The Effect of Educational-Supportive Interventions on Distress Tolerance of Parents of Premature Infants in the Neonatal Intensive Care Unit

Document Type : Original Article


1 Department of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Department of Nursing Education, Nursing and Midwifery School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Department of Psychology, Yazd University, Yazd, Iran.

4 Department of Statistics, Faculty of Science, Fasa University, Fasa, Iran


Background: Parents of premature infants are more likely to be exposed to stressful situations than parents of term infants. This study aimed to determine the effect of educational-supportive interventions on the tolerance of parents of premature infants admitted to the neonatal intensive care unit (NICU).
Methods: In this quasi-experimental study, the participants included 50 parents of premature infants admitted to one of the NICUs in Shiraz, Iran from October 2019 to May 2020. Parents were randomly assigned to intervention and control groups. Educational intervention (training package and its content) was done in five 45-minute sessions for two weeks and three times a week. The supportive stage was done one day after the intervention. The data were collected using a demographic questionnaire and Distress Tolerance Scale and analyzed by SPSS 24 using paired t-test, independent t-test, and chi-square test.
Results: The mean scores of the mothers' and fathers’ distress tolerance in the pre-intervention stage were 36.0 ± 6.1, 33.9 ± 7.4 in the control group (P<0.14), and 38.4±5.8, 38.0 ± 5.9 in the experimental group ((P<0.001), respectively. After the intervention, the mean scores of the mothers’ and fathers’ distress tolerance in the control group were 35.9 ± 5.3 and 36.5 ± 6.3, and in the experimental group 54.7 ± 5.3, 53.0 ± 6.0, which compared to before the intervention had a significant increase (P <0.001).
Conclusion: Supportive-educational programs can increase distress tolerance in parents of premature infants. In the future, these programs can be planned to promote the quality of infant care.


  1. Thanh NX, Toye J, Savu A, Kumar M, Kaul P. Health service use and costs associated with low birth weight: a population level analysis. J Pediatr 2015; 167:551–6.
  2. Purisch SE, Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol 2017; 41:387–91.
  3. Dolatian M, Mirabzadeh A, Forouzan AS, Sajjadi H, Majd HA, Moafi F. Preterm delivery and psycho– social determinants of health based on World Health Organization model in Iran: a narrative review. Global J Health Sci 2013; 5(1):52.
  4. Lawn JE, Kinney MV, Belizan JM, Mason EM, McDougall L, Larson J, et al. Born too soon: accelerating actions for prevention and care of 15 million newborns born too soon. Reprod Health 2013;10 (Suppl 1):6-10
  5. Arnold L, Sawyer A, Rabe H, Abbott J, Gyte G, Duley L, et al. Parents’ first moments with their very preterm babies: a qualitative study. BMJ open 2013; 3(4).
  6. Gray PH, Edwards DM, O'Callaghan MJ, Cuskelly M, Gibbons K. Parenting stress in mothers of very preterm infants --influence of development, temperament and maternal depression. Early Hum Dev 2013; 89(9):625–9.
  7. Hosseini SM, Masoudi R, Mamori GA. [The effect of relaxation training on breastfeeding self-efficacy of mothers with preterm infants: A randomized clinical trial]. Journal of Clinical Nursing and Midwifery 2014; 3(2):37-45. (Persian).
  8. Ong SL, Abdullah KL, Danaee M, Soh KL, Soh KG, Japar S.Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit. J Reprod Infant Psychol 2019; 37:193‑205.
  9. Kawafha MM. Parental stress in the neonate intensive care unit and its association with parental and infant characteristics.J Neonatal Nurs 2018; 24:266‑72.
  10. Valizadeh L, Hosseini MB, Heydarpoor Damanabad Z, Rahkar Farshi M, Asgari Jafarabadi M, Ranjbar Kochaksaraie F. Effect of NICU department orientation program on mother’s anxiety: A randomized clinical trial. J Caring Sci 2016; 5:205‑14.
  11. Rutherford HJ, Goldberg B, Luyten P, Bridgett DJ, Mayes LC. Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm. Infant Behavior and Development 2013;36(4):635-41
  12. Mansourian M, Ziapour A, Kazemian M, et al. Assessment of educational performance of nurses in neonatal intensive care unit from parents' perspective. J Educ Health Promot 2020; 9:8.
  13. Askari M, Noah SBM, Hassan SAB, Baba MB. Comparison the effects of communication and conflict resolution skills training on marital satisfaction. International Journal of Psychological Studies 2012; 4(1):182.
  14. Shahkolahi Z, Abdeyazdan Z, Mehrabi T, Hajiheidari M. Supporting fathers of premature infants hospitalized in Neonatal Intensive Care Unit (NICU). Journal of Critical Care Nursing 2014; 7(1):31-40.
  15. Prouhet PM, Gregory MR, Russell CL, Yaeger LH. Fathers' Stress in the Neonatal Intensive Care Unit: A Systematic Review.Adv Neonatal Care 2018; 18(2):105-120.
  16. Cano Giménez E, Sánchez-Luna M. Providing parents with individualized support in a neonatal intensive care unit reduced stress, anxiety and depression. ActaPaediatr 2015; 104:300–305.
  17. Segre LS, Chuffo-Siewert R, Brock RL, O’Hara MW. Emotional distress in mothers of preterm hospitalized infants: a feasibility trial of nurse-delivered treatment. Journal of Perinatology 2013; 1–5.
  18. Ghorbani M, Dolatian M, Shams J, Alavi-Majd H. Anxiety, post-traumatic stress disorder and social supports among parents of premature and full-term infants. Iran Red Crescent Med J 2014; 6(3):65-73
  19. Karami K, Rostami S, Ghadirian F. Effect of educational- supportive interventions on premature infants’ lentgh of hospitalization and maternal stress. Yafte 2009; 11 (2):67-73.
  20. Simons JS, Gaher RM. The Distress Tolerance Scale: Development and Validation of a Self-Report Measure. Motivation and Emotion 2005; 29(2):83-102.
  21. Azizi Alireza; Mirzaei Azadeh; Shams Jamal . Correlation between distress tolerance and emotional regulation with students smoking dependence. Hakim Research Journal 2010; 13(1):11-18.
  22. Pourmovahed Z, Zareei Mahmoodabadi H, Yassini Ardekani SM, Fallahzadeh H,Tavangar H, Mazloomy Mahmoodabad SS. Validation of the Family Stability Questionnaire in married couples: a confirmatory factor analysis. Electronic Physician 2018; 10(8): 7185-7195.
  23. Mahmoodabadi HZ, Bahrami F, Ahmadi A, Etemadi O, Zadeh MSF. The effectiveness of retraining attribution styles (cognitive therapy) on dimensions of family functioning in divorce applicant couples. International Journal of Psychological Studies 2012;4(2):257-63.
  24. Reyhani T, Sekhavat Pour Z, Heidarzadeh M, Mousavi SM, Mazloom SR. Investigating the effects of spiritual self-care training on psychological stress of mothers with preterm infants admitted in NICU. The Iranian Journal of Obstetrics, Gynecology and Infertility 2014; 17(97):18-27.
  25. Lotfi Kashani F, Vaziri SH, Arjmand S, Misavi SM, Hashemiyeh M. Effectiveness of spiritual interventions to reduce maternal distress in children with cancer. Article in Persian. J Med Ethics 2012; 20 (6):554-564.
  26. Esmaeil Ebrahimi M, Zamani N, Ansari Shahidi M. Relationship between Distress Tolerance, Helplessness and Fundamental Recognition in the Schemes of Mothers of Children with Mental Disorders and Mothers of Children with Physical Disabilities. MEJDS. 2018; 8:19.


Articles in Press, Accepted Manuscript
Available Online from 27 June 2022
  • Receive Date: 27 June 2022
  • Accept Date: 27 June 2022
  • First Publish Date: 27 June 2022