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TitleThe lived experience of mothers regarding care of their hospitalized preterm baby
LanguageEnglish
File Size1.7 MB
Total Pages191
Table of Contents
                            Ncube-Final corrected dissertation
R Ncube declaration page
                        
Document Text Contents
Page 1

The copyright of this thesis vests in the author. No
quotation from it or information derived from it is to be
published without full acknowledgement of the source.
The thesis is to be used for private study or non-
commercial research purposes only.



Published by the University of Cape Town (UCT) in terms
of the non-exclusive license granted to UCT by the author.


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THE LIVED EXPERIENCES OF MOTHERS REGARDING CARE OF

THEIR HOSPITALISED PRETERM BABIES





Rosinah Kereemang Ncube

Student no: NCBROS001





SUBMITTED TO THE UNIVERSITY OF CAPE TOWN

In fulfilment of the requirements for the degree of

Master of Science in Nursing





DIVISION OF NURSING AND MIDWIFERY

DEPARTMENT OF HEALTH AND REHABILITATION SCIENCES

UNIVERSITY OF CAPE TOWN





Submitted September 2011

Supervisors: Ms Hilary Barlow, Child Nurse Practice Development Initiative, School of Child

and Adolescent Health, University of Cape Town

Dr Pat Mayers, Division of Nursing and Midwifery, University of Cape Town

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communication tool parents utilise in interacting with the baby (Bell et al., 1998; Fegran, Helseth

& Fagermoen, 2008). The participants’ intense concern that their actions could harm the

vulnerable preterm baby initially led to less contact between them and their babies. Marninez,

Fonseca and Scochi (2007) and Tiloskulchai et al. (2002) found that mothers reported the desire

to take care of their preterm baby, but were afraid of hurting the baby who was small and

seemed fragile. Fegran, Helseth and Fagermoen (2008) reported that when mothers are deprived

of contact with their infants, the inhibited physical stimulation delays the attachment process.

The participants in this study feared for the survival of their preterm baby, who was small and

seemed vulnerable. Other researchers had similar findings, such as Schenk and Kelly (2010), who

found that mothers reported being worried and scared because they had doubts about their

infant’s chance of survival. Their study reported that mothers were worried because their babies

had tubes inserted and were receiving intravenous fluids. Jackson et al. (2003) and Reid (2000)

found that the mothers’ first sight of their preterm baby filled them with fear, worry and concern.

The separation of their preterm babies from the mothers in this study generated anxiety and

concern for the safety of their babies. Bowlby (1979) reported that threat of loss leads to anxiety.

The participants felt threatened as a result of the separation and became anxious. Their anxiety

was increased when the baby was sick and when the baby’s condition deteriorated. A number of

studies have investigated the numerous challenges that mothers of preterm babies face, by

examining the psychological adjustment of such mothers compared to those who delivered a full-

term baby. Feldman, Weller, Leckman, Kuint and Eidelman (1999) interviewed three groups of

mothers. The first group had delivered full-term infants, were not separated from their infants,

and were able to hold, feed and take care of their baby. The mothers reported medium-high

levels of preoccupations with thoughts and worries of infant safety and well-being. The second

group of mothers had LBW infants and had a chance to hold their infant in their arms outside the

bassinet with or without monitoring devices following initial separation. This group of mothers

reported high levels of preoccupation. In contrast, mothers who had very LBW infants and were

separated from their infants for periods reported low levels of preoccupation. Feldman et al.

(1999) also reported that when mothers were asked about their distress caused by thoughts and

worry, those with full-term infants reported a moderate level of distress, whereas those with LBW

infants reported the highest level of distress. This demonstrates how the child’s illness and

separation from the mother affects the process of maternal attachment.

The infant’s illness leads to maternal anxiety and depression, which may affect maternal-infant

bonding. The findings also indicated that anxious mothers tended to experience higher levels of

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“worrisome aspect of bonding” or bonding with worry (Feldman et al., 1999), which can easily be

challenged or disrupted (Klaus & Kennell (1982). Although separated from their infants,

participants in this study were involved in the care of their babies, and this helped to moderate

their distress as they interacted with their preterm baby.

Studies by Hall (2005) and Holditch-Davis et al. (2009) found that parents of a newborn child,

including preterm infants, reported increased anxiety when the baby’s condition worsened, such

as at admission of the baby to the NICU. Holditch-Davis et al. (2009) conducted a randomised

study in which 177 African-American mothers of preterm infants from the rural and small towns

of the South-Eastern state were recruited from the NICUs of two hospitals. The study was

conducted over a period of 24 months and mothers were divided into four groups. The groups

differed in relation to their psychological distress when they responded to a questionnaire about

their infant appearance stress, parental role stress, depressive symptoms, state of anxiety, post-

traumatic stress symptoms and daily problems. One group reported low distress; another high

stress; one group had high depressive symptoms; and the other group reported extreme distress.

It was reported that there was a decline in the percentages when symptoms of state of anxiety

and depression were checked at 2, 6, 12 and 24 months for all the groups except the low distress

group.

Hurst (2001a) and Rowe and Gardner and Gardner (2005) found that when mothers were

involved in the care of their preterm baby, they were constantly watching over what was unsafe

for the baby and were vigilant of changes of the infant’s condition. In their studies, Jackson,

Ternestedt and Schollin (2003) and Nystrom and Axelsson (2002) found that when mothers were

separated from their baby they expressed concern, worry and fear for their baby. The mothers

had difficulty in leaving the baby because they were worried that something might happen to the

baby. Mothers were reported to be insecure about whether their babies were exposed to blood

tests that were not needed as well as about whether their children were left alone and cried.

5.1.2 An unfamiliar and intimidating environment

The preterm babies in this study were nursed in a technological environment which was stressful

for the participants, to the point that they initially felt afraid when they visited the neonatal unit.

The participants were overwhelmed at the sight of so many babies attached to numerous

monitors and unfamiliar technologies. Several studies have demonstrated how the technological

environment of the neonatal unit overwhelms parents and how it may affect the attachment

process. Franklin (2006), Redshaw (1997) and Shin and White-Traut (2007) found that mothers of

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41 Non-explanation of

the equipment

P6 Non-explanation of

equipment used on the

baby to the mother

An unfamiliar and

intimidating

environment

42 Support by staff P1, P2, P4, P5, P8 Support of the mother by

encouraging her,

reassuring, comforting

and showing her that you

care while in the neonatal

unit

Enabling support

network

43 Support by other

mothers

P1, P2, P5, P7, P8 Mother reassured,

comforted, encouraged,

given information and

helped by other mothers

in the unit

Enabling support

network

44 Support of other

mothers

P1, P4, P7 Mother supporting

another mother by

encouraging her and

offering assistance

Enabling support

network

45 Support by family P2, P4, P6, P7 Family supporting the

mother by visiting,

phoning, reassuring,

encouraging and meeting

other needs

Enabling support

network

46 Belief in God P3, P4, P6, P7 Believing God to intervene

in difficult situations when

one trusts in him and

prays

Enabling support

network

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DECLARATION

I Rosinah K. Ncube, hereby declare that the work on which this dissertation is based is my original

work (except where acknowledgements indicate otherwise) and that neither the whole work nor

any part of it has been, is being, or is to be submitted for another degree in this or any other

university.

I empower the university to reproduce for the purpose of research either the whole or any

portion of the contents in any manner whatsoever.

W:l' ,
Signature

05- \;;t - 1\

Date

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