Exploring the Relationship Between Mother and Baby Essay Example for Free

Exploring the Relationship Between Mother and Baby Essay Exploring the relationship between mother and baby in the NICU in relation to nursing support. Abstract Aim -To explore the effect of interaction related to care-giving and information exchange between nurses and mothers in relation to maternal stress and maternal-infant relationship in the newborn intensive care unit (NICU) throughout the hospital stay. Background Mothers in the NICU experience depression, anxiety, stress, and loss of control, and they fluctuate between feelings of inclusion and exclusion related to the provision of health care to their neonate. This literature review helps to identify nursing interventions that promote positive outcomes between mother and baby by reducing maternal feelings of stress and anxiety. Search Method A literature search covering the period 2008-2012 was conducted. Five articles reporting both quantitative and qualitative studies relative to the subject were retrieved. Findings Findings reveal that positive and trustful relationships between nurses and mothers develop when nurses communicate and interact with mothers. This alleviated mother’s anxiety and enhanced their confidence when interacting with their baby. Discussion Critical analysis as well as strengths and weaknesses of the relative journals reviewed is given together with useful recommendations that emerge from the evidence. Conclusion The literature reviewed shows that nurse-mother interaction improves mother-infant relationship. In turn, this will eventually assist in decreasing maternal stress and improve the maternal well-being. INTRODUCTION Mothers develop attachment to their baby during pregnancy, which continues and develops more fully after the child is born (Cleveland 2009). However, the pathway to becoming a mother is threatened with the admission of the baby to the NICU. This occurs due to the unfamiliar and intimidating environment of the NICU (Obeidat et al 2009). During the initial admission parents can believe that the healthcare team is more able to care for their baby and this can instill feelings of inadequacy (Cockfort 2011). As a result, maternal attachment may be delayed by the lack of socialisation between mother and baby as most of the care is done by nurses (Cleveland 2009). DeRouck and Leys (2009), found that the parents of an infant admitted to the NICU face challenges including access to information, disclosure about the diagnosis, treatment and prognosis of their newborn, as well as a lack of control over the care of their newborn. Adding to this distress is the uncertainty of survival or the eventual impact of the infant’s condition on later health and well-being. In addition, feeling guilty to mother an unhealthy infant creates fear of social prejudice. Further, the structure of the NICU places significant barriers on mothers’ abilities to enact the parental role since decision-making and the daily care of the infant is taken over by medical and nursing staff restricting interactions with the babies stripping off their maternal authority (Cleveland 2009). In fact, when babies are in the NICU, traditional conceptualizations of the parental role are altered. The situation demands heightened parental participation while simultaneously placing severe restrictions on parental involvement. In response, parents need to negotiate this tension and traditional definitions of the parental role, which must be continually redefined throughout their experience What emerges is that the predominant source of distress is inability of the mother to protect the infant from pain and provide appropriate pain management. (Fenwick et al 2008). A lot of procedures cause pain in the neonate creating concerns for the mother, starting from peripheral cannulas, indwelling catheters and intubation to mention a few. In intubated babies, even though morphine infusions are administered, the baby still shows signs of distress during nursing times. In this case, we administer a small bolus of pain relief prior to nursing so that the baby would be more comfortable. Conversely, Fenwick et al (2008) describes factors that contribute to parents’ satisfaction in the NICU. These include; assurance and psychological support, the provision of consistent information, education, environmental follow-up care, appropriate pain management, and parental participation and proximity, as well as physical and spiritual support. Therefore, it is imperative that nurses should do their best to improve the mothers’ sense of confidence, competence and connection with her infant through guided participation (Domanico et al 2011). Johnson (2008) notes that skin-to-skin holding or kangaroo care promotes maternal-infant feelings of closeness, builds maternal confidence, and may be a stress-reducing experience for both the mother and infant. Hence the importance of providing the opportunity for kangaroo care to occur. Hunt (2008), notes that KMC is also crucial to stabilize parameters, such as cardio-respiratory parameters whilst being beneficial for maintaining body temperature. They add that even the incidence of nosocomial sepsis and the duration of hospital stay decreased with practicing KMC. In addition, Ali et al., (2009), found that Kangaroo mother care also showed positive outcomes towards practicing exclusive breastfeeding. Cockfort (2011) notes that, continuity of care needs to be ensured hence the importance of documentation. Therefore, it is suggested that handover should not be rushed, whilst a more comprehensive handover can ensure the smooth transition of care for staff and the family. When parents ask questions relating to their baby they feel assured in the competency of staff when information has been passed on correctly. When information is not shared effectively parents can lose trust and the partnership breaks down. In Malta, even though handover of 2 consecutive days is given, conflicting advice is still given at times due to the nurses’ different view-points. Consequently, this requires ward meetings in order to clarify important issues so that advice given and practice is consistent. In Malta, about 373 babies are admitted yearly (Grech et al 2012). In view of the benefits discussed, nurses should do their utmost to improve the overall experience of the mothers of such babies. Search Method A review of published research consisted of the following steps; broad reading to determine areas of focus, identification of inclusion and exclusion criteria, literature search (appendix 1) and retrieval, critical appraisal and analysis of the research evidence and synthesis of evidence. Evidence was reviewed with the aims of identifying barriers that affect the motherinfant interaction within the neonatal intensive care unit and how nurses can actively support attachment. Articles were included if the setting was primarily in a neonatal intensive care unit (neonatal unit or neonatal intensive care unit) and the participants were mothers of infants admitted to neonatal intensive care units or nurses working within that setting. In addition, All articles were critically analyzed with two primary questions in mind: (a) What are the needs of parents in the NICU? (b) What nursing behaviors support parents in meeting these needs? Articles were also included if they were primary research studies published between 2008 and 2012 and written in the English language. Primary and secondary literature searches were conducted through the EBSCO, ERIC, Sciencedirect and Medline databases. The primary search terms included â€Å"NICU,† â€Å"Neonatal Intensive Care Unit,† â€Å"family support,† â€Å"communication,† â€Å"nurse† and â€Å"early intervention.† The secondary literature search terms included â€Å"nursing support,† â€Å"efficacy,† â€Å"family,† â€Å"communication,† â€Å"support†, â€Å"neonatal† and â€Å"Kangaroo Mother Care†. These terms were used and utilised in all possible combinations to perform an extensive literature search of the above mentioned electronic databases. Thirdly, a review of references was conducted of the identified articles for any further studies. Eighteen articles were found through the search. Six studies met the inclusion criteria of which, 3 were qualitative and 3 quantitative (appendix 2). The subject was limited to the last 5 years. This time frame helps in the getting the most recent experiences since NICU is a changing environment especially as regards to technology which effects the mothers as well as the nurses. Both quantitative and qualitative studies were found. Both qualitative and quantitative research was conducted to identify what is known about the needs of NICU parents and what behaviours support these parents. Both methods of research were included because of the potential for each to contribute to a more complete understanding of this topic. In selecting a research design, researchers should be guided by one overarching consideration: whether the design does the best possible job of providing trustworthy answers to the research questions. One needs to note that both studies have limitations (Cottrell McKenzie, 2011). In quantitative research, the researcher’s aim is to determine the relationship between one variable (an independent variable) and another (a dependent or outcome variable) in a population (Morrow 2009). In contrast to quantitative designs, qualitative designs do not result in numerical data for statistical analysis (Schira, 2009). In qualitative methods, researchers are interested in interpreting social phenomena and exploring the meanings that people attach to their experiences (Polit and Beck 2010). Moreover, views, attitudes and behaviours may be explored (Wood Kerr, 2011), through grounded theory as it develops theories that are grounded in the groups observable experiences, but researchers add their own insight into why those experiences exist. Findings Table 1 includes information about the 5 studies that met the inclusion criteria . Once an infant is admitted into an NICU, many factors account for parental stress. Admission of the infant to the NICU places mothers in a stressful situation where they must cope with the NICU environment and its associated demands. In the study conducted by Parker (2011), a grounded theory approach was used to understand feeling and stressors of 11 mothers whose new-borns were in the NICU. It was found that the early days shock and numbness accompanied feelings of none or little control over their lives. Moreover, all mothers described feeling unprepared for the premature delivery and the sight of their baby in the NICU. Comparative results were found by Lee et al (2009), with regards to the shock experienced with the initial sight of the baby. Everyday unpredictable changes occur leaving no time for adjustment or preparation. Constant fears about the life and death of the baby do not subside and several mothers spoke about their experience of always anticipating the death of the baby. These findings are also reflected in my clinical setting when mothers would be recounting their experience once the baby’s condition improves. This is in line with the findings of Fenwick et al (2009) and Lee et al (2009). In addition, the findings imply that the positive reassurance of the effects of a positive and caring environment and support network between parents and nurses in the NICU is not always evident among every unit. Nicholas-Sargent (2009) found that assurance is the most important aspect to be fulfilled. Her quantitative study of 46 mothers found that the length of stay in the NICU and mothers’ information needs were found to be significantly inversely correlated. Therefore, this suggests that the longer an infant remains hospitalized in the NICU, the less emphasis the mother places on receiving information about the infant’s condition. This shows that the needs of the mothers in the NICU can change over time. My observations match these findings since mothers familiarise themselves and adapt to the situation. Moreover, they would eventually want to be successful with the care of the baby. This is reflected in the grounded theory analysis conducted by Fenwick et al (2008), using semi-structured interviews. They found that the nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. Being successful in their desire to care for the baby, engendered feelings associated with being a ‘‘real’’ mother. However, not all women in this study were able to successfully employ these strategies. In the situation where the mother perceived herself as ‘‘quiet and unassertive’’, and in a position without any power, it was very difficult to gain the confidence needed in order to be able to openly question, negotiate and direct the care of her infant. Therefore, it is very important to identify these mothers in order to help them by giving them continuous reassurance. This would particularly be required when the situation changes from support needing to encouragement in participation. Lee et al (2009) found that mothers received support from the healthcare professionals and the social networks that mothers made. These helped to create the connections that developed between the mothers and infants making their journey towards parenthood possible. They discovered that challenges are further compounded in Taiwan, where women are traditionally required to practice the cultural ritual which includes confinement to the house with a special balanced diet for the first month postnatal. Lee et al (2009) used the grounded theory approach with in-depth interviews and constant comparison. All interviews were audio-taped and notes were made during and immediately after the interview concerning actions and body language of the mother during the interview. The finding of this study further indicated that the initial sight of the life-support equipment was shocking. The technological environment created a fearful atmosphere, and the medical equipment attached to their infants caused the mothers further physical separation. The mothers indicated that they were so afraid of the equipment that it took them a long time to be able to participate in their infants’ care. In turn, this hampered them from establishing positive mother–infant interactions. Chiu and Anderson (2008), found that preterm births often negatively influence mother–infant interaction due to lack of physical contact. In addition, they found that skin-to skin contact post-birth has positive effects on infant development. These researchers conducted a randomized controlled trial (RCT) using questionnaires for data collection. In addition, mothers were further video-taped during a feeding session. Ali et al., (2009),highlight the importance of kangaroo care in their RCT where the researchers conducted their study with one hundred and fourteen infants. This study showed that the infants exposed to kangaroo mother care had an increase in rectal temperature compared to conventional care, therefore having a decreased risk of hypothermia. The mean temperature during kangaroo mother care was of 37 degrees Celsius while the mean temperature during conventional care was of 36.7 degrees Celsius. The data collected was through posted questionnaires. Discussion In the 3 qualitative studies found, the data was collected through interviews of which 2 were semi-structured while 1 was unstructured. Parker (2011), Fenwick et al (2008) and Lee et al (2008), used the Grounded theory approach. However, while Parker and Fenwick use semi-structured interviews, Lee uses unstructured interviews. In semi-structured interviews there is a topic guide with list of areas or questions to be covered with each respondent. This technique ensures that researchers will obtain all the information required, and gives respondents the freedom to respond in their own words, provide as much detail as they wish, and offer illustrations and explanations. Lee et al (2009) uses ground theory approach but incorporated with unstructured interviews. Unstructured interviews also known as are flexible but are more time-consuming than semi-structured since the interviewer listens and does not take the lead. The interviewer listens to what the interviewee has to say. The interviewee leads the conversation (Wood Ross-Kerr, 2011). However, anonymity for confidentiality which is of utmost importance is not possible. When using unstructured interviews, the researchers have to be able to establish rapport with the participant. The reason is that the interviewers have to be trusted if someone is to reveal intimate life information. This may lead to interviewee bias. Also, it is important to realise that unstructured interviewing can produce a great deal of data which can be difficult to analyse. Lee et al (2008) and Fenwick et al (2008) conducted the interviews themselves while Parker (2011) did not, thus reducing the bias. However, interviewer bias occurs even if someone else is conducting the interview. The number of mothers in the study of Lee et al (2008) was adequate since with in-depth interviews 20 participants are enough. However, to account for the small sample, more interviews and observations were done with the same participants in order to reach theoretical saturation. Usually informants are selected for in-depth interviews in a purposive manner questioning the generalizability of the results (Wood Kerr, 2011). A major controversy among grounded theory researchers relates to whether to follow the original Glaser and Strauss procedures or to use the adapted procedures of Strauss and Corbin (Polit Beck 2010). Grounded theory method according to Glaser emphasizes induction or emergence, and the individual researchers creativity within a clear frame of stages, while Strauss is more interested in validation criteria and a systematic approach. Parker (2011) uses the original Glaser and Strauss (1967) paradigm while Lee et al (2008) and Fenwick et al (2008) use Strauss and Corbin (1998) procedures. One of the fundamental features of the grounded theory approach is that data collection, data analysis, and sampling of study participants occur simultaneously. A procedure referred to as constant comparison is used to develop and refine theoretically relevant categories. Categories elicited from the data are constantly compared with data obtained earlier in the data collection process so that commonalities and variations can be determined. As data collection proceeds, the inquiry becomes increasingly focused on emerging theoretical concerns. All 3 studies use constant comparison. All the above 3 studies use audio-taping for data collection except for Fenwick et al (2008) who used field note documentation as well. Audio-taping enables eye contact to be maintained and to have a complete record for analyses, however, some interviewees may be nervous of tape-recorders. On the contrary, in note taking on the other hand, a lot of eye contact is lost unless a type of short-hand is learnt. However, the interviewer will have plenty of useful quotations for report when transcribing the interview. Randomized controlled trials consist of a complete experimental test of a new intervention, involving the random assignment of a large and varied sample to different groups (Polit Beck, 2010). The intention of an RCT is to arrive to a judgment as to whether the novelty of an intervention is more effective than the traditional intervention (Polit Beck, 2010). This intention was well noticed throughout the RCTs chosen by Ali etal., (2009). Wood Kerr, (2011) sustain that RCTs are the most rigorous method to determine a cause-effect relationship between the treatment and the outcome. Furthermore, RCTs were also described as the gold standard trial for evaluating the effectiveness of a clinical intervention ((Muijs 2010). One of the primary aims of RCTs is to prevent selection bias by distributing the patient, randomly between the two groups, so that the difference in the outcome and results can be justified and attributed only to the intervention under study. Thus, through random selection there is a better balancing of any confounding factors, therefore creating similarity between the groups (Cottrell McKenzie, 2010). In effect in this literature review, RCTs were found to be useful and beneficial to compare the effect of KMC and conventional care on the physiological aspects of the infant. Ali et al., (2009) chose to add blocking to randomisation so as to ensure a better balance in the number of infants allocated in the groups. These groups were randomized through simple randomization and the disruption of groups was achieved by delivering a concealed envelope technique. Through random sampling, Polit Beck (2010) explain that each element in the population has an equivalent, autonomous chance of being chosen. However, this design is not used frequently as it is lengthy and may be expensive (Wood Kerr, 2011). Chiu and Anderson (2008), use mixed methods of data collection by using both questionnaires and video-taped interviews. The use of multiple sources or referents to draw conclusions about what constitutes the truth is called triangulation. This is one approach in establishing credibility as it enables the researcher to counteract the weaknesses in both designs. The use of video-taping provides the most comprehensive recording of an interview since it captures body language, facial expressions and interaction (Gerrish and Lacey 2010). However the interviewee may become uncomfortable and act differently than in normal circumstances questioning the reliability of the data collected. In addition, questionnaires are the main research tools used in quantitative research. They are very advantageous as they can be constructed in such a way as to meet the objectives of almost any research project. In the Family Needs Inventory used by Nicholas-Sargent (2009), the ‘not applicable’ part was removed from the Likert scale in order to report definite opinions. Questionnaires can measure the participants factual knowledge about a certain subject or an idea or else they can be used to explore opinions, attitudes or behaviours (McNabb, 2008). Moreover, questionnaires are also less expensive than most other research instruments and are also less time-consuming . Self-administered questionnaires provide the participants with anonymity, and responses are not affected by the interviewers mood or presence (Wood Ross-Kerr, 2011). On the other hand, the main disadvantage of questionnaires is that there is a high possibility of a poor response rate since some questions are ignored, misinterpreted, incorrectly completed or inadequately detailed (Polit and Beck 2010). The RCT of Chiu and Anderson (2009) and Ali etal. (2009),, is one of the most powerful tools of research where people are allocated at random to receive one of several clinical interventions. However RCT’s are vulnerable to multiple types of bias at all stages of their workspan (Geretsegger et al 2012). Hence the need to establish validity and reliability. In the study done by both Ali etal.,(2009) and Chiu and Anderson (2009),the researchers increase the rigor on the study by using a large number of participants. In addition, Chiu and Anderson (2009) use the Nursing Child Assessment Satellite Training Program (NCAST) Feeding and Teaching scales. Nicholas-Sargent (2009), improved the rigour by using the Critical Care Family Needs Inventory (CCFNI), as a framework for the FNI. CCFNI has been thoroughly reported with results indicating internal consistency and construct validity (Gerrish and Lacey 2010). Despite this, Nicholas-Sargent (2009), use a small scale study and therefor e the results cannot be generalized. Limitations In the study done by Lee et al (2008), the data were only collected from one hospital in this present study causing generalisability of the results to be low. Moreover, the sample was restricted to those who did not have additional social, cultural or medical circumstances to consider. Moreover, coding was done by researcher itself and this might have caused some bias. Both Nicholas-Sargent (2009) and Parker (2011) use small scale studies but these were qualitative studies. Therefore, to a certain extent the findings cannot be generalized across the population of families involved with the NICU. In addition, Parker (2011) uses a retrospective study, which might have been subject to bias in recalling information. There was absence of pilot study in both Nicholas-Sargent (2009) and Chiu and Anderson (2009). The use of pilot studies helps to assess the design, methodology and feasibility of the tool and typically includes participants who are similar to those who will be used in the larger research study ( Wood Kerr 2011). Hence, their importance. Also, the instruments chosen by Chiu and Anderson (2009), being the (NCAST and the feeding and teaching scales) for this study might not be sensitive enough to capture any between-group difference in changes resulting from the intervention. Finally, Ali et al., (2009) fail to mention intention to treat analysis where researchers can introduce reality into research by outlining that not all randomised participants will continue throughout the study. Therefore, this might be a potential weakness in this study. It was also noted the there was no detailed report about the time intervals between the two different groups. Hence, this may also have introduced performance bias. In the grounded theory approach taken by Fenwich et al (2008), limitations lie in the method of data collection itself through semi-structured interviews that were tape-recorded and field note documentation done. The authors did not acknowledge limitations in the study. Recommendations Maternal contact Fenwich et al (2008) suggests prioritising maternal-infant closeness when underpinning policies and protocols and suggests the unrestricted access to their child. Lee et al (2008) found that in Taiwan mothers are allowed to visit for 30 minutes twice a day. In Malta, mothers are allowed to stay with the child 24 hours a day. In addition, skin-to-skin contact is recommended by both Lee et al (2008) and Chiu and Anderson (2009). The latter suggests that all mothers, if they are able and whether or not they ask for it, skin-to-skin contact should be encouraged. My suggestions on interventions for critically ill infants include encouraging the parents’ presence at the bedside, assisting the parents in personalizing the bedside, and teaching the parents to gently touch their infant. Another approach is to hang a simple picture board with the first names of nurses and practitioners near the entrance to the unit. This picture board helps anxious families feel welcomed in this healing environment. In our unit, those babies who have central lines such as umbilical arterial catheters (UAC), the mothers are not allowed to hold the baby for fear of bleeding if the UAC gets dislodged. However, if the mother shows signs of needing contact with the baby, we allow her to hold the baby with constant supervision. In the case of babies that are ventilated mothers are only allowed to hold their baby if the prognosis is very poor. Therefore, this shows that, if the baby is on long term ventilation, skin-to-skin is hindered from being introduced. Fenwich et al (2008), recommend the development of tools that can better evaluate the satisfaction of the mother. Hence, the need for longitudinal qualitative research. In my opinion this would yield good results when past experiences would show which improvements were helpful and which were not. NICE standards (2010), specify the use of surveys. We can incorporate these surveys after consideration with the midwifery officer. Mother-nurse-infant interaction Because of the complexity of illness, parents of critically ill infants are anxious and fear the worst with every visit to the NICU. Strategies need to be adapted to decrease maternal anxiety while supporting the needs of these infants. (Nicholas-Sargent 2009). Nurses play a vital role in helping parents throughout the stressful and challenging experience of the NICU by developing therapeutic relationships and providing emotional support. These approaches enable parents to feel more supported, more involved, confident, and more effective as parents of their vulnerable newborn. The experience of parents in the NICU occurs during an emotionally intense period fraught with anxiety, stress, depression, and feelings of hopelessness. Therefore, Nicholas-Sargent (2009) suggests that, it would be vital to do an NICU orientation for expectant parents with a high risk of giving birth to a premature infant or a compromised newborn. Supporting and facilitating their parenting role will help decrease their stress, strain, anxiety, and depression. Lee et al (2008), nurses need to respect the cultural preferences of mothers as this would promote desired health outcomes. This would aid in meaningful, holistic and individualized care. According to Nicholas-Sargent (2009), personalized one-to-one as opposed as opposed to group support would be helpful. In addition Nicholas-Sargent (2009), suggests that nurse education is needed to improve the awareness of the impact of the counselling service. However, the service needs to be more flexible due to fluctuations in the health condition of the baby. In fact, what we notice is that mothers would require counselling at different stages of the hospitalization. Therefore, if the service was refused once, it may still mean that mothers would need it at some other point in time. Nicholas-Sargent (2009), further suggests that the counselling service would be extended to the whole family from the hospital as well as in the community., Both the DH (2009), and NICE (2010) highlight the importance of Family-Centered Care (FCC) views the family as the ‘child’s primary source of strength and support’ and allows for collaboration, respect, and support with the parents and family during all levels of the service delivery. To foster participation in care for the infant, unrestricted visiting hours should be encouraged for the nuclear family of the neonate. In Malta, visiting hours are restricted to parents only due to increase in cross infection when family members were allowed to visit for 1 hour everyday during the day. However, timing of care may still be arranged to facilitate parents’ participation. In addition, special moments such as baby’s first time off CPAP (continuous positive airway pressure) needs to take place during parents’ presence. Cockfort (2011), highlights that missed opportunities to involve parents in care, heighten anxiety and can create a sense of sadness and loneliness . Information for mothers Mothers vary in the amount of information they can assimilate under stress. Therefore identifying parents’ feelings through active listening and observing will help us to pick up on parents cues and respond appropriately in order to provide parents with accurate and clear information (Fenwick et al 2008). Nicholas-Sargent (2009), adds that, information regarding the health status of the baby needs to be give in a timely provision. Parker (2011), recommends the access to certified interpreters for non-English speaking parents to enable them to ask questions and get the information they need as well as information regarding the counselling services. Likewise, an updated information board at the infant’s bedside helps mothers retain information while feeling welcome at the bedside. In my opinion, these interventions create an environment that facilitates maternal- infant attachment by promoting maternal competence with meaningful positive parenting skills and fostering partnership in care.. Conclusion In summary, the findings showed that parents of infants admitted to the NICU experience stress, depression, anxiety, and feelings of powerlessness, hopelessness, and alienation within the environment of the NICU. These situations are often overwhelming and catastrophic for the mothers keeping in mind that the process of motherhood is a protecting and loving phenomenon. Therefore mothers should participate in the care of their sick, fragile infant in the NICU through mother-infant interaction. Nurses need to be supportive and informative in dealing with parents in the NICU. Therefore, the need for parents to be given the access of interpretation by certified interpreters in order to overcome language barriers has been identified. Further, information and emotional support is required throughout the stay in the NICU, However, it was further found that information in preparation for discharge planning is vital. This enhances parental knowledge and decreases stress, which promotes more effective parenting. Further, as understanding of the parents’ experience of having an infant admitted to the NICU increases, nurses will be better prepared to meet parental needs and alleviate parental suffering. Providing holistic, developmentally supportive care and open communication with parents in this stressful experience is essential. Moreover, the need for family-centered care has been identified. REFERENCE LIST Ali, M.S., Sharma. J., Sharma. R., Alam. S. (2009). Kangaroo mother care as compare to conventional care for low birth weight babies. Dicle Tip Dergisi. 36(3), 155-160. Chiu S. Anderson G.C., (2009). Effect of early skin-to-skin contact on mother–preterm infant interaction through 18 months: Randomized controlled trial. International Journal of Nursing Studies, Vol. 46, pp.1168–1180. Cleveland, L.M., 2008. Parenting in the neonatal intensive care unit. 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Watson, H., Booth, J. Whyte, R. (2010). Observation. In Gerrish, K. Lacey, A. (Eds.), The Research Process in Nursing (6th ed.) United Kingdom: Blackwell Publishing Limited. (pp. 382-394). Wood, M. J. Ross Kerr, J. C. (2011). Basic Steps in Planning Nursing Research: From Question to Proposal (7th ed.). Sudbury, Canada, United Kingdom: Jones and Bartlett Publishers.

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Topic: I am studying about heritage languages and bilingualism because I want to find out how one’s language shapes his or her identity in an increasingly globalized society in order to understand why there is still a fear among many immigrants and their descendants of teaching their children their heritage language. Based on the science and research done on bilingualism, learning a heritage or second language while growing up has minimal to no adverse affects on language development and social class. Rather, language presents an opportunity to elevate one’s culture, personality, and identity. For America, heritage and second language education is vital to sustaining its worldwide influence as the world becomes more globalized. Coca-Cola. â€Å"Coca-Cola – It’s Beautiful – Official :60.† YouTube. YouTube, 2 February 2014. Web. 2 February 2014. The main claim of this Coca-Cola commercial is that every American, regardless of ethnicity, religion, and sexuality, enjoys drinking Coca-Cola and so the audience should as well. The sub-claim here is that America is a nation consisting of diverse individuals with backgrounds stemming from around the world. The grounds for this sub-claim are the various scenes in which a variety of Americans are depicted enjoying the freedoms of America with â€Å"America the Beautiful† being sung in multiple languages in the background. This Coca-Cola commercial appeals to the pathos of the American audience with the incorporation of the iconic, patriotic song and the breadth of minorities represented in the video. The multilingual singing of the song had to be a deliberate choice since Coca-Cola could have very easily shown the same clips of the diverse Americans with the English version. This implies that Coca-Co... ... child’s life may simply lead to greater psychological difficulties because of the child’s overwhelming feeling of abandonment. I intend to juxtapose these two pieces in my paper. De Houwer’s article coincides the most with Landau’s in that both agree bilingualism does not create any significant child development issues and that the benefits outweigh the costs. The language used in this article is intended for a general audience, which can promote discussions and questions. As for the credibility of de Houwer, she is currently Professor of Language Acquisition and Language Teaching at the University of Erfurt in Germany, and she is heavily involved with multiple linguistics organizations. At the time of this article’s writing, she taught at the University of Antwerp and Science Foundation of Flanders, Belgium. Therefore, this is clearly a scholarly, credible source.

Multimedia History Essay

Conformity Following World War II America saw an extreme decade of both conformity and nonconformity. A strong post-war economy meant there was money to spend. Settling down, raising a family, and owning a home were the established goals of the American dream. Many tried to attain the ideal family depicted on TV shows such as Leave It to Beaver and Father Knows Best. Deviating from this popular culture was the â€Å"Beat Generation.† The post-war economic boom of the 1950’s in the U.S. resulted in overwhelming prosperity in comparison with the rest of the world. This economic boom produced a white, middle-class consumer culture in which that population had more money and time in which to pursue leisure activities such as television viewing and movie-going. These leisurely pastimes produced a conforming American popular culture. We define conformity as behavior in accordance with the expectations of a social group or adherence to societal and cultural norms. In the 1950à ¢â‚¬â„¢s, these strict social norms were communicated primarily through television. Between 1952 and 1958 the amount of households owning a television set tripled from 3 million to 9 million. TV advertising created new consumer markets and TV sitcoms from the 1950’s portrayed the conservative values and mores of the ideal American life. â€Å"Domestic† comedies were very popular and portrayed the stereotypical suburban white family in neighborhoods seemingly unaware of racial discrimination and ethnic problems, and where mothers never desired or were expected to work outside the home. During a Father knows Best episode it seemed that any problems facing the family could easily be solved in a 30-minute time slot. Shows like this promoted honesty and always had a strong moral lesson to end the program. Westerns were also extremely popular. The pioneering idea of cowboys living in the wild and woolly west where good and bad, right and wrong, were evident was very popular during this era. On the other hand, Dobie Gillis appealed more to teenagers as one of the main characters, Maynard G. Krebs, belonged to the â€Å"beat generation.† Writer Jack Kerouac coined the term â€Å"beat generation† which signified artists who were â€Å"beat down.† Members included a loose-knit group of writers, musicians, painters, and other artists. Centered around New York City and later San Francisco, the Beats were the first to introduce drug use and heavy drinking into this underground society. They enjoyed and incorporated African-American music, such as jazz and blues into their works and they attended late-night clubs. These people were the real non-conformists of the 1950’s. Beats became exiles within the American culture as they denounced middle-class materialism, racism and dullness. They were a reaction to the â€Å"Silent Generation† of the 1950’s. In â€Å"Howl,† poet Allen Ginsberg explains the Beats were merely answering the à ¢â‚¬Å"calls for the unleashing of basic human needs and desires.† However, this deviance from the popular norms may, in effect, be seen as conformity to that particular subculture. The beats had different views of American society. They experimented with new sexual lifestyles, helping to usher in a sexual revolution. During the 1950’s, teenagers experienced a new sexually charged phenomenon. In 1948, Alfred Kinsey caught the world by surprise when he published Sexual Behavior in the Human Male, the first bestseller about sex. Women had always been expected to wait for sex until marriage, and adults considered Kinsey’s work a social upheaval. However, it actually opened up a lot of people to the topic of sex who really knew nothing about it. With the cold war in full force during the 1950’s, U.S. citizens lived in constant fear. Many feared the possibility that World War III with atomic weapons could start at any time. To take precautions, children were taught to â€Å"duck and cover† in case of a bombing. In reality this was little defense against an atomic bomb. The cold war greatly influenced 1950’s society as Americans sought to protect themselves from the Soviet threat. The people were open to a hero, and one emerged in senator Joe McCarthy, or so they thought. Joe McCarthy was desperate to gain fame, so during a speech he declared the Dep artment of State was full of communists, and he knew their names. His anti-communist crusade struck hard at the film industry and literature. Although senator McCarthy was never able to convict any communists, he influenced books and movies greatly as many actors and writers of that day were maligned, blacklisted from work, or self-exiled to Europe. Alex, add info on (in you own words from the popular culture site): Teenagers adapting to rapidly changing times = own new fashions, music of rock and roll which integrated black and white Americans considered a fundamental generation gap with the music of their parents, rebelling against sexual boundaries and questioning authority. Epitomized in the persona of actor James Dean in the movie Rebel without a Cause and the leading character of the anguished and ultimately mentally ill main character in f J. D. Sallinger’s book, Catcher in the Rye. Resulted in the baby boomers seeking major societal changes in the 1960’s.

Infant Nutrition What is best for your baby - breast milk...

You and your husband find out that you are expecting your first child. This new little person is going to change your life forever. Though your baby is not here yet, you already know that you want the best for your baby - the best opportunities, the best schools and the best education. Simply, you want your baby to have the best in life. The first and most important decision that you will make for your baby is whether to feed your baby breast milk or formula. Many women today are opting for formula, but what is the best choice? There are advantages and disadvantages to both breastfeeding and formula feeding. You need to carefully weigh the pros and cons before you make your decision. There are very distinct nutritional differences†¦show more content†¦Macrophages which are a type of white blood cells make lysozyme which will line the baby’s gastrointestinal tract. The main function of a lysozyme is to destroy harmful bacteria. Macrophages will also rally ly mphocytes, another type of white blood cell, into action against bacteria in the digestive tract. Milk lymphocytes found in breast milk make several chemicals that can help strengthen a baby’s immune system. Besides antibodies, breast milk is full of amino acids which are the building blocks of proteins. Interferon is a specific protein that has strong antiviral properties. The body will produce interferon when the presence of a virus or pathogen is detected. There is plenty of interferon found in colostrum which is the milk a mother produces during the first few days after giving birth. Breast milk also contains a protein called lactoferrin. Lactoferrin will tie up random iron atoms in the body which stops the growth of E. coli bacteria. E. coli bacteria are the most common source for diarrhea in babies. Lauric acid is so crucial to the baby’s immunity that by law it must be added to formula. In formula, the cholesterol content is very low, but in breast milk it is very high. Cholesterol provides the building blocks for hormones, vitamin D and intestinal bile. It is also necessary for the development of the brain and nervous system of your baby. Breast milk has more than 300 known ingredientsShow MoreRelatedBreastfeeding Vs. Formula Nutrition Essay1302 Words   |  6 PagesAs you get ready to welcome your baby and introduce her to this world, you are flooded with thoughts of how to take care of your little one in the best possible way. You find that motherhood is not only about loving and caring, it is also about making a few conscious decisions to help your child grow in a healthy manner. One such decision is whether to breastfeed your baby or to offer her formula nutrition. Deciding between breastfeeding and formula nutrition is purely a personal choice. But as aRead MoreBreastfeeding : Breastfeeding And Breastfeeding1309 Words   |  6 PagesWhat is breastfeeding? What is the benefit of breastfeeding? These are vital questions to be answered when one wants to pursue breastfeeding with their child. Breastfeeding by definition is â€Å"the method of feeding a baby with milk directly from the mother s breast†. (http://medicaldictionary.thefreedictionary.com/breastfeeding) Breastfeeding offers many benefits to a baby. Breast milk is also an inimitable nutritional source that cannot adequately be replaced by any other food, including infantRead MoreBreast Feeding Vs. The Bottle1326 Words   |  6 PagesBreast-feeding vs. The Bottle: The Decision is yours â€Å"Some mothers have to give up breastfeeding even though they want to breastfeed. To give up breastfeeding can be a sensitive issue in a time when breastfeeding is promoted as the healthiest for mother and child† (Larsen Kronborg, 2013, p. 848). The debate over whether breast-feeding is better than bottle-feeding or vice versa has been a debate for many years. With more and more research that is continuously being developed, the option to breast-feedRead MoreBreast Feding vs. Formula Feeding862 Words   |  4 PagesBreast Feeding vs. Formula Feeding There are advantages and disadvantages to both breastfeeding and formula feeding. Some things to consider when deciding which to choose are: cost, convenience, nutrition, and the health benefits to both the baby and to the mother. In terms of cost, an advantage to breastfeeding is that breast milk is free. Its estimated that breastfeeding can save you thousands of dollars a year, depending on the brand of formula that would have been used instead. AccordingRead MoreExpository Essay - Breastfeeding1448 Words   |  6 Pagesone decision that will give your child the best start in life is very simple; breastfeeding. Breastfeeding has numerous physical and psychological benefits that it provides an infant. These benefits are often greatly underestimated and under-emphasized. There are many details that go into enforcing the fact that breastfeeding has been proven to be the optimal nutrition for infants, and these details are crucial in encouraging mothers to do what is ultimately the best thing possible for their childrenRead MoreBreastfeeding VS Formula Bottle-feeding Essay1112 Words   |  5 Pages Breastfeeding vs. Formula Bottle-feeding Every mother of a newborn baby must make a very personal decision when it comes to how they are going to feed their infant. I was faced with that decision 3 years ago when I had my first son who I named Ethen. It was one of the very hardest decisions I had to make. I had to consider all the good benefits of breast feeding as well as the benefits of formula bottle-feeding, but the good benefits of breastfeeding outnumbered the bottle feeding ones. I finallyRead MoreBreastfeeding Is The Natural Way Of Providing Food For Infants Essay1528 Words   |  7 PagesBreastfeeding is the natural way of providing food for infants. It is an important part of motherhood, and it is the first major decision that is made when it comes to feeding a child. Breastfeeding is an issue of gender because when a woman is seen breastfeeding, in public or not, she is usually shamed and accused of indecent exposure (Danawi). This is because our society has been shaped to see breasts only as sexual objects and there is an insufficient amount of educating on breastfeeding beingRead MorePersuasive Essay On Breastfeeding1297 Words   |  6 Pagesforced to resort to an alternative way of feeding their infants because the public would not have it. It has become harder for women to breastfeed although history has shown it that is something that has been practiced for a long time. On one hand, women want to be allowed to breastfeed whenever the child is hungry no matter the place; whereas, the public is not very accepting of this public display of care and affection between mother and infant. The medical community has indicated that it is importantRead MoreArgumentative Essay1310 Words   |  6 Pages| Breastfeeding is better for your baby | Argumentative Essay | | | Islas, R. Argumentative essay Among the many decision a woman faces when she is pregnant, is whether or not she will breastfeed her child. In our society and in this day and age, this has become a matter of choice as opposed to long ago where formula was nonexistent and the only means of nurturing your baby was to breastfeed. Many women are oblivious to the health risks their baby may endure having not being breastfedRead MoreProper Nutrition During Infancy and Toddlerhood Essay1008 Words   |  5 PagesProviding proper nutrition during infancy and toddlerhood is important for your child’s health. But how do you provide this? What diet is best for an infant? When does one introduce cow’s milk? What is the best diet for toddlers? These are some questions that come to mind when thinking about infant and toddler nutrition. I hope to answer these questions. I will also discuss some of the foods that should be avoided during infancy and toddlerhood and their potential dangers. According to Sheah