The arrival of new family member as a baby is an exciting and emotional event. But when giving birth to a sick or premature baby can be quite unexpected for any parent. In such new born will require care in a Neonatal Intensive Care Unit (NICU). New born babies who need intensive medical attention are often admitted in tertiary care hospital at the NICU. The NICU combines advanced technology and trained health care professionals to provide specialized care for the neonates. Parents of NICU infants experience stress related feelings of helplessness, exclusion, aberration, lack of sufficient knowledge regarding parenting and medical teaching with tears when infant in the NICU. But critical new born’s needs NICU care for first few days or even months. During this period parental joy is tempered by the unease of separation and the stress of fitting in regular visits at NICU. Bonding between mother and their new born baby is very essential at the initial days of birth to overcome the stress and anxiety of mother. There are a number of interventions to newborns by doctors and nurses in NICU can help in reduce the stress of mothers. This study aimed to measure anxiety among mothers during their newborn stay in NICU by using fifteen questioner Likert scale and showing the treatment video clips of their baby.

Method:

This descriptive pilot study was conducted at NICU, in department of pediatrics at tertiary care hospital, Andhra Pradesh, India. Initially, on two occasions on same day, effort was made to bring down the distress level of the mothers by showing the video recordings of the respective new born, captured on smart phone. It was found to be successful

Study design: An Interventional pilot study was conducted with the approval of institutional ethics committee and written informed consent from the participants was obtained. The study recruited 200 mothers of babies admitted to the NICU, divided them into two groups. Power analyses were used in order to determine the sample size; as a result of a power analysis based on a previous study by Yurdakul et al., this study determined with 85% power that each group should be composed of 95 mothers. This study reached 86% power by examining. The first 100 mothers in each group (NICU or PCS) At first 100 mothers were intervened by using likert scale without showing their baby treatment video clips to measure the distress or anxiety levels when newborns in a NICU (n=100), new born data was collected in an order of cradle numbers. Further next 100 mother were interviewed by using likert scale with showing treatment video clips of their babies admitted in Level 2 and Level 3 NICU in an order of cradle numbers and data was collected. Likert scale consist of 15 questions each question contains 5 options like strongly agree, agree, not known, disagree, strongly disagree. Likert scaling is a bipolar scaling method, measuring either positive or negative response to a statement. Sometimes an even-point scale is used, where the middle option of "neither agree nor disagree" is not available. This is sometimes called a "forced choice" method, since the neutral option is removed. [(1)12]. The lycart scale has been prepared based on the State-Trait Anxiety Inventory Scale (STAI TX-1 – STAI TX-2) and Trait Anxiety Inventory Scale [4].Parents of newborn were counseled based on their baby treatment protocol every day morning as per the study planned. Their reactions are recorded verbatim, analyzed and reported. Grading scales of satisfaction level, distress level, anxiety level and their personal impressions was reported.

Uses of Video Counseling

Parents feel more involved strengthening the trust on the relationships and provides reassurance, allowing healthcare professionals to focus on the job of caring for their NICU patients. There will be a reduction in the distress and anxiety levels of the mothers. A significant enhancement of satisfaction levels of the mothers A greater extent of acceptance of outcomes of hospitalization of newborns. Qualitatively better care is offered to newborns. The aim of our study was to compare the anxiety levels of 200 mothers, 1^st 100 mothers asking the 15 question likert scale without showing the video recordings of their newborn treatment when baby is in NICU and next 100 mothers asking the 15 question likert scale after watching the baby treatment through video. We aimed to determine the factors that can impact anxiety in mothers.

NICU treatment Video: NICU treatment video helps families develop with bond with their presence or hospitalized infant, even when they cannot be at the bedside. (Parents, siblings    and relatives get to know their new born by watching daily progress.

Result:

Descriptive Statistics

Mothers who did not view the treatment videos of their babies had an average mean score of 2.04 (SD = 0.56), while those who viewed the videos reported a higher mean score of 2.54 (SD = 0.80). This indicates a generally more positive perception among mothers who were exposed to the video recordings. This finding implies that viewing the treatment videos may have had a beneficial effect on the mothers' emotional well-being, potentially providing reassurance and reducing anxiety related to their baby's care. Overall, a higher mean in this context reflects a lower perceived level of stress and anxiety among mothers who had access to the video content.

Tab I:

M=Mean, SD=Standard Deviation, SE= Standard Error.

Comparative Analysis

To evaluate the differences between the two groups, independent samples t-tests were conducted for each of the 15 questions. Significant differences were observed for several questions:

Question 1: "I feel stressed right now."

Mothers who viewed video recordings of their newborns' treatment in the NICU reported significantly lower stress levels (M = 2.76, SD = 0.965) compared to those who did not view the videos (M = 2.06, SD = 0.468), t (198) = -6.527, p = 0.000. This indicates that viewed the treatment video was associated with reduced stress among the mothers.

Question 2: “I get scared that something will about to happen."

The mean score for mothers who viewed the videos (M = 3.07, SD = 1.008) was significantly higher than that of mothers who did not view the videos (M = 2.17, SD = 0.620), t(198) = -7.606, p < 0.001. This indicates that mothers who watched the treatment videos experienced less fear about potential negative outcomes regarding their babies.

Question 3: “Worrying thoughts are coming to my mind."

The mean score for mothers who viewed the videos (M = 2.86, SD = 0.995) was significantly higher than that of mothers who did not view the videos (M = 2.09, SD = 0.653), t (198) = -6.470, p < 0.001. This indicates that mothers who watched the treatment videos experienced fewer worrying thoughts.

Question 4: “I can't stay still in one place."

The mean score for mothers who viewed the videos (M = 2.82, SD = 1.067) was significantly higher than that of mothers who did not view the videos (M = 2.00, SD = 0.512), t(198) = -6.926, p < 0.001. This suggests that mothers who watched the treatment videos experienced less restlessness and were more capable of remaining calm.

Question 5: “I want to see the treatment of my baby."

The mean score for mothers who viewed the videos (M = 1.99, SD = 0.362) was significantly lower than that of mothers who did not view the videos (M = 2.17, SD = 0.620), t(198) = 2.505, p = 0.013. This indicates that mothers who watched the treatment videos expressed a greater desire to see their baby's treatment.

Question 6: “I am worried about my baby's treatment."

The mean score for mothers who viewed the videos (M = 3.39, SD = 0.942) was significantly higher than that of mothers who did not view the videos (M = 2.18, SD = 0.575), t(198) = -10.965, p < 0.001. This indicates that mothers who watched the treatment videos had more concerns about their baby's treatment.

Question 7: “I feel like I'm at home."

The mean score for mothers who viewed the videos (M = 4.45, SD = 0.609) was significantly higher than that of mothers who did not view the videos (M = 4.10, SD = 0.577), t(198) = -4.170, p < 0.001. This indicates that mothers who watched the treatment videos felt a greater sense of being at home.

Question 8: “I am happy."

The mean score for mothers who viewed the videos (M = 3.88, SD = 0.988) was slightly lower than that for mothers who did not view the videos (M = 4.04, SD = 0.695), t (198) = 1.325, p = 0.187. This indicates that there was no significant difference in happiness between the two groups.

Question 9: “I am very depressed."

The mean score for mothers who viewed the videos (M = 2.56, SD = 1.122) was significantly higher than that for mothers who did not view the videos (M = 2.13, SD = 0.812), t(198) = -3.104, p = 0.002. This indicates that mothers who watched the treatment videos experienced greater levels of depression.

Question 10: “I am anxious."

The mean score for mothers who viewed the videos (M = 2.94, SD = 0.802) was significantly higher than that for mothers who did not view the videos (M = 2.19, SD = 0.506), t (198) = -7.909, p < 0.001. This indicates that mothers who watched the treatment videos experienced higher levels of anxiety.

Question 11: “I don't even think about how I am."

The mean score for mothers who viewed the videos (M = 2.52, SD = 0.948) was significantly higher than that for mothers who did not view the videos (M = 1.99, SD = 0.438), t(198) = -5.076, p < 0.001. This indicates that mothers who watched the treatment videos were more likely to neglect their own well-being and self-reflection.

Question 12: “I can't even sleep."

The mean score for mothers who viewed the videos (M = 2.86, SD = 1.035) was significantly higher than that for mothers who did not view the videos (M = 2.06, SD = 0.664), t(198) = -6.506, p < 0.001. This indicates that mothers who watched the treatment videos experienced more difficulty sleeping.

Question 13: “I wonder why this happened to my baby."

The mean score for mothers who viewed the videos (M = 1.95, SD = 0.411) was slightly higher than that for mothers who did not view the videos (M = 1.85, SD = 0.359), t(198) = -1.832, p = 0.068. This indicates that there was no significant difference in the extent to which mothers wondered why this happened to their baby between the two groups.

Question 14: “I get a sudden feeling of fear."

The mean score for mothers who viewed the videos (M = 2.70, SD = 1.030) was significantly higher than that for mothers who did not view the videos (M = 2.13, SD = 0.506), t(198) = -4.968, p < 0.001. This indicates that mothers who watched the treatment videos experienced more frequent sudden feelings of fear.

Question 15: “Every minute I am thinking about Baby."

The mean score for mothers who viewed the videos (M = 2.06, SD = 0.617) was slightly higher than that for mothers who did not view the videos (M = 1.83, SD = 0.514), t(198) = -2.866, p = 0.005. This indicates that mothers who watched the treatment videos spent more time thinking about their baby compared to those who did not.

Above scattered plot shows there was no a simple linear relation. Here observed the cumulative score of dots plot before and after showing video clips when baby in NICU. Before showing video clips the dots plot showed more gathered/assembled, indicates respondents/parents had more stress and anxiety. The more anxiety of parents was observed with the greater standard deviation. Second, after showing video clips of baby treatment, the dots plot showed was more scattered/dispersed, which indicates the stress and anxiety levels of the parents was reduced. The less anxiety of parents was observed with the minimal standard deviation. There was a wide difference between the standard deviation of the each question before showing video of newborns in NICU (shown in the above tables).

Discussion:

Parents of NICU infants experience stress related to feelings of helplessness, exclusion and aberration and lack sufficient knowledge regarding parenting and medical teaching with tear infants in the NICU [2]. There are a number of interventions that nurses can do that help reduce the stress of mothers of infants in NICU [3]. Counseling with video clippings of baby in NICU showing treatment being given is one such intervention.

This study sheds light on the feelings of mothers with babies in the NICU, especially regarding their experiences when watching treatment videos. While these videos are meant to provide information and reduce stress, the results show that their effects can be complicated.

Emotional Reactions to Video Viewing

The findings reveal that mothers who watched the treatment videos reported lower stress levels, indicating that seeing their baby’s care might help them feel more secure. However, these same mothers also experienced higher levels of anxiety, fear, and depression. This suggests that while some information can be comforting, it can also lead to increased worry about their baby’s health.

Understanding and Awareness

The study found that mothers who viewed the videos had more worrying thoughts and feelings of fear. This indicates that while knowing more about their baby's treatment can be helpful, it can also make mothers feel more vulnerable. They might want to be informed but also feel overwhelmed by what they see.

Importance of Support

Interestingly, mothers who watched the videos reported feeling more at home and connected to their babies. This suggests that the videos can foster emotional involvement. It highlights the need for additional support alongside information. Providing emotional guidance and coping strategies can help mothers handle the challenges that come with watching these videos.

Implications for Healthcare

These findings have important lessons for healthcare providers. While treatment videos can be useful, it’s essential to balance this information with emotional support. Healthcare professionals should engage in conversations with mothers before and after they watch the videos to address any concerns and prepare them for the emotions that may arise.

Limitations and Future Research

Although this study adds to our understanding of mothers' experiences in the NICU, it has limitations. The sample size, while considerable, may not capture the full range of mothers' experiences. Future research could look at the long-term effects of viewing these videos and explore how different video types impact mothers’ feelings. Qualitative studies could also provide deeper insights into how mothers cope emotionally.

Conclusions:

Mothers of NICU-admitted babies are under significant stress and anxiety, which needs to be identified prior, along with care of the sick neonate, so as to give a complete care to the family.[6] Proper and adequate communication between parents and health professionals in NICU increases parental satisfaction.[7]

In summary, this study highlights the complex relationship between information and emotional well-being for mothers in the NICU. While treatment videos can improve understanding, they can also increase anxiety and stress. A balanced approach that combines information sharing with emotional support is crucial for ensuring positive experiences for mothers in the NICU. Future research should explore additional factors influencing maternal perceptions and investigate long-term effects of such interventions.

Acknowledgment:

We acknowledge the support of the admitted babies and the parents for making this study successful. We also acknowledge all the nurses and other paramedical staffs in the pediatric department of our hospital for helping in patient care and giving the inputs. We are thankful to DHR, GOVT of India and SV Medical College, Andhrapradesh.

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