Purpose

The present study aimed to identify relationships between nursing practice in family-centered care (FCC), and individual nurse attributes and ward organizational climate, which are predicted to be related to nursing practice in a neonatal intensive care unit (NICU).

Methods

A self-reported questionnaire was conducted among 1,700 nurses in the NICUs of 43 perinatal medical centers in Japan. We performed exploratory factor analyses on an FCC scale for nursing practice and a ward organizational climate scale, and we performed a multiple regression analysis with nursing practice in FCC as the dependent variable.

Results

From the 1,700 questionnaires distributed, 771 responses were collected (response rate: 45.4%), of which 764 were eligible for analysis. The participants’ mean age and mean clinical experience were 32.6±8.4 years and 9.9±8.1 years, respectively.

The factor analyses defined five factors to form the FCC scale for nursing practice: 1) provision of general information, 2) provision of support to enhance parent–child bonding, 3) display of interpersonal sensitivity, 4) treatment of people with respect, and 5) provision of specific information about the child. The ward organizational climate scale consisted of five factors: 1) team work among nursing staff, 2) team work between nurses and physicians, 3) approval and support from a nurse manager, 4) opportunities for decision-making about care policies of the ward, and 5) approval and support from senior staff. Organizational climate in the ward was positively correlated with nursing practice in FCC (Pearson's r=0.382, p=0.000) and job satisfaction (r=0.428, p=0.000). Multiple regression analysis revealed that ward organizational climate (β=.293, p<.001), job satisfaction (β=.199, p<.00), and years of clinical experience (β=.184, p<.00) were related to nursing practice in FCC.

Conclusion

Both the FCC scale for nursing practice and the ward organizational climate scale had a five-factor structure and satisfactory reliability. The results suggest that both scales can be used for nurses, including for improvement of continuous nursing staff education. The organizational climate in the wards that individual nurses belong to was the most strongly related factor to nursing practice in FCC, followed by job satisfaction and years of clinical experience.

Purpose

Many newborns often have skin problems resulting in parents generally becoming anxious regarding these conditions. However, the risk factors for skin problems among newborns are not well understood. This study aims to determine the prevalence and such risk factors, especially those that may be potentially associated with diaper dermatitis, seborrheic eczema, and prickly heat among newborns.

Methods

This study combined data from two different researches. The first was an observational study conducted among parents, whose newborns were delivered in a single hospital between May and July 2012. The other was an interventional study related to skincare, which was conducted among parents and their newborns, who were born between March 2014 and February 2015. We analyzed the data of 325 parents. Both researches were conducted on parents of 1-month-old infants, using a self-administered questionnaire. The questions included those related to the presence of skin problems in the newborns that were observed by their parents, including diaper dermatitis, seborrheic eczema, and prickly heat. In addition, data from medical records, including the newborn's sex, family history of atopic dermatitis, gestational age, birth weight, and external factors, which could lead to skin disorders like, season at birth, and frequency of stool, were included. The association between each skin problems (diaper dermatitis, seborrheic eczema, prickly heat) and characteristics of neonates was assessed using multiple logistic regression.

Results

The prevalence of skin problems was 65.5% (n=213), of the skin problems, diaper dermatitis was 33.5% (n=109), seborrheic eczema was 32.3% (n=105), prickly heat was 16.9% (n=55).

The risk factors for diaper dermatitis in newborns were determined as high frequency of stool (AOR=1.19, 95% CI: 1.09–1.30) and male sex (AOR=1.70, 95% CI: 1.04–2.77). The risk factor for seborrheic eczema was a long gestational age (AOR=1.05, 95% CI: 1.02–1.08). Lastly, newborns who were born during spring (AOR=9.34, 95% CI: 1.17–74.90) and summer (AOR=18.97, 95% CI: 2.44–147.44) were at higher risk of prickly heat than those born in winter. In addition, weight gain in the first month after birth was also a risk factor of prickly heat (AOR=1.03, 95%Cl: 1.00–1.06).

Conclusion

We identified the risk factors for skin problems among newborns. These results can help in developing guidance for skincare, which needs to be individualized, depending on the risk factors.

Purpose

Support for child-rearing mothers is an important issue to be addressed, but few studies have longitudinally examined changes in the physical and mental conditions of mothers who are the recipients of such support. This study aimed to clarify on a continuous basis the physical and mental conditions of mothers of children in Japan in order to determine factors that affect confidence in child-care among mothers.

Methods

We surveyed, with appropriate ethical considerations, 700 mothers of three-month-old children using a self-reporting questionnaire, and performed follow-up surveys at the 18-month and 36-month points. We surveyed confidence in child-care (presence/absence), the short-form Child-care Happiness Scale (three subscales), the short-form Child-care Stress Scale (three subscales), and the cumulative fatigue symptoms index (seven subscales), and data were statistically analyzed.

Results

Of the 700 mothers, 297 (42.4%) participated in all three surveys. Mean age of mothers at three months after delivery was 32 years. “Child-care happiness” and “appreciation towards the husband” were lower and “bonding with the children” was higher when the children were three-months, 18-months, and 36-months old. With respect to child-care stress, “lack of support from the husband” was high, and “fatigue of mind and body” decreased with time. No significant change was observed for “child-care anxiety.” Within the CFSI, “general fatigue” was lower and “irritation” was higher when the children were three-months and 36-months old, and “depression” was higher when they were 18-months old. While confidence in child-care among mothers did no significantly change up to when the children were 36-months old, it was consistently associated with the effects of “Child-care happiness” and “child-care anxiety” on child-care confidence.

Conclusion

As children grew, bonding between the mother and children strengthened, and while fatigue decreased, other types of child-care stress and cumulative fatigue increased. Thus, contrary to the child's development, the mental and physical conditions of mothers deteriorated. In midst of the wavering relationship with and support from the husband, our findings highlight the importance of support that increases mothers' confidence in child-care as their children grow.

Purpose

This study aims to compare the changes in bone mass, mineral density, and metabolism that occur during pregnancy between women aged ≥35 and those aged ≤34.

Subjects and methods

Pregnancies were categorized as follows: 1st stage (≤23 weeks), 2nd stage (24-35 weeks), and 3rd stage (≥36 weeks). The subjects were 42 healthy pregnant women at ≤23 weeks of gestation (n=42). The pregnant women were divided into older (≥35, n=19) and younger groups (≤34, n=23), regardless of their parity. The sound of speed (SOS) was assessed as a measure of bone mineral density during every regular prenatal checkup until ≥36 weeks' gestation. The urinary levels of deoxypyridinoline (DPD) and calcium (U-Ca) were evaluated twice (at the 1st and 3rd stages) as measures of bone metabolism. Data analysis was performed using the t-test and one way repeated ANOVA; the significance level was set at 5%.

Results

There were significant differences in age and birth history between the two groups, but no differences in height, weight, or pre-pregnancy weight were observed.

In the evaluation of cross-sectional changes, the SOS tended to decrease from the 1st stage through the 3rd stage (older group: p=0.12, younger group: p=0.05). The change in the older group was larger than that in the younger group, but the difference was not significant. Even in the assessment of longitudinal changes, SOS decreased from the 1st stage through the 3rd stage, and the degree of change in the older group was large.

The urinary DPD level of the older group was significantly lower than that of the younger group (p=0.02), and its tendency to decrease from the 1st to 3rd stage was more marked in the older group (older group: p=0.1, younger group: p=0.38).

The Ca/Cre of the older group tended to decrease from the 1st to 3rd stage and was significantly higher in the 1st stage. However, the Ca/Cre of the younger group increased slightly.

Conclusion

(1) The bone mineral density of the older group tended to decrease during pregnancy, and the change was much greater in the older group than in the younger group. (2) In the older group, little bone resorption occurred, and bone formation did not increase after birth because of the large amount of Ca being lost from bone, so it can be said that prengancy probably causes a reduction in bone density in such patients. Health guidance aimed at maintaining bone density should take account of the age and living conditions of pregnant women.

Objectives

The objectives of this study were: 1) to investigate the relationship between satisfaction with the birth experience and early postnatal depression among women who had had a cesarean delivery; and 2) to determine factors that influence maternal satisfaction with the birth experience.

Participants and Methods

We conducted a survey at 22 obstetrical institutions in A and B prefectures. The research participants were 362 postpartum women who had had a cesarean delivery. The questionnaires were self-administered. Completed questionnaires were returned by post or were left at the participating institutions. The survey items included: the basic attributes of the participating women; maternal satisfaction with the birth experience following cesarean delivery, as assessed by the Scales for Measuring Maternal Satisfaction (SMMS, Japanese version); the status of early postpartum depression, as evaluated by the Edinburgh Postnatal Depression Scale (EPDS); self-esteem, as measured by the Scale for Self-esteem (Japanese version); and maternal attachment, as measured by the Maternal Attachment Questionnaire (MAQ). The relationships between the SMMS score and EPDS score and/or the participants' basic attributes were analyzed using t-tests and one-way analysis of variance. Multiple regression analysis was used to investigate factors influencing maternal satisfaction with the birth experience.

Results

The overall response rate was 83.1% (301 of 362 women). Of those who completed the survey, 130 (44.2%) were primiparae with a first cesarean delivery, 139 (47.3%) were multiparae with two or more cesarean deliveries, and 25 (8.5%) were multiparae with a first cesarean delivery. There were more elective cesarean deliveries (70.4%, n=207) than emergency cesarean deliveries (29.6%, n=87). The mean SMMS score was 169.5. In total, 247 women (84.0%) were satisfied with the cesarean birth experience (the satisfied group; SMMS score ≥147). The mean EPDS score was 6.88. The mean EPDS score of the satisfied group was significantly lower than that of the group who were dissatisfied with the cesarean birth experience (the dissatisfied group; SMMS score ≤146) (p=0.003). A comparison of SMMS score by basic attributes showed no significant difference for all attributes, including cesarean delivery mode (planned or emergency). The MAQ score was the only factor identified as significantly influencing the SMMS score (p<0.001).

Conclusion

Our study suggests that there is a relationship between satisfaction and postnatal depression status among women who experience a cesarean birth. This was deducible from the significant difference in the EPDS scores registered by the two groups, i.e., the satisfied group and the dissatisfied group. We also found that maternal attachment was the only factor contributing to maternal satisfaction with the birth experience. In conclusion, it is important that midwives provide women the opportunity for reviewing the birth experience and continuous support after leaving hospital. In addition, earlier skin-to-skin contact and breastfeeding is recommended in the postpartum care for women experiencing cesarean births. These measures may lead to an improvement in maternal birth experience.

Purpose

This study aimed to examine the family resilience during the period up to discharge of the baby from the neonatal intensive care unit on the basis of the narratives of both parents of very low and extremely low birth weight infants.

Participants and Methods

We conducted semi-structured interviews and participant observations in 8 married couples (16 individuals) who had a very low and extremely low birth weight infants (<1500 g). The interpretative phenomenological analysis was used in this study.

Results

During the period up to discharge of their babies, families of a very low and extremely low birth weight infants advanced toward a sense of reconstruction, while taking one step forward and one step backward from the shock, through three-phase changes: the phase of confusion and perturbation by the sudden shock, the phase of integrating reality and unreality, and the phase of family-life reconstruction for the baby. Furthermore, with regard to family resilience throughout this process, the following 6 themes within brackets were observed.

Concerning feelings of their partner, parents chose their words carefully, and through thoughtful 【emotional interactions】, they deepened their mutual understanding. Furthermore, to 【break free from a preoccupation that “it is not a normal baby”】, parents accepted their reality and accepted their baby as who he/she is and as “our baby.” This indicated that 【fostering family ties by accumulating shared time】 is important, which led to positive feelings toward the baby were developed through interaction. Moreover, 【social exchanges with people the parents who became acquainted with through connections in the local community】 gave rise to empathy, which alleviated solitude, and created an opportunity to obtain necessary knowledge and resources. As the day of discharge was approaching, 【adjusting one's identity as a parent】 while making 【lifestyle compromises to prioritize the baby】 helped to reconstruct the family toward establishing a unique lifestyle that suited their own family inclusive of the baby.

Conclusion

It was suggested that the six family resilience found in the present study facilitated smooth interaction between the parents, and were necessary strengths to progress towards reconstruction of the family unit to include a baby. Results indicated that it is important that nurses focus on the strengths of the parents through conversations and their relationship, and then provide support that enables such strengths to be exhibited and promoted in the natural process of becoming a parent.

Purpose

The necessity of support for a mother's internal factors has been suggested in parenting support. This study focuses on the internal factors of the temperament in mothers and attachment-caregiving balance scale with the aim of examining that relationship.

Methods

A self-administered questionnaire was given to mothers during the 1-month infant health check-up, the city's 6-month infant health consultation, and the 1½-year-old infant check-up. A multi-way analysis of variance was conducted on the relationship among 6 factors of the attachment-caregiving balance scale, maternal attributes, and 6 temperaments.

Results

There were 923 questionnaires collected (collection rate: 61.5%), and 794 valid responses (valid response rate: 86.0%) were analyzed. There was a lower tendency toward attachment factors than caregiving factors in the 6 attachment-caregiving balance factors, while a moderate-to-high correlation was seen among 3 attachment and 3 caregiving factors. No difference was seen in attributes in the distribution of the 6 temperaments. Excluding the “introversion temperament,” there was a relationship with 5 of the temperaments in the attachment factors of “adaptation/attachment,” “sensitivity/attachment,” and “intimacy/attachment.” In the caregiving factors, “adaption/caregiving” and “sensitivity/caregiving” were related to the neuroticism temperament. For “intimacy/caregiving,” a significant relationship in reciprocal action was seen in tenacity and persistence temperaments within birth history. Primipara with a high expression of both tenacity temperament and persistence temperament had low “intimacy/caregiving” compared to mothers with low expression. Multipara with a high expression of the tenacity temperament conversely had high “intimacy/caregiving,” and no significant difference was seen in the persistence temperament.

Conclusion

The relationship between the temperament and attachment-caregiving balance in mothers caring for infants was clarified. In caregiving factors, based on the relationship with a high expression of temperaments other than the introversion temperament, this study suggests that perceiving highly expressed temperaments and providing support accordingly will promote development of the caregiving system and link to parenting support. Since the neuroticism temperament is also related to caregiving factors, support for mothers with a high expression of the neuroticism temperament is especially desirable.

Purpose

This is to verify that if the motivational interviewing (hereafter referred as to “MI”) is applied to pregnant women who gave up smoking due to pregnancy and had maintained non-smoking for 12-18 months post-pregnancy, it maintains their non-smoking until four months after childbirth comparing with other normal care and it increases their self-confidence.

Subjects and Method

The subjects were the women who were visiting seven medical facilities regularly and gave up smoking 12-18 weeks after pregnancy. A non-randomized controlled trial was used for the survey. The support for maintaining non-smoking by MI was conducted to the intervention group of 38 subjects 22-27 weeks after pregnancy, 34-37 weeks after pregnancy, when they were discharged from hospital after delivery, a month after delivery and four months after delivery, five times in total. The comparison group of 19 subjects received no-smoking support that is normally practiced. The primary evaluation item was the measurement of CO concentration in exhalation conducted 22-27 weeks after pregnancy and four months after delivery, and the secondary evaluation items were the importance of non-smoking and self-confidence conducted 12-18 weeks after pregnancy and four months after delivery and scores were grasped. An χ² test, Wilcoxon signed rank test, and effect size were used for data analysis. This research was conducted with the approval of an Ethics Committee.

Results

Subject tracking rate of the intervention group was 55% and that of comparison group was 89%. Regarding the characteristics of the subjects, there was a significant difference in family structure only between both groups and there was no significant difference in other items. The number of subjects who were able to maintain non-smoking were 17 out of 21 from the intervention group and 12 out of 15 from the comparison group. The χ² test for independence was p=.63, so there was no significant difference. As for the differences in the scores for confidence of the intervention group and comparison group, the difference of the intervention group was significant at p=.002, and a great effect size of r=−.68 was confirmed. The difference of the comparison group was p=.06, so there was no significant difference, and a moderate effect size of r=−.48 was confirmed.

Conclusion

Conducting MI for the women who give up smoking during pregnancy was not effective in their maintaining non-smoking. Meanwhile MI showed an increased effect to their confidence in maintaining non-smoking.

HUG (Help-Understanding-Guidance) Your Baby is an international program, developed by Jan Tedder, a family nurse practitioner from North Carolina, USA. This award-winning program presents the newborn's body languages to new parents and shows them the skills for taking care of their newborn thus allowing them to enjoy the child-raising period. This paper introduces the Japanese version of the “HUG” program. Collaborating with Tedder, the researcher who developed the original “HUG” program, we translated the English program to Japanese then back translated to English thereby confirming the content validity. The materials we translated were: slides used in the program, a leaflet explaining the two “HUG” skills, a leaflet for helping effective breastfeeding, and a DVD that explains the newborn's behavior and the skills we introduce in the program. The “HUG” program consists of the following items: introduction of the two skills to help child-rearing, (understanding the newborn's state and understanding the newborn's Sign of Over-Stimulation), how to respond to the newborn's Sign of Over-Stimulation, cues for effective breastfeeding, and understanding the two sleep cycles. In the last part, we use swaddles and baby dolls and practice the effective way to calm a fussing or crying baby. We also invite a mother or father who is already raising a child to share their difficulties, challenges, and hints for child-rearing with participants. In the program we give the participants handouts and a HUG DVD that explain the skills we presented in the program so that they can utilize it at home whenever needed. Now we are gathering outcome data to measure the achievements of the program aims. By examining these outcomes, we will be able to consider and modify the contents of the Japanese “HUG” program for a better fit with Japanese parents.