The Effect of Supportive Nursing Interventions on Reducing Stress Levels of Mothers of Infants in the Neonatal Intensive Care Unit: A Randomized Controlled Trial

Abstract

The purpose of this study was to determine the effects of supportive interventions on the stress levels of mothers with infants hospitalized in the Neonatal Intensive Care Unit (NICU). This study was a prospective, pre-and post-test randomized controlled trial. The research was completed with 85 mothers in two groups of 45 subjects and 40 controls selected at random. Data collection used the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), NICU Parent Belief Scale (NICU:PBS), State-Trait Anxiety Inventory (STAI TX-2) and saliva cortisol analysis. There were statistically significant differences in favor of the experiment group for the PSS:NICU images and sounds subscale and PBS total points after supportive interventions (p < .05). Supportive nursing interventions were effective in reducing stress related to the intensive care environment, anxiety levels and saliva cortisol levels and increasing parental belief among mothers.

Keywords

cortisol mother neonatal intensive care neonate stress supportive intervention

Get full access to this article

View all access options for this article.

References

Aagaard

Hall

E. O.

(2008). Mothers’ experiences of having a preterm infant in the neonatal care unit: A meta-synthesis. Journal of Pediatric Nursing, 23(3), e26–e36.

Abdeyazdan

Shahkolahi

Mehrabi

Hajiheidari

(2014). A family support intervention to reduce stress among parents of preterm infants in neonatal intensive care unit. Iranian Journal of Nursing and Midwifery Research, 19(4), 349–353.

Abuidhail

Al-Motlaq

Mrayan

Salameh

(2017). The lived experience of Jordanian parents in a neonatal intensive care unit: A phenomenological study. Journal of Nursing Research, 25(2), 156–162. https://doi.org/10.1097/jnr.0000000000000134

Akşit

Cimete

(2001). Çocuğun Yoğun Bakım Ünitesine Kabulünde Annelere Uygulanan Hemşirelik Bakımının Ebeveynlerin Anksiyete Düzeyine Etkisi. C.Ü.Hemşirelik Yüksekokulu Dergisi, 5(2), 25–36.

Alkozei

McMahon

Lahav

(2014). Stress levels and depressive symptoms in NICU mothers in the early postpartum period. The Journal of Maternal-Fetal & Neonatal Medicine, 27(17), 1738–1743. https://doi.org/10.3109/14767058.2014.942626

Al Maghaireh

D. F.

Abdullah

K. L.

Chong

M. C.

Chua

Y. P.

Al Kawafha

M. M

. (2017). Stress, anxiety, depression and sleep disturbance among Jordanian mothers and fathers of infants admitted to neonatal intensive care unit: A preliminary study. Journal of Pediatric Nursing, 36, 132–140. https://doi.org/10.1016/j.pedn.2017.06.007

Avery

B. G.

Fletcher

M. A.

MacDonald

M. G.

(2005). Neonatology: Pathophysiology & management of the Newborn (5th ed., pp. 649–698). Lippincott Williams & Wilkins.

Bornstein

M. H.

Cote

L. R.

Haynes

O. M.

Hahn

C. S.

Park

(2010). Parenting knowledge: Experiential and sociodemographic factors in European American mothers of young children. Developmental Psychology, 46, 1677–1693. https://doi.org/10.1037/a0020677

Browne

J. V.

(2004). Early relationship environments: Physiology of skin-to-skin contact for parents and their preterm infants. Clinics in Perinatology, 31(2), 287–298, vii.

10.

Busse

Stromgren

Thorngate

Thomas

K. A.

(2013). Parents’ responses to stress in the neonatal intensive care unit. Critical Care Nurse, 33(4), 52–59. https://doi.org/10.4037/ccn2013715

11.

Çalışır

Şeker

Güler

Anaç

Türkmen

(2008). Yenidoğan yoğun bakım ünitesinde bebeği yatan ebeveynlerin gereksinimleri ve kaygı düzeyleri. Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi, 12(1), 31–44.

12.

Carter

J. D.

Mulder

R. T.

Darlow

B. A.

(2007). Parental stress in the NICU: The influence of personality, psychological, pregnancy and family factors. Personality and Mental Health, 1(1), 40–50.

13.

Çekin

Turan

(2018). The stress levels of parents of premature infants and related factors in Nenoatal Intensive Care Units. The Turkish Journal of Pediatrics, 60, 117–125. https://doi.org/10.24953/turkjped.2018.02.001

14.

Chertok

I. R.

McCrone

Parker

Leslie

(2014). Review of interventions to reduce stress among mothers of infants in the NICU. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 14(1), 30–37. https://doi.org/10.1097/ANC.0000000000000044

15.

Chourasia

Surianarayanan

Adhisivam

Vishnu Bhat

(2013). NICU admissions and maternal stress levels. Indian Journal of Pediatrics, 80(5), 380–384.

16.

Cleveland

L. M.

(2008). Parenting in the neonatal intensive care unit. JOGN Nursing; Journal of Obstetric, Gynecologic, and Neonatal Nursing, 37(6), 666–691.

17.

Cortisol II-Medshop.az. (n.d.) http://medshop.az/content_files/Insert.Cortisol_II.ms_06687733190.V1.tr.pdf

18.

Ergenekon

(2001). Yenidoğan yoğun bakım ünitesi tasarımı. Türkiye Klinikleri, 10, 1–5.

19.

Evans

Whittingham

Boyd

(2012). What helps the mother of a preterm infant become securely attached, responsive and well-adjusted? Infant Behavior and Development, 35(1), 1–11. https://doi.org/10.1016/j.infbeh.2011.10.002

20.

Forcada-Guex

Borghini

Pierrehumbert

Anser-Met

Muller-Nix

(2011). Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship. Early Human Development, 87(1), 21–26. https://doi.org/10.1016/j.earlhumdev.2010.09.006

21.

Fotiou

Vlastarakos

P. V.

Bakoula

Papagaroufalis

Bakoyannis

Darviri

Chrousos

(2016). Parental stress management using relaxation techniques in a neonatal intensive care unit: A randomised controlled trial. Intensive and Critical Care Nursing, 32, 20–28.

22.

Grosik

Snyder

Cleary

G. M.

Breckenridge

D. M.

Tidwell

(2013). Identification of internal and external stressors in parents of newborns in intensive care. The Permanente Journal, 17(3), 36–41. https://doi.org/10.7812/TPP/12-105

23.

Gülçek

(2015). Yenı̇doğan yoğun bakım servı̇sı̇nde bebeğı̇ yatan annelere verı̇len planlı Eğı̇tı̇mı̇n Annelerı̇n anksı̇yete düzeyı̇ne etkı̇sı̇. İnönü Üniversitesi Hemşirelik Anabilim Dalı Halk Sağlığı Hemşireliği Yüksek Lisans Tezi, Malatya.

24.

Hoffenkamp

H. N.

Braeken

Hall

R. A. S.

Tooten

Vingerhoets

A. J. J. M.

van Bakel

H. J. A.

(2015). Parenting in complex conditions: Does preterm birth provide a context for the development of less optimal parental behavior? Journal of Pediatric Psychology, 40(6), 559–571. https://doi.org/10.1093/jpepsy/jsv007

25.

Howe

T. H.

Sheu

C. F.

Wang

T. N.

Hsu

Y. W.

(2014). Parenting stress in families with very low birth weight preterm infants in early infancy. Research in Developmental Disabilities, 35(7), 1748–1756.

26.

Ionio

Colombo

Brazzoduro

Mascheroni

Confalonieri

Castoldi

Lista

(2016). Mothers and fathers in NICU: The impact of preterm birth on parental distress. Europe’s Journal of Psychology, 12(4), 604–621.

27.

Jurczak

Hop

Wieder-Huszla

Stanisławska

Branecka-Woźniak

Grochans

(2015). The level of stress experienced by parents of infants hospitalized in a neonatal intensive care unit. Journal of Public Health, Nursing and Medical Rescue, 1, 32–38.

28.

Kirschbaum

Hellhammer

D. H.

(1994). Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology, 19, 313–333.

29.

Konukbay

Arslan

(2011). Yenidoğan yoğun bakım ünitesinde yatan yenidoğan ailelerinin yaşadıkları güçlüklerin belirlenmesi. Anadolu Hemşirelik Ve Sağlık Bilimleri Dergisi, 14, 16–22.

30.

Korja

Ahlqvist-Björkroth

Savonlahti

Stolt

Haataja

Lapinleimu

Piha

Lehtonen

(2010). Relations between maternal attachment representations and the quality of mother-infant interaction in preterm and full-term infants. Infant Behavior and Development, 33, 330–336. https://doi.org/10.1016/j.infbeh.2010.03.010

31.

Korja

Savonlahti

Haataja

Lapinleimu

Manninen

Piha

Lehtonen

(2009). Attachment representations in mothers of preterm infants. Infant Behavior and Development, 32(3), 305–311.

32.

Leahy-Warren

McCarthy

Corcoran

(2012). First-time mothers: Social support, maternal parental self-efficacy and postnatal depression. Journal of Clinical Nursing, 21, 388–397. https://doi.org/10.1111/j.1365-2702.2011.03701.x

33.

Liu

C. C.

Chen

Y. C.

Yeh

Y. P.

Hsieh

Y. S.

(2012). Effects of maternal confidence and competence on maternal parenting stress in newborn care. Journal of Advanced Nursing, 68, 908–918. https://doi.org/10.1111/j.1365-2648.2011.05796.x

34.

Melnyk

B. M.

Oswalt

K. L.

Sidora-Arcoleo

(2014). Validation and psychometric properties of the neonatal intensive care unit parental beliefs scale. Nursing Research, 63(2), 105–115. https://doi.org/10.1097/NNR.0000000000000023

35.

Miles

M. S.

Burchinal

Holditch-Davis

Brunssen

Wilson

S. M.

(2002). Perceptions of stress, worry, and support in black and white mothers of hospitalized, medically fragile infants. Journal of Pediatric Nursing, 17(2), 82–88.

36.

Miles

M. S.

Funk

S. G.

Carlson

(1993). Parental stressor scale: Neonatal intensive care unit. Nursing Research, 42(3), 148–152.

37.

Musabirema

Brysiewicz

Chipps

(2015). Parents perceptions of stress in a neonatal intensive care unit in Rwanda. Curationis, 38(2), 1499. https://doi.org/10.4102/curationis.v38i2.1499

38.

Nasiri

Akbari

Tagharrobi

Tabatabaee

A. S.

(2018). The effect of progressive muscle relaxation and guided imagery on stress, anxiety, and depression of pregnant women referred to health centers. Journal of Education and Health Promotion, 7, 41. https://doi.org/10.4103/jehp.jehp_158_16

39.

Nasiri

Kordi

Gharavi

Lotfabadi

(2018). Effect of problem solving therapy and relaxation on the severity of postpartum depressive symptoms: A randomized controlled trial. Nursing and Midwifery Studies, 7(1), 6–11.

40.

Öner

Le Compte

(1983). Durumluk-Sürekli kaygı envanteri El Kitabı. Boğaziçi Üniversitesi Yayını.

41.

Özdemir

F. K.

Alemdar

D. K.

(2019). Validity and reliability of the NICU parental beliefs scale for parents in Turkey. Acta Clinica Croatica, 58, 303–310. https://doi.org/10.20471/acc.2019.58.02.14

42.

Özyazıcıoğlu

Güdücü Tüfekci

(2009). Yenidoğan Yoğun Bakım Ünitesinde Bebekleri Bakım Alan Annelerin Kaygı ve Umutsuzluk Düzeylerini Etkileyen Faktörlerin İncelenmesi. Journal of Anatolia Nursing and Health Sciences, 12(4), 66–73.

43.

Palma

I. E.

Von Wussow

K. F.

Morales

B. I.

Cifuentes

R. J.

Ambiado

T. S.

(2017). Stress in parents of hospitalized newborns in a neonatal intensive care unit. Revista Chilena de Pediatria, 88(3), 332–339.

44.

Parker

(2011). Mothers’ experience of receiving counselling/psychotherapy on a neonatal intensive care unit (NICU). Journal of Neonatal Nursing, 17, 182–189.

45.

Ramachandran

Dutta

(2013). Early developmental care interventions of preterm very low birth weight infants. Indian Pediatrics, 50(8), 765–770.

46.

Reck

Noe

Gerstenlauer

Stehle

(2012). Effects of postpartum anxiety disorders and depression on maternal self-confidence. Infant Behavior and Development, 35, 264–272. https://doi.org/10.1016/j.infbeh.2011.12.005

47.

Russell

Sawyer

Rabe

Abbott

Gyte

Duley

Ayers

(2014). Parents’ views on care of their very premature babies in neonatal intensive care units: a qualitative study. BMC Pediatrics, 14(230), 1–10 https://doi.org/10.1186/1471-2431-14-230

48.

Schmidt

K. T.

Sassá

A. H.

Veronez

Higarashi

I. H.

Marcon

S. S.

(2012). The first visit to a child in the neonatal intensive care unit: Parent perception. Escola Anna Nery, 16(1), 73–81. https://doi.org/10.1590/S1414-81452012000100010

49.

Sikorova

Kucova

(2012). The needs of mothers to newborns hospitalised in intensive care units. Biomed, 156(4), 330–336.

50.

Spielberger

C. D.

Gorsuch

R. C.

Luschene

R. E.

(1970). Manual for the state-trait anxiety inventory. Consulting Psychologists Press.

51.

Spinelli

Frigerio

Montali

Fasolo

Spada

M. S.

Mangili

(2016). ‘I still have difficulties feeling like a mother’: The transition to motherhood of preterm infants mothers. Psychology and Health, 31(2), 184–204. https://doi.org/10.1080/08870446.2015.1088015

52.

Trombini

Surcinelli

Piccioni

Alessandroni

Faldella

(2008). Environmental factors associated with stress in mothers of preterm newborns. Acta Paediatrica, 97, 894–898.

53.

Turan

Başbakkal

(2006). Yenidoğan Yoğun Bakım Ünitesi Anne-Baba Stres Ölçeğinin Geçerlilik ve Güvenilirlik Çalışması. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi, 13(2), 32–42.

54.

Turan

Başbakkal

Ozbek

(2008). Effect of nursing interventions on stressors of parents of premature infants in neonatal intensive care unit. Journal of Clinical Nursing, 17(21), 2856–2866.

55.

Türkoğlu

Yalçınöz

B. H.

Küçükoğlu

(2014). Sağlıklı ve Hasta Bebeğe Sahip Annelerin Doğum Sonu Depresyon Düzeylerinin Karşılaştırılması. Cumhuriyet Hemşirelik Dergisi, 3(1), 1–8.

56.

Uludağ

Ünlüoğlu

(2012). Determinants of anxiety among mothers of infants in the Newborn intensive care unit: Role of family physicians on coping with the stressors. Konuralp Tıp Dergisi, 4, 19–26.

57.

Umasankar

Sathiadas

M. G.

(2016). Maternal stress level when a baby is admitted to the neonatal intensive care unit at teaching Hospital Jaffna and the influence of maternal and infant characteristics on this level. Sri Lanka Journal of Child Health, 45(2), 90–94. https://doi.org/10.4038/sljch.v45i2.8003

58.

Yaman

Altay

(2015). Posttraumatic stress and experiences of parents with a newborn in the neonatal intensive care unit. Journal of Reproductive and Infant Psychology, 33(2), 140–152. https://doi.org/10.1080/02646838.2014.990872