Maternal Stress and Anxiety in the Pediatric Cardiac Intensive Care Unit

Abstract

Background Mothers whose infants are born with complex congenital heart disease (CCHD) experience stress during their infant’s hospitalization in a pediatric cardiac intensive care unit (PCICU). Objectives This study addressed 2 research questions: (1) What are the parental stressors for mothers whose infants with CCHD are in the PCICU? And (2) What are the relationships of trait anxiety and 3 parental stressors to the parental stress response of state anxiety in mothers whose infants with CCHD are in the PCICU? Methods This descriptive correlational study included 62 biological mothers of infants admitted to a PCICU within 1 month of birth who had undergone cardiac surgery for CCHD. Maternal and infant demographics and responses to the Parental Stressor Scale: Infant Hospitalization and the State-Trait Anxiety Inventory were collected at 3 major PCICUs across the United States. Results Mothers’ scores revealed that infant appearance and behavior was the greatest stressor, followed by parental role alteration, then sights and sounds. The combination of trait anxiety and parental role alteration explained 26% of the variance in maternal state anxiety. Mothers with other children at home had significantly higher state anxiety than did mothers with only the hospitalized infant. Conclusions Results from this study revealed factors that contribute to the stress of mothers whose infants are born with CCHD and are hospitalized in a PCICU. Nurses are in a critical position to provide education and influence care to reduce maternal stressors in the PCICU, enhance mothers’ parental role, and mitigate maternal state anxiety.

The Pediatric Cardiac Intensive Care Unit Parental Stress Model

“…Within the infant stressor category, mothers confirmed that infant appearance and behavior are a significant source of stress. Studies from both NICU and PCICU settings have found that infant appearance and behavior is the highest source of stress for mothers during the critical care admission[8, 13, 15]. Despite attempts by nurses to provide anticipatory guidance to mothers on the appearance of their infant after cardiac surgery, mothers were overwhelmed by their infant’s appearance and felt that nothing could have prepared them.…”

“…Although survival rates have increased, morbidities are numerous, including feeding difficulties, growth failure, and long term neurodevelopmental delay[4, 5]. Parents of infants born with complex CHD experience extreme stress, often beginning during the prenatal period at the time of fetal diagnosis, and continuing during the infant’s hospitalization and postoperative course, as well as post-discharge [6–8]. Mothers, in particular, have very high stress levels that continue well into the first year.…”

“…Parents of infants less than 1 year of age had significantly higher stress than parents of older children. Another study by Lisanti and colleagues examined the stressors and stress response of mothers during the infant’s admission to a PCICU[8]. Infant appearance and behavior was the highest rated source of stress.…”

“…Expanding on this early work, The PCICU Parental Stress Model was created based on revisions from prior stress models developed by Miles and colleagues, and through synthesis of both classic and recent literature (Figure 1) [8, 20]. The full description of the model, its early development and revisions has been previously described [20].…”

“…The full description of the model, its early development and revisions has been previously described [20]. The PCICU Parental Stress Model posits that parental stress in the critical care setting emanates from three categories of parental stressors: infant, parent, and environment, within which are 10 individual types of stressors.…”