References:
Premise: Father involvement enhances cognitive development in African-American, low-birth-weight preterm infants.
Research Question: Does father involvement have an independent effect on the intellectual and behavioral outcomes of low-birth-weight preterm infants?
Background: Fathers play an important, direct role in the development of full-term infants.
Subjects: The study included 985 low-birth-weight preterm infants.
Study Design: Mothers and infants entered this eight-site trial while still in the hospital. The information was also obtained from the mother at pediatric follow-ups at 40 weeks postconceptional age and 4, 8, 12, 18, 24, 30, and 36 months of age. A randomly assigned intervention group received an educational curriculum, family support, and pediatric follow-up. The other group received only pediatric follow-up and referral to community services. Data were collected on a) demographic and perinatal characteristics of fathers and the families, b) the father's presence in the home, c) paternal involvement in play and care giving, d) maternal satisfaction with paternal involvement, and e) child cognitive and behavioral outcomes. The information was obtained through maternal interviews.
Findings:Approximately 75% of the fathers played with their baby every day. In 41.4% of the families, the father was always present in the home. Race, income, and age were related to the level of father involvement. IQ and behavioral problems were unrelated to family income, Neonatal Health Index, father's age, treatment group status, and the level of father involvement. A higher level of father involvement was associated with higher IQ in the African-American population of this study. Behavior problems at these ages were not shown to be related to father involvement.
Research reviewed by Rita Cooper, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 2:
Premise: The simultaneous perspectives of care among parents and nurses in regard to NICU infants with chronic illness are important.
Research Question: What is the relationship between mothers and nurses during chronically ill neonates’ stay in the hospital, and how does that relationship influence mothers’ parenting of infants in the hospital?
Background: A relationship involves two persons, each contributing from their own unique backgrounds, values, cultures, and experiences. Transfer of care consists of the gradual shifting of responsibility. The mother’s task is to prepare to care for her neonate while the infant becomes stable enough for her to assume care. The nurse’s task is to care for the infant, teach the mother the required care, and then relinquish that care. A gradual trend has emerged to have parents provide increasingly familiar aspects of their infant’s care in the NICU. The expectation of complex-care infants being discharged has created opportunities and conflicts for both parents and nurses as roles and values must be evaluated and renegotiated.
Subjects: Ten mothers of chronically ill NICU babies (GA 24-40 weeks) expected to stay in NICU >6 weeks; nine primary nurses. Subjects were from the NICU of an urban children’s hospital and the NICU of a suburban medical center. Mothers and nurses were diverse in age, ethnic background, race, and health status. Two mothers had previous NICU experience. All the mothers delivered earlier than expected.
Study Design: Twenty-two interviews were completed with mothers and nurses. Grounded theory methodology was used to explore the developing relationship between infant’s primary nurse and mother. Two semi-structured interviews were conducted–one for the nurses and one for the parents–in order to examine both perspectives at the same time. Interviews were conducted during the infant’s hospitalization; a second interview obtained if the duration of the hospital stay permitted. Interviews were conducted in private, lasted approximately one hour, and were recorded on audiotape.
Findings: Four stages in the transfer of care were revealed: nurse providing technical and normal care, nurse and mother sharing normal care, nurse and mother sharing normal care and technical care, and the parent providing all care. With encouragement from the nurses, mothers began to share in normal infant care. Nurses used the time with parents to support and teach them, especially technical care that might be needed at infant’s discharge. Factors that may influence transfer of care included the status of the infant, the mother’s physical status, level of support from others, and the nurse’s expectations of the parents. When common goals, respect, and trust were established, issues could be negotiated and the relationship became a true working alliance.
Research reviewed by Anna A. Weston, RNC, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 3:
Premise: With support, separation of the newborn and the mother for a maximum of six days need not significantly affect breastfeeding.
Research Question: To what extent does the separation of mother and baby in the first few days of life act as a barrier to breastfeeding?
Background: Mother and baby separation should be avoided if at all possible; but in the event that separation is inevitable, breastfeeding should not be dismissed.
Variables: Maternal education.
Study Design: Past medical records were reviewed and telephone interviews were conducted with the mothers to determine successful breastfeeding. Successful breastfeeding was defined as partial or exclusive breastfeeding. Partial breastfeeding was not defined.
Subjects: Participants came from a Swedish community where breastfeeding rates are high. The study included 148 mother-baby pairs in a separated group and 3,516 in a comparison group.
Findings: No significant differences existed between groups. More than 70% of the babies in both groups were breastfed exclusively after two months and more than 50% were breastfed exclusively after four months. Separation of up to six days between mother and newborn as a result of a medical condition need not result in unsuccessful initiation of breastfeeding.
Research reviewed by Ruthie Forehand, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 4:
Premise: Skin-to-skin contact on low-birth-weight infants improves their functioning and their likelihood of sustaining breastfeeding.
Research Question: Does skin-to-skin contact benefit low-birth-weigh infants and encourage them to breastfeed longer?
Background: That belief that skin-to-skin contact promotes bonding and further improves the results of breastfeeding in low-birth-weight infants is widely accepted and practiced in many parts of the US.
Subjects: Out of 3,643 infants, 50 weighing less than 1500 g. (with all mothers testing negative for drug screen and serology) were randomly placed into two groups: skin-to-skin (SSC) or standard contact (SC) group.
Study Design: The groups consisted of of 21 mothers with 25 infants in the SSC group and 20 mothers with 25 infants for the SC group. Observations from 176 mother-infant SSC sessions and 137 mother-infant SC sessions were recorded. The unpaired t-test was used to compare base-line characteristics of both groups. Physiological data measured compared with analysis of variance with repeated measures.
Findings: The researchers concluded that low-birth-weight infants benefit from skin-to-skin contact by fewer incidences of a drop in oxygen saturation levels. Mothers are more likely to continue breastfeeding after one month of discharge. This option is also cost-effective and easy to implement.
Research reviewed by Robin Gilman, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 5:
Premise: Fathers are able to start the attachment process to preterm infants once they are allowed to hold their infants, which is often delayed as a result of medical care.
Research Question: Do the many factors involved with intensive medical care in preterm infants affect the father-infant attachment process and alter the father’s feelings and perceptions?
Background: An infant’s development in language, cognition, motor skills, and health is affected by the parent-infant relationship and the parent’s ability to provide an adequate care-giving environment with encouragement and love.
Subjects: Participants included 27 fathers of preterm infants.
Study Design: Two instruments were used. An adapted version of Broussard and Hartner’s Neonatal Perception Inventory (NPI) was used to assess the father’s perception of his own baby in comparison with an average full-term baby. Levy-Shiff and colleagues’ Parental Feelings Questionnaire (PFQ) was translated from Hebrew into English and administered as well. This assessed parents’ feelings and concern for their baby. These instruments were administered at 48 hours after birth, one week, and again at 5 months of age.
Findings: The fathers reported that their feelings of love were related to the time they first held their babies. These feelings of love were not related to their presence at the birth or the relief that the birth was over, according to the fathers’ reports. The NPI revealed a decrease in the father’s view of perceived difficulty, compared to the average baby, between one week of age and one month of age. The father’s view of perceived difficulty increased as compared to the average baby between one month of age and five months of age. The PFQ revealed a decrease in the fathers’ disappointment with the infant from the first week to the fifth month of life.
Research reviewed by Rita Cooper, RN, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.
Abstract 6:
Premise: The concept of attachment has been inadequately defined. Prematurity and separation at birth can affect the attachment process.
Research Question: How does isolation of the infant from the parents affect the attachment process?
Background: Attachment is a complex, multifactorial, individualized process that requires physical contact and early interaction. A loving relationship is necessary to promote emotional wellbeing of the infant and parents. Hospitalization can interrupt this process of attachment.
Subjects: A total of 25 mothers were interviewed before their infants were discharged from the NICU. Some mothers had previous experience with the NICU and some did not. The mothers were of diverse ethnic and cultural backgrounds, 18 years and older, English-speaking, not visibly distressed, and willing to give informed consent for an interview.
Study Design: The study is descriptive and attempts to describe how prematurity and separation at birth can affect the attachment process. Leninger’s ethnonursing research methodology was utilized, incorporating observation of care, participation of care, and reflection. This research method involves four phases of data collection: primary observation and active listening, primary observation with limited participation, primary participation with continued observation, and primary reflection and reconfirmation of findings with informants.
Findings: Immediate attachment was more likely to occur if the mother was able to see the infant directly after birth. Attachment was strengthened when physical contact occurred between mother and infant. Delayed attachment may occur in the NICU environment. Factors that may influence this attachment included the physical appearance of the infant, the premature infant’s disorganized interaction behavior, and the mothers’ coping mechanisms to prevent grief. Other factors may include the mother’s poor maternal health at the time of and after delivery, lack of social support, presence of other dependent children, drug dependency, financial issues, and breakup of the relationship with her partner. Nurses may facilitate attachment and increase physical and psychological contact by encouraging mothers to stroke the infant.
Research reviewed by Anna A. Weston, RNC, while a student at Virginia Commonwealth University, School of Nursing, in Richmond, VA.