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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 199-205

The effect of home visit on anxiety of mothers with preterm infant discharged from neonatal intensive care unit


1 Department of Pediatric and Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Department of Pediatric and Neonatal Intensive Care Nursing, Nursing Faculty, Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Social Determinants of Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Date of Submission26-Sep-2020
Date of Decision24-May-2021
Date of Acceptance27-May-2021
Date of Web Publication28-Jul-2021

Correspondence Address:
Naiire Salmani
Nursing Faculty, Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.jcn_156_20

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  Abstract 


Context: After being discharged from hospital, most preterm infants need to receive treatments such as gastric gavage, oxygen therapy, apnea control, and medication. Mother's unpreparedness to care for their infants causes anxiety for them. Aims: The purpose of the present study was to investigate the effect of home visit on anxiety of mothers having preterm infant discharged from neonatal intensive care unit (NICU). Settings and Design: This was a experimental control group study on 50 mothers with preterm infant discharged from NICU of Shahid Sadoughi Hospital, an educational hospital with 30 beds in a city in the west of Iran in 2019. Subjects and Methods: Participants with a convenience sampling were randomly assigned in the experimental and control groups. In the experimental group, home visit was done on the 3rd and 5th days after discharging the infants, and the mothers received necessary instructions proportional to their needs. Data collection tools included demographic information and Spielberger State-Trait Anxiety Inventory. Statistical Analysis Used: The findings were analyzed by SPSS 20 software using Kolmogorov–Smirnov, independent t-test, and Chi-square. Results: The mean ages of the participants in the intervention and control groups were 30.59 ± 6.38 and 28.67 ± 5.05 years, respectively. There was no significant difference between the mean obvious and hidden anxiety in the two groups (P > 0.05) before the intervention. However, after the intervention, the mean obvious and hidden anxiety in the experimental group was lower than the mean of the control group, and this difference was significant (P < 0.001). Conclusions: Home visit is effective in decreasing anxiety in mothers of preterm infant who have been discharged from NICU.

Keywords: Anxiety, home visit, mother, neonatal intensive care unit, preterm infant


How to cite this article:
Beigy S, Salmani N, Khodayarian M. The effect of home visit on anxiety of mothers with preterm infant discharged from neonatal intensive care unit. J Clin Neonatol 2021;10:199-205

How to cite this URL:
Beigy S, Salmani N, Khodayarian M. The effect of home visit on anxiety of mothers with preterm infant discharged from neonatal intensive care unit. J Clin Neonatol [serial online] 2021 [cited 2022 Aug 14];10:199-205. Available from: https://www.jcnonweb.com/text.asp?2021/10/3/199/322525




  Introduction Top


Nowadays, preterm birth has increased in many countries all over the world. Fifteen million preterm infants are born every year.[1] They need special cares for normal growth and survival.[2] Hence, after birth, preterm infants become hospitalized in neonatal intensive care unit (NICU) depending on birth age (weeks or months). They may face different problems such as cerebral palsy, respiratory problems, vision problems, hearing loss, and digestive problems.[3]

Therefore nowadays, in order to decrease the complications and hospitalization costs, efficiently use hospital beds, prevent hospital infections, and decrease the period of parent–infant isolation, it is tried to discharge infants from NICU in a short time.[4]

Whereas after being discharged, most preterm infants need to receive treatments such as nasogastric tube, oxygen therapy, apnea monitoring, and medication therapy. They become affected by some complications, and caring for them at home requires awareness of their situation.[5] Furthermore, in spite of the infants' improved health and stable condition, they will experience instability after being discharged and going home.[6]

Meanwhile, when infants are discharged from hospital, mothers have to care for the infant alone. Their challenges in their new role can put them under pressure of a lot of stress.[7] Mothers are emotionally traumatized and their unpreparedness to care premature infant at home causes anxiety and doubts about the competence of care management,[8] decreased sense of confidence in the ability to care for the baby.[9] At discharge, they express their fears about the baby's condition and express their lack of self-confidence by saying, “My baby is very weak, he goes home with medical equipment, medicines and needs specialist's visit.”[10]

The mothers' anxiety and concerns gradually increase and finally lead to unpreparedness to care for their infant after being discharged, decreased quality of caring, the infant's growth disorder, disordered mother–infant relationship, negative mutual effects on parents, the mother's continuous stress, long-term effects on the infant's behavior,[11] and eventually rehospitalization.[12]

In fact, mothers with an infant discharged from NICU face a lot of unanswered questions about caring for their infant at home. Due to lack of other people's support, mothers are continuously worried.[13] They face various needs, and postdischarge follow-up should be done for them until the infant's improvement.[14]

In this regard, home visit has been defined as the most important postdelivery service strategy for checking the mother–infant relationship. Furthermore, it can keep the health-care providers' contact with families for evaluation of the mother and infant's needs,[15] promotion of the health condition, and education of behavior change.[16]

In this way, there is a good opportunity for communicating with families and being aware of their situation; also, health-care providers can provide families with the necessary educations based on their expressed needs, and so, they help families to have an independent contribution in facilitating the conditions.[17]

In order to provide home visits for mothers with a preterm infant discharged from hospital, the visit should be done in the first 7 days after being discharged, so that families can better adapt to the new conditions created by the entrance of a preterm infant to home. In the first few days, parents experience a sense of in confidence and insecurity, and such emotions create anxiety in them.[18]

Review of literatures suggests that few studies have investigated postdischarge interventions, especially home visit, and most studies have not investigated the infant-related consequences. Sakaki et al. trained mothers after discharge of term infants born by cesarean section by home visit. The visits had a positive effect on feeding the infant by only breast milk.[19]

Akbariyan et al. phoned mothers over the first 4 weeks after the preterm infants' discharge from NICU. They provided the mothers with necessary educations about nutrition, bathing, massage, diaper replacement, etc., This intervention was effective in decrease of the infants' rehospitalization.[20]

Peyqhambar Doust and Fadaei reported the effect of home visit on development indicators for newborns with low birth weight,[21] and Peyqhambar Doust et al. reported the effect of home visit on growth indicators in newborns with low birth weight.[22]

However, few studies have investigated postdischarge follow-up of preterm infants, the needs of mothers having a preterm infant, and appropriate interventions for mothers based on their conditions; whereas, it is considered as an important responsibility for health-care providers to facilitate the parents' preparedness in postdischarge stages.[23] The process of follow-up should continue after the infant's discharge and at home,[24],[25] and nursing staff is primarily responsible for taking discharge actions.[26] Hence, postdischarge follow-up actions are necessary to be done by nurses.[27] This research is aimed at investigating the effect of home visit on anxiety in mothers with preterm infant discharged from NICU.


  Subjects and Methods Top


This was a experimental control group study on 50 mothers with preterm infant discharged from NICU of Shahid Sadoughi Hospital, an educational hospital with 30 beds in a city in the west of Iran in 2019.

Detailed methodology

Based on Ghodrati et al. study,[28] using the formula of “comparing two independent society” and the standard deviation of the mothers' anxiety scores (S = 10.5), at the significance level of 50% and test power of 80%, 22 samples were needed for getting a significant difference in the mean anxiety score (at least by 10).

Regarding the 10% dropout of the sample size, 25 samples were assigned to each of the experimental and control groups. Participants with a convenience method were randomly assigned to the experimental and control groups. A total of 50 participants who have preterm infants discharged from NICU ward were selected and equally randomized into two groups of intervention and control using random allocation software. There was no blindness in this study.

The inclusion criteria included: having preterm infant discharged of NICU, the birth age of 28–36 weeks, no congenital anomaly such as neural tube defects, digestive or cardiac disorders, Iranian nationality, being native to Yazd, Persian speaking, willingness to participate in the study, and literacy (the ability of reading and writing).

The exclusion criteria included: mothers with twins or more infants discharged, mothers with a record of preterm birth and infant's hospitalization in NICU, and mothers receiving psychiatric treatments.

Dropout criteria included: mother or infant's death after attending the study, mothers' withdrawal from participation, the infant's rehospitalization, unpredictable and stressful incidents such as occurrence of a disease for the mother and other family members, accident, and death.

Questionnaires

Data collection tools were demographic questionnaire (the infant's fetal age, gender, birth weight, discharge weight, discharge age, mother's age, mother's education, mother's job, birth rank, and type of delivery) and Spielberger State-Trait Anxiety Inventory used for measuring mothers' anxiety.

Anxiety inventory was designed by Spielberger in 1970, and it was revised in 1983. Spielberger State-Trait Anxiety Inventory consists of 40 items; the first 20 items measure state anxiety, and the second 20 items measure trait anxiety. State (obvious) anxiety scale includes 20 items measuring the person's emotions “at the moment of answering the questions.”

Trait (hidden) anxiety scale includes 20 items measuring the person's general and usual emotions. In the trait anxiety scale, there are some choices for each item, and the subjects should choose the one that describes their emotions in the best form. These choices include: (1) very little, (2) little, (3) much, and (4) very much. The score weights are reverse for the items implying no anxiety.

As some items are scored in a reverse manner, the subject's total score of each scale is obtained by the sum of 20 items. Hence, the scores of each of the state and trait anxiety scales can range from 20 to 80. Spielberger anxiety inventory has a high validity, and it has been recognized as a standard test.[29]

Validity of this scale was first approved by Mahram (1994) in Iran, and its reliability has been checked in terms of norm and criterion. In terms of norm, the scale reliability for obvious and hidden scales has been, respectively, obtained as 0.9084 and 0.9025.[30]

Intervention

Data collection began after receiving ethics code approval (IR.SSU.REC.1398.151) from the Vice Chancellor for Research of Shahid Sadoughi University of Medical Sciences, Yazd. The researcher introduced herself to mothers during a visit to the NICU of Shahid Sadoughi Hospital, outlined the aims of the study, and explained the procedure. After obtaining the written consent, the mothers in the experimental group were asked to fill demographic and anxiety questionnaires in a quiet room without any noise.

The researcher went to their home on the 3rd day after discharge of the infants. In this home visit, the researcher asked the mothers some questions about caring for their infant and their problems in the first 3 days after discharge of their infant (breastfeeding, finger feeding, vomit, massage, bathing, medication therapy, etc.). Then, based on the mothers' needs, awareness, and skill in caring for their infant, they received the required educations. Furthermore, their caring skills were recognized, and the probable deficiencies were modified; in the case of the need to receive advice, the mothers were referred to a doctor. The second home visit was done on the 5th day after discharge, and educational supports were provided again.

In the control group, the subjects filled demographic and anxiety questionnaires at the time of discharge, and the control group received no intervention in the 1st week after discharge. In this period, the subjects cared for their infant in accordance with the educations they had received. On the 7th day after discharge, the researcher performed home visit again, and anxiety questionnaire was filled again.

It is noteworthy that from the control group, five mothers and, from the experimental group, three mothers due to the infant's rehospitalization were excluded from the study.

Statistical analysis

The statistical analysis was performed using the descriptive statistics, Kolmogorov–Smirnov (to determine the normality of the variables), Chi-square test, and independent t-test. All analyses were carried out in the SPSS software, version 23 (IBM corporation, Armonk, NY, USA). Significance level was set at 0.05.


  Results Top


According to the results of Kolmogorov–Smirnov test, the obtained data had a normal distribution and parametric tests were used for data analysis. There was no significant difference between the two studied groups in terms of the mother's age, education, job, birth rank, the infant's fetal age, gender, birth weight, discharge weight, discharge age, and the type of delivery [Table 1] and [Table 2].
Table 1: Comparison of quantitative variables in the two studied groups

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Table 2: Comparison of qualitative variables in the two groups

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The mean state anxiety score before the intervention was found as 52.94 ± 8.05 and 53.85 ± 4.02 in the experimental and control groups, respectively. In this regard, the results of the independent t-test showed no significant difference (P = 0.6), and the mean state anxiety was at a moderate level in both the groups [Table 3].
Table 3: Comparison of mean and standard deviation of mothers' anxiety in the two groups before and after the intervention

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However, a significant difference was observed between the two studied groups in terms of the mean state anxiety after the intervention (P < 0.001), so that the mean state anxiety was at a moderate level in the control group and at a mild level in the experimental group [Table 3].

Independent t-test did not show any significant difference between the two studied groups in terms of the mean trait anxiety before the intervention (P < 0.2), and the mean trait anxiety was at a moderate level in both the groups, but the mean trait anxiety score after the intervention was found as 48.20 ± 3.57 and 32.31 ± 5.54 in the experimental and control groups, respectively. In this regard, the results of the independent t-test showed a significant difference (P = 0.001), so that the mean trait anxiety was at a moderate level in the control group and at a mild level in the experimental group.


  Discussion Top


This research has aimed at investigating the effect of home visit on anxiety of mothers with a preterm infant discharged from NICU. Before the intervention, the mothers in both the groups had a moderate level of anxiety at the time of their infant's discharge, and there was no significant difference between the two groups. As a consistent study, Keyvanfar et al. investigated the mothers' mood 3–4 days before the preterm infant's discharge, and they reported a high level of anxiety, stress, and depression.[31]

In fact, being discharged from hospital is considered as a stressful situation. Parents feel to be happy on the one hand and concerned and worried on the other hand.[32] They think about caring for their newborn alone at home for long hours and lack of support and making mistake in caring for their newborn intensify their anxiety and fear.[33]

Morais et al. performed a qualitative research about the experiences of mothers with preterm infants about the process of discharge from NICU and home care. They reported that mothers feel a lot of worry at the time of discharge, because they perceive their newborn as a vulnerable creature and the newborn's little body creates a sense of unpreparedness to care for them. As they are not aware of the way of recognizing and meeting their newborn's needs and also the harming conditions, their concerns become intensified.[34]

The findings suggest that home visit has been effective in decrease of anxiety in mothers of the experimental group after the intervention, so that the anxiety level has decreased from moderate to mild, and a significant difference was observed between the experimental and control groups. As a consistent study, Keyvanfar et al. investigated the effect of presence of a companion nurse at the time of the infant's discharge and going home on mothers' mood; the results suggested improvement of the mothers' mood (decreased anxiety, stress, and depression).[31]

Ericson et al. investigated mothers with a preterm infant discharged from hospital; they supported them by calling them for 14 days after their discharge. The results suggested the increased sense of capability and security in the mothers.[35]

In a support program, Neyestani et al. provided education and advice sessions and also phone consultation for mothers with a preterm infant from the time of the infant's hospitalization in NICU until a week after discharge. They studied the mothers' quality of life, and they found increased quality of life in all dimensions; the observed difference was significant in psychological dimension.[36]

In a qualitative study, dos Santos et al. investigated the mothers' experiences of the two home visits (the first visit was done a few days before the infant's discharge to check the home environment, conditions, and facilities, and the second visit was done 7 days after the infant's discharge to help the parents cope with new conditions). The mothers claimed that home visit is an effective way of decreasing the sense of fear, anxiety, and insecurity; also, they stated that this program had encouraged them to better care for their newborn and continue that.[37]

Since the findings of the present study are consistent with the results of different studies, it can be concluded that home visit program seems to affect achieving family needs, leading to positive changes for both parents and children.[38] Parents and newborns are checked in home visits, their problems are recognized, and they receive the necessary guides to solve their problems; also, nurses provide the necessary supports in a family-based platform.[39]

Furthermore, nurses play a facilitating role in development of a sense of independence in mothers, and they strengthen the sense of capability in mothers.[40] Mothers consider home-visiting nurses as a source of hope and help. They review their previous learning in the presence of nurses and make sure they are done correctly.[36]

This study had some limitations. One of the research limitations was sampling method. The samples were selected from one educational hospital in Yazd. Regarding the difference between the process of discharging the patients in educational and noneducational hospitals, it is suggested to conduct future studies in different hospitals.

Loss of samples in both the groups, which reduced the number of samples also available sampling, prevents the generalization of the results. Therefore, it is recommended that further studies be performed by random sampling with a larger number of samples. Indeed, short duration and low number of home visits were other limitations, so one of the recommendations to be considered in the future studies is study with more number of sessions and spend more time in home visits.


  Conclusion Top


The results showed a significant difference on maternal anxiety between control and experimental group, it can be concluded that home visits in the first week after the discharge of premature infant from the neonatal intensive care unit can be reducing anxiety and it help improve mothers' mental health.

Acknowledgment

This paper is derived from a research project approved by Shahid Sadoughi University of Medical Sciences in Yazd. The authors appreciate the cooperation of the Research Deputy of Shahid Sadoughi University of Medical Sciences, the dear NICU staff, and the mothers participating in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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