Browsing by Author "Maclean, Barbara Lois"

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    Caring for at-risk infants : the experiences of parents with infants on home apnoea monitors : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University
    (Massey University, 1994) Maclean, Barbara Lois
    Home apnoea monitoring for infants considered to be at risk for sudden infant death syndrome (SIDS) has been available in New Zealand since 1978. In light of the fact that the efficacy of home monitoring is unproven (Krongrad and O'Neill. 1986; Phipps and Drotar, 1990) an understanding of the impact of monitoring on families is essential. In the present study, descriptive case studies (as described by Yin, 1984) are presented of six New Zealand families undertaking the home apnoea monitoring of their infants. Indepth interviews, conducted over a three month period, prospectively explored the experiences of one or more caregivers. Analysis of the data confirmed many of the reported findings from previous (mainly American) studies. In particular, parents perceived their infants to be "at risk" whilst monitored, and tended to become socially isolated because of their reluctance to leave their infants with other caregivers. The false alarms were a serious problem, causing negative arousal in the parents. When the alarms sounded parents found it very difficult to determine whether or not the infant was, or had been apnoeic. The monitor itself became the best indicator of the child's risk status and parents sometimes relied on the monitor to the detriment of other treatment regimes and of surveillance of the infant's condition for problems other than the risk of apnoea. The present study used a systemic family nursing perspective to frame the participants' experiences. It was thus considered essential to take into account the family context in which monitoring was undertaken. Parents in the present study who, for example, had previously lost infants to SIDS, spoke of the ongoing grieving processes underpinning their monitoring experiences of subsequent infants. When the youngest child was no longer monitored, the focus of attention shifted from the risk status of the infant to the prospect of a normal childhood. Parents increasingly made their own decisions about how and when to use the monitor, based on their perceptions of their own ability to cope without it, rather than on the medical indications for its use or discontinuance. Mothers, especially, expressed strong needs for support from knowledgeable health professionals who could provide an integrated, holistic approach to the care of their infants, for monitoring supervision and for general parenting advice and support. The concept of a community-based nurse case manager is suggested as an appropriate means to meet their needs for a co-ordinated professional support service.
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    Vulnerable parent, vulnerable child : parenting of a subsequent child following the loss of an infant to Sudden Infant Death Syndrome : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Human Development at Massey University, Palmerston North, New Zealand
    (Massey University, 2003) Maclean, Barbara Lois
    The aim of the present study was to investigate evidence of replacement child and vulnerable child pathology in the caregiving relationship between caregivers who had lost a previous infant to SIDS, and their subsequent children, who were now 2-3 years of age. To assess the possible traumatic disruption to the parent-child caregiving system arising from unresolved parental grieving, 20 mothers of 2-3-year-old subsequent children participated in an attachment-based clinical interview, the Working Model of the Child Interview (WMCI). Verbatim transcripts of the interviews were examined for content themes showing mothers' replacement feelings toward the subsequent child. The interview was then rated on a formal scoring system for the WMCI and the parents' representations of the child were classified into one of three categories: balanced, disengaged, or distorted. In addition, a modified version of the Reaction to Diagnosis Classification System (RTDSC) was used to classify the interview transcripts as Resolved or Unresolved with respect to the trauma to the caregiving system arising from the loss. To look for specific evidence of the Vulnerable Child Syndrome, the 20 mothers and a control group of 100 non-bereaved mothers of children of a similar age also completed three questionnaires: (a) the Vulnerable Child Scale (VCS) to assess parental perceptions of the child's vulnerability, (b) the Parent Protection Scale (PPS) to assess parental protective behaviours, and (c) the Achenbach Child Behaviour Checklist for ages 2-3 years (CBCL/2-3) to assess behaviour and personality problems in the child. Results of the questionnaires showed that in comparison to the control group, mothers of subsequent children perceived their children as significantly more vulnerable and reported higher levels of protective behaviours. Subsequent children, in turn, experienced significantly higher levels of sleep problems and destructive externalising behaviours. Interview data showed that 70% of mothers were Unresolved with respect to the loss regardless of the time since the death, but the children were not regarded as replacements for the dead siblings. Only 25% of interviews were categorised as balanced and the majority were characterised by ongoing fears for the child's safety, and a significant level of emotional distancing from the child.