1. INTRODUCTION:

“Don’t give people what they want, give them what they need”

Joss Whedon -

Neonatal Intensive Care Units (NICUs) around the globe have the enormous responsibility of caring for the most delicate lives that enter this world¹. Neonates are admitted to the Neonatal Intensive Care Unit (NICU) for a variety of reasons including prematurity, sepsis, respiratory difficulty, etc. This experience can be particularly distressing for the families of these neonates². It is stated, “each year, over 40,000 babies are admitted to a newborn intensive care unit (NICU) in the United States”. A private hospital in Kolkata had the statistics in which Out of the total admitted cases, 549 (13.78%) were neonates, A total of 667 (16.74% ) of admissions were infants.

Illness and hospitalisation often occur without any warning, leaving little time for children and parents to prepare. It could result in a significant threat to the stability of the family³.

BACKGROUND OF THE STUDY:

The environment, technology, appearance of the infant and the feeling of a loss of the parental role contribute greatly to the amount of stress found among parents in the NICU.5 There, doctors, nurses, and various staff members care for the neonates. Along with these adult figures, the baby is also exposed to various forms of technology, sounds, and lighting. As the neonate is carefully situated into their own bed, machines to measure heart rates and oxygen levels are beeping and buzzing around them. The environment within the NICU can become very overwhelming not only to the baby, but also to the parents. Parents may be disappointed, they may have feelings of guilt, failure, despair, feelings of anger, helplessness and loss of self esteem, depression, and anxiety. Then, in combination with the lack of knowledge about their child’s future, they might exhibit the worst kind of behaviour. These parents often encounter challenges to the development of their parenting roles, achieving their needs and satisfaction of care. In order to cope up with all these problems, and to facilitate family-centred paediatric critical care nursing, the parental needs as perceived by the parents must be accurately identified, prioritized, and incorporated into the plan of care for the family. Furthermore, accurate identification and prioritization of parental needs are pivotal in the development of effective nursing interventions that will maximize coping strategies and facilitate parental adaptation during the hospitalisation of a critically ill child. One of the yardsticks to measure the success of any service is the quantum of satisfaction, which is produced among the public. It is very much true with the hospital, where quality of treatment to a considerable extent, can be measured from the level of patient satisfaction⁴.

NEED FOR THE STUDY:

Parents are the caretakers of the offspring. Neonates seek more support and care from their parents and are bonded to the parents unlike other group. The bond between mother and child is one of the strongest connections in nature. When the infants are admitted to the neonatal intensive care unit, the contact of the parents with their infant is interrupted which in turn can reduce the possibility to be close to the infant and development of delayed relationship with the baby. Miami Neonatal Intensive Care Unit in USA has the admission rate of more than 800 critically ill newborns in each year⁵.

Admission of a sick child in a hospital is a stressful event for the parents particularly for the mother. Hospitalisation of children may affect the physical and psychological status of the mother, causing mothers to experience headaches, sleeplessness, loss of appetite and tachycardia. Additionally, changes in the psychological status may appear as irritability, nervousness, lack of concentration, depression, fear, grief, anxiety, and feelings of insecurity, tension⁶. In order to cope up with these stress mothers needed to fulfil their certain important needs. Parents have physical needs, psychological needs, and specific information and communication needs: comfort (the need for personal physical comfort), information (the need to obtain realistic information about the infant), proximity (the need to remain near the infant), and assurance (the need to feel confident about the infant’s outcome, and safety (the personal safety and security for belongings)⁷.

STATEMENT OF THE PROBLEM:

A correlative study to assess the perceived needs and satisfaction of care among mothers of neonates admitted in NICU in a selected hospital at Mangalore.

OBJECTIVES OF THE STUDY:

1 To determine the perceived needs among the mothers of neonates in NICU as by a rating scale.

2 To identify the satisfaction of care among the mothers of neonates in NICU as measured by a parental satisfaction rating scale.

3 To find the relationship between perceived needs and satisfaction of care among the mothers of neonates in NICU.

4 To find the association of perceived needs scores among mothers of neonates in NICU with the selected demographic variables.

5 To find the association of satisfaction of care scores among mothers with the selected demographic variables.

ASSUMPTIONS:

1 Basic needs of mothers may be met by the health personnel.

2 Mothers encounter various needs when separated from their newborn.

3 Patient satisfaction is a key factor for quality of care.

4 Meeting of perceived needs leads to satisfaction of care.

DELIMITATIONS:

The study will be delimited to mothers:

1 Whose infants have been admitted to the NICU for more than 5 days.

2 Who are willing to participate in the study.

HYPOTHESES:

The following hypotheses will be tested at .05 level of significance:

H1: There is significant relationship of perceived needs and satisfaction of care among mothers of neonates in NICU.

H2: There is significant association of the perceived need scores among mothers of neonates in the NICU with the selected demographic variables.

H3: There is significant association of the scores on satisfaction of care of mothers of neonates in the NICU and selected demographic variables

RESEARCH METHODOLOGY:

Research approach:

Descriptive correlative research approach is used to study the correlation of perceived needs and satisfaction of care among mothers of neonates admitted in NICU.

Research design:

Descriptive correlative research design is used to study the correlation between perceived needs and satisfaction of care among mothers of neonates admitted in NICU at a selected hospital at Mangalore.

Setting of the study:

The study is conducted in the selected paediatric hospital at Mangalore

Population:

In this study, population represents the mothers of neonates admitted in NICU at a selected hospital at Mangalore

Sample:

Sixty mothers of neonates admitted in NICU at selected hospital at Mangalore comprises the sample of the study.

Sampling technique:

Non-probability, convenient sampling technique is used in this study

Method of Data Collection:

Sampling criteria:

Inclusion criteria for sampling:

· The mothers whose infants are admitted to the NICU for 5 days or more.

· The mothers who are willing to participate.

· The mothers who are able to read and write Kannada or English

Exclusion criteria:

1. The mothers of neonates kept for observation.

2. The surrogate or foster parents

3. The mothers of neonates in ventilator

Description of the tools:

Part I: Baseline proforma:

The baseline proforma was prepared with 10 items to collect the personal information of the subject

Part II: Assessment of mothers perceived needs Using perceived needs rating scale comprised of 22 items

Part III: Assessment of mothers’ satisfaction of care using satisfaction rating scale comprised of 24 items.

RESULTS:

The analyses of the data from the study are presented under the following headings:

Section I: Demographic proforma of the mothers of neonates admitted in the NICU.

Section II: Assessment of perceived needs of mothers of neonates admitted in the NICU.

Section III: Assessment of satisfaction of care among mothers of neonates admitted in the NICU.

Section IV: Correlation of perceived needs and satisfaction of care among mothers of neonates admitted in the NICU.

Section V: Association of perceived needs and selected demographic variables among mothers of neonates admitted in the NICU.

Section VI: Association of satisfaction of care and selected demographic variables among mothers of neonates admitted in the NICU

Section I: Demographic proforma of the mothers of neonates admitted in the NICU N=60

Sl.
Sl.	No. Variables	Frequency	Frequency
1	Age in years
a.	18-27	46	76.7
b.	28-37	12	20
c.	≥ 38	2	3.3
2	Level of education
a.	Postgraduate	3	5
b.	Graduate	10	16.7
c.	PUC	20	33.3
d.	High school	22	37.6
e.	Primary school	5	8.3
3	Occupation
a.	Professional	2	3.3
b.	Semi professional	5	8.3
c.	Skilled worker	2	3.3
d.	Unskilled worker	2	3.3
e.	Home maker	49	81.7
4	Monthly income in rupees
a.	≤ 3,000	46	76.7
b.	3,001-5,000	8	13.3
c.	5,001-7,000	3	5.0
d.	≥ 7,001	3	5.0
5	Number of children
a.	One	42	70.0
b.	Two	15	25.0
c.	Three and more	3	5.0
6	If more than one child, Any previous exposure to NICU hospitalization
a.	None	50	83.3
b.	One	9	15
c.	Two	1	1.7
7	Birth order of the child admitted in NICU
a.	One	42	70
b.	Two	15	25
c.	Three	3	5.0
8	Birth weight in kg
a.	1-1.5	2	3.3
b.	1.6-2	12	20.0
c.	2.1-2.5	15	25.0
d.	2.6-3	30	50.0
e.	> 3	1	1.7
9	Present clinical condition of neonate
a.	Congenital infections	7	11.6
b.	Pre-maturity with LBW	21	35.0
c.	Seizures	1	1.7
d.	Hyperbilirubinemia	11	18.3
e.	Meconium aspiration syndrome	5	8.3
f.	RDS	15	25.0
10	Length of stay in the NICU at the time of data collection
a.	Five	21	35.0
b.	Six	28	46.7
c.	Seven and more	11	18.3

Majority of the subjects (76.7%) are in the age group of 18-27 years. And most of them (70%) had only one child. Most of the subjects (37.6%) had studied up to high school. 81.7% of them are home makers and 76.7% have their monthly income below Rs. 3000. 70% of the subjects had only one child. This data is supported with a study conducted in Bangladesh to assess the patient satisfaction with maternal and child health services among mothers attending Maternal and Child Health Training Institute in Dhaka, Bangladesh. The result of the study showed that most of the mothers (72%) belong to the age group of 20-29, 54% of the subjects had secondary education, 84% of the subjects were housewives, 36% had monthly income

in rupees below Rs. 3000. Majority of the subjects (46.9%) had only one child.

Majority of the neonates (70%) are 1^st child in their families. Most of the neonates (50%) had birth weight between 2.6-3 kg, most of the neonates (46%) were hospitalised up to 6 days. This data is supported with a study conducted in Sweden to assess the Strengths and weaknesses of parent–staff communication in the NICU. The result of the study showed that 91% of the subjects were the first born child in their families. 49.7% neonates had above 2.5 kg birth weight; 51.5% the neonates werehospitalised up to 7 days.

Most of the neonates 35% were premature and LBW babies, 25% of them had RDS. The findings of the study is consistent with the study conducted in Iran to compare the opinions of mothers and nurses on the importance and availability of nursing support for parents with premature infants hospitalised in NICU. The result of the study showed that most of the neonates 66.4% of them were premature infants and 23.3% of them had RDS .

Section II: Assessment of perceived needs among mothers of neonates admitted to the NICU

This section deals with the analysis and interpretation of perceived needs among mothers of neonates admitted to the NICU. The total perceived need scores obtained will be arbitrarily graded as follows:

Perceived need score range	Percentage	Category
22-33	33-50	Less important
34-44	51-66	Moderately important
45-55	67-83	More important
56-66	84-100	Most important

Table 3: Distribution of mothers’ perceived need scores in terms of frequency and percentage-N=60

Perceived need score	Grade	Frequency	Percentage
34-44	Moderately important	1	1.7
45-55	More important	28	46.7
56-66	Most important	31	51.7

Maximum score =66

Table 4: Mean, median, mean percentage, standard deviation of perceived needs scores of mothers N=60

Mean	Median	Mean percentage	Standard deviation	Grade
55.32	56.00	83.81	4.64	Most important

The data in the table 4 shows that perceived needs mean±SD was 55.32±4.64. The mean percentage score of perceived need was 83.81%.

Table 5: Area-wise mean, mean percentage and standard deviation of perceived needs scores of mothers

N=60

Area	Max score	Mean	Mean percentage	SD
Comfort	15	12.73	84.89	.47
Information	18	16.03	89.07	1.92
Assurance	12	9.55	79.58	1.89
Safety	6	4.92	81.94	.96
Proximity	9	7.53	83.70	1.26
Spiritual	6	4.55	75.83	1.17

Maximum score =66

The calculated ‘r’ value presented in the Table 9 and Figure 10 shows that there is a positive correlation between perceived needs and satisfaction of care score. Hence the research hypothesis is accepted Chi-square test showing the association of perceived needs score with selected demographic variables of mothers of neonates

Sl.	Perceived need score N=60
Sl.	No. Variables	< median	≥ median	χ2 value
1	Age in years
a.	18-27	23	23
b.	28-37	5	7	.219
c.	≥ 38	1	1
2	Level of education
a.	Postgraduate	2	1
b.	Graduate	5	5
c.	PUC	7	13	2.146
d.	High school	10	12
e.	Primary school	5	0
3	Occupation
a.	Professional	1	1
b.	Semi professional	3	2
c.	Skilled worker	1	1	.624
d.	Unskilled worker	2	0
e.	Home maker	22	27
4	Monthly income in rupees
a.	≤ 3,000	23	23
b.	3,001-5,000	2	6
c.	5,001-7,000	2	1	.219
d.	≥ 7,001	2	1
5	Number of children
a.	One	22	20
b.	Two	5	10	.918
c.	Three and more	2	1
6	If more than one child, Any previous exposure to NICU hospitalization
a.	None	26	24
b.	One	5	10	.854
c.	Two	1	6
7	Birth order of the child admitted in NICU
a.	One	22	20
b.	Two	5	10
c.	Three	2	1	.918
d.	Four	0	0
8	Birth weight in kg
a.	1-1.5	1	1
b.	1.6-2	7	5
c.	2.1-2.5	4	11	1.087
d.	2.6-3	17	13
e.	> 3	0	1
9	Present condition
a.	Congenital infections	3	4
b.	Pre-maturity with LBW	11	10
c.	Seizures	0	1
d.	Hyperbilirubinemia	5	6
e.	Meconium aspiration syndrome	3	2	.216
f.	RDS	7	8
10	Length of stay in the NICU at the time of data collection
a.	Five	11	10
b.	Six	11	17	0.212
c.	Seven and more	7	4
χ₁²=3.84; χ₂²=5.99

The data presented in Table 10 shows that the needs perceived by the mothers of neonates had no association with selected demographic variables.

Section VI: Association of satisfaction of care score with selected demographic variables

Table 11: Chi-square test showing the association of satisfaction of care score with selected demographic variables of mothers of neonates- N=60

Sl.	Perceived need score N=60
Sl.	No. Variables	< median	≥ median	χ2 value
1	Age in years
a.	18-27	27	22
b.	28-37	4	8	1.164
c.	≥ 38	1	1
2	Level of education
a.	Postgraduate	2	1
b.	Graduate	5	5
c.	PUC	11	9	1.137
d.	High school	9	13
e.	Primary school	2	3
3	Occupation
a.	Professional	1	1
b.	Semi professional	3	2
c.	Skilled worker	2	0	.624
d.	Unskilled worker	1	1
e.	Home maker	22	27
4	Monthly income in rupees
a.	≤ 3,000	22	24
b.	3,001-5,000	3	5
c.	5,001-7,000	2	1	.020
d.	≥ 7,001	2	1
5	Number of children
a.	One	23	19
b.	Two	5	10	2.317
c.	Three and more	1	2
6	If more than one child, Any previous exposure to NICU hospitalization
a.	None	26	24
b.	One	2	7	.854
c.	Two	1	0
7	Birth order of the child admitted in NICU
a.	One	23	19
b.	Two	5	10
c.	Three	1	2	2.317
d.	Four	0	0
8	Birth weight in kg
a.	1-1.5	2	0
b.	1.6-2	4	8
c.	2.1-2.5	6	9	1.087
d.	2.6-3	16	14
e.	> 3	1	0
8	Present condition
a.	Congenital infections	4	3
b.	Pre-maturity with LBW	9	12
c.	Seizures	0	1
d.	Hyperbilirubinemia	7	4
e.	Meconium aspiration syndrome	2	3	1.325
f.	RDS	7	8
10	Length of stay in the NICU at the time of data collection
a.	Five	10	11
b.	Six	12	16	.007
c.	Seven and more	7	4
χ₁²=3.84; χ₂²=5.99

Data presented in Table 11 shows that the satisfaction of care received by the mothers of neonates had no significant association with selected demographic variables.

DISCUSSION:

Section I: Demographic proforma of the mothers of neonates admitted to the NICU

Section II: Assessment of perceived needs among mothers of neonates admitted in NICU

Majority of the mothers (51.7%) perceived their needs were most important, 46.7% of them perceived it as more important, and 1.7% of them perceived it as moderately important. Perceived need score is maximum (89.07%) in the ‘information area ‘and minimum(75.83%) in the ‘spiritual area’. The findings of the study are consistent with the study conducted in Midwestern hospital on Perceived needs of parents of critically ill children. The result of the study showed that most of the Parents (84%) perceived their needs were very important.14.3% of them perceived it as important, and 1.7% of them perceived it as less important. Perceived need score is maximum (80.07%) in the ‘information area’and minimum (65.83%) in the ‘spiritual area’.

Section III: Assessment of satisfaction of care among mothers of neonates admitted in NICU

Majority of mothers (70%) are highly satisfied with the care, 25% of them are satisfied with the care , 3.3% are moderately satisfied with the care, and 1.7% are not satisfied with the care . Satisfaction of care score is maximum(89.77%) in the area of information, and minimum in the area of patient care (83.89%). The finding of the study was consistent with the study conducted in Bangladesh to assess the patient’s satisfaction on MCH services in MCHTI hospital. The result of the study shows that 47 % of the respondents were highly satisfied with the services of the hospital. 39% of the respondents were moderately satisfied with the services of the hospital . Only 14% of the respondent’s satisfaction level was low. Satisfaction of care score is maximum(47%) in the area of communication, and minimum in the area of patient care(37%).

Section IV: Correlation of perceived needs and satisfaction of care among mothers of neonates admitted in the NICU

There is a positive correlation between the perceived needs and satisfaction of care among mothers of neonates admitted in the NICU. (r=0.265, df=58, table value=0.255). The finding of the study contradicts a study conducted in Montana to assess the satisfaction determinants of parents whose children are admitted in inpatients units. The findings of the study revealed that there was no significant relationship between process and clinical quality with satisfaction of care (r=0.153, P=0.130).

Section V: Association of perceived needs with the selected demographic variables of mothers

The Chi-square test between the perceived needs scores and selected demographic variables shows that there is no significant association between perceived needs score and selected demographic variables like age in years, educational status, occupational status, monthly income in rupees, number of children in the family, birth order of the child, birth weight, length of stay in NICU, and present condition of the child admitted in the NICU.

The above finding is consistent with a study conducted in USA to assess the needs of mothers with infants in NICU. The result of the study shows that there was no association between the needs and selected demographic data such as age of parent, educational status, occupation, number of children, birth weight, length of stay in NICU, and present condition of the child admitted in the NICU.

Section VI: Association of satisfaction care with selected demographic variables of mothers

The Chi-square test between the satisfaction of care and selected demographical variables showed that there is no significant association between the satisfaction of care and selected demographical variables like age, educational status, occupational status, monthly income in rupees, number of children in the family, birth weight, present condition, and length of stay of the child admitted in the NICU.

The above finding is consistent with a study conducted in Columbia to determine the level of consequence between parent satisfactions with nursing care of their children admitted in NICU and the nurses’ perception of parent satisfaction. The result of the study shows that there was no association between the satisfaction of care and selected demographic variables like age of parent, educational status, occupation, number of children, birth weight, present condition, and length of stay of the child admitted in the NICU.

NURSING IMPLICATIONS:

The findings of the present study have implications in the field of nursing education, nursing practice, nursing administration and nursing research. The nursing curriculum is concerned with the preparation of future nurses. They deal with all the stages of human life both in ill and well state. Many factors influence the perceived needs and satisfaction of care among mothers of neonates admitted in NICU. Nurses should be alert to the perceived needs of mothers and offer assistance in meeting their perceived needs and getting satisfaction of care.

Nursing practice

Nursing personnel, as members of the healthcare team, have an important role in meeting the perceived needs of the patient as well as their family. Admission of a sick child in a hospital is a stressful event for the parents particularly for the mothers. It is the nurse who is the core member spending most of her working time with patients and their family. Hence it is the responsibility of the nurses to help the mothers in meeting their perceived needs and bring in the family in the caring process. For this nurses need to have adequate knowledge regarding perceived needs felt by the mothers, how to assess their perceived needs, and encourage the parents to interact with other parents who are have similar problems. Nurses need to help mothers to adjust to hospital environment by giving information and proper explanations throughout the child’s stay and fulfil their perceived needs and satisfaction of care.

Nursing education

Without satisfied patients, parents, and relatives healthcare cannot achieve its goal. The unexpected hospitalisation of a child with a critical illness can be overwhelming and stressful for parents and their children .So the present nursing curriculum gives importance in the family care centred approach. The nursing curriculum should prepare the nurses to impart education to all family members especially to the mothers regarding hospital routines and the child care during hospitalisation.

Nursing administration

Nurse administrators should see all the aspects of care provided from the hospital beyond health promotion, prevention, and treatment of health problems of mother as well as baby. The nurse administrator should get the feedback from the parents and relatives that the care they provided and appraisal of the care they received. The nurse administrator can take the initiative in providing hospital information through individual and group teaching in the hospitals, schools and other community settings. Client education programme and in-service education programmes gives opportunity for the nurse administrator to train mothers on child care during their hospitalisation. Nursing administrators can plan organise, implement, and evaluate the health education programmes conducted through participatory approach.

Nursing research

Research in the nursing field helps in the growth of the professional and personal life. The emphasis on research and clinical studies is needed to improve the quality of nursing care. The present study is only a descriptive correlative study to assess the perceived needs and satisfaction of care received by the mothers of neonates admitted in NICU. Research can be done in the area of perceived needs and satisfaction of care among mothers of neonates admitted in NICU to identify unique needs of mothers in the particular settings. Further research studies can build on this database and involve comparison of these variables in urban and rural hospitals Nurses need to engage in multidisciplinary research, so that it will help them to improve their knowledge and by applying it. Nurse researchers should be aware of the healthcare system and the status of the profession. By conducting research and formulating new theories, researchers can enhance the knowledge of nurses and ultimately improve the status and standard of the nursing profession can be solved.

LIMITATION OF THE STUDY:

1. The study was confined to only sixty mothers in a selected hospital.

2. Study included only a descriptive approach.

3. A convenient sampling technique was used for the study ,Which limited the generalisation of the study findings .

4. A rating scale was used for data collection, which restricted the amount of information that can be obtained from the respondents.

RECOMMENDATIONS:

1. A comparative study on perceived needs and satisfaction of care among mothers of neonates admitted in both urban and rural hospital settings can be done.

2. A study can be replicated on a larger sample thereby findings can be generalized for a larger population.

3. A similar study can be replicated in other settings with different age groups.

CONCLUSION:

This study was conducted with the objective to assess the perceived needs and satisfaction of care Among mothers of neonates admitted in NICU in a selected hospital at Mangalore.

REFERENCES:

1. Nicholas AL. An examination of the needs of mothers with infants in the neonatal intensive care unit. Ph. D. Dissertation; 2006.

2. Obeidat HM, Bond EA, Callister LC. The parental experience of having an infant in the newborn intensive care unit. J Perinat Educ 2009 Summer;18(3):23–9.

3. Santa Clara Valley Medical Centre. Specialty Centres. [online]. Available from: URL:http://www.scvmc.org/specialtycenters/childrens_health/nicu/Pages/new s.aspx

4. Nizam M, Norzila MZ. Stress among parents with acutely ill children. Med J Malaysia 2001 Oct;56(4);428-34.

5. Browne TN, Flanigan ML, Comiskey AC, Preper P. Nursing care of paediatric surgical patient. 2nd ed. USA: Jones and Bartlett Publishers; 2007.

6. Sikorova L, Kucova J. The needs of mothers to newborns hospitalised in intensive care units. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012;156:XX.

7. Ward K. Perceived needs of parents of critically ill infants in NICU. Paediatr Nurs 2001;27:281-6.

Received on 25.07.2015 Modified on 16.08.2015

Int. J. Nur. Edu. and Research 3(4): Oct.-Dec., 2015; Page 382-392

DOI: 10.5958/2454-2660.2015.00028.9

Satisfaction of care score range	Percentage	Category
24-36	33-50	Not satisfied
37-48	51-66	Satisfactory
49-60	67-83	Moderately satisfied
61-72	84-100	Highly satisfied

Satisfaction of care	Grade	Frequency	Percentage
24-36	Not satisfied	1	1.7
37-48	Satisfactory	2	3.3
49-60	Moderately satisfied	15	25.0
61-72	Highly satisfied	42	70.0

Area	Max. score	Mean	Mean percentage	SD
Hospital environment	15	13.20	88.00	2.18
Patient care	21	17.62	83.89	2.97
Information	36	32.32	89.77	3.91

Variables	Max. score	Min. score	SD	‘r’ value	df	Inference
Perceived need score	63	44	4.64	.265	58	Significant
Satisfaction of care score	72	35	7.65	.265	58