NEONATAL INTENSIVE CARE UNIT NURSES IN THE EYES OF MOTHERS: A

PERSPECTIVE ANALYSIS THROUGH Q METHODOLOGY

Krisha Czarine S L!"#hian$
For parents, birth of a newborn is a stressful and exciting event since they can experience joy
and many other emotions (Preyde & Ardal, 2!"# $he thrill they feel may be brief and can
become concern if the infant is born unwell and re%uires any medical intervention and treatment
with speciali&ed nursing care ($ran, 'edhurst, & ()*onnell, 2+"# ,nexpected admissions are
typical and newborns are usually admitted directly to the -eonatal .ntensive *are ,nit (-.*,"
resulting in separation and limited time for the newborn and mother to bond (/vans & 'adsen,
20"# 1hen a sic2 infant is admitted to the -.*,, parents can often feel shoc2, fear, anxiety,
guilt, and helplessness (3am, 4pence, & 5alliday, 26" and the outcome can be long7lasting
conse%uences for the infant8mother relationship (9autava, 3ehtonen, 5elenius, & 4illanpaa,
2!"# ,nderstanding the needs of parents, especially mothers, are vital to the development of
successful nurse7parent relationships and to lessen the stress they are experiencing#
-urses have an essential role in the care of sic2 infants# $hey can ease parental stress by
establishing a caring relationship ('c:rath, 20" -eonatal .ntensive *are ,nit nurses could
involve themselves better in decision ma2ing and help reduce parental stress if they recogni&e
the experiences and feelings of the parents of sic2 infants# 'others also rated a high value on the
importance of care being given, exchanges of information and relationships between
professionals and parents (;runs & 'c*ollum, 22"# ;ecause of that, the researcher has come
up with the %uestion 8 how do mothers of infants admitted in the -eonatal .ntensive *are ,nit
perceive -.*, nurses<
Parent)s perception on the support given by nurses are mostly influenced to the point to
which nurses appear to be confident in their s2ills in how they present professional demeanor#
Perceptions, even if it)s not always accurate, are very important in 2nowing the satisfaction with
the support given and it may be influenced by the one who gives the support# Parental opinion is
important in connection with care is seen as one aspect of %uality care ($ran, 'edhurst, &
1
()*onnell, 2+"# ,sing = methodology, the researcher will assess the perception of the
mothers regarding neonatal care unit nurses, how it impacts the nurse7mother relationship and
how nurses can turn the stress experienced by the mothers of sic2 infants to a friendly
environment#
$he study will benefit the -eonatal .ntensive *are ,nit nurses by ma2ing them aware on
how the mothers of sic2 infants that they handle perceive the support they give# .t can also be a
tool in which a health care provider evaluate on how nursing support can affect a parent under
different 2ind of emotions when their newborn is admitted in the -.*,#
A number of studies have shown on how the effect of the relationship between nurses and
mothers of infants admitted in the -.*, can achieve a sound partnership and more positive
experience for the mothers of the sic2 infants# According to a study by 5eermann, 1ilson &
1ilhelm (20", before mothers could focus on their babies, -.*, environment is her first
concern# $he expertise of the nurse, technologies used in the -.*, and the language and culture
of the health care provider is the foreground of the mother)s attention# 'others consider nurses as
experts and in charge of their babies and they feel good when nurses encourages and reassures
them on the babies condition# (n the other hand, some mothers felt frustrated when nurses did
not allow or encourage them to participate in the care of their new born, they feel that their
opinions did not count even if they are the primary care giver# 'others felt that their role in the
-.*, depends of the nurse on duty and they learned that not all nurses are willing to accept
them in partnership with the care for their infant#
.n -.*,, interactions between mothers and caregivers mostly involve >telling> rather that
meaningful exchanges of information (Fenwic2 et al#, ?+++ as cited in 5eermann, 1ilson &
1ilhelm, 20"# $he challenge of incorporating human caring relationship building to -.*,
settings where nursing expertise is a primary value ('c:rath, 2 as cited in 5eermann,
1ilson & 1ilhelm, 20"# $hree individual transitions central to nurse partnering with parents
in the -.*,@ Aac2nowledging the central role of the parentB fostering the parent as a competent
caregiver and integrating the roles of expert coach, teacher, and facilitator into the existing
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technically expert nurse roleC (5eermann and 1ilson , 2 as cited in 5eermann, 1ilson &
1ilhelm, 20"#
.n another study made by 3am, 4pence & 5alliday (26", 6+D of the E2 participants that
were included in their study indicated that being unsure that the nurse would call them about the
changes in the baby)s condition is the second most stressful experience they had# Parents felt they
nurses disregarded experience that re%uire considerable emotional or psychological support such
as their feelings, worries and concerns# Finding in the said study revealed that the stress
perceived by the family will would be less if there is high level of nursing support# 4ome parents
perceived that nursing communication and behavior contributed to the stress that they
experience, particularly when they felt the nurses did not give them enough information about
tests or treatments being underta2en#
.t is indeed a challenge for -.*, nurses to be aware of the impact of their relationship with
the parents# There are few literatures describing nurse7parent relationship but none of them
focused solely on the study of subjectivity of the mothers regarding -.*, nurses# 5ence, it is the
purpose of this study to deal with that subjectivity#
O%&e#"i'es () "he S"!*+
?# $o describe the divergent perspectives of mothers about -.*, nurses#
2# $o identify subjective viewpoint held by mothers as clusters or factors that describes such
viewpoints#
METHOD
Resear#h Desi$n
$he study will focus on the perception of mothers of sic2 infants regarding the support
given by -.*, nurses ma2ing it highly subjective# $his is the reason why the researcher will be
utili&ing = methodological analysis, because it offered a scientific approach through which
researchers could attain a systematic examination and understanding of individuals) subjectivity#
(4tephenson, ?++! as cited in 4imons, 2?!"#
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Par"i#i,an"s an* Se""in$
A total of F mothers whose infants are admitted in the -.*, for over a wee2 coming from
various hospitals in Pampanga during the time of data collection will be the target population for
this study, regardless of age, social status and educational attainment # $he selection of the
participants will be chosen non randomly and included those willing to participate in the said
study#
As this study aims to present the perception of mothers whose infants are admitted in the
-.*, regarding the support given to them by nurses, the study will be conducted in a hospital
setting, either secondary or tertiary and private or government7operated hospitals in Pampanga#
E"hi#a- C(nsi*era"i(ns
$he researcher will present a letter of consent to the selected participants# $he consent will
also serve as a guarantee to the participants that their identity and everything they say during the
interview will be confidentially protected#
Resear#h Me"h(*(-($+
Following the course of = methodology, the researcher will present a systematic way of data
of collection procedure# =7'ethodology has several steps to follow in order to attain a reliable
outcome and results based from the viewpoints of the participants#
. C(n#(!rse De'e-(,/en"
.n = methodology, concourse refers to Athe flow of communicability surrounding any topicC
in Athe ordinary conversation, commentary, and discourse of everyday lifeC# $he concourse
should contain all the related aspects of all the discourses# .t is up to the researcher to choose a
representative sample from the concourse# $he concourse may consist of self7referent statements
or from opinions, objects and pictures# A verbal concourse, may be obtained in a number of
ways@ interviewing, observing the participants, media reports, newspapers, maga&ines, novel and
scientific literature, li2e papers, essays, and boo2s# $he statements that will be gathered
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represents existing opinions and arguments things that the participants have to say about the
topic (;rown,?++! as cited in Gan /xel & He :raaf, 20"#
$he researcher will be collecting statements from the selected participants about their
perception on the given topic# $he concourse will be consisting not only of self7referent
statements from the selected mothers but as well as related literatures# P set will each encounter
a face to face interview with the researcher that will ta2e 27! minutes using a semi7structured
self7report techni%ue# Possible %uestions will be formulated prior the set date and upon the
interview, follow7up %uestions will be added for necessary elaborations#
0 De'e-(,/en" () "he Q se"
After the development of the concourse, development of = set or = sample should be
followed7 a subset of statement from the concourse that often consist F070 statements, but less
or more statements are possible# 4election from the concourse of statements that will be included
as = set is crucial# $he researcher uses a structure for selection of a representative of the
concourse# 4tatements are then numbered and printed on separate cards 8 the = dec2 8 for =
sorting# (;rown,?+I as cited in Gan /xel & He :raaf, 20"#
$he = set will contain both negative and positive statements but with the same opinion and
idea# 1hen = set is developed, determination of the P set and = sort may follows#
1 De"er/ina"i(n () "he P se"
$he participants that will underta2e the study are 2nown as the >p set># A >p set> that
contains F and E individuals wor2 best (9ogers,?++0 as cited in 4imons, 2?!"# A p set of F
to E is more than enough for most studies, but far fewer may be needed for some studies
(;rown ?+I as cited in 4imons, 2?!" -umbers of participants is not an issue but how they
represent different viewpoints about the theme being studied # $he aim in = methodology is to
be able to depict typical representations of different viewpoints rather than find a part of
individuals with specific viewpoints (A2htar7Hanesh, ;aumann & *ordingley, 2I as cited in
4imons, 2?!"# $he researcher will identify F participants for the p set#
1 Q S(r"in$
5
(nce the =7sample has been specified it will be given to the P sets in the form of a pac2 of
randomly numbered cards, each card containing one of the statements from the = set#
9espondents will be instructed to ran2 the % sample according to hisJher viewpoint regarding the
issue and is provided a score sheet and they will distribute the statement for % sorting# $he score
sheet or score table is a ranges from most to most, and in between a distribution that usually
ta2es the form of a %uasi7normal distribution# $o simplify the process of ran2ing, participants
will start by reading all of the statements carefully and afterwards separating all the statements
into ! piles@ statements sJhe generally agrees with (li2es or finds important", those that sJhe
disagrees with and those about which sJhe is neutral, doubtful or undecided# After the separation,
the respondents are as2ed to ran2 order the statements in the continuum ranging from 70 to K0,
from most disagreed to most agreed, using a table called the =7sort table or =7table# $o facilitate
=7sorting process, the =7table has a %uasi7normal distribution labeled from strongly disagree (or
similar description" at the left to strongly agree at the right# (;rown,?++! as cited in Gan /xel &
He :raaf, 20"#
After the arrangement, the researcher will use a %uestionnaire for elaboration pertaining the
= sorting done# 9espondent is encouraged to elaborate his viewpoint especially on the most
salient statements to derive information that is helpful in interpretation of factors later on (/xel
and de :raaf 20"
Da"a Ana-+sis
= sort analysis is a purely technical, objective procedure 8 and is referred to as the scientific
base of = (/xel & de :raaf, 20"# $he correlation matrix of all = sorts is calculated # $his
corresponds to the level of agreement or disagreement between the respondent sorts, that is, the
degree of similarity or difference in points of view between the individual = sorters# After that,
this correlation matrix is subject to factor analysis, with the purpose to identify the number of
natural groupings of = sorts by virtue of being same or different to one another, and to examine
how many basically different = sorts are in evidence (;rown ?+IB ?++! as cited in /xel & de
:raaf, 20"# P sets with the same views on the issue will share the same factor# A factor loading
is determined for each = sort, stating the extent to which each = sort is associated with each
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factor# $he number of factors in the final set depends on the variability in the gained = sorts
(/xel & de :raaf, 20"#
P='ethod 4oftware that is developed by Lohn At2inson, a senior multimedia developer at
Ment 4tate ,niversity, under the supervision of a =7methodology pioneer, 4teven 9# ;rown,
will be used to analy&e A mothers of infants admitted in the -.*,)s perception on -.*, nursesC
items# P= 'ethod is a statistical program that is used to the re%uirements of = studies#
4pecifically the program allows to easily enter data (=74orts" the way they are collected#
*orrelations among =74orts are being computed, which are then factor7analy&ed with the
*entroid#
Garimax will be use for factor rotation# Hoing this, the factor will condense the items into an
assortment of highly related items and through rotation it will ma2e the explanation or
interpretation of the factors simple because each factor became representative of a small amount
of highly inter7correlated statements# .t is also less time7consuming, widely used and better for
practical purposes and highly dependent on topographical features of the correlation matrix
(A2htar7Hanesh, ;aumann & *ordingley, 2I as cited in 4imons, 2?!"
$he resulting factors can be rotated either analytically, or judgmentally with the help of two7
dimensional plots# 3astly, after selecting the factors that are related and extracting the entries that
define the factors, the analysis step produces an extensive report with a variety of tables on factor
loadings, statement factor scores, discriminating statements for each of the factors as well as
consensus statements across factors#
*alculation of factor scores and difference scores is the step before describing and
interpreting the factors# $he normal weighted average statement score (N7score" of respondents
that define that factor is the statementOs factor score# 4tatements can be attributed to the original
%uasi7normal distribution based on their N7scores, resulting in a composite = sort for each factor#
$he composite = sort of a factor stands on how a respondent with a ?D loading on that factor
would have ordered all the statements of the =7set# (ne can loo2 bac2 at the = sorts and see how
high their loadings are on the different factors after the factors are computed#
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$he next step would be the selection of factor for interpretation# A standard re%uirement is to
select only those factors with an eigenvalue in excess of ?## $he second standard re%uirement
is that an interpretable =7methodological factor must ordinarily have at least two =7sorts that
load significantly upon it alone or 2nown as factor exemplars# *onfounded =7sorts which load
on two or more factors are excluded# Factors with single exemplars will be forced to use as the
individualOs own =7sort as the best estimate (1atts & 4tenner, 20 as cited in 4imons, 2?!"#
/ach factor then is interpreted using statements specific to that factor# A distinguishing
statement, defining the individuality of each factor, for a factor is a statement which scores on
that factor is notably different from its score on any other factor# $hese statements are used to
interpret and label each factor# $he validity of the interpretation depends on the use of factor
analysis in extracting the distinguishing statements and the use of domain experts in
interpretations# $he accuracy of the interpretation can be further confirmed by as2ing the content
experts to comment on their views about the theme of the study# .n the end it always depends on
the nature of the data and aims of the investigation (1atts & 4tenner, 20 as cited in 4imons,
2?!"# $he endpoint of the statistical analysis is duly reached when each of the selected factors is
represented by its own best7estimate = sort or Pfactor arrayO# $his factor array or best7estimate =
sorts can then be subjected interpretation# /xplanations the respondents gave during the follow7
up interview can be helpful in interpretation of the factors, in ex7post verification of the
interpretation, and as illustration material (/xel & de :raaf, 20"#
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