Early intervention care programme for parents of neonates

Curationis 28(3): 54-63 Parents with neonates in the neonatal intensive care unit (NICU) experience different needs at different stages of their neonates’ stay in the NICU. The needs of parents with neonates in NICU’s play an important role in aspects such as the ability to cope with changing parental roles and emotions, the relationship between parent and infant and the managing of the parents’ own needs. The aim of this study was to develop an intervention care programme for parents with neonates in the NICU. This intervention care programme will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and after discharge from the NICU / hospital. Literature is available on care programmes for neonates, but not on programmes for the parents o f neonates in NICU. The study was a multi-phased study, using qualitative methodologies to determine the needs of South African parents with neonates in level III NICU’s. In phase I, the needs of parents with neonates in NICU were elicited qualitatively. The needs were identified from the data and the results led to the implementation of phase II. In phase II the question was adjusted and new data was collected. Phase III was implemented to validate the data derived from phases I and II. The data was categorised in different need categories and these categories were used to plan an intervention care programme for parents with neonates in NICU’s. The programme provides information to address needs as identified by parents in the research study and as derived from the literature. Need categories identified from the study and literature were as follows: information, communication, emotional, learning, discharge and individual needs. This programme is available in electronic format to enable parents to obtain information according to their changing needs and to provide unlim ited access to updated information. The “Early intervention care programme for parents of neonates” will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and'after discharge from the NICU / hospital.

neonate, m aar nie oor program m e vir die ouers van neonate nie.
Hierdie studie was 'n multi-fase studie, w at g e b ru ik g e m a a k h e t v an 'n kwalitatiewe navorsingsontw erp om die behoeftes van S uid-A frikaanse ouers met neonate in vlak III N IS E 's te bepaal.In fase I is die behoeftes van ouers van neonate in NISE kw alitatief bepaal.Die behoeftes is geïden tifiseer vanuit die data en die resultate het gelei tot die implementering van  Die "Intervensiesorgprogram vir ouers met neonate" sal die ouers bem agtig om hul eie behoeftes en die van hul neonaat te hanteer, terwyl die neonaat in die NISE opgeneem is, en ook na ontslag uit die N ISE/hospitaal.introduction E x p ec tin g a b a b y s u p p o s e s th e expectation o f a norm al b irth and a normal infant.According to Younger, K endell and P ic k ie r (1 9 9 7 :3 0 ) the transition to m otherhood is a norm al developmental crisis.Therefore adapting to parenthood is an emotional experience for new parents.A lthough it brings change, experiencing a normal forty-week pregnancy leaves room for adapting to these emotional and role changes.
Expecting a healthy neonate and then being c o n fro n te d w ith a n e o n a te ad m itted to a N IC U is not o n ly an adaptation fo r the p a re n ts to a new situation; it is a nerve-racking experience.A c c o rd in g to S h e lla b a rg e r and Thom pson (1993:39), parents must cope w ith intense and confusing em otions during the crisis of premature parenthood.These emotions stem from the following circumstances: • An unexpected delivery Giving birth to a premature neonate is a stressor and has additional emotional and psychological effects on the parents.D ealing with the loss o f the expected healthy neonate is an overw helm ing psychological adjustment for the parent (Shellabarger & Thompson, 1993:39).
T h e n e e d s o f p a re n ts m ay d iffe r according to the illness o f the baby, the length o f stay in the N ICU and other factors.For the purpose o f this study the research er focussed on N IC U in Tshwane.

Clarifying definitions
N IC U : Neonatal intensive care unit I>evel III NICU: Specialist NICU with specialised equipment for management o f very ill patients.Full time specialist nursing and medical staff available.

Problem statement
The researcher experienced that parents w ith n e o n a te s in N IC U e x p e rie n c e fluctuating emotions and needs.Due to a lack of knowledge regarding the care of their neonates, these parents were not empowered to manage the needs of their neonates or their own needs, while the neonate was still admitted to the NICU and after discharge from the NICU or hospital.
According to Dreyer (2000:14) parents are initially shocked by the appearance o f th e ir n e o n a te .T h e y are th e n * confronted with feelings o f fear, and worries about the neonate's survival or life lo n g p h y s ic a l o u tc o m e .An overwhelming psychological adjustment for the parent is dealing with the loss of th e e x p e c te d h e a lth y n e o n a te .In addition parents have feelings of guilt in sp ite o f re a s s u ra n c e .T h e N IC U environment can also be described as a tra u m a tic stresso r.The n e e d s and stressors mentioned are not the problem as such, but the problem is that parents o f neonates in NICU are not empowered to manage their own needs or the needs o f their neonate while adm itted to the NICU or after discharge.
A t p re s e n t n e o n a ta l su p p o rtiv e developm ental care is im plem ented in some neonatal units in South Africa, with p o s itiv e o u tc o m e s m o stly fo r the neonates.H ow ever there is still no intervention care program m e for the p arents w ith neonates in the N IC U .Parental needs are neglected and parents are not involved in the decision making o f their infant's care.Parents are not equipped and empowered to care for their neonate when it is time to take their baby home.

Research aim
The aim of this study was to develop an intervention care programme for parents w ith neonates in level III N IC U 's in private hospitals in Tshwane.

•
To explore the needs o f parents with neonates in N IC U 's regarding the care of their infant and their own personal needs  1996:42;Strydom, 2000:25-27) from hospital and unit managers, as well as the parents with • neonates admitted to the NICU A description of the study was given to the hospital and/or nursing services managers in the form of a proposal (Strydom, 2000:30) Respondents were informed that they would not be exposed to any physical or emotional • harm (Strydom, 2000:25) through the consent form they filled out (Babbie and Mouton, • 2002:522) Anonymity and confidentiality was assured (Babbie &Mouton, 2002:523-524 andBrink. 1996:45).Respondents were asked to complete a naïve sketch anonymously.Any identifying information that was accidentally included on the • naïve sketch was removed and all naïve sketches were numbered before handed to the co-coder Participation in the study was voluntary and respondents were informed that they might withdraw from the study w henever they wanted to (Babbie & Mouton, 2002:521) Negative findings were reported if related to the analysis (Babbie & Mouton, 2002:526) Unexpected findings were also reported (Babbie & Mouton, 2002:526) The limits of the findings were indicated at the conclusion of the study, as well as the methodological constraints that determined the validity o f such findings.Findings were fully reported and results were not misrepresented in any manner (Babbie & Mouton, 2002:526) No data or observations were changed under any circumstances (Babbie &

Research design
The study was a m ulti-phased study, u sin g q u a lita tiv e m e th o d o lo g ie s to determ ine the needs o f South African parents with neonates in level III NICU's.
The aim o f this study was to explore and d e sc rib e the n eed s o f p are n ts w ith neonates in the NICU (Babbie & Mouton, 2 0 0 2 :7 9 -8 1 ).To m eet this aim an exploratory and descriptive strategy with a q u a lita tiv e o rien ta tio n was im p le mented. 56

Research method
The stu d y w as p e rfo rm e d in th re e phases.In phase I, the needs o f parents with neonates in N ICU w ere elicited q u a lita tiv e ly u sin g n a ïv e s k e tc h e s com pleted by p arents w ith b abies in NICU.The question asked was " What are y o u r p e rso n a l n eeds con cern in g your involvem ent in the basic care o f your neonate in the neonatal intensive care unit?P lease include any o ther needs you m ay encounter".
The needs were identified from the data using open coding and the results led to the implementation of phase II.In phase II the question was adjusted and new data were collected.

Research method Population
For this study the target population was all the p aren ts w ith a n eo n ate(s) in N IC U 's in level III N IC U 's in private hospitals in Tshwane.The accessible p o p u la tio n w as all the p a re n ts o f n eo n ates in level III N IC U 's o f the selected private h o sp itals w illing to partake in the study.

Sampling
A sam ple will be representative o f the population from which it is selected if the aggregate characteristics o f the sample c lo s e ly a p p ro x im a te th o se sam e a g g re g a te c h a r a c te ris tic s in the population (Babbie & Mouton, 2002:172-173, 2 8 7 ).A cco rd in g to S ch u rin k (2 0 0 0 :2 5 3 ), a sa m p le is se le c te d p u rp o siv e ly and con v en ien tly .The sam ple for this study was selected by including participants in the study until thick description was achieved.That is until no new information was gathered anym ore.A ccording to B abbie and Mouton (2002:172-173,287), an indication for a study in the interpretive (qualitative) paradigm is between five (5) and 20 or 25 respondents, depending on the nature o f the study and the num ber o f tim es d a ta -g a th e rin g te c h n iq u e s w ill be repeated with each respondent.

Target population
The target population was the entire group o f parents that was of interest to the researcher and met the criteria the researcher was interested in studying (Brink, 1996:132).For this study the target population was all the parents with a neonate(s) in NICU's in level III NICU's in private hospitals in Tshwane.The accessible population was all the parents o f neonates in level III N IC U 's o f the selected private hospitals w illing to partake in the study.
There They accom m odated m ore (a bigger num ber), as well as more acutely ill, neonates and were the most accessible to the researcher.

Data gathering
A pilot study was launched to test the q u e stio n p o sed to the re sp o n d e n ts.Naïve sketches were used since this is a self-report technique of data gathering and give the respondents the ability to e x p re ss any n eeds w ith o u t fe e lin g intimidated (Zeelie, 1999:18).
The question asked in the naïve sketches was an open-ended question (Fouché 2000:160) requesting the respondent to describe his / her needs concerning their involvem ent in the basic care o f their neonate in the NICU and to include any other needs they may encounter.An open-ended question approach is more likely to reveal true needs, than a direct question, which often receives an answer which the respondents think is socially desirable (Brink, 1996:160-161).With the analysis o f the results from the pilot study it seem ed that the respondents were not sure o f the meaning o f basic care and therefore the researcher, in 57 Curationis August 2005 collaboration with the research specialist, decided to adjust the question and add some examples of basic care for the main study.Data gathering for phase I and II were done using naïve sketches and in phase III validating of these data were done using a Lickert-scale.

Data analysis
Data was gathered through an openended question and these descriptions were categorised in order to identify concepts on the needs of the parents with n e o n ate s in N IC U .T h e d a ta w as c o lle c te d as w ritte n s ta te m e n tsnonnumeric in nature, which therefore required qualitative analysis.The data was a n a ly se d a c c o rd in g to T e s c h 's approach for data analysis o f a qualitative design (Poggenpoel, 2000:343-344).
To address the issue o f internal validity, the accuracy o f the in fo rm atio n and whether it matches reality, the researcher made use of an independent coder that was asked to validate the decisions made by the researcher (Creswell, 1994:158).Coding checked for reliability by having another person encode the same data and by ch eck in g fo r a g re e m e n t (B rin k , 19%: 192).

Trustworthiness
The criteria for trustw orthiness in this study were credibility, transferability, d e p e n d a b ility an d c o n firm a b ility .T ru stw o rth in e ss w as illu s tr a te d according to G uba's model (Poggenpoel, 2000:348-350).

(a)
Credibility: Credibility establishes how confident the researcher is with the truth of the findings.The study will be considered credible when it p re s e n ts su c h a c c u ra te descriptions that people, who also share that exp erien ce, w ould im m ed iately recognise the description (Sandelowski, as c ite d by S c h u rin k , S c h u rin k & Poggenpoel, 2000:331,349).This was determ ined through reach in g a thick description in the data collection.

(b)
Transferability: This refers to the extent to w hich the findings can be applied in other contexts or with other respondents (Schurink et al., 2000:331,349).Within the qualitative parad ig m , g e n e ra lisa tio n o f re su lts should not be done.The aim o f this study was to provide an understanding o f the n eeds o f p a re n ts w ith n e o n a te s in N IC U 's.It included a few respondents and did not aim to generalise (Babbie & M outon, 2002:274).The obligation for dem onstrating transferability therefore rests on those who wish to apply it to the receiving context (the reader of the study).

(c)
Dependability: An inquiry must also provide its audience with evidence that if it were to be repeated with the same or similar respondents in a sim ilar context, its findings would be similar (Schurink et al., 2000:331,350).A study cannot have credibility w ithout dependability.If credibility can be proved it is n o t n e c e ssa ry to d e m o n s tra te dependability separately.

(d)
Confirmability: C onfirm ability refers to the degree to which the findings are the product of the focus of the inquiry and not o f the biases of the researcher, other m otivations and perspectives (Schurink et al., 2000:331).Qualitative researchers try to increase the worth of the findings by decreasing the distance between the researcher and the informants.In this study the researcher Independent coding was done to ensure trustworthiness.The independent coder for this study was a lecturer in research m ethodology w ho had experience in qualitative research.The independent coder was asked to do open coding.
In this study trustworthiness was proved through the following: • Naïve sketches were obtained past thick description (sandelowski as cited by de vos, 2000:331,349).
• Consensus discussions were held with the independent coder.
• Findings, conclusion and recommendations have been supported by the data.

Results
The study was performed in three phases and the results will be discussed as such.
Phase I: The results obtained from phase I w ere d escribed as needs stated by parents that reached a thick description and in d iv id u a l need s id e n tifie d by parents.
P hase II: On analysis of the data of phase II there were still needs that did not reach thick description.This data supported both individual needs and new needs that were identified by parents with neonates in.NICU.P hase III: Statements that were rated as agreed or definitely agreed with on the L ickert-scale, were regarded as thick descriptions.These statem ents were included in the data that was used to categorise and conceptualise.
A summary of the needs and categories as derived from the research data are given in table 1.

Discussion of results with justification from the literature
Literature was explored to support the results obtained from the research study and to aid in planning an intervention care plan for parents of neonates.

Information needs
Since parents are still in a state o f shock w hen they first en ter the unit, they suggested that this information should be repeated at a later stage when they feel calm er.T hey also find w ritten re q u e s ts o r in fo rm a tio n e a s ie r to rem em ber, for exam ple provision of nappies.W hen parents are anxious, they may not be able to understand or retain inform ation.It may be nessesarry to repeat information several times.In addition, creative p resen tatio n o f m aterial through visual presentation, videotapes and computers may be helpful (Reichm an, Miller, Gordon & Hendricks-Munoz, 2000:290).Sweeney (1997:65) supported the importance o f access to written information.The need to repeat information and interpret explanations, because of the inability of parents with neonates to rem em ber information the first tim e it is given, is supported by Reichman, Miller, Gordon and Hendricks-Munoz, (2000:290), McKim, as cited by Yssel (1998:18), andShellabarger andThompson (1993:42).

Emotional needs
According to Ruben as cited by Younger, Kendell and Pickier, (1997:30), giving birth during the second trimester of pregnancy results in role confusion for the mother.M others that deliver prem aturely and give birth to premature neonates have been known to also experience increased stress and depression during the early postpartum period.According to Haut, P eddicord and O 'B rien, (1994:19) a premature birth precipitates a crisis for parents, forcing them to redefine and adapt th eir parenting roles.P arents dealing w ith the loss o f an expected h e a lth y n e o n a te n eed to m ak e o v e rw h e lm in g p s y c h o lo g ic a l a d ju s tm e n ts .
W ard and H ay es (2001:282,284) and Trowell and Bower (1 9 9 5 :5 4 -5 7 ), stated that p aren ts o f neonates in the NICU often describe feelings of shock, self-blame, anticipation, despair, pain, helplessness, anger, raised levels of depression and / or anxiety and u ncertainty concerning the n eo n ate's health outcomes, especially during the first week o f hospitalisation.

Communication needs
Parent-neonate separation is inevitable w hen the n eonate req u ires n eo n atal intensive care.Parents are denied to see, touch or hold their neonates before they are taken to the NICU.If they are allowed to see their neonate, it might be for only a few seconds, which do not allow for p a re n t-n e o n a te in te ra c tio n .
T h is separation is extremely painful for the parents, and it greatly increases their anxiety and fear.G rief and loss are very real to these parents.Parents should also be re a s s u re d th a t c o m m u n ic a tio n channels are open to keep them well informed about the current condition of their neonate.D u rin g th e in itia l N IC U v is it com m unication needs are particularly great, because parents must learn a new la n g u a g e , e s ta b lis h tru s t in new relationships, and accept their role in this setting.Parents display a variety o f verbal and non-verbal signs to indicate •that they are struggling to gain a sense of security in the NICU.
During the hospitalisation of the neonate three (3 ) specific communication issues are o f g re a t im p o rta n ce to p a re n ts, namely inform ation sharing, decision m aking and encouraging contact with th e ir n e o n a te -e sp e c ia lly to u c h .A c c o rd in g to S h e lla b a rg e r and T h o m p so n ( 1 9 9 3 : 4 2 ) and R a in es (1 9 9 8 :4 3 ), parents need to be included in decision-m aking about issues such as scheduling baths or feeding, clothing for the neonate, and choice o f skin care p ro d u cts as an im p o rta n t m eans o f support.Inclusion in decision-m aking h elps p aren ts to understand w hat is happening to their neonates and gives them op p o rtu n ities to ask questions, e x p re ss fe e lin g s and co n c e rn s, and establish trust relationships with staff.It also helps them internalise a parental sense o f responsibility.Parents felt more h e lp le s s an d h av e m ore d iffic u lty adjusting if they are not involved in d e c is io n s .
P in ch and S p ie lm a n ( 1989:1018), Raines ( 1996:10;1998:42-43) and Sweeney (1 9 9 7 :6 5 ) stated that the in v o lv em ent o f parents in d e c isio n making is not optional, but should be a standard practice.Shellabarger and Thompson ( 1993:40-44) and M aroney (1 9 9 4 :1 3 2 ) also stated that support is perceived as helpful when it gives the parents back some control via p ro v id in g in fo rm a tio n .E n co u ra g e p a re n ts to sp e n d as m uch tim e as p o s s ib le w ith th e ir n e o n a te and p articip ate in the n eo n ate's bathing, feeding and changing as soon as it is medically safe.
Parents should be encouraged from the beginning, to touch, stroke, and speak to their neonate as far as possible.When the neonate is ready, they can change, feed and continue to comfort and soothe their neonate (Reichman et al" 2000 :2 9 1 ).The early introduction of positive touch lay s the fo u n d a tio n fo r c o n tin u e d positive interaction with the neonate.

Discharge needs
W hen it is time for the discharge of the neonate from the NICU, the goal o f all the com m unication that has occurred throughout the entire NICU experience, is re a c h e d .T he a n tic ip a tio n and tentative jo y can be accom panied by feelings of fear, anxiety, low self-esteem, failure, and inability to cope (Drake, 1995:49, Roets, 1995:5, Shellabarger & Thom pson, 1993:43;Van der Heyde, 1993:47).The negative emotional states appear to be heightened just prior to the neonate's hospital discharge (Doering, Moser & Dracup, 2000:15).

The programme
Intervention care programmes has been im p le m e n te d fo r d iffe re n t re a so n s.Cusson and Lee (1994:61) stated that with adequate support and early contact, the mother may be assisted to focus on the p o s itiv e a sp e c ts o f h e r n e o n a te .Mothers, who have difficulty interacting with their neonates, may become more com m unicative w ith their neonate if assisted with early interventions.

Existing programmes
Existing care programmes for the parents of neonates that are relevant to this study include the following: T he " In te rv e n tio n ca re program me for parents of neonates" is outlined as follow: P a g e 1 o f th e " In te rv e n tio n care p rogram m e for parents o f neo n ates" contains general information specific to the w o rk in g o f the p ro g ram m e and d is c u s s e s the o b je c tiv e s o f the program m e. P age 2 includes general information regarding NICU's.Activities are included for the parents to complete in order to gather information specific to the N IC U their baby is ad m itted to.A ctivities on using o f the Internet are also included to address parental support needs.These activities include the "Chat box" where parents can share information w ith o th er parents and the "E -m ail" function that enables them to contact professionals with any questions they m ay have.P ag e 3 is the page w ith im p o rta n t e d u c a tio n a l in fo rm a tio n .Again not all information could be given by text, but could be gathered through activities or web links.P age 4 discusses and demonstrates feeding options for the prem atu re neonate.F inally, p a g e 5 c o n ta in s in fo rm a tio n re g a rd in g the discharge o f a premature neonate from the NICU to home.This page will only be o f u se fo r th o se p a re n ts w h o se neonates are about to be discharged.Their needs should already have been a d d re s s e d if the p ro g ra m m e w ere im plem ented from the day o f admission, therefore this page concentrates on an activity containing a checklist of skills the parents should have mastered at the time they are taking their neonate home.It also contains web links for further support and inform ation on neonatal developm ent and milestones.
Since this is an interactive com puter based programme, parents will receive the CD together with an information file.This is an empty ring binder that can be filled with information as the parents collect it.This ring binder can be collected from the researcher.• Effective antenatal preparation of parents for admission of their neonate to the NICU.& Mouton, 2002:40).

Recommendations from the research study
Parents are just as important in the NICU as the n e o n a te .H e a lth c are p ro fessio n als should therefore never forget that it is the parents' precious little baby that is admitted to the NICU and they have the right to be there, care for and love him / her.Never forget, we are experts too.We are parents, experts in love.C R E S W E L L , JVV 1994: R esea rch d e sig n : q u a lita tiv e and q u a n tita tiv e approaches.New Delphi: Sage.

CUSSON, RN & LEE
fase II.In fase II is die vraag aan g ep as en nuw e d ata is versamel.Fase III is gei'mplementeer om die data verkry uit fase I en fase II te valideer.Die data is gekategoriseer in v erskillen d e b e h o e fte -k a te g o rië e en hierdie k a teg o riëe is g e b ru ik om 'n ingrypingsorgprogram vir die ouers met neonate in NISE te beplan.Die program voorsien inligting om die behoeftes aan te sp re ek so o s d e u r d ie o u e rs geïdentifiseer in die navorsingstudie en soos afgelei uit die literatuurstudie.Behoefte kategorieë soos geïdentifiseer uit die literatuur en die navorsingstudie, is die volgende: inligtings-, kom m unikasie-, em osionele-, leer-, ontslag-en individuele behoeftes.Die program is in elektroniese formaat beskikbaar, sodat ouers die inligting kan verkry v o lg e n s hul v e ra n d e re n d e behoeftes en sodat h ulle o n b ep erk te toegang tot opgedateerde inligting kan hê.
h ad p ro lo n g e d c o n ta c t w ith the re sp o n d e n ts.C o n firm a b ility is the c rite rio n o f n e u trality (P o g g en p o el, 2000:350).This was achieved when c re d ib ility and tra n s fe ra b ility w ere established.
Partnerships from the Institute for Fam ily-Centred Care, parent intervention care program m es might include learning how to physically and medically care for a fragile infant, preparing for discharge to home, linking to com m unity resources, learning to identify behaviours and developmental patterns, learning to communicate with m e d ic a l s ta f f and d e v e lo p m e derived from the research and lite r a tu r e stu d y an " E a rly intervention care program m e for parents o f n e o n a te s " w as c o m p ile d .T h e program m e p ro v id es in fo rm a tio n to address needs as identified by parents and as derived from the literature study.T his p ro g ra m m e is b a se d on the programmes of Budin (Cusson & Lee, 1994:60-61), Costello (Costello, Bracht, Van Camp & Carman, 1996:44-45) and Cusson (Cusson & Lee, 1994:60-68), co m bined w ith th e D e v e lo p m e n ta l interventions for preterm and high-risk infants program m e by the staff o f the Children's Hospital, Denver, Colorado.The contents o f the program m e have been determined by data gathered from this stud y an d fro m n a tio n a l and international literature.This therefore addressed the research question: W hat will an intervention care program m e for parents of neonates consist of?All the information included in the program me has not b een d e v e lo p e d by th e researcher, but links to updated websites have been used to g iv e p a re n ts the o p p o rtu n ity to o b ta in u p d a te d information and be linked w ith other reliable resources.This programme has been developed to answ er th e n e e d s o f p a re n ts w ith neonates admitted to the NICU; therefore the aim o f the study has been reached.The program m e aim ed to lead to the empowerment of parents to manage their own n ee d s an d th e n e e d s o f th e ir neonates.T he c o n trib u tio n o f th is programm e is that the p rogram m e is offered via multimedia and the advantage of such a m edium is th a t it is s e lf regulated learning.Parents are enabled to obtain information according to their changing needs and provided unlimited access to u p d a te d an d r e lia b information.They can refer back to any part of information w henever they want, without feeling that they are bothering the staff.The result of this is less nursing hours spent on repeating inform ation to parents with neonates in N ICU , more frequent updating o f inform ation and building parent confidence.Parents can be linked to w ebsites sp ecific to the condition of their neonate via the Internet and on-line support groups can also be c re a te d .
Several recommendations arose form the research study and were supported by the literature.It focused on a change in the approach and education of parents w ith neonates adm itted to the NICU.Recommendations suggested by parents o f neonates and literature, regarding the approach to and education o f parents, are discussed following.R e c o m m e n d a tio n s su g g e ste d by literature, regarding the approach to and education o f parents: • Identification of each neonate's level of behavioural organisation and recognition of their stress and stability signals by their parents.
Please help us do fo r our child W hat you would do fo r yours.Parent in fo rm atio n b in d e r: in d iv id u a liz in g education for parents o f preterm infants.Neonatal Network.15(5), August: 43-46.
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Phases of the study resulting in final categories
& Mouton, 2002:528)The researcher obtained informed written consent (Brink, FIGURE 1: are 13 private hospitals in Tshwane with NICU's, ranging from 4 bed NICU's to 20 bed N IC U 's.They are divided into level II and level III N IC U 's.The acuteness levels of neonates in level II N IC U 's do not exceed that of neonates in level III NICU's.The assumption was therefore made that level II N IC U 's were represented by level III N IC U 's and consequently the needs o f parents in level II N ICU 's were represented by the needs of parents in level III N ICU 's.The h o s p ita ls th a t w ere s e le c te d as representative o f the other N IC U 's in Tshwane were two (2) private hospitals in Tshwane.The units were the only two units with more than 10 beds per NICU.