Volume 32, Issue 121 (December 2019)                   IJN 2019, 32(121): 94-106 | Back to browse issues page


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Moradi H, Borimnejad L, Seyed Fatemi N, Haghani H, Moradi M. The Effect of the Empowerment Program on the Chronic Sorrow of the Parents of Premature Newborn in Neonatal Intensive Care Units. IJN 2019; 32 (121) :94-106
URL: http://ijn.iums.ac.ir/article-1-3127-en.html
1- . MS in Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: 88201978 Email: borimnejad.l@iums.ac.ir
3- . Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
4- Instructor, Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
5- MS in Medical-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Abstract:   (4138 Views)
Background & Aims: Sorrow is a natural response to adverse events such as loss and birth of premature or abnormal neonates, which increases the risk of chronic physical diseases, substance abuse, and suicide if prolonged. In addition, sorrow decreases the quality of life of individuals, causing variable degrees of disability in individual and social functions. The components of chronic sorrow in the parents of premature neonates include premature birth, developmental disabilities, Down syndrome, neural tube defects (e.g., meningococcus), and chronic diseases (e.g., cancer). The parents of these neonates experience variable degrees of chronic sorrow, which in turn makes it difficult to care for and interact with the newborn. The birth of a premature neonate is the main challenge in postpartum care. In general, approximately 13 million births lead to premature birth each year. Iran has one of the highest prevalence rates of premature birth across the world, where 5,000 neonates are born daily, 12% of whom are underweight and 10-15% are born premature before 37 weeks of gestation. The birth of a newborn that needs special care causes psychologically special and shocking conditions for the parents, preventing the fulfillment of their true role as a parent. Sorrow occurs when parents find out that their newborn is 'incomplete'. Sorrow encompasses both internal phenomena (e.g., thoughts and feelings) and external phenomena in the form of behaviors related to sorrow (e.g., sadness and crying). One of the main nursing interventions in this regard involves diminishing the problems of the parents whose newborn is hospitalized in the intensive care unit through their empowerment by providing the required knowledge for the better care of admitted premature neonates, which has been highlighted within the context of family-oriented care to increase the quality of life of the neonate and families. In general, the implementation of proper nursing interventions could lead to positive outcomes for parents, reducing issues such as grief, stress, changed parental roles as a major nursing measure for diminishing the problems of the parents whose neonates are admitted to the neonatal intensive care unit. The empowerment of parents occurs by providing the necessary conditions for the interaction and participation of parents in the care of premature neonates. The creating opportunities for parent empowerment (COPE) was designed by Melnyk et al. in 2001 for the parents of premature infants. COPE is a four-stage educational-behavioral intervention based on the self-regulatory and control theories. In addition to the mental support of parents, this program provides the necessary information regarding the complexion and behaviors of premature infants, parental roles, conditions of the intensive care unit, and proper care of the neonates. The present study aimed to assess the effects of the COPE on the chronic sorrow of the parents of the premature neonates admitted to the neonatal intensive care unit (NICU).
Materials & Methods: This non-randomized clinical trial was conducted with a control group after the approval of the research plan and obtaining the required permit from the Ethics Committee and an introduction letter from Iran University of Medical Sciences at NICUs of Rasoul Akram and Ali Asghar hospitals in Tehran, Iran. Based on the inclusion criteria, 68 parents with premature infants admitted to the NICU were selected via convenience sampling. The stratification of the subjects to two groups was based on a time framework. Initially, the control group was samples, followed by the sampling of the intervention group. Data were collected using a demographic questionnaire and Kendall chronic sorrow instrument with 18 items scored based on a Likert scale, which were collected by the subjects in both groups. In the intervention group, the COPE program (four-stage educational-behavioral intervention) was carried out, and the control group received the routine care of the ward. The trainings and meetings with the parents were performed in groups of 2-4, including the mother and father, in the conference room of the ward with the permission of the head nurse by the researcher and the co-researcher. One month after the launching of the study, the questionnaires were completed again by the subjects via WhatsApp social network. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution tables and numerical indices), followed by inferential statistics using Chi-square, Fisher's exact test, independent t-test, and paired t-test for the comparison of the study groups.
Results: No significant differences were observed between the intervention and control groups in terms of age, education level, place of residence, length of the neonate's admission, gender of the neonates, and mode of delivery between the intervention and control groups, and the groups were homogenous in this regard at the significance level of 0.05. In addition, the results of independent t-test showed no significant difference between the intervention and control groups in terms of the score of chronic sorrow (P>0.05). After the intervention, the mean score of chronic sorrow in the control and intervention groups was 43.11±8.38 and 32.85±5.45, respectively, which indicated a significant difference in this regard (P<0.001). This finding indicated the effectiveness of the COPE program in decreasing the chronic sorrow of the parents of the premature infants admitted to the NICU.
Conclusion: According to the results, the symptoms of sorrow appeared in the parents in the intervention and control groups upon the admission of the premature neonates to the NICU. Therefore, the parents whose premature infants are admitted to the NICU require proper examination and treatment for the symptoms of sorrow. Our findings confirmed the effectiveness of the COPE program in the alleviation of the sorrow of the parents whose premature neonates were admitted to the NICU. Therefore, it is recommended that this program be implemented as an effective and cost-efficient strategy in NICUs. Furthermore, the use of audio-visual training programs along with routine treatments could positively influence the care of premature infants and reduce the psychological effects on care on the parents. Owing to technological advancement, the easy application of such educational programs could maintain the independence of families and increase the knowledge interaction of parents in the care of the newborn, while decreasing their stress and sorrow.
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Type of Study: Research | Subject: nursing
Received: 2019/09/23 | Accepted: 2019/12/23 | Published: 2019/12/23

References
1. Vitale SA, Falco C. Children born prematurely: risk of parental chronic sorrow. J Pediat Nurs. 2014;29(3):248-51. [DOI:10.1016/j.pedn.2013.10.012] [PMID]
2. Nematipour z, Golzari mahmoud, Baqeri fariborz. evaluating the effectiveness of collective patience training on reduction of depression and stress symptoms of bereaved mother. Journal of Clinical Psychology Studies. 2012;2(7):31-59.
3. Hobdell E. Chronic sorrow and depression in parents of children with neural tube defects. J Neurosci Nurs. 2004;36(2):82. [DOI:10.1097/01376517-200404000-00005] [PMID]
4. Ghamari Givi H, Zahed A, Fathi D. Effectiveness of group cognitive-behavioral therapy on depression among the mournful elderly. Journal of Geriatric Nursing. 2016;2(3):22-31. [DOI:10.21859/jgn.2.3.22]
5. Khajeh M, Sadat Hosseini AS, Karimi R. The effect of parents empowerment program on their beliefs about parental role, behaviors and characteristics of their premature infants in nicu. The Journal of Urmia Nursing and Midwifery Faculty. 2013;11(6):419-27.
6. Nikfarid L, Rasuli M, Borimneghad L, Alavimajd H. Psychometric Characteristics of Persian Version of Kendall Chronic Sorrow Instrument (KCSI) in Mothers of Children with Cancer. Iranian Journal of Psychiatry & Clinical Psychology. 2014;20(2):144-52.
7. Mathews TJ, Miniño AM, Osterman MJ, Strobino DM, Guyer B. Annual summary of vital statistics: 2008. Pediatrics. 2011;127(1):146-57. [DOI:10.1542/peds.2010-3175] [PMID]
8. W.H.O. preterm-birth 2018 [cited 2019/9/12 2019/9/12]. Available from: https://www.who.int/news-room/fact-sheets/detail/preterm-birth. 2020.
9. Kalhor ME, SamieeRad F, Garshasbi MA, MohitAbadi ZA, Sefollah SI. Evaluating the effect of mother-baby skin-to-skin care on neonatal outcomes in preterm infants. SSU_Journals. 2016;24(5):375-86.
10. Khanjari S, Mosavipoor SS, Oskouie F, Haghani H. Quality of life and sense of coherence in the mothers with term and preterm infants. Iran Journal of Nursing. 2017;30(106):57-67. [DOI:10.29252/ijn.30.106.57]
11. Beheshtipour N, Baharlu SM, Montaseri S, Razavinezhad AS. Comparison of parental stress in premature infants admitted in neonatal intensive care unit (NICU). Sadra Medical Sciences Journal. 2014;2(4):361-68.
12. Nikfarid L, Eezadi H, Shakoori M. Coping Behaviors of Mothers of Chronically Ill Children. Iran Journal of Nursing. 2012;24(74):53-62.
13. Masoodi R, Alhani F, Rabiei L, Majdinasab N, Moghaddasi J, Esmaeili SA, Noorian C. The effect of family-centered empowerment model on quality of life and self efficacy of multiple sclerosis patients family care givers. Iranian Journal of Nursing Research. 2013;7(27):32-43.
14. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, Stone PW, Small L, Tu X, Gross SJ. Reducing premature infants' length of stay and improving parents' mental health outcomes with the Creating Opportunities for Parent Empowerment (COPE) neonatal intensive care unit program: a randomized, controlled trial. Pediatrics. 2006;118(5):e1414-27. [DOI:10.1542/peds.2005-2580] [PMID]
15. Coughlin MB, Sethares KA. Chronic sorrow in parents of children with a chronic illness or disability: An integrative literature review. J Pediat Nurs. 2017;37:108-16. [DOI:10.1016/j.pedn.2017.06.011] [PMID]
16. Hobdell EF, Grant ML, Valencia I, Mare J, Kothare SV, Legido A, Khurana DS. Chronic sorrow and coping in families of children with epilepsy. J Neurosci Nurs. 2007;39(2):76-82. [DOI:10.1097/01376517-200704000-00003] [PMID]
17. Nikfarid L, Rassouli M, Borimnejad L, Alavimajd H. Chronic sorrow in mothers of children with cancer. Journal of Pediatric Oncology Nursing. 2015;32(5):314-9. [DOI:10.1177/1043454214563407] [PMID]
18. Kendall LC. The experience of living with ongoing loss: Testing the Kendall Chronic Sorrow Instrument. Virginia Commonwealth University; 2005.
19. Masterson MK. Chronic sorrow in mothers of adult children with cerebral palsy: An exploratory study (Doctoral dissertation, Kansas State University) 2020.
20. Heidari H, Hasanpour M, Fooladi M. Stress Management among Parents of Neonates Hospitalized in NICU: A Qualitative Study. J Caring Sci. 2017;6(1):29-38. [DOI:10.15171/jcs.2017.004] [PMID] [PMCID]
21. Aliabadi F, Kamali M, Borimnejad L, Rassafiani M, Rasti M, Shafaroodi N, Rafii F, Kachoosangy RA. Supporting-emotional needs of Iranian parents with premature infants admitted to Neonatal Intensive Care Units. Medical journal of the Islamic Republic of Iran. 2014;28:53.
22. Davis L, Edwards H, Mohay H, Wollin J. The impact of very premature birth on the psychological health of mothers. Early human development. 2003;73(1-2):61-70. [DOI:10.1016/S0378-3782(03)00073-2]
23. Nyström K, Axelsson K. Mothers' experience of being separated from their newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2002;31(3):275-82. [DOI:10.1111/j.1552-6909.2002.tb00049.x] [PMID]
24. Dyer K. Identifying, understanding, and working with grieving parents in the NICU, part I: Identifying and understanding loss and the grief response. Neonatal Network. 2005;24(3):35-46. [DOI:10.1891/0730-0832.24.3.35] [PMID]
25. Aho AL, Åstedt‐Kurki P, Tarkka MT, Kaunonen M. Development and implementation of a bereavement follow‐up intervention for grieving fathers: an action research. J Clin Nurs. 2011;20(3‐4):408-19. [DOI:10.1111/j.1365-2702.2010.03523.x] [PMID]
26. Roose RE, Blanford CR. Perinatal grief and support spans the generations: parents' and grandparents' evaluations of an intergenerational perinatal bereavement program. J Perinat Neonatal Nurs. 2011;25(1):77-85. [DOI:10.1097/JPN.0b013e318208cb74] [PMID]
27. Büssing A, Waßermann U, Hvidt NC, Längler A, Thiel M. Spiritual needs of mothers with sick new born or premature infants-A cross sectional survey among German mothers. Women and Birth. 2018;31(2):e89-98. [DOI:10.1016/j.wombi.2017.08.002] [PMID]
28. Rahiminia E. Nursing Behaviors which Facilitate the Grief Work of Parents with Premature Infants in Neonatal Intensive Care Unit: A Comparison of Mothers and Fathers. Nurs Midwifery Stud. 2013;2(2):206-9. [DOI:10.5812/nms.10369] [PMID] [PMCID]
29. Heinemann AB, Hellström‐Westas L, Hedberg Nyqvist K. Factors affecting parents' presence with their extremely preterm infants in a neonatal intensive care room. Acta Paediatrica. 2013;102(7):695-702. [DOI:10.1111/apa.12267] [PMID]
30. Mirghafourvand M, Ouladsahebmadarek E, Hosseini MB, Heidarabadi S, Asghari-Jafarabadi M, Hasanpour S. The effect of creating opportunities for parent empowerment program on parent's mental health: A systematic review. Iranian Journal of Pediatrics. 2017;27(2):e5704. [DOI:10.5812/ijp.5704]
31. Jafari Mianaei S, Alaei Karahroudi F, Rasouli M. Study of the impacts of rehabilitation program on mothers with premature hospitalized infants. Education & Ethic In Nursing. 2012;1(1):2-37.
32. Bowes S, Lowes L, Warner J, Gregory JW. Chronic sorrow in parents of children with type 1 diabetes. J Adv Nurs. 2009;65(5):992-1000. [DOI:10.1111/j.1365-2648.2009.04963.x] [PMID]
33. Doering LV, Dracup K, Moser D. Comparison of psychosocial adjustment of mothers and fathers of high-risk infants in the neonatal intensive care unit. Journal of Perinatology. 1999;19(2):132-7. [DOI:10.1038/sj.jp.7200083] [PMID]
34. Valizadeh L, Zamanzadeh V, Rahiminia E. Comparison of anticipatory grief reaction between fathers and mothers of premature infants in neonatal intensive care unit. Scand J Caring Sci. 2013;27(4):921-6. [DOI:10.1111/scs.12005] [PMID]
35. Zamanzadeh V, Valizadeh L, Rahiminia E, Ranjbar Kochaksaraie F. Anticipatory grief reactions in fathers of preterm infants hospitalized in neonatal intensive care unit. J Caring Sci. 2013;2(1):83-8.
36. Ionio C, Colombo C, Brazzoduro V, Mascheroni E, Confalonieri E, Castoldi F, Lista G. Mothers and fathers in NICU: The impact of preterm birth on parental distress. Eur J Psychol. 2016;12(4):604-21. [DOI:10.5964/ejop.v12i4.1093] [PMID] [PMCID]

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