Date of Graduation

2015

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Adult Health

Committee Chair

Susan McCrone

Committee Co-Chair

Nan Leslie

Committee Member

Judi Polak

Abstract

Background: Nearly half a million premature infants are born in the United States each year. The majority of infants born prematurely are admitted to neonatal intensive care units (NICU) for specialized care. Clinical problems related to parental stress due to preterm birth and NICU admission extend beyond feelings of simple stress by parents to that of helplessness, insufficient knowledge, decreased bonding, depression, and the potential development of Post Partum-Post Traumatic Stress Disorder. Furthermore, these clinical problems can extend to the child. Decreased bonding can cause the child to have clinical and subclinical anxiety disorders; and may further equate to future chronic illness, adult psychopathology, and even impact their child's role as a caregiver. The literature supports the effectiveness of educational interventions, including the COPE (Creating Opportunities for Parent Empowerment) program in decreasing the level of maternal stress of mothers of preterm/NICU infants.;Objectives: The overall objective was to evaluate the effectiveness of a practice change using an adapted version of COPE phase one in decreasing stress in gravid women aged 18 years and older at who were at risk of preterm delivery and admitted to an inpatient high-risk obstetrical unit. Patients who receive the adapted COPE phase 1 written materials were evaluated for anxiety, depression, and expectations of preterm infants.;Design: The study used a quasi-experimental prospective before and after design with a convenience sample of gravid women admitted to a high-risk inpatient obstetrics unit. Data was collected pre and post intervention using the State Trait Anxiety Inventory (STAI), Edinburgh Postnatal Depression Scale (EPDS), and the NICU Parental Beliefs Scale (NICU PBS).;Subjects: Thirty women were enrolled in the study and all thirty completed both pre and post testing. The mean age was 26, with a range of 18 to 38. The majority was Caucasian (93%) with an average gestational age of 311/7 weeks, and a gestational range of 280/7 to 345/7 weeks. The length of stay or hospital admission of the women varied from 2 days to 70 with the average being 15 days, and about 50% of the woman revealed experiencing some type of financial strain due to their hospitalization.;Results: In regard to the STAI, there was a significant difference in the scores for pre state (M=42.73, SD=13.444) to post state (M=33.90, SD=10.532) STAI scores; t (29)=5.794, p=.000. The pre trait scores had a mean of 36.80, and a SD of 9.936.;These results suggest that the adapted phase one COPE intervention did have an effect on maternal anxiety. Only four participants scored 13 or greater on the EPDS pre test, indicating depression. Two of these women already had a preexisting diagnosis of depression prior to admission. Post test only two participants scored 13 or greater. Although the majority of participants (26 pre/28 post) did not meet a score for diagnosis of depression there was a significant difference in the scores for pre (M=7.30, SD=5.167) and post EPDS (M=5.43, SD=4.337) scores; t (29)=2.937, p=.006. These results suggest that the adapted phase one COPE intervention did have an effect on factors that can contribute to maternal depression. The NICU PBS demonstrated a significant difference in the scores from pre (M=64.77, SD=15.206) and post intervention (M=75.27, SD=8.839) scores; t (29)=-3.846, p=.001. These results suggest that the adapted phase one COPE intervention did have an effect on maternal beliefs and expectations.;Conclusion: This capstone demonstrated that an existing program (NICU COPE) could be easily adapted to the obstetric inpatient setting, instead of waiting until the point of premature birth and actual NICU admission. As the length of stay of the participants in this capstone averaged 15 days, it shows that there is a missed opportunity for mothers to not only be educated, but to also decrease their anxiety and contributors to depression during this stressful time in their life.

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