The Effect of Nursing Counseling Perceived Stress, Coping and Birth Outcomes Among Pregnant Women
Condition: Preterm Birth
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      Aim: The aim of this study is to determine the effect of the Pregnant Nursing Education and
      Counseling Program (HEGDAP), which is structured on the Neuman Systems Model, on the
      perception of stress, coping with stress and birth outcomes in pregnant women with preterm
      labor risk.

      Method: This study was conducted with 60 pregnant women at risk of preterm labor, including
      30 experimental and 30 control, non-randomized double-blind pregnant women using pretest,
      interim follow-up and posttest. Data were collected using a personal information form,
      Perceived Stress in Risky Pregnancies Questionnaire, Ways of Coping with Stress Scale and
      Birth Outcomes Evaluation Form. Nursing counseling based on Neuman's System Model was applied
      to the intervention group. Data were evaluated using analysis methods such as t-test,
      chi-square, etc.
    

Detailed description: 
      Although pregnancy is a physiological condition involving homeostatic adaptations, it is also
      a process that can subject pregnant women to stress and vulnerability. Pregnant women
      experience stress due to various factors such as bodily changes, hormonal fluctuations,
      physical symptoms, concerns about parenting, relationship issues, fear of childbirth, and the
      health of their baby. Risky pregnant women, compared to non-risky pregnant women, experience
      even more intense stress related to their own health and the health of their babies. The
      stressors faced by risky pregnant women include being diagnosed with a risky pregnancy,
      experiencing an unwanted pregnancy, encountering signs of danger during pregnancy, negative
      thoughts related to the baby, hospitalization, fear of childbirth, adolescent pregnancies,
      marital problems, lack of social support, economic concerns, and postpartum problems.
      Perceived stress during pregnancy can lead to negative birth outcomes such as preterm labor,
      spontaneous abortion, neonatal malformation, low birth weight, and prenatal developmental
      delay. Pregnant women reporting high stress have a 25% to 60% increased risk of preterm birth
      compared to those reporting low stress. A study found that pregnant women perceiving high
      stress during pregnancy were twice as likely to experience premature labor and twelve times
      more likely to give birth to a low birth weight baby. Another study showed that stressed
      pregnant women give birth an average of one and a half weeks earlier than healthy pregnant
      women. Stress is considered a modifiable factor that contributes to preterm birth, and
      eliminating its negative effects can help reduce the rate of preterm birth due to maternal
      stress.To cope with the stress associated with a risky pregnancy, it is crucial for pregnant
      women to utilize coping mechanisms they have used in the past and learn new coping
      strategies. However, 27.4 percent of pregnant women in Turkey feel that their ability to cope
      with stress is inadequate. It is recommended that nurses provide training and counseling to
      help pregnant women at risk of preterm birth cope with stress more effectively. Encouraging
      participation in stress-reduction programs that provide specific information, education, or
      relaxation methods is important for pregnant women at risk, and counseling should be provided
      toward the end of the second trimester. Nurses can contribute to better health outcomes for
      both the mother and the baby by supporting the use of appropriate stress-coping methods in
      high-risk pregnant women. In addition to addressing the individual information needs of
      nurses, systematic training and consultation on nutrition, rest, activity, sexual life, fetal
      growth and development, potential complications, and fetal movement monitoring should be
      provided to reduce the stress levels of pregnant women at risk of preterm birth. It is
      believed that structuring the training and counseling program based on nursing theory will
      enhance the benefits provided.

      This research is conducted based on the nursing theorist Neuman's Systems Model (NSM), which
      focuses on concepts such as stress, coping with stress, and the environment. The Neuman
      Systems Model offers a holistic approach to care, going beyond the traditional concept of
      illness. It emphasizes interdisciplinary approaches to disease treatment, prevention, health
      education, and health promotion. No previous studies were found that monitored the results of
      providing training and counseling to pregnant women at risk of preterm birth using the Neuman
      Systems Model. This study aims to present an innovative approach to reducing perceived
      stress, improving stress coping, and supporting positive birth outcomes in pregnant women at
      risk of preterm labor by implementing the Pregnant Nursing Education and Counseling Program
      (PNECP) structured on the Neuman Systems Model.
    

Intervention name(s): NPECP based on NSM
Intervention type(s): Other
Intervention description(s): A comprehensive training booklet which integrated NPECP and NSM principles was sent to five experts for their evaluation and feedback. Among these experts, one was a physician who specialized in obstetrics and gynecology while the remaining individuals were nurses. Group training sessions were conducted online, with each group comprising 4-6 participants. These sessions spanned four weeks, with each session being held weekly and lasting for approximately 60-90 minutes. The training covered various topics - including pregnancy, pregnancy-related changes, pregnancy danger signs, premature birth, stress, stress symptoms, stress coping strategies, childbirth, the postpartum period and the challenges of parenting (particularly when dealing with a pre-term baby)
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Risk of Preterm Labor; Neuman Systems Model; Stress; Coping with Stress; Birth Outcomes