In Canada, there were approximately 29,000 premature infants born every year (Canadian Premature Babies Foundation, n.d). Infants who are born prior to their full gestational term are underdeveloped and often very ill (Obeidat, Bond, & Callister, 2009). The birth of a child and the shift to parenthood represents an emotional experience for many parents and may cause pressure in their changing lives due to their new roles as a parent. Parents of a premature child face an experience that is considerably different from that of parents of a full-term infant. This is due to lack of parenting preparation, restricted contact with their infant soon after birth and prolonged hospitalization contributing to parent’s difficulty to cope after the birth (Henderson, Carson, & Redshaw, 2016). Furthermore, there can also be negative effects on the parent’s relationship with each other as well as their child (Ionio et al., 2016). The studies listed reflected mostly on the mother’s perspective only and did not consider how a father can be impacted by the birth of a premature infant. The following will focus on the father’s perspective.
Challenges of greeting a premature infant in the world present significant concerns for fathers of infants in the neonatal intensive care unit (NICU). Some fathers expressed feeling stress and anxiety as the birth of their preterm infant was unexpected thus impacting their transition to fatherhood (Lindberg, Axelsson, & Ohrling, 2007). While Candelori, Trumello, Babore, Keren, & Romanelli, (2015), states that fathers were less inclined to participate in child care and bonding, citing the need to focus on job commitments and supporting financial needs of a family. Additionally, some emerging themes Cinar, Kuguogku, Sahin, & Altinkaynak, 2016; such as the need to share the experience with someone in a similar situation and the desire to not participate in infant care potentially occurred due to the lack of information provided to fathers on the NICU environment. Furthermore, these studies are critical to understanding the father’s experience after the birth of a premature child in Northern Ontario context. The majority of research was conducted in countries other then Canada (Candelori, Trumello, Babore, Keren, & Romanelli, 2015; Cinar, Kuguogku, Sahin, & Altinkaynak, 2016; Lindberg, Axelsson, & Ohrling, 2007; Sheu, Wang, & Hsu 2014) as the previously mentioned they may not be applicable to Canadian families as the context presented differs from Canada’s health care system.
Many studies previously conducted focus primarily on the mothers’ experience. The impact of preterm birth on fathers is especially important to understand as fathers are equally involved and influence the infant’s social, behavioural and psychological well being (Candelori, Trumello, Babore, Keren, & Romanelli, 2015). Moreover, it is important to acknowledge that fathers are equal partners in the role of parenting, and having research conducted on the father’s experience in neonatal intensive care units (NICU) specific to Northern Ontario may help others in similar situations feel more at ease. Lindberg, Axelsson, & Ohrling, 2007 echo this value and attest that fathers desired to feel better included and understood as exhibiting normal reactions and free to share their personal experiences.
Problem, Purpose and Research Questions
It is inevitable that caring for infants who are born prematurely can add further strain in the parents’ lives. A large amount of researchers has established the difficulties of fathering a premature infant in a NICU however, these studies may not be applicable in a Northern Ontario context as the majority of the studies were conducted in other countries. Problems such as stress, parental needs, coping strategies, and caregiver engagement have been investigated in many studies regarding fathers lived experience of infants in NICU. However, there is no research that focuses on the live experience of fathers caring for infants in the NICU in a Northern Ontario setting, and the set of different needs, coping strategies. (Provenzi & Santoro, 2015). The purpose of this phenomenological study is to explore the thoughts and feelings of fathers living through the hospitalization of premature infants in the NICU, specific to Northern Ontario.
The impact of preterm birth on fathers is especially important for nurses to understand, as their experience will be unlike that of a mother’s experience. Therefore, additional research is needed to determine how fathers work through such an intense experience, how they cope with stress, and how this experience is affecting their life. This information could be beneficial since knowing the physical and psychological effects can lead to the specific nursing implementation of interventions with the overall aim to decrease the struggles of a father’s experience (Whittingham, Boyd, Sanders & Colditz, 2013). Provenzi & Santoro, 2015, indicates that the specific actions such as caregiver engagement and transition to parenthood are optional to accomplish family-centred care. The primary question intended to guide the research is: what is the lived experience of fathers with an infant in the NICU. Several secondary questions to guide this research include: A) How has caring for a preterm infant changed the participant’s relationship with their significant other? B) How has the hospitalization of the participant’s infant affected their daily life? C) How has the hospitalization of the participant’s infant changed how they manage their feelings and emotions? D) What is your experienced with services available to you in your region? Has there been a lack thereof and which ones?
This study will use a qualitative methodology in order to gain understanding and identify the context and meaning of a father’s experience. Qualitative research is used to answer questions about experience, meaning and perspective of proposed participants (Hammarberg, Kirkman & de Lacey, 2016). The phenomenological approach to research is beneficial when trying to understand an experience in a way that a person having the experience understand it through intense dialogue (LoBiondo-Wood & Haber, 2013). Qualitative research believes that reality is socially composed and depends on the situation, meaning that an observation is described by the context or environment and varied on individually experience (LoBiondo-Wood & Haber, 2013). Therefore, for this research it is important to take into account individual context, such as ages of participants, the severity of infant condition, family dynamic, coping mechanizes and employment and financial status.
The setting of the suggested research will be in three Northern Ontario communities: Sudbury, Sault Saint Marie and Thunder Bay, specifically Health Sciences North, Sault Area Hospital and Thunder Bay Regional Health Sciences Centre. There has been limited data conducted previously that pertains to Canada, which may not be applicable to Canadian families since the healthcare system differs a great deal. The interviews will be conducted in the three hospitals chosen in the three Northern Ontario cities. Interviews have been chosen in order to examine the views, occurrences, beliefs and incentive of the participants (LoBiondo-Wood and Haber, 2013).
The proposed sample will include first-time fathers of infants born 28-36 weeks’ gestation. The inclusion criteria include first-time fathers who are 18 years or older, live in Northern Ontario and infants that are born before 37 weeks’ gestation. Exclusion criteria are fathers that have already had experience with their newborn infant, preterm or not. Purposive sampling will be used in order to select participants for this research proposal. This involves intentional choosing of participants based on qualities that they possess, in this instance, fathering a preterm infant that is hospitalized (Etikan, Musa & Alkassim, 2016). Essentially, purposive sampling involves identifying and choosing participants that are experienced and well-informed in regards to the circumstance being analyzed (Etikan, Musa & Alkassim, 2016).
For the sample mentioned, the sample size will be determined once data saturation has occurred. Conducting interviews until data saturation occurs is important in order to ensure content validity and exhausting all common perspectives (Fusch & Ness, 2015). In order to gather participants for the research, fathers will be recruited from maternity wards and neonatal intensive care units (NICU) of the participating hospitals. Consent will be obtained prior to participation to ensure fathers are informed of the implications of the research being conducted, as well as are willing to participate and ensure they match the inclusion criteria outlined.
Ongoing, weekly interviews will be carried out in order to collect the majority of the data. Interviews will be concluded after six months postpartum. Demographic data collected from participants will include age, marital status, employment status and race. This All data will be recorded through voice recorded semi-structured interviews, specifically using open-ended questions. This information will be beneficial to research since it will provide context. Employment status will be asked since fathers that are employed and have less time to be at the hospital with their infant will have different experiences than fathers that are actively involved with their newborn. Open-ended questions allow participants to share important information such as their feelings and attitude towards caring for a preterm infant, which is especially important for the purpose of this phenomenological study (LoBiondo-Wood and Haber, 2013). Semi-structured style of interviews allows for more detailed responses and answers to the research questions, especially when incorporating open-ended questions (LoBiondo-Wood and Haber, 2013). By conducting weekly interviews, fathers participating in this study will be able to update the researchers with recurring or new feelings experienced during the postpartum period, aiding in data saturation.
Exhibiting rigour in qualitative research is imperative in order for the findings to be considered ethical and influence practice (Hadi and Jose, 2016). In order to maintain rigour during the conduction of this study, researchers will include details focusing on maintaining reliability, suitability and audibility of research. Unlike quantitative data, qualitative data analysis cannot be measured. Therefore, researchers of qualitative data must account for biases that may have an influence on the findings of the research. Furthermore, acknowledging such biases ensures depth and relevance of data collection (Noble & Smith, 2015). Documenting findings by recording the semi-structured interviews also provides a decision trail and shows consistency and transparency of data (Noble & Smith, 2015). Conducting interviews until data saturation is reached ensures that all perspectives are presented to the researchers and similarities or differences can be grouped (Noble & Smith, 2015). Additionally, field notes taken during interviews and after reviewing audio tapes will outline descriptions more thoroughly, as well as the process in which the researcher came to final conclusions on the topic. This will allow individuals to understand the researchers thinking during the study.
In an effort to adequately and logically analyze this phenomenological research study, Thorne (2000) suggests that both Colaizzi and Giorgi utilize a phenomenological analysis method and have developed a manageable, logical approach to processing nursing research data (p.69). As such, Colaizzi’s seven-step phenomenological method of analysis was deemed most appropriate for this research study. In addition to the seven steps outlined by Colaizzi (1978), an eighth step has been applied to the process by Edward & Welch (2011) in an effort to ensure extended accountability and validate phenomenological themes of the participants. With the inclusion of the eighth step, the analytical steps that will be utilized for this study will include: transcribing essential themes from participant interviews and then validating these findings with the participant; identifying prominent statements put forth by the participants that directly correspond to the study phenomenon and building a number list from them; deriving and extracting meanings from the participant statements; mapping concepts and grouping similar meanings; formulating a synthesis of descriptions based on the aforementioned grouping and applying an interpretation from the researchers; interpreting and outlining the phenomenological structure through thorough analysis; and finally reappraising the validity of phenomenological themes using participant feedback (p. 165).
Due to the unique and specific context of this study, a variety of notable limitations must be addressed. The first notable limitation involves the ability of the researcher to critically interpret responses and solicit deeper meaning from the interviews. As a standardized, pre-determined set of open-ended questions will be administered during the interviews, responses will likely have to be clarified or probed by the interviewers to ensure that meaningful responses are given. This, in turn, permits the extraction of emerging themes during the analytical phase and will help research attain meaning from the responses. The interviewer’s ability to extract these meaningful responses largely relies on the mannerisms, and social and nonverbal cues of the interviewer. The relationship between the interviewer and each participant will reflect the depth of the interview and as such, may limit how much some fathers are willing to disclose. This limitation is seemingly socially variable and uncontrollable. A similar notable limitation lies in circumstantial and setting variability. Northern Ontario is a very diverse setting and is comprised of a wide array of unique individuals. This suggests that participants will have varying backgrounds, and possibly contrasting family dynamics. As many diverse cultural patterns are present in this location as well, different attitudes and social issues will undoubtedly arise and must be considered. A study conducted by Hammarlund, Andersson, Tenenbaum, & Sundler (2015) examined paternal limitations in the context of postnatal research and deduced that a considerable drawback was the father’s involvement in the birthing process. Feelings and attitudes of the mother traditionally hold the most consideration, as the mother is more directly involved in the birthing process. Fathers were found to consider their role in this stage more auxiliary and supplemental compared to the mother’s role. These attitudes were found to suppress communication by the father to varying degrees. In the context of this study, this could directly affect the depth in which fathers are willing to divulge in regards to their feelings and emotions.
Researchers have a responsibility to protect participants from harm by fostering ethical standards (Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences and Humanities Research Council of Canada, 2014). These standards are required in order to ensure that the research is being conducted legally and ethically (Lobiondo-Wood, & Haber, 2013). This study will utilize these ethical standards by disclosing the study purpose and design to participants and providing a detailed information package. This will outline the potential risks and benefits of participating in the study and will allow participants to make an informed decision, thus promoting patient autonomy (Canadian Institutes of Health Research et al., 2014, p. 6). Participation will be voluntarily, and no research will be conducted until informed consent has been obtained. Each participant will be given copies of the consent form for their own records. To maintain participant privacy, an arbitrary ID number will be assigned to each individual and documents and interview recordings will be protected and have restricted access. Apart from these addressed confidentiality concerns, predictable risks are deemed to be minimal and potential benefits that provide insight into the coping mechanisms of the father greatly outweigh these risks.
In summation, a considerable amount of research has been conducted across the globe that examines many aspects of different birthing variables that challenge the involved parents. Despite this research, fathers are often underutilized and often even omitted. As the role of the father is undeniably important in the child-rearing process, this study will provide valuable insight into perceptions that are contextually based. Information attained from this study can be considered for use in similar settings and may provide necessary insight to healthcare provider perceptions of families faced with similar challenges.
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