A Father-friendly Neonatal Intensive Care Unit

Study Overview
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Brief Summary
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An early parent-child relationship is important for a child's development, both intellectually and socially. The admission of premature or ill newborns to neonatal intensive care units (NICUs) may make the establishment of the parent-child relationship challenging due to parents' anxiety and despair. Traditionally, most healthcare professionals have mainly focused on infants and mothers, even though fathers often feel stressed, powerless, and helpless, and find it difficult to establish a father-child relationship. The aim of this study is to investigate the effect of a father-friendly NICU on infants, parents and staff.

Detailed Description
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An early parent-child relationship is important for a child's development, both intellectually and socially. The admission of premature or ill newborns to neonatal intensive care units (NICUs) may make the establishment of the parent-child relationship challenging due to parents' anxiety and despair. Traditionally, most healthcare professionals have mainly focused on infants and mothers, even though fathers often feel stressed, powerless, and helpless, and find it difficult to establish a father-child relationship. The aim of this study is to investigate the effect of a father-friendly NICU on infants, parents and staff. The study was conducted in 3 steps A baseline measurement Development and implementation of the intervention a father friendly NICU After measurement Different questionnaires were used: The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) The Nurse Parent Support Tool (NPST) A questionnaire intended to measure nurses self-efficacy (SE). The study was approved by the Danish Data Protection Agency (No 19/20297) and the procedures were in accordance with the Helsinki Declaration. In accordance with the Danish law, this study did not need to be reviewed by an ethics committee.

Official Title
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What Effect Does a Father-friendly NICU Have on Children, Parents, and Staff?

Conditions
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Stress, Self Efficacy, Perception, Self

Intervention / Treatment
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* Behavioral: The father-friendly NICU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: fathers/mothers with infants admitted to the NICU were eligible nurses who work in Danish NICUs Exclusion Criteria: fathers/mothers who did not understand verbal and written Danish fathers/mothers of critically ill newborn infants fathers of newborn infants whose mother was critically ill fathers/mothers of newborn infants admitted to the NICU from home. nurses without patient-contact, on maternity- or long-term sickness-leave
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: A before- and-after intervention study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Father-friendly NICU<br>Fathers have skin-to-skin contact with their infants Fathers participate in important situations Fathers receive information and guidance directly Both parents participate in meaningful conversations The department organize mother and father groups The families have the opportunity to have a close family member to support them Older siblings have the opportunity to stay overnight. The department offer counseling by a social worker | Behavioral: The father-friendly NICU<br>* Fathers have skin-to-skin contact with their infants Fathers participate in important situations Fathers receive information and guidance directly Both parents participate in meaningful conversations The department organize mother and father groups The families have the opportunity to have a close family member to support them Older siblings have the opportunity to stay overnight. The department offer counseling by a social worker<br>|
| No Intervention: No Father-friendly NICU (baseline)<br>Baseline - before implementation of the intervention | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stress (The Parental Stressor Scale: Neonatal Intensive Care Unit) | The primary outcome was the difference in the overall stress score, determined using the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) score in both the control and intervention groups. Fathers were asked to rate their stress related to particular situations on a 5-point Likert scale, ranging from 1 (not at all stressful) to 5 (extremely stressful). Fathers who had not experienced a particular situation on an item indicated this with a not relevant response. The maximal score was 5, a high score indicating a high level of paternal stress. | Measured on admission to the NICU (during the first 3 days of hospitalization), at the 14th day of hospitalization , and at the day of discharge from the NICU (up to 1/2 year) | 
| Parental Support (The Nurse Parent Support Tool) | The primary outcome was the difference in fathers' perception of received staff support in the control group compared to the intervention group. The questionnaire included four dimensions of nurse support: 1) communication of information related to the infant's condition and care (nine items), 2) support mainly directed to enhance parental role (four items), 3) emotional support to help parents cope with their infant's sickness (three items), and 4) caregiving support concerning the quality of care provided to the infant (five items). For each item, the parents indicated the degree of support on a 5-point Likert scale ranging from 1 (never) to 5 (always) 19. | Measured on admission to the NICU (during the first 3 days of hospitalization), and at the day of discharge from the NICU (up to 1/2 year) | 
| Nurses self-efficacy (Self-efficacy (SE)) | The primary outcome was the difference between the nurses' SE scores for father and mother questions in the intervention group in comparison with the control group The nurses were asked to evaluate own ability to guide and support the parents in different situations (Self-efficacy score). The SE score was rated on a scale ranging from 1, indicating Not at all sure, to 10, indicating Definitely sure. | Before the start of the development of the intervention (August 2011) till 18 months after the implementation of the intervention (January 2015) | 
| Self-efficacy follow-up | The primary outcome was the difference between the nurses' SE score on father and mother questions from after the implementation of the intervention to five years after. The nurses were asked to evaluate own ability to guide and support the parents in different situations (Self-efficacy score). The SE score was rated on a scale ranging from 1, indicating Not at all sure, to 10, indicating Definitely sure. | After the implementation of the intervention (January 2015) to five years after (February 2021). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mothers, Father, Intensive Care Units, Neonatal, Parental support, Stress, Self-efficacy, Nurse, Participatory reseach, Masculinity