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    Babies and Babble : parents’ experiences of the neonatal unit and the role of the Babble app : a thesis presented in partial fulfilment of the requirements for the degree Doctor of Clinical Psychology at Massey University, Auckland, New Zealand
    (Massey University, 2020) Gibson, Charlotte
    Neonatal unit admission is commonly a highly distressing and difficult time for new parents, impacting their confidence in their parenting abilities and predisposing them to significant mental health difficulties (Ballantyne et al., 2017; Holditch-Davis & Miles, 2000). In response to admission, parents commonly report a need for clear, concise information and inclusion in neonatal care (Cleveland, 2008). Alongside the rise of technology and the prevalence of smartphones across the world, mobile health applications have been theorised as an effective method of delivering rapid, consistent and accessible information to health consumer populations. Within the neonatal sphere, such approaches have been growing in popularity, however, little research has focused on the development and efficacy of mobile health applications dedicated to needs of parents with an infant admitted to a neonatal unit. In response, MidCentral District Health Board has developed an informational mobile health application, Babble, for use in conjunction with traditional care formats and with the hopes of providing greater support to parents in neonatal units (Spargo & de Vries, 2018). Although utilised by parents, the Babble app is yet to be empirically evaluated and the impacts of its use are not well understood. In this thesis, an exploration as to parents’ experiences of the neonatal unit and the role of the Babble app is conducted in two parts. Study One explores the experiences of 449 parents with an infant admitted to a neonatal unit in New Zealand, across measures of distress, self-efficacy, how informed they felt during their infant’s admission, and their Babble app use. Study Two involved in-depth qualitative interviews with eight mothers from the Palmerston North neonatal unit, (where the Babble app originated), exploring their perspectives of their infant’s hospitalisation, and the Babble app itself. Study One showed that parents experienced moderate distress, felt reasonably informed and considered themselves to be somewhat confident in their parental role during their infant’s neonatal admission. The Babble app did not demonstrate any significant effect on any of the variables of interest. However, results indicated that the more informed parents felt, the less distress they experienced. This relationship was partially mediated by enhanced self-efficacy, suggesting the importance of information in supporting parental self-efficacy and reducing distress. Study Two expanded on these findings, identifying several key themes present in the experiences of mothers with infants admitted to a Level II+ neonatal unit. Firstly, findings indicated there were various ways in which mothers struggled with their parental role within a neonatal context, experiencing challenges related to managing their own expectations of the experience and asserting their role within the unit. Consistent and supportive relationships with staff, family, friends, and their partners, were seen as influential in the maternal experience. Most significantly, good communication and strong relationships with staff were seen to improve maternal confidence. Information was highly valued by mothers, with some variation in their interactions with information, depending on individual needs and styles. The Babble app was considered a useful adjunct to traditional care formats by mothers who identified that they were able to adapt and integrate its use in alignment with their individual preferences and needs. Taken together, these findings suggest that for families, neonatal admission is a challenging and diverse experience. Staff are essential, not only as sources of information, but as part of a supportive relationship with families. The importance of informational support cannot be understated and its value in building parental self-efficacy and reducing parental distress was evidenced across both studies. Ultimately, the findings presented here suggest that informational resources, such as Babble, can act supportively for parents and therefore, are worthy of further development and exploration.
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    Changing rooms in NICU : a comparative descriptive study of parental perceptions of the physical environment of neonatal intensive care units : a thesis presented in partial fulfilment of the requirements for the degree in Master of Philosophy in Nursing at Massey University
    (Massey University, 2007) Wilkinson, Robyn Clare
    The physical environment of a neonatal intensive care unit (NICU) is unique and can be challenging and stressful for families. As infant survival rates and technology improved, many NICUs became 'busy', overcrowded, noisy environments. New directions in the design of newborn nurseries highlight the potential for the physical environment to support parental needs and optimise the parenting experience. In October 2004 the NICU at National Women's Hospital (NWH) in Auckland (New Zealand), relocated to a new facility at Auckland City Hospital (ACH). A key principle in the design of the new NICU was improvement of family space at the cot side. This non-experimental study sought to describe and compare parental perceptions of the physical environment of a traditional NICU configuration with a new custom built NICU. A sample of parents with infants hospitalised in NICU from NWH (n = 30) and a different group of parents from ACH (n = 30) completed a self report Likert-type questionnaire (with a scale from 1 = strongly disagree to 7 = strongly agree). Qualitative data was sought using open ended questions. Significant differences were found between the old NWH NICU and the newly designed ACH NICU. Parents perception of the space at the cot-side was more adequate (p = 0.001), lighting levels more comfortable (p = 0.002), the cot-side was quieter (p = 0.02) and technology less intrusive (p = 0.03) at ACH NICU when compared to NWH NICU. Impact of these design changes on privacy, sense of belonging, and socialisation of parents did not show significant differences. Lack of cot-side space for NWH parents was the predominate theme from the open-ended questions. Parents viewed the family space and aesthetics of the new ACH rooms positively. Providers of newborn services contemplating redesign need to consider that increasing cot side space and decreasing infant numbers in clinical rooms can significantly improve a parent's view of NICU and therefore provide an environment that is supportive to parent's needs.
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    Saving lives and changing dirty nappies : illuminating nursing in the neonatal nurse practitioner role : the New Zealand experience : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2000) Jones, Bronwyn
    In New Zealand Neonatal Nurse Practitioners (NNPs) have been practicing in an advanced nursing role since 1994. The nature of expert nursing makes it difficult for NNPs to articulate the nursing component of the NNP role. It is essential that the expert nursing component of the NNP role be documented to maintain the role within the culture of nursing. Aim: The aim of this thesis was to explore and describe how expert nursing is incorporated in the NNP role, in the New Zealand context. Method: An explorative design, using multiple data collection methods, was used. These methods included questionnaires, interviews, journal-keeping (journalling), and analysis of written data. All NNPs in current practice were sent questionnaires (n=18) and a purposive sample of 5 NNPs agreed to be interviewed and keep journals. Standing orders, job descriptions and other written data from each of the three neonatal services that employ NNPs was compared and analysed. Results: Fifteen NNPs (83.3%) responded to the questionnaires. Results showed that NNPs tend toward a nursing identity, but see themselves as sitting between nursing and medicine. Professional issues were important to the NNPs. There was some ambivalence toward the NNPs leadership role in the questionnaire results, but interview and journal data showed the NNPs performing a multifaceted leadership role. Neonatal Nurse Practitioners are committed to post-graduate education, with a tendency toward preferring that to be in a nursing school with access to medical resources. The qualitative data revealed six themes derived from practice. They were 'a consciousness of baby', 'orientation to family', 'uniqueness of NNP care', 'leadership', 'culture of nursing' and 'NNP experience of advanced practice'. Expert nursing was embedded in the clinical themes and implicated in the professional themes of NNP practice. Conclusions: Expert nursing is inherent in the practice of the NNP role in New Zealand. Neonatal Nurse Practitioners practice in a unique role in the care of sick babies, incorporating medical skills with nursing philosophy and expertise. Education needs to address some of the issues of nursing in this advanced practice role. There is a need for institutional support for the NNP role. The NNP group needs to develop as a support and educational network.
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    What is the effect of suctioning and frequency on oxygenation and bradycardias in infants [less than and equal to] 30 weeks gestation requiring Bubble Continuous Positive Airway Pressure (CPAP)? : a thesis presented in partial fulfilment of the requirements for the degree of Masters in Philosophy in Nursing at Massey University, Albany, New Zealand
    (Massey University, 2014) Greensill, Susan Elizabeth
    Background: Previous research around suctioning premature infants has focused on endotracheal suctioning. Continuous positive airway pressure (CPAP) has become a major mode of respiratory support. Consequently, there is a need for research that is relevant to this mode of respiratory support. Aim: To determine the effect suctioning and suctioning frequency has on oxygen saturation levels and bradycardias in infants =30 weeks gestation on “bubble” CPAP. Method: The research comprised of two parts: • An observational study to determine the effect of suctioning on oxygen saturation, desaturations, and bradycardias. • A randomised crossover study to determine the effect of frequency of suctioning on oxygen saturation, desaturations, and bradycardias. Results: Part One: Analysis demonstrated that increased suctioning frequency significantly decreased oxygen saturation levels and resulted in more desaturations. However, one more desaturation per hour required 5.3 and 7 more suctioning episodes each day for desaturations of =10 seconds and =60 seconds respectively. Of note was the increased likelihood of desaturations when the suctioning interval was longer. An increase interval of 1 hour 40 minutes between suctioning times led to one more desaturation =10 seconds per hour, with one more desaturation =60 seconds with 3½ hours increase in interval. Bradycardias were also significantly increased by one per hour, when suctioning frequency increased by 15 intervals per day. Conversely, the odds of a bradycardia occurring if the suctioning interval increased one hour was 1.9. Part Two: Analysis demonstrated that overall there were less desaturations and bradycardias with 2 hourly suctioning compared to 4 hourly. However, numbers were too small to determine statistical significance. Data from the effect of suctioning, for both parts, demonstrated prolonged periods of recovery for infants, with minimal or no change in supplemental oxygen, which may have affected results. Conclusion: Significance was demonstrated in relation to more desaturations and bradycardias with increased frequency of suctioning in Part One, though the prolonged recovery time may have influenced these outcomes. Of more significance were the findings that demonstrated increased desaturations and bradycardias with longer intervals between suctioning. Results from Part Two were inconclusive due to small numbers of participants. This study provides a baseline for evidence on suctioning premature infants on CPAP, guideline development and a foundation for future research.