logic model for the (COPE )

1 Section A: Program Description The name of this pro gra m is th e C O PE (cre atin g o pport unit ie s fo r p are nt e m pow erm ent) NICU (neonatal intensive ca re u nit ) Pro gra m. T his part icu la r pro gra m h as m ult ip le ta rg et populations. It is geared to ward s pare nts, in fa nts and n urse s in vo lve d in th e p ro gra m . O ne g oal of this program is to help te ach p are nts how to e ffe ct ive ly in te ra ct w it h th eir p re te rm in fa nt in a way that will enhance cogn it ive a nd p hysi cal d eve lo pme nt. An oth er g oal o f th e p ro gra m is to give parents an understa ndin g o f th e N IC U p ro gra m in o rd er to m ake th em m ore co mfo rta ble while their infant is staying th ere . T hese g oals will le ad to th e o ve ra ll o bje ct ive o f lo w erin g th e stress of the parents and te ach th em how to p ro perly ca re fo r th eir b abie s. A fte r co mple tio n o f the program, parents will know w hat to e xp ect fro m th eir pre ma tu re b abie s, h ow to in te ra ct a nd build a relationship with t heir in fa nt w hile th ey’ re in th e N IC U, a nd h ow to d eal w it h th e st re sse s that will come along with b ein g p are nts of in fa nts in th e N IC U.

Activities include an e duca tio nal p ro gra m give n to p are nts in fo ur p hase s th ro ughout their stay. Phase one is gi ven 2 -4 d ays afte r admi ssi on in to th e N IC U a nd in cl udes help in g th e baby grow and develop. Ph ase tw o is give n 4 -8 a fte r admi ssi on a nd in vo lve s help in g th e parents cope. Phase three o ccu rs 1-7 d ays befo re d isch arg e a nd in vo lve s gettin g b oth p are nt and infant ready for life at h ome . Ph ase fo ur ta ke s pla ce 1 -2 w eeks afte r d isch arg e a nd in vo lve s adjusting to life at home w it h a p re te rm baby. Al l th ese e duca tio nal a ct ivi tie s pro vi ded b y th e program are aimed towar ds help in g w it h th e p ro gra m’ s ma in g oals.

The stakeholders are th e in fa nts bein g tre ate d, p are nts of th e in fa nts, n urse s in vo lve d in the program, the hospital th at h as th e p ro gra m, th e ta xp aye rs th at p ay ta xe s th at b enefit th e hospital, insurance compa nie s, a nd th e fa mi ly and fri e nds of th ose w it h in fa nts in th e N IC U.

2 Section B: Literature Review Introduction The primary topic of in te re st fo r our lit e ra tu re re view is Cre atin g O pportu nit ie s fo r P are nt Empowerment (COPE) P rogra ms and th e e ffe ct s of th ese p ro gra ms. W e lo oke d a t va rio us different aspects, such as in fa ntile d eve lo pme nt a nd th e a nxi ety of th e p are nts in th e p ro gra m compared to parents who did n ot p art ici pate .

Parental Coping A main goal of COPE Progra ms is to h elp p are nts wit h th e st re ss of h avi ng a p re te rm infant. An article by Meln yk (2001) st ate s th at, “re search ers have fo und th at th e a ppeara nce and behaviors of LBW [low b irt h w eig ht] p re ma tu re in fa nts are a nxi ety pro duci ng fo r p are nts. ” COPE Programs aim to r educe st re ss by educa tin g p are nts about w hat th eir in fa nt w ill lo ok like as well as how the infant w ill a ct . T here w ere se veral a rt icl es th at g ave st atist ica l a nalysi s th at showed that mothers had a n o ve rall d ecre ase in a nxi ety afte r co mple tin g a C O PE P ro gra m (Mianaei, 2014; Melnyk, 20 01). T he a rt icl e b y Me ln yk use d th e S ta te -tr a it A nxi ety In ve nto ry Test to determine several diffe rent e mo tio nal co pin g o utco me s in cl udin g: te nsi on, a nxi ety, depression, dejection, an ger-h ost ilit y, fa tig ue, a nd co nfu si on. R esu lt s fo und th at w hen a n educational COPE Progra m was imp le me nte d, mo th ers exp erie nce d a n o ve ra ll d ecr ease in these areas. One of the main focuses of th e C O PE pro gra m, a s well a s oth er p ro gra m s like it , is to ensure the parents are co mfort able , a nd th at th e th ey will a ct ually use th e it w hile th eir ch ild resides in the NICU. Acco rdin g to Ire ne H urst (2 006), th e b est p are nt su pport p ro gra m s are those that utilize more tha n o ne typ e o f fo rma t. Pro gra ms th at p ro vide e m otio nal su pport, a s well as group support, info rmatio n su pport a bout th e N IC U a nd in vo lve ment w it h b aby’ s ca re a re 3 better because the variety of su pport a llo w s pare nts to fin d so me th in g th at w orks best fo r th em instead of being stuck with o ne o ptio n. “Pa rent su pport p ro gra ms o ffe r a n im porta nt m ech anism to assess provider approa ches to fa ci lit a te fa mi ly-ce nte re d ca re,” ( H urst , 2 006).

Infant Development Another goal of the C O PE Progra m is to h elp d eve lo p a p re te rm in fa nt’s co gnit ive development. At baseline, th ere w as no si gnif ica nt st atist ica l d if fe re nce b etw een in fa nts th at their parents participated in C O PE Progra m and th ose w hose p are nts did n ot p artici pate in COPE Programs. The pil ot st udy co nduct ed b y Me ln yk show ed th at in fa nts th at w ere in vo lve d in a COPE Program showe d si gnif ica ntly hig her sco res on th e BSI D-II M DI ( a co gnit ive te st ) th an infants that were not invo lve d in a C O PE Progra m (2001). T he sco re s were e ve n fa rth er a part when the infants were rem easu red a t si x mo nth s of a ge (Me ln yk, 2001).

Section C: Critique Preparation The name of this study is The e ffe ct o f C re atin g O pport unit ie s fo r P are nt E m pow erm ent program on maternal stre ss, a nxi ety, a nd p art ici patio n in N IC U w ard s in Ir a n. T he st udy was performed by ​Soheila Jafari Mi anaei, F ate me h Al aee Ka rahro udy, M arya m R asso uli, a nd Mansoureh Zagheri Tafresh i. T he st udy was re le ase d in Vo lu me 1 9, issu e 1 o f th e jo urn al Iranian Nursing and Midwi fe ry Rese arch ​on p ages 94-1 00.

​The p urp ose o f th is was study was to implement the COPE Pro gra m fo r Ira nia n mo th ers and e va lu ate th e e ffe ct ive ness of th e program. It evaluated the e ffe ct ive ness of re duci ng st re ss and a nxi ety am ong m oth ers wit h preterm infants. The study was a ra ndomi ze d cl in ica l tri a l co mp le te d in Ir a n. T he co ntr o l g ro up did not participate in the CO PE Progra m and th e st udy gro up p artici pate d in th e C O PE Program. All of the partic ip ants to ok th e St ate -T rait An xiety In ve nto ry (S TA I) a s a b ase lin e, a nd then again after every ph ase o f th e p ro gra m. T he ST AI me asu res anxi ety, a nd th e h ig her th e 4 score, the more anxious th e p erso n is. T he mo th ers th at p art ici pate d in th e p ro gra m co nsi st ently had lower scores on the S TAI .

The study clearly state s it s purp ose o f e va lu atin g th e e ffe ct ive ness of th e C O PE Program in the introduct io n. T he o bje ct ive o f th is study was to e va lu ate th e e ffe ct ive ness of th e COPE Program on the mo th er’s anxi ety le ve ls. T his obje ct ive is appro pria te b eca use o ne o f th e goals of the COPE Progr am is to re duce st re ss and a nxi ety fo r th e p are nta l u nit s. T he a uth ors explained all of the method s and to ols use d in th eir st udy, b ut th ey did n ot e xp la in h ow to interpret the results from t he ST AI. T hey ju st p ut th e re su lt s in a ta ble in th e st udy. W hen th e authors explained that the y use d th e ST AI, th ey descri bed it a s well- kn ow n a nd le ft th at a s enough for a description of it . T hey did n ot e xp la in h ow to in te rp re t th e r e su lt s. It w ould b e incredibly simple for the a uth ors to si mp ly add a ve ry short e xp la natio n to w hat th e n um bers th at the STAI mean. The autho rs could h ave a lso e xp la in ed th e d if fe re nce b etw een tr a it a nd st ate anxiety. Another major fa ctor of th e st udy was th at th e a uth ors did n ot im ple m ent p hase III o r IV of COPE Programs. Whil e it ca n b e a ssu med th at th e re su lt s would m ost like ly be co nsi st ent with the previous parts of th e st udy, it ca nnot b e va lid ate d w it h out a ct ually im ple m entin g th e program and observing the re su lt s. Ph ase s III a nd IV both re quir e si gnif ica ntly m ore tim e th an phases I and II, and phase IV ta ke s pla ce a t h ome w here th e mo th er is no lo nger in th e h osp it a l to immediately ask any qu est io ns th at th ey mi ght h ave . T he e nvi ro nm ent a t h om e m ay be significantly different eno ugh to h ave a n egative imp act o n th e m oth ers th at p artici pate d in th e program. One of the key obje ct ive s of th e p ro gra m is to h elp re duce p are nta l st re ss at h om e b y teaching the parents eno ugh a bout ca rin g fo r th eir in fa nts to b e co nfid ent in th eir a bilit ie s to ca re for their infant. Without havi ng th e la st tw o p hase s of th e p ro gra m im ple m ente d, th ere isn ’t enough information to det ermi ne if th e p ro gra m worke d th e sa me w ay as it d oes in o th er countries, which was part o f th e st udy. T he st udy wante d to co mpare h ow C O PE P ro gra m s 5 worked in Iran compared to o th er st udie s th at h ad b een d one o n th e p ro gra m , b ut th ey did n’t have the full program impl eme nte d to d o so . T he a uth ors could co mpare th e r e su lt s afte r th e first two phases, but that’ s not a co mp rehensi ve co mp ariso n o f th e p ro gra m . O ne r e aso n fo r why the authors did not imp le me nt Ph ase s III a nd IV was th at h om e vi sits are n ot co mmon in Iran, and it is very importa nt to u nderst and cu lt u ra l d if fe re nce s wheneve r yo u d o st udie s in foreign areas, but this prog ram require s home vi sits fo r fu ll imp le m enta tio n. Id eally, fu tu re studies will be able to impl eme nt th e la st tw o p hase s afte r enough tim e a nd e vi dence to p ro ve the effectiveness will buil d e nough tru st to a llo w th e re se arch ers to d o th e h om e vi sits th at a re necessary for implementat io n o f Ph ase IV.

6 Work C ite d B. Melnyk, L. Alpert-Gillis , N . F ein st ein , e t a l. (2 001) Imp roving C ognit ive D eve lo pm ent o f Low-Birth-Weight Prema tu re In fa nts W it h T he C O PE Progra m: A P ilo t S tu dy of T he B enefit of Early NICU Interven tio ns wit h Mo th ers. R ese arch in N ursi ng a nd H ealt h , 2 4, 3 73-3 89.

Hurst, I. (2006). One Size Does Not F it Al l: Pa rents’ Eva lu atio ns of a S upport P ro gra m in a Newborn Intensive Ca re N urse ry.

​ Journ al o f Pe rin ata l a nd N eonata l N ursi ng ​, ​ 2 0 ​(3 ), 252-261. Karahroudy, F. A., Mianae i, S. J. , R asso uli, M. , T afre sh i, M. Z . (2 014). T he e ffe ct o f C re atin g Opportunities for Parent Emp ow erme nt p ro gra m on ma te rn al st re ss, a nxi ety, a nd participation in NICU w ard s in Ira n. Ira nia n Jo urn al o f N ursi ng M id w if e ry Rese arch . 1 4.

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