Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study.

AIMS AND OBJECTIVES: To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep. BACKGROUND: Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centred care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) 24 hours a day. Lack of sleep may affect new parents' ability to cope with the many challenges they face on a daily basis. DESIGN: A phenomenographic study with an inductive and exploratory design. METHODS: Semi-structured interviews were conducted with twelve parents of infants in neonatal care between January-March 2012. To describe variations in perception of the phenomenon, data were analysed using phenomenography. FINDINGS: Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care: impact of stress on sleep; how the environment affects sleep; keeping the family together improves sleep; and, how parents manage and prevent tiredness. CONCLUSION: Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance and practical support. Skin-to-skin care was perceived as a stress-reducing factor that improved relaxation and sleep and should be encouraged by the nurse. The parents also mentioned the importance of being together. Having a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation. RELEVANCE FOR CLINICAL PRACTICE: Improved parental sleep in neonatal care may help the families cope with the situation and facilitate problem-solving, emotional regulation and the transition to parenthood.

Prediction of adaptation difficulties by country of origin, cumulate psychosocial stressors and attitude toward integrating: a Swedish study of first-generation immigrants from Somalia, Vietnam and China.

BACKGROUND: Different types of accumulated stress have been found to have negative consequences for immigrants' capacity to adapt to the new environment. It remains unclear which factors have the greatest influence. AIMS: The study investigated whether immigrants' experience of great difficulty in adapting to a new country could best be explained by (1) country of origin, (2) exposure to accumulated stressors before arrival or (3) after arrival in the new country and/or (4) reserved attitude toward integrating into the new society. METHODS: The 119 first-generation immigrants from Somalia, Vietnam and China, living in Malmö, Sweden, were interviewed in a standardized manner. RESULTS: Experiencing great difficulty in adapting to Sweden was independent of length of residence, but significantly related to all four influences, studied one at a time. Country of origin was also related to stressors and attitude. When the effects of the other influences were mutually controlled for, only exposure to accumulated stressors in Sweden (and especially experiencing discrimination/xenophobia/racism) accounted for great adaptation difficulty. Stressors in Sweden had a greater effect if the immigrant had been exposed to stressors earlier. CONCLUSIONS: Immigrants' long-term experiences of great difficulty in adapting to a new country were explained primarily by exposure to accumulated stressors while moving to and living in the new country, rather than by their backgrounds or attitudes toward integrating. This suggests promoting strategies to avoid discrimination and other stressors in the host country.