Effectiveness of a structured nursing intervention on maternal stress, anxiety, ability and quality of life in neonatal intensive care unit / Ong Swee Leong

Ong , Swee Leong (2018) Effectiveness of a structured nursing intervention on maternal stress, anxiety, ability and quality of life in neonatal intensive care unit / Ong Swee Leong. PhD thesis, University of Malaya.

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Abstract

Premature birth is a stressful event to mothers whose infants may be admitted to the neonatal intensive care unit (NICU) for several weeks or months. Most mothers of premature infants will experience stress, anxiety, low NICU-related maternal ability and quality of life. The study aims to evaluate the effectiveness of Structured Nursing Intervention (SNI), an educational program that specifically developed based on mother needs which was identified prior an actual study to reduce maternal stress, anxiety and improving maternal ability and mother’s quality of life. Method: A cross-sectional and quasi experimental study was conducted in a large tertiary public level III hospital NICU in East Coast Malaysia. This study consisted of three phases: First phase (n=180), a survey used to identify mothers’ psychological problems in related to their premature infants admitted to NICU. Second phase was the SNI development phase and last phase was run on 216 mothers to evaluate the effectiveness of SNI on maternal stress, anxiety, maternal ability and QoL. The questionnaires used were Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU), State-trait Anxiety Inventory (STAI), Maternal Ability Checklist (MA) and World Health Organization Quality of Life (WHOQOL-BREF). The quantitative results were analyzed using Statistical Package of Social Sciences (SPSS) version 23. Descriptive statistics was used to analyze the demographic data and items of questionnaire. The inferential method included two ways repeated measure analysis of variance (RMANOVA) followed by Bonferroni test for mean comparison between control and experimental groups at two phases (pre and post intervention tests). Results: More than 50% of mother (n= 180) scored high level of stress and anxiety 153 (85%), low NICU-related maternal ability (M=2.85, SD=068) and moderate level of overall QoL (M=3.67, SD=0.80). Two items scored highest in affecting maternal stress are ‘being separated from the baby’ (M=3.66, SD=1.29) and ‘not feeding the infant’ (M=3.66, SD=1.31). There was no significant relationship iii between maternal and infant characteristic except between birth weight and trait anxiety which showed weak relationship and moderate relationship with state anxiety. A negative and significant relationship between maternal ability and maternal stress in all correlation coefficients were less than 0.3 which indicated a weak relationship. The relationship between maternal stress and quality of life ranged between -0.184 to -0.295 which were weak while the relationship between total stress and psychology domain was moderate (r=0.301, p<0.001). In the intervention phase, the results of data analysis confirmed significant percentage of reduction in PSS: NICU among mothers under intervention was 12.9% in intervention group and in control group (4.7%) while for maternal ability there was a 39.2% improvement in the intervention group compared to 18.4% in the control group. Conclusion: The use of a SNI, designed and delivered factual information on caring of a premature infant in a Malaysian NICU, followed by provision of planned therapeutic nurse mother interaction, can effectively reduce level of maternal stress and anxiety, as well as improved maternal ability and hence, maternal QoL.

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