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oai:dspace.unza.zm:123456789/79312023-01-13T14:08:26Zcom_123456789_18col_123456789_83

Masumo, Maureen Malumbe. 2023-01-13T12:08:20Z 2023-01-13T12:08:20Z 2021 Thesis Background: Admission of a new-born to the Neonatal Intensive Care Unit (NICU) is a stressful and unexpected event to most parents. This study aimed at developing a stress alleviation model after identifying stressors and their associated factors in mothers nursing babies in the Neonatal Intensive Care Unit at the Women and New Born Hospital in Zambia. Methods: A two phased study approach was undertaken where phase one used a mixed method (convergent concurrent) study design. The quantitative component of the study facilitated identification of NICU environmental stressors and associated factors among mothers with neonates admitted to the NICU while the qualitative component focussed on nurses’ perceptions of stressors and stress levels among mothers nursing babies in NICU. The two components formed phase one of the study and their data sets informed the development of a stress alleviation model. Stakeholder consultation and literature based interventions were used to develop a maternal stress alleviation model. From the identified stressors and literature review a model was developed. The quantitative component was conducted among 280 mothers and their neonates who were randomly selected over a three-month period. This component was conducted to determine stress levels and NICU stressors using a 46 item Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) questionnaire. Informed consent was obtained from the mothers. Further, the Qualitative component was vi conducted among 15 nurses working in the unit who were purposefully sampled by maximum variation as it aimed at exploring nurses’ perceptions of maternal stressors in NICU. In-depth interviews were conducted using structured interview guide to collect qualitative data. Hybrid approach of qualitative methods of thematic analysis was used to analyse data. Stata software version 13 was used to analyse quantitative data. Chi square test of independence was used to determine if there is a relationship between the dependent variable (maternal stress) and independent variables (maternal and situational characteristics), and where it was not applicable Fishers Exact test was reported. The cut off point for statistical significance was set at five percent, P value less than 0.05 were considered statistically significant. Interquartile and median were calculated since the data was not normally distributed, while Kruskal-Wallis rank sum test was performed to assess if the medians of the items in each subscale and between subscales were statistically different. In addition, Post hoc Dunn’s multiple comparison test was used to identify the items with different medians, and Ordinal Logistic Regression constructed to explain whether independent variables could predict stress among the mothers with neonates admitted to the Neonatal Intensive Care Unit. Predictive margins to predict the likely hood of the mother being stressed if she has a neonate admitted to NICU and a combination of levels of specified variables in the data. vii Findings: The results from the quantitative component revealed that prevalence of stress among mothers with babies admitted to NICU was high with 262 (93.6%) respondents reporting that they were very stressed. The most stressful NICU environmental stressors measured by the PSS: NICU were Infant appearance and behaviour (median 3; IQR 3 -4) and Parent Infant relationship (median 4; IQR 3 – 4). The ordinal regression results showed that those mothers who breastfed their babies were 52% less likely to be in high stress category (COR= 0.487; 95% CI [0.278 – 0.854]; p= 0.012) versus the combined mild and moderate categories keeping all other variables constant. The women who were working and getting a monthly salary were 67% less likely to be in high stress category (COR= 0.435; 95% CI [0.244 – 0.773]; p= 0.005). The odds of being in the high stress category for those with tertiary education versus the mild and moderate categories of stress are 2.12 times greater (COR= 2.124; 95% CI [1.218 – 3.702]; p= 0.008.) given that the other variables in the model are held constant. Multivariable ordinal regression revealed that birth weight (0.008) and type of feeding (0.001) were statistically associated with maternal stress. The predictive margins revealed a probability of increased stress in a mother who stay in NICU for more than seven days regardless of whether the baby was born prematurely or at term. Additionally, results from the qualitative component showed that the major themes that emerged as stressors in NICU were NICU environment, standard operating procedures in NICU, maternal infant relationship, staff behaviour and communication. Conclusion: The study has developed a stress alleviation model based on the NICU environmental stressors and the associated factors identified in phase one. The nurses who work in the unit can support the mothers provided they are guided by the model and empowered with knowledge on FCC. The aim of supporting mothers is to ensure that once their emotional support needs are met, they will be able to attain their maternal role and consequently enhance recovery of the baby. Therefore, a recommendation has been given to Ministry of Health and management at Women and New-born Hospital to adopt the model in NICU. Further recommendations are to the trainers of nurses to include family centred care model in the nursing curriculum. Key words: Maternal stressors, neonatal intensive care, Parental Stressor Scale - Neonatal Intensive Care Unit, Maternal stress alleviation model http://dspace.unza.zm/handle/123456789/7931 en The University of Zambia Maternal stressors. Neonatal intensive care. Neonatal intensive care unit environmental stressors: towards developing a stress alleviating model for mothers nursing sick neonates in Lusaka - Zambia. Thesis