From Alienation to Familiarity: Experience of Mothers and Fathers of Preterm Infants
Problem statement and or hypothesis
The situation depicted in the article is something which is widespread in present societies. Although this is one which is very commonplace, not much research is done. To address this gap, this study was conducted. The authors have wanted to find out if the parents of preterm infants experience emotions that are very much unlike what other parents with normal infants feel.
The aim of the research is to study how mothers and fathers of preterm infants describe their experiences of parenthood during the infant’s first 18 months of life. The selected participants of the study was not included in the study question but gave the generalized population to be studied. The study question also lacks information on what interventions are to be given in the study.
Literature review
The parents of preterm infants experience a range of emotions right from the moment of the birth of the child. Although there is excitement, it is also inevitable that there is fear on the parents’ part since the infant is born preterm. Aside from this, the parents also experience a mixture of other emotions in their care for the preterm infant.
Careful attention is important in infants who are born preterm. The manner in which mothers and fathers of preterm infants adapt to parenthood, even before infant hospital discharge, is very different to those who have infants born normally. By knowing this, it can help clinicians, nurses, and other health care professionals in identifying parents who are at particularly high risk of developing perceptions of infant vulnerability later in the infant’s first year (2005).
Many other complications can pose for the preterm infant and this can create additional parenting duties and responsibilities to the parents most especially. Some parents may feel unsure about their situation and this can significantly affect how they perform their roles as parents and ultimately also affect the infant’s development.
One study found that the temperament of an infant born preterm is different from one born full-term (2005). Therefore, parents who have preterm infants are more likely to be faced with unknown and more complicated problems, leading to a difficulty in coping. The premature infant is at high risk for developing many physical and psychosocial delays. One of the most influential factors affecting the outcome of the premature infant is the parent-infant relationship (1998). If the parents are coping well with their situation, most likely there will be a less risk for the infant’s development. This particular research further aids the nursing community in providing individualized support for the parents of preterm infants.
Theoretical and conceptual framework
As mentioned in the earlier paragraph, there is a scarcity of research on the particular issue of the experiences of mothers and fathers of preterm infants. Due to this scarcity of research, the nursing communities are unaware of the best way to provide individualized support for the parents of preterm infants. These parents are not in ordinary situations therefore care given should be suited to their situation. This particular study was conducted in order to attend to the unique needs of parents of preterm infants. By this, implications on clinical practice for the improvement of care to parents and preterm infants could be achieved.
Research Design
The study employed qualitative methodology and this is appropriate since it seeks to interpret or illuminate the actions and/or subjective experiences of the parents regarding their experiences of parenthood during the preterm infants’ first 18 months of life. The qualitative approach is often associated with naturalistic inquiry, which explores the subjective and complex experiences of human beings (Kozier & Erb, 2004).
The scientific approach of phenomenology was employed in the study. Phenomenology is concerned with the experiences that can be grasped and analyzed in intuition in their essential generality, but not with empirically apperceived experiences as real matters of fact, as experiences of experiencing people or animals in the appearing world, posited as a matter of fact of natural experience (Chrisholm, 1960). This kind of method was used simply because the study involved examining the experiences of the phenomenon of parenthood as it was described by the parents themselves.
The participants were seven consecutive sets of Swedish-speaking parents residing in the county, with infants born at a gestational age of less than or equal to 34 weeks without any known congenital or chromosomal defects and born during the spring and summer of 1999. A university hospital which has a neonatal intensive care unit and a delivery ward was where these participants were selected from.
How the participants were selected depends on who are available that can fit in the needed participants for the study (Swedish speaking parents and residing in the county with an infant of less than or equal to 34 weeks gestational age). No statistical or power calculations were made to obtain how many participants are to be included. The researchers did not see any need for proper allocation of the participants to intervention and control groups. The researchers did not see any need for such. The selection of participants was not truly done at random but selected based on the inclusion criteria and availability.
Data collection procedures
As with any other studies that involve human subjects, an approval to perform the study was obtained from the ethics committee before it was started. The narrative interview method of data collection was employed. The themes were experiences of the delivery, the neonatal period, hospital discharge, and subsequent daily life, with a focus on parenthood from the perspective of the mothers and fathers.
The seven sets of parents were interviewed as a couple except on two occasions where the parents were not interviewed together. The two occasions where the parents were not interviewed together is important since this could check if they still give the same answers that they give in interviews where they are together. These interviews are recorded on tape and transcribed verbatim.
A total of four sets of interviews were made, held weeks apart in order to keep in line with the aim of the research to describe experiences over time. The first interview was held 1-2 weeks after birth except with one couple. The second interview was held at the time of discharge from the neonatal ward, when the infants were 2-4 months of age. The third and fourth interviews took place in the couples’ homes when the infants were 6 and 18 months old respectively. The interviews were timed so as to include important periods in infant development and in the establishment of parenthood in both the short and long term.
The interviews were all conducted in the same manner and data are all collected in the same way. But there was one couple whose first interview was not held at the same time with the other couples. The reason was because of the unstable health status of the infant and the interview was moved from 1-2 weeks to 2 months.
Qualitative analysis
Data analysis employed in the study was based on the work of (phenomenology) and was carried out in several steps. Audiotape-recorded and transcribed data were carefully read by one of the researchers in order for the others to have an idea of the results. It was then divided into meaningful units and transformed into a nursing perspective as the authors assumed a nursing attitude towards the analysis. Data were condensed and resulted into four syntheses which were integrated to form the structure of the phenomenon of parenthood. These were then checked and validated by another researcher.
The method of data analysis employed by the researchers in the study was not clearly presented. There is no detailed description of the analysis. An explanation was not provided on how the researchers came up with the four syntheses. A person who is not familiar with the phenomenological method that was used will have a hard time understanding how the researchers tabulated their data and transformed it into a meaningful whole. The roles of the researchers were not critically examined, as well as the potential bias and influence during the analysis and selection of data for presentation.
Interpretation of results
Based on the data obtained, there are four syntheses: Alienation, Responsibility, Confidence and Familiarity. Internalization of parenthood was described as a process over time, where feelings of alienation and responsibility gradually changed into increased confidence and familiarity. Within these four syntheses, the different ways of experiencing the parental role were presented.
The study also found out that there are similarities and differences in the ways in which mothers’ and fathers’ described their experiences in parenthood. The differences are attributed as maybe related to cultural beliefs and expectations of parenthood from female and male perspectives.
As a whole, an adequate discussion of the results of the study was presented. A thorough discussion of the findings of the study in relation to the original research questions was also provided. The credibility of the findings of the study was presented by comparing it with other studies that are more or less the same.
Ethical aspects
The researchers did not provide details of how the research was explained to participants. The issues of informed consent as well as confidentiality were also not discussed in the research. An approval to perform the study was mentioned as obtained from the Research Ethics Committee at the Orebro University Hospital.
Data Quality
The data from the study is of high quality and is beneficial not only for the entire nursing community but also for the parents of preterm infants. It can be used for decision-making and planning of the nurses, which can ultimately improve the effectiveness of nursing care and could provide nurses the best way to provide individualized support for mothers and fathers of preterm infants. The results of the study can be considered true and valid but this is only a representation of a certain group of people and is possible that this is not true for everyone. Many other factors could alter the results of this study like culture for instance.
Randomised Double-Blind, Placebo-Controlled Trial of Coenzyme Q10 Therapy in Class II and III Systolic Heart Failure.
Problem statement and or hypothesis
The purpose of the study is to determine the effects of Coenzyme Q10 in patients with a New York Heart Association (NYHA) Class II or III heart failure due to ischaemic or dilated cardiomyopathy who have been treated with angiotensin converting enzyme inhibitors (ACEI) but not with beta blockers. This purpose was clearly presented at the beginning of the study. The importance and relevance as to why the study was conducted is apparent in the background that was given. There are already researches regarding the use of Coenzyme Q10 in improving the symptoms of heart failure and this particular research substantiates that.
There was a clear presentation in the study question of the population to be studied (patients with a New York Heart Association (NYHA) Class II or III heart failure due to ischaemic or dilated cardiomyopathy who have been treated with angiotensin converting enzyme inhibitors (ACEI) but not with beta blockers), the intervention given (Coenzyme Q10) and the outcomes considered (improvement of heart failure symptoms). The problem statement was therefore presented clearly.
Literature review
Heart failure is a clinical syndrome characterized by inadequate systemic perfusion to meet the body’s metabolic demands as a result of impaired cardiac pump function. This may be further subdivided into either systolic or diastolic heart failure. In systolic heart failure, there is reduced cardiac contractility (2004).
In treating systolic heart failures, there are already a number of alternative or complementary health resources that are used. One of these alternative treatments is the oral form of Coenzyme Q10 – an over-the-counter nutritional supplement. Coenzyme Q10 (2,3 dimethoxy-5 methyl-6-decaprenyl benzoquinone) is also known as ubiquinone. It is a naturally occurring fat soluble quinone present everywhere in eukaryotic cells (2000). This endogenous antioxidant has potential for use in prevention and treatment of cardiovascular disease, particularly hypertension, hyperlipidemia, coronary artery disease, and heart failure ( 2002).
Coenzyme Q10 is found in large amounts in the cells of the heart and serves as a cofactor in many metabolic processes. Coenzyme Q10 is an obligatory member of the respiratory chain in the mitochondria of all cells. One of the most important roles it plays is in the final production of adenosine triphosphate (ATP), the body’s form of “energy currency,” during the process of oxidative respiration (2000). It also is one of two endogenous antioxidants within the low-density lipoprotein (LDL) molecule.
Therefore, in addition to its role in mitochondrial energy production, it is part of a network of antioxidants that delay or prevent the oxidation of membrane-bound lipid peroxide free radicals. This role has important clinical implications, for it is oxidation of lipids that contributes to the pathogenesis of atherosclerosis. One study concluded that ubiquinol-10 protected LDL-cholesterol more efficiently against lipid peroxidation than did vitamin E, suggesting that it is a powerful antioxidant that may be useful in the prevention of heart disease ( 2002).
Theoretical and conceptual framework
This study was conducted to further examine the recognized and proven effects of Coenzyme Q10 in patients with a New York Heart Association (NYHA) Class II or III heart failure due to ischaemic or dilated cardiomyopathy who have been treated with angiotensin converting enzyme inhibitors (ACEI) but not with beta blockers.
Research Design
Thirty-nine patients in NYHA Class II or III heart failure were randomized in a double-blind, placebo-controlled study with 150 mg/day of oral Coenzyme Q10 given in three divided doses or a matching placebo to be taken for three months. Twenty patients were randomly selected for 150 mg/day treatment of oral Coenzyme Q10 while 19 randomly selected participants were also selected for matching placebo. A placebo was used in order to be able to compare and gauge the effectiveness of Coenzyme Q10. The rationale why the 150mg/day dose is used is because this has been shown in their unit pilot study to increase the serum Coenzyme Q10 level by at least twofold after seven days of therapy.
The study provided a detailed account on how the participants of the study were chosen. Included as participants are patients aged 18-30 years and had Class II or III heart failure symptoms due to ischaemic, valvular or idiopathic dilated cardiomyopathy with left ventricular systolic impairment. Their baseline heart failure medications were stable for 2 months. The participants should also be on maximum medical therapy with ACEI and other medications. These participants are all patients of St. Vincent’s Hospital Heart Failure Unit and The Sydney Cardiology Group Practice in 1996-1997.
On the exclusion criteria were patients with reversible causes for left ventricular dysfunction as well as those requiring greater than or equal to five sublingual nitrate administrations per week or those taking beta-blockers, selenium or vitamins A, C, and E.
The particular research design that was employed in this study is appropriate for such data that is being sought. This study uses the experimental or quantitative method since the effects of Coenzyme Q10 cannot be measured merely by the qualitative method or by observation and interview.
Data collection procedures
An approval to perform the study by the Research and Ethics Committee of St. Vincent’s Hospital was first obtained. Informed consent was also obtained from all the participants. The thirty-nine study participants were observed and reviewed monthly at the Heart Failure clinics and underwent six assessments at baseline after three months of blinded therapy. The six assessments included (1) symptom class by NYHA and SAS; (2) exercise tolerance by a 6 minute walk test and a treadmill exercise test; (3) assessment for clinical outcomes of heart failure including readmission, transplantation or death; (4) echocardiographic left ventricular fractional shortening; (5) plasma levels of Coenzyme Q10, serum creatinine, sodium and potassium; and (6) tablet return compliance assessment. This data collection procedure is appropriate for the kind of data that is to be collected.
Power calculations were performed for the NYHA and SAS class to come up with the exact number of participants needed to be come up with the right results of the study. The required sample size is 16 per group.
Data analysis
In the analysis of the data, not all data from participants were used. Two patients withdrew from the placebo group for medical reasons. One patient withdrew in the Coenzyme Q10 group after 56 days due to increased lethargy and one withdrew in order to start a prohibited medication. These data were excluded from the analysis, leaving only data from 17 patients in the Coenzyme Q10 group and 18 in the placebo group. This still follows the sample size calculations of 16 participants per group. The number of tablets that were issued to participants at the start of the study were counted and compared at the end of three months.
In the analysis of data, the Coenzyme Q10 levels of the participants were measured in organic extracts by high performance liquid chromatography with an electrochemical detector. After measuring the Coenzyme Q10 levels, statistical methods were employed. The end-points at the beginning and at the end of the three-month trial were compared both within each group and between placebo and Coenzyme Q10 groups. The final analysis used between-group comparisons of differences between baseline and three months.
All parameters were measured during the start and end of the three-month trial. The difference between the values obtained was then compared between the two groups. All the participants in both groups underwent follow up and the data were collected in the same manner.
Interpretation of results
The study found out that the Coenzyme Q10 group showed a small but significant improvement whereas the placebo group showed no significant change. It showed a significant improvement in the NYHA and SAS symptom class and a trend towards improvement in the exercise time in the Coenzyme Q10 patients, but this was not the case in the placebo patients after three months of using 150 mg oral Coenzyme Q10 per day. A positive correlation between the levels of serum Coenzyme Q10 and improved exercise tolerance was also demonstrated in the results of the study. As a whole, the results of the study further gave validation to the claims that Coenzyme Q10 therapy improves cardiac functional status in patients with moderately severe dilated cardiomyopathy receiving maximal non beta-blocker therapy.
Ethical aspects
The ethical considerations of the study were seriously considered and were well documented. An approval to perform the study was given by the Research and Ethics Committee of St. Vincent’s Hospital and an informed consent was obtained by one of the two chief investigators from all the patients who participated in the study in both centers.
Data Quality
According to the researchers, this particular study lays the ground work for future trials of Coenzyme Q10 in the beta-blocker era of heart failure treatment. The results of the study also presented a reason for medical professionals to recommend to patients with symptomatic heart failure to take 150-300 mg of Coenzyme Q10 every day.
The results of the study are beneficial not only to the researchers and participants but to the entire community as well. The population could be different or the setting could be different but that is not a factor which can significantly alter the results of the study since this is dealing with a medical condition that affects people irregardless of race, age or location.
Credit:ivythesis.typepad.com
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