PURPOSE:The purpose of this article is to outline a quality-improvement initiative designed to improve screening for post-traumatic stress disorder (PTSD) among parents with preterm infants born less than 30 weeks of gestation into the neonatal ICU (NICU). BACKGROUND:Parents of infants admitted to the NICU face significant trauma, leading to elevated risks of postpartum PTSD. Left undetected, PTSD can results in impaired maternal-infant bonding, parental functioning, and long-term child cognitive and emotional development. Despite available guidelines, routine assessment specifically for PTSD in the NICU environment remains uncommon. DISCUSSION:A screening bundle was initiated consisting of staff education on the use of the City Birth Trauma Scale, planned parent PTSD assessments, and a designated staff nurse champion. Among 16 analyzed responses (13 mothers, 3 significant others), 25% met all diagnostic criteria for high likelihood of PTSD, with 75% of those exhibiting dissociative symptoms. Additionally, negative cognitions/mood (68.8%) and hyperarousal (56.3%) were highly prevalent, and 50% reported significant life impairment. IMPLICATIONS FOR RESEARCH AND PRACTICE:Implementing a screening process is a practical and parent focused method to uncover substantial, previously unrecognized PTSD symptoms among NICU parents. Clinical practice locations have an opportunity to create an inclusive environment for the assessment and discussion of PTSD and the impacts on the family and infant. Future research should explore larger multi-site studies, tracking non-response rates, and evaluating screening at multiple intervals to capture delayed-onset PTSD.
ABSTRACT Purpose: The purpose of this article is to outline a quality-improvement initiative designed to improve screening for post-traumatic stress disorder (PTSD) among parents with preterm infants born less than 30 weeks of gestation into the neonatal ICU (NICU). Background: Parents of infants admitted to the NICU face significant trauma, leading to elevated risks of postpartum PTSD. Left undetected, PTSD can results in impaired maternal-infant bonding, parental functioning, and long-term child cognitive and emotional development. Despite available guidelines, routine assessment specifically for PTSD in the NICU environment remains uncommon. Discussion: A screening bundle was initiated consisting of staff education on the use of the City Birth Trauma Scale, planned parent PTSD assessments, and a designated staff nurse champion. Among 16 analyzed responses (13 mothers, 3 significant others), 25% met all diagnostic criteria for high likelihood of PTSD, with 75% of those exhibiting dissociative symptoms. Additionally, negative cognitions/mood (68.8%) and hyperarousal (56.3%) were highly prevalent, and 50% reported significant life impairment. Implications for Research and Practice: Implementing a screening process is a practical and parent focused method to uncover substantial, previously unrecognized PTSD symptoms among NICU parents. Clinical practice locations have an opportunity to create an inclusive environment for the assessment and discussion of PTSD and the impacts on the family and infant. Future research should explore larger multi-site studies, tracking non-response rates, and evaluating screening at multiple intervals to capture delayed-onset PTSD.
BACKGROUND:Feeding difficulties in preterm infants prolong transitions to full oral feeding and worsen developmental outcomes. OBJECTIVE:This study examined the effects of maternal voice exposure on feeding transition outcomes in this group. METHODS:This quasi-experimental, nonrandomized study enrolled 62 preterm infants (≤34 weeks gestation) in a Taiwanese tertiary neonatal intensive care unit (NICU). The intervention group (n = 31) received 15 minutes recorded maternal voice sessions twice daily for 10 days, standardized for visitation restrictions. The control group (n = 31) received standard care. Primary outcomes were feeding transition duration and oral feeding efficiency (mL/min). Secondary outcomes included feeding intolerance and duration of nasogastric tube, independent oral feeding, and hospital stay. Data were analyzed using chi-square and Mann-Whitney U tests. RESULTS:Exposure to maternal voice recordings shortened the feeding transition period (P < .001), increased oral feeding efficiency (P = .003), reduced feeding intolerance (P = .006), and shortened the duration to independent oral feeding (P < .001). However, no significant differences were observed in nasogastric tube duration, NICU stay, or total hospital days. CONCLUSIONS:Maternal voice exposure improved feeding-related outcomes in preterm infants. IMPLICATIONS FOR PRACTICE:Maternal voice recordings represent a safe, low-cost, nursing-led developmental care intervention that can be integrated into routine NICU feeding care.
ABSTRACT Purpose: To evaluate the effectiveness of a structured, nurse-led early ambulation program on postoperative pain, uterine involution, gastrointestinal recovery, and psychological outcomes among women after cesarean delivery. Methods: A cluster-randomized controlled trial was conducted in a tertiary hospital in India among post-cesarean women assigned to either a structured early ambulation program or routine care by study week (10 clusters, 1:1 ratio). The intervention began 8-10 hours after surgery and continued for 4 days under nurse supervision. Primary outcome was pain intensity; secondary outcomes included uterine involution, constipation, psychological well-being, anxiety, obstetric recovery, and global health, assessed on postoperative days 1 and 4. Results: Sixty women were equally allocated. The intervention group showed greater pain reduction, faster uterine involution, fewer gastrointestinal symptoms, improved psychological well-being, and better perceived global health. Obstetric recovery scores were higher, and early ambulation independently predicted lower pain on day 4. Conclusions: A structured, nurse-delivered early ambulation program initiated within 10 hours post-cesarean reduced pain and promoted early recovery. Implications for Practice and Research: Early ambulation is a feasible, low-cost strategy that can be integrated into routine post-cesarean care. Precis: Early nurse-led ambulation improves physical and psychological recovery after cesarean birth.
ABSTRACT Purpose: The purpose of this review was to explore the primary obstacles to providing comprehensive, family-centered palliative care during the perinatal and neonatal period, using insights from existing literature and clinical practice. Background: Perinatal and neonatal palliative care (PNPC) represents a holistic, interdisciplinary, and family-centered approach aimed at improving the quality of life for newborns diagnosed with life-limiting or life-threatening conditions. Despite its clinical and ethical significance, the provision of such care in low- and middle-income countries, such as Iran, remains substantially underdeveloped and fraught with multifaceted barriers. Methods: In this narrative review, the WHO's House Model was used to systematically examine perinatal and neonatal palliative care challenges and propose viable solutions for analyzing the current landscape in Iran and similar low-resource settings. This model comprises 6 foundational domains: (1) Empowerment of people and communities, (2) Health policy, (3) Research, (4) Use of essential medicines, (5) Education and training, and (6) Provision of palliative care. Discussion: The challenges are multifaceted and include deep-rooted cultural and religious norms, restrictive legal frameworks, and the absence of standardized national guidelines. Furthermore, there is limited access to essential medications, particularly opioids, and shortages in trained human resources. Finally, significant gaps exist in interdisciplinary education and communication skills among healthcare professionals. Implications for Practice: The findings underscore the urgent need to develop culturally and legally informed care frameworks, invest in interdisciplinary capacity-building, expand access to essential medications, palliative care services and enhanced psychosocial and spiritual supports. Addressing these issues may not only improve end-of-life outcomes for neonates but also mitigate parental distress, promote ethical care practices, and enhance the overall responsiveness and equity of the health system.
OBJECTIVES:This study aimed to investigate the current status and factors influencing parents' knowledge, beliefs, and behaviors in coping with infant crying. METHODS:A descriptive cross-sectional study. Convenience sampling was used. Data were collected by the Questionnaire on Infant Parents' Coping with Crying and analyzed using SPSS software version 19.0. Independent sample t-tests, one-way analysis of variance, Pearson correlation, and hierarchical regression analyses were used to identify infant and parental factors influencing parents' coping with infant crying and the knowledge, beliefs, and behavior dimensions. RESULTS:The parents' knowledge, belief, and behavior in coping with infant crying were not high, especially in the belief dimension. Parents' sociodemographic factors (the availability of time for parents to accompany and care for their infant, whether having participated in related training and maternal return to work postpartum), and infants' physical factors (gestational age at birth, birth weight, whether was the first child and the infant's age in the current month) had an impact on parents' knowledge, belief, and behavior of parents' coping to infants' crying. The knowledge dimension is an influencing factor of the belief, observation behavior, and resolving behavior dimensions. CONCLUSIONS:The study points out parents' deficiencies in their beliefs, knowledge, and actions in infant crying coping, which implies the cognitive and behavioral responses of parents to infant crying. The results of this study provide a theoretical basis for improving targeted support for the parents in caregiving.
PURPOSE:To determine the prevalence of postpartum depression and anxiety symptoms in nonbirthing parents, overall and by sex, gender, and sexual orientation. BACKGROUND:The postpartum period is a vulnerable time for parents. Although the focus of most research is on the birthing parent, evidence of postpartum mental health challenges for nonbirthing parents is lacking. METHODS:An online cross-sectional study was conducted with nonbirthing parents from across Canada who had an infant <12 months of age. Recruitment occurred through social media and an online survey company. Parents completed questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder (GAD). Scores >9 and >10 on the EPDS and GAD, respectively, were considered positive for postpartum depression and anxiety symptoms. T-tests were used to determine differences based on sex, gender, and sexual orientation. RESULTS:A total of 133 nonbirthing parents participated (54.9% first-time parents, 90.2% fathers). Overall, 56.4% of nonbirthing parents had postpartum depression, 23.3% had postpartum anxiety, and 21.8% had comorbid postpartum anxiety and depression. There were no differences based on sex or gender; however, sexual minority parents had a significantly higher prevalence of both postpartum depression (73.3%) and anxiety symptoms (46.7%) than heterosexual parents (52.5% and 16.8%), respectively. DISCUSSION:The postpartum mental health of nonbirthing parents is of critical concern with one in two experiencing symptoms of depression and one in 4 experiencing symptoms of anxiety. IMPLICATION FOR PRACTICE AND RESEARCH:More work is needed to better support nonbirthing parents during their first year postpartum.
PURPOSE:The purpose of this review was to explore the primary obstacles to providing comprehensive, family-centered palliative care during the perinatal and neonatal period, using insights from existing literature and clinical practice. BACKGROUND:Perinatal and neonatal palliative care (PNPC) represents a holistic, interdisciplinary, and family-centered approach aimed at improving the quality of life for newborns diagnosed with life-limiting or life-threatening conditions. Despite its clinical and ethical significance, the provision of such care in low- and middle-income countries, such as Iran, remains substantially underdeveloped and fraught with multifaceted barriers. METHODS:In this narrative review, the WHO's House Model was used to systematically examine perinatal and neonatal palliative care challenges and propose viable solutions for analyzing the current landscape in Iran and similar low-resource settings. This model comprises 6 foundational domains: (1) Empowerment of people and communities, (2) Health policy, (3) Research, (4) Use of essential medicines, (5) Education and training, and (6) Provision of palliative care. DISCUSSION:The challenges are multifaceted and include deep-rooted cultural and religious norms, restrictive legal frameworks, and the absence of standardized national guidelines. Furthermore, there is limited access to essential medications, particularly opioids, and shortages in trained human resources. Finally, significant gaps exist in interdisciplinary education and communication skills among healthcare professionals. IMPLICATIONS FOR PRACTICE:The findings underscore the urgent need to develop culturally and legally informed care frameworks, invest in interdisciplinary capacity-building, expand access to essential medications, palliative care services and enhanced psychosocial and spiritual supports. Addressing these issues may not only improve end-of-life outcomes for neonates but also mitigate parental distress, promote ethical care practices, and enhance the overall responsiveness and equity of the health system.
PURPOSE:To evaluate the effect of postpartum mothers' health literacy levels on their knowledge and attitudes toward newborn screening. METHODS:This descriptive, cross-sectional, correlational study was conducted in the postpartum ward of a university hospital in Ankara, Türkiye. The sample consisted of 160 postpartum mothers. Data were collected using a parent identification form, a health literacy scale, and a researcher-developed scale assessing maternal knowledge and attitudes toward newborn screening. Spearman correlation analysis, regression analysis, and path analysis were used to evaluate relationships among variables. RESULTS:Mothers' health literacy levels were at a moderate-to-high level (94.55 ± 13.4), while their knowledge and attitudes toward newborn screening were at a moderate level (37.23 ± 3.7). Maternal health literacy had a significant effect on overall knowledge and attitudes regarding newborn screening (β = 0.17, P = .032). Health literacy demonstrated a stronger effect on attitudes toward newborn screening (β = 0.23, P = .003) and a substantial effect on knowledge level (β = 0.30, P < .001). CONCLUSION:Postpartum mothers' health literacy levels significantly influence their knowledge and attitudes toward newborn screening. Enhancing maternal health literacy may improve awareness, engagement, and the overall effectiveness of newborn screening programs. IMPLICATIONS FOR PRACTICE AND RESEARCH:Given that nurses are a primary source of information for parents, strengthening nurse-led education and counseling is essential. Ongoing training should support nurses' communication and educational competencies. Future multicenter studies with larger samples are needed to examine the long-term effects of health literacy-focused educational interventions on newborn screening outcomes.
Background: Implementing family-centered care (FCC) presents challenges to parental-healthcare provider partnership and collaboration in newborn care in neonatal intensive care units (NICUs). Aims: To explore NICU nurses' perceptions of FCC (respect, collaboration, and support) during the COVID-19 pandemic and to compare these between nurses working in secondary and tertiary/higher care settings. Methods: A multicenter, cross-sectional exploratory online survey design study was conducted to identify Thai NICU nurses' perceptions. The online survey of the Perceptions of Family-Centered Care-Staff (PFCC-S) was distributed via a Web page and professional networks between July and September 2022. Results: Of the 187 survey respondents, most NICU nurses worked in the NICU for less than 16 years and were employed in tertiary care/higher care settings in southern Thailand. There was a significant difference in perceptions of support subscale between NICU nurses in secondary (mean: 3.32, SD +/- 0.53) and tertiary/higher care settings (mean: 3.17, SD +/- 0.46) (P < .05). Conclusion: Despite the challenges of the visitation restriction of COVID-19 in Thailand, nurses' perceptions of the value of FCC were maintained. Relevance to Clinical Practice: Further research is recommended to investigate how FCC can be implemented where there is a lack of material and infrastructure resources and staff shortage.
