Parental Response to the Birth and Hospitalization of a High Risk Infant

High Risk Infant and Parental Response to the Birth

 

High Risk Infant and Hospitalization,Hospitalization as a Stressors,Parents Role in Seriously Ill Preterm Baby,Factors Affecting Parental Distress,Parental Stress in NICU,Future View and Neonatal Care,Neonatal Hospitalization and Nursing Role.

High Risk Infant and Hospitalization

    Recognizing that parents play an important role in the lives of their infants, nurses have long been concerned about the needs of parents of high-risk infants, that is, preterm and term infants with serious health problems who are hospitalized in neonatal intensive care units ( NICUs). 

    The recent thrust on family centered care in the NICU is a direct result of these concerns about parental needs. Thus, a major focus of research in maternal-child nursing has been on parents of preterm infants hospitalized in a NICU, with a few. studies also focusing on parents of term infants with serious health problems. 

    Over the past 2 decades, much of nursing research in this area has focused on two broad areas: 

(a) describing the sources of stress experienced by parents and identifying factors related to this stress.

(b) examining the emotional responses of parents. Research in this area reflects the works of nurses across the world.

Hospitalization as a Stressors

    Identification of the stressors experienced by parents related to the hospitalization of their infant in an NICU was greatly facilitated by the development of the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) (Miles, Funk, & Carlson, 1993). Worldwide research has been conducted using this scale. 

    In general, the findings indicate that aspects of the parental role, such as not being able to protect the baby, feeling helpless, separation, and the appearance and behavior of the sick infant.

    Such as seeing the child experiencing pain or apnea, seeing needles and tubes put into the child, and watching the respirator breath for the child, cause the most distress (Miles, Funk, & Kasper, 1992; Miles & Holditch-Davis, 1997; Shields- Poe &Pinelli , 1997). 

    Limited focus has been placed on parents' perception of their relationship with nursing and medical staff, particularly related to life and death decisions, and to the interplay between the nurses and parents as they each assume responsibility for the sick infant. 

    The emotional distress of parents that results from having a sick infant hospitalized in a NICU has been another direction of research. Studies have focused primarily on depression, anxiety, and general psychological adjustment (Doering, Moser, &Dracup , 2000; Meyer et al., 1995; Miles et al., 1992; Miles, Holditch - Davis, Burchinal , & Nelson, 1999; Shields-Poe &Pinelli , 1997). 

    It has been hypothesized that mothers' responses are similar to those reported for posttraumatic stress ( Holditch -Davis, Bartlett, Blick man, & Miles, 2003). While most of this research has focused on negative outcomes, there is a beginning focus on positive outcomes and growth (Miles et al., 1999).

Parents Role in Seriously Ill Preterm Baby

    In general, this research suggested that parents of preterm and seriously ill infants experience stress during hospitalization and have intense emotional responses, particularly anxiety and depressive symptoms. Several studies have reported that mothers reported more stress than fathers (Doering et al., 1999; Meyer et al., 1995; Miles et al., 1992; Shields-Poe & Pinelli, 1997 ) . 

    However, most of these studies use small convenience samples of mostly Caucasian, married fathers. More research is needed regarding the experience and needs of single and married fathers and fathers from diverse ethnic backgrounds. Also important is understanding the father's contribution to maternal mental health and parenting and to infant outcomes.

Factors Affecting Parental Distress

    Most of the studies have used quantitative descriptive studies with limited use of conceptual frameworks to explore factors related to parental distress (Miles &Holditch -Davis, 1997). 

    A handful of studies have found that parent and family characteristics and characteristics of the infant's illness are related to stress and emotional distress (Doering et al., 2000; Miles et al., 1999; Shields-Poc & Pinelli , 1997 ) . Few longitudinal studies have been conducted, leaving the findings inconclusive regarding the long-term implications of this distress (Miles &Holditch -Davis). 

    As preterm infants often experience long hospitalizations and the assumption and attainment of the parental role with newborn infants is known to be a process that occur saver time, it is essential that we study parental responses over time to really understand the process and outcomes of this experience. 

    Similarly, we need to link parents and the infants conceptually or methodologically in the design of these studies in order to under- stand how parental emotional distress and other responses influence parenting behaviors in the critical care period and parenting and the parent child relationship during childhood . 

    While there is another body of literature related to parent-infant interaction within the NICU, this research is rarely linked to parental emotional responses ( Holditch -Davis & Miles, 1997). There are only a limited number of studies using methods of qualitative design that could add more depth to our understanding of parental experiences.

Parental Stress in NICU 

    Given the amount of descriptive research on parental stress in the NICU, few researchers have developed and tested interventions aimed at reducing the distress of parents and enhancing their parental role with their infant. 

    Melnyk and colleagues (Melnyk, BM, et al., 2001) tested a parent empowerment intervention and reported positive outcomes for low birthweight infants and their mothers, who reported less stress related to the NICU environment and a better understanding of their preterm infants' behavior .

Future View and Neonatal Care 

    Future research should be more firmly grounded in developmentally sensitive ecological conceptual models that explore personal and illness related factors that affect parental responses and link parental responses to parenting and child outcomes. 

    Methods of qualitative and quantitative research should be used and even combined to gain a fuller picture of parental experiences. Longitudinal and repeated measures designs are essential. Research on emotional distress and mental health of parents should include both problematic responses and growth outcomes. 

    Of utmost importance is the need to examine how parents from different ethnic groups respond to birth and hospitalization of a high-risk infant.

Neonatal Hospitalization and Nursing Role 

    In conclusion, nurse researchers internationally have made important contributions to the study of parental responses to birth and hospitalization of a preterm or seriously ill infant. 

    This research has undoubtedly influenced nursing interventions with parents. NICUS generally have open visiting hours, recognize the important role of parents, and work hard to facilitate the development of the parental role even while the infant is critically ill.