression, and role restriction, and exhibit more sensitive interactive behavior, than control group mothers. Methods: A total of 121 mothers of VLBW infants were randomly assigned to either the experimental (Cues) intervention or an attention control (Care) condition. The Cues program combined training to reduce anxiety and enhance sensitivity. The control group received general information about infant care. Both programs were initiated during the neonatal intensive care unit stay. Maternal anxiety, stress, depression, and demographic variables were evaluated at baseline, prior to randomization. Postintervention outcomes were assessed during a home visit when the infant was ∼6 to 8 weeks of corrected age. Results: Although mothers in the Cues group demonstrated greater knowledge of the content of the experimental intervention than mothers in the Care group, the groups did not differ in levels of anxiety, depression, and symptoms of posttraumatic stress. They were similar in their reports of parental role restrictions and stress related to the infants appearance and behavior. Cues and Care group mothers were equally sensitive in interaction with their infants. Conclusion: Nonspecific attention was as effective as an early skill-based intervention in reducing maternal anxiety and enhancing sensitive behavior in mothers of VLBW infants.

Assessing the feasibility and acceptability of an intervention to reduce anxiety and enhance sensitivity among mothers of very low birth-weight infants.

PURPOSEA pilot study was conducted to assess the feasibility and acceptability of an intervention program for mothers of very low birth-weight infants in the neonatal intensive care unit (NICU). SUBJECTSThirty-three mothers of infants born weighing less than 1500 g. DESIGNA single-group, pretest—posttest design was used. METHODSPreintervention mothers completed self-report questionnaires and their interaction with their infant was observed. Mothers then received the intervention program. Mothers were assessed twice postintervention, first when the infant was 11/2 months old and again at 6 months. At the postintervention assessments, mothers completed the same questionnaires and interaction was observed. MAIN OUTCOME MEASURESMothers completed the State-Trait Anxiety Inventory, the revised Parental Stress Scale: Neonatal Intensive Care Unit, the NICU Parental Beliefs Scale, and the Perinatal PTSD Questionnaire. Interactions between mothers and infants were rated by trained research staff using the Index of Parental Behaviour in the NICU. Postintervention mothers also responded to a questionnaire that assessed their perceptions of the intervention program. RESULTSIt was feasible to enroll mothers because 62% of eligible mothers agreed to participate. However, 39% of mothers who enrolled withdrew. Most of the mothers who withdrew did so before even beginning the intervention, and many of these women were mothers of multiples. It was also feasible to provide the intervention because more than 80% of mothers who began the intervention received all 6 teaching sessions. Mothers found both the content and the format of the program to be acceptable. There were nonetheless several challenges in conducting an intervention study with mothers early in the NICU hospitalization. CONCLUSIONSThe results of this pilot study are encouraging. It was found to be both feasible and acceptable to provide the intervention program to mothers during the NICU hospitalization. The effectiveness of this program needs to be assessed in a randomized controlled trial.

Women’s experience of an emergency caesarean birth

AIMSnTo explore womens experience of an emergency caesarean birth to gain a better understanding of their thoughts, and feelings throughout the birth process.nnnBACKGROUNDnWomen who experience an emergency caesarean birth have an increased risk of psychological distress, however, little is known about the nature of this experience from their perspective. Given the sudden and unexpected nature of this type of birth and the increased risk of psychological distress for these women, it is important for nurses to understand the experience of women who have had an emergency caesarean birth.nnnDESIGNnA qualitative descriptive study was conducted.nnnMETHODnNine Canadian women who had healthy infants were interviewed a few days after having an emergency caesarean birth. Thematic analysis of interview data was conducted concurrent with the data collection.nnnRESULTSnSeven themes were identified describing the womens experience: (1) It was for the best, (2) I did not have control, (3) Everything was going to be okay, (4) I was so disappointed, (5) I was so scared, (6) I could not believe it and (7) I was excited.nnnCONCLUSIONnA key finding was that women felt out of control during this event and used reassuring thoughts to minimise their distress.nnnRELEVANCE TO CLINICAL PRACTICEnNurses should aim to enhance womens perception of control during the emergency caesarean birth, encourage open expression of their thoughts and feelings about the birth experience, and support the use of positive reframing to cope with this event.

The evidence base for the cues program for mothers of very low birth weight infants: an innovative approach to reduce anxiety and support sensitive interaction.

Very low birth weight (VLBW) infants, born weighing less than 1,500 g, are at risk for several developmental problems. Consequently, there has been interest in developing intervention programs to prevent such problems. This article describes the empirical evidence that guided the development of an innovative, multicomponent intervention program for mothers of VLBW infants, as well as the program content and features. Based on the evidence, the program was designed to include six sessions and commence shortly after birth to reduce maternal psychological distress during the infant’s hospitalization in the neonatal intensive care unit and to promote sensitive mother–infant interaction. The program incorporates various learning activities, including written materials, observational exercises, discussion, and video feedback.

The experience of mothers whose very low-birth-weight infant requires the delivery of supplemental oxygen in the neonatal intensive care unit.

Purpose: This study examines the experience of mothers whose very low-birth-weight infants require the delivery of supplemental oxygen during their hospitalization in the neonatal intensive care unit (NICU). Subjects: Eleven mothers of very low-birth-weight infants who have received various supplemental oxygen delivery methods in the NICU for a minimum of 7 days were selected for interview. Design: Qualitative descriptive. Methods: One semistructured interview exploring mothers experiences surrounding oxygen delivery methods was conducted. Qualitative content analysis was undertaken to describe mothers experience. Principle Results: Four themes emerged related to the oxygen therapy and the various methods of delivery: Oxygen therapy is a positive, worries about the adverse effects for my baby now and in the future, a learning experience, and the delivery of supplemental oxygen is a barrier to mothering. Conclusion: Mothers balanced the positive aspects of oxygen therapy with their fears of the negative consequences. They were able to adapt to the equipment and trajectory of having their infant on supplemental oxygen delivery methods. Mothers were particularly distressed by the physical barriers created by oxygen delivery methods (ie, unable to hold, hear, or see their baby). Nurses in the NICU should support mothers positive reframing as a way of coping, provide education about the consequences of this therapy, encourage mothers to touch and hold their infants, and provide opportunities for them to see their infants faces.