PedsCCM: Pediatric Critical Care Nursing Literature Reviews

Article Reviewed:

Clark SM, Miles MS. Conflicting responses: The experiences of fathers of infants diagnosed with severe congenital heart disease. Journal of the Society of Pediatric Nurses 1999; 4:7-14.

Reviewed by:

Jodi Rogers, BSN, RN,C, CCRN
The Children's Medical Center
Dayton, Ohio.
jrogers@cmc-dayton.org

Posted 5/29/98

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Study Purpose:

The birth of a child has been described as a powerful experience and fathers have reported feelings of joy and happiness. Because a fatherÕs relationship with his infant can be threatened when the infant is diagnosed with a life-threatening chronic illness, this study sought to investigate the experiences of fathers whose newborn infants were newly diagnosed with severe congenital heart disease (CHD).

Study Design:

Qualitative; semistructured interviews.

Participants:

This study was part of a larger longitudinal study of parental role attainment with medically fragile infants during the infantÕs initial hospitalization and extending until the infant was about 18 months of age. A total of 81 infants and their mothers and 43 fathers were enrolled in the larger study. The infants had a variety of diagnoses, including severe CHD.

Sample Characteristics:

The ages of the fathers ranged from 23 to 40. Six of the fathers were white, one was Asian, and one was African American. The infants in the study were the first children born to a majority of the fathers (6). Seven of the fathers were married to the mothers. All of the fathers had completed high school and all had some college experience, including two that had attended graduate school.

Seven of the infants had been diagnosed at birth and the eighth was diagnosed after being home for 3 weeks. Time hospitalized ranged from 24-75 days except for one infant who was in the hospital for 200 days. All but one infant had at least one surgical procedure.

Data Collection:

In the larger study, interviews were conducted at least once in the hospital, at home following discharge, and at home or in the hospital when the infant was 6, 12, and 18 months old. This article reports only the hospital and the 12-month interviews conducted with the eight fathers. The interview in the hospital focused on the fathersÕ experiences during the infantsÕ initial diagnosis and treatment including their experiences parenting their infant, and their views of the hospital environment and staff. At the 12-month interview, the fathers talked about the hospital experiences retrospectively.

Data Analysis:

The data was analyzed using content analysis. Analysis focused on the fatherÕs response to his infantÕs initial diagnosis and ongoing procedures; on his coping mechanisms; and on the development of the father-infant relationship. Themes were clustered into broader categories and comparisons made to examine similarities and differences across the paternal responses.

Findings:

Fathers experience four interrelated conflicting reactions:

1. The joy and sadness of becoming a father
2. Becoming attached while dealing with fears about the infantÕs outcomes
3. Trying to maintain control while losing control
4. Providing strength while hiding emotions

Discussion and Practice Implications:

Despite their infantÕs diagnosis and hospitalization, fathers experience positive emotions related to the birth of their infant. These positive emotions conflict with feelings of sadness and loss and with fear related to the childÕs illness. Therefore critical care nurses should provide fathers the opportunity to share both the joy at the birth of their infant and their sadness and concerns.

Fathers expressed the need to maintain control and be strong for the mother. Fathers hid their own feelings of emotional distress. Critical care nurses can support fathers by meeting with them alone, so they have the opportunity to discuss their feelings in private. It is important to include fathers in decisions about their child. Care conferences should be scheduled at a time convenient for both mother and father so the father can take an active role in the plan of care.

The majority of fathers expressed fear about becoming attached and interacting with their infant because of the childÕs illness and threat of death. There is a need to address these fears of attachment in order to promote father-infant interaction. Fathers need to understand that they are important to their childÕs recovery and development. The nurse can encourage the father to hold and care for the child and then point out to the father how the infant responds uniquely to his presence.

Limitations and Further Research:

Factors that limit generalizability:

• small sample size
• subjects predominately white and well educated
• only one study site used

Little research has been done regarding the paternal response to the birth of a seriously ill infant. The finding from this study identified the emotional and behavioral conflicts experienced by these fathers. Further research sampling a larger, more ethnically diverse population from multiple geographic locations should be done. Nursing interventions with fathers of seriously ill infants should be evaluated.