Trying to Do What Is Best: A Qualitative Study of Maternal-Infant Bonding and Neonatal Abstinence Syndrome.

BACKGROUND: The maternal experience of caring for and bonding with infants affected by neonatal abstinence syndrome (NAS) has not been adequately characterized. PURPOSE: This study was designed to describe mothers' experiences of, supports for, and barriers to bonding with infants with NAS. METHODS: Semistructured interviews were coded using computer-assisted thematic content analysis. A code co-occurrence model was used to visualize the relationships between themes. RESULTS: Thirteen mothers of infants with NAS participated. Trying to Do What Is Best emerged as the overarching theme with which several subthemes co-occurred. Subthemes that captured mothers loving their infants and bonding, feeling supported by the infants' fathers, feeling supported in the community, and receiving information from hospital staff were associated with mothers' trying to do what is best. Barriers to trying to do what is best included feeling unsupported in the community, guilt about taking medications or substances during pregnancy, feeling judged, and infant withdrawal. IMPLICATIONS FOR PRACTICE: Specific implications for practice may be derived from the mothers' criticisms of NAS assessment tools. Mothers highlighted the value of reassurance and education from providers and the uniquely nonjudgmental support received from peers and male coparents. IMPLICATIONS FOR RESEARCH: There is a lack of information about maternal-infant bonding in dyads affected by NAS and factors that contribute to parental loss of custody. Qualitative, quantitative, and mixed-methods studies in diverse populations might help researchers better understand the long-term outcomes of NAS and develop interventions that decrease family separation.

Health-related quality-of-life outcomes in coronary artery bypass surgery patients and partners.

PURPOSE: The purpose of this study was to examine health-related quality-of-life (HRQOL) outcomes in coronary artery bypass surgery (CABS) patients and partners enrolled together in cardiac rehabilitation versus a usual care group. METHODS: After CABS, couples were randomly assigned to the Partners Together in Health (PaTH) intervention (n = 17) or usual care (n = 17) groups. Health-related quality-of-life was operationalized as physical function (SF-36 Physical Functioning subscale), depression (Patient Health Questionnaire), and marital adjustment (Dyadic Adjustment Scale). Data were measured in patients and partners at the start (T1) and end of cardiac rehabilitation (T2), and 3 months after cardiac rehabilitation (T3). Nonparametric statistics were used to examine changes over time and differences between groups. RESULTS: Patients in both groups, and partners in the PaTH group, significantly improved physical function between T1 and T2. At T1, 18% of patients and 6% of partners were depressed. At T2 and T3, only 3% of patients and no partners were depressed. Almost 12% of patients and partners were maritally distressed at T1. At T2 and T3, patients' marital distress was unchanged, but more partners reported marital distress (15%). CONCLUSIONS: This study adds to our understanding of the trajectory of HRQOL outcomes after CABS for patients and partners. These findings demonstrated promise for the PaTH intervention. Future testing of the intervention is warranted in a larger sample. Because patients and partners are impacted by CABS as a shared life experience, couple-centered interventions may improve HRQOL outcomes more than individually focused interventions.