A study to assess the level of stress and coping strategies among mothers of preterm infants admitted in Neonatal Intensive Care Unit at selected hospital, Puducherry.

Mrs. S. Rajalakshmi¹, Dr. Mrs. S. Kalavathi²

¹Reader in Nursing, SMVNC, Puducherry

²Principal, Rani Meyyammai College of Nursing, Annamalai University, Annamalai Nagar

*Corresponding Author E-mail: rajalakshmibaskaran2003@gmail.com

ABSTRACT:

Stress in human life includes tension, anxiety, worry and pressure. It is an accepted fact that stress is necessary for life and it can be either beneficial or detrimental. Stress is the tension producing factors that have the potential of weakening the normal lines of defense, which is divided into physical, physiological, emotional, cognitive, psychological and parental, economical domains. Coping is the cognitive and behavioral efforts used to manage external and internal stressful demands that are appraised to be exceeding the resources of the persons. The birth of a child can represent a significant transition for most families and requires establishment of new family roles and routines. The birth of a child with a critical illness, however, creates unanticipated crises, alters family patterns in ways that are stressful and makes coping demands for dealing with a critical child more pronounced for the family system. How families respond to stress will depend on the interaction of multiple factors such as economic and social stability of the family and its internal support system, and the amount of external support to which the family has access. A quantitative research approach was selected for this study. The study was conducted at selected hospital, Puducherry. The target population is 30. The study consists of the all the motherss of preterm newborns admitted in NICU. Purposive sampling technique was selected for this study. The Sample size of the study consist of 30 motherss of preterm newborns. Research variables include age, religion, occupation, education status, income, residence, religion, number of children, admission condition, number of days hospitalized. Three point likert scale was selected for the study and it was considered to be the most appropriate instrument to elicit the stress and coping strategies of motherss of preterm newborns admitted in NICU. RESULT: From the study it was concluded that 3.33% of motherss had mild stress, 63.33% of motherss had moderate stress and 33.33% of motherss had severe stress. 9.99% of motherss had mild coping, 20% of motherss had moderate coping, 23.33% of motherss had poor coping.

KEY WORDS: Stress, Anxiety, Coping, Preterm, NICU.

INTRODUCTION:

“If by saying that all men are born and equal, you mean that they areall equally born, it is true, but true is in other sense; birth, talent, labour, virtue, and providence, are forever making the differences.”

-Eugene Edwards

The birth of a child can represent a significant transition for most families and requires establishment of new family roles and routines. The birth of a child with a critical illness, however, creates unanticipated crises, alters family patterns in ways that are stressful and makes coping demands for dealing with a critical child more pronounced for the family system. How families respond to stress will depend on the interaction of multiple factors such as economic and social stability of the family and its internal support system, and the amount of external support to which the family has access.(1)

Meeting the needs of parents of preterm newborns who are in neonatal intensive care unit (NICU) is increasingly being recognized as important factor related to their future parenting as well as child clinical outcome. Having a child admitted to a NICU creates stressful situation for parents. Parents of preterm infant admitted to NICU are faced with high technology environment that inhibits normal parenting activities. Parents of preterm child admitted to the NICU typically responding to the crisis of sudden illness of the child of the gravity planned major surgery. Parents of preterm infants in NICU experience interruption of family normal activities and their parental responsibilities.(2)

The arrival of a child prematurely or ill could be a disruption to the mothers mental coping process. Without question, early arrival of a child is a period of difficulty for the fetus, which arrives without bodily and/or mental maturity; however, it is also a time of emotional difficulty for the parents. While studies have been conducted looking for the etiology and severity of parental problems, few have looked at helping and supporting the parents jointly (most have looked exclusively at the mothers), and even fewer have looked at the problem through the lens of social psychology. (3)

NEED FOR THE STUDY:

Neonatal mortality rate of India reporter in 2009 is 34 per 1000 live births as per the UNICEF. The principal causes of neonatal mortality in India are sepsis, prenatal asphyxia, and prematurity. About 40% of neonatal deaths occur on the first day of life, almost half within three days and nearly three –fourth in the first week. (4)

November 12, 2010 in state level Neonatal mortality is disproportionately common among infants with very low birth weight (VLBW) (<1,500g [3.3 lbs]). In 2006, the mortality rate among infants with VLBW was 240. 4 per 1.000 live births, parents find it very stressful when their baby is admitted to the neonatal unit for any reason. Different sources of stress have been identified and certain occasions are particularly difficult. These experiences impact on families in positive and negative ways, and people adopt a range of coping mechanisms. (5)

Gupta, RK. concluded that 57% women have mild psychological problems and 78% women are adopting coping strategies to overcome these problems. Association between the psychological problems and coping strategies shows that there is a strong significant association between the psychological problems and coping strategies. (6)

Score of both psychological problems and coping strategies are observed to be lying between 21-60.The global burden of neonatal deaths is estimated to be 5 million of which 3.2 million deaths occur during the first week of life. Almost a quarter of the burden of neonatal mortality is shared by India with three babies dying every minute, and every fourth baby born being low birth weight. The problems faced by newborn infants vary significantly in different parts of the globe; even among developing nations there is much heterogeneity in the causes of neonatal morbidity and mortality. While planning and providing health care services to newborn infants, we have primarily looked at the information originating in specialized neonatal units rather than at the gross root level. (7)

STATEMENT OF THE PROBLEM:

A study to assess the level of stress and coping strategies among mothers of preterm infants admitted in Neonatal Intensive Care Unit at selected hospital, puducherry.

OBJECTIVES:

· To assess the level of stress and coping strategies of mothers of preterm infants admitted in NICU.

· To associate the level of stress and coping strategies of motherss of preterm infants admitted in NICU with their selected demographic variables.

RESEARCH APPROACH:

A quantitative research was selected for this study.

RESEARCH DESIGN:

A Descriptive research design was adopted for this study.

SETTINGS:

The study is conducted at Selected hospitals, at Puduchery.

POPULATION:

All the mothers of preterm infants

SAMPLE:

The mothers of preterm infants admitted in NICU at selected hospital , Puducherry.

SAMPLE SIZE:

Sample consist of 30 mothers of preterm admitted in NICU

SAMPLE TECHNIQUE:

Convenient sampling technique was used to select the samples

TABLE – 1: Frequency and percentage wise distribution demographic variables of motherss of preterm infants (n=30)

DEMOGRAPHIC VARIABLES	NO. OF SAMPLES	PERCENTAGE
1)Age :
Below 20	5	16.67
21-25yrs	16	53.33
26- 30yrs	9	29.99
>30	-	-
2)Education qualification :
No formal education	3	9.99
Primary school	3	26.67
HSE	12	39.99
Graduate and above	7	23.34
3) Occupation of the mothers:
House wife	13	43.34
Government employee	7	23.33
Private employee	9	29.99
Others	1	3.33
4) Monthly income
Rs.<1000	5	16.67
Rs.1001-2000	5	16.6
Rs.2001-3000	7	23.33
Rs..3000	13	43.33
5) Residence :
Rural	12	39.99
Urban	18	59.99
6) Religion:
hindu	16	53.33
Christian	10	33.33
Muslim	2	6.67
others	2	6.67
7) Number of children:
one	12	39.99
two	16	53.33
above three	2	36.67
8) Admission condition :
medical	20	66.67
surgical	10	73.33
other investigation	0	0
9) Number of day hospitalized :
< 2days	1	3.33
2 -4 days	9	29.99
5-7 days	14	46.67
>7 days	6	19.99

SAMPLE CRITERIA:

Inclusion Criteria:

The mothers of preterm newborns admitted in NICU

The mothers of preterm newborns who are all willing to participate in the study.

Exclusion Criteria:

Preterm infants at very high risk

The mothers of neonate who are not present at the time of data collection.

Those who do not know Tamil and English.

Those who are not willing to give consent for participation in the study.

DESCRPTION OF TOOLS:

SECTION A:

It consist of demographic variables including age of the mothers, education of the mothers, occupation of the mothers, family monthly income, residence, religion, number of children, admission condition, number of days hospitalized.

SECTION B:

The three point likert scale was developed to assess the level of stress among motherss of preterm newborns admitted in NICU.

SECTION C:

The three point likert scale was developed to assess the level of coping strategies of motherss preterm newborns admitted in NICU.

ANALYSIS AND INTERPRETATION:

SECTION-I: Demographic variables of the samples

Table I: Reveals the frequency and percentage distribution of demographic variables of motherss of preterm infants, by considering the age majority of age group is 21-25yrs (53.33) with the regards of educational qualification majority of them in SSLC (39.99%), by seeing the religion all of them belongs to the hindu (53.33%), by seeing the occupational status all of the motherss are housewife (43.34%), by seeing the area of residence most of them coming from urban (59.99%) rest of them from rural place, by seeing number of children the majority is two (53.33),by seeing admission condition the majority is medical (66.67),by seeing number of days hospitalized the majority is 5-7 days (46.67).

Table-II: Frequency and percentage wise distribution of level of stress among motherss of preterm newborns admitted in NICU

LEVEL OF STRESS	STRESS
	F	%
Mild stress	1	3.33
Moderate stress	19	63.33
Severe stress	10	33.33
Total	30	100

Table –II reveals the level of stress among motherss of preterm infants, in that. 3.33% of motherss have under mild stress, 63.33%, of motherss were with moderate stress and 33.3%. Motherss were with severe stress.

TABLE – III: Frequency and percentage wise distribution of level of coping strategies among mothers of preterm newborns admitted in NICU

Level of coping Strategies	Coping
Level of coping Strategies	F	%
Mild coping	3	9.99
Moderate coping	20	66.67
Poor coping	7	23.33
Total	30	100

TABLE – III: reveals the level of coping strategies among motherss of preterm newborns in that 9.99% of motherss were with mild coping, 66.67%, were with moderate coping and 23.22% were with poor coping.

TABLE – IV :Mean, SD, mean % of stress and coping strategies among motherss of preterm infants admitted in NICU

	STRESS			COPING STRATEGIES
	Mean	SD	Mean%	Mean	SD	Mean%
Overall	91.80	5.45	306	96.23	7.96	320

Table V: Association of level of stress among mothers of preterm neonate admitted in NICU with selected demographic variables.

DEMOGRAPHIC VARIABLES	Mild stress		Moderate stress		Severe stress		χ2	P
DEMOGRAPHIC VARIABLES	f	%	f	%	f	%
1)Age of mothers in year
Below 20-30	0	0	3	10	2	6.66	4.67 (df=3)	0.1976
21-25	1	3.33	10	33.33	5	16.66
26	0	0	5	16.66	2	6.66
>30	0	0	0	0	2	6.66
2)Education status :
No formal education	0	0	2	6.66	1	3.33	8.834 (df=3)	0.0315
Primary school	0	0	3	10	4	13.33
HSC	1	3.33	9	30	3	10
Undergraduate	0	0	5	16.66	2	6.66
3)occupation:							4.5307 (df=3)	0.2095
House wife	0	0	9	30	4	13.33
Government employee	0	0	4	13.33	4	13.33
Private employee	1	3.33	5	16.66	2	6.66
Others	0	0	1	3.33	0	0
4)monthly income:							5.12 (df=3)	0.1632
Rs<1000	0	0	4	13.33	1	3.33
Rs 1001-2000	0	0	4	13.33	2	6.66
Rs 2001-3000	0	0	2	6.66	4	13.33
Rs>3000	1	3.33	9	30	3	10
5) Area of residence :
Rural	0	0	10	33.33	8	26.66	2.49 (df=1)	0.1145
Urban	0	0	10	33.3	2	6.66	2.49 (df=1)	0.1145
6) Religion
Hindu	0	0	13	40.3	3	10	5.97 (df=3)	0.1130
Christian	0	0	4	13.33	6	20
Muslim	0	0	2	6.66	0	0
Other	0	0	1	3.33	1	3.33
7) Number of children
One	0	0	8	26.66	5	16.66	1.553 (df=2)	0.4600
Two	1	3.33	10	33.33	4	13.33
Above three	0	0	11	3.33	1	3.33
8) Admission condition:
Medical	1	3.33	13	43.3	6	20	0.73 (df=2)	0.6941
Surgical	0	0	6	20	4	13.33
Other	0	0	0	0	0	0
9) Number of hospitalized:
<2 days	0	0	1	3.33	1	3.33	5.82 (df=3)	0.1207
2-4 days	0	0	4	13.33	4	13.33
5-7 days	0	0	10	33.33	4	13.33
>7 days	1	3.33	4	13.33	1	3.33

Table VI: Association for level of coping strategies among mothers of preterm infants admitted in NICU with selected demographic variables.

DEMOGRAPHIC VARIABLES	Mild stress			Moderate stress		Severe stress	χ2
DEMOGRAPHIC VARIABLES	f	%	f	%	f	%
1)Age of mothers in year							3.65 (df=3)	0.301
Below 20-30	0	0	3	10	2	6.66
21-25	2	6.66	12	40	2	6.66
26	1	3.33	4	13.3	2	6.66
>30	0	0	1	3.33	1	3.33
2)Education status :							7.70 (df=3)	0.0526
No formal education	1	3.33	1	3.33	1	3.33
Primary school	0	0	7	23.3	0	0
HSC	1	3.33	9	30	3	10
Undergraduate	1	3.33	31	10	3	10
3)occupation:							5.57 (df=3)	0.1339
House wife	2	6.66	8	26.6	3	10
Government employee	1	3.33	5	16.66	2	6.66
Private employee	0	0	7	23.3	1	3.33
Others	0	0	0	0	1	3.33
4)monthly income:
Rs<1000	1	3.33	2	6.66	2	6.66	3.48 (df=3)	0.3233
Rs 1001-2000	0	0	4	13.33	2	6.66
Rs 2001-3000	1	3.33	4	13.33	1	3.33
Rs>3000	1	3.33	10	33.33	2	6.66
5) Area of residence :							3 (df=1)	0.0832
Rural	1	3.33	11	36.6	6	20
Urban	2	6.66	9	30	1	3.33

6) Religion							7.86 (df=3)	0.0489
Hindu	2	6.66	11	36.66	3	10
Christian	1	3.33	7	23.3	2	6.66
Muslim	0	0	0	0	2	6.66
Other	0	0	2	6.66	0	0
7) Number of children							7.26 (df=2)	0.0265
One	3	10	6	20	4	13.33
Two	0	0	13	43.3	2	6.66
Above three	0	0	1	3.33	1	3.33
8) Admission condition:							1.97 (df=2)	0.3734
Medical	3	10	12	40	5	16.66
Surgical	0	0	8	26.6	2	6.66
Other	0	0	0	0	0	0
9) Number of hospitalized:							1.65 (df=3)	0.4090
<2 days	0	0	2	6.66	0	0
2-4 days	0	0	6	20	2	6.66
5-7 days	2	6.66	8	26.6	4	13.33
>7 days	1	3.33	4	13.3	1	3.33

*-p<0.05 significant, ** -p<0.01 and ***-p<0.001 Highly significant

Table-VI:

The chi-square test revealed that there is statistically significant association between selected demographic variables such as religion, number of children. But there is no significant association between variables such as age, occupation, income, residence, educational status of mothers, admission condition, number of days hospitalized.

CONCLUSION:

A descriptive study was undertaken at selected hospitals of Puducherry, where data was collected from 30 mothers to assess the level of stress and coping strategies. The collected data were analyzed using descriptive and inferential statistics.

MAJOR FINDINGS IN THE STUDY:

Out of 30 motherss higher percentage of 19 (63.33%) had moderately stress, 10 (33.33%) had severe stress, 1 (3.33%) had mild stress. Higher percentage of 20 (66.67%) had moderately coping, 7 (23.33%) had poor coping, 3 (9.99%) had mild coping.

NURSING IMPLICATIONS:

The health of nation is the wealth of the nation. Today’s children are tomorrow’s adults. Among the life span of the childhood period, neonatal period is very crucial. The neonatal period determines to a large extent, the overall health status of the child and in turn adult life. Birth is manor challenge to the newborn to negotiate successfully from intrauterine to extauterine life of a newborn baby is considered to be tiny and powerless, completely dependent on other for life.

NUSRSING PRACTICE:

Several implications can be drawn from the present study for nursing practice. Instructional teaching programme conducted by nursing personnel, both in hospital and community helps to enhance the knowledge of postnatal motherss about newborn care an helps to reduce the stress and promote coping.

NURSING EDUCATION:

Since today’s nursing student are tomorrows staff nurses, educators, administrators and supervisors, this study has great implications in nursing education. Nursing teachers should emphasize the importance of health education and the method of imparting education in an effective was during the training period of students.

Student should be provided with adequate opportunities in developing skills in handling such clients and how to identify their difficulties and help them to promote comfort and wellbeing.

NURSING ADMINISTRATION:

The nurse administrator needs to take interest in providing information on health care of newborn baby. The nurse as an administrator, should plan and oragize CNE programme for the nursing personnel and motivate them in conducting instruction teaching programs regarding newborn care. Planning and organization of such programmer requires efficient team work, planning for man power, money, material, method and time to conduct successful instructional teaching programmes..

NURSING RESEARCH:

Research provides nurses needs credibility to influence decision making policy and protocol formulation regarding interventional strategies to meet the specific need for education motherss of neweborn babies regarding newborn care.

RECOMMENDATIONS:

Even through the level of stress and coping strategies of mothers of neonate admitted in NICU some specific research has to be carried out in future such as:

1. Similar study can be conducted in other parts of the country with a large sample.

2. The same study can be conducted in community settings.

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Received on 28.09.2016 Modified on 21.12.2016

Int. J. Adv. Nur. Management. 2017; 5(1): 45-50.

DOI: 10.5958/2454-2652.2017.00010.5