Parental Stress Following the Birth of a Very Preterm Infant Admitted to a Neonatal Intensive Care Unit: Maternal, Paternal and Staff Perceptions of Stress
Degree GrantorUniversity of Canterbury
Degree NameMaster of Science
Many parents experience high levels of stress after the birth of a premature infant admitted to a neonatal intensive care unit (NICU) given the often fragile status of their infant and the numerous medical interventions necessary to stabilize the infant. Previous research has found that parents of very preterm (VPT; <32 weeks‟ gestation) infants often experience high levels of stress, particularly in relation to feelings of having lost their parental role. Of particular concern are findings which suggest that such symptoms may last beyond the immediate hospitalization period to have an adverse effect on the parental ability to provide quality infant care-giving at home. However, little is known about the paternal NICU stress response, the role of stressors external to the NICU environment and the perceptions of NICU staff. Against this background, aims of this thesis were: 1) to describe and compare sources of NICU stress for mothers and fathers of VPT infants, 2) to identify key predictors of parental NICU stress, 3) to describe staff perceptions of parental NICU stress, and 4) to identify parental stressors external to the NICU.
Two cohorts of parents of VPT infants were studied: 11 mothers and 10 fathers of VPT infants (<32 weeks' gestation) admitted to a level III NICU, Christchurch Women's Hospital; and 68 mothers and 68 fathers of VPT infants (<30 weeks' gestation) who participated in the Victorian Infant Brain Studies, admitted to the Royal Women‟s Hospital NICU, Melbourne. Twenty-three NICU nurses from Christchurch Women‟s Hospital, level III NICU were also interviewed. The Parental Stressors Scale: NICU (PSS: NICU) determined sources of stress among parents. NICU nurses completed an adapted version of the PSS: NICU that measured nursing staffs‟ perceptions of parental NICU stress. Parents also completed the Life Events Scale on upsetting life events from the previous 12 months. An external stressors scale which measured stress relating to finances, transport and childcare was developed and completed by parents and staff. Familial demographic and infant clinical information was collected from birth records and hospital databases.
Results showed across both cohorts studied that mothers reported significantly higher levels of NICU stress than fathers on the “sights and sounds”, “infant appearance”, and “loss of parental role” subscales on the PSS: NICU (p < .05). The number of upsetting life events (B = .33, p = .01)) and paternal level of NICU stress predicted maternal NICU stress (B = .23, p = .03). Maternal NICU stress also predicted paternal NICU stress (B = .37, p = .01). Staff consistently overestimated parental stress levels (p < .05). The most stressful item on the external stressors scale reported by parents and staff was “fitting in everything else I have to do”.
Findings emphasize the need for increased awareness of NICU-specific and NICU-external factors contributing to parental stress. Research into the extent to which staff perceptions of parent experiences may affect the quality of staff-parent relations in the NICU is also warranted. These findings contribute to our understanding of the parental experience of having a preterm infant in the NICU and implications for practice and future research are discussed.
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