Phenomenological Study : Grieving Process And Coping Of Mothers With Premature Infant In Neonatal Intensive Care Unit

The premature birth of infants is a process that leads to physical unpreparedness, sources of stress, and traumatize effects for the parents. Mostly mothers showed unpleasant memories that interfered the parents’ ability to take care of their premature baby. The aim of this study was to explore experience of grieving process and mothers coping during early life care in neonatal intensive care unit. This qualitative research with phenomenological approach used eight participants. Data analysis used in this research was Colaizzi. The result was the grieving process with various self-coping overview during baby care in the neonatal intensive care unit. The result of this study recommended professional nurses to conduct an assessment toward parents (the mother). The principle of family centeredcare was very important in helping parents to develop therapeutic relationships, providing emotional support, and providing accurate and clear information to parents.


INTRODUCTION
The experience of having a premature infant has a long lasting impact on the lives of parents.When a baby is born prematurely, the mental state and the process of becoming  In this study, the researcher served as the primary instrument in the data collecting process.
The data collection was done by in-depth interviews to the participants, and the researcher also used the secondary instruments in the research data collection (the voice recorder using MP4, interview guidelines, and fi eld notes).
There were three stages of data collection procedure, they were: 1) the preparation phase, where the researcher had obtained a permit and had socialized by doing a presentation in the research place, 2) the implementation phase, it was in-depth interviews with the participants for 30 minutes to 60 minutes, and 3) the termination stage, the researchers conducted a clarifi cation and validation of data analysis that had been obtained to ensure the researcher that the analysis result was in accordance with the experiences of the participants and to ensure the credibility of the results.
Reliability and validity of research data were done by showing and asking back to the participants about the description of the data whether they were consistent with the experiences of the participants or not.In this study, the researcher applied four criteria for obtaining the validity of the data, they were: the degree of confi dence (credibility), transferability, certainty (confirm ability), and dependability (8).
Mothers' experience during the treatment of premature babies in the neonatal intensive care unit was a sensitive aspect for the mothers, so that the principles of ethical considerations were necessary to ensure that there were no infringement of the participants during the study conducted.This study used some ethical principles of respect for human dignity, they were: the principle of autonomy, benefi cence, non-malefi cence, anonymity, and justice (9).

RESULTS AND DISCUSSION
In this study, it can be seen the phenomenon of mothers experience about the process of grieving and mothers coping during early life care in a neonatal intensive care unit.Struggling is also one of mothers self coping for taking care of premature babies in the neonatal intensive care unit.Self coping is expressed by three participants, namely: fi rst, third, and eight participants.As for the statement of the participants are the following: "... yaa saya berusaha semaksimal mungkin mbak, udah usaha cari darah ke PMI juga, trus saya yaa berusaha semaksimal mungkin bisa tenang menjalani semua ..." (P1) [...well I struggle as hard as I can, Mbak, (I) already try to fi nd blood to PMI also, then I try as hard as possible to be calm in undergoing all this..." (P1)] "... saya sama suami yaa cuma berusaha semaksimal mungkin biar cepat sehat anak saya ..." (P6) ["...I and my husband just struggle as hard as possible to make our child be healthy quickly...

" (P6)]
Having a positive thinking towards the recovery and safety of premature babies is also one of the participants self coping.A total of three participants from eight participants reveal self coping statements which support it.The statements of the participants can be described as follows: Mothers with experience of grief would normally use a coping to overcome the problems tey are facing.One of the afformentioned copings can come from the mother's self (personal coping) (11).The theory of "chronic sorrow" discusses the problems that arise from chronic disease include the process of grieving, lost, precipitating factors and management strategies (9).Management strategies can be done internally or externally.
Self-care management strategies are designed as internal coping strategies, including: action, cognitive, interpersonal and emotional.This management strategy is said to be effective if an individual shows that her sad feelings has decreased (12).The other management strategy is family centered care (FCC) in the threatment of premature infant and grieving process.
There is a signifi cant difference in control and intervention group.FCC Programme can be a model of nursing intervention that implication of this research (13).
According to the results of the researcher analysis, in this study is described seven self

a
parent are distracted.Parents are not ready physically, psychologically, and emotionally for this condition.Premature birth changes the behavior of the parents because they are exposed to the roles and the responsibilities for their premature infant care in the neonatal intensive care unit.The physical condition of the parents becomes tired and even annoyed as the effects of their responsibility when they have to take care of their baby in the hospital.Having a premature infant also causes shock, feeling of sadness and loss.Those emotions sometimes are very strong.Maybe some parents have diffi culty to handle this situation well (1,2) The experience of premature infant hospitalization in NICU can inhibiting the process of parents-baby interaction and attachment.This is because the parent-infant separation causes stress for parents and families who are involved (2).The experience of hospitalization in NICU also has negative impacts on the psychological condition of the parents and the development of the premature infant in the future.Those negative impacts are high levels of anxiety, symptoms of depression, loss of confi dence in the care of the baby because of the lack of information, and overprotective care (3).In addition, the condition of the unfamiliar nursery with a wide variety of complex and awful equipment makes parents of premature infant experiencing high levels of stress and feeling of helplessness in NICU.Parents' psychological stress combined with the lack of sufficient information and knowledge about how parents interact with their babies during hospitalized.Thus, parents often experience negative feeling, diffi culty in interacting, and inability to perform care and upbringing of the baby.These conditions will be worsened by the presence of depressive symptoms and dysfunctional parenting disorders after hospitalization (3,4).T h e m a i n p s y c h o l o g i c a l p r o b l e m experienced by parents is the psychological stress associated with the condition of the baby with special care in NICU, or babies' physical problem and family social problem.A qualitative study entitled "Fathers' experiences in the neonatal intensive care unit: A search for control", about the psychological stress in fathers with premature babies showed that the fathers suffered lack emotional control when they had a baby with the condition of serious illness, or a premature infant in NICU (5).Another study entitled "Experiences of having a prematurely born infant from the perspective of mothers in Northern Sweden", conducted by Lindberg and Ohrling, their research was qualitative study, showed that the mothers were not ready to have a baby born prematurely, and they had diffi culty becoming a mother in the early postpartum.Mothers experienced feeling of anxiety at the separation from their baby and they considered the proximity with their baby was very important (6).The previous description indicated that grieving process and mothers coping in the care of premature babies in NICU are different.
copings performed by mothers during infant care in a neonatal intensive care unit.As for the mother copings, among other things: being patient, strengthening themselves, praying, struggling, having a positive thinking, sharing stories with others, and putting trust in the nursing service.Various self coping is described by the mothers in this research is a form of activity that aims to reduce the psychological burden of anxiety, worry, fear, sadness, and a feeling of helplessness experienced by the mother.Coping with it will foster confi dence in the recovery and safety of their babies.Some researches have also explained about parents coping with premature babies to resolve psychological problems encountered during the treatment in the NICU.It is showed in the result that in order to regain a good emotional control, mothers must often be engaged in directed activities, always think positive, communicate problems with people who understand the condition, and always pray to God with her faith(14).CONCLUSIONMother's reaction during the treatment of premature infants early life that is the grieving process with an overview of various self coping during the infant care in a neonatal intensive care unit.The process of grieving and self coping of the mother are things that need to be studied more deeply.Attention from nurse to the individual problem of mother requires an individual assessment to obtain intervention which is in accordance with the experiences felt by the mother.This will create a relationship of communication and nursing care that involves families to run well.The principles of treatment in premature infants is intended to involve parents as partners in care (family centered-care), as well as helping them to establish a good bond with their baby.The intervention will help the family and the nursing staff to work in the child care.Nurses play an important role in helping parents to develop therapeutic relationships, providing emotional support, providing accurate and clear information to parents and involving parents in the care of her baby.Nurses are expected to play an important role to help parents to talk and discuss the issues, and facilitate parents to be closer to their baby.