We have nominated this evaluation for exceptional quality. It exemplifies approaches that are rare in maternal and newborn healthcare:

• The intervention was designed and delivered to engage with both mothers and fathers equally as individuals and catered for the fact that their needs may be different.
• In families with unequal roles (a clear primary and secondary carer), the secondary carer was specifically encouraged to engage.
• The results of the research were carefully analysed and reported by gender, in order to reveal different responses by mothers and fathers.

Since 2015, we have nominated 12 reports as exceptional out of a total of 282.

An evaluation of a neonatal Parent Participation Improvement Program in Seoul, South Korea, has found improvements in how mothers and fathers experience partnership with nurses and attachment with their infants. 66 families were assigned in equal numbers to an intervention group and a control group that received the standard care already available at the neonatal unit.

The Parent Participation Improvement Program consisted of three stages:

• Stage 1: ‘individualised interaction’. Nurses worked with individual mothers and fathers to identify issues impeding their experience of neonatal care. An agreement was reached about the parent’s goals for the next stages. These concerned issues like feeding, breastfeeding, bathing, clothing, holding and knowing baby signals.
• Stage 2: ‘pre-participation’. During three one-hour sessions, the mothers and fathers were provided with information on the topics they identified in stage 1. They learned about the environment of the neonatal unit, the equipment, baby signals and preterm babies’ sleep cycles. They were informed about the importance of their participation.
• Stage 3: ‘active participation’. Six practical sessions were organised on the unit, covering issues raised by the parents earlier, for example, changing diapers, breastfeeding, soothing, kangaroo care, bathing, clothing, singing and talking. If one of the parents was a clearly primary carer, the other was required to participate in at least three of the sessions.
• Post-intervention. Parents recorded their activity, thoughts and feelings and reported on their levels of knowledge and proficiency in a booklet. Nurses gave feedback to the parents.

The researchers illustrate the process with one example: “For example, in the individualized interaction stage, parents would talk to their nurse about wanting to feed their babies themselves but would express that they did not know how to and did not have opportunities. To solve this issue, parents and nurses would set a mutual goal for the parents to become proficient at feeding. After setting the goal, education and practice would be provided. In the pre-participation stage, parents would learn about and practice the appropriate posture for feeding, how to monitor the baby’s breathing and sucking patterns during feeding, how to cope appropriately with problems, and how to interact effectively with the baby during feeding. Then, in the active participation stage, parets would be able to feed their baby without nursing intervention. The nurse, however, would be present to encourage and closely monitor the interaction. After the active participation stage ended, the parents would record the experience in the booklet, and the nurse would help to maintain safe and effective parent participation by giving them feedback.”

The intervention was designed to facilitate parent-nurse communication and negotiation of priorities. When evaluated this was found to be successful. The mothers and fathers in the intervention group reported higher partnership with nurses, particularly in the first three of the following measures:

• higher assessment of the quality of the nursing and how nurses speak to and help parents
• sensitivity of the nurses to the baby and to the parents
• more care in how parents talk and interact with nurses
• more reciprocity / working together – mutual respect, understanding, listening trust, information sharing
• greater collaboration with nurses – shared goals, more equal relationship
• more sharing by nurses of information about the baby

Meanwhile, a measure of parent-baby attachment showed both mothers and fathers reporting better attachment.

“I was relieved that the nurse kept reminding me that I was doing well, and I was able to participate in the care more actively with confidence.”

“Through the program, I got used to caring for my baby, singing songs and playing with him without knowing how much time had passed.”

“I was most afraid of feeding him with the bottle, but soon I was proud of myself as I got better day by day, and I felt the baby getting used to me.”

“I gained confidence that I could do something for my baby as a parent and felt I was necessary for my baby.”

Two gender differences were observed.

In the first stage of the intervention, the goals of mothers tended to be more specific than those of fathers, and fathers tended to focus more on basic care, such as soothing, feeding and holding babies safely. Fathers often expressed feelings of being less experienced in care relative to mothers.

When the evaluation scores of mothers and fathers were compared, the researchers found that fathers’ rating of attachment to the baby increased more than mothers’ did, and that mothers’ rating of parent-nurse partnership increased more than fathers’ did.

Heo YJ & Oh W-O (2019), The effectiveness of a parent participation improvement program for parents on partnership, attachment infant growth in a neonatal intensive care unit: A randomized controlled trial, International Journal of Nursing Studies 95

Header photo: Hypnotica Studios. Creative Commons.