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- Sahlén Helmer, Charlotte, 1971-
(författare)
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Interaction between preterm infants and their parents : Studies of early interventions in neonatal care
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Preterm birth negatively affects infant well-being and development. A well-functioning parent-infant interaction can mitigate the risk of preterm birth on infant development. However, parent-infant interaction is often disrupted after preterm birth because of organizational factors in care, infants’ immature interaction cues, and maternal health problems. Different interventions supporting parental-infant interaction exist, but only a few target support for interaction between preterm infants born at gestational week 30-36 and their parents. Thus, an early, feasible and effective intervention that supports the preterm infant and the parents in the neonatal intensive care unit was needed. Aim The overall aim of the thesis was two-fold; first to evaluate the early intervention skin-to-skin contact on mother-infant interaction; and second, to develop a new intervention, the Early Collaborative Intervention (EACI), to explore how mothers’ experience the new intervention, and to study its effects on mother-infant interaction. Methods Study I was a randomized controlled trial with two groups. Families were randomly assigned to either continuous or intermittent skin-to-skin con-tact directly after birth. Mother-infant interaction was video recorded when the infant was four months corrected age during a Still face procedure. The interaction was later scored using two different instruments, the Ains-worth’s Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scale. Furthermore, the dose-response relationship between time in skin-to-skin contact and interaction quality was calculated. Study II had a descriptive design where the rationale, development, frame-work, and practical provision of the EACI program was described. Study III had a qualitative design. Mothers were interviewed about their experiences of the EACI. Data were analyzed with reflexive thematic analysis. Study IV was a randomized controlled trial with two groups. Families were randomly assigned to either the EACI or standard care. The intervention started within three days after birth. Mother-infant interaction was video recorded when the infant was one month corrected age during a bathing session. The interaction was later scored using two different instruments, the Ainsworth’s Maternal Sensitivity Scales, and the Emotional Availability system. Intention to treat and per protocol analysis were calculated as three sessions were considered the minimum required to detect a difference. Results Study I showed no significant differences in maternal interaction behavior between the groups randomized to continuous skin-to-skin contact or intermittent skin-to-skin contact. Dose-response calculations between time in skin-to-skin-contact and interaction quality showed no correlations. In Study II, the theoretical framework of the EACI was based on the attachment theory, the assessment of infant behavior described by Brazelton, and psychoeducational theory. The rationale was to provide tailored early support that improved parent-infant interaction and thereby optimized infant well-being and development. The intervention was developed by a core group in the neonatal intensive care unit at Crown Princess Victoria Children’s Hospital. It was a three-session intervention, provided during an ordinary care procedure with instant provider feedback and hands on guidance during active parental involvement. Two sessions were provided at the hospital, and one after discharge in the home of the family. In Study III two main themes were constructed, “mothers feelings evoked from the Early Collaborative Intervention” and “based on the preterm baby’s behavior”. The mothers experienced the intervention as helpful for their interaction with the infant and for them to see their infant as an individual. The per protocol analysis in Study IV showed that the intervention group had significantly higher mean scores in the Availability, Acceptance and Non-hostility subscales, indicating a more well-functioning interaction. Conclusion Continuous SSC was not superior to intermittent SSC for improving maternal interactive behavior. In contrast, the Early Collaborative Intervention, improved maternal interactive behavior if all three sessions of the intervention were provided. This was also confirmed in the interviews, in which the mothers described the intervention as helpful for their interactive behavior with their preterm infants.
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| 2. |
- Zhang, Hui
(författare)
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Learning from Experience : The Use of Structured Video-Assisted Debriefing Among Nursing Students
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Simulation enhances experiential learning through creating experience to form the basis of learning, and it has been recognized as an effective pedagogy in current health professions education. As an integral element of simulation, debriefing contributes to transforming the created experience to new knowledge. Video-assisted debriefing (VAD) refers to adding audio-visual capture and review to traditional verbal debriefing (VD). Despite being regarded as ‘gold standard’ for simulation, evidence reporting educational effects of VAD is mixed and its best practice remains absent.Aims: The aims of this thesis were to develop a framework for VAD, to test and compare its effects on prelicensure nursing students’ debriefing experiences, reflective abilities and nursing competencies with VD without video, as well as to explore its potential impact on facilitators’ perceptions and practices following high-fidelity simulation.Design and methods: This thesis comprised of four studies with different research designs. Study I was a systematic review which synthesized the characteristics of existing VAD practices in health professions education and evaluated its effectiveness on learners’ reactions, learning and behaviors. Study II was a proof-of-concept study which developed of a three-phase framework for VAD and tested its preliminary effects on nursing students’ debriefing experiences, reflective abilities, and nursing competencies using a pretest-posttest design. Study III adopted a qualitative method to explore nursing students’ experiences and perspectives of a structured VAD using focus groups. Data were analyzed using thematic analysis approach. Study IV employed a mixed-method research design to investigate the impact of a three-phase VAD on nursing students’ debriefing experiences, perceived stress, as well as facilitators’ perceptions and debriefing practices.Results: Study I showed that existing VAD offered comparable educational effects as VD in terms of learners’ experiences, attitudes, and performance, except on knowledge acquisition. Video did not demonstrate its continuous advantage in debriefing, which informed the absence of best practice. The preliminary results of Study II reported that a three-phase VAD significantly improved students’ debriefing experiences (p<0.001), reflective abilities (p<0.01), and nursing competencies (p<0.001). Study III disclosed an emotional roller coaster experienced by nursing students in VAD, from unwillingness and fear of being judged, followed by stress and defensiveness, to sense of appreciation and satisfaction. Most students agreed that VAD provided a good learning experience with few preferred not to receive peer feedback after video review. Study IV demonstrated that VAD improved nursing students’ debriefing experiences (p=0.01) and caused comparable stress as VD. Repeated exposure to VAD significantly reduced stress levels. VAD also enhanced facilitators’ perceptions and debriefing practices.Conclusions: This project developed a three-phase framework for VAD, and affirmed its educational effects on improving nursing students’ debriefing experiences, reflective abilities, and competencies following high fidelity simulation, with comparable stress experienced as in VD. The finding of an emotional roller coaster experienced by nursing students in VAD challenged the snapshot of negative emotions reported in other studies, offering some clarity to the inconsistent evidence regarding learners’ experiences of VAD and contributing to its best practice. This thesis also proved that this three-phase VAD held the potential to enhance facilitators’ debriefing practices towards student-centered learning.
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| 3. |
- Flankegård, Gunilla, 1974-
(författare)
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Childhood functional constipation : Parents' everyday life experiences
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Functional constipation is the most common chronic disorder in childhood with a great impact on family life. Treatment focuses on the behavioural nature of the disorder with toilet training and laxatives, with the goal of daily stool passage without difficulties. Management of care is predominantly carried out at home by parents, making them key partners in the paediatric care.Aim: The overall aim of this thesis was to explore and understand childhood functional constipation through the experiences of parents.Design and method: This thesis comprise two studies based on a phenomenological research method and design with an inductive reflective lifeworld approach using qualitative individual interviews to gather data. A theoretical framework was used in the analysis to further elucidate the findings.Findings: Shame was the essential finding, providing the reason parents acted in certain ways and the result of the same actions. Study I showed that everyday life was put on hold due to the time and effort invested in the adaptations demanded by the constipation. This left the parents feeling lonely, guilty, and fighting frustrating battles as they tried to gain control by being always one step ahead. Study II showed that giving constipation treatment resulted in parents questioning their parental identity. Treatment needed to be affirmed, as doubt and second thoughts sometimes made parents give treatment against their own will as well as defying their child’s will, bordering on feelings of being abusive. The findings were interpreted in the light of theories of illness beliefs and good parenting beliefs, suggesting belief systems are the path into the parents’ feelings of shame. Re-evaluating the beliefs might diminish failure to adhere to treatment regimens.Conclusions: This project shows that functional constipation is like other childhood chronic illnesses in respect of its importance and impact on everyday family life. Shame is a prominent feature of functional constipation experiences. However, the shame felt might be mitigated by targeting and re-evaluating the belief systems that form the lifeworld of the parents and family.
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| 4. |
- Mörelius, Evalotte, 1965-, et al.
(författare)
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OC09 - Early maternal contact has an impact on preterm infants' brain systems that manage stress.
- 2016
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Ingår i: Nursing children and young people. - London, Middx, United Kingdom : RCNi. - 2046-2344 .- 2046-2336. ; 28:4, s. 62-63
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Tidskriftsartikel (refereegranskat)abstract
- UNLABELLED: Theme: Parenting/parenthood.INTRODUCTION: Early maternal contact can protect the infants' brain from harmful effects of stress while deprivation increases the stress level and leads to increased sensitivity to stress.AIM: To evaluate the effects of continuous skin-to-skin contact (SSC) after preterm birth on stress.METHODS: Late preterm infants from two neonatal care units were randomized to either SSC or standard care. Salivary cortisol was measured in response to a nappy change at one month, and again at four months in response to a still-face procedure.RESULTS: Infants randomized to SSC had a significantly lower salivary cortisol reactivity at one month and there was a correlation between the mothers' and the preterm infants' salivary cortisol levels at four months.CONCLUSIONS: The results show that close parental contact and human touch have a buffering effect on the infant's stress reactivity and stimulate a more rapid development of regularity.
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| 5. |
- Mörelius, Evalotte, 1965-
(författare)
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Stress in infants and parents : Studies of salivary cortisol, behaviour and psychometric measures
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The life of a preterm infant admitted to a neonatal intensive care unit may be stressful from the moment of birth. Ever since Hans Selye’s initial characterisation of the biological stress response, cortisol has been frequently measured as an indicator of stress responsivity. However, research of the stress response and cortisol in infants, especially those who are preterm and/or ill, has been scarce basically because of methodological issues.The first aim with this thesis was to investigate the acute stress response, as measured by salivary cortisol and behaviour, for preterm infants, healthy infants, and infants at high psychosocial risk in response to certain defined handling procedures. The second aim was to investigate the stress response, as measured by salivary cortisol and psychometric measures, for parents present during the handling procedure of their infants. The intention was to perform all investigations in an as naturally occurring situation as possible, which means that the studied procedures would have been performed irrespectively of the research.The present thesis includes six original articles. The results of the first study demonstrate that it is feasible to collect sufficient amounts of saliva and to analyse salivary cortisol in neonates using the presented method of collection and analysis. The second study shows that preterm infants, usually cared for in incubators, show no signs of discomfort and have variable cortisol responses during skin-to-skin care with their mothers. The mothers, however, experience stress and low control before their first skin-to-skin care with their preterm infant and do not relax completely until after the session. In the third study we found that preterm infants have higher baseline salivary cortisol as compared to healthy full-term infants. Moreover, preterm infants have higher and sustained pain response during a nappy change as compared to healthy full-term infants. The results of the fourth study shows that infants younger than three months, living in psychosocial high-risk families, have increased cortisol responses during a nappy change, performed by the mother. However, support with the aim of improving mother-infant interaction, dampens the stress response. The results of the fifth study show that oral sweet-tasting solution in combination with a pacifier dampen the levels of the stress hormone cortisol in three months old infants during routine immunisation. Moreover, parents experience more self-rated emotional stress before immunisation if it is their first child who is being immunised. The sixth paper shows that the material used for saliva collection (cotton buds with wooden or plastic sticks) is of importance when saliva is collected but for practical reasons not centrifuged within 24 hours prior to cortisol analyse.The present thesis shows that it is practically feasible to collect saliva and to analyse the stress hormone cortisol in infants. The interpretation of infants’ and parents’ salivary cortisol responses to different handling procedures are discussed in relation to shortand long-term consequences, neonatal intensive care, preterm birth, attachment, mood, and pain.
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