الفهرس 
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Abstract
Premature infant is an infant born before the end of 37weeks of gestation, regardless of birth weight. It represents the highest percentage of high-risk group and account for the largest number of admission to the Neonatal Intensive Care Units (NICUs) (Waitzman, et al., 2021).
The birth of premature infants that needs admission in the Neonatal Intensive Care Unit (NICU) can be very stressful for the parents. Severe stress is experienced by a significant number of parents and can affect parents–premature infants relationship and development subsequently parents alike, but for parents there are added stressors. The presence or absence of social support and economic challenges and other factors impacts stress for characteristics and parenting responsibilities that influence well-being in general, and parents’ mental health in particular (Arabzadeh et al., 2022).
Aim of study
This study aimed to assess parents’ stressors regarding their premature infant in neonatal intensive care units (NICUs).
Research questions:
1- What are the stressors of parents regarding their premature infant in neonatal intensive care units (NICUs)?
Subject and Methods
The study will be portrayed under the four main designs as follows:
I. Technical design.
II. Operational design.
III. Administrative design
IV. Statistical design
Technical design:
The technical design includes research design, setting, subject and tools for data collection.
Research design:
A descriptive research design was utilized to achieve the aim of the current study and answer the research question.
Research settings:
This study was conducted in Neonatal Intensive Care Units at Children’s Hospital affiliated to Ain Shams University Hospitals and Neonatal Intensive Care Units at Children Hospital in Al Hamoul General Hospital in Kafr El-Sheikh due to the availability of large number of premature infants.
Research Subject:
A Purposive sample was included the premature infant. The sample size was1estimated1by 50 premature infants.
Inclusion criteria for the study preterm infants.
- Preterm infants regardless of their gender and birth weight.
Tools of the study:
Three tools were used in this study for data collection;
I - An Interviewing Questionnaire formate:
It was developed by the researcher after reviewing the relevant literatures. It was written in simple Arabic language to suit parents level of education. It was consist of two parts:
Part I: It was concerned with characteristics of study subjects:
a) Characteristics of the studied parents include: age, Level of education, jobs, residence, and medical history, number of children in family, health problems.
b) Characteristics of the studied premature infant include: age, gestational age, gender, medical history, ranking, diagnosis.
Part II: It concerned with the knowledge of parents regarding premature infants: definition, factors, health problems, prevention, complications, needs, role of parents participation care, participation in the care of premature infants in NICU, adhered to measures during dealing with premature infants, benefits of parental participation of their premature infants, problems, challenges.
- There were multiple-choice questions (12)
Scoring system:
Parents responses according to number of answer of the each questions has different total score, Each question scored one grade for correct answer and scored zero for incorrect answer or don’t know.
The total score of questionnaire is 33grade that equal 100%. These scores were converted into a percentage score and classified as the following:
- Unsatisfactory knowledge less than 50%
- Satisfactory knowledge 50 % and more.
II- Hospital stressors Scale:
It was adopted from Broome (2008) to assess stressors for parents having premature infants in NICU, this scale consists of three parts
- Physical stressors factors. (20 items)
- Psychological stressors factors. (14 items).
- Social stressors factors. (15 items).
- Financial stressors (10 items).
This tool was adapted from Jalowiec, and Powers, (1991) to assess financial stressors of parents having premature infants in NICU, and include 10 items.
Scoring system:
For each items in physical, psychological& social stressors the scoring system ranged from zero to two for never, sometimes and always respectively. The scores of the items of each part were summed-up and the total divided by the number of the items, giving mean score for the part. These scores converted into a percentage score and the total stressors for parents having premature infants classified as the following:
- Mild stressors 0- 32
- Moderate stressors 33 -66
- Sever stress Score 67 -98
Scoring system
For each items in financial stressors the scoring system ranged from yes response was scored one grade and for no response scored zero these scores were summed - up and converted into a percent age score. Accordingly, the total scored was the following:
- 1 - 3 referred to low level of stress
- 4 - 6 referred to average level of stress
- 7- 10 referred to high level of stress
III - Parents Anxiety Scale:
It was adopted from Spitzer et al., (2006) to assess parents ’ anxiety level, regarding premature infants.
Scoring system:
The scale composed of 7 statement, each statement ranged in its response from not occur, sometimes to usually, which scored as ranged from one grade, two grades and three grade respectively. The total score of the scale 21 degree and the parents’s anxiety level was categories into:
- 5- 9 grades referred to mild anxiety.
- 10 - 14 grade referred to moderate anxiety.
- 15 - 21grade referred to severe anxiety.
Il. Operational Design
It includes preparatory phase, ethical consideration, pilot study and field work.
Preparatory Phase:
This phase included reviewing of literature related to stressors for parents having premature infants in NICU. This served to develop the study tools for data collection. During this phase, the researcher also visited the selected places to be acquainted with the personnel and the study settings. Development of the tools was under supervisors’ guidance and experts’ opinions.
Face and content validity:
The tools were tested and evaluated for its face and content validity, by a jury consists of three experts in the field of Pediatric Nursing to test the content validity. Modificaüons of the tools done according to the panel judgment on the clarity of sentences, appropriateness of content and sequence of items.
Reliability:
Reliability was examined using Alpha Cronbach test was used to measure reliability of the tools it was 0.729 for interviewing questionnaire formate and 0.935 for hospital stressors scale and 0.919 for parents anxiety Scale.
Pilot Study:
Pilot study carried out on 10% of the total sample (5 parents) before starting the actual study to evaluate the clarity and applicability of the study tools and to estimate the time needed to fulfill the tools of date collection. After obtained the result of the pilot study, the ambiguous items were omitted, other items were added or modified according to study subjects response. Then final form was developed. All the study subjects included in the pilot study were excluded from study sample.
Results:
Findings of the current study can be summarized as the following:
More than two fifth of studied mothers were in the age group 30<40 years and had high education.
More than half of studied fathers aged from thirty to less than forty years and had high education level. Moreover, more than three quarters of them had not enough monthly income.
Almost two thirds of the studied parents had 1-2 premature infants in their families. Also more than one third of them had 3-4 premature infants in families.
More than three fifth of them delivered cesarean section and also about three quarters of them had Previous presence of premature infant.
More than three quarters of studied premature infants had equal or less than thirty six gestational age/ weeks
More than two thirds of studied parents had moderate level of total physical stressors regarding premature infants.
More than two thirds of studied parents had sever level of psychological stressors regarding premature infants.
Half of studied parents had sever level of social stressors regarding premature infants.
Most of the studied parents had high level of financial stressors regarding their premature infants.
No statistical significant different between studied parents’ characteristics and their total knowledge regarding premature infant.
No statistical significant different between studied parents’ characteristics and their physical stressors level regarding Premature Infant.
No statistical significant different between studied parents’ characteristics and their psychological stressors level regarding Premature Infant.
Statistical significant different between studied mothers’ characteristics and their social stressors level regarding premature infant.
No statistical significant different between studied fathers’ characteristics and their social stressors level regarding premature infant.
Statistical significant different between studied mothers’ characteristics and their financial stressors level regarding Premature Infant.
No statistical significant different between studied fathers’ characteristics and their Financial stressors level regarding premature infant.
No statistical significant different between studied parents’ characteristics and their anxiety level regarding Premature Infant.
Strong positive correlation between studied parents’ knowledge, stressors and their anxiety.
Conclusion
Based on the findings of the current study, it can be concluded that, more than two thirds of studied parents had moderate level of physical stressors and two thirds of them had sever level of psychological stressors.