Date of Award

2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Shannon Phillips

Second Advisor

Julie Barroso

Third Advisor

Nicholas Forand

Abstract

Problem: The hospitalization of their infant in the neonatal intensive care unit (NICU), regardless of the circumstances, is stressful and shocking. Parents find themselves unprepared and on an emotional rollercoaster. Parents are at risk for depression, anxiety and PTS- the effects of which can be lasting and can adversely affect the relationship between the parents in the dyad, and their ability to bond with, and parent their child. Parents have little influence over their circumstances and need information from staff in order to appraise their situation and determine how to cope. Methods: A scoping review of parents’ mental health in the NICU within the social ecological model, utilizing the Arksey and O’Malley framework, was conducted to establish the breadth of the problem. Then, an integrative review of qualitative studies of parents’ experiences in the NICU within the transactional theory of stress and coping utilizing the Whittemore and Knafl framework was conducted. Finally, a descriptive qualitative study examined the experience of parent dyads in the neonatal intensive care unit, using the transactional theory of stress and coping as a framework. Results: The scoping review of parents’ mental health in the NICU included 26 studies and revealed that this distress is a cluster of symptoms (anxiety, acute stress, in some cases depression) that is eased or exacerbated by multiple factors, at multiple levels of the SEM. The integrative review of qualitative studies of parents’ experience in the NICU included 16 studies and resulting themes included emotional upheaval and faith, and subthemes of the NICU environment and learning to parent, as factors that affect how parents appraise and cope with stress, and whether or not they adapt successfully. In the final qualitative descriptive study, nine themes from eight dyad interviews emerged and were categorized within the six domains of the transactional theory of stress and coping. The major themes were: Deeply Distressing, Unexpected and Unprepared, Expecting to Hear and Be Heard, Becoming Parents, Stronger Together, Support is Key, Parents Want Better Communication, and Adjusting to the NICU. Implications for Practice and Research: Support from professionals and family, and clear and consistent communication from the treatment team helped alleviate parents’ anxiety about their infant. Research regarding the impact of a NICU hospitalization on the relationship between parent dyad members, specifically longitudinal studies, may lead to a better understanding of the long-term effects of this specific stressor on parents.

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