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Brief Reports Indian Pediatrics 2003; 40:772-775 |
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Impact of Bed Side Communication with Fathers on Their Anxiety About Newborn |
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Harmesh Singh, Daljit Singh, Puneet A. Pooni, *R.K. Soni From the Neonatal Division, Department of Pediatrics and Department of Community Medicine*, Dayanand Medical College & Hospital, Ludhiana (Punjab), India. Correspondence to: Dr. Harmesh Singh Bains, 18-E, Tagore Nagar, Ludhiana 141 001, India. E-mail: [email protected] Manuscript received: October 22, 2002; Initial review completed: November 13, 2002; Revision accepted: February 28, 2003.
Anxiety, Bed side communication, Fathers, Sick neonates. The greatest needs of parents while their infant is in Special Care Neonatal Unit (SCNU) include to be near the baby, receive honest information, and believe that their child is receiving the best possible care. The usual barriers for visitation of parents are staff attitudes and misconceptions of parental needs(1,2). Anxious parents can present a challenge to pediatricians. The major sources of anxiety in the parents of sick neonates include morbidity, mortality, unfamiliar environment and insufficient information about condition of baby, treatment and hospital procedures(3). In western countries and some units in India both the parents are allowed to visit in the SCNU but at many centers in India only mothers are allowed. Data on parental stress during various procedures and surgery are available(4,5), but there is paucity of literature regarding impact of fathers visit in SCNU and bedside communication on their anxiety. Therefore the present study was conducted to determine whether bedside communication with father in SCNU reduces their anxiety and also to evaluate whether father’s presence was helpful to them; and/or harmful to nurses. Subjects and Methods The study and control group comprised of 100 fathers of admitted newborns in each of the two units of the Department of Pediatrics. The informed consent was taken from all of them. The fathers in the two groups were explained and requested to complete a questionnaire available in English as well as local language (Punjabi). The patients with stay less than 7 days and inconsistent availability of father were excluded. The questionnaire consisted of items related to age, occupation, education and rating of fathers anxiety about their child and the effects of their presence on themselves, doctors and nurses. In the control group the items regarding the effect of their presence in the SCNU on them, doctors and nurses were eliminated. The anxiety levels were measured using the 5 points Likert’s Scale on day 1 (at admission) and day 7. The fathers in the study group were allowed to see the baby daily and were communicated about clinical condition of the baby, procedures, treatment and progress. They were requested to wash hands and put on gowns before entering the unit. Fathers in the control group were not allowed inside the SCNU and were explained about the condition of the baby, procedures, treatment and progress outside the unit. Mothers had free access to SCNU in both the groups. After 7 days the questionnaire of survey was repeated in both the groups. Another questionnaire given to staff nurses was primarily related to their views on the effect of father’s presence on their working and also on parents. Mann Whitney test was applied to find the significance of data obtained wherever applicable. Results The majority of fathers in the study group (68%) and controls (74%) were in the age group of 20-30 years. The occupations in the two groups were agriculture, business, teacher and professionals. Education levels were primary (study 20%, controls 27%), secondary (study 49%, controls 48%), graduates (study 16%, controls 13%) and postgraduates (study 15%, controls 12%). The birth weight, diagnoses and outcome were comparable in both the groups. Low birth weight babies comprised 66% in the study group and 70% in the controls. Primary diagnoses were sepsis, hyperbilirubinemia, birth asphyxia and respiratory distress. Hospital stay of more than 10 days was 27% in the study group and 21% in the controls. The mortality rate in the study group and controls were 12% and 14% respectively. At the time of admission there was no difference in the level of anxiety between the study group and controls (p >0.05). There was a statistically significant difference (P<0.01) in the level of anxiety between the study and control group at 7 days (Table I). This indicates that father’s visit and bed side communication in SCNU significantly reduced their anxiety about the newborn. When compared within the group, the anxiety in the fathers of study group was significantly less (p <0.01) at 7 days than at admission. In the control group there was no such significant difference. Eighty seven of the hundred fathers found their presence helpful to themselves (78 very, 9 somewhat) and 78 had similar feelings for nursing staff (65 very, 13 somewhat). 98% fathers liked the visit to SCNU. All the staff nurses found fathers visit helpful to them (13 very, 3 somewhat); all of them indicated that allowing father in SCNU was an appropriate policy. There was no significant difference noted in response of nurses based on their years of experience. TABLE I Comparison of Anxiety Between Study and Control Group
*P > 0.0 5, Mann Whitney Test: (non-significant),** P < 0.0 1, Mann Whitney Test: (significant). Discussion The study assessed the impact of bedside communication on the father’s anxiety and its change over time. Fathers in study group showed a decrease in anxiety from day 1 to day 7 whereas in the controls anxiety remained fairly constant during this period. Tiedeman(6) also found decrease in anxiety of fathers overtime during and after the hospitalization of their 5 -11 year old children. Cameron et al.(7) observed that there were benefits for the parents to be present during anesthetic induction(7). Powers and Rubenstein(9) studied the impact of family presence on parental anxiety during invasive procedures in the Pediatric Intensive Care Unit and found a significant reduction in anxiety related to the procedures (p = 0.005). However, parental presence did not change the condition related anxiety (p = 0.90). Thirteen of the 16 parents in the Power study(8) felt that their presence during the procedure was helpful to them as well as to the medical staff. The respective figures in the present study were 86% and 78%. All the nurses in our study also felt that father’s visit was helpful to them. It is apparent that bedside communication with fathers can have positive effect for them. Research suggests that anxiety may be reduced when parents are sufficiently informed. The communication of accurate information may diminish anxiety because it enables parents to anticipate events and allows for accurate expectations(9). Results of our study suggest that communication at bed side reduces anxiety to a greater extent which may be because of better psychological satisfaction. Contributors: HS was the principal investigator and co-ordinator. He was responsible for the conception, study design, analysis and interpretation of the data and preparation of the manuscript. He will act as a guarantor for this article. DS helped in the study design, interpretation and preparation of the manuscript. PA helped in the literature search and designing of the manuscript. RKS helped in the analysis and interpretation of data and critical review of the manuscript. Funding: None. Competing interests : None stated.
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