The Effect of Mother Empowerment Program on Mothers’ Attachment to their Hospitalized Premature Neonates

Document Type: Original Quantitative and Qualitative Research Paper

Authors

1 1. Evidence Based Care Research Centre, Instructor of Nursing, Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 MSc Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate professor of Neonatology, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran

4 Evidence Based Care Research Center, Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

5 Assistant Professor of Psychology, faculty member of Islamic Azad University, Torbat-e Jam, Iran

Abstract

Background: Birth of a premature neonate is associated with hospital admission and separation from the family. Admission of the neonates intervenes on infant-mother attachment and so adversely affects on the quality of care given by the mother, and subsequently increases the risk of delayed behavioral problems in the children.
Aim: To assess the effectiveness of mother empowerment program on the premature infant-mother attachment.
Methods: In this randomized clinical trial, 70 mothers of premature infants, admitted to the neonatal intensive care unit (NICU) of Omolbanin hospital of Mashhad in 2014, were divided into of intervention and control groups. The Empowerment program was a multi-step treatment program, in which information about the premature infants was provided to mothers through an illustrated booklet with a workbook and audio file in each step. Mothers in the control group received information and routine care according to the hospital guideline. The mother-infant attachment was measured after the intervention using the maternal and neonatal behaviors Avant tool. Data analysis was performed using chi-square and t-student tests by SPSS software version 11.5.
Results:The mean scores of maternal attachment behaviors after the intervention in the empowerment and control groups were (56.62±8.06) and (39.51±7.77), respectively; the difference between the groups was statistically significant (P<0.001).
Conclusion: Our findings revealed that implementation of mother empowerment program increases the mother-premature-infant attachment. Therefore, it is recommended that the empowerment program be routinely utilized to promote the maternal attachment to the premature neonates hospitalized in NICUs.

Keywords


  1. Als H, Lawhon G, Duffy FH, McAnulty GB, Gibes-Grossman R, Blickman JG. Individualized Developmental Care for the Very Low-Birth-Weight Preterm Infant: Medical and Neurofunctional Effects. Jama. 1994;272(11):853-8.
  2. Franck LS, Cox S, Allen A, Winter I. Measuring Neonatal Iintensive Care Unit‐Related Parental Stress. J Adv Nurs. 2005;49(6):608-15.
  3. Hildebrandt KA, Fitzgerald HE. The Infant's Physical Attractiveness: Its Effect on Bonding and Attachment. Infant Ment Health J. 1983;4(1):1-12.
  4. Kussano C, Maehara S. Japanese and Brazilian Maternal Bonding Behaviour Towards Preterm Infants: A Comparative Study. JNN-. 1998;4:23-18.
  5. Tilokskulchai F, Phatthanasiriwethin S, Vichitsukon K, Serisathien Y. Attachment Behaviors in Mothers of Premature Infants: a Descriptive Study in Thai Mothers. The J Perinat Neonatal Nurs. 2002;16(3):69-83.
  6. Bowlby J. Attachment: Basic BooksClassics. Vol 2. New York. Jessica Kingsley Publishers; 2008.
  7. Forcada-Guex M, Pierrehumbert B, Borghini A, Moessinger A, Muller-Nix C. Early Dyadic Patterns of Mother–Infant Interactions and Outcomes of Prematurity At 18 Months. Pediatrics. 2006;118(1):e107-e14.
  8. Bialoskurski M, Cox CL, Hayes JA. The Nature of Attachment in a Neonatal Intensive Care Unit. The Journal of Perinatal & Neonatal Nursing. 1999;13(1):66-77.
  9. Nouri A, Malekpour M, Abedi A. The Relationship Between Child’s Secure Attachment and Factors of Maternal Behavior.
  10. Aviezer O, Sagi-Schwartz A, Koren-Karie N. Ecological Constraints on the Formation of Infant–Mother Attachment Relations: When Maternal Sensitivity Becomes Ineffective. Infant Behavior and Development. 2003;26(3):285-99.
  11. Harrison LJ, Ungerer JA. Maternal Employment and Infant-Mother Attachment Security at 12 Months PostPartum. Dev Psychol. 2. 758:(5)38;002
  12. Borimnejad L, Mehrnush N, Seyed-Fatemi N, Haghani H. The Effect of Empowerment Program on Mother-Infant Interaction and Weight Gain in Preterm Infants. .zjrms. 2012;14(9):19-23 .( Persian).
  13. Cloherty JP, Eichenwald EC, Stark AR. Manual of Neonatal Care: Lippincott Williams & Wilkins; 2008.
  14. Melnyk BM, Alpert‐Gillis L, Feinstein NF, Fairbanks E, Schultz‐Czarniak J, Hust D, et al. Improving Cognitive Development of Low‐Birth‐Weight Premature Infants With the COPE Program: A pilotStudy of the Benefit of Early NICU Intervention With Mothers. Res Nurs Health. 2001;24(5):373-89.
  15. Mianaei SJ, Karahroudy FA, Rassouli M, Tafreshi MZ. The effect of Creating Opportunities for Parent Empowerment Program on Maternal Stress, Anxiety, and Participation in NICU Wards in Iran. Iran J Nurs Midwifery Res. 2014;19(1):94.
  16. Melnyk BM, Feinstein NF, Alpert-Gillis L, Fairbanks E, Crean HF, Sinkin RA, et al. 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-e27.
  17. Browne JV, Talmi A. Family-Based Intervention to Enhance Infant–Parent Relationships In the Neonatal Intensive Care Unit. J Pediatr Psychol. 2005;30(8):667-77.
  18. Norr KF, Roberts JE, Freese U. Early Post Partum Rooming and Mathernal Attachment Behavior in a Group  of  Medically Indigent Primiparas. J Nurse Midwifery. 1989;34(2):85-91.
  19. Norr KF, Roberts JE. Early Maternal Attachment Behaviors of Adolescent and Adult Mothers. J Nurse Midwifery. 1991;36(6):334-42.
  20. Vakilian K, Khatamidoust F, Khoursandi M. Effect of Kangaroo Mother Care on Maternal Attachment Behavior before Hospital Discharge. HMJ. . 2007;15(9):10-25; (Persian).
  21. Hae-Kyung L. Effects of Massage and Attachment Promotion Program on Social Maturity, Child Autism and Attachment of Children with Autism and Their Mothers. CHNR 2008;14(1):14-21.
  22. Ahn HY, Lee J, Shin H-J. Kangaroo Care on Premature Infant Growth and Maternal Attachment and PostPartum Depression in South Korea. J Trop Pediatr 2010;56(5):342-4.